sudhamony s additional director / head,
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ICT for
Cancer Diagnosis, Treatment and Management
Sudhamony SAdditional Director / Head, Medical Informatics Section, Centre for Development for Advanced Computing (C-DAC),Thiruvananthapuram, INDIA.
Sudhamony SAdditional Director / Head, Medical Informatics Section, Centre for Development for Advanced Computing (C-DAC),Thiruvananthapuram, INDIA.
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• 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-DACC-DAC
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Centre for Development of Advanced Computing
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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.
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The NeedStatistics 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
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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
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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
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
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0
1000
2000
3000
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5000
6000
7000
8000
9000
Appointments during the year 2002
Kasargod
Kannur
Wayanad
Kozhikode
Malappuram
Palakkad
Thrissur
Ernakulam
Idukki
Kottayam
Alapuzha
Pathanamthitta
Statistics from KeralaNumber of patients visiting
Cancer care facility
RCC, RCC, ThiruvananthapuramThiruvananthapuram
RCC, RCC, ThiruvananthapuramThiruvananthapuram 3/4/2009C-DAC Medical Informatics
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Logistics Distance Travelled
0
100
200
300
400
500
600
Distance (km) Travelled to theCentre
Kasargod
Kannur
Wayanad
Kozhikode
Malappuram
Palakkad
Thrissur
Ernakulam
Idukki
Kottayam
Alapuzha
Pathanathitta
Kollam3/4/2009C-DAC Medical Informatics
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Logistics Cost of Travel
0
200
400
600
800
1000
1200
1400
1600
1800
Total Expensesfor One Visit
(Rs)
Kasargod
Kannur
Wayanad
Kozhikode
Malappuram
Palakkad
Thrissur
Ernakulam
Idukki
Kottayam
Alappuzha
Pathanamthitta
Kollam
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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
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Tele ONCOlogy NETwork
Our Peripheral Clinics
1. Malabar Cancer care Society, Kannur.
2. Early cancer detection center, Palakkad.
3. Early cancer detection center, Kochi.
4. Early cancer detection center, Kollam.
5. District cancer control cente, Kozhencheri.
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VSAT Network forONCONET
Satellite communication link & Bandwidth provided by ISRO (Totally free)
Satellite : INSAT 3C Antenna : 3.8 mCarrier : Extended C Band Bandwidth : 384 kbps
Failover mechanism128 Kbps ISDN connection
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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
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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
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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
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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
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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
withISDN
(Backup)
X-Ray Film Scanner
LAN
SPECIALTY CENTRE
ROUTER
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Tele-Pathology and Radiology
systems
ECDC KOCHI
ECDC KANNUR
Microscope
DICOM CDFilm / 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
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ONCONET SoftwareTelemedicine Enabled Hospital
Automation System (TEJHAS)
Core Serviceso OP & IP Managemento Consultationo Surgical Oncologyo Resource Schedulingo Investigationo Nuclear Medicineo Radiation Oncologyo Chemotherapy o Pharmacy
Support Serviceso Cash & Billingo Central Storeso Purchaseo Blood Banko Radiologyo Engineeringo C.S.S.D
Back Officeo Enquiryo MISo Master Datao Users
Comprises of all essential modules :Comprises of all essential modules :
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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
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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
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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…
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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
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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
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ONCONET goes
National(ONCONET India)
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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
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AllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabadAllahabad
LucknowLucknowLucknowLucknowLucknowLucknowLucknowLucknowLucknow
GwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwaliorGwalior
DelhiDelhiDelhiDelhiDelhiDelhiDelhiDelhiDelhi
ChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarhChandigarh
RohtakRohtakRohtakRohtakRohtakRohtakRohtakRohtakRohtak
ShimlaShimlaShimlaShimlaShimlaShimlaShimlaShimlaShimla
Shrinagar
AizwalAizwalAizwalAizwalAizwalAizwalAizwalAizwalAizwal
BikanerBikanerBikanerBikanerBikanerBikanerBikanerBikanerBikaner
HyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabadHyderabad
RaipurRaipurRaipurRaipurRaipurRaipurRaipurRaipurRaipur
NagpurNagpurNagpurNagpurNagpurNagpurNagpurNagpurNagpur CuttakCuttakCuttakCuttakCuttakCuttakCuttakCuttakCuttak
BangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangaloreBangalore ChennaiChennaiChennaiChennaiChennaiChennaiChennaiChennaiChennaiKanchipuram
PondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherryPondicherry
ThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuramThiruvananthapuram
MumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbaiMumbai
KolkataKolkataKolkataKolkataKolkataKolkataKolkataKolkataKolkata
GuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahatiGuwahati
PatnaPatnaPatnaPatnaPatnaPatnaPatnaPatnaPatna
AhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabadAhmadabad
ImphalImphal
ONCONET INDIA
1. Trivandrum2. Chennai3. Bangalore4. Mumbai5. Hyderabad6. Cuttack7. Gwalior8. Kolkata9. New Delhi10. Allahabad11. Patna12. Bikaner13. Shimla14. Rothak15. Gauhati16. Aizwal17. Nagpur18. Ahmadabad19. Pondicherry20. Lucknow21. Chandigarh22. Raipur 23. Imphal24. Srinagar25. Kancheepuram
Regional Cancer CentresRegional Cancer Centres
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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 RCCsAt RCCs
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System Configuration at RCC
Deliverables at RCC
1. PC with software
2. Video Conferencing System & TV
3. Film Scanner
4. Digital Microscope
5. UPS, Printer
6. Networking items
Deliverables at RCC
1. PC with software
2. Video Conferencing System & TV
3. Film Scanner
4. Digital Microscope
5. UPS, Printer
6. Networking items
ROUTER
VCS
Television
Telemedicine PC
LAN
Audio /Video
USB
Printer
Scanner
DigitalMicroscope
384 Kbps
Internet
Leased Line(384Kbps
MPS L3 VPN)
Provided by BSNL
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System Configuration at Peripheral Centres
Deliverables at Peripheral Centre
1. PC with software
2. Video Conferencing System and TV
3. Film Scanner
4. UPS, Printer
5. Networking equipments
Deliverables at Peripheral Centre
1. PC with software
2. Video Conferencing System and TV
3. Film Scanner
4. UPS, Printer
5. Networking equipments
TelevisionTelevision
SwitchSwitch
Tele Medicine PCTele Medicine PC
PrinterPrinterVCVCSS
384 384 KbpsKbps
BB VPNBB VPN(384 Kbps)(384 Kbps)
Provided by Provided by BSNLBSNL
ScannerScanner
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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.Portal
2.Internet Browsing
3.Multi Conferencing
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NETWORK DIAGRAMS SHOWING
HOW THE PROPOSED NETWORK
MEETS ONCONET -India
FUNCTIONAL REQUIREMENTS
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PE
PE
Mumbai
Delhi
Lucknow
Raipur
PE
PEPE
Guwahati
Cuttak
Chennai
PEPE
Shimla
Chandigarh
Bangalore
Ahmedabad
Gwalior
Trivandrum
PE
PE
PE
PEPE PE
PE
PE
Router
LEGEND
PE
Kancheepuram
PE
Pondicherry
PE
Rohtak
PE
Implementing Agency
Patna
Imphal
Bikaner
Srinagar
AizhwalRaipur
PE
PEPE
PEPE
Allahabad
HUB
MPLS L3 VPN Backbone
2Mbps
384Kbps
256 Kbps
Internet
Proposed MPLS Network linking 25 RCCs
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OVERALL ARCHITECTURE of
ONCONET India network
RCC4
RCC2 RCC3
MPLS BACKBONE
RCC25
Peripheral Centre 4
Peripheral Centre 1
RCC1
384Kbps L3 VPN
Peripheral Centre 1
Peripheral Centre 1
Peripheral Centre 1
Peripheral Centre 1
Peripheral Centre 4
Peripheral Centre 4
Peripheral Centre 4
Peripheral Centre 4
384 KbpsBBVPN
384 KbpsBBVPN
384 KbpsBBVPN
384 KbpsBBVPN
384 KbpsBBVPN
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Tele-consultation between one RCC and its Peripheral center through Broadband VPN
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BSNL MPLS
Backbone
RCC
512KbpsBBVPN
PE
PE
E1 link
MCU, Video streamer
&WEB
PORTAL
PEPE
Group1PE
PE
PE
256Kbps (1:1)
Internet
LL
LL
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
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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
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CONTACT:Sudhamony SAdditional Director / Head, Medical Informatics Section Centre for Development for Advanced
Computing (C-DAC),Thiruvananthapuram-695033. KeralaINDIA.E-mail: sudha@cdactvm.in Ph: 91- 471- 272 1042 (D) / 272 3333 Ext: 229Mob. No: 91-98479 14872 (M)Fax: 91-471- 272 3456 / 272 2230
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Applying Advanced Computing for Human Applying Advanced Computing for Human AdvancementAdvancement
3/4/2009C-DAC Medical Informatics
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