ICT for Cancer Diagnosis, Treatment and Management

1
ICT
for Cancer
Diagnosis, Treatment and Management
Sudhamony S Additional Director / Head, Medical
Informatics Section, Centre for Development for
Advanced Computing (C-DAC),Thiruvananthapuram,
INDIA.
APAN-Healthcare-2009
2
C-DAC

• A Scientific research organization of Ministry of
  Communication and Information Technology,
  Government of India
• Vision To emerge as the premier RD Institution
  for the design, development and deployment of
  world class electronic and IT solutions for
  economic and human advancement
• Ten centres across India
• C-DAC, Thiruvananthapuram is in the state of
  Kerala

Centre for Development of Advanced Computing
APAN-Healthcare-2009
3
About ONCONET

• The first successful Tele-Oncology Network in
  India
• which provides
• telemedicine services in early detection,
  patient follow up and pain relief for cancer
  patients from rural areas.

APAN-Healthcare-2009
4
The Need

• Statistics from India
• 1 million new cancer cases per annum
• 3 million cancer patients
• Low socio-economic status and low literacy rates
  in rural areas
• Lack of infrastructure and expertise at Public
  Health Centers in rural areas for early detection
  of Cancer
• Long and relatively expensive travel to reach
  Cancer Care facility
• 30 of cancers can be prevented 40 can be cured

APAN-Healthcare-2009
5
ONCONET

• A research project funded by Govt. of India
• Designed, developed, implemented and supported by
  C-DAC, Thiruvananthapuram
• Implemented at Regional Cancer Centre
  Thiruvananthapuram, Kerala, India and its five
  peripheral clinics across the state

APAN-Healthcare-2009
6
Regional Cancer Centre Trivandrum (RCC)

• RCC is the only cancer hospital in the Govt.
  sector catering to the population of the state of
  Kerala and neighboring states.
• Approx. 12,000 new cases are registered every
  year and the annual follow-up visits reach
  150,000 every year

APAN-Healthcare-2009
7
Statistics from KeralaNumber of patients
visiting Cancer care facility
RCC, Thiruvananthapuram
8
Logistics Distance Travelled
APAN-Healthcare-2009
9
Logistics Cost of Travel
APAN-Healthcare-2009
10
How to provide affordable cancer care

• Reduce overhead on patients by bringing Cancer
  care closer to them
• Facility for Early Cancer detection and diagnosis
  nearby
• Health education and awareness camps for the
  rural population

APAN-Healthcare-2009
11
Tele ONCOlogy NETwork

• Our Peripheral Clinics
• Malabar Cancer care Society, Kannur.
• Early cancer detection center, Palakkad.
• Early cancer detection center, Kochi.
• Early cancer detection center, Kollam.
• District cancer control cente, Kozhencheri.

APAN-Healthcare-2009
12
VSAT Network forONCONET
Satellite communication link Bandwidth provided
by ISRO (Totally free) Satellite INSAT 3C
Antenna 3.8 m Carrier Extended C Band
Bandwidth 384 kbps Failover mechanism 128
Kbps ISDN connection
APAN-Healthcare-2009
13
ONCONET

• CDAC launched ONCONET in Sept. 2004 at RCC and
  its peripheral clinics with Bandwidth offered
  totally free by Indian Space Research
  Organization (ISRO) through its VSAT facility.
• Currently RCC is linked with over a hundred
  hospitals across the country including areas with
  high military presence like Srinagar and Ladakh
  (2300 miles North), and geographically separated
  areas like Andaman and Lakshadweep islands

APAN-Healthcare-2009
14
ONCONET - Features

• Tele-medicine infrastructure at RCC and five
  peripheral clinics
• Tele-Pathology and Radiology systems
• High bandwidth connection between these centers (
  384 Kbps)
• Backup arrangement for connectivity through ISDN
  facility

APAN-Healthcare-2009
15
ONCONET Features

• Software - Web based Telemedicine software
  integrated with Hospital Information System
  software (TEJHAS)
• EHR, securely made available over the network at
  remote centres
• Oncology Resource Centre Cancer specific
  information made available at remote centres
  through a Digital Library

APAN-Healthcare-2009
16
TM Infrastructure

• Powerful Video Conferencing System
• Server system with software for Creation,
  storage, transfer and sharing of EHR of
  patients, Telemedicine PCs at clinics
• Tele Pathology / Radiology System with Digital
  Microscope, X Ray Film Scanner and software for
  
• Capture , storage and uploading of medical images
  
• Sharing and annotation of image between remote
  centres for discussion

APAN-Healthcare-2009
17
System Architecture
SPECIALTY CENTRE
PERIPHERAL CENTRE
Video- conferencing
Video-conferencing
VSAT Network with ISDN (Backup)
Telemedicine PC
TP / TR Server
ROUTER
Tele-medicine PC
ROUTER
Digital library
X-Ray Film Scanner
APAN-Healthcare-2009
LAN
Database App. Servers
Hospital Information System
Digital Microscope
RCC-Regional Cancer Centre Thiruvananthapuram
18
Tele-Pathology and Radiology systems
ECDC KANNUR
Images received from remote centres stored in
Server Experts view the image through viewing
station at their department. Experts prepare the
report and send to remote locations Doctors
share and view the images online and discusses
the case.
Network
Images captured from microscope X-Rays
Documents scanned Images locally stored DICOM CD
imported Patient folder sent to RCC, TVM Reports
received from remote expert doctor
ECDC KOCHI
RCC TRIVANDRUM
19
ONCONET SoftwareTelemedicine Enabled Hospital
Automation System (TEJHAS)
Comprises of all essential modules

• Support Services
• Cash Billing
• Central Stores
• Purchase
• Blood Bank
• Radiology
• Engineering
• C.S.S.D

• Back Office
• Enquiry
• MIS
• Master Data
• Users

APAN-Healthcare-2009
20
FINDINGS

• Patients on Chemotherapy can communicate with
  their physician regarding blood count and seek
  advice
• Early Intervention is facilitated
• Initial patient presentation and diagnosis is
  made in a primary sitting thereby avoiding
  unnecessary patient referrals and reducing
  patient load at RCC
• For specialty care, appointment is fixed through
  the system, thereby avoiding unnecessary delay

APAN-Healthcare-2009
21
Interpretation

• Number of emergency visit to the hospital is
  reduced
• Unnecessary referrals and admissions are avoided
• Routine follow-up visits are limited to
  peripheral clinics thereby avoiding unwanted
  expense

APAN-Healthcare-2009
22
Interpretation

• Saves cost to patient, provider and system
• Palliative care through close interaction with
  tertiary care physician
• Conduct distant medical education programs, panel
  discussions, nurses training programs and talks
  by doctors

APAN-Healthcare-2009
23
Usage Statistics( from 2004 onwards)(Available
online at www.rcctvm.org )
Remote Peripheral Centres No. of follow up Patients Money Saved by Patients in USD
KOCHI 9422 103950
KANNUR 3052 60650
PALAKKAD 262 4075
KOZHENCHERY 274 1575
KOLLAM 556 575
APAN-Healthcare-2009
24
Usage for Tele Education ( from 2004 onwards)
CME Programs 53
Panel Discussions 33
Nurses Training programs 41
Didactic talks by Academic staff 23
Public awareness campaigns 14
APAN-Healthcare-2009
25

• ONCONET
• goes
• National
• (ONCONET India)

APAN-Healthcare-2009
26
ONCONET India( National Tele Oncology Network)

• Establish knowledge enabled Tele Oncology network
  in India
• Connect 25 Regional Cancer Centres and 100
  peripheral centres ( 4 for each RCC) across the
  country
• Project Report approved by Ministry of Health,
  GOI implementation to start soon

APAN-Healthcare-2009
27
Regional Cancer Centres

1. Trivandrum
2. Chennai
3. Bangalore
4. Mumbai
5. Hyderabad
6. Cuttack
7. Gwalior
8. Kolkata
9. New Delhi
10. Allahabad
11. Patna
12. Bikaner
13. Shimla
14. Rothak
15. Gauhati
16. Aizwal
17. Nagpur
18. Ahmadabad
19. Pondicherry

APAN-Healthcare-2009
28
Telemedicine System
At RCCs

• Powerful Video Conferencing System LCD TV
• Tele consultation system consisting of
  Telemedicine PC with Telemedicine software which
  facilitates
• -- Creation, storage, transfer and sharing of
  Electronic Medical Record of patients
• Tele-Pathology / Tele-Radiology System with
  Digital Microscope and Scanner/Digital Camera
• -- Capture of medical images
• -- Uploading image to remote end
• -- Storage of image as part of EMR
• -- Sharing of image between remote centres for
  discussion

APAN-Healthcare-2009
29
System Configuration at RCC
Leased Line (384Kbps MPS L3 VPN)
Provided by BSNL

• Deliverables at RCC
• PC with software
• Video Conferencing System TV
• Film Scanner
• Digital Microscope
• UPS, Printer
• Networking items

Digital Microscope
Printer
384 Kbps
VCS
ROUTER
Scanner
Telemedicine PC
APAN-Healthcare-2009
Television
Internet
30
System Configuration at Peripheral Centres
BB VPN (384 Kbps)
Provided by BSNL

• Deliverables at Peripheral Centre
• PC with software
• Video Conferencing System and TV
• Film Scanner
• UPS, Printer
• Networking equipments

Scanner
384 Kbps
Printer
VCS
APAN-Healthcare-2009
Switch
Tele Medicine PC
Television
31
System Configuration at Hub location
2 Mbps Leased Line (MPLS L3 VPN)
256 Kbps Internet Leased Line
Multi Conferencing Unit
Internet access to all RCCs thru MPLS VPN
Router

• Services
• Portal
• Internet Browsing
• Multi Conferencing

APAN-Healthcare-2009
Video Streaming Server
ONCONET India Portal Server
32
NETWORK DIAGRAMS SHOWING HOW THE PROPOSED
NETWORK MEETS ONCONET -India FUNCTIONAL
REQUIREMENTS
APAN-Healthcare-2009
33
Proposed MPLS Network linking 25 RCCs
APAN-Healthcare-2009
34
OVERALL ARCHITECTURE of ONCONET India network
Peripheral Centre 1
Peripheral Centre 4
Peripheral Centre 4
Peripheral Centre 1
Peripheral Centre 1
Peripheral Centre 4
MPLS BACKBONE
384Kbps L3 VPN
Peripheral Centre 1
APAN-Healthcare-2009
RCC25
Peripheral Centre 4
Peripheral Centre 1
Peripheral Centre 4
35
Tele-consultation between one RCC and its
Peripheral center through Broadband VPN
APAN-Healthcare-2009
36
APAN-Healthcare-2009
37
Conclusion

• By this proposed system, the cancer patients from
  any part of India can get the consultation and
  treatment from any RCC in India
• The rest of India will follow ONCONET-Kerala
  pattern in the coming years
• This ONCONET- India with appropriate low-cost
  technology might be able to be duplicated as a
  model for developing countries with low capital
  inputs

APAN-Healthcare-2009
38
CONTACT Sudhamony S Additional Director /
Head, Medical Informatics Section Centre for
Development for Advanced Computing
(C-DAC), Thiruvananthapuram-695033.
Kerala INDIA. E-mail sudha_at_cdactvm.in Ph
91- 471- 272 1042  (D) / 272 3333 Ext 229 Mob.
No 91-98479 14872 (M) Fax [phone] /
272 2230
39
Applying Advanced Computing for Human Advancement
Thank You