Dr. Vinod KhandharMS(ENT), MS(GEN SURG), DIPLOMA IN LASER SURGERY (SPAIN), LLB.

TELEMEDICINE PROJECTS IN INDIA

INDIA

•INTRODUCTION•BENEFITS/UTILITIES•TYPES•PRESENT DAY SCENARIO•INFRASTRUCTURE•GOALS•NEEDS•CHALLENGES•RESULTS•DISCUSSIONS•CONCLUSIONS

OUTLINE

TELEMEDICINE

Click to add Title1 Improved diagnosis and better treatment management 1

Click to add Title22

Click to add Title1 Quick and timely follow-up of discharged patients

3

Click to add Title2 Access to computerized comprehensive data of patients, both offline & real time

4

1

Benefits to Healthcare Professionals

Continuing education and training

Benefits to patients

• Access to specialized health care services to under-served rural, semi-urban and remote areas

• Early diagnosis and treatment

• Access to expertise of Medical Specialists

• Reduced physician’s fees and cost of medicine

• Reduced visits to specialty hospitals

• Reduced travel expenses

• Early detection of disease

• Reduced burden of morbidity

Benefits to Government

Types of technology2 types

Store and forward

For non – emergency situations

Teleradiography, teleradiopathy & teledermatolgy

Two-way interactive televisionVideo-conferencing.

Almost equivalent to a face to face ‘real time’ consultation

HEALTHCARE IN RURAL INDIA

Psychiatry34%

Endocrinology9%

Neurology Peds5%

Nutrition Services

4%

Other19%

Dermatology29%

•70 % of India’s population live in rural areas

•90% of secondary & tertiary care facility are in cities and towns

•Low penetration of healthcare services

•Lack of investment in health care in rural areas

•Inadequate medical facilities in rural areas

• Problem of retaining doctors in rural areas specially the specialist doctors

SUPERSPECIALITY SERVICES REQUIRED (besides the basic medical health services)

Public Health Care Delivery Model

23,236 PHC1,46,026 Sub centers

3,346 CHC4,400 Dist. Hospitals1200 Other Public Hospitals

242 Medical colleges205 Dental colleges

Source : K. Park, 20th Ed.

Telemedicine: Ideal for India

• Area : 32,87,268 Sq. Km.

• Population : over 1 Billion

• Urban Rural Divide• Inaccessible hilly

regions, islands, desert, coasts, tribal areas

• Strong Fiber Backbone

• Indigenous satellite Communication technology in place

• IT trained Human resource

• Pilot Projects with Successful outcomes

SUPPORT

In India, telemedicine programs are being actively supported by:

• Department of Information Technology (DIT)• Indian Space Research Organization• NEC Telemedicine program for North-Eastern states• Apollo Hospitals• Asia Heart Foundation• State governments• Telemedicine technology also supported by some other

private organizations

Evolution of telemedicine

Point to

Point

• One patient connected to one doctor

• Within same hospital

Point to

Multi Point

•One patient end at a time connected to many specialist doctors•Within the same hospitalMultip

oint to Multip

oint

• Several patient ends connected to several different specialist doctors

• At different hospitals, in different geographical distances

Telemedicine :

ways of communication

DIT INITIATIVES

DIT has taken following leads in Telemedicine: Development of Technology

Initiation of pilot schemes Selected Specialty e.g. Oncology, Tropical Diseases General telemedicine system covering all specialties

Standardization

Framework for building IT Infrastructure in health

National Task Force on Telemedicine(2005)

Benefits for Health Care Delivery

System

Benefits to patients

Benefits to HealthCare Professionals

• Health, Communication & Information Technology

• Indian Space Research Organization

• Indian Council of Medical Research

• Medical Council of India • Center for Development of

Advanced Computing • Academic medical institutions

and corporate hospitals

Includes members from the following departments

Utility of NRTN

•To provide access to timely and quality specialty medical care to the people living in rural & remote areas.•To reduce rural urban divide in delivery of medical care•To improve diagnosis and treatment facilities in rural areas •To mitigate the obstacles due to geographical isolation• To provide continuous medical education and training to the healthcare professionals working in rural/remote areas

PROPOSED OBJECTIVES OF NRTN

Tele-consultation room Patient engagement facilities (bed, scopes,

etc.) Selective medical and medico-IT equipments,

preferably IT compatible, with interface to Telemedicine and/or other software / hardware

Computer hardware / software platform (PC, switch, etc.) and IT electronics equipments

Mobile vans are a part of telemedicine service

LEVEL-1:Software &Hardware

Digital ECG4

Desktop PC platform with Laser Printer1

2IP Video Conferencing Kit

3

A3 Film Scanner5

6 Digital Microscope & Camera

7

Tele medicine software

8

Glucometer & Haemogram analyzer

Non-invasive Pulse & Blood Pressure unit

Connectivity device & Router9

GOALS AND NEEDSLooking to the past experience for success of telemedicine:• Video conferencing

•Accompanied by data and image transfer (live)

• Common software usage at both ends, thus globalization of a single database software

•Role of trained technical personnel is equally important and necessary at the patient end.

•Successful remuneration system to attract private practitioners

•It is feasible to set up a National Health Grid to be shared by healthcare providers, trainers & beneficiaries taking the advantage of a • strong fiber backbone• indigenous satellite communication technology• large trained manpower

•The ground work has also been established by • ISRO• DIT• State Governments • Specialty Institutes/ Hospitals

•National Rural Telemedicine network will help to provide quality healthcare where there is none and will improve healthcare where there is some

Plus points

• Low bandwidth Neither telephone lines nor electricity in rural

areas International bandwidth of RAFT countries is very

limitedEnd 2004: 18 Mbps for the entire country, 1,34 bps/capita (Mali)Switzerland 2002: 66.000 Mbps, 9.040 bps per capita(Source: ITU World Telecommunication Indicators Database)

Satellite transmission can help but is pricey Mobile communication is gaining ground

• Unstable electricity supply.

CHALLENGES

CHALLENGES

• Patients' fear and unfamiliarity• Financial unavailability• Lack of basic amenities• Literacy rate and diversity in languages• Quality aspect• Government Support• Perspective of medical practitioners

Pragmatism and the realism with tools adapted to the context must remain the rule.

India is a booming economy

Telemedicine is a new yet extremely lucrative concept

With the right marketing and government approach, combined with hard efforts in the right direction, this can bea huge success!

DISCUSSIONS

CONCLUSION

Paraphrasing Neil Armstrong,

“ Telemedicine: one small step for IT , a giant leap for Healthcare!”

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REFERENCES

THANK

YOU!