TELEMEDICINE PROJECTS

in
West Bengal

A Presentation by
Dr. Rajendra S. Shukla, Special Secretary,
H & FW Dept, Government of West Bengal
&
Dr. J. N. Maity, Director,
WEBEL ECS Ltd.

29th 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
 Objectives of Telemedicine
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.
 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 of Telemedicine (II)

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 (III)
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
 Telemedicine : The Model
Patient under treatment
Physician treating the patient
A remote telemedicine console having
audio visual and data conferencing
Nodal Hospital facilities

Referral Hospital
An expert / specialised doctor
A central telemedicine server having
audio visual and data conferencing
facility
 System Schematic
Referral Center

Digital Camera Web Cam

PSTN /
Leased Line Doctor / Web Cam
Scanner Patient Electronics
/ ISDN /
Microscope
VSAT

Printer
Specialist Doctor
Scanner
Digital camera

ECG Machine

Printer
Electronics
Stethoscope
Nodal Center
Sequence of Tele-consultation (I)
PATIENT IN

Patient visits OPD Patient receives treatment

and is not referred to OUT
Local Doctor checks up
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
OUT
test results, appointment date is fixed for online
telemedicine session
Offline Data
transfer
from Nodal
Centre
Sequence of Tele-consultation (II)

Patient 1
Patient 2 Online video conference &
Patient 3 tele-consultation for patients
Patient 4 between local doctors at the
. IN OUT
nodal hospital and specialist
. doctors at the referral
. hospital

Patient queue
Health Infrastructure in West Bengal
(Government)

Medical College Hospitals 9

Dental College Hospitals 2
School of Tropical Medicine 1
District Hospitals 15
Sub-Divisional & State General Hospitals 70
Rural Hospitals 95
Block Primary Health Centres 251
Primary Health Centres 922
Sub-Centres 10,356
** Health on the March 2004-05 Gov. WB
Telemedicine in West Bengal (I)

Project Implementation by Webel ECS Ltd,

Kolkata (Dept of IT, Govt. West Bengal)
Software development by CS & E Dept. IIT,
Kharagpur
Project sponsored & funded by the Dept of IT,
Min. of Communications & IT, Govt. of India
Implementation and usage of facilities by the
Dept. of Health & FW, Govt. of West Bengal
 Telemedicine in West Bengal (II)
PROJECT - I
Referral Center : School of Tropical Medicine, Kolkata
Nodal Centers : Habra State General Hospital, 24th
Parganas (North)
: MJN Hospital, Coochbehar

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

DIT Sanction No. : 2(5)/98-H&B Dated 21.01.1999

Project Cost : Rs. 150 lakhs
Location of Centers
0f Project I
Koochbehar MJN

LEGEND

Habra SGH

STM
128 KBPS ISDN Link
 PROJECT - II
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

DIT Sanction No. : 2(11)/2001-HBT, dated 31.03.2002
DIT, GOI Contribution : Rs. 147 lakhs
Location of Centers
Of Project II

Behrampur DH

Suri DH
LEGEND`

Burdwan MC&H

Purulia DH
NRS MC&H
512 KBPS Leased Line
MidnapurMC&H
 PROJECT - III
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.

DIT Sanction No. : 2(20)/2003-Telemed Dt. 08.03.04

DIT, GOI Contribution : Rs. 287 lakhs 0
Location of Centers Darjeeling DH
Of Project III
NBMCH

Raiganj DH

LEGEND

Arambag SDH
512 KBPS Leased Line

CMC&H
128 KBPS ISDN Link CNCI

Tamluk DH
Total Mapping of Darjeeling DH

The Nodal and

NBMCH
Referral Centers Koochbehar MJN

Raiganj DH
KOLKATA

NRS MC&H
Burdwan MCH
Behrampur DH

CMC&H
Suri DH
STM Arambag SDH
CNCI

Habra SGH
LEGEND
Purulia DH

MidnapurMC&H

Tamluk DH
 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
 TelemediK Software (II)

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

 Training Provided
Tele-medicine Centers Doctors Paramedics
Habra SDH 03 12
Coochbehar DH 08 12
Midnapur MC & H 12 03
Behrampur DH 05 02
Purulia DH 18 08
Suri DH 15 02
NRS MC & H 03 01
Burdwan MC & H 15 07
STM, Kolkata 05 01
Total 84 48
Discipline wise Patient Consultation

Pediatrics 75
Orthopedics 96
Neurology 34
Cardiovascular Medicine 27
Psychiatry 12
ENT 31
Urosurgery 11
Hematology, Dermatology, General Medicine, 3300
OBG, Leprosy, etc
 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
 Utilization of Tele-cardiology
Facilities
Bankura Sammilani Siliguri SD
Medical College Hospital
Patients Admitted 1493 2418
Thrombolysed 296 197
Tele-consultation 915 458
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.