e-health initiatives in indiasgpgitelemedicine.org/telemedicine/ppt/nethealth_skm.pdf · 2019. 11....

Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore

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

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

Lucknow,[email protected]

www.sgpgi-telemedicine.org

1Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore


Content

• Introduction: India Demography & Health DeliverySystem

• Brief review of Application of Telemedicine Projectaround the country

• m-Health in India• Application of Telemedicine technology in Health and

Medical Education by Premier Academic & CorporateMedical Institution of India

• Opportunities and Challenges• Participation of India in ITU-D Activities

2


3


India-Introduction

4

Total Area : 3 million sq. kmNo. of Provinces : 29Union Territories : 6Coastal line : 6,700 kmDiverse geography - inaccessible

hilly regions, islands, desert, coasts, tribal areas

Population - more than 1 billion (70% rural) Medical Experts: 70% urban

Lucknow


Indian Health Scenario

• 620 million live in rural India (NCAER)• Bed-Population ratio 1:1333 (1991) Vs. ideal of 1:500• 2 million beds are required as against 0.7 million available• 700 hospitals of 250 beds each are required every year• Only 9% of 1 billion people are covered health schemes• Only 0.9% of GDP for health (WHO recommends 5%)• 5% of annual family income spent towards curative health

care.• Specialists relocating to sub-urban or rural areas


Public Health care delivery in India

• Primary Healthcare centers

– 23,236 PHC & 46,026 Sub centers

• Secondary Healthcare centers

– 3,346 CHC 4,400 Dist. Hospitals & 1200

other Public Hospitals

• Tertiary Care & Teaching

– 275 Medical colleges, 205 Dental collegesThird International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore


Potential of ICT to improve Healthcare

• 66% of 1100 million are literate • 70% of India has access to TV coverage • 650,000 existing PCOs ® internet kiosks • 400,000 villages already have telephone connections• Mobile user in India 584.32 million as on 31st March

2010• Internet users in 16.18 million as on 31st March 2010• Hardware, software and brain ware all available



8


Major Implementing Agencies

• Department of Information Technology (DIT) , Ministry of

Communication & IT, Govt. of India – terrestrial line

• Indian Space Research Organisation (ISRO) – Satellite

communication

• Ministry of Health and Family Welfare, Govt. of India

• Ministry of External Affairs, Govt. of India

• State Governments

• Medical Institutions (public & corporate)9Third International Conference on Communication Systems and Networks

(COMSNET 2011), January 4-8; Bangalore


State wise location of Telemedicine platforms

10


Dept of Information Technology (DIT)Ministry of Communication & IT-

Since -1999 • Initiated some successful pilot projects• Selected specialty

– OncoNET Kerala– development of a Tele-Oncology System – Development & Application of Tele-radiology - West Bengal– Diagnosis & monitoring of Tropical diseases – West Bengal – General telemedicine system -various states

• Standardization activities in e-health/Telemedicine• Prepared a framework for IT Infrastructure for Health

http://www.mit.gov.in/default.aspx?id=709



West Bengal

Kerala

Nagaland

Mizoram Tripura

Tamil Nadu

Telemedicine Projects by DIT in various states of India

Punjab

Maharashtra

Uttar PradeshNew Delhi

Manipur

Himachal Pradesh

Haryana


Application of Telemedicine Technology to provide Tele-health care during mela festival and disaster Year 2001 - DIT-SGPGIMS

• Religious Importance– Happen once in 12 Years– At the bank of confluence of

three holy rivers Ganges, Yamuna & Saraswati(Sangam)at holy city Prayagin the Northern India

– Pilgrims congregate and take Shahi Snans (Holy bath)

– Population:Circulatingpopulation -7 0 million

– Temporary population“Kalpavasees”-Five million


Exchange of Health Information

• Daily discussion between DGHS, Lko& Medical College, Allahabad onpublic health activity

• Tele-consultation from SGPGI- 174 patients

• Results of stool culture, throatconjunctivae & wound swab-onlinetransmission & preventive measures


Monitoring of Public Health

• Drinking water at State PH lab• OT test for chlorination• Microbiological examination at SGPGIMS-• Total sample Suspicious Fecal cont.

149 31 05Sangam water: Total sample MPN/100 ml V. cholerae

9 >1100 in 5 None• Food samples– 24 vendor shops– Police line mess

15

Ayyagari A, Bhargava A, Agarwal R, Mishra SK, Mishra AK, Das SR, Shah R, Singh SK, PandeyA. Use of telemedicine in evading cholera outbreak in Mahakumbh Mela, Prayag, UP, India: an encouraging experience. Telemed J E Health;9(1):89-94, 2003



Development and Application of Telemedicine for Tropical Diseases – Year 2002

• School of Tropical Medicine, Kolkata- Referral center

• Kooch Bihar District Hospital & Habra State General Hospital in West Bengal

• IIT, Kharagpur and Webel ECS Ltd. - Telemedik software

• Telecommunication - PSTN


Development and Application of Telemedicine forRadiology for Govt. Hospitals of West Bengal– Year 2002

• Referral Center

– NRS Medical College & Hospital, Kolkata & Burdwan Medical College & Hospital, Burdwan

• Nodal Centers : Purulia District Hospital, Purulia , Suri District Hospital, Birbhum , Baharampur District Hospital, Murshidabad, Midnapur Medical College & Hospital, Midnapur

• Connectivity: 64/128 Kbps Leased line& WBSWAN as backbone

• Activities : Cases of Radiology, Cardiology, Medicine, Haematology

17


Development of Telemedicine technology and its applications towards optimization of medical resources -Year 2002

• Networking of Three Premier Medical Institutions of the Country

• Using technology to set up a number of telemedicine networks connecting remote health centers with specialty hospitals

18

Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow

All India Institute of Medical Sciences, New Delhi

Postgraduate Institute of Medical Education & Research,

Chandigarh

Mercury Telemedicine Software


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• Public Awareness campaigns - 14

www.rctvm.org


Common Service Centers(CSCs)100,000 CSCs (80 services) in 600,000 villages

• e-governance, education, health, telemedicine, entertainment and other private services

• Health – Vaccination Schedule, Maternity Care,

Family Planning, Medicines, Ambulance Services, Hospital / PHCs information, Blood Bank, Life Saving Drugs, Doctor’s Database, Appointment with Doctors, E-Diagnostics, Medicines

http://www.csc-india.org/


Common Service CentersImplementation Status till 31Mar10

21


Indian Space Research OrganizationSince - 2001

• Satellite-Telemedicine

Network through Indian

Satellite System (INSAT)

• Collaboration with state

governments

• 439 nodes across the

country – 17 Mobile Vans

• Free satellite bandwidthwww.isro.org/scripts/telemedicine.aspx


Rural Telemedicine Yr 2001

• Referral Hospital – Apollo Hospital at Chennai and Hyderabad

• Remote Hospital: – Apollo Rural Hospital at Aragonda village in the

Chittor district of Andhra Pradesh • Activities – Preventive healthcare program, tele-

consultation & tele-follow up • 40,000 consultations

23

http://www.telemedicineindia.com/KeyProjects.htm /



Karnataka Telemedicine project Yr 2002

• Referral Hospital– Narayana Hrudayalaya, Bangalore

• Remote Hospital– District Hospital, Chamarajanagar– Vivekananda Memorial Trust Hospital at Saragur in south interior

Karnataka• Connectivity : Satellite• Activities : Tele-cardiology, woman and child health, orthopedics,

pathology, etc• 52,000 patients

24

Cardiac care: NH manages the cardiac care unit at the Chamarajanagar District Hospital



Disaster ManagementAndaman & Nicobar Islands Telemedicine Project-Year 2004

• GB Pant Hospital & INHS Dhanvantariat Port Blair, Andaman Island and Bishop Richardson Hospital at Car Nicobar at 8 islands used during postTsunami disaster relief work

• GB Pant Hospital connected to Sri Ramachandra Medical College & Research Institute, Chennai for specialty consultation

• ISRO GRAMSAT Network• Patients need not to come to main land

for diagnosis, consultation and treatment



Village Resource Centers (VRCs) ISRO initiatives

• A step closer to the grassroots • Communication and remote sensing satellite• Delivering the variety of space technology services

directly to the grassroots including telemedicine and tele-health education

• 550 villages in various states



Village Resource Center

27

http://www.gisdevelopment.net/magazine/global/2008/august/30.htm


Ministry of Health & FW, Govt. of India

• Integrated Disease Surveillance Project (IDSP)• OncoNET India• Tele-ophthalmology project• National Digital Medical Library Consortium

(ERMED)• National Rural Telemedicine Project• National Medical College Telemedicine Network

28

http://www.mohfw.nic.in/

Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; BangaloreThird International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore

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

• EDUSAT Satellite

• Decentralized state based surveillance

system for communicable & non

communicable diseases

• Improve the efficiency of surveillance

activities, detect disease trends,

evaluate control strategies of the

disease control programmes

Current status

• Data Centre - 750 locations

• Connectivity - 559 locations

• Training Centre

– NIC 218 / 400 sites

– ISRO 297 / 400 sites

• 38 Hi-End VC Equipments (Multi

conference 5 nodes) - between

CSU and States/UTs HQ

29

http://idsp.nic.in/


Central Scheme: ONCONET India

• Under National Cancer Control Programme

• Nationwide Tele-oncology Network in India

• Connect 27 Regional Cancer Centres with 4 peripheral district hospitals/medical colleges for each RCC across the country

AllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabad

LucknowLucknowLucknowLucknowLucknowLucknowLucknowLucknowLucknow

GwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwalior

DelhiDelhiDelhiDelhiDelhiDelhiDelhiDelhiDelhi

ChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarh

RohtakRohtakRohtakRohtakRohtakRohtakRohtakRohtakRohtak

ShimlaShimlaShimlaShimlaShimlaShimlaShimlaShimlaShimla

Shrinagar

AizwalAizwalAizwalAizwalAizwalAizwalAizwalAizwalAizwal

BikanerBikanerBikanerBikanerBikanerBikanerBikanerBikanerBikaner

HyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabad

RaipurRaipurRaipurRaipurRaipurRaipurRaipurRaipurRaipur

NagpurNagpurNagpurNagpurNagpurNagpurNagpurNagpurNagpur CuttakCuttakCuttakCuttakCuttakCuttakCuttakCuttakCuttak

BangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangalore ChennaiChennaiChennaiChennaiChennaiChennaiChennaiChennaiChennaiKanchipuram

PondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherry

ThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuram

MumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbai

KolkataKolkataKolkataKolkataKolkataKolkataKolkataKolkataKolkata

GuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiPatnaPatnaPatnaPatnaPatnaPatnaPatnaPatnaPatna

AhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabad

ImphalImphal

ONCONET INDIA


Central Scheme: Tripura Tele-ophthalmology Project

• Tripura Tele-ophthalmology (Vision) Centres set up in Blocks toprovide 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• 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 patients

referred to Referral Hospital (IGM Hospital)• Average number of patients per Centre per month: around 100.• National e-Governance Gold Award for 2009.

31

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


National Rural Telemedicine Project under National Rural Health Mission

• 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 module– Technology platform for harvest, compilation, storage

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

32

www.mohfw.nic.in/National%20Rural%20Telemedicine%20Network%20for%20India-...



UP State Telemedicine Network

• Department of Medical Education, Govt. of U.P. took a policy decision tosetup U.P. Medical Colleges Telemedicine Network.

• School of Telemedicine & Biomedical Informatics, SGPGIMS, Lucknowentrusted the job of designing the technical architecture and Systemrequirement

• National Co-operative Consumer Federation of India Ltd. (NCCF) wasidentified to implement the project.

• The pilot phase has been completed with deployment of telemedicineinfrastructure in Medical Colleges at Allahabad, Kanpur and Meerut.

• After technical trials and training the project is operational since September2010.

• Currently the Clinical Grand Round held every week at SGPGI is gettingshared with all three medical colleges.

• Two conference/workshop held at SGPGI was similarly shared. Bothreceived wide acclaim from the users.



1. SGPGIMS, Lucknow2. CSMMU, Lucknow3. MLN Medical College, Allahabad4. GSVM Medical College, Gorakhpur5. J. K. Cancer Institute, Kanpur6. L.P.S. Institute of Cardiology, Kanpur7. B.R.D. Medical College, Gorakhpur8. R.L.B. Medical College, Jhansi9. L.L.R.M. Medical College, Meerut10. S.N. Medical College, Agra11. UPRIMS, Saifai12. IMS, BHU, Varanasi13. JN Medical College, AMU, Aligarh14. RML institute of Medical Sciences, Lucknow15. RML Hospital, Lucknow16. Balrampur Hospital, Lucknow

34

Nodes Activated in Phase I


Block Diagram for UP Medical College Telemedicine Network #1

WAN Connectivity



Design of UP Medical College Network #2WAN & LAN Connectivity



Design of the System & Network at each medical college #3Digital Library



Ministry of External Affairs Project, GoI

SAARC Telemedicine Network• Implementing Agency:

Telecommunications Consultants India Ltd. (TCIL)

• Connectivity: Satellite & fiber optic network

• Networking of one/two hospitals in each of the SAARC countries with 3-4 Super Specialty hospitals in India

• Current Status: JDWNRH, Bhutan , Indira Gandhi Child Hospital, Kabul, Afghanistan & Patan Hospital, Kathmandu, Nepal with SGPGIMS, Lucknow & PGIMER, Chandigarh with academic activities

Pan-African e Network Project• Implementing Agency: TCIL• 53 countries of the African Union • Connectivity: Satellite & fibre optic

network • Activities: tele-healthcare & tele-

education• Current status: 3 African countries

joined the project

38http://www.tcil-india.com/new/html/26feb.htm


39

Third International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; BangaloreThird International Conference on Communication Systems and Networks (COMSNET 2011), January 4-8; Bangalore

Review of mHealth projects in IndiaName of the Project Reference Link

Freedom HIV/AIDS Project http://www.freedomhivaids.in/FreedomHivAids.htm

Community Accessible & Sustainable Health System (Ca:sh

http://www.medialabasia.in/healthcare.html

Shared Resource for Rural Health Management & Information Infrastructure

http://www.medialabasia.in/healthcare.html

Mobile-Based Primary Healthcare Management System

http://www.w3.org/2008/02/MS4D_WS/papers/cdac-mobile-healthcare-paper.pdf

Mobile Care, Support & Treatment Manager (MCST)

http://www.freedomhivaids.in/mCST.htm

Mobile Phones for Health Monitoring http://www.lboro.ac.uk/service/publicity/newsreleases/2007

The Acute Encephalitis Syndrome Surveillance Information (AESSI)

http://unpan1.un.org/intradoc/groups/public/documents

Handhelds for Health http://handheldsforhealth.org

Tamil Nadu Health Watch http://unpan1.un.org/intradoc/groups/public/documents/UN/UNPAN030003.pdf

Ericsson and Apollo Hospital Initiative http://www.ericsson.com/ericsson/press/releases/20080605-1225191.shtml


Sanjeevani – Mobile Telemedicine Unit(CDAC-TVM., MCCS, Kannur, RCC TVM. , ISRO); DIT Funded



42


Telemedicine at SGPGIMS, Lucknow

• Started – 1999

• Total Nodes - 21

• Tele-communication link

– ISDN, VSAT, Fiber

Optic, Global IP

• SAARC Telemedicine

Network Project

• IDSP Project

43

SGPGIMS, Lucknow

Patient care, teaching, training & research

National Resource CenterSchool of Telemedicine & Biomedical Informatics


44

PGIMER, Chandigarh

IG Medical College, Shimla

AIIMS, Delhi

Base Hospitals, Almora & Srinagar

Dist. Hospital , Raibarelli

RIMS, Imphal

VSS Medical College, Burla

MKCG Medical College Berhampur

SRMC, Chennai

CMC, Vellore

AIMS, Kochi

SCB Medical , Cuttack

Railway Hospital, Izzat Nagar, Bareli 8 Northeastern

states (NIC)

PBDS Post Graduate Institute of medical

Science, Rohtak

National Network Partners


SAARC & Overseas Partners

Oregon Health & Science University, Portland, USA

Ranguel University, Tolouse, France

Holy Family Hospital, Rawalpindi, Pakistan

I G Child Hospital, Kabul, Afghanistan

JDWNR Hospital, Thimphu, Bhutan

45


Telemedicine Initiatives

• Application & Research project

• Consultancy, project planning and implementation of network in states

• Tele-health care & Distant Education in Medicine

• Tele-mentoring

• Research &Development• Organizational Activities• Telemedicine Awareness • National & International

collaboration in policy initiatives, technical knowledge exchange

• Training & structured courses in telemedicine

46


Tele-microbiology Tele-pathology

Tele-consultation

Snap shot - Telemedicine Activities at SGPGIMS

Tele-education Tele-health care

Capacity Building Policy Initiatives & Consultation47


R & DSnap shot

IP Based Intra-operative Tele-consultation Module

Low cost portable Telemedicine Unit

Internet based Mobile Telemedicine Van

Telemedicine Software


• Orissa Telemedicine Project (ISRO) - Sept’03-Sept’09– SCB Medical College

Cuttack (1500) kms– MKCG Medical College,

Berhampur (1800 kms)– VSS Medical College,

Burla (1500 kms.)• Technology – Real time• Telecommunication link-

VSAT

Tele-consultation Medical Colleges of Orissa State (n=620pts)

49


• Balrampur and Civil Hospital, Lucknow (20 kms) – Year 2000 using PSTN

• Pithoragarh District Hospital, Pithoragarh(500 kms. Hilly area) & Sushila TewariForest Hospital, Haldwani (250 kms base of the hill) in Northern India– Year 2000 (n=30 pts as Proof of Concept using PSTN)

• Uttaranchal Telemedicine Network –Apr’04-Mar’08-(Two district hospitals: n=265 pts using ISDN)

• Raebareli Telemedicine Network Project –Oct’06-ongoing (n=50 pts)

• Technology - Store & Forward Technology,Real time (On demand)

Tele-consultation District Hospitals

Screen Shot of one of the Tele-radiology Opinion transmitted to one of District Hospital in

Uttaranchal region50


Tele-follow up – Case-study-3(March 2004 ~ Ongoing)

• Patients from the Orissa state ( Eastern Coast)

• Technology - Real time• Telecommunication -VSAT• Departments

– Endocrine Surgery (n=50 pts)– Nuclear medicine (n=127 pts)– Rheumatology(n=60 pts)

• Average visit – 1-12

Anjali Mishra , Lily Kapoor, Saroj Kanta Mishra, Post-operative care through tele-follow up visits in patients undergoing thyroidectomy and parathyroidectomy in a resource-constrained environment, J Telemed Telecare; 2009,15:73-76

51


Tele-follow up – Snap Shots

Dept of Endocrine Surgery

Dept of Nuclear Medicine

Dept of Rheumatology52


Post-graduate Students of Medical Colleges (Sept 2001-ongoing )

• Orissa Telemedicine Network Project

• Funding Agency - Indian Space Research Organisation

• Network Partners– SCB Medical College,

Cuttack– MKCG Medical College,

Berhampur– VSS Medical College, Burla

• No. of Tele-education sessions –720 sessions

• Clarified problems in management of difficult and complicated cases

• Guidelines for management of complicated cases

• Good interesting and illustrative cases

• Keep them abreast of the recent advances in medical field

• Optimal utilization of existing resources

53


UP Tele-radiotherapy Network Project (2007-ongoing)

• Funding Agency - Department of Bio-technology

• Network Partners - Chhatarpati Sahuji Maharaj

Medical University, Lucknow

• No. of Tele-education sessions - 176

54

Mahapatra Ashok Kumar, Mishra Saroj Kanta, Kapoor Lily, Singh Indra Pratap, “Critical Issues in Medical Education and the Implications for Telemedicine Techology”. Journal of Telemedicine & eHealth, VOL. 15, No. 6, P 592-596, August 2009


Post-graduate students of medical colleges-Snap shots - Virtual Classroom

55


Medical Education for District Hospitals doctors - n=293

• National Informatics Centre (NIC) (Jul’03 –Oct’04) (n=13) , Point to multipoint

• Uttaranchal Telemedicine Network Project (Apr04-Mar08) (n=104), Point to multipoint

• Raibareli Telemedicine Network Project (Apr06-Aug’09) (n=176)

• Getting expert opinions• Enhancing medical

knowledge in the management of common medical problems

• Improving consultation skill

• Continuing education

56


District Hospital Doctors – Snap shots

57Mahapatra AK, Mishra SK, “Bridging the Knowledge and Skill Gap in Healthcare: SGPGIMS, Lucknow, India Initiatives” Journal of eHealth Technology and Application; 5(2):67-69, , June 2007


Para-medical Healthcare - n=106 sessions

• Orissa Telemedicine Network Project

• Uttaranchal Telemedicine Network Project

• Raebareli Telemedicine Network Project

• Participants - Nurses, Hospital Administrators, Lab Technicians, Dieticians, Physiotherapists

• Enhancing nursing skills• Better patient care• Continuing education• Exposure to new

techniques and equipments• Better hospital

administration

58


Para-medical Healthcare Professionals

59


Knowledge Sharing

• Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala (n=132)

• All India Institute of Medical Sciences, New Delhi & Postgraduate Institute of Medical Education and Research, Chandigarh (n=23)

• Christian Medical College, Vellore (n=83)

• Sri Ramchandra Medical College, Chennai (n=6)

• Regional Institute of Medical Sciences, Imphal (n=2)

• Share interesting and complicated cases

• Peer opinion and consultation

60


Knowledge Sharing - Snap Shots

61


Tele-mentoring

• Emergency situations• Skill development

– Laparoscopic surgery– Complex surgical procedures

• Institutions Involved – SGPGIMS, Lucknow– AIMS, Kochi

• Telecommunication link– VAST – 512 kbps

62


LocalCablenetwork

Video conferencing unit

512 Kbps

512Kbps

Tele-mentoring

AIMS, Kochi

2500 Km

SGPGIMS, Lko

63


Tele-mentoringSnap shots of surgical field

64

Telementoring in Endocrine Surgery, Mishra SK, Mishra A, Pradeep PV; Chapter 11,Telesurgery Book, Edited by Kumar S/ Marescaux J Springer-Verlag GmbH, Heidelberg/Germany. ISBN no. 978-3-540-72998-3, 2007


Sub-specialty Development Endocrine Surgery

• Rare specialty

– Few centers

– Few faculty

– Few opportunity

• SCB Medical College, Cuttack

• Tele-communication link – VSAT

• To assess the feasibility and impact of telemedicine in

reinforcement of endocrine surgery training at distant places to

develop this subspecialty in a developing country like India


Sub-specialty Development


Case Study : National Resource Center (NRC) for Telemedicine

School of Telemedicine and Biomedical Informatics, SGPGIMS, Lucknow


Network Backbone of SGPGI, Lucknow


Integrated Hospital Network


HD Surgical e-content Process

Green Valley Edius

FCP(final cut Pro)

Adobe Premiere

Maya

Online sharing

Streaming

Video Conferencing

Offline SharingDeveloped Content

Website

Editing Storage Sharing

Professional Camera (02)

Video Conference (04)

Hitech Digital Lecture Theater (01)

Integrated Operation Theater (01)

Data CenterEquipped with Latest Blade Servers

Rack Servers

Streaming ServerBoth Apple & IBM Servers

Raid Configuration

Harvest


Creation


Collections


Network Monitoring & Data Storage


Integrated Operation Theatre System

• Integrated Operation Theatre System– Various Video Sources

• In-Light Camera• Endoscopic camera• PTZ Camera etc.

• Data Center as Video Archival and Distribution Center

• Upgraded Hi-Speed Hospital Network i.e 10G Network


In-light Camera and various light sources


Touch Panel to Control Various Video Sources


Video Hub

VC • Polycom Codec

Switcher • Matrix Switcher


Video Router inside OT

Recorder •SDC Ultra

Control •SIDNE

Router • Infinity 2


Video Edit and Capture Stations

• Editing Stations– Canopus Edius 4.5

(Windows)– Final Cut Pro

(Apple Mac)• Voice Over Booth

– Apple Platform• Ingest capture stations

using– B4m Production Suite

with clients in Apple Mac Plate form


Software used

• Adobe Collection, including Flash, Premiere etc.• Maya - modeling & animated e-contents• Offline Surgical Video Editing

– Edius, FCP• Live Video Ingest - B4M Production Suite• Live Surgery DVD - SDC Ultra (Stryker Digital

OT Integration) or similar solutions by other vendors

• Educational portal – Dream Weaver, Flash, XML


Hardware for Capturing & Archiving Surgical Videos

• Live Conference were recorded using SonyXDCAM, and professional studio videocameras for grabbing the quality contentmoreover in HD format.

• For Audio and Video Streaming Servers likeStarbak and Polycom RSS-2000 needed tostore the content.

• Audio streaming is best used while Tele-Educational and CME sessions.


Sharing HD Surgical Knowledge


Editing Stations


Data Storage


All India Institute of Medical Sciences (AIIMS), New Delhi

• Total Nodes – 50

• Pan African e-Network &

SAARC Telemedicine

Network Project

• Activities – Tele-

education & healthcare

85

http://www.aiims.edu/aiims/tel-med/tm-inauguration5.htm/


Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh

• Total Nodes -10

• Pan African e-Network & SAARC

Telemedicine Network Project

• Activities – Tele-education & healthcare

86http://pgimer.nic.in/code/telecentre/html/e-

health.htm


Amrita Institute of Medical Sciences, Kochi

• Total Nodes – 166• 1 Mobile telemedicine – tele-

ophthalmology, tele-general medicine, tele-gastroenterology, tele-cardiology

• Emergency Medical Center at Pampa

• Activities: Tele-healthcare, Tele-surgery, Tele, CMEs, Tele-Health (Public), Distance Education

• Telemedicine solution provider

87http://www.amritatech.com/telemedicine.htm


Christian Medical College, Vellore

• Total Nodes –7

• Connectivity – ISDN/ VSAT

• Activities: Tele-healthcare,

Tele, CMEs, Demonstration

Distance Medical Education

http://clin.cmcvellore.ac.in/otherwebsite/mission_support/Telemedicine.asp


Telemedicine at Corporate Hospitals

Apollo Telemedicine Network Foundation

• Total nodes – 130• 1 Mobile telemedicine – Tele-

general medicine• Pan African e-Network Project • Aragonda, Government of Gujarat,

Aditya Birla Group, KudankulamNuclear Power Project

• Telemedicine consultancy and software providers

Sri Ramchandra Medical College, Chennai

89

www.telemedicineindia.com

• Total nodes – 100• 1 Mobile telemedicine – Tele-

general medicine• Services: Tele-Diagnosis, Tele-

Consultation, Tele-follow ups ,Expert’s Opinion, Public Awareness programs, Tele- CME, Guest Lectures, Tele-Conferences, National Workshops Clinical Society Meetings (Surgeons), Live Surgeries, Capacity Building

• Telemedicine @ Southern Railway, Chennai

http://www.srmc.edu/telemedicine.htm


Tele-OnconetRegional Cancer Centre,

Thiruvananthapuram

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

CME, Panel Discussions, NursesTraining programs, talks bydoctors of RCC, CancerAwareness

Tata Memorial Hospital, Mumbai

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

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

Tele-pathology / Radiology

90http://www.rcctvm.org/Telemedicine.htm http://tmc.gov.in/misc/aboutus.htm


Tele-onconetUP Tele-radiotherapy Network

• Total Nodes – 2 (1st Phase)

• Connectivity: ISDN

• Activities : Tele-education & Tele-CME

RCC, Adyar , Chennai

• Total nodes: 7

• Connectivity: ISDN & VSAT

• Activities: Tele-consultation & Tele-follow up

91

http://www.cancerinstitutewia.in/


Tele-cardiology

Asia Heart Foundation Kolkata & Narayana Hrudayalaya,

Bangalore• Total Nodes: 20• Pan African e-Network• Connectivity : VSAT/ ISDN/ PSTN• Activities: Tele-consultation & VC,

TTECG, Tele-CME

Fortis healthcare Network & Escort Heart Institute,

New Delhi • Total Nodes: 12 satellite/heart

command centers

92

www.narayanahospitals.com/tele_medicine_centers.html


Mobile Tele-ophthalmologyShankara Nethralaya, Chennai

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

• Connectivity: VSAT• Activities: Eye check up, tele-

consultation, educating the local community about eye care, Teaching and Training for local Ophthalmologist / General Physicians / Optometrists / Opticians / Nurses and teachers

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

Aravind Tele-Ophthalmology Network

• Mobile Unit: 1• Connectivity :VSAT• Activities: Diabetic Retinopathy

Assessment & Grading Over Network

93

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


94

Opportunities and Challenges


Opportunities

• Vast and diverse geography with dominantrural population

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

expertise• Fast adoption of Mobile technology• Successful pilot projects• Policy on adoption of ICT in service delivery

95


Challenges 1

• 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 yet to be launched

96


Challenges 2

• 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

97


98

Participation of India in ITU-D Q14 2/2 Activities


2nd APT Telemedicine Workshop

25- 26 February 2004New Delhi, India

• Experience with Endocrine Surgery Tele-clinic, Saroj K Mishra, Biswa N. Mohanty, Ashok K Verma, Amit Aggarwal, GauravAggarwal

• Human Resource Development in the Field of e Health Technology, Saroj K Mishra

• Maha Kumbh Mela, Saroj K Mishra

• Moral, ethical, legal and other issues in telemedicine, V K Kapoor

3rd APT Telemedicine Workshop

27-28 January2005Malaysia

• Towards building a National Network of Medical College for Distance Learning through ICT, Kartar Singh

• Current Status of E-health in India, S K Mishra

• Tsunami, Indian Ocean, Dec 26, 2004, Impact on Indian sub-continent & Telemedicine Interventions - S K Mishra

99


4th APT Telemedicine Workshop

25-26th January2006Islamabad, Pakistan

• Telemedicine practice in extreme geographic environment: Uttaranchal State Telemedicine Network Project – A Case Study, Lily Kapoor, Rajesh Basnet, RepuDaman Chand, Sandeep Singh, Pankaj Joshi, Maneesh Semwal, Durgapal, K S Negi, Ragesh Shah, S K Mishra, Kartar Singh

• India Country Report on Telemedicine & e-health, KartarSingh, S K Mishra

• Continuing Medical Education (CME) Network: Current Position in India, Kartar Singh, S K Mishra

5th APT Telemedicine Workshop

6-9 February 2007Chiangmai, Thailand

• Developing Core Competence in Telemedicine & e-health –SGPGI, Lucknow Initiative, S K Mishra

• Current Telemedicine Infrastructure, Network, Applications in India, S K Mishra

• Short term analysis of impact of telemedicine technology enabled follow-up of surgical patients, S K Mishra

100


Participation of India In APTSnap Shots

101


PSC/APT Workshop, Okinawa,15-16, June 2007Okinawa, JAPAN

• Analysis of Telemedicine Project deployed in Sub-Himalayan Region in the Indian state of Uttaranchal, Lily Kapoor, Rajesh Basnet, Repu Daman Chand, Sandeep Singh, Varad Pradhan,

Pankaj Joshi, Maneesh Semwal, Durgapal, K S Negi, RageshShah, S K Mishra

• Bridging the Knowledge and Skill Gap in Healthcare: SGPGIMS, Lucknow, India Initiatives, A K Mahapatra, S K Mishra

102


ITU Rapporteurs Grp Meeting 25-26th June 2004

Tokai University, Japan

• Telemedicine Initiative in India, S K Mishra

Q10-1/2: Communications for Rural & Remote areasITU-D Study Groups, Rapporteurs Group Meeting

20-21 June 2005 Tokyo, Japan

• Telemedicine Application in Surgery : Indian Experience and Update on Telemedicine Activities in India, S K Mishra

• Outcome of case study (project completed) on Field Telemedicine Application in Indian Setting, S K Mishra

• Tsunami, Indian Ocean, Dec 26, 2004: Impact on Indian sub-continent and telemedicine interventions

103


• Current Telemedicine Infrastructure, Network, Applications in India, S K Mishra

• e-Health: India Country Report, S K Mishra

• Capacity Building in e-Health in a Developing Country –Indian Initiatives, A K Mahapatra, Lily Kapoor, IndraPratap Singh, Repu Daman Chand, S K Mishra

Q142-/2 ITU-D Rapporteurs Meeting17-18, June 2007Okinawa, Japan

Q-14-2/2 Rapporteurs Grp Meeting3rd-4th July, 2008

Tokyo, Japan

104


Participation of India in ITU-D ActivitiesSnap shots

105


Thank you

www.nrct.in | www.telemedindia.org | www.stbmi.ac.in | www.sgpgi-telemedicine.org

School of Telemedicine & Biomedical Informatics

National Resource Center

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