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Outcome of case study (project completed)on Field Telemedicine Application in Indian Setting

Question 10-1/2: Communications for Rural & Remote areas ITU-D Study Groups Rapporteur’s Group Meeting, Tokyo, Japan, 20-21 June 2005

Prof. S K Mishra,MS, FACS Head, Dept. of Endocrine Surgery Nodal Officer Telemedicine SGPGIMS, Lucknow,India

Application of the Telemedicine Technology to provide Tele-health Care during Mela/ Festival and Disaster Executed
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
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 Camp1 Camp2 Camp n DGHS ? ? Mela Main Hospital Mela
Genesis of experiment concept
Camp1
Camp2
Camp n
DGHS
?
?
Mela Main Hospital
Mela monitoring
cell, Secretariat
MLN med coll
Alld. dist hosp.
City hosp.
?
?
Database
SGPGIMS
Technology
Insertion

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 station in Kumbh Mela

Location of Telemedicine work station in Kumbh Mela
Location of Telemedicine work station in Kumbh Mela

Equipments used and their cost

S.

 

Head

Approved Outlay

Expenditure

No

 
 

Capital equipment

   

1.

(i)

Monitor –12

Rs.58.50 lacs

Rs.58.50

lacs

(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

Equipments used and their cost Contd…

S.No

 

Head

Approved Outlay

Expenditure

2.

Consumable Items/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

3.

Staff salaries

6.50

Rs.3,42,911.00

4.

Contingencies (including telecommunication, travel, conference organisation and other miscellaneous expenses)

15.00

Rs.20,67,239.00

lacs

 

Total

Rs.80.00 lacs

Rs.82,60,150.00

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

samples

• Daily event report

Tele-monitoring of public health

• Drinking water

– OT test for chlorination

Total sample

1024

OT +ve

869

OT -ve

155

– Microbiological Examination

Total sample

Suspicious

149

31

Fecal cont.

05

• Sangam water

– Total sample

9

MPN/100 ml V. cholerae

>1100in 5

None

Tele-monitoring of public health

Food samples:

24 vendor shops

Police line mess

Results of Stool Culture

Few stool samples and rectal swabs (pt belonging to sec 9)

Total no.

80

Positive growth

16

Organisms isolated

All V. cholerae O139

Reports sent immediately on line and preventive measures taken both for patients and water as instructed.

Other Cultures

Throat swab (n=16) NPG = 10 Growth +ve = 6 [ 4 HI, 2 Acinetobacter spp] Conjunctival swab (n=20) NPG = 16 Growth +ve =4 [ S. aureus] Wound swab (n=14) Sterile = 8 Growth +ve = 6

A Sample of Daily Report of OT Test of Water Samples Exchanged through Telemedicine Network

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

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

Tele-consultation

Specialities

No. of

Transmitted Documents

Consult.

Cardiology

64

On line ECG, Documents and snap shot

Radiology

32

Documents and X-ray / CT scans

Orthopedics

13

Snap shot, X-ray, Documents

Neurology

01

Documents and snap shot

Neurosurgery

01

Documents, CT scan

Physician

01

Documents

Opthalmology

02

Documents, snap shot of eye

Dermatology

01

Documents and snap shot

Path. Slides

01

Slide pictures

Samples of Online ECG in Progress at the Field Hospital

Samples of Online ECG in Progress at the Field Hospital
Samples of Online ECG in Progress at the Field Hospital
Samples of Online ECG in Progress at the Field Hospital
Samples of Online ECG in Progress at the Field Hospital
Samples of Online ECG in Progress at the Field Hospital
Samples of Online ECG in Progress at the Field Hospital
Samples of Online ECG in Progress at the Field Hospital
Samples of Online ECG in Progress at the Field Hospital
Samples of Online ECG in Progress at the Field Hospital
Samples of Online ECG in Progress at the Field Hospital

Teleconsultation- Case Studies

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

rate of 104 per minute, no breathlessness at present cvs NAD R/S clear. There is no creptation.Lever

not palpable. No oedema on feet.

5 mg and 100 mg aspri. On examination the patient is consicus oriented and with heart

not palpable. No oedema on feet. 5 mg and 100 mg aspri. On examination the patient

A Sample of Online ECG at the Consulting end monitor

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.

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

Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
Sample of Clinical Examination of Eye: Snap shot Images as seen at the consulting end
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

Samples of Tele-microscopic pictures of Blood Smears in suspected cases of Malaria
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

exchange of History & Clinical examination carried out through Tele-medical Video Conference at the Consulting End
exchange of History & Clinical examination carried out through Tele-medical Video Conference at the Consulting End
exchange of History & Clinical examination carried out through Tele-medical Video Conference at the Consulting End
exchange of History & Clinical examination carried out through Tele-medical Video Conference at the Consulting End
exchange of History & Clinical examination carried out through Tele-medical Video Conference at the Consulting End
exchange of History & Clinical examination carried out through Tele-medical Video Conference at the Consulting End
exchange of History & Clinical examination carried out through Tele-medical Video Conference at the Consulting End
exchange of History & Clinical examination carried out through Tele-medical Video Conference at the Consulting End
exchange of History & Clinical examination carried out through Tele-medical Video Conference at the Consulting End
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
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
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
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
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

Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.

Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.
Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.
Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.
Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.
Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.
Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.
Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.
Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.
Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.
Snap Shots of the Clinical Examination findings as seen at the consulting end… contd.
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

Public Awareness
Public Awareness
Public Awareness
Public Awareness
Public Awareness
Public Awareness
Public Awareness

Mobile Telehospital

Mobile Telehospital

Portable Telemedicine Workstation for Disaster

Portable Telemedicine Workstation for Disaster
Portable Telemedicine Workstation for Disaster

Tele-Hospital Model contd.

Tele-Hospital Model contd.

Milestones

• 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 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

Thank You
Thank You