1. 1 Indian Telemedicine Program: Marching Toward Transforming National Healthcare Delivery System Authors: R.L.N. Murthy & L.S. Satyamurthy Telemedicine Programme Indian Space Research Organisation (ISRO) Bangalore, India June 12, 2007 Presented by: Shabbir Syed Abdul

2. 2 Population of only 1.1 + billion, 28 States & 5 union territories Vast Population (80%) spread in inaccessible & remote areas (border areas) & remote islands in around 627,000 villages 8O % of super-specialty live in big cities INDIA – THE LAND OF DIVERSITY

3. 3 The Indian healthcare system Predominantly government managed Three-tier hierarchical system of –Primary, Secondary and tertiary healthcare ~ 23000 Primary Healthcare Centres (PHCs), 3000 Community Healthcare Centres (CHCs) and 670 District Hospitals (DHs) as the major governmental healthcare delivery system + Private institutions serving the population.

4. 4 TeleMedicine in India Agencies like ISRO, Dept of IT, Railways, Few State governments, Private network by Apollo, AHF, AIMS, ESCORTS etc and are also part of this movement in their own capacity Efforts by ISRO: –Space based Rural Development Programmes since 1990s –Major thrust for TM as a special programme since 2001 –Spearheading the Telemedicine Movement in India with the largest network and contineous improvement

5. 5 SPACE FOR THE SOCIETY FIRST ROCKET LAUNCH ON 21st NOVEMBER 1963 THUMBA “ …. SECOND TO NONE IN THE APPLICATION OF ADVANCED TECHNOLOGIES TO THE REAL PROBLEMS OF MAN AND SOCIETY ” Satellites Launch Services Ground Systems Operational Services

6. 6 ISRO’s Initiative in Telemedicine ISRO initiated Telemedicine programme in 2001 as a special programme, for providing Telehealth to the un-served and the under-served Set up Telemedicine Facilities in distant and rural of India to supplement the general healthcare infrastructure.

7. 7 Advantages of Satellite Communication Easy reach, quick installation No geographical and environmental barriers Flexible, high quality network Extensive and Consistent geographic coverage Efficient support to broadcast and multipoint communications for medical education and consultation sessions Network capacity flexibility, reliability and security

8. 8 ISRO’s Telemedicine Program - Thrust Areas Providing Technology and Connectivity   Remote/rural hospitals and specialty hospital   Continuing Medical education (CME)   Mobile telemedicine units   Disaster Management Support (DMS)   Integrating with Village Resource Centres (VRC) / information kiosks for multiple services

9. 9 Growth of TM Applications 2001 : Tele-radiology –still images 2002 : Tele-cardiology – Moving images, CME 2003 : Tele-pathology, Tele-ophthalmology 2004 : Tele-oncology, Tele-surgery 2005 : Mobile TeleHealth - augmentation 2006 : Telemedicine for Primary healthcare -- VRC ……the journey continues ……

10. 10 ISRO TELEMEDICINE Network 2003 58 nodes 36 – Remote 22 - Speciality 2003 58 nodes 36 – Remote 22 - Speciality 2002 27 nodes 17 – Remote 10 - Speciality 2002 27 nodes 17 – Remote 10 - Speciality 2001 5 nodes 3 – Remote 2 - Speciality 2001 5 nodes 3 – Remote 2 - Speciality Growth by Maximising the reach 2004 100 nodes 78 – Remote 22 - Speciality 2004 100 nodes 78 – Remote 22 - Speciality 2005 140 + nodes 109 - Remote 31 - Speciality 2005 140 + nodes 109 - Remote 31 - Speciality Pilot project in 2001, connecting : Aragonda Apollo, Chennai & Chamaraj Nagar Narayana Hrudayalaya 2006 184 + nodes 148 - Remote 36 - Speciality 2006 184 + nodes 148 - Remote 36 - Speciality 2007 220 + nodes ( target 280 nodes) 181 - Remote 40 - Speciality 2007 220 + nodes ( target 280 nodes) 181 - Remote 40 - Speciality

11. 11 SYSTEM COST ( PATIENT END per Node) 2002 18 Lakhs VSAT- 10 L TM system- 8 L ( S/W : 3 L) 2002 18 Lakhs VSAT- 10 L TM system- 8 L ( S/W : 3 L) Minimising the Costs for Growth 2004 8.2 Lakhs VSAT- 5 L TM system - 3.2 L ( S/W : 0.65 L) 40% 2004 8.2 Lakhs VSAT- 5 L TM system - 3.2 L ( S/W : 0.65 L) 40% 2005 5 Lakhs VSAT- 2 L TM system – 3 L ( S/W : 0.25 L) 40% 2005 5 Lakhs VSAT- 2 L TM system – 3 L ( S/W : 0.25 L) 40% 2003 14 Lakhs VSAT- 8 L TM system- 6 L ( S/W : 1.6 L) 2003 14 Lakhs VSAT- 8 L TM system- 6 L ( S/W : 1.6 L) 33% 2006 4 Lakhs VSAT- 1.2 L TM system – 2.8 L ( S/W : 0.25 L) 20% 2006 4 Lakhs VSAT- 1.2 L TM system – 2.8 L ( S/W : 0.25 L) 20%

12. 12 Satcom Based Telemedicine Connectivity

13. Approach followed by ISRO 1. 1.Proof of Concept - Technology Demonstration thru’ Pilot Projects in several states 2. 2.Development of national standards and guidelines 3. 3.Efforts to optimise the clinical requirements for evolving a suitable e- heath technology 4. 4.Efforts to minimise the costs to bring in affordability and maximise the reach

14. Approach followed by ISRO 8. 8. Encouraging new models and efforts like innovative insurance schemes 9. 9. Integrating the healthcare administrators, planners, technologists and entrepreneurs and bringing all the stake holders to a common platform. 10. 10.Training and educating users (doctors and patients) to create interest in utilizing Telemed and eHealth tools 11. 11. Developing Mobile healthcare system for reaching the doorsteps of the rural population

15. 15 Telemedicine Technology Evolution in India: – –Point to point – –Point to multipoint – –Multipoint to multipoint – – Tele-education Patient end

16. SkyIp Terminal Switch District Client Station TV Monitor Video Conferencing Camera 12 Lead ECG Digital Camera A3 Scanner OR Point to point System SkyIp or FlexiDama Terminal Hub/Switch Doctor-End Station TV Monitor Video Conferencing Camera Patient end Doctor end

17. Point-to-Multipoint System Configuration Doctor-End Server Patient-End Super Specialty HospitalRural/District Hospital

18. Continuing Medical Education (CME) Configuration DVB-RCS In-Door Unit Hub/Switch Work Station (s) TV Monitor Server(s) Antenna & ODU LCD Projector Scanner Mixer/Switcher Video Camera Document Camera Microphone

19. 19 MOBILE TELEMEDICINE To overcome the prohibitive costs of large number of terminals and reaching out to the rural areas Sankara Nethralaya Aravind Eye Hospital Tele-Ophthalmic Van – Shankara Nethralaya Tele-Ophthalmic Van – Aravind Eye Hospital

20. 20 Telemedicine STANDARDS in India Guidelines and Standards for –Telemedicine System – Network / Connectivity – Interoperation of Telemedicine Systems – Standards for Security & Process guidelines Efforts to standardize healthcare data interchange using DICOM - Digital Imaging and Communication in Medicine HL7 - Health Level Seven and ITU standards for Video conferencing

21. 21 All states represented including the far-flung areas like – J&K, Andaman & Nicobar islands, Lakshadweep, Uttaranchal and North East etc. Special networks for Army, Navy & Air Force 221 nodes 181 remote hospitals 40 Specilaity hospitals ISRO TELEMEDICINE PROGRAMME

22. 22 National Task Force Constituted by Federal Ministry of Health & Family Welfare To make TM to enter the mainstream of Healthcare delivery To Define a National TM Grid and consider its standards and operational aspects To identify & Evaluate all players and projects currently involved in TM in India To prepare National Cancer TM Network To define standards & structures of EMR and patient data base To draft a National Policy on TM and CME to prepare a Central Scheme for the 11 th FYP

23. Awareness Programme & International Cooperation INTELEMEDINDIA 2005 – attended by various Intl’ specialists Joint working group with Canadian Space Agency ISRO CNES interaction on Technology Asia Pacific Telemedicine Collaboration under ITU Interaction with WHO, ISfT and other agencies UN OOSA Workshop in China, India Training Programme for Afghanistan UN workshop in India

24. Road Map for the Future ISRO to continue leading Telemedicine efforts in India Enhancing awareness and interest among the stake holders Introducing Telemedicine in an operational mode across the country Integrating SatCom and complementing technologies (wireless and Terrestrial) for seamless connectivity Creation of web portal as a repository and knowledge base Steps towards National eHealth policy formulation Efforts to develop and encourage Telemedicine project in SAARC region

25. 25 We value your feedback and Suggestions ! Be open…., to close the gap between ill health & health !! Thank you for Your Attention For Details: murthy@antrix.gov.inmurthy@antrix.gov.in