nm comp and telemed
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telemedicine
narendra malhotrajaideep malhotra
neharika malhotra borarishabh bora
www.rainbowhospitals.orgwww.malhotrahospitals.com
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What is TelemedicineWhat is Telemedicine
Telemedicine may be defined as the use of computers and telecommunication technologies to provide medical information and services from distant locations
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3ITU-T Workshop on Standardization in E-
Health, Geneva, 23-25 May 2003
• Telemedicine comprises all medical actions which extend the action space of health care professional beyond the face-to-face relationship with the patient in the direct surroundings.
• It is medicine at a distance.This includes health care delivery, diagnosis, consultation, treatment, education and the transfer of related data.
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Use of information and communication technologies:
i) To provide specialized health care consultation to patients in remote locations,
ii) To facilitate video-conferencing among health care experts for better treatment & care,
iii) To provide opportunities for continuing education of health
care personnel.
Objectives of Telemedicine
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Relevance of Telemedicine
Inadequate infrastructure in rural/district hospitals
Large number of indoor/outdoor patients requiring referral for specialized care
Low-availability of Health Experts in district/remote hospitals
Dearth of adequate opportunities for training or continuing Medical Education for Doctors in Rural/Remote Health facilities.
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Benefits of Telemedicine (I)Benefits to Patients:
Access to specialized health care services to under-served rural, semi-urban and remote areas,
Access to expertise of Medical Specialists to a larger population without physical referral,
Reduced visits to specialty hospitals for long term follow-up care for the aged and terminally ill patients.
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Benefits to Physicians: Improved diagnosis and better
treatment management
Access to computerized, comprehensive data (text, voice, images etc.) of patients – offline as well as real time
Quick and timely follow-up of patients discharged after palliative care
Continuing education or training through video conferencing periodically
Benefits of Telemedicine (II)
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Hospital and Insurance Benefits:
Significant reduction in unnecessary visits & hospitalization for specialized care at tertiary hospitals,
Earlier discharge of patients leading to shorter length of stay in hospitals,
Increase in the scope of services without creating physical infrastructure in remote hospitals
Benefits of Telemedicine (III)
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9ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003
Implementation challenge
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Telemedicine : The Model Patient under treatment Physician treating the patient A remote telemedicine console
having audio visual and data conferencing facilitiesNodal HospitalNodal Hospital
Referral HospitalReferral Hospital
POTS / ISDN / LEASED LINE / VSAT
POTS / ISDN / LEASED LINE / VSAT
An expert / specialised doctor A central telemedicine server
having audio visual and data conferencing facility
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Different types of services Telecardiology
Teleradiology
Telepathology
Telepsychiatry
Early Warning System [ Prevention and control of endemic and infectious diseases ]
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ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003
Benefits of E-Health
• Support for diagnostic (primary diagnostic, collaboration, 2nd opinion)
• Triage for evacuation of patients• Distant education• Enhancement of collaboration spirit• Diminution of isolation• Use of personal computers for health care.
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Telemedicine in India•Existing system limited only to private hospital
• CORPORATE Group of Hospitals.
• RN Tagore Cardiac Hospital, Calcutta. (Asia Heart Foundation)
• No Telemedicine system for public health care
•Corporate Sectors Offering Telemedicine Systems• APPOLO & OTHER CORPORATE Groups
• Online Telemedicine System, Ahmedabad.
• WIPRO GE
• SIEMENS
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Aim of the Telemedik SystemAim of the Telemedik System• Information management
– Patient information– Medical data (signs, symptoms, test reports, etc..)– Appointment scheduling– Archival and retrieval of patient records
• Low cost solution– Using ordinary telephone line
• Service to large population– Through public health care delivery systems
• Development of knowledge-based system– For decision support– For training and education
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Why it is relevant to our society
Poor infrastructure
Non-availability of experts (disparate
distribution)
Low doctor-patient ratio (large population)
Lack of proper medical education Special attention required for Public Health Care System
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ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003
Medical constraints and challenges
• Need and will of cooperation between medical sites;
• Complementary function of involved institutions and organizations;
• Acceptance of technology and change of working environment;
• Interoperability issues ignored.
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Major Challenges
•Poor Data Communication Infrastructure.
•A Large Population Catered by Government Hospitals.
•System Features should be scalable.
•Cost of the system should be scalable.
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ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003
Telecommunication constraints
• Minimum requirement is reliable telephone line at 19.2KBit/s
• Simultaneous Internet access recommended
• ISDN permits more advanced solutions like video-conferencing
• xDSL for the future.
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19ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003
Few E-Health Standards applicable
• DICOM (Digital Communication Medicine) for medical imaging
• ITU H320/H120 for video-conferencing• Proprietary systems for “Store-And-Forward”• Proprietary interactive and collaborative systems
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Digital Imaging Communications in Medicine (DICOM )
originally the ACR-NEMA developed by American College of Radiology (ACR)
and the National Electrical Manufacturer's Association (NEMA)
provides standardised formats for image capture and storage coupled with a common information model specifying service definitions and protocols for communication
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Digital camera
Doctor / Patient
Scanner
Printer
ElectronicsMicroscop
e
ECG Machine
ElectronicsStethoscope
PSTN / Leased Line
/ ISDN / VSAT
Specialist Doctor
Digital Camera
Scanner
Printer
Web Cam
Web Cam
Nodal Center
Referral Center
System Schematic
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Requirement SpecificationRequirement Specification
Nodal HospitalNodal Hospital
Referral HospitalReferral Hospital
• A patient getting treated• A Doctor• A remote telemedicine console having audio visual and data conferencing facilities
• An expert/ specialized doctor• A central telemedicine server having audio visual and data conferencing facility
POTS / ISDN
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Sequence of OperationSequence of OperationPATIENT IN
Patient visits OPD Local Doctor checks up
Patient receives local treatment and not referred to telemedicine system
Patient referred to the Telemedicine system (some special investigations may be suggested)
Patient visits Telemedicine data-entry console.Operator entries patient record, data and images of test results, appointment date is fixed for online telemedicine session
OUT
OUT
Offline Data transferfrom Nodal Centre
Day
One
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Sequence of OperationSequence of Operation
Patient 1Patient 2Patient 3Patient 4
.
.
.
Online conference for the patient.
Patient, local doctors at the nodal hospital and specialist doctors at the referral hospital
Patient queue
IN OUT
Day
Tw
o
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25ITU-T Workshop on Standardization in E-
Health, Geneva, 23-25 May 2003
Concept of “Store and Forward”
RadiographScanner
PC
DocumentScanner
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Hardware ConfigurationHardware Configuration
Digital camera
Referral Hospital
Nodal Hospital
PSTN/ISDN/VSAT link
Scanner
PrinterModem
Modem
Microscope and other medical instruments
Video Conference
Video Conference
Telephone
Telephone
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Software ModulesSoftware Modules
Offline Activities
Online Activities
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ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003
Videoconferencing
• Interactive• Well suited for seminars or special case discussion• Less adapted and expensive for routine work• Requires ISDN
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29ITU-T Workshop on Standardization in E-
Health, Geneva, 23-25 May 2003
Second opinion telemedicine concept
Telemedicine Center
Digitalisation
Radiologist
Pathologist
Other
Store & Forward Telemedicine
Internet/ISDN/Phone
Medical supervisionPatient Record and
Medical Images
Digitalisation
Private doctorSmall clinic
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The Data The Data• Data related to a patient’s personal information• Data related to a patients medical information• Data for patient management in Telemedicine• Data related to the doctors• Data for system management
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ImagesImages
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Vector DataVector Data
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GraphicsGraphics
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Video Clip for second opinion
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Data related to the doctors
• Doctor’s personal information
• Unique Identification key
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38ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003
Medical information on Internet
• Gives valuable on-line access to huge medical knowledge & databases.
• Lack of quality control-> www.hon.ch
• Language barrier. -> www.etho.org
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Nodal Hospital
Referral Centre
Writers Bldg.State
Switching Centre
DM OFFICEDistrict
Switch Centre
2 Mbps Optic
al Link WBSWAN
512 Kbps Leased Line
512 Kbps Leased Line
Schematic Diagram for Proposed Telemedicine using WBSWAN
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Telemedicine for Tropical Diseases
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…. way forward
1. Hand-holding support to Hospital administration for 3-4 years for stabilization of telemedicine services.
2. Integration of Telemedicine activities with Health Management Information System for regular reporting (preferably web-based)
3. Including Telemedicine activities in the performance appraisal of individuals and institutions.
4. Introducing Telemedicine (concept, technical aspects and implementation arrangements) as part of medical education & continuing medical education.
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“ Telemedicine: one small step for IT , a giant leap for Healthcare!” Paraphrasing Neil Armstrong,
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At raibbow hospitals Agra , we are in the process of establishing a tele med depttfor second opinions and for reportings
THANK YOU FOR HEARING ME OUT