telemedicine in a disconnected environment

Telemedicine in a Disconnected Environment

Dr Sakti Srivastava, MBBS, MSAdjunct Professor

Indian Institute of Technology, Delhi

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Outline Healthcare and Telemedicine in

India Continuing Challenges Today Our Proposed Solution Results and Further Work

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Healthcare in India India spends <1% GDP on

health Urban/Rural mismatch of health

professionals and population >70% of India’s population is

rural Most lack access to basic health

facilities

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Telemedicine in India Aravind Hospitals –

Teleopthamology Network Apollo Hospitals – Aragonda Project OTRI (Online Telemedicine

Research Institute) Asia Heart Foundation OncoNet (Kerala) Common Service Centers e-

governance

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Telemedicine in India VSAT based (ISRO) Broadband based (BSNL) High cost (setup and

maintenance) High technical expertise Low bandwidth Limited scalability

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Continuing challenges Remotest of remote No connectivity Limited infrastructure “Bottom of Pyramid” (<$1 per

day) Landless farmers, illiterate

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Criteria Inexpensive and low maintenance Easy and quick to setup Robust and durable Minimal new technology usage and

skills requirement User-friendly, able to cope with

infrastructure Support large datasets and scalable

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Our proposed solution Asynchronous (Store &

Forward) Delay tolerant network (DTN) Large datasets Several unique features Highly scalable

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Application overview

Background

Challenges

Solution

ResultsKiosk-PC

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Case Flow 1

Internet Region

D1(Neuro)

D2(Pediatrics)

D3(Ortho)

D4(Ortho)

Dispatcher

New Case Submission Path

Reply from Doctor

Health Care Worker

Primary Healthcare Centre (Rural)

RadiologyEquipment

DICOM

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Case Flow 2

Internet Region

D1(Neuro)

D2(Pediatrics)

D3(Ortho)

D4(Ortho)

Dispatcher

New Case Submission Path

Reply from Doctor

Health Care Worker

Primary Healthcare Centre (Rural)

RadiologyEquipment

DICOM

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

DICOM

Internet Region

D1(Neuro)

D2(Pediatrics)

D3(Ortho)

D4(Ortho)

Dispatcher

New Case Submission Path

Reply from Referred Doctor

Referral to another Doctor

Health Care Worker

Primary Healthcare Centre (Rural)

RadiologyEquipment

Background

Challenges

Solution

Results

Case Flow 3

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Design Overview

Kiosknet Hardware

DTN – Communication Infrastructure

DICOM Interfacing

Automatic Case

• Allocation

• Forwarding

• Consolidation

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Design Overview

Kiosknet Hardware

DTN – Communication Infrastructure

Automatic Case

• Allocation

• Forwarding

• Consolidation

Background

Challenges

Solution

Results

DCMTK

CreatorDecomposer

GUI

DICOM Viewer

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Design Overview

Kiosknet Hardware

DTN – Communication Infrastructure

Background

Challenges

Solution

Results

DCMTK

CreatorDecomposer

GUI

DICOM Viewer

DtnReceiver

DocDBSync

DB

NetReceiver

Consolidation

Sender

Sender

Receiver

GUI

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Automatic Case Allocation

Physician database at proxy Doctor’s Name, Specialty,

Location, ID, IP, email address Case specifies only specialty Based on specialty and

availability, allocation done Any allocation algorithm can

be implemented now

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Automatic Case Consolidation

Unique Case ID assigned to a case at creation

One consolidated file per case ID maintained at the proxy

Consolidated file can be retrieved from any location

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Implementation Details

Components Hardware Software

Databases Application level routing Screenshots

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Hardware Components

Background

Challenges

Solution

Results Via Box, 512MB RAM, 40 GB HDD, Ethernet, Wireless

PC, Low RAM, No HDD, Ethernet,Wireless

Soekris 4801-60 Box, 256MB RAM, 40 GB HDD, Wireless

Soekris 4801-60 Box, 256MB RAM, 40 GB HDD, Wireless

PC (P4) , 512MB RAM, 80 GB HDD, EthernetWireless

PC, 512MB RAM, 40 GB HDD, Ethernet

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Software Components

Background

Challenges

Solution

Results Debian OSApache 2.2, PHP 5.2.6, DICOM Viewer Mricro

Debian OSdtnd, dcmtk toolkit, dhcp, nfsCreator, Decomposer (java modules)

Debian OSdtnd

Linux OSApache 2.2, PHP 5.2.6Receiver, Sender(java modules)

Debian OSdtnd

Debian OSdtnd, dcmtk toolkit, dhcp, nfsCreator, Decomposer (java modules)

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Screenshots

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Results

1 GB data bidirectional transfer

Measured time for link detection and transfer time Time to link detection: Worst

case – 10 mins Throughput: 1 MBPS

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Future Work

SMS integration Call allocation methods Enable querying Security and privacy Utility based routing

Background

Challenges

Solution

Results

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

Acknowledgments

IIT Delhi Prof Huzur Saran Prof Sanjiva Prasad Rohan Jain Varun Sharma

CDAC Mr B S Bedi

August 06, 2008 TIDE project/ IIT Delhi / Srivastava

ss@it.iitd.ac.in