CtttfTldiiNtkiCurrent status of Telemedicine Network in ... · Cancer, AIDS, TB, Cardiac diseases &...

C t t t f T l di i N t k iCurrent status of Telemedicine Network in India and Future perspective

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

Faculty I/C, SGPGI Telemedicine ProgrammeSanjay Gandhi Postgraduate Institute of Medical Sciences

(SGPGIMS) Lucknow,[email protected]

ContentContent

• Brief review of Application of Telemedicine Project around the country• Nation wide Telemedicine Network

– IDSP– National Rural Telemedicine Project– ONCONET India– Proposed layout of National Medical College Network

• International Telemedicine Network– SAARC Telemedicine Network– PAN AFRICA Network

• m-Health in India– Mobile eHealth units for specific health conditions– General Purpose Mobile Telemedicine Units

Wi l M bil H lth S t– Wireless Mobile Health System

• Opportunities and Challenges

Update on 32nd APAN Meeting in New Delhi, India; 22-27 August 2011

Brief overview of telemedicineBrief overview of telemedicine project around the country


Major Implementing AgenciesMajor Implementing Agencies


Indian Space Research OrganizationSince - 2001

• Satellite Telemedicine Network• Satellite-Telemedicine Network

through Indian Satellite System

(INSAT)(INSAT)

• Collaboration with state

tgovernments

• 439 nodes across the country – 17

Mobile Vans

• Free satellite bandwidth

www isro org/scripts/telemedicine aspxwww isro org/scripts/telemedicine aspx


www.isro.org/scripts/telemedicine.aspxwww.isro.org/scripts/telemedicine.aspx

ONCONET KeralaC C f R l MCancer Care for Rural Masses

Free Satellite i icommunication

link & Bandwidth provided by ISRO

Satellite : INSAT 3CAntenna : 3.8 mCarrier : Extended C BandBandwidth : 384 kbps

Backup Link 128 Kbps ISDN connection

Active Nodes• Kannur,

128 Kbps ISDN connection

,• Kochi, • Palakkad, • Kozhencherry


• Kollam

OncoNET Kerala- Year 2003

• Regional Cancer Centre, Trivandrum• 5 peripheral centers linked • No. of Follow-up pts -13566

(yr 2004 onwards)• CMEs- 53 & Panel Discussion – 33• Nursing training prog. – 41• Didactics talk – 13• Didactics talk – 13• Public Awareness campaigns - 14


www.rctvm.org

Tele-onconet

Regional Cancer Centre,Thiruvananthapuram

Tata Memorial Hospital, Mumbai• Total Nodes: 8Thiruvananthapuram

• Total nodes-5• Connectivity – VSAT• Activities: Tele Follow up

• Total Nodes: 8• Connectivity: VSAT• Activities: Tele-consultation

/ Follow up and CME• Activities: Tele-Follow up,Tele-CME, Panel Discussions, NursesTraining programs, talks by doctors ofRCC, Cancer Awareness

/ Follow up and CME • Platform- Data Sharing, VC,

Tele-pathology / Radiology,

http://www.rcctvm.org/Telemedicine.htm http://tmc.gov.in/misc/aboutus.htm

UP Tele-radiotherapy Network

T l N d 2RCC, Adyar , Chennai

• Total Nodes – 2 (1st Phase)

• Connectivity: ISDN

• Total nodes: 7

• Connectivity: ISDN & VSAT

• Activities: Tele-consultationy

• Activities:Tele-education & Tele-CME

• Activities: Tele-consultation& Tele-follow up


http://www.cancerinstitutewia.in/

Tripura Tele-ophthalmology Projectp p gy j

• Tripura Tele-ophthalmology (Vision) Centres set up in Blocks top p gy ( ) pprovide eye-care to patients at door-steps

• Linked to IGM Hospital through Tele-medicine infrastructure.Started in April 2007; 35 Centres set up so far• Started in April 2007; 35 Centres set up so far

• 5 Blocks (Korbook, Jampui Hills, Dasda, Chawmanu and Bishalgarh)yet to be covered.

• Over 71,000 patients screened upto August 10, of which 5,092 patientsreferred to Referral Hospital (IGM Hospital)Average number of patients per Centre per month: around 100• Average number of patients per Centre per month: around 100.

• National e-Governance Gold Award for 2009.


http://www.ilfsindia.com/projects1.asp?Category=2&Project=12&subLink=125http://www.ilfsindia.com/projects1.asp?Category=2&Project=12&subLink=125

Current Status

• 40-50 ophthalmalic centers are connected to tertiary center• Mobile vans with satellite connectivity providing ophthalmic y p g p

care at doorsteps.

Sankara Nethralaya, Chennai 2Aravind Eye Hospital Madurai 1Agarwal Eye Hospital 1Agarwal Eye Hospital, Chennai

1

Chaitanya Hospital, Cochin 1www.drmohandiabetes.com

Prabha Eye Clinic, Bangalore 1

Blindness Prevention Initiative


Blindness Prevention InitiativeDiabetic Retinopathy Screening

Mobile Tele-ophthalmology ProgramsMobile Tele ophthalmology Programs

Shankara Nethralaya, Chennai Aravind Tele-Ophthalmology Network

• Total Mobile Unit: 4 (Karnataka, Andhra Pradesh, Tamil Nadu & Maharashtra)

• Connectivity: VSAT

• Mobile Unit: 1• Connectivity :VSAT• Connectivity: VSAT

• Activities: Eye check up, tele-consultation, educating about eye care, Teaching & Training for local Ophthalmologist /

y• Activities: Diabetic Retinopathy Assessment

& Grading Over Networkg p g

General Physicians / Optometrists / Opticians / Nurses & teachers

• Tele-education & Tele-CMEs – nodes -3


http://www.sankaranethralaya.org/tele_mobile.htm www.aravind.org/Telemedicine/mobilevan.htm

Tele-cardiologygy

Asia Heart Foundation Kolkata & F ti h lth N t k &Asia Heart Foundation Kolkata & Narayana Hrudayalaya, Bangalore

• Total Nodes: 20

Fortis healthcare Network & Escort Heart Institute, New Delhi

• Total Nodes: 12 satellite/heart • Pan African e-Network• Connectivity : VSAT/ ISDN/ PSTN• Activities: Tele-consultation & VC,

command centers

Activities: Tele consultation & VC, Tele-CME


www.narayanahospitals.com/tele_medicine_centers.html

Nation Wide Telemedicine Networks


Disease Surveillance Integrated Disease Surveillance Project (IDSP)- Year 2004

• EDUSAT Satellite Current status

• Decentralized state based surveillance

Current status

• Data Centre - 750 locations

system for communicable & non

communicable diseases

• Connectivity - 559 locations

• Training Centrecommunicable diseases

• Improve the efficiency of surveillance – NIC 218 / 400 sites

– ISRO 297 / 400 sites

activities, detect disease trends,

– ISRO 297 / 400 sites

• 38 Hi-End VC Equipments (Multi

f )evaluate control strategies of the

disease control programmes

conference 5 nodes) - between

CSU and States/UTs HQ


disease control programmeshttp://idsp.nic.in/

National Rural Telemedicine Project National Rural Health Mission ( Framework developed)

• Design, development and implementation of– Low cost rural telemedicine infrastructure– Village Tele-ambulance System and rural emergency

healthcare services / Trauma care module– Rural Health Knowledge Resource through web portal and

e-CME modulef f– Technology platform for harvest, compilation, storage

(Data Base) at Regional District Hub and Central DataCenter at MOH & FW archive and distribution acrossCenter at MOH & FW, archive and distribution acrossnetwork


www.mohfw.nic.inwww.mohfw.nic.in

ONCONET-IndiaMinistry of Health & Family Welfare (Govt. of India)

ONCONET KERALA ONCONET

INDIAINDIA

27 RCCs & 108 Peripheral27 RCCs & 108 Peripheral Cancer Centers (PCC) in India(Under implementation)

Dept. of Information Technology Ministry of Health & FW


p gyGovt. of India

Ministry of Health & FWGovt. of India

ONCONET IndiaONCONET India

U d N ti l C C t l• Under National Cancer Control Programme Nationwide Tele-oncology Network in India

ChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarh

ShimlaShimlaShimlaShimlaShimlaShimlaShimlaShimlaShimla

Shrinagar

ONCONET • To facilitate early detection of cancer

patients across the country through peripheral centers, delivery of t l di i i t th ti

AllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabad

LucknowLucknowLucknowLucknowLucknowLucknowLucknowLucknowLucknow

GwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwalior

DelhiDelhiDelhiDelhiDelhiDelhiDelhiDelhiDelhiRohtakRohtakRohtakRohtakRohtakRohtakRohtakRohtakRohtak

BikanerBikanerBikanerBikanerBikanerBikanerBikanerBikanerBikanerGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahati

PatnaPatnaPatnaPatnaPatnaPatnaPatnaPatnaPatnaImphalImphal

INDIAtelemedicine services to them, creation of cancer patients' register, Electronic Health Records (EHR), Continued Medical Education (CME)

AizwalAizwalAizwalAizwalAizwalAizwalAizwalAizwalAizwal

RaipurRaipurRaipurRaipurRaipurRaipurRaipurRaipurRaipur

NagpurNagpurNagpurNagpurNagpurNagpurNagpurNagpurNagpur CuttakCuttakCuttakCuttakCuttakCuttakCuttakCuttakCuttak

KolkataKolkataKolkataKolkataKolkataKolkataKolkataKolkataKolkata

AhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabad

ImphalImphal

Medical Education (CME) programmes, R & D works etc..

• Connect 27 Regional Cancer Centres ith 4 i h l di t i t

HyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabad

MumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbai

with 4 peripheral district hospitals/medical colleges for each RCC across the country

BangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangalore ChennaiChennaiChennaiChennaiChennaiChennaiChennaiChennaiChennaiKanchipuram

PondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherry

Thi thThi thThi th


ThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuram

http://onconet.nic.in/

U.P. State Telemedicine Network

• Department of Medical Education,G t f U P t U P M di lGovt. of U.P. setup U.P. MedicalColleges Telemedicine Network.

• School of Telemedicine &Bi di l I f ti SGPGIMSBiomedical Informatics, SGPGIMS,Lucknow entrusted the job ofdesigning the technical architectureand System requirementand System requirement

• National Co-operative ConsumerFederation of India Ltd. (NCCF)

id tifi d t i l t thwas identified to implement theproject.

• The pilot phase has beenl t d ith d l t fcompleted with deployment of

telemedicine infrastructure inMedical Colleges at Allahabad,Kanpur and Meerut


Kanpur and Meerut.

Design of UP Medical College Network WAN & LAN & Digital Library NetworkWAN & LAN & Digital Library Network


Proposed National Medical College TelemedicineNational Medical College Telemedicine Network Architecture


Design of National Medical College Network WAN & LAN N t kWAN & LAN Network

National Resource Center

Apex Medical Institutions

Medical Colleges


National HUB at SGPGI, Lucknowat o a U at SG G , uc o


Network Monitoring & Data Storageet o o to g & ata Sto age


International Telemedicine Networks


Update on 32nd APAN Meeting in New Delhi, India; 22-27 August 2011http://www.jdwnrh.gov.bt/?page_id=69

SAARC Telemedicine Network

• Ministry of External Affairs, Govt. of IndiaIndia

• Implementing Agency: Telecommunications Consultants India Ltd (TCIL)Ltd. (TCIL)

• Connectivity: Satellite & fiber optic network N t ki f /t h it l i• Networking of one/two hospitals in each of the SAARC countries with 3-4 Super Specialty hospitals in IndiaC S• Current Status: JDWNRH, Bhutan , Indira Gandhi Child Hospital, Kabul, Afghanistan & Patan Hospital, K th d N l ith SGPGIMSKathmandu, Nepal with SGPGIMS, Lucknow & PGIMER, Chandigarh with academic activities


Update on 32nd APAN Meeting in New Delhi, India; 22-27 August 2011www.panafricanenetwork.com

PAN Africa Network

Ministry of External Affairs, Govt. of India

• Implementing Agency: TCIL• 53 countries of the African Union • Connectivity: Satellite & fibre optic

networknetwork • Activities: tele-healthcare & tele-

education• Current status: 47 African countries• Current status: 47 African countries

joined the project


mHealth in India


1st Mobile eHealth System & Disaster Management Kity g

Prototype of First Mobile eHealth System developed. Suitcase and Mobile Van were developed and demonstrated. ISDN as Communication Media

Designed and Developed as P.O.C. used in Gujarat Earthquake


Mobile eHealth units for specificMobile eHealth units for specific health conditions


Shankar Nethralaya Tele-Opthalmology Unity p gy

WDF Mobile Unit in Karnataka

Vidarbha Mobile Unit at Maharastra

ISRO Mobile Unit at Maharastra

htt // k th l /


Vidarbha Mobile Unit at Maharastrahttp://www.sankaranethralaya.org/

Mobile Refraction UnitMobile Refraction Unit


Aravind Mobile Eye Screening VANAravind Mobile Eye Screening VAN

• ISRO Connectivity• Known Diabetic Pts are collected by

Physician• Recorded in a specialized softwareRecorded in a specialized software

“EyeTalk” & transmitted to the reading grading center at Base Hospital


http://www.aravind.org/telemedicine/va.htm

Satellite Based Mobile Telemedicine Unit

Asia Heart Foundation, Kolkata

Chitrakoot, MPGangaram Hospital, New Delhi


http://laico.org/v2020resource/files/remote_rural_population.htm

Madras Diabetes Research Foundation (MDRF)

• Collaboration between MDRF, World Diabetes ,Foundation and ISRO.

• Serves 42 villages (in and round Chunmpetvillage) in Kancheepuram District, Tamilnadu, I diIndia.

• The experts testing, diagnosis, medicines and even laser surgery are at door step


Tele-Oncology UnitM l b C C S i t KMalabar Cancer Care Society, Kannur

Comprehensive Disease Control Activities Through EarlyDetection Treatment & Awareness Building for CancerDetection, Treatment & Awareness Building for CancerCancer, AIDS, TB, Cardiac diseases & Pre and post natalrequirements.‘Sanjeevani’ is a Mobile Tele Oncology unit with satelliteSanjeevani is a Mobile Tele Oncology unit with satellitecommunication link, advanced diagnostic and treatmentequipments, telemedicine infrastructure, software forElectronic Health Record e-Health Card for patients etcElectronic Health Record, e Health Card for patients etc.aimed to provide telemedicine services for early cancerdetection, follow up consultation, treatment of cervicalcancers and awareness building to rural masses at fiveca ce s a d a a e ess bu d g to u a asses at enorthern districts of Kerala.


http://cancercaremccskannur.org/

Interior view of Tele-Oncology Unitgy

Laboratory


Videoconference Station Operation Table for Colposcopy and cauterization for early

cervical cancer

Equipment installed inside mobile van, Patient Access Door and Satellite External Unit HousingDoor and Satellite External Unit Housing

M bil Ul d d X U i Colposcopy Unit used for earlyMobile Ultrasound and X-ray Unit Colposcopy Unit used for early detection

of Cervical Cancer & intervention


Patient Access DoorSatellite external Unit housing

Regional Institute of Ophthalmology“Sunayanam” A Tele ophthalmology UnitSunayanam – A Tele-ophthalmology Unit

• Regional Institute of Ophthalmology• Regional Institute of Ophthalmology(RIO), Trivendrum

• Designed and implemented by C-DAC

• Well-equipped to carry out completeophthalmic examinationophthalmic examination.

• Further assistance are met with bycontacting the specialists at RIO by

f id f iway of videoconferencing• Equipped with photo slit lamps.

http://www yentha com/news/view/1/2724


http://www.yentha.com/news/view/1/2724

General PurposeGeneral Purpose Mobile Telemedicine Unit


General Purpose Mobile Telemedicine Unite

Sri Ram Medical College, Amrita Institute of Medical Sciences, C hi

Sri Ram Medical College, Chennai & Amrita Institute of Medical Sciences

g ,Chennai

General Purpose Rural Tele-health Clinic with ISRO Antenna & VSAT

i i

Cochin AIMS Hospital’s Mobile Telemedicine Unit isthe size of a city bus and includes X-rayfacilities ECG scanner pathology lab workconnectivity facilities, ECG scanner, pathology-lab-workfacility, specialty cardiac services and atelemedicine satellite link with AIMS Hospital.


http://www.srmc.edu/telemedicine.htm http://www.aimshospital.org/hospital/cdh/facilities_telemedicine.php#8

Application of AIMS Telemedicine Van Tele health service in Koshi flood affected AreaTele-health service in Koshi flood affected Area

First used in tsunami-relief work in Kerala and Tamil Nadu. Direct Relief International ( a U.Sbased NGO) has supported in setting up of this van while Indian Space Research Organization


based NGO) has supported in setting up of this van while Indian Space Research Organization( ISRO) provides the satellite-technology and connectivity

Apollo Telemedicine Network Foundationp

• Jointly undertaken by ISRO, Philips India, y y , p ,Apollo Telemedicine Networking Foundation (ATNF) and the Madurai based NGO, Development of Human Action (DHAN)

• A tele clinical van equipped with diagnostic• A tele-clinical van, equipped with diagnostic equipment provided by Philips India. The van has an ultrasound machine, an X-ray, a defibrillator and an ECG machine

• ISRO is providing the connectivity through VSAT

www.medetel.lu/download/2010/.../Growth_and_Development.pdf


Wireless Mobile Health System


Wireless Mobile Health Systemy

• Evolution of wireless communication• Evolution of wireless communicationtechnologies have enabled telemedicinesystems to operate in the remotest place forsystems to operate in the remotest place forrural health practices hence expandingtelemedicine benefits applications andtelemedicine benefits, applications, andservices.

• In India majority of the people are living in therural and remote locations where even the basicfacilities are not available for the society.


3G enabled mHealthApollo Telemedicine Network FoundationApollo Telemedicine Network Foundation


http://www.medetel.lu/download/2010/parallel_sessions/presentation/day1/mHealth_Bridging.pdf

C-DAC Mohali : Tele-Ophthalmology Van

Mobile Tele-Ophthalmology Van is equipped with various equipments like Slit lamp, auto-refractometer,tonometer, ophthalmoscope, retinoscope and a wireless internet enabled computer with which theuser can connect to internet at anytime and anywhere in the field to transfer the captured images ofpatient’s eyes and other related data through the software e-Sanjeevani


patient s eyes and other related data through the software e-Sanjeevanihttp://www.cdacmohali.in

mHealth4u Suitcase and backpack modelSchool of Telemedicine & Biomedical Informatics SGPGIMSSchool of Telemedicine & Biomedical Informatics, SGPGIMS


Integrated Medical Equipments

PC Interface:USB & Bluetooth

Blood Pressure

Digital Glucometer

Common Interface

Spirometer

Wrist ClinicWrist Clinic

Weighing Machine

SPO2

Atom based Low Cost Laptop with Integrated Telemedicine Software

ECG


Connectivity via High Speed Broadband (HSB)

Opportunities and ChallengesOpportunities and Challenges


OpportunitiesOpportunities

• Vast and diverse geography with dominantrural population

• Disparity in healthcare infrastructure• Low cost local technical solution & ICT• Low cost local technical solution & ICT

expertiseFast adoption of Mobile technology• Fast adoption of Mobile technology

• Successful pilot projects• Policy on adoption of ICT in service delivery


Challenges 1g

N ti l H lth P li• National e Health Policy

• Evaluation & Identification of Best Telemedicine

Practices

• Confidentiality & Security of Personal Health Record

• Credentials and competence of the remote physicianCredentials and competence of the remote physician

• Legal, ethical and social issues yet to be addressed

• Broadband internet yet to reach rural areas

NGN lik Wi M d 3G t t b l h d


• NGN like Wi Max and 3G yet to be launched

Challenges 2Challenges 2

• E-health adoption by stake holdersp y

• e-Health Program sustainability Models

• Inter-operability of e Health system

• Integration into prevailing Health System• Integration into prevailing Health System

• Development of National e-Health Observatory

• Capacity Building in e-health System

• Research & Development in e-health technology and

system appropriate for local situation with global impact


y pp p g p

School of Telemedicine & Biomedical Informatics

Thank you

Update on 32nd APAN Meeting in New Delhi, India; 22-27 August 2011www.nrct.in | www.telemedindia.org | www.stbmi.ac.in | www.sgpgi-telemedicine.org

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