Telemedicine : A low cost solution

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Telemedicine A low cost solution
Anunay Nayak Jayanta Mukherjee Arun Kumar
Majumdar Department of Computer Science and
Engineering IIT Kharagpur
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A brief sketch of our journey

• May 1997 Invitation for a proposal by MCIT
  (then DOE) on Telemedicine over ordinary
  telephone lines.
• March 1998 Submission of a Draft proposal in
  collaboration with School of Tropical Medicine
  and WECS (WEBEL).
• Jan 1999 Starting of Project Work.
• Aug 2000 A Prototype system developed
  (TelemediK Software Version 1.0)
• Nov 2000 Installed in STM for in house training
  and demonstration.
• Feb 2001 First beta test between STM Kolkata
  and IIT Kharagpur.
• Feb 2002 Inauguration of Telemedicine between
  School of Tropical Medicine, Kolkata and Habra
  State General Hospital.
• April 2002 Inauguration of the second nodal
  center at Cooch Bihar.
• May 2002 Project involving connections of six
  hospitals of Government of West Bengal is taken
  by WEBEL (IIT Kharagpur being the consultant).
• Nov 2002 TelemediK version 3.0 with a better
  front end and flexibilities in users operations.

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Schematic Diagram for Proposed Telemedicine using
WBSWAN
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Field trials and demonstrations

• Between West Bank Hospital, Mourigram and B.C.Roy
  Hospital, IIT Kharagpur
• Between IIT Extn. Center Bhubaneswar and IIT
  Kharagpur
• CMC Vellore.
• Chittaranjan Cancer Research Center, Kolkata.
• National Institute of Cholera and Enteric
  Diseases, Kolkata.
• ELITEX 2001 and ELITEX 2002, New Delhi.
• -Sikkim Manipal Institute of Medical
  Sciences, Sikkim
• -Mahatma Gandhi Institute of Medical
  Sciences, Sevagram, Wardha

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What is Telemedicine

• Telemedicine may be defined as the use of
  computers and telecommunication technologies to
  provide medical information and services from
  distant locations

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Different types of services

• Telecardiology
• Teleradiology
• Telepathology
• Telepsychiatry
• Early Warning System
• Prevention and control of endemic and
  infectious diseases

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Telemedicine in India

• Existing system limited only to private hospital
• APPOLO Group of Hospitals.
• RN Tagore Cardiac Hospital, Calcutta. (Asia
  Heart Foundation)
• No Telemedicine system for public health care
• Corporate Sectors Offering Telemedicine Systems
• APPOLO Group
• Online Telemedicine System, Ahmedabad.
• WIPRO GE
• SIEMENS

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Government Efforts

• MCIT
• IIT Kharagpur
• CDAC
• ISRO

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Why it is relevant to our society

• Poor infrastructure
• Non-availability of experts (disparate
  distribution)
• Low doctor-patient ratio (large population)
• Lack of proper medical education

Special attention required for Public Health Care
System
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Major Challenges

• Poor Data Communication Infrastructure.
• A Large Population Catered by Government
  Hospitals.
• System Features should be scalable.
• Cost of the system should be scalable.

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Aim of the Telemedik System

• Information management
• Patient information
• Medical data (signs, symptoms, test reports,
  etc..)
• Appointment scheduling
• Archival and retrieval of patient records
• Low cost solution
• Using ordinary telephone line
• Service to large population
• Through public health care delivery systems
• Development of knowledge-based system
• For decision support
• For training and education

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Key Principles

• Avoid Adhocism Preorganisation of Patient Data
• Minimize online data transfer
• Patient Management with Database support

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Technical issues over Low Bandwidth
Problem Solution

• Longer time for data transfer
• Poor video quality

• Store and forward policy
• Transferring sequence of still images

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Requirement Specification
Nodal Hospital

• A patient getting treated
• A Doctor
• A remote telemedicine console having audio
  visual
• and data conferencing facilities

POTS / ISDN
Referral Hospital

• An expert/ specialized doctor
• A central telemedicine server having
• audio visual and data conferencing facility

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Sequence of Operation
PATIENT IN
Patient visits OPD Local Doctor checks up
Patient receives local treatment and not referred
to telemedicine system
OUT
Patient referred to the Telemedicine system (some
special investigations may be suggested)
Day One
Patient visits Telemedicine data-entry
console. Operator entries patient record, data
and images of test results, appointment date is
fixed for online telemedicine session
OUT
Offline Data transfer from Nodal Centre
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Sequence of Operation
Patient 1 Patient 2 Patient 3 Patient 4 . . .
Online conference for the patient. Patient,
local doctors at the nodal hospital and
specialist doctors at the referral hospital
OUT
Day Two
IN
Patient queue
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Hardware Configuration
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Software Modules
Offline Activities
Online Activities
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Offline Module
NODAL CENTRE
REFERRAL CENTRE
User Interface
Data Acquisition
Patient data Browser
Data Distributor
Local DB
Temp Files
Master Database
Temp Files
Data Distributor
Data Decryption
Data Encryption
D A T A
Data Receiver
Data Sender
Acknowledgement
Data Flow Diagram For Off line Communication
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Online Module
NODAL CENTRE
REFERRAL CENTRE
Data Acquisition
Online Session Coordinator and communicator
Secure Communication Channel
Local DB
Master DB
Online Session Coordinator and communicator
Video Conferencing
Video Conferencing
Data Flow Diagram For Online Communication
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The Data

• Data related to a patients personal information
• Data related to a patients medical information
• Data for patient management in Telemedicine
• Data related to the doctors
• Data for system management

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Employment Generation

• Extension of existing services.
• Personals involved.

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Personnel Involved
Referral end A group of specialist doctors System
Administrator Studio technician
Nodal end A group of general physicians System
administrator Data entry operator Studio
technician Patients
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Other Issues

• Incorporation of Standard.
• Health Level Seven (HL7)
• Digital Imaging Communication in Medicine
  (DICOM)
• Data Security.
• Legal Ethical Issue

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Patients personal information

• Patient ID
• Name
• Age
• Sex

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Patients medical information

• Textual
• Plain Text
• Structured Document
• Image
• Graphics
• Video
• Vector

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Plain Text
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Structured Document
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Images
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Vector Data
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Graphics
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Video Clip
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Data for patient management in Telemedicine
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Data related to the doctors

• Doctors personal information
• Unique Identification key

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Data for system management

• Users list
• Password file
• Log files

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Digital Imaging Communications in Medicine
(DICOM )

• originally the ACR-NEMA
• developed by American College of Radiology (ACR)
  and the National Electrical Manufacturer's
  Association (NEMA)
• provides standardised formats for image capture
  and storage coupled with a common information
  model specifying service definitions and
  protocols for communication

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HEALTH LEVEL SEVEN

• HL7 Health Level Seven
• standards for the exchange, management and
  integration of data
• that support clinical patient care, and the
  management and delivery of healthcare services
• defines the protocol for exchanging clinical data
  between diverse healthcare information systems
• Australia, Canada, Finland, Germany, India, The
  Netherlands, New Zealand, South Africa and the
  United Kingdom

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Teleradiology over WBSWAN
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Telemedicine for Tropical Diseases
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Thank You