S K Mishra, MS, FACS - GARUDA Medical college... · S K Mishra, MS, FACS Head, ... Sushila Tewari...
Transcript of S K Mishra, MS, FACS - GARUDA Medical college... · S K Mishra, MS, FACS Head, ... Sushila Tewari...
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www.sgpgi-telemedicine.org | www.stbmi.ac.in
National Medical College Telemedicine Network
S K Mishra, MS, FACSHead, Dept. of Endocrine Surgery &
Faculty I/C, SGPGI Telemedicine Program
Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) Lucknow, India
Email: [email protected]
National Network of Medical CollegeNeed
Diversity in the standard of
Quality of Teachers
Availability of Educational Tools (slide projectors,
projecting microscope, still and moving digital images)
Books and Journals
Quality and type of patient materials (geographical
difference in the incidences of various diseases)
Rural, Urban and Semi urban patients
Diversity in the quality of students because of entry and
exit parameters
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Introduction
• Networking of medical colleges can bridge distance
between Student & Teacher
• Quality of Postgraduate education in Indian Medical
colleges needs improvement
• Tertiary academic medical centers can provide
additional inputs through networking
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Objectives 1
• Improving quality of medical / paramedical education
and meeting the educational needs of the students
despite paucity of teachers
• Facilitating cognitive component of learning by
providing interactive teaching material online
developed by a group of competent teachers at
undergraduate, postgraduate and super-specialty levels
• To promote psychomotor skill development through
tele-mentoring4
Objectives 2
• To link Medical Libraries with adequate stock of books and
journals for access to all thereby reducing state expenditure on
medical college libraries (Digital Library Network)
• To promote medical research by providing infrastructure for
quick exchange of ideas and co-ordination with group of
researchers involved in collaborative multicentre studies and
facilitating current information access through digital library
network
• Online Continuing Medical Education (e CME) to enhance
knowledge and teaching skill and possible Accreditation of
Medical Teachers and Health Care Professionals
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Objectives 3
• Implementing uniform examination pattern and evaluation.
Coaching students with online and offline in MCQs
• Enhancing computer literacy among medical students and teachers
• Facilitating eHealth Governance
• Sharing of resources and establishing effective communication
between the medical colleges and its faculty
• Providing educational material & tools to medical teachers
• Improving quality and reducing the cost of health care delivery by
tele-consultation and tele-follow up
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• Identification of a National Telemedicine Resource Center which
will be connected with high speed fiber network with few
selected apex medical institutions which in turn will be
networked with medical colleges in the region
• Identification of few apex medical academic institutions region
wise (Regional Telemedicine Resource Center) and networking
each with medical colleges in the region covering few states.
• MPLS-VPN Network backbone to provide bandwidth 10 Mbps to
start with (ultimately 1G) at Regional & 2 Mbps at medical
college telemedicine nodes.
• Each medical college telemedicine node to be linked with district
hospitals in their perimeter.
Road Map 1
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Road Map 2
• One lecture theatre of each medical college will be
converted to digital integrated medical lecture theater
providing necessary infra structure.
• Each resource center will have facility for multimedia
education content development.
• All the medical education knowledge content will be
stored in the central repository located at the data
center of national resource center with a backup
facility at disaster site.
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Expected Outcome 1
• The network will support multimedia data
exchange, multi-point video conference, both in
interactive and video broadcast mode.
• Central Repository of Medical Education
Content will do live transmission of the content
on day to day basis.
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Expected Outcome 2
• Entire network will provide a platform for interactive
distance learning and adaptive environment for
medical students, teachers and health care
professionals.
• It will also support digital library network.
• Ultimately Virtual Medical University can be
established at National Level.
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Orissa Telemedicine
Project (ISRO) - Sept’03-
Sept’09
SCB Medical College Cuttack
(1500) kms
MKCG Medical College,
Berhampur (1800 kms)
VSS Medical College, Burla
(1500 kms.)
Technology – Real time
Telecommunication link-
VSAT
Tele-consultation – Case Study-1Medical Colleges of Orissa State (n=620pts)
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Balrampur and Civil Hospital, Lucknow
(20 kms) – Year 2000 using PSTN
Pithoragarh District Hospital,
Pithoragarh (500 kms. Hilly area) &
Sushila Tewari Forest Hospital,
Haldwani (250 kms base of the hill) in
Northern India
– Year 2000 (n=30 pts as Proof of
Concept using PSTN)
Uttaranchal Telemedicine Network –
Apr’04-Mar’08-(Two district hospitals:
n=265 pts using ISDN)
Raebareli Telemedicine Network
Project – Oct’06-ongoing (n=50 pts)
Technology - Store & Forward
Technology,Real time (On demand)
Tele-consultation – Case Study-2
District Hospitals
Screen Shot of one of the Tele-radiology Opinion transmitted to one of District
Hospital in Uttaranchal region
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Tele-follow up – Case-study-3
(March 2004 ~ Ongoing)
• Patients from the Orissa
state ( Eastern Coast)
• Technology - Real time
• Telecommunication -
VSAT
• Departments
– Endocrine Surgery (n=50 pts)
– Nuclear medicine (n=127 pts)
– Rheumatology(n=60 pts)
• Average visit – 1-12
Anjali Mishra , Lily Kapoor, Saroj Kanta Mishra, Post-operative care through tele-follow up visits in patients undergoing thyroidectomy and parathyroidectomy in a resource-constrained environment, J Telemed Telecare; 2009,15:73-76 13
Tele-follow up – Snap Shots
Dept of Endocrine Surgery
Dept of Nuclear Medicine
Dept of Rheumatology14
Case Study-1Post-graduate Students of
Medical Colleges Sept 2001-ongoing
• Orissa Telemedicine Network
Project
• Funding Agency - Indian Space
Research Organisation
• Network Partners
– SCB Medical College, Cuttack
– MKCG Medical College, Berhampur
– VSS Medical College, Burla
• No. of Tele-education sessions –
720 sessions
Clarified problems in management
of difficult and complicated cases
Guidelines for management of
complicated cases
Good interesting and illustrative
cases
Keep them abreast of the recent
advances in medical field
Optimal utilization of existing
resources
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Post-graduate students of medical colleges-Snap
shots - Virtual Classroom
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Case study-2 -Medical Education for District
Hospitals doctors -
n=293 National Informatics Centre
(NIC) (Jul’03 –Oct’04) (n=13)
, Point to multipoint
Uttaranchal Telemedicine
Network Project (Apr04-
Mar08) (n=104), Point to
multipoint
Raibareli Telemedicine
Network Project (Apr06-
Aug’09) (n=176)
Getting expert opinions
Enhancing medical
knowledge in the
management of common
medical problems
Improving consultation
skill
Continuing education
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District Hospital Doctors – Snap shots
18Mahapatra AK, Mishra SK, “Bridging the Knowledge and Skill Gap in Healthcare: SGPGIMS, Lucknow, India Initiatives”
Journal of eHealth Technology and Application; 5(2):67-69, , June 2007
Para-medical Healthcare Professionals-Case
Study-3 - n=106 sessionsOrissa Telemedicine Network
Project
Uttaranchal Telemedicine
Network Project
Raebareli Telemedicine
Network Project
Participants - Nurses,
Hospital Administrators, Lab
Technicians, Dieticians,
Physiotherapists
Enhancing nursing skills
Better patient care
Continuing education
Exposure to new
techniques and
equipments
Better hospital
administration
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Para-medical Healthcare Professionals
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Case Study-4 Knowledge Sharing
• Amrita Institute of Medical
Sciences (AIMS), Kochi, Kerala
(n=132)
• All India Institute of Medical
Sciences, New Delhi &
Postgraduate Institute of
Medical Education and
Research, Chandigarh (n=23)
• Christian Medical College,
Vellore (n=83)
• Sri Ramchandra Medical
College, Chennai (n=6)
• Regional Institute of Medical
Sciences, Imphal (n=2)
Share interesting and
complicated cases
Peer opinion and
consultation
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Knowledge Sharing - Snap Shots
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Case Study-5- Tele-mentoring
• Emergency situations
• Skill development
– Laparoscopic surgery
– Complex surgical procedures
• Institutions Involved – SGPGIMS, Lucknow
– AIMS, Kochi
• Telecommunication link– VAST – 512 kbps
23Telementoring in Endocrine Surgery, Mishra SK, Mishra A, Pradeep PV; Chapter 11,Telesurgery Book, Edited by
Kumar S/ Marescaux J Springer-Verlag GmbH, Heidelberg/Germany. ISBN no. 978-3-540-72998-3, 2007
LocalCablenetwork
Video conferencing unit
512 Kbps
512Kbps
Tele-mentoring
AIMS, Kochi
2500 Km
SGPGIMS, Lko
Tele-mentoringSnap shots of surgical field
Case Study-6 Sub-specialty Development
Endocrine Surgery
• Rare specialty
– Few centers
– Few faculty
– Few opportunity
• SCB Medical College, Cuttack
• Tele-communication link – VSAT
• To assess the feasibility and impact of telemedicine in
reinforcement of endocrine surgery training at distant places to
develop this subspecialty in a developing country like India
Sub-specialty Development
Based on
Case based Learning
&
Problem based Learning
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Case Study on web based medical education around the world
www.websurg.com/m
Weblink: www.websurg.com
31http://www.orlive.com/
Case Study
Uttar Pradesh Telemedicine Network Project
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Sanjay Gandhi Postgraduate Institute of Medical
Sciences (SGPGIMS) Initiatives
“Institutes with tradition of excellence have demonstrated abundantly
that research enhances the vitality of teaching,
teaching lifts the standards of service, and
service opens new avenues of investigation.”
www.sgpgi.ac.in
Patient-care, teaching and research
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1. SGPGIMS, Lucknow
2. CSMMU, Lucknow
3. MLN Medical College, Allahabad
4. GSVM Medical College, Gorakhpur
5. J. K. Cancer Institute, Kanpur
6. L.P.S. Institute of Cardiology, Kanpur
7. B.R.D. Medical College, Gorakhpur
8. R.L.B. Medical College, Jhansi
9. L.L.R.M. Medical College, Meerut
10. S.N. Medical College, Agra
11. UPRIMS, Saifai
12. IMS, BHU, Varanasi
13. JN Medical College, AMU, Aligarh
14. RML institute of Medical Sciences, Lucknow
15. RML Hospital, Lucknow
16. Balrampur Hospital, Lucknow
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Block Diagram for UP Medical College & District Telemedicine NetworkWAN Connectivity
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Digital Lecture Theater
Tele-Consultation Facility eLearning & Digital Library
UP Medical College NetworkBlock Diagram for Medical College Level : WAN & LAN Connectivity
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UP Medical College NetworkBlock Diagram of Digital Library at Medical College
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School of Telemedicine & Biomedical Informatics
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Knowledge Workflow @ STBMI
Green Valley Edius
FCP(final cut Pro)
Adobe Premiere
Maya
Online sharing
Streaming
Video Conferencing
Offline SharingDeveloped Content
Website
Editing Storage Sharing
Professional Camera
Video Conference
Hitech Digital Lecture Theater
Integrated Operation Theater
Data Center
Rack Servers
Streaming Server
Harvesting
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Data Server
Network Monitoring Hub
Production Control Unit
(PCR)
Hi-Tech Lecture Theatre
Integrated Operation Theatre
Video Conferencing Suite
Edit Stations
Broadcast Quality Studio
Camera
Knowledge Resources
Digital Medical Lecture Theatre Video Conferencing Suite
Integrated Digital Operation Theatre41
Content Development Facility
Voice Over Station
Sound Proof Edit RoomsLarge screen flat monitors
Production Control Room
PCR
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Edit Stations
Edius Edit Station
Windows Platform
FCP (Final Cut Pro)
Apple Platform
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Data Center (Health Knowledge Park)
&
U.P. State Telemedicine Network Monitoring Stations
U.P. State Telemedicine Network
Monitoring Stations
Data Center (Health Knowledge Park)
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Proposed National Medical College
Telemedicine Network Architecture
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Medical Colleges
Apex Medical Institutions
National Resource Center
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Thank you
www.sgpgi-telemedicine.orgwww.sgpgi.ac.in 48