Telemedicine : A low cost solution

Anunay Nayak
Jayanta Mukherjee
Arun Kumar Majumdar

Department of Computer Science and & Engineering

IIT Kharagpur
 A brief sketch of our journey
•May 1997 : Invitation for a proposal by MCIT (then DOE) on Telemedicine over
ordinary telephone lines.
•March 1998 : Submission of a Draft proposal in collaboration with School of
Tropical Medicine and WECS (WEBEL).
•Jan 1999 : Starting of Project Work.
•Aug 2000 : A Prototype system developed (TelemediK Software Version 1.0)
•Nov 2000 : Installed in STM for in house training and demonstration.
•Feb 2001 : First beta test between STM Kolkata and IIT Kharagpur.
•Feb 2002 : Inauguration of Telemedicine between School of Tropical Medicine,
Kolkata and Habra State General Hospital.
•April 2002 : Inauguration of the second nodal center at Cooch Bihar.
• May 2002 : Project involving connections of six hospitals of Government of West
Bengal is taken by WEBEL (IIT Kharagpur being the consultant).
•Nov 2002 : TelemediK version 3.0 with a better front end and flexibilities in users
operations.
 Field trials and demonstrations

–Between West Bank Hospital, Mourigram and B.C.Roy Hospital, IIT

Kharagpur
–Between IIT Extn. Center Bhubaneswar and IIT Kharagpur
–CMC Vellore.
–Chittaranjan Cancer Research Center, Kolkata.
–National Institute of Cholera and Enteric Diseases, Kolkata.
–ELITEX’ 2001 and ELITEX’ 2002, New Delhi.
-Sikkim Manipal Institute of Medical Sciences, Sikkim
-Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha
 What is Telemedicine
• Telemedicine may be defined as the
use of computers and
telecommunication technologies to
provide medical information and
services from distant locations
 Different types of services
 Telecardiology

 Teleradiology

 Telepathology

 Telepsychiatry

 Early Warning System

[ Prevention and control of endemic and infectious diseases ]
 Telemedicine in India
•Existing system limited only to private hospital
•APPOLO Group of Hospitals.
•RN Tagore Cardiac Hospital, Calcutta. (Asia Heart
Foundation)

• No Telemedicine system for public health care

•Corporate Sectors Offering Telemedicine Systems

•APPOLO Group
•Online Telemedicine System, Ahmedabad.
•WIPRO GE
•SIEMENS
Government Efforts

•MCIT
•IIT Kharagpur
•CDAC
•ISRO
 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

 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.
 Aim 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
 Key Principles

•Avoid Adhocism : Preorganisation of Patient Data

•Minimize online data transfer
•Patient Management with Database support
 Technical issues over Low Bandwidth

Problem Solution

• Longer time for Store and forward

data transfer policy
• Poor video quality Transferring
sequence of still
images
 Requirement Specification
• A patient getting treated
Nodal Hospital • A Doctor
• A remote telemedicine console having audio visual
and data conferencing facilities

POTS / ISDN

• An expert/ specialized doctor

Referral Hospital • A central telemedicine server having
audio visual and data conferencing facility
 Sequence of Operation
PATIENT IN

Patient visits OPD Patient receives local treatment and

OUT
Local Doctor checks up 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 OUT
results, appointment date is fixed for online telemedicine
session

Offline Data transfer

from Nodal Centre
 Sequence of Operation

Patient 1
Patient 2
Patient 3 Online conference for the patient.
Patient 4
. IN Patient, local doctors at the nodal hospital OUT
. and specialist doctors at the referral
. hospital

Patient queue
 Hardware Configuration

Video Conference

Modem Telephone
Referral Hospital Microscope and other
medical instruments
Video Conference
PSTN/ISDN/VSAT link

Digital camera
Scanner

Telephone Modem Printer

Nodal Hospital
Software Modules

Offline Activities

Online Activities
 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
 Employment Generation

•Extension of existing services.

•Personals involved.
 Other Issues
•Incorporation of Standard.
•Health Level Seven (HL7)
•Digital Imaging Communication in Medicine (DICOM)
•Data Security.
•Legal & Ethical Issue