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Indian Telemedicine Program: Marching Toward Transforming

National Healthcare Delivery System

Authors:R.L.N. Murthy & L.S. Satyamurthy

Telemedicine Programme

Indian Space Research Organisation (ISRO)

Bangalore, India

June 12, 2007

Presented by: Shabbir Syed Abdul

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• Population of only 1.1 + billion, 28 States & 5 union territories

• Vast Population (80%) spread in inaccessible & remote areas (border areas) & remote islands in around 627,000 villages

• 8O % of super-specialty live in big cities

INDIA – THE LAND OF DIVERSITY

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The Indian healthcare system• Predominantly government managed

• Three-tier hierarchical system of – Primary, Secondary and tertiary healthcare

• ~ 23000 Primary Healthcare Centres (PHCs), 3000 Community Healthcare Centres (CHCs) and 670 District Hospitals (DHs) as the major governmental healthcare delivery system

• + Private institutions serving the population.

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TeleMedicine in India

• Agencies like ISRO, Dept of IT, Railways, Few State governments, Private network by Apollo, AHF, AIMS, ESCORTS etc and are also part of this movement in their own capacity

• Efforts by ISRO:– Space based Rural Development Programmes since 1990s

– Major thrust for TM as a special programme since 2001

– Spearheading the Telemedicine Movement in India with the largest network and contineous improvement

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SPACE FOR THE SOCIETYSPACE FOR THE SOCIETY

FIRST ROCKET LAUNCH ON 21st NOVEMBER 1963THUMBA

“ …. SECOND TO NONE IN THE APPLICATION OF

ADVANCED TECHNOLOGIES TO THE REAL PROBLEMS OF

MAN AND SOCIETY ”

SatellitesSatellitesLaunch ServicesLaunch ServicesGround SystemsGround Systems

Operational ServicesOperational Services

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ISRO’s Initiative in Telemedicine

• ISRO initiated Telemedicine programme in 2001 as a special programme, for providing Telehealth to the un-served and the under-served

• Set up Telemedicine Facilities in distant and rural of India to supplement the general healthcare infrastructure.

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Advantages of Satellite Advantages of Satellite CommunicationCommunication• Easy reach, quick installation• No geographical and environmental barriers• Flexible, high quality network• Extensive and Consistent geographic coverage

• Efficient support to broadcast and multipoint communications for medical education and consultation sessions

• Network capacity flexibility, reliability and security

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ISRO’s Telemedicine Program ISRO’s Telemedicine Program - Thrust Areas- Thrust Areas

Providing Technology and Connectivity Remote/rural hospitals and specialty hospital

Continuing Medical education (CME)

Mobile telemedicine units

Disaster Management Support (DMS)

Integrating with Village Resource Centres (VRC) /

information kiosks for multiple services

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Growth of TM Applications

• 2001 : Tele-radiology –still images • 2002 : Tele-cardiology – Moving images, CME • 2003 : Tele-pathology, Tele-ophthalmology• 2004 : Tele-oncology, Tele-surgery• 2005 : Mobile TeleHealth - augmentation• 2006 : Telemedicine for Primary healthcare -- VRC

……the journey continues ……

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ISRO TELEMEDICINE Network

2003

58 nodes

36 – Remote 22 - Speciality

2003

58 nodes

36 – Remote 22 - Speciality

2002

27 nodes

17 – Remote 10 - Speciality

2002

27 nodes

17 – Remote 10 - Speciality

2001

5 nodes

3 – Remote 2 - Speciality

2001

5 nodes

3 – Remote 2 - Speciality

Growth by Maximising the reach

2004

100 nodes

78 – Remote22 - Speciality

2004

100 nodes

78 – Remote22 - Speciality

2005

140 + nodes

109 - Remote31 - Speciality

2005

140 + nodes

109 - Remote31 - Speciality

Pilot project in 2001, connecting :

Aragonda Apollo, Chennai &

Chamaraj Nagar Narayana Hrudayalaya

2006

184 + nodes

148 - Remote36 - Speciality

2006

184 + nodes

148 - Remote36 - Speciality

2007

220 + nodes( target 280 nodes)

181 - Remote40 - Speciality

2007

220 + nodes( target 280 nodes)

181 - Remote40 - Speciality

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SYSTEM COST( PATIENT END per Node)

2002

18 Lakhs

VSAT- 10 L TM system- 8 L

( S/W : 3 L)

2002

18 Lakhs

VSAT- 10 L TM system- 8 L

( S/W : 3 L)

Minimising the Costs for Growth

2004

8.2 Lakhs

VSAT- 5 L TM system - 3.2 L

( S/W : 0 .65 L)40%

2004

8.2 Lakhs

VSAT- 5 L TM system - 3.2 L

( S/W : 0 .65 L)40%

20055 Lakhs

VSAT- 2 L TM system – 3 L

( S/W : 0.25 L)40%

20055 Lakhs

VSAT- 2 L TM system – 3 L

( S/W : 0.25 L)40%

2003

14 Lakhs

VSAT- 8 L TM system- 6 L

( S/W : 1.6 L)

2003

14 Lakhs

VSAT- 8 L TM system- 6 L

( S/W : 1.6 L)

33%

20064 Lakhs

VSAT- 1.2 L TM system – 2.8 L

( S/W : 0.25 L)20%

20064 Lakhs

VSAT- 1.2 L TM system – 2.8 L

( S/W : 0.25 L)20%

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Satcom Based Telemedicine Connectivity

Approach followed by ISRO

1. Proof of Concept - Technology Demonstration thru’ Pilot Projects in several states

2. Development of national standards and guidelines

3. Efforts to optimise the clinical requirements for evolving a suitable e-heath technology

4. Efforts to minimise the costs to bring in affordability and maximise the reach

Approach followed by ISRO

8. Encouraging new models and efforts like innovative insurance schemes

9. Integrating the healthcare administrators, planners, technologists and entrepreneurs and bringing all the stake holders to a common platform.

10.Training and educating users (doctors and patients) to create interest in utilizing Telemed and eHealth tools

11. Developing Mobile healthcare system for reaching the doorsteps of the rural population

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Telemedicine Technology Evolution in India:

–Point to point

–Point to multipoint

–Multipoint to multipoint

– Tele-education

Patient end

SkyIp Terminal

Switch

District Client Station

TV Monitor

Video Conferencing Camera

12 Lead ECG

Digital Camera

A3 Scanner

OR

Point to point System

SkyIp or FlexiDamaTerminal

Hub/Switch

Doctor-End Station

TV Monitor

Video Conferencing Camera

Patient endDoctor end

Point-to-Multipoint System Configuration

Doctor-End Doctor-End Doctor-End

Server Patient-End

Super Specialty Hospital Rural/District Hospital

Continuing Medical Education (CME) Configuration

DVB-RCSIn-Door Unit

Hub/Switch

Work Station (s)

TV Monitor

Server(s)

Antenna & ODU

LCD Projector

Scanner

Mixer/Switcher

Video Camera

Document Camera

Microphone

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MOBILE TELEMEDICINE

To overcome the prohibitive costs of large number of terminals and reaching out to the rural areas

• Sankara Nethralaya• Aravind Eye Hospital

Tele-Ophthalmic Van – Shankara Nethralaya Tele-Ophthalmic Van –

Aravind Eye Hospital

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Telemedicine STANDARDS in India

• Guidelines and Standards for– Telemedicine System – Network / Connectivity– Interoperation of Telemedicine Systems– Standards for Security & Process guidelines

• Efforts to standardize healthcare data interchange using

• DICOM - Digital Imaging and Communication in Medicine

• HL7 - Health Level Seven and

• ITU standards for Video conferencing

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• All states represented including the far-flung areas like – J&K, Andaman & Nicobar islands, Lakshadweep, Uttaranchal and North East etc.

• Special networks for Army, Navy & Air Force

• 221 nodes• 181 remote hospitals• 40 Specilaity hospitals

ISRO TELEMEDICINE

PROGRAMME

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National Task Force Constituted by Federal

Ministry of Health & Family Welfare • To make TM to enter the mainstream of Healthcare

delivery• To Define a National TM Grid and consider its standards

and operational aspects• To identify & Evaluate all players and projects currently

involved in TM in India• To prepare National Cancer TM Network • To define standards & structures of EMR and patient data

base• To draft a National Policy on TM and CME to prepare a

Central Scheme for the 11th FYP

Awareness Programme & International Cooperation

• INTELEMEDINDIA 2005 – attended by various Intl’ specialists

• Joint working group with Canadian Space Agency

• ISRO CNES interaction on Technology

• Asia Pacific Telemedicine Collaboration under ITU

• Interaction with WHO, ISfT and other agencies

• UN OOSA Workshop in China, India

• Training Programme for Afghanistan

• UN workshop in India

Road Map for the Future • ISRO to continue leading Telemedicine efforts in India • Enhancing awareness and interest among the stake holders• Introducing Telemedicine in an operational mode across the

country• Integrating SatCom and complementing technologies

(wireless and Terrestrial) for seamless connectivity • Creation of web portal as a repository and knowledge base• Steps towards National eHealth policy formulation • Efforts to develop and encourage Telemedicine project in

SAARC region

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Thank you for Your Attention

For Details: murthy@antrix.gov.in