Slide 1

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 Slide 2 22 2 A Scientific research organization of Ministry of Communication and Information Technology, Government of India Vision: To emerge as the premier R&D 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 C-DAC APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Centre for Development of Advanced Computing Slide 3 33 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 3/4/2009C-DAC Medical Informatics Slide 4 44 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 3/4/2009C-DAC Medical Informatics Slide 5 55 5 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 ONCONET APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 6 66 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 3/4/2009C-DAC Medical Informatics Slide 7 77 7 Statistics from Kerala Number of patients visiting Cancer care facility RCC, Thiruvananthapuram 3/4/2009C-DAC Medical Informatics Slide 8 88 8 Logistics Distance Travelled APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 9 99 9 Logistics Cost of Travel APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 10 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 3/4/2009C-DAC Medical Informatics Slide 11 11 Tele ONCOlogy NETwork Our Peripheral Clinics 1. 1.Malabar Cancer care Society, Kannur. 2. 2.Early cancer detection center, Palakkad. 3. 3.Early cancer detection center, Kochi. 4. 4.Early cancer detection center, Kollam. 5. 5.District cancer control cente, Kozhencheri. APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 12 12 VSAT Network for ONCONET 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 3/4/2009C-DAC Medical Informatics Slide 13 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 3/4/2009C-DAC Medical Informatics Slide 14 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 3/4/2009C-DAC Medical Informatics Slide 15 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 3/4/2009C-DAC Medical Informatics Slide 16 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 3/4/2009C-DAC Medical Informatics Slide 17 17 System Architecture TP / TR Server Digital Microscope RCC-Regional Cancer Centre Thiruvananthapuram Video- conferencing Telemedicine PC Digital library Hospital Information System Video- conferencing Tele-medicine PC ROUTER Database & App. Servers PERIPHERAL CENTRE VSAT Network with ISDN (Backup) X-Ray Film Scanner LAN SPECIALTY CENTRE APAN-Healthcare-2009 ROUTER 3/4/2009C-DAC Medical Informatics Slide 18 18 Tele-Pathology and Radiology systems ECDC KOCHI ECDC KANNUR Microsco pe DICOM CD Film / Document SCANNER DIAGNOSTIC Work Station cum SERVER WEB-Viewing Station @ Doctors desk 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 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. RCC TRIVANDRUM 3/4/2009C-DAC Medical Informatics Slide 19 19 ONCONET Software Telemedicine Enabled Hospital Automation System (TEJHAS) Core Services o o OP & IP Management o o Consultation o o Surgical Oncology o o Resource Scheduling o o Investigation o o Nuclear Medicine o o Radiation Oncology o o Chemotherapy o o Pharmacy Support Services o o Cash & Billing o o Central Stores o o Purchase o o Blood Bank o o Radiology o o Engineering o o C.S.S.D Back Office o o Enquiry o o MIS o o Master Data o o Users Comprises of all essential modules : APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 20 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 3/4/2009C-DAC Medical Informatics Slide 21 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 3/4/2009C-DAC Medical Informatics Slide 22 22 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 Interpretation APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 23 23 Usage Statistics ( from 2004 onwards) (Available online at www.rcctvm.org )www.rcctvm.org Remote Peripheral Centres No. of follow up Patients Money Saved by Patients in USD KOCHI9422 103950 KANNUR3052 60650 PALAKKAD262 4075 KOZHENCHERY274 1575 KOLLAM556 575 APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 24 24 Usage for Tele Education ( from 2004 onwards) CME Programs53 Panel Discussions33 Nurses Training programs 41 Didactic talks by Academic staff 23 Public awareness campaigns 14 APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 25 25 ONCONET goes National (ONCONET India) APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 26 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 3/4/2009C-DAC Medical Informatics Slide 27 27 ONCONET INDIA 1. 1. Trivandrum 2. 2. Chennai 3. 3. Bangalore 4. 4. Mumbai 5. 5. Hyderabad 6. 6. Cuttack 7. 7. Gwalior 8. 8. Kolkata 9. 9. New Delhi 10. 10. Allahabad 11. 11. Patna 12. 12. Bikaner 13. 13. Shimla 14. 14. Rothak 15. 15. Gauhati 16. 16. Aizwal 17. 17. Nagpur 18. 18. Ahmadabad 19. 19. Pondicherry 20. 20. Lucknow 21. 21. Chandigarh 22. 22. Raipur 23. 23. Imphal 24. 24. Srinagar 25. 25. Kancheepuram Regional Cancer Centres APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 28 28 Telemedicine System 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 At RCCs APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 29 29 System Configuration at RCC Deliverables at RCC 1. 1. PC with software 2. 2. Video Conferencing System & TV 3. 3. Film Scanner 4. 4. Digital Microscope 5. 5. UPS, Printer 6. 6. Networking items Deliverables at RCC 1. 1. PC with software 2. 2. Video Conferencing System & TV 3. 3. Film Scanner 4. 4. Digital Microscope 5. 5. UPS, Printer 6. 6. Networking items ROUTER VCS Television Telemedicine PC LAN Audio /Video USB Printer Scanner Digital Microscope 384 Kbps Internet Leased Line (384Kbps MPS L3 VPN) Provided by BSNL APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 30 30 System Configuration at Peripheral Centres Deliverables at Peripheral Centre 1. 1. PC with software 2. 2. Video Conferencing System and TV 3. 3. Film Scanner 4. 4. UPS, Printer 5. 5. Networking equipments Deliverables at Peripheral Centre 1. 1. PC with software 2. 2. Video Conferencing System and TV 3. 3. Film Scanner 4. 4. UPS, Printer 5. 5. Networking equipments Television Switch Tele Medicine PC Printer VC S 384 Kbps BB VPN (384 Kbps) Provided by BSNL Scanner APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 31 31 System Configuration at Hub location Router ONCONET India Portal Server Internet access to all RCCs thru MPLS VPN 256 Kbps Internet Leased Line Video Streaming Server Multi Conferencing Unit 2 Mbps Leased Line (MPLS L3 VPN) Services: 1. 1. Portal 2. 2. Internet Browsing 3. 3. Multi Conferencing APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 32 32 NETWORK DIAGRAMS SHOWING HOW THE PROPOSED NETWORK MEETS ONCONET -India FUNCTIONAL REQUIREMENTS APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 33 33 Proposed MPLS Network linking 25 RCCs APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 34 34 OVERALL ARCHITECTURE of ONCONET India network RCC4RCC2 RCC3 MPLS BACKBONE RCC25 Peripheral Centre 4 Peripheral Centre 1 RCC1 384Kbps L3 VPN Peripheral Centre 1 Peripheral Centre 4 384 Kbps BBVPN 384 Kbps BBVPN 384 Kbps BBVPN 384 Kbps BBVPN 384 Kbps BBVPN APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 35 35 Tele-consultation between one RCC and its Peripheral center through Broadband VPN APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 36 36 BSNL MPLS Backbone RCC 512Kbps BBVPN PE E1 link MCU, Video streamer & WEB PORTAL PE Group1 PE 256Kbps (1:1) Internet LL TELE-CONSULTATION between one RCC and its peripheral centre- data flow Tele-consultation between a RCC on MPLS VPN and a PC on BB VPN RCCs using MPLS VPN Peripheral Centers using Broadband VPN Central HUB APAN-Healthcare-2009 3/4/2009C-DAC Medical Informatics Slide 37 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 3/4/2009C-DAC Medical Informatics Slide 38 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@cdactvm.in Ph: 91- 471- 272 1042 (D) / 272 3333 Ext: 229 Mob. No: 91-98479 14872 (M) Fax: 91-471- 272 3456 / 272 2230 3/4/2009C-DAC Medical Informatics Slide 39 39 Applying Advanced Computing for Human Advancement 3/4/2009C-DAC Medical Informatics