CENTRAL ASIA e-NETWORK CENTRE FOR DEVELOPMENT OF ADVANCED COMPUTING GOVERNMENT OF INDIA Ministry of External Affairs CENTRAL ASIA e-NETWORK Telemedicine CENTRE FOR DEVELOPMENT OF ADVANCED COMPUTING Ministry of Electronics & Information Technology Government of India 1

STATUS MEA appointed CDAC as PMC and signed an Agreement on Nov 6, 2013 Central Asia e-Network envisages connecting Tajikistan, Uzbekistan, Turkmenistan, Kyrgyzstan & Kazakhstan to India for offering Tele-medicine & Tele-education as a service After Agreement; study visits were undertaken to 5 Central Asian countries by CDAC & domain experts from Leading Hospitals & Universities in India during Feb - Aug 2014 After the visit Detailed Project Report (DPR) has been submitted to MEA on Oct 20, 2014 for approval & a presentation was made to Secretary (West) on Feb 26, 2015 MEA asked CDAC to implement Telemedicine Network in Kyrgyzstan which was inaugurated on Jul 12th 2015 by Hon’ble PM of India As desired by MEA, CDAC submitted separate DPR’s on Telemedicine & Telemedicine on Oct 8, 2015. A further revised budgetary estimate as per meetings with ERS & IFD, MEA was submitted on March 18, 2016 In Dec 2016 it has been informed that the DPR for Telemedicine has been ‘In-Principle’ approved by MEA. However, CDAC is yet to receive the detailed budgetary estimate approved in order to take the project further. Also, concurrence from Stakeholders viz. Indian Missions & Foreign counterparts is being sought before initiating the project

OBJECTIVE DELIVERABLES Tele-Medicine services from Super Specialty Hospitals in India to Hospitals in 5 Central Asian CIS Countries DELIVERABLES State-of-the-art Central Hub in India comprising of NOC & Date Centre to monitor end locations in the network Modern Tele-Medicine setup at 5 Leading Hospitals & 25 Remote Hospitals in 5 Central Asian CIS countries consisting of IT infrastructure, Audio Video Equipment, medical diagnostic instruments and tele-medicine application Tele-consultation & Continuing Medical Education from Indian Hospitals to Doctors, Nurses & Paramedics in Leading & Remote Hospitals in 5 Central Asian CIS Countries Broadcasting live surgeries, skill enhancement programme, conferences and exercises in the event of epidemic/ disaster to 15 seater CME Room in Leading CIS Hospitals A reservoir of e-content consisting of recorded lectures & CME sessions at the Central Hub in India State-of-the-art studio setup at participating Hospitals in India for Tele-consultation Regular Project Monitoring visits by Indian Experts Operation & maintenance of the network for a period of 5 years since its commissioning

DOMAINS & PROGRAMMES Continuing Medical Education (CMEs) & Tele-Consultations (Online/ Offline): General/ Internal Medicine Cardiology Surgery Neurology Neurosurgery Pathology Dermatology Urology Endocrinology Gastroenterology Oncology Gynecology Basic Preventive Care for diabetes, pregnancy, etc. Paramedical Staff training

CONNECTIVITY Central Asian Side Indian Side The Central Asia e-Network envisages setting up an e-network connecting Hospitals in the Central Asian countries with Leading Hospitals in India for providing Tele-Medicine services.

CENTRAL HUB The e-network requires continuous scheduling, monitoring, controlling, reporting, recording & archival of Tele-Medicine services All five Central Asian countries may not join the network at once hence the Central Hub should be scalable & upgradeable Residing Servers, Data and applications centrally for enhancing the throughput & cutting down the cost on hardware infrastructure that would have been supplied to each of the end locations, otherwise Enhancing the scalability factor of the project Showcasing the functionality of Network to foreign delegates in MEA / MeitY / CDAC itself Ensuring better security of the state of the art infrastructure After five years the physical infrastructure & content will be the property of MEA

CENTRAL HUB (Contd.) The Central Hub will act as a single gateway for delivery of Tele-medicine services from India to Central Asian countries. The functions that would be performed at Central Hub are Scheduling, Monitoring, Controlling, Reporting, Recording & Archival.

TELE-MEDICINE STUDIO Super Specialty Hospitals in India will be equipped with high-end multipoint VC facility, sophisticated audio-video equipment & Tele-medicine software for Tele-consultations to the patients & doctors at remote end. Tele-medicine Studio will also deliver Continuing Medical Education (CME) to Doctors & Skill Enhancement Programme to Paramedics and Nurses.

TELE-CONSULTATION ROOM Tele-medicine Room at each leading hospital in Central Asian Countries will be provided with high-end multipoint VC facility and medical diagnostic instruments for generating EMR of the patient to the Tele-Medicine software for consultations.

CME ROOM A 15-seater smart classroom is proposed at each of the leading hospital for delivery of Continuing Medical Education (CME) to Doctors & Skill Enhancement Courses for Paramedics & Nurses.

TELE-CONSULTATION ROOM (Remote) Tele-medicine Room at each remote hospital in Central Asian Countries will be provided with high-end single point VC facility and medical diagnostic instruments for generating EMR of the patient to the Tele-Medicine software for consultation with the leading hospital

TELE-MEDICINE APPLICATION

TELE-MEDICINE APPLICATION Browser-based Centralized and Secured Patient Data Base Real-time store and forwarding of patient data Highly flexible and modular Compliance to the International healthcare standards (DICOM, HL7 etc.) Electronic Medical Record Management module Real time monitoring, assessment, analysis and viewing Support variety of the medical device data formats Upgradable / maintainable from a remote location Flexible and customizable user interface Remote control of ECG speed, sensitivity, sampling rate, selectable lead combinations and pause feature Support for multiple physicians to view single patient data in real-time Support Multi parameters such as SPO2, Spiro-meter, ECG, Blood Pressure

TELE-CONSULTATION The Remote Hospital (RH) will generate EMR of patients to be stored at Leading Hospital (LH) at Central Asian Side. RH will consult LH first, who in turn can refer the case to Super Specialty Hospital at Indian side. The Indian super Specialty can then connect directly with RH at Central Asian side.

ROLES & RESPONSIBILITIES CDAC CDAC shall provide expert inputs in the Detailed Project Report (DPR) for setting up of Central Asia e-Network. CDAC shall design, develop, deliver and commission the turnkey solution for setting up of Central Asia e-Network in the agreed time frame. CDAC on behalf of MEA shall procure and supply the IT hardware/ software, medical equipments & services as required and agreed. CDAC shall be responsible for identification and selection of the Hospital in consultation with MEA. CDAC shall coordinate and facilitate Agreements between MEA & Indian Hospitals CDAC shall be responsible for Project Monitoring for the entire duration of project. CDAC shall also certify and forward the bills of Hospitals to MEA for release of payment. During the period of 5 years of monitoring, CDAC shall comment on the sustainability factor of the network after 5 years.

ROLES & RESPONSIBILITIES (Contd.) MEA MEA shall provide necessary funding for setting up of required IT infrastructure & Equipments at each site. MEA shall also provide the necessary funding for required IT infrastructure, services and other expenditure at Central Hub, participating Super Specialty Hospitals in India. MEA shall also sign MOU with Government of the Central Asian countries outlining the arrangements for setting up of Central Asia e-Network. MEA shall also enter into an Agreement with selected Indian Hospital.

ROLES & RESPONSIBILITIES (Contd.) Government of the respective Central Asian Country The Government of the Central Asian countries shall provide Physical infrastructure, stabilized electricity supply with back up, environmental conditioning, internet connectivity (>=2Mbps) & communication facility. They shall provide Interpreter as and when required. They shall exempt all the products & services being supplied/ offered under this project from custom duty or any other tax prevailing in the Host Country. They shall facilitate custom clearance and local transportation from airport/ seaport to project site(s). They shall select & arrange the Hospitals, Doctors, Paramedical staff, Interpreter etc. They shall obtain all statutory approvals and permissions required for establishment and operation of the network within their countries.

ROLES & RESPONSIBILITIES (Contd.) Super/ Multi Specialty Hospitals in India The Indian Super Specialty Hospitals shall sign an Agreement with MEA to render quality services as per defined criteria. They shall identify the Specialist Doctors for the required Tele-Medicine services who have relevant experience in their specialization. The Hospitals shall provide required acoustic friendly space/ building with basic furnishing and stabilized electricity supply, air conditioning with power back-up, Internet Bandwidth (>=2Mbps) and an Interpreter. They shall develop content (bi-lingual, if required) for the required CMEs and provide quality Tele-Consultation as per the fixed schedule and charges along Interpreter, as required. The CME & Tele-consultations will be on-line/ off-line depending on the criticality of situation; however in case of offline consultation the response time should not exceed 4 working hours.

CONCERNS Clear Vision & Interest by participating Stakeholders viz. Indian Missions, Foreign Counterparts, Indian Hospitals etc. Responsibilities by all stakeholders to be agreed for fulfillment of objectives Onus of effective usage & Marketing of Telemedicine Network should rest on the implementing agency (ies) of Central Asian side & Indian Hospitals To initiate the Project, the intra-country Telemedicine Network (like Kyrgyzstan & Armenia) may be established first Depending on success of (IV) above the Intra – country Network may be linked to Indian Hospitals As the project framework is likely to be modified, an addendum to the agreement between MEA & CDAC should be signed

Applying Advanced Computing for Human Advancement Thank you http://www.cdac.in/