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