Telemedicine Concept to Implementation UN OOSA Expert Meeting Kochi,August 29, 2006 L.S. Satyamurthy Programme Coordinator, Telemedicine ISRO Director - Antrix Corporation Bangalore, India 1
WHO s definition of health (1946) a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity. Where in : Physical Health is directly dependent upon the facilities and the facilitators available within the reach of the needy.. Health : An imperative need for human resource development 2
Alma Ata Declaration (1978) To achieve the goal of health for all, global health agencies pledged to work toward meeting people s basic health needs through a comprehensive approach called Primary Healthcare. 3
HEALTH DIVIDE Between Urban and Rural areas Typical Indian Scenario Year Health Doctor / Hospital Infant 90-98 expenditure 1000 beds / 1000 mortality / % GDP 1000 India 0.8 0.45 0.8 71 World 2.6 1.5 3.3 54 Developed 6.1 2.8 7.2 6 Countries Medical consultants Urban : 75% Semi urban : 23% Rural : 2% Hospital beds / 1000 Rural : 0.19% Urban : 2.20% Health : An imperative need for human resource development 4
Telemedicine & e-health WHO defines TM as The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities Medical Science Communication Technology TELEMEDICINE Information Technology Biomedical Engineering E-HEALTH: IS THE USE IN THE HEALTH SECTOR, OF DIGITAL DATA-TRANSMITTED, STORED AND RETRIEVED ELECTRONICALLY-IN SUPPORT OF HEALTHCARE, BOTH AT THE LOCALSITE AND AT A DISTANCE.
Telemedicine Telemedicine generally has two important functions: Transfer of Patients medical data instead of patient from one location to another -Video Conferencing between patient end and Expert Doctors for consultation, treatment and follow up. 6
Benefits of Telemedicine Improved access to patients Reduced cost for patients Reduced Isolation for doctors Improved quality of care 7
Types of Telemedicine Based on the Consultation: Real time Consultation or Store & Forward Based on Medium of Communication : SATcom based Terrestrial lines based ISDN or Wireless based Combination 8
Advantages of Satellite Communication Easy reach, quick installation Not affected by environment Flexible network Bandwidth can be shared by number of users High-quality network Extensive and Consistent geographic coverage Efficient support to broadcast and multipoint communications for medical education and consultation sessions Network capacity flexibility, reliability and security 9
Telemedicine in India 10
INDIA THE LAND OF DIVERSITY Population of 1.1 + billion, 28 States & 5 union territories Vast Population (80%) spread in inaccessible & remote areas (border areas) & remote islands in around 627,000 villages 80% of super-specialty live in big cities 11
TM in India Agencies like ISRO, Dept of IT, Railways, Few State governments, Private network by Apollo, AHF, AIMS, ESCORTS etc and are also part of this movement in their own capacity Efforts by ISRO: Space based Rural Development Programmes like TDCC and JDCP since 1990s Major thrust for TM as a special programme since 2001 Spearheading the Telemedicine Movement in India with the largest network and contineous improvement 12
SPACE FOR THE SOCIETY. SECOND TO NONE IN THE APPLICATION OF ADVANCED TECHNOLOGIES TO THE REAL PROBLEMS OF MAN AND SOCIETY As part of Space Technology utilization, ISRO has taken the initiative to provide SATCOM based Telemedicine facility as a societal cause THUMBA FIRST ROCKET LAUNCH ON 21st NOVEMBER 1963 13
Telemedicine in India JDCP Programme of ISRO INSAT INTEGRATED SYSTEM VOICE VIDEO DATA TALK-BACK 2-WAY VIDEO DAMA TV AUDIO TV AUDIO TV MI C TV TALKBACK TERMINAL TALKBACK CLASS ROOM (12) TEACHING END CLASS ROOM )(TV RECEIVE ONLY) 14
ISRO s Telemedicine Program - Thrust Areas Providing Technology and Connectivity Remote/rural hospitals and specialty hospital Continuing Medical education (CME) Mobile telemedicine units Disaster Management Support (DMS) Integrating with village resource centres/information kiosks 15
Satcom Based Telemedicine Connectivity 16
Modes of Tele-Health Services : Teleconsultation Diagnosis and treatment CME- for Doctors and Para-medics Mobile Tele-health to reach doorsteps of rural population Telemedicine for Primary Health care Telemedicine in Disaster Management Support Real Time Store and Forward TM APPLICATIONS Cardiology Radiology Pathology Ophthalmology Oncology 17
Approach followed by ISRO Proof of Concept - Technology Demonstration thru Pilot Projects Adopting new Technologies and Techniques Integrating Government, Industry, Medical Community and Health Administration Supportive Initiatives by Insurance Agencies Journey from Technology model through Operational model towards Revenue model Limited and Centralized Health Care Delivery Infrastructure Distributed and Virtual Health Care delivery Infrastructure 18
Telemedicine Technology Evolution in India : Point to point Point to multipoint Multipoint to multipoint Hub & Spokes (CUG) Patient end 19
Point to point System Patient end 12 Lead ECG Doctor end Digital Camera A3 Scanner OR Video Conferencing Camera SkyIp Terminal Switch Video Conferencing Camera SkyIp or FlexiDama Terminal Hub/Switch TV Monitor TV Monitor Doctor-End Station District Client Station
Point-to-Multipoint System Configuration Super Specialty Hospital Rural/District Hospital Server Patient-End Doctor-End Doctor-End Doctor-End
Multipoint-to-Multipoint System Configuration Super Speciality Hospitals Rural/District Hospitals Patient-End Server Patient-End Doctor-End Doctor-End Doctor-End Patient-End
Continuing Medical Education (CME) Configuration TV Monitor LCD Projector Mixer/Switcher Antenna & ODU Video Camera DVB-RCS In-Door Unit Microphone Hub/Switch Document Camera Server(s) Scanner Work Station (s)
MOBILE TELEMEDICINE To overcome the prohibitive costs of large number of terminals and reaching out to the rural areas Tele-Ophthalmic Van Shankara Nethralaya Tele-Ophthalmic Van Aravind Eye Hospital 24
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Communication Link ISRO 26
Telemedicine STANDARDS in India Guidelines and Standards for Telemedicine System Network / Connectivity Interoperation of Telemedicine Systems Standards for Security & Process guidelines Efforts to standardize healthcare data interchange using DICOM - Digital Imaging and Communication in Medicine HL7 - Health Level Seven and ITU standards for Video conferencing 27
EFFORTS TOWARDS COST REDUCTION Serious efforts to bring down the total system cost to bring to affordable levels through : Optimization : Software and Hardware Network Topology : Star network, DVB-S Larger Quantity factor Multiple vendor development 28
ISRO TELEMEDICINE PROGRAMME - Concept to Realisation Pilot project in 2001, connecting : Aragonda Apollo, Chennai & Chamaraj Nagar Narayana Hrudayalaya ISRO TELEMEDICINE Network 2005/06 2001 2001 55 nodes nodes 33 Remote Remote 22 -- Speciality 2002 2002 27 27 nodes nodes 17 17 Remote Remote 10 10 --Speciality 2003 2003 58 58 nodes nodes 36 36 Remote Remote 22 22 --Speciality 2004 2004 100 100 nodes nodes 78 78 Remote Remote 22 22 --Speciality 176+ 176+ nodes nodes 142 142 --Remote Remote 34 34 --Speciality 29
Minimising Costs SYSTEM COST ( PATIENT END per Node) 2002 2002 18 18 Lakhs Lakhs VSAT- VSAT-10 10 L L TM TM system- system-8 8 LL (( S/W S/W :: 33 L) L) 2003 2003 14 14 Lakhs Lakhs VSAT- VSAT-8 8 L L TM TM system- system-6 6 LL (( S/W S/W :: 1.6 1.6 L) L) 33% 2004 2004 8.2 8.2 Lakhs Lakhs 2005/06 44 Lakhs Lakhs VSAT- VSAT-5 5 L L VSAT- VSAT-1.2 1.2 L L TM TM system system --3.2 3.2 LL TM TM system system 2.8 2.8 LL (( S/W S/W :: 00.65.65 L) L) (( S/W S/W :: 0.25 0.25 L) L) 40% 40% 40% 40% 30
AMBULANCE ISRO TELEMEDICINE NETWORK - ESTABLISHED SO FAR 176 Hospitals 142 Remote/Dist/MC/Mobile Hospitals + 34 Super Specialty Hospitals AIIMS New Delhi SKIMS, Srinagar SGPGMI, Lucknow R& R, New Delhi RCC, Trivandrum MC, Trivandrum AHF, Kolkata Apollo, New Delhi AIMS, Kochi SGPGMI, Lucknow JIPMER Pondichery SUPER SPECILITY HOSPITALS 34 CMC, Vellore SRMC, Chennai PGMIR Chandigarh SN, Chennai Apollo Chennai TMC, Mumbai NH, Bangalore SN -Mobile Aravind Hospital, Madurai SCTIMST, Trivandrum 31
ISRO TELEMEDICINE NETWORK - ESTABLISHED SO FAR AMBULANCE 176 Hospitals 142 Remote/Dist/MC/Mobile Hospitals + 34 Super Specialty Hospitals Kerala 17 nodes Karnataka 18 nodes ONCONET 5 nodes J & K 9 nodes KERALA CANCERNET 6 nodes NAVY 1 nodes Punjab 4 nodes Andaman Nicobar 2 +2 nodes J & K Army 6 nodes DISTRICT/RURAL HOSPITALS - 142 Orissa 4 nodes AP Mobile Nodes-4 Tamil Nadu 6 nodes 2 nodes West Bengal 4 nodes Air Force 2 nodes Chhattisgarh 14 Nodes UP 2 nodes Pondichery 5 nodes Jharkhand 2 nodes Lakshdweep 5 nodes North East 10 nodes 32
IMPACT and UTILIZATION STUDY User survey has found that: Telemedicine is being increasingly adopted by both the doctors and the patients. Potential to improve the quality of healthcare at remote places Providing timely healthcare delivery at lower costs Initiated Web based feedback system for reporting utilization and problems from each node EVALUATION OF IMPACT Total OPD : 945 Total in-patients : 187 Total thrombolised:37 COST SAVINGS > 81% Patients have spent only ~ 19% of the amount, which they would have otherwise spent 33
Setting up a TM Centre: Project goals and objectives meet Pre-implementation phase Implementation phase Post-implementation phase 34
Pre-implementation phase Prepare roadmap Client appraised of his duties Appraised of TM service provider's(tsp) duties Readiness of site monitored Site certified fit for implementation Inform TSP to deliver the equipment
Implementation phase Delivery of equipment to the client s site Involve Client's staff for On-Job-Training(OJT) Assemble the equipment should be component-bycomponent Test software & Hardware Test with data drawn live from medical equipment Finally a combination of live VC with high resolution data capture and transfer should be tested. Hands on by client staff Declare Go-Live 36
Post implementation Collect the Sign Off, handing over certificates, doctor remarks/comments, payments Have a Hand Holding period Support staff smoothly take over from TSP Make an operational plan Run 37
Suggested Room Configuration 38
Operations & Maintenance: Have a prior understanding with the Specilaity Hospitals Plan the consultations Inform the Patients, local doctors and the specialist for smooth conduct of consultations Vendors will provide standard warranty for 1 / 2 years Plan for Annul Maintenance beyond warranty 39
Telemedicine into Mainstream of Healthcare delivery Once the pilot projects are successful and useful, plan for a national level deployment & making a part of Mainstream Healthcare delivery India is in such a phase with about 200 nodes operational and NTF formed by Ministry of Health 40
National Task Force - constituted by the union Min. of Health To work on inter-operability To Define a National TM Grid and consider its standards and operational aspects To identify & Evaluate all players and projects currently involved in TM in India To prepare National Cancer TM Network To define standards & structures of EMR and patient data base To draft a National Policy on TM and CME to prepare a Central Scheme for the 11 th FYP To make TM to enter the mainstream of Healthcare delivery 41
National Telemedicine Grid 42
National & Regional Cancer centres E-Health Web Portal Selected District Hospitals National Telemedicine Grid National medical Training Identified Speciality hospitals Premier Medical Institutions 43
E-Health Web portal of National Telemedicine Group Disease surveillance Digital Library & Medical Informatics Association/society /health portals Health informatics Disease surveillance National Disease Surveillance Educational Information 44
Awareness Programme & International Cooperation INTELEMEDINDIA 2005 attended by various Intl specialists Joint working group with Canadian Space Agency ISRO CNES interaction on Technology Asia Pacific Telemedicine Collaboration under ITU Interaction with WHO, ISfT and other agencies UN OOSA Workshop in China Training Programme for Afghanistan 45
IMPORTANT PARAMETERS GOVERNING TM IMPLEMENTATION Sustainability aspects Barriers Current status and future outlook Collaboration with foreign countries 46
Indian Telemedicine Roadmap To bring Telemedicine into the Mainstream of Healthcare Delivery in INDIA Programme conceptualization Proof of Concept - Technology Demonstration (Pilot projects) Extension of Pilot Project to more states DH, PHC, CHC Support towards operationalisation Extension of Telemedicine- Teleepidemiology. Sustainable Business & Revenue model Integration with Village Resource Centre Interaction with State governments and Health service Providers Technology Upgradation & Standardisation Awareness workshops/ National seminars Integration of Telemedicine & Disaster management State / National Networks : T M CME Oncology etc. National Task force by Dept of Health towards formulation of national policy September, 2005 47
Health Sat THANK YOU for your Attention 48