Sudhamony S Additional Director / Head,

1

ICT for

Cancer Diagnosis, Treatment and Management

Sudhamony SAdditional Director / Head, Medical Informatics Section, Centre for Development for Advanced Computing (C-DAC),Thiruvananthapuram, INDIA.

Sudhamony SAdditional Director / Head, Medical Informatics Section, Centre for Development for Advanced Computing (C-DAC),Thiruvananthapuram, INDIA.

222

• A Scientific research organization of Ministry of Communication and Information Technology, Government of India

• Vision: To emerge as the premier R&D Institution for the design, development and deployment of world class electronic and IT solutions for economic and human advancement

• Ten centres across India• C-DAC, Thiruvananthapuram is in the state of Kerala

C-DACC-DAC

3/4/2009C-DAC Medical Informatics

Centre for Development of Advanced Computing

333

About ONCONET

The first successful Tele-Oncology Network in India

which provides telemedicine services in early detection,

patient follow up and pain relief for cancer patients from rural areas.


444

The NeedStatistics from India : 1 million new cancer cases per annum 3 million cancer patients Low socio-economic status and low literacy

rates in rural areas Lack of infrastructure and expertise at Public

Health Centers in rural areas for early detection of Cancer

Long and relatively expensive travel to reach Cancer Care facility

30% of cancers can be prevented; 40% can be cured


555

A research project funded by Govt. of India

Designed, developed, implemented and supported by C-DAC, Thiruvananthapuram

Implemented at Regional Cancer Centre Thiruvananthapuram, Kerala, India and its five peripheral clinics across the state

ONCONET


666

Regional Cancer Centre Trivandrum (RCC)

RCC is the only cancer hospital in the Govt. sector catering to the population of the state of Kerala and neighboring states.

Approx. 12,000 new cases are registered every year and the annual follow-up visits reach 150,000 every year

RCC is the only cancer hospital in the Govt. sector catering to the population of the state of Kerala and neighboring states.

Approx. 12,000 new cases are registered every year and the annual follow-up visits reach 150,000 every year


777

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Appointments during the year 2002

Kasargod

Kannur

Wayanad

Kozhikode

Malappuram

Palakkad

Thrissur

Ernakulam

Idukki

Kottayam

Alapuzha

Pathanamthitta

Statistics from KeralaNumber of patients visiting

Cancer care facility

RCC, RCC, ThiruvananthapuramThiruvananthapuram

RCC, RCC, ThiruvananthapuramThiruvananthapuram 3/4/2009C-DAC Medical Informatics

888

Logistics Distance Travelled

0

100

200

300

400

500

600

Distance (km) Travelled to theCentre

Kasargod

Kannur

Wayanad

Kozhikode

Malappuram

Palakkad

Thrissur

Ernakulam

Idukki

Kottayam

Alapuzha

Pathanathitta

Kollam3/4/2009C-DAC Medical Informatics

999

Logistics Cost of Travel

0

200

400

600

800

1000

1200

1400

1600

1800

Total Expensesfor One Visit

(Rs)

Kasargod

Kannur

Wayanad

Kozhikode

Malappuram

Palakkad

Thrissur

Ernakulam

Idukki

Kottayam

Alappuzha

Pathanamthitta

Kollam


101010

How to provide affordable cancer care

Reduce overhead on patients by bringing Cancer care closer to them

Facility for Early Cancer detection and diagnosis nearby

Health education and awareness camps for the rural population


111111

Tele ONCOlogy NETwork

Our Peripheral Clinics

1. Malabar Cancer care Society, Kannur.

2. Early cancer detection center, Palakkad.

3. Early cancer detection center, Kochi.

4. Early cancer detection center, Kollam.

5. District cancer control cente, Kozhencheri.


121212

VSAT Network forONCONET

Satellite communication link & Bandwidth provided by ISRO (Totally free)

Satellite : INSAT 3C Antenna : 3.8 mCarrier : Extended C Band Bandwidth : 384 kbps

Failover mechanism128 Kbps ISDN connection


131313

ONCONET

CDAC launched ONCONET in Sept. 2004 at RCC and its peripheral clinics with Bandwidth offered totally free by Indian Space Research Organization (ISRO) through its VSAT facility.

Currently RCC is linked with over a hundred hospitals across the country including areas with high military presence like Srinagar and Ladakh (2300 miles North), and geographically separated areas like Andaman and Lakshadweep islands


141414

ONCONET - Features

Tele-medicine infrastructure at RCC and five peripheral clinics

Tele-Pathology and Radiology systems High bandwidth connection between these

centers ( 384 Kbps) Backup arrangement for connectivity

through ISDN facility


151515

ONCONET – Features …

Software - Web based Telemedicine software integrated with Hospital Information System software (TEJHAS)

EHR, securely made available over the network at remote centres

Oncology Resource Centre – Cancer specific information made available at remote centres through a Digital Library


161616

TM Infrastructure Powerful Video Conferencing System Server system with software for Creation,

storage, transfer and sharing of EHR of patients, Telemedicine PCs at clinics

Tele Pathology / Radiology System with Digital Microscope, X Ray Film Scanner and software for :

Capture , storage and uploading of medical images

Sharing and annotation of image between remote centres for discussion


171717

System Architecture

TP / TR Server

Digital Microscope

RCC-Regional Cancer Centre Thiruvananthapuram

Video-conferencing

Telemedicine PC

Digital library

Hospital Information System

Video-conferencing

Tele-medicine PC

ROUTER

Database &App. Servers

PERIPHERAL CENTRE

VSAT Network

withISDN

(Backup)

X-Ray Film Scanner

LAN

SPECIALTY CENTRE

ROUTER


181818

Tele-Pathology and Radiology

systems

ECDC KOCHI

ECDC KANNUR

Microscope

DICOM CDFilm / Document SCANNER

DIAGNOSTIC Work Station cum SERVER

WEB-Viewing Station @ Doctors desk

Network

Images captured from microscope

X-Rays & Documents scanned

Images locally stored

DICOM CD imported

Patient folder sent to RCC, TVM

Reports received from remote expert doctor

Images received from remote centres & stored in Server

Experts view the image through viewing station at their department.

Experts prepare the report and send to remote locations

Doctors share and view the images online and discusses the case.

RCC TRIVANDRUM


191919

ONCONET SoftwareTelemedicine Enabled Hospital

Automation System (TEJHAS)

Core Serviceso OP & IP Managemento Consultationo Surgical Oncologyo Resource Schedulingo Investigationo Nuclear Medicineo Radiation Oncologyo Chemotherapy o Pharmacy

Support Serviceso Cash & Billingo Central Storeso Purchaseo Blood Banko Radiologyo Engineeringo C.S.S.D

Back Officeo Enquiryo MISo Master Datao Users

Comprises of all essential modules :Comprises of all essential modules :


202020

FINDINGS Patients on Chemotherapy can communicate with

their physician regarding blood count and seek advice

Early Intervention is facilitated Initial patient presentation and diagnosis is made

in a primary sitting thereby avoiding unnecessary patient referrals and reducing patient load at RCC

For specialty care, appointment is fixed through the system, thereby avoiding unnecessary delay


212121

Interpretation

Number of emergency visit to the hospital is reduced

Unnecessary referrals and admissions are avoided

Routine follow-up visits are limited to peripheral clinics thereby avoiding unwanted expense


222222

Saves cost to patient, provider and system

Palliative care through close interaction with tertiary care physician

Conduct distant medical education programs, panel discussions, nurses training programs and talks by doctors

Interpretation…


232323

Usage Statistics( from 2004 onwards)

(Available online at www.rcctvm.org )

Remote Peripheral

Centres

No. of follow up Patients

Money Saved by

Patients in USD

KOCHI 9422 103950

KANNUR 3052 60650

PALAKKAD 262 4075

KOZHENCHERY 274 1575

KOLLAM 556 575


242424

Usage for Tele Education ( from 2004 onwards)

CME Programs 53

Panel Discussions 33

Nurses Training programs

41

Didactic talks by Academic staff

23

Public awareness campaigns

14


252525

ONCONET goes

National(ONCONET India)


262626

ONCONET India( National Tele Oncology Network)

Establish knowledge enabled Tele Oncology network in India

Connect 25 Regional Cancer Centres and 100 peripheral centres ( 4 for each RCC) across the country

Project Report approved by Ministry of Health, GOI; implementation to start soon


272727

AllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabad

LucknowLucknowLucknowLucknowLucknowLucknowLucknowLucknowLucknow

GwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwalior

DelhiDelhiDelhiDelhiDelhiDelhiDelhiDelhiDelhi

ChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarh

RohtakRohtakRohtakRohtakRohtakRohtakRohtakRohtakRohtak

ShimlaShimlaShimlaShimlaShimlaShimlaShimlaShimlaShimla

Shrinagar

AizwalAizwalAizwalAizwalAizwalAizwalAizwalAizwalAizwal

BikanerBikanerBikanerBikanerBikanerBikanerBikanerBikanerBikaner

HyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabad

RaipurRaipurRaipurRaipurRaipurRaipurRaipurRaipurRaipur

NagpurNagpurNagpurNagpurNagpurNagpurNagpurNagpurNagpur CuttakCuttakCuttakCuttakCuttakCuttakCuttakCuttakCuttak

BangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangalore ChennaiChennaiChennaiChennaiChennaiChennaiChennaiChennaiChennaiKanchipuram

PondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherry

ThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuram

MumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbai

KolkataKolkataKolkataKolkataKolkataKolkataKolkataKolkataKolkata

GuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahati

PatnaPatnaPatnaPatnaPatnaPatnaPatnaPatnaPatna

AhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabad

ImphalImphal

ONCONET INDIA

1. Trivandrum2. Chennai3. Bangalore4. Mumbai5. Hyderabad6. Cuttack7. Gwalior8. Kolkata9. New Delhi10. Allahabad11. Patna12. Bikaner13. Shimla14. Rothak15. Gauhati16. Aizwal17. Nagpur18. Ahmadabad19. Pondicherry20. Lucknow21. Chandigarh22. Raipur 23. Imphal24. Srinagar25. Kancheepuram

Regional Cancer CentresRegional Cancer Centres


282828

Telemedicine System

Powerful Video Conferencing System & LCD TV Tele consultation system consisting of Telemedicine PC with

Telemedicine software which facilitates :-- Creation, storage, transfer and sharing of Electronic Medical

Record of patients Tele-Pathology / Tele-Radiology System with Digital

Microscope and Scanner/Digital Camera-- Capture of medical images -- Uploading image to remote end-- Storage of image as part of EMR-- Sharing of image between remote centres for discussion

At RCCsAt RCCs


292929

System Configuration at RCC

Deliverables at RCC

1. PC with software

2. Video Conferencing System & TV

3. Film Scanner

4. Digital Microscope

5. UPS, Printer

6. Networking items

Deliverables at RCC

1. PC with software

2. Video Conferencing System & TV

3. Film Scanner

4. Digital Microscope

5. UPS, Printer

6. Networking items

ROUTER

VCS

Television

Telemedicine PC

LAN

Audio /Video

USB

Printer

Scanner

DigitalMicroscope

384 Kbps

Internet

Leased Line(384Kbps

MPS L3 VPN)

Provided by BSNL


303030

System Configuration at Peripheral Centres

Deliverables at Peripheral Centre

1. PC with software

2. Video Conferencing System and TV

3. Film Scanner

4. UPS, Printer

5. Networking equipments

Deliverables at Peripheral Centre

1. PC with software

2. Video Conferencing System and TV

3. Film Scanner

4. UPS, Printer

5. Networking equipments

TelevisionTelevision

SwitchSwitch

Tele Medicine PCTele Medicine PC

PrinterPrinterVCVCSS

384 384 KbpsKbps

BB VPNBB VPN(384 Kbps)(384 Kbps)

Provided by Provided by BSNLBSNL

ScannerScanner


313131

System Configuration at Hub location

Router

ONCONET India Portal Server

Internet access to all RCCs thru MPLS VPN

256 Kbps Internet Leased

Line

Video Streaming Server

Multi Conferencing

Unit

2 Mbps Leased

Line (MPLS L3

VPN)

Services:

1.Portal

2.Internet Browsing

3.Multi Conferencing


323232

NETWORK DIAGRAMS SHOWING

HOW THE PROPOSED NETWORK

MEETS ONCONET -India

FUNCTIONAL REQUIREMENTS


333333

PE

PE

Mumbai

Delhi

Lucknow

Raipur

PE

PEPE

Guwahati

Cuttak

Chennai

PEPE

Shimla

Chandigarh

Bangalore

Ahmedabad

Gwalior

Trivandrum

PE

PE

PE

PEPE PE

PE

PE

Router

LEGEND

PE

Kancheepuram

PE

Pondicherry

PE

Rohtak

PE

Implementing Agency

Patna

Imphal

Bikaner

Srinagar

AizhwalRaipur

PE

PEPE

PEPE

Allahabad

HUB

MPLS L3 VPN Backbone

2Mbps

384Kbps

256 Kbps

Internet

Proposed MPLS Network linking 25 RCCs


343434

OVERALL ARCHITECTURE of

ONCONET India network

RCC4

RCC2 RCC3

MPLS BACKBONE

RCC25

Peripheral Centre 4

Peripheral Centre 1

RCC1

384Kbps L3 VPN

Peripheral Centre 1

Peripheral Centre 1

Peripheral Centre 1

Peripheral Centre 1

Peripheral Centre 4

Peripheral Centre 4

Peripheral Centre 4

Peripheral Centre 4

384 KbpsBBVPN

384 KbpsBBVPN

384 KbpsBBVPN

384 KbpsBBVPN

384 KbpsBBVPN


353535

Tele-consultation between one RCC and its Peripheral center through Broadband VPN


363636

BSNL MPLS

Backbone

RCC

512KbpsBBVPN

PE

PE

E1 link

MCU, Video streamer

&WEB

PORTAL

PEPE

Group1PE

PE

PE

256Kbps (1:1)

Internet

LL

LL

LL

TELE-CONSULTATION between one RCC and its peripheral centre- data flow

Tele-consultation between a RCC on MPLS VPN and a PC

on BB VPN

RCCs using MPLS VPN

Peripheral Centers using Broadband VPN

Central HUB


373737

Conclusion• By this proposed system, the cancer patients

from any part of India can get the consultation and treatment from any RCC in India

• The rest of India will follow ONCONET-Kerala pattern in the coming years

• This ONCONET- India with appropriate low-cost technology might be able to be duplicated as a model for developing countries with low capital inputs


383838

CONTACT:Sudhamony SAdditional Director / Head, Medical Informatics Section Centre for Development for Advanced

Computing (C-DAC),Thiruvananthapuram-695033. KeralaINDIA.E-mail: [email protected] Ph: 91- 471- 272 1042 (D) / 272 3333 Ext: 229Mob. No: 91-98479 14872 (M)Fax: 91-471- 272 3456 / 272 2230


393939

Applying Advanced Computing for Human Applying Advanced Computing for Human AdvancementAdvancement


Sudhamony S Additional Director / Head,

Documents

Transcript of Sudhamony S Additional Director / Head,