Outcome of case study (project completed)on Field Telemedicine Application in Indian Setting Prof. S K Mishra,MS, FACS Head, Dept. of Endocrine Surgery Nodal Officer Telemedicine SGPGIMS, Lucknow,India Question 10-1/2: Communications for Rural & Remote areas ITU-D Study Groups Rapporteur’s Group Meeting, Tokyo, Japan, 20-21 June 2005
it tells about how kumbh mela makes allahabad emerge as a popping city with a population of more then 2 crore
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Outcome of case study (project completed)on Field Telemedicine Application in Indian Setting
Prof. S K Mishra,MS, FACSHead, Dept. of Endocrine Surgery
Nodal Officer TelemedicineSGPGIMS, Lucknow,India
Question 10-1/2: Communications for Rural & Remote areas
ITU-D Study Groups
Rapporteur’s Group Meeting, Tokyo, Japan, 20-21 June 2005
Application of the Telemedicine Technology to provide Tele-health
Care during Mela/ Festival and Disaster
Executed by :Sanjay Gandhi Postgraduate Institute, Lucknow
in collaboration with • Dept. of Information Technology & Health, Govt. of U P• Online Telemedicine Research Institute, Ahmedabad
Project Funded by : Dept. of Information Technology,Ministry of Communication &.IT, Govt. of India
Mahakumbh Mela: Indian Hindu religious festival Jan 6- Feb 26, 2001 (1/12 year)
Junction of two sacred rivers (Ganges and Yamuna)More than 10 millions pilgrims congregated and took holy dip
Genesis of experiment concept
City hosp.
Camp1 Camp2 Camp n
Mela Main Hospital
MLN med coll Alld. dist hosp.
SGPGIMS
DGHS
Mela monitoring cell, Secretariat
Technology Insertion
Database
?
?
?
?
Apprehension
• Highly Technical venture not yet tested in such setting
• Multi agency involvement
• Human factors eg. Attitude, Lack of confidence on the technology
•Technology insertion to the existing health system
• Need of big financial grant
Objectives
• Tele-monitoring of Public Health activities.
• Tele-monitoring of Health care facility.
• Tele-health education to public.
• Computation of database on health problems during Mela / Disaster.
• Tele-consultation (Specific medical advice from specialist)
Implementation
• Survey of the proposed telemedicine work
stations
• Clearance obtained from concerned govt.
authorities
• Setting up of telecommunication network &
proper power source
Telemedicine Network Infrastructure Used for
Field Application
Location of Telemedicine work stationin Kumbh Mela
Equipments used and their cost
Rs.58.50 lacsRs.58.50 lacsCapital equipment
(i) Monitor –12(ii) CPU - 12 (iii) Pen Key Board – 12 (iv) Colour Inkjet Printer –05 (v) Web Camera – 12 (vi) Hub & Adopter – 04 (vii) Microphone – 06 (viii) Desk Top Modem – 04(ix) ECG Phone – 05(x) Telemedicine Table – 08(xi) Power Distribution Board -(xii) Hand Set – 05(xiii) PFT Machine – 01(xiv) Portable Xray Machine – 01(xv) Ethernet Adopter Card – 02(xvi) Microscope with Camera – 01(xvii) X ray Flatbed Scanner – 01(xvii Online ECG Monitoring Unit – 02
1.
ExpenditureApproved OutlayHeadS. No
Equipments used and their cost Contd…
Rs.82,60,150.00Rs.80.00 lacsTotal
Rs.20,67,239.0015.00lacs
Contingencies (including telecommunication, travel, conference organisation and other miscellaneous expenses)
4.
Rs.3,42,911.006.50 Staff salaries3.
ConsumableItems/components(Fe comp}(i) Telemedicine license software – 06(ii) Service Kit – 06(iii) Cable set – 06(iv) Printer Stationary rim – 05(v) Operating manual – 02
2.
ExpenditureApproved OutlayHeadS.No
Tele-Public Health Measures
Tele-conferencing
• Teleconferencing was carried out between
telemedicine works stations & technology
support centers as & when required
• Everyday DGHS, Lko was carrying out
teleconference with MLN hospital to discuss
public health activity regarding safe drinking
water, sanitation, food hygiene and infectious
diseases status etc.
Online exchange of data
• Daily progress report of water testing (OT test) &
culture sensitivity, bacteriological examination of
A Sample of Daily Report of OT Test of Water Samples Exchanged through Telemedicine Network
Health Administration through the Telemedicine Network from ‘Festival Monitoring Cell’ located at State head
quarter 300 Km away
A Sample of Daily Progress Report exchanged through Telemedicine Network
KUMBH MELA - 2001
Kind attn: - Director General Medical & Health Services, Govt. of U.P., Lucknow
WORK DONE UNDER P.F.A. ACT UP TO 11/1/2001
1) No. of Samples collected - 5 2) No. of Licence issued - 12 3) No. of shops inspected - 24 From: Mr. K.P.Gupta Chief Food Inspector Kumbh mela.
THE PATIENT OF KUMBH MELA - 2001 THE DETAILES OF INDOOR PATIENTS WITH
ACUTE GASTROENTERITIS TILL DATED 13th January. (4:00 PM) ---------------------------------------------------------------------------------------------------------------------------------------------------- Sr. No. Name of Patient Age/Sex Address Duration DOA DOD ---------------------------------------------------------------------------------------------------------------------------------------------------- 01. Munnalal 35/M Antifly 1 Day 29/12 30/12 02. Kalam Ahmed 30/M M.G. Marg P.S --- 31/12 31/12 03. Varunkumar singh 16/M C/o. Dy.S.P. 5 Days 03/01 05/01 04. Gopal 26/M Sarhia, Raipur. (M.P) 15 Days 05/01 07/01 05. Rajkumar 40/M Sri Pargaha ( Bihar) 5 Days 07/01 08/01 06. Anil Rama 27/M Thana Pared --- 07/01 --- 07. Birota Devi 55/F Saraswati Satsung --- 09/01 --- 08. Jagni Bai 67/F Tripuda ( Panjab) --- 10/01 --- 09. Champa Devi 65/F Tripuda ( Hariyana) --- 10/01 --- 10. Rajesh Kumar 20/M Aligunj ,Lko. 1 Day 10/01 11/01 11. Siddheshwar Nath 55/M Durga Ashram-Riva --- 11/01 --- 12. Baburam 75/M Rakshar Balia --- 11/01 (Ref.T.B.M) 13. Shyambabu 35/M Hanuman Mandir --- 11/01 12/01 14. Dr. S.K.Tewari 40/M Main Hospital,Bhopal 1 Day 12/01 O.P.D. 15. Bhuttanray 36/M VIP Camp Police 1 Day 12/01 13/01 16. Badri 70/M Gorakhpur 1 Day 12/01 13/01 17. Chamli Sharma 50/M Panchganiya-Bihar ----- Admitted Today -----
KUMBH MELA PATIENT REPORT
Total patient up to Dated 20/01/2001 at 8 p.m. 1) Emergency Patient 35 2) Non-Emergency Patient 28 ( Data Patient ) 3) Evaluation Patient 15 ( 2nd Opinion Patient) --------- TOTAL PATIENT 78
KUMBH MELA PATIENT REPORT
Total no. of patients from 6.01.2001 upto 27.01.2001 at 2 p.m. 1) Emergency Patient 77 2) Non-Emergency Patient 37 ( Data Patient ) 3) Evalution Patient 17 ( 2nd Opinion Patient ) Total Patients ------ 131
Clinical Tele-consultation
Slide pictures01Path. Slides
Documents01Physician
Documents and snap shot01Neurology
Documents and X-ray / CT scans32Radiology
Documents and snap shot01Dermatology
Documents, snap shot of eye02Opthalmology
Documents, CT scan01Neurosurgery
Snap shot, X-ray, Documents13Orthopedics
On line ECG, Documents and snap shot64Cardiology
Tele-consultation
Transmitted DocumentsNo. of Consult.
Specialities
Samples of Online ECG in Progress at the Field Hospital
A 70 years old male came with chief complaint of chest pain since seven months. Headache and giddness since today morning. Patient has past history of hypertention and on treatment of 5 mg od amlodipin, enalapirl 5 mg and 100 mg aspri. On examination the patient is consicus oriented and with heartrate of 104 per minute, no breathlessness at present cvs NAD R/S clear. There is no creptation.Lever not palpable. No oedema on feet.
Teleconsultation- Case Studies
A Sample of Online ECG at the Consulting end monitor
The case was a human bite, One policeman was bitten by rickow puller. Doctor from Main Hospital, kumbh mela talked about the case on videoconferencing. The expert from M L N Medical College adviced injuction treatvas, antibiotics pain killer but no anti rabbies vaccine or sirum. Status asthimatics for proper management.
Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
Samples of Tele-microscopic pictures of Blood Smears in suspected cases of Malaria
Snap Shots of exchange of History & Clinical examination carried out through Tele-medical
Video Conference at the Consulting End
Snap Shots of the Clinical Examination findings as seen at the consulting end
Snap Shots of the Clinical Examination findings as seen at the consulting end…..contd.
Summary of Outcome - 1
• First successful deployment of telemedicine in Field
Situation in India
• Set an example of preparedness for mitigation of public
health disaster
–A small outbreak of cholera was aborted efficiently
by timely diagnosis and proper preventive measures
promptly taken with on line consultation
–Monitoring of public health measures on day today
basis
Summary of Outcome - 2
• Specialist consultation access in field situation
• E-health governance in such unique rural location
–Co-ordination and centralized decision
promptly
–Data base could be generated
• Public awareness on Telemedicine Technology
Spin-off effect of the Project
• Creation of infrastructure for Telemedicine at SGPGIMS, Lucknow, North India and SCB Medical College at Cuttack, Orissa, East of India
• Implementation of distantTele-education for the postgraduate students of SCB Medical College
• Concept of Mobile and Portable Telemedicine project emerged
• Awareness of Health Technology among health care workers, media professionals, policy makers and masses
Public Awareness
Mobile Telehospital
Portable Telemedicine Workstation for Disaster
Tele-Hospital Model contd.
• Jan 2,2001 Project sanctioned [ No . 2(36)/2000-HBT ]
• Jan 3-5,2001 : Development of Telemedicine network.
• Jan 6-Feb 26,2001 : Maha Kumbh Mela Telemed Project.
• Jan 8-10,2001 : First Project review meeting at Lucknow & Allahabad.
• Jan 31-4 Feb,2001 : Demonstration in Health Mela at Lucknow organized by MoH, GoI.
• March - July,2001 : Evaluation of the Project, preparation of report, upgradation of tele-radiology software & digitization of 2000 Xray films.
Milestones
Milestones contd.
• April 23-27,2001 : National telemedicine Conference.
• Sept. 4,2001-March 22,2002 :Preparation for application
in Flood situation in Orissa & Distant medical education
with S.C.B. medical college cuttack utilizing telemedicine
technology.
• Nov 09-10,2001 : Second Project review meeting at
cuttack.
• Jan 3-8,2002 : Demonstration in Indian National Science
Congress. Inauguration of Mobile telemedicine system