TELEMEDICINE PROJECTS in

West Bengal

A Presentation by

Dr. Rajendra S. Shukla, Special Secretary, H & FW Dep’t, Government of West Bengal

&Dr. J. N. Maity, Director,

WEBEL ECS Ltd.

29th September 2006, Vigyan Bhawan, New Delhi

Outline of Presentation

• Objectives & Relevance• Benefits• Model• Telemedicine Projects in West Bengal• Telemedicine & PPP• Images & Graphics• Awards• Challenges & Way Forward

Use of information and communication technologies:

i) To provide specialized health care consultation to patients in remote locations,

ii) To facilitate video-conferencing among health care experts for better treatment & care,

iii) To provide opportunities for continuing education of health care personnel.

Objectives of Telemedicine

Relevance of Telemedicine

Inadequate infrastructure in rural/district Inadequate infrastructure in rural/district hospitals hospitals

Large number of indoor/outdoor patients Large number of indoor/outdoor patients requiring referral for specialized carerequiring referral for specialized care

Low-availability of Health Experts in Low-availability of Health Experts in district/remote hospitalsdistrict/remote hospitals

Dearth of adequate opportunities for training or Dearth of adequate opportunities for training or continuing Medical Education for Doctors in continuing Medical Education for Doctors in Rural/Remote Health facilities.Rural/Remote Health facilities.

Benefits of Telemedicine (I)

Benefits to Patients:

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

Access to expertise of Medical Specialists to a Access to expertise of Medical Specialists to a larger population without physical referral, larger population without physical referral,

Reduced visits to specialty hospitals for long Reduced visits to specialty hospitals for long term follow-up care for the aged and terminally term follow-up care for the aged and terminally ill patients.ill patients.

Benefits to Physicians:

Improved diagnosis and better treatment Improved diagnosis and better treatment management management

Access to computerized, comprehensive data Access to computerized, comprehensive data (text, voice, images etc.) of patients – offline (text, voice, images etc.) of patients – offline as well as real timeas well as real time

Quick and timely follow-up of patients Quick and timely follow-up of patients discharged after palliative caredischarged after palliative care

Continuing education or training through Continuing education or training through video conferencing periodicallyvideo conferencing periodically

Benefits of Telemedicine (II)

Hospital and Insurance Benefits:

Significant reduction in unnecessary visits & Significant reduction in unnecessary visits & hospitalization for specialized care at tertiary hospitalization for specialized care at tertiary hospitals,hospitals,

Earlier discharge of patients leading to shorter Earlier discharge of patients leading to shorter length of stay in hospitals,length of stay in hospitals,

Increase in the scope of services without Increase in the scope of services without creating physical infrastructure in remote creating physical infrastructure in remote hospitalshospitals

Benefits of Telemedicine (III)

Telemedicine : The Model Patient under treatment Physician treating the patient A remote telemedicine console having audio visual and data conferencing facilitiesNodal HospitalNodal HospitalNodal HospitalNodal Hospital

Referral HospitalReferral HospitalReferral HospitalReferral Hospital

POTS / ISDN / LEASED LINE / VSAT

POTS / ISDN / LEASED LINE / VSAT

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

Digital camera

Doctor / Patient

Scanner

Printer

ElectronicsMicroscop

e

ECG Machine

ElectronicsStethoscope

PSTN / Leased Line

/ ISDN / VSAT

Specialist Doctor

Digital Camera

Scanner

Printer

Web Cam

Web Cam

Nodal CenterNodal Center

Referral CenterReferral Center

System Schematic

Sequence of Tele-consultation (I)Sequence of Tele-consultation (I)PATIENT IN

Patient visits OPD Local Doctor checks up

Patient receives treatment and is not referred to telemedicine system

Patient referred to the Telemedicine system (some special investigations may be suggested)

Patient visits Telemedicine data-entry console.Operator enters patient record, data and images of test results, appointment date is fixed for online telemedicine session

OUT

OUT

Offline Data transfer

from Nodal Centre

Ste

p O

ne

Patient 1Patient 2Patient 3Patient 4

.

.

.

Online video conference & tele-consultation for patients between local doctors at the nodal hospital and specialist doctors at the referral hospital

Patient queue

IN OUT

Ste

p T

wo

Sequence of Tele-consultation (II)

Sequence of Tele-consultation (II)

Health Infrastructure in West Bengal(Government)

Medical College Hospitals 9

Dental College Hospitals 2

School of Tropical Medicine 1

District Hospitals 15

Sub-Divisional & State General Hospitals 70

Rural Hospitals 95

Block Primary Health Centres 251

Primary Health Centres 922

Sub-Centres 10,356

** Health on the March 2004-05 Gov. WB

Telemedicine in West Bengal (I)

Project Implementation by Webel ECS Ltd, Kolkata (Dep’t of IT, Govt. West Bengal)

Software development by CS & E Dept. IIT, Kharagpur

Project sponsored & funded by the Dep’t of IT, Min. of Communications & IT, Govt. of India

Implementation and usage of facilities by the Dept. of Health & FW, Govt. of West Bengal

PROJECT - I

DIT Sanction No. : 2(5)/98-H&B Dated 21.01.1999Project Cost : Rs. 150 lakhs

Referral Center : School of Tropical Medicine, Kolkata

Nodal Centers : Habra State General Hospital, 24th Parganas (North)

: MJN Hospital, Coochbehar

Telemedicine in West Bengal (II)

Connectivity: First with POTS, upgradation with ISDN, lastly with 512 Kbps Leased Line using WBSWAN as backbone.

Disease Types: Skin Related and Blood Related Diseases,Leprosy .Project Completed: December 2003

128 KBPS ISDN Link

Koochbehar MJN

Habra SGH

STM

Location of Centers0f Project I

LEGEND

PROJECT - II

DIT Sanction No. : 2(11)/2001-HBT, dated 31.03.2002DIT, GOI Contribution : Rs. 147 lakhs

Referral Center : NRS Medical College & Hospital, Kolkata

: Burdwan Medical College & Hospital, Burdwan

Nodal Centers : Purulia District Hospital, Purulia

: Suri District Hospital, Birbhum

: Baharampur District Hospital, Murshidabad

: Midnapur Medical College & Hospital, Midnapur

Connectivity: 512 Kbps Leased Line using WBSWAN as backbone.

Disciplines: Cardiology, Radiology, Medicine, Pediatrics, Pathology, Neurology, Dermatology etc.

Project Completed: December 2004

512 KBPS Leased Line

Behrampur DH

Suri DH

MidnapurMC&H

Burdwan MC&H

NRS MC&H

Purulia DH

Location of CentersOf Project II

LEGEND`

PROJECT - III

DIT Sanction No. : 2(20)/2003-Telemed Dt. 08.03.04DIT, GOI Contribution : Rs. 287 lakhs 0

Referral Center : Calcutta Medical College, North Bengal Medical College, Chittaranjan National Cancer Institute, Kolkata

Nodal Centers : Darjeeling, Raigunj & Tamluk District Hospitals

: Arambag Sub. Div. Hospital, Hoogly

Connectivity: ISDN for Arambag Nodal center and 512 Kbps Leased Line using WBSWAN as backbone for other centers.

Disciplines: Cardiology, Radiology, Medicine, Pediatrics, Pathology, Neurology, Dermatology, Oncology etc.

512 KBPS Leased Line

128 KBPS ISDN Link

NBMCH

Darjeeling DH

Tamluk DH

Arambag SDH

CMC&H

Raiganj DH

CNCI

Location of CentersOf Project III

LEGEND

Koochbehar MJN

Habra SGH

Behrampur DH

Suri DH

MidnapurMC&H

Purulia DH

Darjeeling DH

Tamluk DH

Arambag SDH

Raiganj DH

CMC&H

CNCISTM

NRS MC&H

NBMCH

Burdwan MCH

KOLKATA

LEGEND

Total Mapping ofThe Nodal and Referral Centers

TelemediK Software (I) Is a point-to-point telemedicine system

Symmetric No distinction between nodal and referral centers Any hospital can communicate to other hospitals 2nd level referral is allowed

Multi nodal, multi referral environment

Operates over a spectrum of low to high bandwidth communication channels - POTS, ISDN, leased line, VSAT and wireless media

Store & Forward Technical information

Online video conferencing and data transfer

Electronics Medical Record (EMR) Supported - Text, Image, Graphics, Audio, Video

Integration with different medical instrument- EEG, ECG, USG, MRI, CT SCAN, Electronic stethoscope, Microscope fitted with digital camera

Support of medical standards

TelemediK Software (II)

Training Provided Training Provided

Tele-medicine Centers Doctors Paramedics

Habra SDH 03 12

Coochbehar DH 08 12

Midnapur MC & H 12 03

Behrampur DH 05 02

Purulia DH 18 08

Suri DH 15 02

NRS MC & H 03 01

Burdwan MC & H 15 07

STM, Kolkata 05 01

Total 84 48

Discipline wise Patient Consultation

Pediatrics 75

Orthopedics 96

Neurology 34

Cardiovascular Medicine 27

Psychiatry 12

ENT 31

Urosurgery 11

Hematology, Dermatology, General Medicine, OBG, Leprosy, etc

3300

Public-Private Partnership in Tele-medicine

Integrated Tele-Cardiology & Tele-health Project

Govt. facilities covered - BSMCH & Siliguri SDH

Partnership with Asia Heart Foundation & RN Tagore International Institute of Cardiac Sciences, Kolkata

Connectivity through POTS & ISDN

Services Provided

Treatment of Acute Heart Attack cases as evidenced by history and ECG,

Treatment by “Thrombolysis”

Referral & Tele-consultation & video conferencing with RN Tagore International Institute of Cardiac Sciences, Kolkata

Bankura Sammilani Medical College

Siliguri SD Hospital

Patients Admitted 1493 2418

Thrombolysed 296 197

Tele-consultation 915 458

Utilization of Tele-cardiology Facilities

Live session using 512 Kbps Leased Line

Images Images

Video Clip

Vector Data

Vector Data

Awards Received

National e-Governance Award, 2004 – from Govt. of India under Category “ Outstanding Performance in Service Delivery”

Skoch Challenger Award, 2005

Manthan – American India Foundation

Award, 2006 under “e- Health” Category

Challenges in Implementing Telemedicine

1. Identification of a Suitable site and preparation of site for Telemedicine facility.

2. Synchronization of civil, electrical and equipment related works.

3. Identification of a nodal officer (Other than Superintendent) for coordinating Telemedicine activities in the hospital.

4. Sensitization and repeated hands-on training of concerned Doctors, Technicians and Nurses.

5. Coordinating with referral centers to fix mutually convenient tele-consultation sessions on a regular basis.

6. Ensuring trouble free & smooth connectivity through WAN (ISDN/Leased Line)

…. way forward

1. Hand-holding support to Hospital administration for 3-4 years for stabilization of telemedicine services.

2. Integration of Telemedicine activities with Health Management Information System for regular reporting (preferably web-based)

3. Including Telemedicine activities in the performance appraisal of individuals and institutions.

4. Introducing Telemedicine (concept, technical aspects and implementation arrangements) as part of medical education & continuing medical education.