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. 29 th 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 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.

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.

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)

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)

Telemedicine : The Model  Patient under treatment  Physician treating the patient  A remote telemedicine console having audio visual and data conferencing facilities Nodal Hospital Referral Hospital 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 Electronics Microscope ECG Machine Electronics Stethoscope PSTN / Leased Line / ISDN / VSAT Specialist Doctor Digital Camera Scanner Printer Web Cam Nodal Center Referral Center System Schematic

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 Offline Data transfer from Nodal Centre Step One

Patient 1 Patient 2 Patient 3 Patient 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 Step Two Sequence of Tele-consultation (II)

Health Infrastructure in West Bengal (Government) Medical College Hospitals9 Dental College Hospitals2 School of Tropical Medicine1 District Hospitals15 Sub-Divisional & State General Hospitals70 Rural Hospitals95 Block Primary Health Centres251 Primary Health Centres922 Sub-Centres10,356 ** Health on the March 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 Project 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

128 KBPS ISDN Link Koochbehar MJN Habra SGH STM Location of Centers 0f Project I LEGEND

PROJECT - II DIT Sanction No. : 2(11)/2001-HBT, dated DIT, 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 Centers Of Project II LEGEND`

PROJECT - III DIT Sanction No. : 2(20)/2003-Telemed Dt DIT, 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 Centers Of 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 CNCI STM NRS MC&H NBMCH Burdwan MCH KOLKATA LEGEND Total Mapping of The 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 Tele-medicine CentersDoctorsParamedics Habra SDH0312 Coochbehar DH0812 Midnapur MC & H1203 Behrampur DH0502 Purulia DH1808 Suri DH1502 NRS MC & H0301 Burdwan MC & H1507 STM, Kolkata0501 Total8448

Discipline wise Patient Consultation Pediatrics75 Orthopedics96 Neurology34 Cardiovascular Medicine27 Psychiatry12 ENT31 Urosurgery11 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 Thrombolysed Tele-consultation Utilization of Tele-cardiology Facilities

Live session using 512 Kbps Leased Line

Images

Video Clip

Vector Data

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.