The uses of Telemedicine are

limited

Only by our IMAGINATION

Healthcare in Rural India

2

70 % of India’s population live in rural areas

Lack of investment in health care in rural areas

90% of secondary & tertiary care facility are in cities and towns

Low penetration of healthcare services

Inadequate medical facilities in rural areas

Problem of retaining doctors in rural areas specially the specialist doctors

Rural & remote areas continue to suffer from absence of quality healthcare services

Public Health Care Delivery Model

Primary Care

Secondary care

Tertiary Care

Teaching Hospitals

23,236 PHC1,46,026 Sub centers

3,346 CHC4,400 Dist. Hospitals1200 Other Public Hospitals

242 Medical colleges205 Dental colleges

Source : K. Park, 19th Ed.

Relevance of Telemedicine Inadequate infrastructure in rural hospitals Inadequate infrastructure in rural hospitals

Large number of patients require referral for specialty Large number of patients require referral for specialty carecare

Low-availability of Health Experts in remote hospitalsLow-availability of Health Experts in remote hospitals

Dearth of adequate opportunities for training & CME for Dearth of adequate opportunities for training & CME for Healthcare professionals in Rural/Remote Health Healthcare professionals in Rural/Remote Health facilitiesfacilities

A significant proportion of patients in remote locations could be successfully managed with some advice and guidance from specialists and super-specialists in the cities and towns

Telemedicine has the potential to assist in electronic delivery of diagnostic and healthcare services to remote rural population thus can create a platform to network India

Telemedicine: Ideal for India

• Area : 32,87,268 Sq. Km.

• Population : over 1 Billion

• Urban Rural Divide• Inaccessible hilly

regions, islands, desert, coasts, tribal areas

• Strong Fiber Backbone

• Indigenous satellite Communication technology in place

• IT trained Human resource

• Pilot Projects with Successful outcomes

Evolution of the concept of NRTN

National Task Force on Telemedicine Constituted in September 2005 Members incorporated from following departments

– Health, Communication & Information Technology

– Indian Space Research Organization

– Indian Council of Medical Research

– Medical Council of India

– Center for Development of Advanced Computing

– Academic medical institutions and corporate hospitals

Terms of References To work on inter-operability, standards for data

transmission, software, hardware, training etc

To define a national telemedicine grid & consider its standards and operational aspects

To identify all players and projects currently involved in telemedicine in India and evaluate their performance and capacity

To prepare pilot projects for connection of health care facilities especially keeping in mind to provide access to remote areas

DIT Initiatives

DIT has taken following leads in Telemedicine: Development of Technology

Initiation of pilot schemes – Selected Specialty e.g. Oncology, Tropical Diseases– General telemedicine system covering all specialties

Standardization Framework for building IT Infrastructure in

health

Telemedicine Standardization

Needo Large number of Telemedicine networks being

installedo Lack of uniform, multipurpose telemedicine

standards hamper effective use of telemedicine

Adherence/adoption to standards ensureso Telemedicine Systems are interoperableo Compatibility with new version of technologyo Scalability of systems without total replacement

while expanding capability

The working group on Telemedicine standardization submitted the “Recommended Guidelines & Standards

for Practice of telemedicine in India”

Draft Proposal NRTN Objectives

To provide access to timely and quality specialty medical care to the people living in rural & remote areas.

To reduce rural urban divide in delivery of medical care To improve diagnosis and treatment facilities in rural

areas To mitigate the obstacles due to geographical isolation To provide continuous medical education and training to

the healthcare professionals working in rural/remote areas

Draft Proposal : NRTN Scope Expected Benefits Guidelines/framework Standardization Processes Hardware / Software requirements Organizational Plan Project Implementation Strategy Financial requirements Manpower requirement Monitoring / Evaluation

Hierarchical Structure of NRTN

LEVEL-1: Primary Health Center (PHC) / Community Health Center (CHC) connected to a District Hospital

LEVEL-1: Primary Health Center (PHC) / Community Health Center (CHC) connected to a District Hospital

LEVEL-3: State Hospital / National Super Specialty Hospital connected to each other

LEVEL-3: State Hospital / National Super Specialty Hospital connected to each other

LEVEL-2: District Hospital connected to a State Hospital / National Super Specialty Hospital

LEVEL-2: District Hospital connected to a State Hospital / National Super Specialty Hospital

DistrictHospital

StateMedical College

CHC

PHC

Super Specialty Hospital

MOBILE

Lev

el 1

/ M

Lev

el 2

Lev

el 3

LEVEL-1: PHC / CHC

Tele-consultation roomPatient engagement facilities (bed, scopes,

etc.)Telemedicine Platform

Selective medical and medico-IT equipments, preferably IT compatible, with interface to Telemedicine and/or other software / hardware

Computer hardware / software platform (PC, switch, etc.) and IT electronics equipments

Connectivity / bandwidth requirements (e.g. ISDN, Leased line, VSAT, Broadband, Wireless)

Point-to-Point video-conferencing system

LEVEL-1:Software &Hardware

Digital ECG4

Desktop PC platform with Laser Printer1

2IP Video Conferencing Kit

3

A3 Film Scanner5

6 Digital Microscope & Camera

7

Tele medicine software

8

Glucometer & Haemogram analyzer

Non-invasive Pulse & Blood Pressure unit

Connectivity device & Router9

Draft Proposal

During the first Phase100 Level 150 Level 25 Level 350 level M

The Draft proposal has been circulated to states and funds released to create /

expand the existing initiatives

Utility of NRTN

Benefits for Health Care

Delivery System

Benefits to patients

Benefits to HealthCare Professionals

Benefits to Patients

Access to specialized health care services Access to specialized health care services to under-served rural, semi-urban and to under-served rural, semi-urban and remote areasremote areas

Access to expertise of Medical Specialists Access to expertise of Medical Specialists without physical referralwithout physical referral

Reduced physician’s fees and cost of medicine

Reduced visits to specialty hospitalsReduced visits to specialty hospitals

Reduced travel expenses

Early detection of disease

Reduced burden of morbidity

Click to add Title1 Improved diagnosis and better treatment Improved diagnosis and better treatment management management

1

Click to add Title22

Click to add Title1 Quick and timely follow-up of patients Quick and timely follow-up of patients discharged after palliative care discharged after palliative care

3

Click to add Title2 Access to computerized comprehensive Access to computerized comprehensive data of patients, both offline & real data of patients, both offline & real timetime

4

1

Benefits to Healthcare Professionals:

Continuing education and trainingContinuing education and training

Benefits for Healthcare Delivery System

Significant reduction in unnecessary visits & Significant reduction in unnecessary visits & hospitalization for specialized care at tertiary hospitalization for specialized care at tertiary hospitalshospitals

Earlier discharge of patients leading to shorter Earlier discharge of patients leading to shorter length of stay in hospitalslength of stay in hospitals

Increase in the scope of services without creating Increase in the scope of services without creating physical infrastructure in remote hospitalsphysical infrastructure in remote hospitals

Improve monitoring facilities at the rural based centres

Increases stuff productivity

TrainingTraining

Conclusion India is ideal setting for IT assisted healthcare

It is feasible to set up a National Health Grid to be shared by healthcare providers, trainers & beneficiaries taking the advantage of a strong fiber backbone and indigenous satellite communication technology with large trained manpower in this sector

The ground work on telemedicine has also been established by ISRO, DIT, State Governments and specialty Institutes/ Hospitals

National Rural Telemedicine network will help to provide quality healthcare where there is none and will improve healthcare where there is some