Telemedicine: Experience

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Telemedicine Experience in West Bengal
Tripura
Prof. Jayanta Mukhopadhyay Dept. of Computer
Science Engineering. IIT Kharagpur.
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A contradiction ? (2004)

• A rural hospital in Hingelgange, North 24
  Parganas, West Bengal, is almost without any
  doctor since its inception (1997).
• IMA opposes introduction of new medical colleges
  in West Bengal.

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Qualified Consulting Doctors.
Total No. of Doctors 5 lakhs.
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Population Distribution
Total Population 1 billion.
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Disproportionate Distribution of Medical
Professional.

• No. of doctors per town 75
• No. of villages per doctors 5
• Avg. No. of people served per doctor (in Urban
  area) 750
• Avg. No. of people served per doctor (in Rural
  area) 5750

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Health Professional Statistics
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Health Infrastructure in West Bengal.
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Which gets priorities in planning?

• Lack of infrastructure.
• Non-utilization of infrastructure.
• Wastage of resources.

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Telemedicine

• Telemedicine is the remote communication of
  information to facilitate the clinical care.

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Relevance under Indian Context

• 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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Technologies Involved
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Applications in different forms
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Benefits of Telemedicine

• Improved Access
• Covers previously unserved or underserved
  areas.
• Improved quality of care
• Enhanced decision making through
  collaborative efforts.
• Reduced isolation of healthcare professionals
• Peer and professional contacts for patient
  consultations and
• continuing education.
• Reduced costs
• Decreased necessity for travel and optimum
  uses of resources.

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What travels to a village?

• Technology.
• Human Expertise.
• Training education.

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Telemedicine in India

• Ministry of Communication Information
  Technology Govt. of India initiated pilot
  projects on Telemedicine-

• At AIIMS (New Delhi), SGPGI (Lucknow), PGIMER
  (Chandigar), with CDAC system.

• At STM (Kolkata) and some districts /
  subdivisional hospitals in West Bengal with
  TelemediK system developed by IIT Kharagpur.

• Cancer net at Kerala, etc.

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• Hospitals with satellite links from ISRO (40
  Super Specialty hospitals and 160 rural/remote
  hospitals)

• APOLLO Group of Hospitals.

• RN Tagore Cardiac Hospital, Calcutta. Narayan
  Hrydualaya Bangalore (Asia Heart Foundation),
  District Hospitals at North East and Karnataka.

• SSKM Hospital Kolkata district hospital Malda
  and Nadia

• Cuttack Medical College and Hospital, Baharampur
  and Sambalpur District Hospitals Orissa, and
  SGPGI Lucknow.

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• Corporate Sectors Offering Telemedicine Systems

• APOLLO Group (45 telemedicine centres)

• Escorts Heart Research Institute, New Delhi

• Care Foundation, Hyderabad

• Online Telemedicine System, Ahmedabad.

• WIPRO GE

• SIEMENS

• Telemedicine system for public health care
  covering PHC, SHC and Tertiary hospitals across
  the country is still a distant dream.

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Objectives of Our Telemedicine Projects

• Supplement public health system.
• Better sharing of medical knowledge and expertise
  among doctors.
• Providing treatment to people at remote
  locations.

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Major Challenges

• Poor Data Communication Infrastructure.
• A Large Population to be catered.
• System Features should be scalable.
• Cost of the system should be scalable.
• Adaptation to the daily activities of a hospital.
• Building Awareness among patients.
• Acceptance by the Medical Fraternities.

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Major Challenges

• Building awareness among patients and doctors
  regarding benefits of telemedicine
• Leadership expected from doctors for successful
  utilization of telemedicine facilities

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Project Software Features/Enhancements
WAN Telemed 2.1 Telemedicine over Low Speed Communication channel, Store and forward policy, Online Graphics Communicator,
Tele Radiology Telemedik 3.0 TelemediK Client Tools with integrated browser, DICOM Viewer, Offline Image Marking, RMS ECG Integration, Larger File Uploads using ftp. Webpages are developed using ASP.
DTGH SUTF TelemediK 2005 Statistical tools added, session log added, - Multireferral, Multi nodal introduced with all the above features. - No distinction between nodal and referral centers - Any hospital can communicate to other hospitals - 2nd level referral is allowed - Statistics Generation - Enhancement of data security - Additional disease categories included -  Gynecology, Pediatrics, Oncology, Emergency - HL7 integration
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Evolution of Telemedicine Software at IIT
Kharagpur
Version Year of Release Major Emphasis Period of Operation
TelemediK-2 2000 Dermatology and Hematology 2000-2003
TelemediK-3 2003 Radiology 2003-2005
TelemediK-2005 2005 Pediatrics, Gynecology, Ophthalmology 2005- till date
iMediK 2007 HIV patients Yet to start
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Patient treatment workflow in Telemedik
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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Cont
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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Video Conference
Doctor
Patient
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Disease categories supported in Telemedik 2005

• Category of diseases
• Tropical Diseases
• Radiology
• Cardiology and Pulmonary Diseases
• Gynecology
• Pediatrics
• Oncology
• Emergency

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Telemedicine Network in West Bengal

• TelemediK 2005 deployed in 16 hospitals
• 6 Referral Hospitals
• - 10 Nodal Hospitals in different districts.

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Telemedicine Network in Tripura

• TelemediK 2005 deployed in 11 hospitals
• 2 Referral Hospital in Agartala
• - 9 Nodal Hospital in different districts.

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Schematic Diagram for Telemedicine using WBSWAN
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Implementation Issues

• Software and Hardware support
• Information management and Exchange of Health
  Records
• Standardization and Interoperability
• Security and confidentiality of patient
  information
• Reliability
• Liability, Licensing and Legal issues
• Statistical analysis, Report generation and
  Decision support
• Legality of electronic signatures
• Archival durability of electronic format
• Relevance and Obsolescence removal

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Telemedicine research at IIT Kharagpur

• Initiated in 1999
• Sponsored by
• The Ministry of Information Technology,
  Government Of India.
• Project title -
• Telemedicine over low-speed WAN for diagnosis and
  monitoring of tropical diseases

• Implementation Agency-
• - WEBEL, Kolkata.

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Sl. No. Name of the project Duration
1. Telemedicine over low-speed WAN for diagnosis and monitoring of tropical diseases 1999 - 2003
2. Development and application of Telemedicine using WBSWAN as backbone 64/128 kbps lease line for Govt. Hospital in WB 2002 - 2004
3. Deployment of Telemedicine in West Bengal Government Hospitals 2004 - 2006
4. Setting up of  Telemedicine Facilities in Tripura 2004 - 2005
5. Web Enabled Medical Information Access Using Handheld Devices in a Wireless Environment for Telemedicine Applications On-Going
6. Deployment of Telemedicine in Tripura On-Going
7. Tele - opthalmology towards development of software On-Going
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WEM iMediK - Three Tier Architecture (for enhanced security features) - No Client Tools, fully web-based system. - Multi-party Online Graphics communicator - Features extended to handheld devices such as PDA with maximum possible features.
TPLM - Pilot project successfully implemented between RIO, Kolkata (Referral) and Raigunj DH (Nodal) -Incorporated Opthalmology related forms in consultation with doctors at RIO
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Video Conference
Doctor
Patient
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Hospitals in West Bengal Period Patients Referred
Medinipur 26.01.04- 14.07.05 415
Baharampur 26.01.04- 14.07.05 472
Suri 26.01.04- 14.07.05 524
Purulia 26.01.04- 14.07.05 587
Kuchbihar 31.07.02- 10.02.04 603
Habra 04.02.02- 24.03.04 810
Raigunj 01.08.06- 30.11.07 163
Arambag 01.09.06- 30.11.07 27
Darjeeling 01.01.07- 30.11.07 55
Tamluk 01.11.06- 30.11.07 51
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Hospitals in Tripura Period Patients Referred
Amarpur 09.06.05-30.11.07 349
Kanchanpur 09.06.05-30.11.07 320
Gandachera 09.06.05-30.11.07 429
Chailengta 09.06.05-30.11.07 207
Kathalia 18.09.06-30.11.07 189
Melaghar 29.08.07-30.11.07 96
Belonia 02.04.07-30.11.07 214
Sabroom 11.07.07-30.11.07 33
Kumarghat 05.04.07-30.11.07 75
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CASE STUDIES
A patient of Habra Hospital treated under
Telemedicine
The name of the patient is say, XXX. His case
history is   Before 16-17 years back once
the patient applied Blacknit oil on his head for
blacking of the hair. Then he noticed allergy on
the head. For that he took so many medicine
including homeopath but all in vein. After that
he used BETNOVATE OINTMENT but it would not help
him. In SKIN CARE Centre they adviced Manolicen
Ointment and Tablet and used to take sunlight but
it would not help. Then he noticed small spots on
the knee, elbow, head and other different parts
of the body. Then DR. D. Banerjee of STM
prescribed other medicines and lotion. It helped
him.
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The medical images of the skin disease - patient
are shown below
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Internet
Global Connectivity
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More than a technical exercise.

• Building awareness of Telemedicine services.
• Motivating doctors to take the lead.
• Fixing responsibilities.
• Protecting patient privacy and confidentiality.
• Use of this infrastructure for managing
  community health care services.

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Thank You