TELEMEDICINE: INDIAN PERSPECTIVE

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TELE-MEDICINE INDIAN PERSPECTIVE DIT
INITIATIVES  

• B.S.Bedi,
• Adviser C-DAC

ISRO-UNOOSA WORKSHOP 21 OCT 2008
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Telemedicine in India The Perspective

• India characterized by low penetration of
  healthcare services
• 90 of secondary tertiary healthcare facilities
  in cities and towns away from rural India where
  68 of population lives
• Primary health care facilities for rural
  population highly inadequate
• Despite several initiatives by Government
  private sector the rural and remote areas
  continue to suffer from absence of quality
  healthcare
• Significant proportion of patients in remote
  locations could be successfully managed locally
  with advice/ guidance from specialists/
  super-specialists in cities, without having to
  travel to the specialists.

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Telemedicine The Promise

• Majority of diseases not requiring surgery
  conducive to telemedicine
• Can also play a significant role in training of
  medical personnel across the country
• Decrease in price and complexity of this
  technology over last five years makes it
  economically viable
• Increasing availability of communication
  infrastructure
• Strong capability in terms of technical and
  medical expertise
• Key driver of publicprivate partnership for
  health care delivery to the people of India
• Major opportunity for cross border business for
  India considering these strengths

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Telemedicine - Applications
Second Opinion Complex Interpretations
Telementored procedures/ Surgery - Robotics
Remote Consultation Critical Care Monitoring
Telemedicine
Home Care Ambulatory monitoring
Disease Surveillance Program tracking
Disease Management
Continuing Medical Education Public Awareness
Disaster Management
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Current Efforts

• Many programs worldwide using variety of
  telemedicine technologies
• In India telemedicine programs actively supported
  by
• Dept. of Information Technology
• Indian Space Research Organization (ISRO)
• Media Lab Asia
• NEC Telemedicine program for North-Eastern states
• Apollo Hospitals
• Asia Heart Foundation
• State governments
• Telemedicine technology also supported by some
  other private organizations and Hospitals.
• Major Communication infrastructure support by
  ISRO BSNL
• Ownership by Ministry of Health Family
  Welfare-To Plan ahead by Setting up of National
  Task Force

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DIT Initiatives

• As a Facilitator, with long term objective of
  effective utilization/incorporation of IT in all
  major sectors , DIT has taken following leads in
  Telemedicine
• Development of Technology-CDAC, IITs
• Initiation of pilot schemes
• Selected Specialty e.g. Oncology, Tropical
  Diseases
• General telemedicine system covering all
  specialties
• - Disaster management/Prevention
• Standardization
• Framework for building IT Infrastructure in health

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Development of Telemedicine Technology
DIT Initiatives

• Considerations
• - Cost effective
• - Compatible with available communication
  infrastructure like
• -VSAT, ISDN, Leased Lines, POTS etc.
• - Conformity to Standards
• -Interoperability with existing vendors
• - Benchmarking by clinical specialists

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Telemedicine in Kerala
DIT Initiatives Pilot Schemes

• Setting up of Telemedicine Telehealth Education
  facilities
• OncoNet Telemedicine system for Cancer Patients
  in Kerala
• More than 5000 patients treated/consulted at
  these nodal centres
• System upgraded with high bandwidth VSAT
  connectivity
• Major financial benefit to patients
• Major Roll out planned by MoHFW to cover 25 RCCs
  100 outreach centres

Telemedicine System in West Bengal

• Telemedicine for Tropical Diseases
• Telemedicine projects to cover five referral
  hospitals and nine District hospitals

Telemedicine Network for Himachal Pradesh (HP)

• 20 remote hospitals being connected with IGMC
  Shimla to be further connected with PGIMER

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Telemedicine in North East States in India

• Need Remote area and lacks Specialty
  Healthcare
• Kohima Turnkey Project
• Implementation of Telemedicine Solution at Kohima
  Hospital in Nagaland
• Partnership between Govt. of Nagaland, Marubeni
  India Ltd, Apollo and M C I T. System in
  operation.
• Two telemedicine centres connecting district
  hospitals in Sikkim Mizoram with Apollo,New
  Delhi operational
• Telemedicine facilities in Tripura connecting
  Referral Hospitals at Agartala with four
  sub-divisional hospitals.
• -Network inaugurated in June 2005
• -Enthusiastic response from remote
  hospitals
• -Network being expanded to cover six
  more remote hospitals
• - Major scheme is planned by N E C and ISRO to
  cover all 75 districts in seven states through
  Telemedicine

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Media Lab Asia Initiative for Rural eHealth

• Sehat Sathi Portable/ mobile model of
  healthcare services and delivery- Provides
  Tele-consultation and information on health and
  disease through empowered rural health worker
• CaSh A replicable model for IT based health
  management information system using handheld
  devices at grassroots. Plans for major
  development pilot deployment to cover full
  district
• Pilot projects on mobile rural Telemedicine

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Other Current Initiatives

• Telemedicine Network in Tamil Nadu-Six remote
  centres being connected with Specialty hospital
  in Chennai
• A Telemedicine Network System under
  implementation at Cancer Institute (WIA), Adyar
  and at seven peripheral centres in Tamil Nadu
  Andhra Pradesh
• Punjab Rural Telemedicine Network- More than 20
  rural hospitals being linked with Referral
  hospitals
• Telehealth one of the major agenda for
  incorporation in 100,000 Common Service Centres
  (CSC) being set up as e-Governance delivery points

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Telemedicine Standardisation

• Need
• Large number of Telemedicine networks being
  installed in the country
• Lack of uniform, multipurpose telemedicine
  standards meeting needs of diverse user groups at
  different hierarchical levels hamper effective
  use of telemedicine
• Important for promoting International business
• Adherence/adoption to standards ensures
• Telemedicine Systems are interoperable
• Compatibility with new version of technology
• Scalability of systems without total replacement
  while expanding capability
• Recommended Guidelines and standards for
  Telemedicine Technology Practice in India
  evolved under a high level committee of DIT.
• Document released and under wider circulation
  with excellent response
• Major attention and follow up by MoHFW National
  Task Force for arriving at mandatory Standards

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DIT Initiatives
Framework for Information Technology
Infrastructure for Health (ITIH)

• Primary aim of building an Information Technology
  Infrastructure for Health (ITIH) to efficiently
  address all information needs of different
  stakeholders (government, hospitals, insurance
  companies, patients, vendors and others) in the
  healthcare industry.
• Addresses the key elements of Standards, Legal
  Framework and Medical Informatics Education.
• DIT has taken a major exercise in defining a
  framework for ITIH in India with involvement of
  a large number of concerned stake holders
• Some Recommendations considered and accepted by
  Insurance Regulatory Dev. Authoritys Working
  Group
• Base document for National Knowledge Commissions
  WG India-Health Information Network Dev (I-HIND)

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Task Force for Telemedicine in India Current
activity

• Task Force has met and initiated action on the
  terms of reference by setting up following five
  Subgroups to cover major terms of reference
• Sub group on Telemedicine Standards (covers EMR)
• Sub Group for formation of National Telemedicine
  Grid.
• Sub Group for evaluation framework for projects,
  prepare pilot projects like National Medical
  College Network, National Cancer Network
• Sub Group for utilization of existing tele
  linkages, training, CMEs in Telemedicine, human
  resources medical informatics.
• Sub Group for preparation of National Policy on
  Telemedicine and tele medical education and to
  prepare central scheme for 11th Five Year Plan
• Some Sub Groups including at 1 have submitted
  final Reports

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Vision Defining a National Telemedicine Network

• Vision for National Telemedicine Network to
  cover large population. A three tier hierarchical
  connectivity structure can be contemplated for
  implementation in phases to include
• A Primary Health Centre (PHC)/Community Health
  Centre connected to District level hospital
• A District level Hospital connected to a State
  Level Hospital/ Selected Specialty Hospital
• State Hospitals and selective District hospitals
  being connected to a super specialty hospital at
  the National level
• Possibility of inclusion of hospitals/Health
  centres in private sector
• Issue being addressed by National Task Force

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Chandigarh
Ludhiana
Bhubaneshwar
Jamshedpur
Delhi
Ranchi
Bilaspur
Jaipur
Guwahati
Bhopal
Indore
Kanpur
Kolkatta
Lucknow
Siliguri
Goa
Kakinada
Vizag
Mumbai
Pune
Hyderabad
Vijayawada
Nagpur
Ahmedabad
Tirupathi
Bangalore
Nellore
Chennai
Baroda
Madurai
Erode
CBE
Anantapur
Mysore
Davengere
Thirunelvelli
Belgaum
Hampi
Ramanathapurar
Trichy
Chenganoor
Bhavnagar
Salem
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Chandigarh (State Hospital)
Delhi (Super Specialty Hospital)
Jaipur
Bhopal
Faridabad (District Hospital)
Lucknow
Kolkatta
Ayodhya (PHC)
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National Telemedicine Network Major
Challenges

• Resource requirement evaluation
• Connectivity/ Bandwidth (B/W) provision
  reliability
• Telemedicine cost consideration /affordability
• - Telemedicine platform-H/W,S/W,Video
  Conferencing
• - Basic Equipment (depending on
  Centre-scanner,digital med. equipment
• Adherence to open platforms and open architecture
  standards
• Sustainability
• Sourcing Specialist availability
• Trained manpower
• Crucial Role being now played by Ministry of
  Health Family Welfare to Plan the National
  Telemedicine Grid

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Thank you

• bedi11_at_yahoo.com