innovation in action: taking telemedicine to masses mishra.pdf · camp1 camp2 camp n mela main...
Post on 30-Aug-2018
215 Views
Preview:
TRANSCRIPT
Prof. S. K. Mishra, MS, FACS Head, Dept. of Endocrine Surgery &
Faculty I/C, SGPGI Telemedicine Programme
School of Telemedicine & Biomedical Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences
Lucknow, India skmishra@sgpgi.ac.in
Innovation in Action: Taking Telemedicine to masses
• Introduction
• Issues to be considered
• Policy & Strategy
• Technology & System
• Sustenance Model
• Case Studies
• Barriers
Agenda
• Telemedicine is the use of medical information that is exchanged from one treatment site to another via electronic communications
• It comprise videoconferencing, transmission of still medical images, document sharing, remote monitoring of vital signs
• ICT based solutions for various types of customization and allowing support for a wider set of application requirements
• Evolution of wireless communication technologies have enabled telemedicine systems to operate in the remotest place for rural health practices, hence expanding telemedicine benefits, applications, and services
• In India majority of the people are living in the rural and remote locations where even the basic facilities are not available for the society
Introduction
Issues to be considered
Stake Holder Triangle
System
Care Givers Citizen
•Policy •Strategy •Technology •Operational Model •Business Model
•Healthy •Sick •Chronic Disease •Aging
•Healthcare provider - Medial, Nursing Practitioner •Institutions •Hospitals at different level - Medical College, DH, CHC,PHC
Technology & System
• Tools
– Fixed Platform
– Mobile Platform e.g. mHealth4U, PDA, etc.
• Network
– Wired (National Optical Fibre Network)
– Wireless (3G, 4G, Wi-Max etc)
• SOP
– Standard Operating Protocol
• Policy
• Strategy
mHealth4U®
mHealth4U-Backpack
mHealth4U- Suitcase
Integrated Medical Equipments
PC Interface:
USB & Bluetooth
Atom based Low Cost Laptop with
Integrated Telemedicine Software
Connectivity via High Speed Broadband (HSB)
Blood
Pressure
Digital
Glucometer
Common
Interface
Spirometer
Wrist Clinic
Weighing
Machine
SPO2
ECG
Video Clip
New generation of Integrated Medical Diagnostic with Mobile Communication Devices
Source: http://www.mobisante.com
MobiUS™SP1
system: smart
phone-based
sound imaging
system
Sustenance Model
Community Based Model
• Telemedicine on Wheel (ToW)
• Health Access near to citizen
– OTTET Model
• Access in Mass congregate
– Maha Kumbh Mela- 2001
– Ratha Yatra, Puri, Odisha- 2009
– Gujarat Field Deployment- 2010
– Airtel, Aircel etc
Telemedicine on Wheel (ToW)
Satcom Based mHealth System
Courtesy: C-DA C TVM, Malabar cancer Society and DIT, MCIT, Govt. of India
1st Mobile eHealth System- 2001
• Prototype of First Mobile eHealth System developed.
• Suitcase and Mobile Van were developed and demonstrated.
• ISDN as Communication Media
Disaster Telemedicine Kit- 2002
• Designed and Developed in Year 2002 as P.O.C. used in Gujarat Earthquake
Shankar Nethralaya Tele-Ophthalmology Unit
Vidarbha Mobile Unit at Maharastra
WDF Mobile Unit in Karnataka
ISRO Mobile Unit at Maharastra
http://www.sankaranethralaya.org/
Mobile Refraction Unit
Aravind Mobile Eye Screening VAN
• ISRO Connectivity
• Known Diabetic Pts are collected by Physician
• Recorded 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
Chitrakoot, MP Gangaram Hospital, New Delhi
Asia Heart Foundation, Kolkata
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 Chunmpet village) in Kancheepuram District, Tamilnadu, India.
• The experts testing, diagnosis, medicines and even laser surgery are at door step
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 the
user can connect to internet at anytime and anywhere in the field to transfer the captured images of
patient’s eyes and other related data through the software e-Sanjeevani
http://www.cdacmohali.in
Regional Institute of Ophthalmology “Sunayanam” – A Tele-ophthalmology Unit
• Regional Institute of Ophthalmology (RIO), Trivendrum
• Designed and implemented by C-DAC
• Well-equipped to carry out complete ophthalmic examination.
• Further assistance are met with by contacting the specialists at RIO by way of videoconferencing
• Equipped with photo slit lamps.
http://www.yentha.com/news/view/1/2724
Sri Ram Medical College, Chennai
• ISRO Antenna & VSAT connectivity.
• General Purpose Rural Tele-health Clinic
http://www.srmc.edu/telemedicine.htm
Amrita Institute of Medical Sciences, Cochin
• AIMS Hospital’s Mobile Telemedicine Unit is the size of a city bus and includes X-ray facilities, ECG scanner, pathology-lab-work facility, specialty cardiac services and a telemedicine satellite link with AIMS Hospital.
• First used in tsunami-relief work in Kerala and Tamil Nadu.
• Direct Relief International ( a U.S based NGO) has supported in setting up of this van while Indian Space Research Organization ( ISRO) provides the satellite-technology and connectivity
http://www.aimshospital.org/hospital/cdh/facilities_telemedicine.php#8
Application of AIMS Telemedicine Van Tele-health service in Koshi flood affected Area
Apollo Telemedicine Network Foundation
• Jointly undertaken by ISRO, Philips
India, Apollo Telemedicine
Networking Foundation (ATNF) and
the Madurai based NGO,
Development of Human Action
(DHAN)
• 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
3G enabled mHealth
Apollo Telemedicine Network Foundation
http://www.medetel.lu/download/2010/parallel_sessions/presentation/day1/mHealth_Bridging.pdf
Telemedicine enabled Kit Apollo Telemedicine Network Foundation
• Vital Parameters (12Lead ECG, BP, Stethoscope,PO2,
Meter, Temperature Probe, and Glucometer)
• 3G Broadband
Health Access near to citizen-OTTET Model
Healthcare Access in Mass congregate
Innovation in Action: Taking Telemedicine to masses- SGPGI Initiative
since 2001
Maha Kumbh Mela
Telemedicine Project
Jan 6- Feb 26, 2001
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
?
?
?
?
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)
Location of Telemedicine work station in Kumbh Mela
Cardiology 64 On line ECG, Documents and snap shot
Radiology 32 Documents and X-ray / CT scans
Orthopedics 13 Snap shot, X-ray, Documents
Neurology 01 Documents and snap shot
Neurosurgery 01 Documents, CT scan
Physician 01 Documents
Ophthalmology 02 Documents, snap shot of eye
Dermatology 01 Documents and snap shot
Path. Slides 01 Slide pictures
Tele-consultation
Specialties No. of
Consult.
Transmitted Documents
Case Study: “Telemedicine enabled specialty healthcare access for health emergencies”
• Telemedicine enabled specialty healthcare access for health emergencies during Lord Jagannath Rath Yatra at Puri was initiated by the School of Telemedicine & Biomedical Informatics (STBMI), SGPGIMS, Lucknow in collaboration with OTTET, Bhubaneswar and Govt. of Odisha
• An enterprise based telemedicine network was set up connecting specialty hospitals at Bhubaneswar and Cuttack using wireless broadband IP network to exchange E.C.G. and carry out peoplelink® software based videoconference for tele-consultation
2009: Puri Rath Yatra @ Odihsa
Technical Layout Diagram of Rath Yatra
• Field deployment was done in four Primary Health Center (PHC), one Community Health Center (CHC) and one state Hospital in the State of Gujarat, western India
• Basic orientation, demonstration and hands-on-training programme was imparted to in-service paramedical, laboratory technician & nursing staff to give them first hand exposure on the kit
• All five nodes were connected over mobile wireless internet with expert hospital located in the city. The electronic medical record was created using the Curesoft® telemedicine software and the input from integrated medical devices like ECG, NIBP; Spo2 etc were captured through USB 2.0 port into this software which was then exchanged between the nodes and videoconference session followed for tele-consultation after the successful transmission of the data to specialist.
2010: Field Deployment @ Gujarat, India
Hand Holding
Case Studies: Nepal
IOM Smart Healthline
Work Flow chart of Health Call Center operational at
IOM
Health Call Center in operation at Institute of Medicine
(IOM), Tribhuvan University, Kathmandu
Wireless Health Nepal
• Wi-Fi Based Telemedicine network in Himalaya mountain region
• Basic Tele-consultation services accessed from Kathmandu
• Basic health skills taught to non-traditional health workers in village
• Low cost model
• Mobile communication getting integrated
Case Study: Bhutan
Landscape: Total size: 46,500 Km2
Forest coverage: 72%
Agriculture & Pasture: 12.6%
Population: 0.7 million
Growth Rate: 2.5%
Predominantly rural (79%)
Life expectancy at 66.3 years
Health Help Center (HHC)
• 24x7 Accesses to Healthcare Services in Bhutan Though a Toll Free Number 112
• HHC is an initiative under the Accelerating Bhutan’s Socio-Economic
Development (ABSD) program • Two specific initiatives:
– Health-care Helpline – Emergency Response System
• Performance contract signed with the Prime Minister on December 12, 2009
• Helpline, patients can call a toll free number 24x7 and seek
medication, counseling, public health information and other associated services online
• Emergency Response System, patients in emergency can call a toll free
number 24x7 and can request an ambulance at the incident location
Snap Shot- HHC
Barriers
• National e Health Policy
• Evaluation & Identification of Best Telemedicine Practices
• Confidentiality & Security of Personal Health Record
• Credentials and competence of the remote physician
• Legal, ethical and social issues yet to be addressed
• Broadband internet yet to reach rural areas
• NGN like Wi Max and 3G not widely available
Barriers
• E-health adoption by stake holders
• e-Health Program sustainability Models
• Inter-operability of e 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
School of Telemedicine & Biomedical Informatics, SGPGI, Lucknow
www.sgpgi-telemedicine.org | www.telemedindia.org
www.stbmi.ac.in | www.nrct.in
Thank You
top related