An introduction to Tele Medicine An introduction to Tele Medicine where are we now?where are we now?

Vijay SardanaVijay Sardana MD,DM (neurology)MD,DM (neurology)

Professor &HeadProfessor &Head

Deptt of Neurology,Deptt of Neurology,

Medical College, KotaMedical College, Kota

Tele MedicineTele Medicine

Definition-Method-patient can be Definition-Method-patient can be examined, monitored & treated with examined, monitored & treated with patient and doctor located at patient and doctor located at different placedifferent place

Tele (Greek) –distanceTele (Greek) –distanceMederi(latin)-to healMederi(latin)-to healHealing by wireHealing by wireSimplest e.g.-telephoneSimplest e.g.-telephoneAdvanced video conferencing Advanced video conferencing

between two continentsbetween two continents

Tele Medicine: HistoryTele Medicine: History

1876-Alexender graham bell1876-Alexender graham bell1910- 11910- 1stst electrical stethoscope electrical stethoscope

&telephone relay&telephone relay1959-11959-1stst video communication for video communication for

medical consultationmedical consultation

The Rapid changes that characterise The Rapid changes that characterise medicine &computing give us the chance medicine &computing give us the chance to be behind not one but two fast to be behind not one but two fast changing fields.changing fields.

In the information age, In the information age, knowledge is your best weaponknowledge is your best weapon

The problem the future is that it is always The problem the future is that it is always ahead of scheduleahead of schedule

Tele Medicine: JustificationTele Medicine: Justification

Neurological care-450/1075 millionNeurological care-450/1075 million1500 Neurologist1500 Neurologist100 Neurologist/year100 Neurologist/year50% of medical college have 50% of medical college have

Neurology/Neurosurgery deptt.Neurology/Neurosurgery deptt.15 centers of excellence15 centers of excellence

Tele Medicine: JustificationTele Medicine: Justification

City based specialists-unwilling for suburban/ City based specialists-unwilling for suburban/ Rural placesRural places

Lack of infrastructureLack of infrastructure

Quality of lifeQuality of life

Professional isolationProfessional isolation• Improper distributionImproper distribution

Delhi>North eastern IndiaDelhi>North eastern India

Unpreceduted growth of information Unpreceduted growth of information technologytechnology

-decreased Computer prices-decreased Computer prices -Internet through cables-Internet through cables -Fibro-optic cable-Fibro-optic cable -Satellite transmission-Satellite transmission -increase brand width-increase brand width -Improvement in video+data compression -Improvement in video+data compression

licensing of private internet servicelicensing of private internet service providersproviders

Telecommunication infrastructure in Telecommunication infrastructure in suburban/rural- easier specialist suburban/rural- easier specialist placement-difficultplacement-difficult

Tele Medicine: AdvantagesTele Medicine: Advantages

Suburban/rural patient careSuburban/rural patient care Max. utilization of suburban hospitalsMax. utilization of suburban hospitals Prim care physician doesn't loose patientPrim care physician doesn't loose patient Up to 95% normal interaction can be Up to 95% normal interaction can be

establishedestablished Cost saving of unnecessary transferCost saving of unnecessary transfer Continuing education for rural practitionersContinuing education for rural practitioners Motivation for computer literacyMotivation for computer literacy

Tele Medicine: problemTele Medicine: problem

No hands on interaction with patientNo hands on interaction with patientConfidentiality of patient interactionConfidentiality of patient interactionReimbursement constraintsReimbursement constraintsaccuracy of diagnosis from remote placeaccuracy of diagnosis from remote placewho should take up? Time constraintswho should take up? Time constraints

Tele Medicine: RequirementTele Medicine: Requirement

PCPCScannersScannersDigital camerasDigital camerasModified softwareModified softwareAppropriate networking systemAppropriate networking systemAppropriate telecommunication Appropriate telecommunication

technologytechnology

Tele Medicine: technologiesTele Medicine: technologies

Store and forwardStore and forwardTwo way interaction television/Two Two way interaction television/Two

way interactive video conferencing.way interactive video conferencing.

Telemedicine- TechnologiesTelemedicine- Technologies

ISDN linesISDN lines Internet protocolInternet protocolSatelliteSatellite

Tele MedicineTele Medicine

StrokeStroke

-</.5%acute stroke treated with -</.5%acute stroke treated with Thrombolytic therapyThrombolytic therapy

Tele-stroke management.Tele-stroke management.

Tele Medicine: UsesTele Medicine: Uses

Parkinson’s diseaseParkinson’s diseaseDementiaDementiaEpilepsyEpilepsy

Tele Medicine: UsesTele Medicine: Uses

NeurotraumaNeurotrauma

-decrease unnecessary transfer-decrease unnecessary transfer

-Early therapeutic interventions -Early therapeutic interventions taken before transfertaken before transfer

Tele Medicine:TelepathologyTele Medicine:Telepathology

Intra-operative PathologyIntra-operative PathologyRoutine Surgical PathologyRoutine Surgical Pathology22ndnd opinion opinion?FNAC?FNAC?Autopsy?Autopsy

Tele Medicine: Indian scenarioTele Medicine: Indian scenario

620 million- rural India620 million- rural IndiaBed populationratio-1:13330 (1991)Bed populationratio-1:13330 (1991)

-ideal-1:1500-ideal-1:15002 million beds required. available 0.7 2 million beds required. available 0.7

millionsmillions

Tele Medicine: Indian scenarioTele Medicine: Indian scenarioARAGONDA (population 5000)ARAGONDA (population 5000)

First secondary care rural hospital using First secondary care rural hospital using telemedicine-Apollo chennaitelemedicine-Apollo chennai

40 bedded- physician, surgeon, 40 bedded- physician, surgeon, pediatrician, 3 GDMOspediatrician, 3 GDMOs

USG, Echo, ECG,Automated laboratory, CT USG, Echo, ECG,Automated laboratory, CT scan, OT, Telemedicine unitscan, OT, Telemedicine unit

Web camera-ISDN linesWeb camera-ISDN lines

Digital camera-VSATDigital camera-VSATD-microscopeD-microscope

Tele Medicine: Indian scenarioTele Medicine: Indian scenario

ISRO- 200 hospitalsISRO- 200 hospitals

J&K, Karnataka, NE, Lakshadweep, Army,J&K, Karnataka, NE, Lakshadweep, Army,

OrrisaOrrisa Apollo hospital- chennai, Delhi, Hyderabad Tele Apollo hospital- chennai, Delhi, Hyderabad Tele

medicine centers medicine centers --Guwahati, Kolkata, Kohima, Portblair, Guwahati, Kolkata, Kohima, Portblair, Silcher, Mysore, Madurai, Military hospital Chennai, Silcher, Mysore, Madurai, Military hospital Chennai, Dhaka Dhaka

RajasthanRajasthan

Population-56.5 millionPopulation-56.5 millionPopulation growth rate-Population growth rate-

28.33(21.43)28.33(21.43)Rural: Urban- 77:33Rural: Urban- 77:33Large distancesLarge distances

Rajasthan Telemedicine programmeRajasthan Telemedicine programme

One of Biggest Tele medicine One of Biggest Tele medicine network in Indianetwork in India

Population-56.5 mPopulation-56.5 mRural: urban- 77:23Rural: urban- 77:23Growth rate India:raj- 21.43:28.33Growth rate India:raj- 21.43:28.33

Rajasthan Telemedicine programmeRajasthan Telemedicine programme

ISRO + GovtISRO + Govt32 district hosp., 6 medical colleges, 6 32 district hosp., 6 medical colleges, 6

mobile vansmobile vansVSAT at each locationVSAT at each location INSATINSAT

MBS Tele medicine unitMBS Tele medicine unit

2 PCs2 PCsTVTVVideo conferencing SONY camera with Video conferencing SONY camera with

360 degree tilt360 degree tiltDigital BP recorder, Digital ECG, Digital Digital BP recorder, Digital ECG, Digital

microscope, Digital PFTmicroscope, Digital PFTSitting capacity-30Sitting capacity-30384 Kpbs384 Kpbs

Tele Medicine: Learning PartsTele Medicine: Learning Parts

Telemedicine here to stay despite Telemedicine here to stay despite advantages and disadvantagesadvantages and disadvantages

Not a goal itself. should be used as a Not a goal itself. should be used as a support to treat patientssupport to treat patients

Practical Problems-underutilized world Practical Problems-underutilized world overover

Specialist consultation in sub urban and Specialist consultation in sub urban and rural India & Rajasthan is now a mouse rural India & Rajasthan is now a mouse click awayclick away

ThanksThanks