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 Rapporteurs 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 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

Camp1 Camp2 Camp n DGHS

? ?

Mela Main Hospital

?
Mela monitoring cell, Secretariat City hosp.

MLN med coll

Alld. dist hosp.

?
SGPGIMS

Database

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

Equipments used and their cost

S. No
Capital equipment
1. (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 Rs.58.50 lacs Rs.58.50 lacs

Head

Approved Outlay

Expenditure

Equipments used and their cost Contd

S.No
2.

Head
Consumable Items/components (Fe comp}
(i) (ii) (iii) (iv) (v) Telemedicine license software 06 Service Kit 06 Cable set 06 Printer Stationary rim 05 Operating manual 02

Approved Outlay

Expenditure

3.

Staff salaries

6.50

Rs.3,42,911.00

4.

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

15.00 lacs

Rs.20,67,239.00

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 OT +ve OT -ve 1024 869 155 Microbiological Examination Total sample Suspicious Fecal cont. 149 31 05 Sangam water Total sample MPN/100 ml V. cholerae 9 >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. Positive growth Organisms isolated 80 16 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

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. 03. 04. 05. 06. 07. 08. 09. 10. 11. 12. 13. 14. 15. 16. 17. Kalam Ahmed Varunkumar singh Gopal Rajkumar Anil Rama Birota Devi Jagni Bai Champa Devi Rajesh Kumar Siddheshwar Nath Baburam Shyambabu Dr. S.K.Tewari Bhuttanray Badri Chamli Sharma 30/M 16/M 26/M 40/M 27/M 55/F 67/F 65/F 20/M 55/M 75/M 35/M 40/M 36/M 70/M 50/M M.G. Marg P.S C/o. Dy.S.P. Sarhia, Raipur. (M.P) Sri Pargaha ( Bihar) Thana Pared Saraswati Satsung Tripuda ( Panjab) Tripuda ( Hariyana) Aligunj ,Lko. Durga Ashram-Riva Rakshar Balia Hanuman Mandir Main Hospital,Bhopal VIP Camp Police Gorakhpur Panchganiya-Bihar --31/12 31/12 05/01 07/01 08/01 ---------

5 Days 03/01 15 Days 05/01 5 Days 07/01 --------1 Day ------1 Day 1 Day 1 Day 07/01 09/01 10/01 10/01

10/01 11/01 11/01 11/01 11/01 12/01 12/01 12/01 --(Ref.T.B.M) 12/01 O.P.D. 13/01 13/01

----- Admitted Today -----

KUMBH MELA PATIENT REPORT

Total patient up to Dated 20/01/2001 at 8 p.m.

1) Emergency Patient 2) Non-Emergency Patient ( Data Patient ) 3) Evaluation Patient ( 2nd Opinion Patient)

35 28 15

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 2) Non-Emergency Patient ( Data Patient ) 3) Evalution Patient ( 2nd Opinion Patient )

77 37 17

Total Patients

-----131

Clinical Tele-consultation

Tele-consultation
Specialities Cardiology Radiology Orthopedics Neurology Neurosurgery Physician Opthalmology Dermatology Path. Slides No. of Consult. 64 32 13 01 01 01 02 01 01 Transmitted Documents On line ECG, Documents and snap shot Documents and X-ray / CT scans Snap shot, X-ray, Documents Documents and snap shot Documents, CT scan Documents Documents, snap shot of eye Documents and snap shot Slide pictures

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

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.

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