Post on 07-May-2015
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Dr. Vinod KhandharMS(ENT), MS(GEN SURG), DIPLOMA IN LASER SURGERY (SPAIN), LLB.
TELEMEDICINE PROJECTS IN INDIA
INDIA
•INTRODUCTION•BENEFITS/UTILITIES•TYPES•PRESENT DAY SCENARIO•INFRASTRUCTURE•GOALS•NEEDS•CHALLENGES•RESULTS•DISCUSSIONS•CONCLUSIONS
OUTLINE
TELEMEDICINE
Click to add Title1 Improved diagnosis and better treatment management 1
Click to add Title22
Click to add Title1 Quick and timely follow-up of discharged patients
3
Click to add Title2 Access to computerized comprehensive data of patients, both offline & real time
4
1
Benefits to Healthcare Professionals
Continuing education and training
Benefits to patients
• Access to specialized health care services to under-served rural, semi-urban and remote areas
• Early diagnosis and treatment
• Access to expertise of Medical Specialists
• Reduced physician’s fees and cost of medicine
• Reduced visits to specialty hospitals
• Reduced travel expenses
• Early detection of disease
• Reduced burden of morbidity
Benefits to Government
Types of technology2 types
Store and forward
For non – emergency situations
Teleradiography, teleradiopathy & teledermatolgy
Two-way interactive televisionVideo-conferencing.
Almost equivalent to a face to face ‘real time’ consultation
HEALTHCARE IN RURAL INDIA
Psychiatry34%
Endocrinology9%
Neurology Peds5%
Nutrition Services
4%
Other19%
Dermatology29%
•70 % of India’s population live in rural areas
•90% of secondary & tertiary care facility are in cities and towns
•Low penetration of healthcare services
•Lack of investment in health care in rural areas
•Inadequate medical facilities in rural areas
• Problem of retaining doctors in rural areas specially the specialist doctors
SUPERSPECIALITY SERVICES REQUIRED (besides the basic medical health services)
Public Health Care Delivery Model
23,236 PHC1,46,026 Sub centers
3,346 CHC4,400 Dist. Hospitals1200 Other Public Hospitals
242 Medical colleges205 Dental colleges
Source : K. Park, 20th Ed.
Telemedicine: Ideal for India
• Area : 32,87,268 Sq. Km.
• Population : over 1 Billion
• Urban Rural Divide• Inaccessible hilly
regions, islands, desert, coasts, tribal areas
• Strong Fiber Backbone
• Indigenous satellite Communication technology in place
• IT trained Human resource
• Pilot Projects with Successful outcomes
SUPPORT
In India, telemedicine programs are being actively supported by:
• Department of Information Technology (DIT)• Indian Space Research Organization• NEC Telemedicine program for North-Eastern states• Apollo Hospitals• Asia Heart Foundation• State governments• Telemedicine technology also supported by some other
private organizations
Evolution of telemedicine
Point to
Point
• One patient connected to one doctor
• Within same hospital
Point to
Multi Point
•One patient end at a time connected to many specialist doctors•Within the same hospitalMultip
oint to Multip
oint
• Several patient ends connected to several different specialist doctors
• At different hospitals, in different geographical distances
Telemedicine :
ways of communication
DIT INITIATIVES
DIT has taken following leads in Telemedicine: Development of Technology
Initiation of pilot schemes Selected Specialty e.g. Oncology, Tropical Diseases General telemedicine system covering all specialties
Standardization
Framework for building IT Infrastructure in health
National Task Force on Telemedicine(2005)
Benefits for Health Care Delivery
System
Benefits to patients
Benefits to HealthCare Professionals
• Health, Communication & Information Technology
• Indian Space Research Organization
• Indian Council of Medical Research
• Medical Council of India • Center for Development of
Advanced Computing • Academic medical institutions
and corporate hospitals
Includes members from the following departments
Utility of NRTN
•To provide access to timely and quality specialty medical care to the people living in rural & remote areas.•To reduce rural urban divide in delivery of medical care•To improve diagnosis and treatment facilities in rural areas •To mitigate the obstacles due to geographical isolation• To provide continuous medical education and training to the healthcare professionals working in rural/remote areas
PROPOSED OBJECTIVES OF NRTN
Tele-consultation room Patient engagement facilities (bed, scopes,
etc.) Selective medical and medico-IT equipments,
preferably IT compatible, with interface to Telemedicine and/or other software / hardware
Computer hardware / software platform (PC, switch, etc.) and IT electronics equipments
Mobile vans are a part of telemedicine service
LEVEL-1:Software &Hardware
Digital ECG4
Desktop PC platform with Laser Printer1
2IP Video Conferencing Kit
3
A3 Film Scanner5
6 Digital Microscope & Camera
7
Tele medicine software
8
Glucometer & Haemogram analyzer
Non-invasive Pulse & Blood Pressure unit
Connectivity device & Router9
GOALS AND NEEDSLooking to the past experience for success of telemedicine:• Video conferencing
•Accompanied by data and image transfer (live)
• Common software usage at both ends, thus globalization of a single database software
•Role of trained technical personnel is equally important and necessary at the patient end.
•Successful remuneration system to attract private practitioners
•It is feasible to set up a National Health Grid to be shared by healthcare providers, trainers & beneficiaries taking the advantage of a • strong fiber backbone• indigenous satellite communication technology• large trained manpower
•The ground work has also been established by • ISRO• DIT• State Governments • Specialty Institutes/ Hospitals
•National Rural Telemedicine network will help to provide quality healthcare where there is none and will improve healthcare where there is some
Plus points
• Low bandwidth Neither telephone lines nor electricity in rural
areas International bandwidth of RAFT countries is very
limitedEnd 2004: 18 Mbps for the entire country, 1,34 bps/capita (Mali)Switzerland 2002: 66.000 Mbps, 9.040 bps per capita(Source: ITU World Telecommunication Indicators Database)
Satellite transmission can help but is pricey Mobile communication is gaining ground
• Unstable electricity supply.
CHALLENGES
CHALLENGES
• Patients' fear and unfamiliarity• Financial unavailability• Lack of basic amenities• Literacy rate and diversity in languages• Quality aspect• Government Support• Perspective of medical practitioners
Pragmatism and the realism with tools adapted to the context must remain the rule.
India is a booming economy
Telemedicine is a new yet extremely lucrative concept
With the right marketing and government approach, combined with hard efforts in the right direction, this can bea huge success!
DISCUSSIONS
CONCLUSION
Paraphrasing Neil Armstrong,
“ Telemedicine: one small step for IT , a giant leap for Healthcare!”
1. Brown N. A brief history of telemedicine. Telemedicine Information Exchange. 1995;105:833–5.2. Ganapathy K. Neurosurgeon, Apollo Hospitals, Chennai, Telemedicine in India-the Apollo experience, Neurosurgery on the Web. 2001. 3. Bashshur RL, Armstrong PA, Youssef ZI. Telemedicine: Explorations in the use of telecommunications in health care. Springfield, IL: Charles C Thomas; 1975. 4. Bashshur R, Lovett J. Assessment of telemedicine: Results of the initial experience. Aviation Space Environ Med. 1977;48:65–70.5. Bashshur R. Superintendent of Documents. Washington DC: US Government Printing Office; 1980. Technology serves the people: The story of a cooperative telemedicine project by NASA, the Indian Health Service and the Papago people.6. Watson DS. Telemedicine. Med J Aust. 1989;151:62–66. 8,71. [PubMed]7. Foote D, Hudson H, Parker EB. National Technical Information Service (NTIS) Springfield, VA: US Department of Commerce; 1976. Telemedicine in Alaska: The ATS-6 satellite biomedical demonstration.8. Allen A, Allen D. Telemedicine programs: 2nd annual review reveals doubling of programs in a year. Telemedicine Today. 1995;3(1):10–4.9. Report of the Technical Working Group on Telemedicine Standardization, Technical working group for Telemedicine Standardization Department of Information Technology (DIT), Ministry of Communications and Information Technology (MCIT), May 2003.10. Houtchens BA, Allen A, Clemmer TP, Lindberg DA, Pedersen S. Telemedicine protocols and standards: Development and implementation. J Med Sys. 1995;9(2):93–119.11. Balas EA, Jaffery F, Pinciroli F. Patient care from a distance: Analysis of evidence. Annu Meet Int Soc Technol Assess Health Care. 1996;12:17.12. Grigsby J, Schlenker RE, Kaehny MM, et al. Analytic framework for evaluation of telemedicine. Telemedicine J. 1995;1(1):31–39.13. Bedi BS. Telemedicine in India: Initiatives and Perspective, eHealth 2003: Addressing the Digital Divide-17th Oct. 2003. 14. Mexrich RS, DeMarco JK, Negin S, et al. Radiology on the information superhighway. Radiology. 1995;195(1):73–81. [PubMed]15. Brown N. Telemedicine coming of age. TIE. 1996 Sep 28;16. Wachter GW. Telecommunication, linking providers and patients. Telemedicine Information Exchange. 2000 Jun 30;17. Kopp S, Schuchman R, Stretcher V, Gueye M, Ledlow J, Philip T, et al. Telemedicine. Telemedicine J E-health. 2002;8:18.18. Grigsby B, Brown N. ATSP Report on US Telemedicine Activity: Portland; 1999 or Association of Telehealth Service Providers.
REFERENCES
THANK
YOU!