Prof' A' K' Majumdar

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RD Activities in Telemedicine at IIT Kharagpur

• Prof. A. K. Majumdar

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What is Telemedicine

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

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Related Technologies

• Medical Instrumentation
• Sensing Bio-medical Signals,
• Medical Imaging, Measurement of Physical
• Parameters e.g. Body Temperature, Pressure etc.
• Telecommunication Technology
• Trans-receiver on different communication
• channels and network such as, on wired network,
• wireless medium etc.
• Information Technology
• Information representation, storage,
• retrieval, processing, and presentation.

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Telemedicine Involves

• Patient Identification
• Patient Medical Record (PMR)
• Data Acquisition
• Storage And Retrieval
• Communication
• It is an Integrated Patient Management System
  and not just Video Conferencing

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Telemedicine in India

• Ministry of Communication Information
  Technology Govt. of India initiated pilot
  projects on Telemedicine-
• At AIIMS (New Delhi), SGPI (Lucknow), PGIMER
  (Chandigar), with CDAC system.
• At districts / subdivisional hospitals in West
  Bengal and Tripura with TelemediK System
  developed by IIT Kharagpur.
• Cancer net at Kerala, etc.
• Corporate Sectors Offering Telemedicine Systems
• APPOLO Group
• Online Telemedicine System, Ahmedabad.
• WIPRO GE
• SIEMENS

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TelemediK

• A software developed at the Department of
  Computer Science and Engineering, IIT Kharagpur
  to provide  low-cost Telemedicine services.
• Sponsored by Ministry of Communication and
  Information Technology (MCIT), Govt. of India.
• Implementation agency WECS Kolkata for deployment
  in Govt. Hospitals in West Bengal and Tripura.

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Background

• TelemediK has been operational in West Bengal
  since 2002.
• Currently installed in 20 hospitals in West
  Bengal and Tripura.
• Specialties covered Tropical diseases,
  Cardiology, Radiology, Oncology, Hematology,
  Dermatology and General medicine.
• Current version Telemedik 2005.

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Remote consultation using TelemediK 2005

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

Local Hospital
POTS / ISDN / LAN / WAN

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

Remote Hospital
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TelemediK Features

• The system operates with communication channel of
  varying bandwidths such as
• Plain Old Telephone System (POTS)
• ISDN
• VSAT
• High bandwidth leased lines
• It records patient information in various forms
  such as
• Text/Hypertext (HTML)
• Image (JPEG, BMP, DICOM)
• Graphics
• Audio (mp3, avi)
• Video (mpeg, avi)

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Features introduced in TelemediK 2005

• Peer to peer applications.
• Bandwidth scalability.
• Data and video conferencing.
• Back-end RDBMS support.
• Internet browser based GUI.
• Patient information system for various diseases.
• Interfaces with medical equipments.

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Additional Features

• Symmetric
• No distinction between nodal and referral centers
• Any hospital can communicate to other hospitals
• 2nd level referral is allowed
• Statistics Generation
• Additional category of diseases
• Gynecology
• Pediatrics
• Oncology
• Emergency
• Enhancement of data security

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Symmetric tele-consultation
Local Hospital

• Both hospitals can register patient
• Can ask for other hospitals tele-
• consultation help
• Both can provide tele-consultation
• service to other hospital on their
• expertise field

POTS / ISDN
Remote Hospital
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Fixed nodal multiple referral model (one-to-many)
Remote Hospitals
Attending local doctor
Local Hospital
Patient
Data of a patient can be sent to multiple
hospitals
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Second level patient referral model(Hospital-to-h
ospital)
Attending local doctor
First Referral
Second Referral
Local Hospital
Patient
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TelemediK statistics and reporting tools

• This system generates
• Hospital total data flow, usage report.
• Frequency distribution over age, disease,
  diagnosis reports.
• Graphical representa-tion of all query results.
• Decision supports system for hospital management.
• Auto time count for telemedicine attending
  doctors.

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Software Components

• Operating System
• Microsoft Windows 2003 Server / 2000 Server /
  2000 Professional / XP.
• Database
• MS SQL Server 2000 or MS SQL Server 7.0.
• Others
• IIS Server.

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Additional Projects
TelemediX A Linux-based Telemedicine System
PDA Based User Interface
Web-based Telemedicine Project
Health Level 7 (HL7)
RD Effort in Medical Instrumentation
Continuing Medical Education Using TelemediK
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TelemediX
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TelemediX

• Open-source Telemedicine System
• Built using JSP and JavaScript in Linux
  environment
• Functionally equivalent to TelemediK 2005
• Client Access via standard Java enabled browser
  from both Windows and Linux
• Supports Whiteboard discussion involving text and
  images
• Cost effective compared to TelemediK 2005

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System Architecture
Client 1
Server Local
IE
ltltdatabasegtgt mySql
ClientLocal
Web Browser
Multiple clients connected to server
Client n
IE
Server Remote
Client 1
ltltdatabasegtgt mySql
Client (n) Remote
IE
Multiple clients connected to server
Web Browser
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TelemediX
Sequence of Operation
Software Modules
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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 Local Centre
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Sequence of Operation
Patient 1 Patient 2 Patient 3 Patient 4 . . .
Online conference for the patient. Patient,
doctors at the local hospital and specialist
doctors at the Remote hospital
OUT
Day Two
IN
Patient queue
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Software Modules
Offline Activities
Online Activities
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Offline Module
Local Mode
Remote Mode
User Interface
Data Acquisition
Patient data Browser
Data Distributor
Local DB
Temp Files
Data Conversion
Master Database
Temp Files
Data Distributor
D A T A
Data Sender
Data Receiver
Acknowledgement
Data Flow Diagram For Off line Communication
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Online Module
Local Mode
Remote Mode
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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Online Communicator
Zoom Image
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Requirements

• At Server
• RISC / CISC (Intel Xeon, Pentium) / APIC
  (Itanium) Processor based server
• 2 GB DDR RAM
• HDD 2160 GB
• Operating System Linux
• Applications
• Jakarta Tomcat Web Server
• MySQL Database
• Java version 1.5

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Continued

• At Client
• Any desktop computer
• 512 MB RAM
• High resolution graphics monitor
• USB support for interfacing with devices
• Operating System Linux / Windows
• Applications
• Java Runtime Environment 1.5
• Java enabled web browser e.g. Internet Explorer,
  Mozilla Firefox etc.

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Web Based Telemedicine System
Internet
Global Connectivity
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Objective

• Security
• Flexibility
• Robustness
• Interoperability
• Universal Accessibility

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Architecture

• Following a Multi-tier Application Architecture
• Web Proxy Layer
• Firewall
• Application Server
• Presentation Layer
• Business Logic Layer
• Database Layer
• Client ? Standard web browser

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Request Processing
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Features

• Completely Browser-based
• One time installation at server
• Service-oriented Approach
• Greater Flexibility and Scalability
• Complies with the Electronic Patient Record (EPR)
  standards draft proposed by National Task Force
  for Telemedicine Standards of the Ministry of
  Information Technology, Government of India.

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Continued

• Security
• Follows Technical Guidelines of HIPAA Security
  Standards
• Additional Measures to Handle Application
  Security and Component Security

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Requirements

• Windows 2003 Server
• Microsoft .NET 2.0
• Microsoft SQL Server 2000
• Java Runtime Environment 1.5
• IIS 6.0 or higher
• Firewall

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In Progress

• Currently Under Development
• Kiosk module for greater accessibility
• Integration of multiple hospitals in a single
  web-based system

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Continuing Medical Education

• Online Workshop in March 2005 between
• N.R.S Medical College Hospital, Kolkata
• School of Tropical Medicine (STM), Kolkata
• MJN Hospital, Coochbehar
• Baharampur District Hospital, Baharampur
• Workshop on Telemedicine in Tripura conducted in
  June 2005

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Video Conference
Doctor
Patient
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Continuing Medical Education

• Ongoing Course in Pediatric HIV between Johns
  Hopkins University and School of Medical Science
  and Technology, IIT Kharagpur
• Inauguration by Honourable President of India,
  Dr. A. P. J. Abdul Kalam.

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Potential Usage of TelemediK for CME

• Content Development
• Support from medical professionals needed
• Course Materials may be posted at TelemediK
  Website
• Using Telemedicine software with
  Videoconferencing
• Virtual Classroom
• Static Content Hosted at Server
• Interactive Classroom

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Requirements

• Additional Requirements
• Streaming media server
• VC Equipment for Interactive Classroom
• Higher Bandwidth

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Use of Handheld Devices in Telemedicine
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PDA Based System

• Why separate module ?
• Screen resolution
• Less momory
• A web server, namely, Wireless Media Information
  Access Server (WMIAS) has been developed to serve
  http requests from PDAs

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• Medical records can be browsed efficiently using
  handheld devices like PDAs.
• Medical staff can be alerted during emergencies
  through PDAs or cell phones while outside the
  ward.

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Display of different medical records in PDA
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HL7 Module for Telemedik

• HL7 (Health Level 7) is one of the most popular
  medical standards, which maps between native
  format and the universe of medical information.
• Essential for interoperability between different
  e-Healthcare systems.

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How HL7 Works in TelemediK
Hospital A
Hospital B

• We are using HL7 version 2.4 as message standard
• Migrating to HL7 version 3.0

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Medical Instrumentation

• R D Effort Under Progress
• Data acquisition, analysis and display of
• Plethysmograph
• Pulse Oximeter
• Phonocardiogram
• Acquisition, transmission and display of ECG data
  over wireless media

Lead II ECG signal
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Prototype probes for Plethysmogrphy and Pulse
oximeter
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Summary
Telemedik 2005

• Telemedicine Services

• Access Over Handheld Devices

• Health Level 7 (HL7) Compatibility

• Continuing Medical Education

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Thank You