
2/27

Content

1.Ee!"tive #"mmary....................................................................................................$

%.Introd"!tion.................................................................................................................$

$.a!'(ro"nd.................................................................................................................$).*"rrent #!enario..........................................................................................................)

+.#!ope of the Pro,e!t....................................................................................................-

-.Epe!ted enefits........................................................................................................-

.Proposed G"idelines / Frameor' for Indian "ral 2elemedi!ine 3etor'..............

.1.Definin( a 3ational "ral 2elemedi!ine 3etor'...............................................

.%.#tandardi4ation 5First #tep 2oards 3ational "ral 2elemedi!ine 3etor'......6

.$.*onstit"ents of 2elemedi!ine 3etor'.................................................................6

.$.1.7EVE7819 Primary Health *enter :PH*; / *omm"nity Health *enter :*H*;

/ Villa(e


3/27

1. EXECUTIE SU!!AR"

#. INTR$%UCTI$N

India is the se!ond most pop"lo"s !o"ntry of the orld and has !han(in( so!io8

politi!al8demo(raphi! and mor>idity patterns that have >een drain( (lo>al attention

in re!ent years. Despite several (roth8orientated poli!ies adopted >y the

(overnmentB the idenin( e!onomi!B re(ional and (ender disparities are posin(

!hallen(es for the health se!tor. C>o"t + of health infrastr"!t"reB medi!al manpoer and other health reso"r!es are !on!entrated in "r>an areas here % of the

pop"lations live. *onta(io"sB infe!tio"s and ater>orne diseases s"!h as diarrhea,

amoebiasis, typhoid, infectious hepatitis, worm infestations, measles, malaria,

tuberculosis, whooping cough, respiratory infections, pneumonia and reproductive

tract infectionsdominate the mor>idity patternB espe!ially in r"ral areas. HoeverB

non8!omm"ni!a>le diseases s"!h as cancer, blindness, mental illness, hypertension,

cardio vascular disorders, diabetes, HIV/AIDS, accidents and injuries are also on the

rise. 2he health stat"s of IndiansB is still a !a"se for (rave !on!ernB espe!ially that of

the r"ral pop"lation. 2his is refle!ted in the life epe!tan!y :-$ years;B infant

mortality rate :60/1000 live >irths;B maternal mortality rate :)$6/100 000 live >irths;

hoeverB over a period some pro(ress has >een made. 2o improve the prevailin(sit"ationB the pro>lem of r"ral health is to >e addressed at >oth ma!ro :national and

state; and mi!ro :distri!t and re(ional; levels. 2his is to >e done in a holisti! ayB

ith a (en"ine effort to >rin( the poorest of the pop"lation to the !entre of the fis!al

poli!ies. C paradi(m shift from the !"rrent >iomedi!al model to a so!io8!"lt"ral

modelB hi!h sho"ld >rid(e the (aps and improve @"ality of r"ral lifeB is the !"rrent

need. C revised 3ational Health Poli!y addressin( the prevailin( ine@"alitiesB and

or'in( toards promotin( a lon(8term perspe!tive planB mainly for r"ral healthB is

imperative. e!ent la"n!h of 3ational "ral Health Mission :3HM; >y the Ministry

of Health & Family Welfare is a step in this dire!tion.

&. 'AC(GR$UN%

India lives in its villa(esB so said Mahatma GandhiB Father of the 3ationB >"t the

!o"ntry todayB after -0 years of independen!eB is !hara!teri4ed >y lo penetration of

health!are servi!es to its villa(e pop"lation. Even tho"(h there have >een several

initiatives ta'en >y >oth the Government and the Private se!torB the r"ral and remote

areas !ontin"e to s"ffer from a>sen!e of @"ality health!are servi!es. 2he health

indi!ators of the nation are in dismal sit"ation even after implementation of several

nationide pro,e!ts to improve it. e!entlyB the "nion (overnment has adopted a

mission approa!h to >oost the p">li! health for the masses >y la"n!hin( 3ational

"ral Health Mission :3HM;. Ane of the o>,e!tives of the 3HM is to provide ther"ral pop"lation a!!ess to health!are servi!es. In this !ontetB 2elemedi!ineB an

information and !omm"ni!ation te!hnolo(y >ased toolB has the potential to assist in

$


4/27

ele!troni! delivery of dia(nosti! and health!are servi!es to remote r"ral pop"lation

even in the a>sen!e of physi!al infrastr"!t"re in pla!e th"s !an !reate a platform to

netor' India. 2elemedi!ine helps to provide health!are here there is none and

improve health!are here there is some.

2he fa!t is that hile 0 of o"r pop"lation lives in r"ral India =0 of se!ondary &

tertiary !are fa!ilities are in the !ities and tons far aay from the r"ral India. Ct the

same timeB it is also a fa!t that a si(nifi!ant proportion of patients in these remote

lo!ations !o"ld >e s"!!essf"lly mana(ed ith some advi!e and ("idan!e from

spe!ialists and s"per8spe!ialists in the !ities and tons. 2his is the poer of

2elemedi!ine. It is no s"rprise that 2elemedi!ine is playin( an in!reasin(ly important

role in not only providin( dia(nosti! and !ons"ltation servi!es >"t also in fa!ilitatin(

2ele8ed"!ation and trainin( of personnel a!ross the !o"ntry.

). CURRENT SCENARI$

C n"m>er of initiatives are "nderay in the area of telemedi!ine ith the o>,e!tive

for providin( @"ality !ons"ltation and !arin( for patients in areas here spe!iali4ed

patient !are is not availa>le. Cltho"(h telemedi!ine implementation remains in its

infan!yB interest and a!tivity appears to >e (roin( to provide !ons"ltation of a

#"per8spe!ialty do!tor from a distan!e thro"(h video!onferen!in( alon( ith

e!han(e of medi!al re!ords online. In addition to ma,or s"pport and thr"st provided

>y DI2 thro"(h pro,e!ts and systemsB or(ani4ations li'e I#AB rep"ted a!ademi!

medi!al instit"tions li'e #GPGIB CIIM#B PGIMEB CIM#B #M* and !orporate

hospitals li'e Csia Heart Fo"ndationB Cpollo HospitalsB #GHB FortisB Ma et!. have

ta'en and !ontin"in( to ta'e si(nifi!ant initiatives for installation of telemedi!ine

systems at different parts of the !o"ntry.

2he Department of Information 2e!hnolo(y :"nder M*I2; has ta'en a pivotal role in

definin( and shapin( the f"t"re of 2elemedi!ine appli!ation in India. a!'ed >y a

stron( vision to >"ild a national 2elemedi!ine 3etor' in IndiaB DI2 has >een

involved at m"ltiple levels 5 this in!l"des Development of 2e!hnolo(yB Initiation of

pilot s!hemes and standardi4ation of 2elemedi!ine in the !o"ntry. #ome of these are

>riefly des!ri>ed >elo.

DI2 has f"nded development of 2elemedi!ine softare systems8 the prominent ones

>ein( Mer!"ry and #an,eevani softare >y *8DC*. DI2 has also sponsored the

telemedi!ine pro,e!t !onne!tin( three premier medi!al instit"tions8 vi4. #GPGIB7"!'noB CIIM#B 3e DelhiB and PGIMEB *handi(arh8 "sin( I#D3 !onne!tivity.

2hese hospitals as in t"rn !onne!ted to other state level hospitals.

DI2 Implemented 2ele8medi!ine foe Dia(nosis & Monitorin( of tropi!al diseases in

West en(al "sin( lo speed WC3B developed >y We>el :ol'ata;B II2B hara(p"r

and #!hool of 2ropi!al Medi!ineB ol'ata. 2he system has >een installed in #!hool of

2ropi!al Medi!ine ol'ata and to Distri!t Hospitals.

#imilarlyB DI2 has f"nded esta>lishment of an An!olo(y 3etor' for providin(

2elemedi!ine servi!es in !an!er dete!tionB treatmentB pain reliefB patient follo8"p

and !ontin"ity of !are in peripheral hospitals :nodal !enters; of **. 2he pro,e!t asimplemented >y *8DC*B 2rivandr"m and e(ional *an!er *enter :**;B

2rivandr"m. 2he erala An!o3E2 model has >een repli!ated >y DI2 at **B Cdiyar

)


5/27

in *hennai ith *8DC*s Mer!"ry 2elemedi!ine #ol"tion. #"!!ess of the !an!er

netor' in erala has >een adopted >y the Ministry of Health & Family WelfareB

Government of India to ta'e ma,or step toards la"n!hin( 3ational *an!er *are

3etor'.

Clso pro,e!ts on settin( "p of telemedi!ine fa!ilities at to referral hospitals and fo"r

Distri!t hospitals "sin( West en(al #tate Wide area netor' of % M>psB and settin(

"p 2elemedi!ine and 2ele8ed"!ation :!ontin"in( Medi!al Ed"!ation ; fa!ilities in

erala !onne!tin( e(ional *an!er *enter :**;B #ri *hitra 2hir"nal Instit"te of

Medi!al #!ien!es:#*2IM#2;B Medi!al *olle(e Hospital :M*H; and 2rivandr"m

Medi!al *olle(e :2M*;. 2rivandr"m ith fo"r hospitals at 2al"' and Distri!t level

"sin( I#D3 !onne!tivity is implemented ith *8DC*s Mer!"ry 2elemedi!ine

#ol"tion.

#everal state level 2elemedi!ine netor' li'e erala state 2elemedi!ine 3etor'B

2amilnad" state 2elemedi!ine 3etor'B Haryana & Pan,a> state 2elemedi!ine

3etor'B et!. are !omin( "p as pilot pro,e!t and have shon promisin( res"lts.

In additionB three state !apital distri!t level hospitals in north eastern states of India

are (ettin( !onne!ted ith s"per8 spe!ialty hospitalsB one at ohimaB 3a(aland

already >ein( operational. Cnother one lin'in( one ea!h state level hospital in #i''im

and Mi4oram ith Indraprastha Cpollo Hospital is eample of P">li!8Private

2elemedi!ine 3etor' in pla!e and "nder effe!tive "se.

In a short span of timeB some si(nifi!ant pro(ress has >een a!hieved in the field of

2elemedi!ine in India. HoeverB there is still a lon( ay to (o. While there are over

%0B000 PH*s providin( primary !are servi!es in the r"ral areasB and a>o"t +00

distri!t hospitalsB 2elemedi!ine has rea!hed to a>o"t 100 !enters and more +0 ofthem are in the "r>an !enters only.

If e ere to loo' at a five8 year hori4on for 2elemedi!ine in IndiaB efforts o"ld >e

!onsidered s"!!essf"l only if e have 2elemedi!ine rea!hin( o"t to at least all distri!t

and 2al"' level hospitals thro"(ho"t the !o"ntry. "t for this to >e a realityB e need

a ma,or thr"st not from the Government and Private #e!tor >"t also help from

International a(en!iesB hi!h ill (o a lon( ay in a!hievin( this o>,e!tive.

Ane of the 'ey fa!tors to s"!!ess of 2elemedi!ine in India is (oin( to >e the relia>ility

of tele!omm"ni!ation lin'. In this !ontetB it is of !onsidera>le si(nifi!an!e the

!ommitment made >y I#A *hairman to provide free >andidth for the p"rpose of2elemedi!ine and 2ele8ed"!ation. I#A has >een deployin( satellite >ased

telemedi!ine nodes in !olla>oration ith state (overnments. #o far it has deployed

aro"nd %+0 nodes a!ross the !o"ntry.

Ministry of Health and Family Welfare has set "p a 3ational 2as' For!e to address

vario"s iss"es to promote telemedi!ine in the !o"ntry and has la"n!hed a ma,or

!o"ntry ide netor' of distri!t hospitals and medi!al !olle(es "nder the Inte(rated

Disease #"rveillan!e Pro,e!t. 3ational *an!er *are 3etor' and Medi!al *olle(es

netor' are (oin( to >e implemented in the near f"t"re.

In vie of a n"m>er of la"da>le >"t disparate efforts and initiativesB need for an overar!hin( ar!hite!t"re/ frameor' for the !o"ntry !overin( $ levelsB namelyB PH* to

Distri!tB Distri!t to referral/ #"per8spe!ialty hospitals and also !overin(

+


6/27

hardare/softare re@"irementsB >andidth and !onne!tivity iss"es has >een felt.

2his paves the ay for introd"!tion of inte(rated telemedi!ine netor' in India.

Fi>er opti! netor' a!ross the !o"ntry has >een laid don >y >oth (overnment /

p">li! se!tor and private tele!omm"ni!ation servi!e providers pavin( the ay for

availa>ility of hi(h >andidth terrestrial !onne!tivity to >"ild ">i@"ito"s health

netor' for telemedi!ine !o"ntry ide ith !ompetin( pri!e. What started as

appli!ation of s!ien!e and te!hnolo(y in the field of telemedi!ine >y the MinistryB it

has no (ot a si(nifi!ant attention as an important national pro(ramme

*. SC$+E $, T-E +R$ECT

Desi(nB development and implementation of lo !ost r"ral telemedi!ine

infrastr"!t"re !onsistin( of fiedB mo>ile and hand8held platforms and e>

te!hnolo(y >ased >road >and ired / ireless ide area netor' !enterin( aro"nd

the distri!t hospital a!tin( as h">.

Desi(n and development of JVilla(e 2ele8am>"lan!e #ystem and r"ral emer(en!y

health!are servi!es / 2ra"ma !are mod"leKB a ne !on!eptB thro"(h mo>ile

telemedi!ine netor' >ased on Wi8MCL ireless mesh netor'

Development of "ral Health noled(e eso"r!e thro"(h e> portal on p">li!

health domain and !reation of e8*ME mod"le for its a!!ess >y the sta'e holders

thro"(h e8learnin( te!hnolo(y on the telemedi!ine platform

Development of te!hnolo(y platform for harvestB !ompilationB stora(e :Data ase;

at re(ional distri!t h"> and !entral Data *enter at MAH & FWB ar!hive and

distri>"tion a!ross netor'.

/. EX+ECTE% 'ENE,ITS

2imely a!!ess to dia(nosti!B spe!ialty health!are advi!e at the (rass root level

thro"(h the lo !ost telemedi!ine netor' !enterin( aro"nd the distri!t hospital as

the servi!e provider

C"(mented r"ral health!are delivery system >y inte(ration of lo !ostBs"staina>leB s!ala>le fiedB mo>ile and hand8held telemedi!ine te!hnolo(y

platform into eistin( r"ral health!are servi!es infrastr"!t"re

*reation of a model for "ral Emer(en!y / 2ra"ma servi!es on 2elemedi!ine

infrastr"!t"re

Improvement on 'noled(e >ase of the r"ral pop"lation :to empoer the r"ral

fol's on self health!are 5 disease prevention & health promotion;

emote ed"!ationB trainin( / retrainin( and s'ill development of (rass root

health!are or'ers and professionals "nder 3HM

-


7/27

Ens"rin( p">li! health related data :as has >een in!orporated "nder 3HM;

harvest B !ompilationB stora(e at distri!t h">B ar!hive and distri>"tion a!ross

netor' to fa!ilitate ele!troni! (overnan!e of 3HM.

0. +R$+$SE% GUI%EINES 2 ,RA!E3$R( ,$R IN%IAN RURA

TEE!E%ICINE NET3$R(

0.1. %e4ining a National Rural Telemedicine Network

While I#A is providin( free >andidth thro"(h V #C2 !onne!tivityB e are also

loo'in( forard to definin( a modal for a 3ational 2elemedi!ine !onne!tivity GID

on hy>rid model "tili4in( eistin( terrestrial fi>er opti! and "p!omin( ireless media

te!hnolo(y. 2his o"ld loo' at "tili4in( >andidth a!ross different !omm"ni!ation

lin's dependin( on the appli!ation and the investment !onsiderations. 2he spe!ifi!

str"!t"re of any parti!"lar telemedi!ine !enter of the netor' o"ld depend on the(eo(raphi! fa!tors of the area that ill >e servi!ed >y the netor'B and the type of

lo!al "sers there. We vis"ali4e the 3ational "ral 2elemedi!ine 3etor' to >e a

tiered hierar!hi!al str"!t"re. 2his o"ld in!l"de9

EE516Primary Health *enter :PH*; / *omm"nity Health *enter :*H*;

connected to a District Hospital

EE5#6Distri!t Hospital connected to a State Hospital / ational Super

Specialty Hospital

EE5&6#tate Hospital / 3ational #"per #pe!ialty Hospital connected to

each other

EE5!6 Mo>ile 2elemedi!ine asis of spe!ialtyand re@"irement of se!ond / third / nth opinion.

In definin( the 3ational "ral 2elemedi!ine 3etor'B sele!tin( the !onne!tivity ill

>e definin( fa!tor in rea!hin( o"t to distant lo!ations in!l"din( here traditional land

>ased !omm"ni!ation systems have not yet rea!hed or are pla("ed >y poor

!onne!tivity.

2his netor' needs to >e >ased on open platform and on open ar!hite!t"re standards

that ma'e it a!!essi>le to one and all. It o"ld not >e restri!tive in any ay 5 and any

party interested to !ontri>"te to or >enefit from this no>le appli!ation o"ld >e a>le to

do so. Developin( an ade@"ate and afforda>le telemedi!ine infrastr"!t"re !an help to!lose the (ap >eteen the haves and the have8nots in health !are.


8/27

0.#. Standardi7ation 8,irst Ste9 Towards National Rural Telemedicine

Network

Cs a startin( point of >"ildin( the 3ational "ral 2elemedi!ine 3etor'B MoH&FW

has initiated definin( the national standards and ("idelines for 2elemedi!ine

appli!ation in IndiaB in !ons"ltation ith DI2B M*I2. 2elemedi!ine or'in( (ro"p

set"p has already finali4ed a n"!le"s frameor' J$ecommendation on %uidelines,

Standards and !ractices for &elemedicine in India.K Definin( standards no ill

ins"re that all o"r systems are interoperableand are a>le to !omm"ni!ate ith ea!h

other instead of >ein( restri!tive and limited to a parti!"lar provider netor'. What

this means is that if a !enter has a 2elemedi!ine system already implementedB it !an

tal' to another !enter ith different 2elemedi!ine #ystem as lon( as they adhere to

the defined standards. 2his ill also form the >asis of !olla>orations 8 >eteen the

(overnment and private players as ell as >eteen different private players 5 ith the

patients >ein( the final >enefi!iaries.

0.&. Constituents o4 Telemedicine Network

C telemedi!ine netor' in!orporates folloin( !omponents in addition to *ons"ltin(

Do!tors and #"per #pe!ialty *ons"ltants at >oth re!ipient and referral hospitals9

0.&.1. EE516 +rimar: -ealth Center ;+-C< 2 Communit: -ealth Center

;C-C< 2 illage Unit

2ele8!ons"ltation room

Patient en(a(ement fa!ilities :>edB s!opesB et!.;

2elemedi!ine Platformo #ele!tive medi!al and medi!o8I2 e@"ipmentsB prefera>ly I2 !ompati>leB

ith interfa!e to 2elemedi!ine and/or other softare / hardare

o *omp"ter hardare / softare platform :P*B sit!hB et!.; and I2

ele!troni!s e@"ipments

*onne!tivity / >andidth re@"irements :e.(. I#D3B 7eased lineB V#C2B

road>andB Wireless;

Point8to8Point video8!onferen!in( system :may >e porta>le;

0.&.#. EE5#6 %istrict -os9ital

2elemedi!ine room

Patient en(a(ement fa!ilities :>edB s!opesB et!.;

2elemedi!ine Platform

o #ele!tive medi!al and medi!o8I2 e@"ipmentsB prefera>ly I2 !ompati>leB

ith interfa!e to 2elemedi!ine and/or other I2 softare / hardare

o *omp"ter hardare / softare platform :P*B serverB sit!hB et!.; and I2


*onne!tivity / >andidth re@"irements :e.(. I#D3B 7eased lineB V#C2B road

>andB Wireless;

M"lti8point video !onferen!in( system Aptional telemedi!ine softare a!!ess fa!ility at !ons"ltants room thro"(h

Hospital87C3

6


9/27

Aptional se!"re !entrali4ed lon(8term ele!troni! re!ord stora(e for assi(ned

7EVE781 and 7EVE78M "nits


road>andB Wireless;

3ote that9

o Distri!t Hospital may a!t as referrin(/!ons"ltin( "nit as ell and mayhave some medi!al e@"ipments for tele8!ons"ltation ith #tate Hospital /

3ational #"per #pe!ialty Hospital

o Cll "nits ill re@"ire m"ltiple telemedi!ine stations for sim"ltaneo"s tele8

!ons"ltation ith referrin( "nits

0.&.&. EE5&6 State -os9ital 2 National Su9er S9ecialt: -os9ital

2elemedi!ine room

2elemedi!ine Platform

o *omp"ter hardare / softare platform :P*B serverB sit!hB et!.; and I2


*onne!tivity / >andidth re@"irements :e.(. I#D3B 7eased lineB V#C2B road

>andB Wireless;

M"lti8point video !onferen!in( system

Aptional telemedi!ine softare a!!ess fa!ility at !ons"ltants room thro"(h

Hospital87C3

Aptional se!"re !entrali4ed lon(8term ele!troni! re!ord stora(e for assi(ned

7EVE781B 7EVE78%B and 7EVE78M "nits


road>andB Wireless;

3ote that9

o Cll "nits ill re@"ire m"ltiple telemedi!ine stations for sim"ltaneo"s tele8

!ons"ltation ith referrin( "nits

0.&.). EE5!6 !o=ile Telemedicine Unit >

C"tomo>ile Vehi!le

o *hasis #i4e9 +.= L %.166 L 1.=00 mts

o *"stomi4ed fa>ri!ation to a!!ommodate I2 and medi!al e@"ipmentso Inte(rated DG set

o #pa!e for tele8!ons"ltationB patient eamination

o #pa!e for !arryin( o"t investi(ation pro!ed"res li'e andB Wireless;

Point8to8Point video8!onferen!in( system :may >e porta>le;

=


10/27

esides vansB Mo>ile 2elemedi!ine "nits !an >e !"stomi4ed for

deployment in any of the folloin(9

o oat :e.(. for appli!ation on >a!' ater re(ions in erala or in

rahmap"tra in Cssam;

o *hha'ras :e.(. "sed in G",arat;

o

*amel *arts :e.(. in deserts of a,asthan; Cppli!ation spe!ifi! mo>ile "nits !an >e !onfi("red9

o 2ele8ophthalmolo(y

o 2ele8*an!er !are

o 2ele8Cm>"lan!e for 2ra"ma 3etor' and "ral Emer(en!y system

o #"it!ase8>ased 2elemedi!ine mod"le for Disaster8hit areaB et!.

o Mo>ile hand held "nits to a!t as data harvestin( point for 3HM at the

(rass8root level

? Ea!h state ill have initially 0%80) "nits dependin( on the si4e and pop"lation.

ClternativelyB the mo>ile vans pro!"red "nder 3HM may >e made telemedi!ine8

ena>led ith s"ita>le modifi!ations and installations.

0.&.*. NR-! Smart Card

Ct lo investmentB e !an have the r"ral !iti4en health re!ord in!orporatin( life time

health events startin( from !radle to (rave. Hen!eB this devi!e inte(ration "nder "ral

2elemedi!ine netor' may >e !onsidered.

0.). +rocess and In4rastructure Guidelines at %i44erent a:ers o4 -ierarch:

0.).1. Telemedicine +rocess 4or EE5! and EE51 units

2he proposed Mo>ile 2elemedi!ine ased health !enter !aterin( to r"ral pop"lation. 2he Mo>ile

2elemedi!ine e sent to Distri!t Hospital and (et the se!ond / epert opinion.

2ypi!allyB these !enters do not have very (ood dia(nosti! fa!ilitiesB hen!eB some >asi!

e@"ipment o"tlined >elo needs to >e installed herever not present.

*omm"ni!ation lin' >eteen 7EVE781 and Distri!t Hospital :7EVE78%; !o"ld >e

thro"(h Wi8MCLB road>andB or V8#C2 !onne!tivity dependin( on availa>ility. C

s"stained >andidth of +1% '>ps or more for video!onferen!e and data transmission

is deemed s"ffi!ient.

asi! set"p ill have a sin(le m"ltimedia !omp"ter system and IP8>ased Video

!onferen!e system ith P2 fa!ility. Dia(nosti! reports of the patient are forarded

to Distri!t Hospital "sin( the telemedi!ine softare system. Film #!anner may >e

"sed for sendin( L8ray / *2 / MI ima(es and 2ele8mi!ros!opy system to send smear

for parasite in >lood and "rine for >a!teriolo(i!al st"dies. CdditionallyB a di(ital E*G

devi!e may also >e provided. C >asi! printer may also >e provided for printin( reportand re!ords for distri>"tion to patient.

10


11/27

2he telemedi!ine f"n!tionality at these "nits may >e either9

C self8s"ffi!ient system ith a>ility to !reate and maintain lon(8term

ele!troni! medi!al re!ord :EM; of patientB vieB !onne!tB transmitB and

retrieve epert opinion. 2his model s"pports offlineB onlineB and intera!tive

telemedi!ine !reatin( !omplete te!hnolo(i!al >ase of all types of servi!es /

modalities.

C e>8>ased / thin8!lient a!!ess to #ervers at 7EVE78%. 2his model

s"pports offlineB and e>8>ased telemedi!ine !reatin( s"ffi!ient and !ost8

effe!tive te!hnolo(i!al >ase of all types of servi!es / modalities. HoeverB

in this modelB the "nit sho"ld >e a>le to lo!ally !reate ne re!ord of ne

patient :some type of red"!ed f"n!tion >"t still "sa>le; in !ase of

dis!onne!tion ith 7EVE78% servers. 2he lo!ally !reated re!ords sho"ld

>e "ploaded to 7EVE78% server hen !onne!tivity is restored.

0.).#. Telemedicine +rocess 4or EE5# and EE5& units

2he proposed set"p at Distri!t Hospital :7EVE78%; has d"al p"rpose. It a!ts as a

referral "nit for all 7EVE781 and 7EVE78M "nits assi(ned to it. It also a!ts as a data

!olle!tion and referrin( "nit for 7EVE78$ "nits. Film #!anner may >e "sed for

sendin( L8ray / *2 / MI ima(es and 2ele8mi!ros!opy system to send smear for

parasite in >lood and "rine for >a!teriolo(i!al st"dies. CdditionallyB a di(ital E*G

devi!e may also >e provided. C mid8si4e printer may also >e provided for printin(

report and re!ords for distri>"tion to patient and provide hard8!opy reports to eperts /

spe!ialist for dis!"ssion / deli>eration.

2he 7EVE78$ "nits are p"rely referral in nat"re and provide epert opinion on data

sent from Distri!t Hospitals or those (enerated at PH* level and then forarded >yDistri!t Hospitals assi(ned to it.

D"e to nat"re of these "nits >ein( referral in nat"reB ith m"ltiple loer level "nits

!onne!tin(B transmittin( dataB and re@"irin( epert opinion / interventionB it is

ne!essary to provide m"ltiple telemedi!ine stations at these lo!ations. 2hese "nits ill

have m"lti8point video8!onferen!in( system so that it !an !ater to vario"s lo!ations at

a time.

*omm"ni!ation lin' >eteen 7EVE78% and 7EVE78$ "nits !an >e over terrestrial

fi>er opti! !a>lesB Wi8MCLB road>andB I#D3B or V8#C2 !onne!tivity dependin( on

availa>ility. C s"stained >andidth of +1% '>ps or more for video!onferen!e and %+-

'>ps per sim"ltaneo"s data transmission is deemed s"ffi!ient.

#et"p at ea!h s"!h lo!ation ill !onsist of a #erver :or a #erver farm in !ase of lar(e

load; ith m"ltiple !lient / a!!ess "nits for telemedi!ine. Fail8safe lon(8term data

stora(e servers to store data (enerated at lo!al lo!ation and loer8levels need to >e

esta>lished. 2o promote anytime/anyhere telemedi!ine a!!essB all !ons"ltants in the

pro(ram sho"ld >e provided ith a!!ess s"pport at their room in hospital thro"(h

hospital 7C3. CdditionallyB some a!tive !ons"ltants may >e provided dial8"p or Wi8

Fi a!!ess from a laptop dependin( on nearness to the fa!ility.

2he telemedi!ine f"n!tionality at these "nits may >e either9

C #erver / *lient system ith a>ility to !reate and maintain lon(8term

ele!troni! medi!al re!ord :EM; of patientB vieB !onne!tB

11


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13/27

o Aphthalmos!ope

o Mo>ile le L8ray oard CID *ontroller and Hot8sap dis's

o % $- G #*#I / #C# CID81for (S

o ) $00 G #*#I / #C# CID8-

01

%. (ptional2elemedi!ine *entral Data #tora(e #erver

'may be combined with S 0 with spec increase*

D"al *ore Intel Leon $.% GH4 :or e@"ivalent;B

%0=-M CMB DVD8W DriveB D"al 10/100/1000

3I*B emote mana(ement

Cppropriate $rd party #oftare :CVB Data>ase;

Aperatin( #ystem :dependin( on telemedi!ine sol"tion

!hosen;9

o Windos %00$ % #tandard #erver

o edHat Enterprise 7in" + #tandard

Inte(rated Graphi!s *ard

Wireless ey>oard and mo"se

1=K 2F2 7*D monitor

An>oard CID *ontroller and Hot8sap dis's 'may

be on separate enclosure*

01

1$


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o % 60 G #C2C% CID81for (S

o 1% +00 G #C2C% CID8-

$. (ptional2ape 7i>rary and a!'"p system

B et!.

3etor' devi!e 5 6 port 10/100 M>ps sit!h and

pat!h !a>les

) VC An87ine ps IP >ased V* "nit

$%K 7*D 2V 'with wall mounting +it*

01

. 2elemedi!ine *lient softare :either of folloin(;

Intera!tive 2elemedi!ine *lient 'with interactive

connect to &elemedicine Server*

7o!al We>8>ased a!!ess 'with connectivity to )eb#

based Server*

01

6. 2elemedi!ine #erver softare :either of folloin(;

Intera!tive 2elemedi!ine #erve ith We> a!!ess

mod"le

We>8>ased 2elemedi!ine #erve

=. Di(ital E*G

C$ Film #!anner

Di(ital Mi!ros!ope

Di(ital *amera

Gl"!ometer

3on8invasive P"lse & lood Press"re "nit

01

10. *onne!tivity devi!e :either of them;

I#D3 Modem :ith 32;

CD#7%N / *DMC / P#23 Modem

V#C2 #'yIP "nit Wi8MCL *PE

Fi>er Apti! *PE

01

1)


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11. Aptionally %/) mod"le ro"ter ith items in #.3. -

'in case of multiple connectivity medium*

In case of ISD lines, dial#up router must be ta+en

01

0.).*. Telemedicine -ardware 2 So4tware Re?uirement at EE5&

S.N. Item @t:

1. 2elemedi!ine #erver Platform

% D"al *ore Intel Leon $.% GH4 :or e@"ivalent;B

)0=-M CMB DVD8W DriveB D"al 10/100/1000

3I*B emote mana(ement

Cppropriate $rd party #oftare :CV;

Aperatin( #ystem :dependin( on telemedi!ine sol"tion

!hosen;9

o Windos %00$ % #tandard #erverB M# Affi!e

#tandardB M# #O7 #ervero edHat Enterprise 7in" + #tandardB Post(re#O7

Inte(rated Graphi!s *ard


1=K 2F2 7*D monitor

An>oard CID *ontroller and Hot8sap dis's

o % $- G #*#I / #C# CID81for (S

o ) $00 G #*#I / #C# CID8-

01

%. Des'top P* platform

Intel *ore% %.)GH4 :or e@"ivalent;B 10%)M CMB

)00G HDDB DVD8AM DriveB 10/100 3I*

Cppropriate $rd party #oftare :CVB Data>ase;

Windos LP ProfessionalB M# Affi!e #tandard

Hardare C!!elerator Graphi!s *ard :dedi!ated

%+-M on>oard CM;


1=K 2F2 7*D monitor

#"ita>le We>8*amera for intera!tion d"rin( Anline

2ele8*ons"ltation

Mi!rophoneB #tereo #pea'ers and Headset

0$

$. Peripherals 5 7aser PrinterB )8port 8>ased a!!ess 'with connectivity to )eb#

based Server*

01

-. 2elemedi!ine #erver softare :either of folloin(;

1+


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Intera!tive 2elemedi!ine #erve ith We> a!!ess

mod"le

We>8>ased 2elemedi!ine #erve

. *onne!tivity devi!e :either of them;

I#D3 Modem :ith 32;

CD#7%N / *DMC / P#23 Modem V#C2 #'yIP "nit

Wi8MCL *PE

Fi>er Apti! *PE

01

6. Aptionally %/) mod"le ro"ter ith items in #.3. -

'in case of multiple connectivity medium*

In case of ISD lines, dial#up router must be ta+en

01

0.*. +ro9osed $rgani7ational +lan

0.*.1. +re9aration o4 In4rastructure E5-ealth Education and Training

Cde@"ate physi!al infrastr"!t"re is no made availa>le in many of the r"ral PH*s /

*H*s and Distri!t hospitals ith World an' aid "nder Health #ystem Development

pro,e!t. Even many distri!t hospitals have no advan!ed medi!al e@"ipments

in!l"din( *2 s!anB *olo"red Doppler et!. efore startin( !lini!al

telemedi!ine pro!ess.

2he >andidth and !omm"ni!ation infrastr"!t"re is !r"!ial for the s"!!ess of the

pro(ram. *omm"ni!ation a(en!ies that have nationide footprint :e.(. #37; need

to >e roped in for providin( !onne!tivity at all lo!ation ith internal virt"al ro"tes

>eteen all "nits. In s"!h a s!enarioB only Jlast mileK !onne!tivity is to >e provided

hile a nationide netor' is already in pla!e.

#im"ltaneo"slyB some Medi!al trainin( instit"te sho"ld also >e made part of the

pro(ram to promote *ME and self8pa!ed trainin( pro(ram for Cn(anadi / lo!al

health or'ers and do!tors at 7EVE78MB 7EVE781B and 7EVE78%. 2he trainin( !an

>e delivered over the same netor'.

0.*.#. Setting Guidelines 4or Administration and Clinical Educational and

GoBernance Telemedicine +ractices

2he MoH&FW sho"ld appoint a National %irector:ith ade@"ate seniority level;

for the pro(ram advised / assisted >y a n"!lear epert panel of people / or(ani4ational

representatives eperien!ed in 2elemedi!ine pro(ram plannin( and role8o"t.

#imilarlyB a State %irector :ith ade@"ate seniority level; reportin( to the 3ational

Dire!tor sho"ld >e appointed to ens"re smooth role8o"t and f"n!tionin( of the

pro(ram. C %istrict %irectorat 7EVE781 and 7EVE78M shall ens"re pro(rams

s"!!ess.

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2he n"!le"s frameor' J$ecommendation on %uidelines, Standards and !ractices

for &elemedicine in India.K #pe!ifies vario"s ("idelines that need to >e folloed >y

all "nits for proper f"n!tionin(.

0.*.&. Identi4ication o4 endor 4or +roect Im9lementation

2here are vario"s 2elemedi!ine te!hnolo(y providers in the !o"ntry. DI2B M*I2 has

f"nded some very s"!!essf"l 2elemedi!ine pro(rams in the nation and may >e

!ons"lted on sele!tin( a s"ita>le 2elemedi!ine te!hnolo(y platform for adaptation in

the pro(ram. It is important that !hosen te!hnolo(y is s"pported and s"stainedB

prefera>ly >y a national te!hnolo(y a(en!yB for the period of pro(ram and >eyond it.

An!e the 2elemedi!ine te!hnolo(y platform is identifiedB then sele!tion of other

hardare and softare sho"ld >e done in !lose !ons"ltation ith !hosen te!hnolo(y

provider. HoeverB a me!hanism of open tender sho"ld >e en!o"ra(ed in p"r!hase of

identified hardare and softare.

2he implementin( a(en!y need to have national rea!h and eperien!e in ee!"tin(

2elemedi!ine pro,e!t.

0.*.). Recruitment o4 Technical 2 !edical !an9ower

2he manpoer employed for the pro(ram are very !r"!ial to the s"!!ess of pro(ram.

In !ase manpoer is dran from eistin( stren(th / positionsB a me!hanism of

in!entives need to >e p"t in pla!e that ill en!o"ra(e staff to en(a(e fr"itf"lly. Cll

appointments !an >e on term !ontra!t >asis ith periodi! performan!e revie.

0.*.*. Installation o4 E?ui9ments Network !edia Testing Training and -and5

-olding

#ite identifi!ationB preparationB and installation ill >e ta'en in phased manner. 2he

implementer shall provide for at least - months of hand8holdin( to the deployed

lo!ation. Hand8holdin( !an >e done remotely. C trainin(B as appropriate a!!ordin( to

f"n!tion / roleB need to >e provided to staff on the pro(ram >y implementin( a(en!y.

0.*./. +eriodic !onitoring and +re9aration o4 Interim Re9ort

2he pro(ram dire!tors ill >e responsi>le for monitorin( the pro(ram thro"(ho"t its

implementation and "se period.

0.*.0. Im9act EBaluation at the End o4 Each "ear and A4ter ,iBe "ear

C s"ita>le me!hanism to revie effe!tiveness of pro(ram at end of ea!h year and a

>road revie at the end of + year period need to >e done >y pro(ram dire!tors and

report >e prepared for pla!in( >efore MoH&FW.

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D. 'U%GET RE@UIRE!ENT

2he pro,e!t needs to >e implemented in phases.

D.1. ,inancial Re?uirement 4or +hase5I

D"rin( the first phase of the pro,e!tB it is proposed to lin' "p folloin( in Phase8I9

100 7EVE781 :PH* / *H* / Villa(e; "nits

+0 7EVE78% :Distri!t Hospitals; "nits

+ 7EVE78$ :#tate Hospitals / #"per #pe!ialty Hospitals; "nits

+0 Mo>ile 2elemedi!ine Van '10 per District Hospital in program*

2he finan!ial re@"irement of Phase8I ill !onsist of the !ost for settin( "p

2elemedi!ine fa!ilitiesB re!"rrin( !ost for operation and maintenan!eB and their

!onne!tivity !har(es.

D.#. EE51 ;+-C 2 C-C 2 illage< Units

,ied Costs

16


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Annual Recurring Costs

#l.3o Item Des!ription Cpproimate *ost

:in "pees;

emar's

1. #ite Cdministrator N 2e!hni!ian $B+0B000 Cdministrator

s%B00B000

2e!hni!ian #

1B+0B000

%. Medi!al staff in!entive /

alloan!e

1B06B000 Do!tors :01 nos;

+000/month

Medi!al staff :0%

nos; %000/month

%. Cnn"al Maintenan!e *har(es

Hardare/softare per node

%B00B000 Css"min( 1+ of

E@"ipment !osts N

s/ s">s!ription /

"pdate

$. Cnn"al and

). Ele!tri!ityB other !ons"ma>lesB

et!

0 2o >e provided >y

the hospital

Sl.

No.

Item %escri9tion Estimated alue

;In Ru9ees8

>ased mod"le may

>e !heaper.

). Video *onferen!in( it %B +0B000

+. 2errestrial IP :+1% '>ps; s!ala>le 10B000 May varyB

road>and set"p

!har(e ass"med.-. 7andB >"ildin(B f"rnit"re

ele!tri!al fittin(sB fit"res or any

other non ele!troni! item

0 2o >e provided >y

the hospital

!on!erned

. 2rainin( !osts +0B000 2o >e provided >y

vendorB hospital

>ears !ost of its

staff.

6. Installation & *ommissionin( 1B00B000 2o >e !ond"!ted >y

vario"s vendors.

Total 1*/FFFF

1=


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Total ;with incentiBes< 0)DFFF

Total ;without incentiBes< /)FFFF

%0


21/27

D.&. EE5! ;!o=ile Telemedicine ane provided >y

vendorB hospital

>ears !ost of itsstaff.

=. Installation & *ommissionin( 1B00B000 2o >e !ond"!ted >y

vario"s vendors.

Total 01/FFFF

%1


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*har(es of 2elemedi!ine

softare

!osts

$. Cnn"al >andidth !ost per year

per node

+0B 000 Css"med

road>and

). F"elB Van maintenan!e 0 2o >e provided >y

the hospital

Total ;with incentiBes< 1#FFF

2otal ;without incentiBes< 11//FFF

%%


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D.). EE5# ;%istrict -os9italse!heaper.

+. 2elemedi!ine #erver #oftare +B00B000

). Video *onferen!in( it 6B +0B000

+. 2errestrial IP :% m>ps; s!ala>le 10B000 May varyB road>and

set"p !har(e ass"med.

-. 7andB >"ildin(B f"rnit"re

ele!tri!al fittin(sB fit"res or

any other non ele!troni! item

0 2o >e provided >y the

hospital !on!erned

. 2rainin( !osts 1B00B000 2o >e provided >y

vendorB hospital >ears

!ost of its staff.6. Installation & *ommissionin( %B00B000 2o >e !ond"!ted >y

vario"s vendors.

Total ;with o9tional items< )/FFFF

Total ;without o9tional item< )1/FFFF

%$


24/27

softare

$. Cnn"al >andidth !ost per year

per node

1B+0B 000 Css"med

road>and


et!

0 2o >e provided >y

the hospital

Total ;with incentiBes< 1)1)*FF

Total ;without incentiBes< 1&F/*FF

%)


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D.*. EE5& ;State -os9ital 2Su9er S9ecialist -os9itals8

>ased mod"le may >e

!heaper.

). 2elemedi!ine #erver #oftare +B00B000+. Video *onferen!in( it 6B +0B000

-. 2errestrial IP :% m>ps; s!ala>le 10B000 May varyB road>and

set"p !har(e ass"med.

. 7andB >"ildin(B f"rnit"re

ele!tri!al fittin(sB fit"res or

any other non ele!troni! item

0 2o >e provided >y the

hospital !on!erned

6. 2rainin( !osts 1B00B000 2o >e provided >y

vendorB hospital >ears

!ost of its staff.

=. Installation & *ommissionin( %B00B000 2o >e !ond"!ted >y

vario"s vendors.Total &*1FFFF

%+


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et!

0 2o >e provided >y

the hospital

Total ;with incentiBes< 110FFF

Total ;without incentiBes< 1FDFFF

%-


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D./. ,inancial Summar:

Cltho"(h there are vario"s varyin( !omponents in the tentative >"d(et provisions

(iven a>oveB here the maim"m val"e per "nit is ta'en to 'no the etent of >"d(et.

*omm"ni!ation set"p and r"nnin( !ost may !han(e !ompletely dependin( on the type

of !onne!tivity !hosen finally.

Unit ,ied Recurring @t: Total

7EVE78M 1B-0B000 1$B%%B000 +0 )%B)1B00B000

7EVE781 1+B-0B00 0B)6B000 100 0=B0)B00B000

7EVE78% )=B-0B000 1)B1)B+00 +0 $1B6B%+B000

7EVE78$ $+B10B000 11B=B000 + 0%B$+B$+B000

Total #F* D*/0/FFFF

2he total >"d(et :"sin( maim"m !omponent valveB e!ept !onne!tivity; !ome toaro"nd Ru9ees Eight5,iBe Crore Sit:5SeBen akhs Sit: Thousand onl:.

National Rural Telemedicine Network for India- MoHFWdddddd

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