telemedicine projects in west bengal a presentation by dr. rajendra s. shukla, special secretary, h...
TRANSCRIPT
TELEMEDICINE PROJECTS in
West Bengal
A Presentation by
Dr. Rajendra S. Shukla, Special Secretary, H & FW Dep’t, Government of West Bengal
&Dr. J. N. Maity, Director,
WEBEL ECS Ltd.
29th September 2006, Vigyan Bhawan, New Delhi
Outline of Presentation
• Objectives & Relevance• Benefits• Model• Telemedicine Projects in West Bengal• Telemedicine & PPP• Images & Graphics• Awards• Challenges & Way Forward
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
Relevance of Telemedicine
Inadequate infrastructure in rural/district Inadequate infrastructure in rural/district hospitals hospitals
Large number of indoor/outdoor patients Large number of indoor/outdoor patients requiring referral for specialized carerequiring referral for specialized care
Low-availability of Health Experts in Low-availability of Health Experts in district/remote hospitalsdistrict/remote hospitals
Dearth of adequate opportunities for training or Dearth of adequate opportunities for training or continuing Medical Education for Doctors in continuing Medical Education for Doctors in Rural/Remote Health facilities.Rural/Remote Health facilities.
Benefits of Telemedicine (I)
Benefits to Patients:
Access to specialized health care services to Access to specialized health care services to under-served rural, semi-urban and remote under-served rural, semi-urban and remote areas,areas,
Access to expertise of Medical Specialists to a Access to expertise of Medical Specialists to a larger population without physical referral, larger population without physical referral,
Reduced visits to specialty hospitals for long Reduced visits to specialty hospitals for long term follow-up care for the aged and terminally term follow-up care for the aged and terminally ill patients.ill patients.
Benefits to Physicians:
Improved diagnosis and better treatment Improved diagnosis and better treatment management management
Access to computerized, comprehensive data Access to computerized, comprehensive data (text, voice, images etc.) of patients – offline (text, voice, images etc.) of patients – offline as well as real timeas well as real time
Quick and timely follow-up of patients Quick and timely follow-up of patients discharged after palliative caredischarged after palliative care
Continuing education or training through Continuing education or training through video conferencing periodicallyvideo conferencing periodically
Benefits of Telemedicine (II)
Hospital and Insurance Benefits:
Significant reduction in unnecessary visits & Significant reduction in unnecessary visits & hospitalization for specialized care at tertiary hospitalization for specialized care at tertiary hospitals,hospitals,
Earlier discharge of patients leading to shorter Earlier discharge of patients leading to shorter length of stay in hospitals,length of stay in hospitals,
Increase in the scope of services without Increase in the scope of services without creating physical infrastructure in remote creating physical infrastructure in remote hospitalshospitals
Benefits of Telemedicine (III)
Telemedicine : The Model Patient under treatment Physician treating the patient A remote telemedicine console having audio visual and data conferencing facilitiesNodal HospitalNodal HospitalNodal HospitalNodal Hospital
Referral HospitalReferral HospitalReferral 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
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 CenterNodal Center
Referral CenterReferral Center
System Schematic
Sequence of Tele-consultation (I)Sequence of Tele-consultation (I)PATIENT IN
Patient visits OPD Local Doctor checks up
Patient receives treatment and is not referred to telemedicine system
Patient referred to the Telemedicine system (some special investigations may be suggested)
Patient visits Telemedicine data-entry console.Operator enters patient record, data and images of test results, appointment date is fixed for online telemedicine session
OUT
OUT
Offline Data transfer
from Nodal Centre
Ste
p O
ne
Patient 1Patient 2Patient 3Patient 4
.
.
.
Online video conference & tele-consultation for patients between local doctors at the nodal hospital and specialist doctors at the referral hospital
Patient queue
IN OUT
Ste
p T
wo
Sequence of Tele-consultation (II)
Sequence of Tele-consultation (II)
Health Infrastructure in West Bengal(Government)
Medical College Hospitals 9
Dental College Hospitals 2
School of Tropical Medicine 1
District Hospitals 15
Sub-Divisional & State General Hospitals 70
Rural Hospitals 95
Block Primary Health Centres 251
Primary Health Centres 922
Sub-Centres 10,356
** Health on the March 2004-05 Gov. WB
Telemedicine in West Bengal (I)
Project Implementation by Webel ECS Ltd, Kolkata (Dep’t of IT, Govt. West Bengal)
Software development by CS & E Dept. IIT, Kharagpur
Project sponsored & funded by the Dep’t of IT, Min. of Communications & IT, Govt. of India
Implementation and usage of facilities by the Dept. of Health & FW, Govt. of West Bengal
PROJECT - I
DIT Sanction No. : 2(5)/98-H&B Dated 21.01.1999Project Cost : Rs. 150 lakhs
Referral Center : School of Tropical Medicine, Kolkata
Nodal Centers : Habra State General Hospital, 24th Parganas (North)
: MJN Hospital, Coochbehar
Telemedicine in West Bengal (II)
Connectivity: First with POTS, upgradation with ISDN, lastly with 512 Kbps Leased Line using WBSWAN as backbone.
Disease Types: Skin Related and Blood Related Diseases,Leprosy .Project Completed: December 2003
PROJECT - II
DIT Sanction No. : 2(11)/2001-HBT, dated 31.03.2002DIT, GOI Contribution : Rs. 147 lakhs
Referral Center : NRS Medical College & Hospital, Kolkata
: Burdwan Medical College & Hospital, Burdwan
Nodal Centers : Purulia District Hospital, Purulia
: Suri District Hospital, Birbhum
: Baharampur District Hospital, Murshidabad
: Midnapur Medical College & Hospital, Midnapur
Connectivity: 512 Kbps Leased Line using WBSWAN as backbone.
Disciplines: Cardiology, Radiology, Medicine, Pediatrics, Pathology, Neurology, Dermatology etc.
Project Completed: December 2004
512 KBPS Leased Line
Behrampur DH
Suri DH
MidnapurMC&H
Burdwan MC&H
NRS MC&H
Purulia DH
Location of CentersOf Project II
LEGEND`
PROJECT - III
DIT Sanction No. : 2(20)/2003-Telemed Dt. 08.03.04DIT, GOI Contribution : Rs. 287 lakhs 0
Referral Center : Calcutta Medical College, North Bengal Medical College, Chittaranjan National Cancer Institute, Kolkata
Nodal Centers : Darjeeling, Raigunj & Tamluk District Hospitals
: Arambag Sub. Div. Hospital, Hoogly
Connectivity: ISDN for Arambag Nodal center and 512 Kbps Leased Line using WBSWAN as backbone for other centers.
Disciplines: Cardiology, Radiology, Medicine, Pediatrics, Pathology, Neurology, Dermatology, Oncology etc.
512 KBPS Leased Line
128 KBPS ISDN Link
NBMCH
Darjeeling DH
Tamluk DH
Arambag SDH
CMC&H
Raiganj DH
CNCI
Location of CentersOf Project III
LEGEND
Koochbehar MJN
Habra SGH
Behrampur DH
Suri DH
MidnapurMC&H
Purulia DH
Darjeeling DH
Tamluk DH
Arambag SDH
Raiganj DH
CMC&H
CNCISTM
NRS MC&H
NBMCH
Burdwan MCH
KOLKATA
LEGEND
Total Mapping ofThe Nodal and Referral Centers
TelemediK Software (I) Is a point-to-point telemedicine system
Symmetric No distinction between nodal and referral centers Any hospital can communicate to other hospitals 2nd level referral is allowed
Multi nodal, multi referral environment
Operates over a spectrum of low to high bandwidth communication channels - POTS, ISDN, leased line, VSAT and wireless media
Store & Forward Technical information
Online video conferencing and data transfer
Electronics Medical Record (EMR) Supported - Text, Image, Graphics, Audio, Video
Integration with different medical instrument- EEG, ECG, USG, MRI, CT SCAN, Electronic stethoscope, Microscope fitted with digital camera
Support of medical standards
TelemediK Software (II)
Training Provided Training Provided
Tele-medicine Centers Doctors Paramedics
Habra SDH 03 12
Coochbehar DH 08 12
Midnapur MC & H 12 03
Behrampur DH 05 02
Purulia DH 18 08
Suri DH 15 02
NRS MC & H 03 01
Burdwan MC & H 15 07
STM, Kolkata 05 01
Total 84 48
Discipline wise Patient Consultation
Pediatrics 75
Orthopedics 96
Neurology 34
Cardiovascular Medicine 27
Psychiatry 12
ENT 31
Urosurgery 11
Hematology, Dermatology, General Medicine, OBG, Leprosy, etc
3300
Public-Private Partnership in Tele-medicine
Integrated Tele-Cardiology & Tele-health Project
Govt. facilities covered - BSMCH & Siliguri SDH
Partnership with Asia Heart Foundation & RN Tagore International Institute of Cardiac Sciences, Kolkata
Connectivity through POTS & ISDN
Services Provided
Treatment of Acute Heart Attack cases as evidenced by history and ECG,
Treatment by “Thrombolysis”
Referral & Tele-consultation & video conferencing with RN Tagore International Institute of Cardiac Sciences, Kolkata
Bankura Sammilani Medical College
Siliguri SD Hospital
Patients Admitted 1493 2418
Thrombolysed 296 197
Tele-consultation 915 458
Utilization of Tele-cardiology Facilities
Awards Received
National e-Governance Award, 2004 – from Govt. of India under Category “ Outstanding Performance in Service Delivery”
Skoch Challenger Award, 2005
Manthan – American India Foundation
Award, 2006 under “e- Health” Category
Challenges in Implementing Telemedicine
1. Identification of a Suitable site and preparation of site for Telemedicine facility.
2. Synchronization of civil, electrical and equipment related works.
3. Identification of a nodal officer (Other than Superintendent) for coordinating Telemedicine activities in the hospital.
4. Sensitization and repeated hands-on training of concerned Doctors, Technicians and Nurses.
5. Coordinating with referral centers to fix mutually convenient tele-consultation sessions on a regular basis.
6. Ensuring trouble free & smooth connectivity through WAN (ISDN/Leased Line)
…. 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.