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 ofPresentation • Objectives & Relevance • Benefits • Model • Telemedicine Projects in West Bengal • Telemedicine & PPP • Images & Graphics • Awards • Challenges & Way Forward
Objectives of Telemedicine Use of information and communication technologies: 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.
Relevance of Telemedicine • Inadequate infrastructure in rural/district hospitals • Large number of indoor/outdoor patients requiring referral for specialized care • Low-availability of Health Experts in district/remote hospitals • Dearth of adequate opportunities for training or continuing Medical Education for Doctors in Rural/Remote Health facilities.
Benefits of Telemedicine (I) • BenefitstoPatients: • Access to specialized health care services to under-served rural, semi-urban and remote areas, • Access to expertise of Medical Specialists to a larger population without physical referral, • Reduced visits to specialty hospitals for long term follow-up care for the aged and terminally ill patients.
Benefits of Telemedicine (II) • Benefits to Physicians: • Improved diagnosis and better treatment management • Access to computerized, comprehensive data (text, voice, images etc.) of patients – offline as well as real time • Quick and timely follow-up of patients discharged after palliative care • Continuing education or training through video conferencing periodically
Benefits of Telemedicine (III) • Hospital and Insurance Benefits: • Significant reduction in unnecessary visits & hospitalization for specialized care at tertiary hospitals, • Earlier discharge of patients leading to shorter length of stay in hospitals, • Increase in the scope of services without creating physical infrastructure in remote hospitals
Telemedicine : The Model • Patient under treatment • Physician treating the patient • A remote telemedicine console having audio visual and data conferencing facilities Nodal Hospital POTS / ISDN / LEASED LINE / VSAT Referral Hospital • An expert / specialised doctor • A central telemedicine server having audio visual and data conferencing facility
System Schematic Referral Center Web Cam Digital Camera PSTN / Leased Line / ISDN / VSAT Doctor / Patient Web Cam Scanner Electronics Microscope Printer Specialist Doctor Scanner Digital camera ECG Machine Printer Electronics Stethoscope Nodal Center
Sequence of Tele-consultation (I) PATIENT IN Patient receives treatment and is not referred to telemedicine system Patient visits OPD Local Doctor checks up OUT Patient referred to the Telemedicine system (some special investigations may be suggested) Step One 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 Offline Data transfer from Nodal Centre
Sequence of Tele-consultation (II) Patient 1 Patient 2 Patient 3 Patient 4 . . . Online video conference & tele-consultation for patients between local doctors at the nodal hospital and specialist doctors at the referral hospital Step Two OUT IN Patient queue
Health Infrastructure in West Bengal (Government) ** 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
Telemedicine in West Bengal (II) PROJECT - I Referral Center : School of Tropical Medicine, Kolkata Nodal Centers : Habra State General Hospital, 24th Parganas (North) : MJN Hospital, Coochbehar 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 DIT Sanction No.:2(5)/98-H&B Dated 21.01.1999 Project Cost : Rs. 150 lakhs
Location of Centers 0f Project I Koochbehar MJN LEGEND Habra SGH STM 128 KBPS ISDN Link
PROJECT - II 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 DIT Sanction No.: 2(11)/2001-HBT, dated 31.03.2002 DIT, GOI Contribution : Rs. 147 lakhs
Location of Centers Of Project II Behrampur DH Suri DH LEGEND` Burdwan MC&H Purulia DH NRS MC&H 512 KBPS Leased Line MidnapurMC&H
PROJECT - III 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. DIT Sanction No.: 2(20)/2003-Telemed Dt. 08.03.04 DIT, GOI Contribution : Rs. 287 lakhs 0
Location of Centers Of Project III Darjeeling DH NBMCH Raiganj DH LEGEND Arambag SDH 512 KBPS Leased Line CMC&H 128 KBPS ISDN Link CNCI Tamluk DH
Total Mapping of The Nodal and Referral Centers Darjeeling DH NBMCH Koochbehar MJN Raiganj DH KOLKATA NRS MC&H Burdwan MCH Behrampur DH CMC&H Suri DH Arambag SDH STM CNCI Habra SGH LEGEND Purulia DH MidnapurMC&H Tamluk DH
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
TelemediK Software (II) • 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
Training Provided Training Provided
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
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 • 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.