Outcome of case study (project completed)on Field Telemedicine Application in Indian Setting

Prof. S K Mishra,MS, FACSHead, Dept. of Endocrine Surgery

Nodal Officer TelemedicineSGPGIMS, Lucknow,India

Question 10-1/2: Communications for Rural & Remote areas

ITU-D Study Groups

Rapporteur’s Group Meeting, Tokyo, Japan, 20-21 June 2005

Application of the Telemedicine Technology to provide Tele-health

Care during Mela/ Festival and Disaster

Executed by :Sanjay Gandhi Postgraduate Institute, Lucknow

in collaboration with • Dept. of Information Technology & Health, Govt. of U P• Online Telemedicine Research Institute, Ahmedabad

Project Funded by : Dept. of Information Technology,Ministry of Communication &.IT, Govt. of India

Mahakumbh Mela: Indian Hindu religious festival Jan 6- Feb 26, 2001 (1/12 year)

Junction of two sacred rivers (Ganges and Yamuna)More than 10 millions pilgrims congregated and took holy dip

Genesis of experiment concept

City hosp.

Camp1 Camp2 Camp n

Mela Main Hospital

MLN med coll Alld. dist hosp.

SGPGIMS

DGHS

Mela monitoring cell, Secretariat

Technology Insertion

Database

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?

?

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Apprehension

• Highly Technical venture not yet tested in such setting

• Multi agency involvement

• Human factors eg. Attitude, Lack of confidence on the technology

•Technology insertion to the existing health system

• Need of big financial grant

Objectives

• Tele-monitoring of Public Health activities.

• Tele-monitoring of Health care facility.

• Tele-health education to public.

• Computation of database on health problems during Mela / Disaster.

• Tele-consultation (Specific medical advice from specialist)

Implementation

• Survey of the proposed telemedicine work

stations

• Clearance obtained from concerned govt.

authorities

• Setting up of telecommunication network &

proper power source

Telemedicine Network Infrastructure Used for

Field Application

Location of Telemedicine work stationin Kumbh Mela

Equipments used and their cost

Rs.58.50 lacsRs.58.50 lacsCapital equipment

(i) Monitor –12(ii) CPU - 12 (iii) Pen Key Board – 12 (iv) Colour Inkjet Printer –05 (v) Web Camera – 12 (vi) Hub & Adopter – 04 (vii) Microphone – 06 (viii) Desk Top Modem – 04(ix) ECG Phone – 05(x) Telemedicine Table – 08(xi) Power Distribution Board -(xii) Hand Set – 05(xiii) PFT Machine – 01(xiv) Portable Xray Machine – 01(xv) Ethernet Adopter Card – 02(xvi) Microscope with Camera – 01(xvii) X ray Flatbed Scanner – 01(xvii Online ECG Monitoring Unit – 02

1.

ExpenditureApproved OutlayHeadS. No

Equipments used and their cost Contd…

Rs.82,60,150.00Rs.80.00 lacsTotal

Rs.20,67,239.0015.00lacs

Contingencies (including telecommunication, travel, conference organisation and other miscellaneous expenses)

4.

Rs.3,42,911.006.50 Staff salaries3.

ConsumableItems/components(Fe comp}(i) Telemedicine license software – 06(ii) Service Kit – 06(iii) Cable set – 06(iv) Printer Stationary rim – 05(v) Operating manual – 02

2.

ExpenditureApproved OutlayHeadS.No

Tele-Public Health Measures

Tele-conferencing

• Teleconferencing was carried out between

telemedicine works stations & technology

support centers as & when required

• Everyday DGHS, Lko was carrying out

teleconference with MLN hospital to discuss

public health activity regarding safe drinking

water, sanitation, food hygiene and infectious

diseases status etc.

Online exchange of data

• Daily progress report of water testing (OT test) &

culture sensitivity, bacteriological examination of

samples

• Daily event report

Tele-monitoring of public health

• Drinking water– OT test for chlorination

Total sample OT +ve OT -ve 1024 869 155

– Microbiological ExaminationTotal sample Suspicious Fecal cont.

149 31 05• Sangam water

– Total sample MPN/100 ml V. cholerae9 >1100in 5 None

Tele-monitoring of public health

Food samples:

24 vendor shops

Police line mess

Results of Stool Culture

Few stool samples and rectal swabs (pt belonging to sec 9)

Total no. 80

Positive growth 16

Organisms isolated All V. cholerae O139

Reports sent immediately on line and preventive measures taken both for patients and water as instructed.

Other Cultures

Throat swab (n=16)NPG = 10Growth +ve = 6 [ 4 HI, 2

Acinetobacter spp]Conjunctival swab (n=20)

NPG = 16Growth +ve =4 [ S. aureus]

Wound swab (n=14)Sterile = 8Growth +ve = 6

A Sample of Daily Report of OT Test of Water Samples Exchanged through Telemedicine Network

Health Administration through the Telemedicine Network from ‘Festival Monitoring Cell’ located at State head

quarter 300 Km away

A Sample of Daily Progress Report exchanged through Telemedicine Network

KUMBH MELA - 2001

Kind attn: - Director General Medical & Health Services, Govt. of U.P., Lucknow

WORK DONE UNDER P.F.A. ACT UP TO 11/1/2001

1) No. of Samples collected - 5 2) No. of Licence issued - 12 3) No. of shops inspected - 24 From: Mr. K.P.Gupta Chief Food Inspector Kumbh mela.

THE PATIENT OF KUMBH MELA - 2001 THE DETAILES OF INDOOR PATIENTS WITH

ACUTE GASTROENTERITIS TILL DATED 13th January. (4:00 PM) ---------------------------------------------------------------------------------------------------------------------------------------------------- Sr. No. Name of Patient Age/Sex Address Duration DOA DOD ---------------------------------------------------------------------------------------------------------------------------------------------------- 01. Munnalal 35/M Antifly 1 Day 29/12 30/12 02. Kalam Ahmed 30/M M.G. Marg P.S --- 31/12 31/12 03. Varunkumar singh 16/M C/o. Dy.S.P. 5 Days 03/01 05/01 04. Gopal 26/M Sarhia, Raipur. (M.P) 15 Days 05/01 07/01 05. Rajkumar 40/M Sri Pargaha ( Bihar) 5 Days 07/01 08/01 06. Anil Rama 27/M Thana Pared --- 07/01 --- 07. Birota Devi 55/F Saraswati Satsung --- 09/01 --- 08. Jagni Bai 67/F Tripuda ( Panjab) --- 10/01 --- 09. Champa Devi 65/F Tripuda ( Hariyana) --- 10/01 --- 10. Rajesh Kumar 20/M Aligunj ,Lko. 1 Day 10/01 11/01 11. Siddheshwar Nath 55/M Durga Ashram-Riva --- 11/01 --- 12. Baburam 75/M Rakshar Balia --- 11/01 (Ref.T.B.M) 13. Shyambabu 35/M Hanuman Mandir --- 11/01 12/01 14. Dr. S.K.Tewari 40/M Main Hospital,Bhopal 1 Day 12/01 O.P.D. 15. Bhuttanray 36/M VIP Camp Police 1 Day 12/01 13/01 16. Badri 70/M Gorakhpur 1 Day 12/01 13/01 17. Chamli Sharma 50/M Panchganiya-Bihar ----- Admitted Today -----

KUMBH MELA PATIENT REPORT

Total patient up to Dated 20/01/2001 at 8 p.m. 1) Emergency Patient 35 2) Non-Emergency Patient 28 ( Data Patient ) 3) Evaluation Patient 15 ( 2nd Opinion Patient) --------- TOTAL PATIENT 78

KUMBH MELA PATIENT REPORT

Total no. of patients from 6.01.2001 upto 27.01.2001 at 2 p.m. 1) Emergency Patient 77 2) Non-Emergency Patient 37 ( Data Patient ) 3) Evalution Patient 17 ( 2nd Opinion Patient ) Total Patients ------ 131

Clinical Tele-consultation

Slide pictures01Path. Slides

Documents01Physician

Documents and snap shot01Neurology

Documents and X-ray / CT scans32Radiology

Documents and snap shot01Dermatology

Documents, snap shot of eye02Opthalmology

Documents, CT scan01Neurosurgery

Snap shot, X-ray, Documents13Orthopedics

On line ECG, Documents and snap shot64Cardiology

Tele-consultation

Transmitted DocumentsNo. of Consult.

Specialities

Samples of Online ECG in Progress at the Field Hospital

A 70 years old male came with chief complaint of chest pain since seven months. Headache and giddness since today morning. Patient has past history of hypertention and on treatment of 5 mg od amlodipin, enalapirl 5 mg and 100 mg aspri. On examination the patient is consicus oriented and with heartrate of 104 per minute, no breathlessness at present cvs NAD R/S clear. There is no creptation.Lever not palpable. No oedema on feet.

Teleconsultation- Case Studies

A Sample of Online ECG at the Consulting end monitor

The case was a human bite, One policeman was bitten by rickow puller. Doctor from Main Hospital, kumbh mela talked about the case on videoconferencing. The expert from M L N Medical College adviced injuction treatvas, antibiotics pain killer but no anti rabbies vaccine or sirum. Status asthimatics for proper management.

Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end

Samples of Tele-microscopic pictures of Blood Smears in suspected cases of Malaria

Snap Shots of exchange of History & Clinical examination carried out through Tele-medical

Video Conference at the Consulting End

Snap Shots of the Clinical Examination findings as seen at the consulting end

Snap Shots of the Clinical Examination findings as seen at the consulting end…..contd.

Summary of Outcome - 1

• First successful deployment of telemedicine in Field

Situation in India

• Set an example of preparedness for mitigation of public

health disaster

–A small outbreak of cholera was aborted efficiently

by timely diagnosis and proper preventive measures

promptly taken with on line consultation

–Monitoring of public health measures on day today

basis

Summary of Outcome - 2

• Specialist consultation access in field situation

• E-health governance in such unique rural location

–Co-ordination and centralized decision

promptly

–Data base could be generated

• Public awareness on Telemedicine Technology

Spin-off effect of the Project

• Creation of infrastructure for Telemedicine at SGPGIMS, Lucknow, North India and SCB Medical College at Cuttack, Orissa, East of India

• Implementation of distantTele-education for the postgraduate students of SCB Medical College

• Concept of Mobile and Portable Telemedicine project emerged

• Awareness of Health Technology among health care workers, media professionals, policy makers and masses

Public Awareness

Mobile Telehospital

Portable Telemedicine Workstation for Disaster

Tele-Hospital Model contd.

• Jan 2,2001 Project sanctioned [ No . 2(36)/2000-HBT ]

• Jan 3-5,2001 : Development of Telemedicine network.

• Jan 6-Feb 26,2001 : Maha Kumbh Mela Telemed Project.

• Jan 8-10,2001 : First Project review meeting at Lucknow & Allahabad.

• Jan 31-4 Feb,2001 : Demonstration in Health Mela at Lucknow organized by MoH, GoI.

• March - July,2001 : Evaluation of the Project, preparation of report, upgradation of tele-radiology software & digitization of 2000 Xray films.

Milestones

Milestones contd.

• April 23-27,2001 : National telemedicine Conference.

• Sept. 4,2001-March 22,2002 :Preparation for application

in Flood situation in Orissa & Distant medical education

with S.C.B. medical college cuttack utilizing telemedicine

technology.

• Nov 09-10,2001 : Second Project review meeting at

cuttack.

• Jan 3-8,2002 : Demonstration in Indian National Science

Congress. Inauguration of Mobile telemedicine system

Thank You