1. telemedicine
narendra malhotra
jaideep malhotra
neharika malhotra bora
rishabh bora
www.rainbowhospitals.org
www.malhotrahospitals.com

2. What is Telemedicine
Telemedicine may be
defined as the use of
computers and
telecommunication
technologies to provide
medical information and
services from distant
locations

3. • Telemedicine comprises all medical actions which
extend the action space of health care professional
beyond the face-to-face relationship with the patient
in the direct surroundings.
• It is medicine at a distance.
This includes health care
delivery, diagnosis, consultation, treatment, educatio
n and the transfer of related data.
ITU-T Workshop on
Standardization in E-Health,
3
Geneva, 23-25 May 2003

4. 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.

5. 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.

6. 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.

7. 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

8. 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

9. Implementation challenge
ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003 9

10. 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

11. Different types of services
 Telecardiology
 Teleradiology
 Telepathology
 Telepsychiatry
 Early Warning System
[ Prevention and control of endemic and infectious diseases ]

12. Benefits of E-Health
• Support for diagnostic (primary
diagnostic, collaboration, 2nd opinion)
• Triage for evacuation of patients
• Distant education
• Enhancement of collaboration spirit
• Diminution of isolation
• Use of personal computers for health care.
ITU-T Workshop on
Standardization in E-
Health, Geneva, 23-25 May
2003

13. Telemedicine in India
•Existing system limited only to private hospital
•CORPORATE Group of Hospitals.
•RN Tagore Cardiac Hospital, Calcutta. (Asia Heart Foundation)
• No Telemedicine system for public health care
•Corporate Sectors Offering Telemedicine Systems
•APPOLO & OTHER CORPORATE Groups
•Online Telemedicine System, Ahmedabad.
•WIPRO GE
•SIEMENS

14. Aim of the Telemedik System
• Information management
– Patient information
– Medical data (signs, symptoms, test reports, etc..)
– Appointment scheduling
– Archival and retrieval of patient records
• Low cost solution
– Using ordinary telephone line
• Service to large population
– Through public health care delivery systems
• Development of knowledge-based system
– For decision support
– For training and education

15. Why it is relevant to our society
Poor infrastructure
Non-availability of experts (disparate distribution)
Low doctor-patient ratio (large population)
Lack of proper medical education
Special attention required for Public Health Care System

16. Medical constraints and challenges
• Need and will of cooperation
between medical sites;
• Complementary function of
involved institutions and
organizations;
• Acceptance of technology and
change of working environment;
• Interoperability issues ignored.
ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003

17. Major Challenges
•Poor Data Communication Infrastructure.
•A Large Population Catered by
Government Hospitals.
•System Features should be scalable.
•Cost of the system should be scalable.

18. Telecommunication constraints
• Minimum requirement is
reliable telephone line at
19.2KBit/s
• Simultaneous Internet
access recommended
• ISDN permits more
advanced solutions like
video-conferencing
• xDSL for the future.
ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003

19. Few E-Health Standards applicable
• DICOM (Digital Communication Medicine) for
medical imaging
• ITU H320/H120 for video-conferencing
• Proprietary systems for “Store-And-Forward”
• Proprietary interactive and collaborative systems
ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003 19

20. Digital Imaging Communications in Medicine
(DICOM )
originally the ACR-NEMA
developed by American College of Radiology (ACR) and
the National Electrical Manufacturer's Association (NEMA)
provides standardised formats for image capture and storage
coupled with a common information model specifying service
definitions and protocols for communication

21. 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

22. Requirement Specification
• A patient getting treated
Nodal Hospital • A Doctor
• A remote telemedicine console having audio visual
and data conferencing facilities
POTS / ISDN
• An expert/ specialized doctor
Referral Hospital • A central telemedicine server having
audio visual and data conferencing facility

23. Sequence of Operation
PATIENT IN
Patient visits OPD Patient receives local treatment
OUT
Local Doctor checks up and not referred to telemedicine
system
Patient referred to the Telemedicine system (some special
investigations may be suggested)
Patient visits Telemedicine data-entry console.
Operator entries patient record, data and images of test OUT
results, appointment date is fixed for online telemedicine
session
Offline Data transfer
from Nodal Centre

24. Sequence of Operation
Patient 1
Patient 2
Patient 3 Online conference for the patient.
Patient 4
. IN Patient, local doctors at the nodal hospital OUT
. and specialist doctors at the referral
. hospital
Patient queue

25. Concept of “Store and Forward”
Radiograph PC
Scanner
Document
Scanner
ITU-T Workshop on
Standardization in E-
Health, Geneva, 23-25 May 25
2003

26. Hardware Configuration
Video Conference
Modem Telephone
Referral Hospital Microscope and other
medical instruments
Video Conference
PSTN/ISDN/VSAT link
Digital camera
Scanner
Telephone Modem Printer
Nodal Hospital

27. Software Modules
Offline Activities
Online Activities

28. Videoconferencing
• Interactive
• Well suited for seminars or special case discussion
• Less adapted and expensive for routine work
• Requires ISDN
ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003

29. Second opinion telemedicine concept
Internet/ISDN/Phone
Digitalisation Digitalisation
Radiologist
Telemedicine Center Pathologist
Other
Patient Record and Store & Forward
Medical Images Medical supervision Telemedicine
Private doctor
Small clinic
ITU-T Workshop on
Standardization in E-Health,
29
Geneva, 23-25 May 2003

30. The Data
• Data related to a patient’s personal information
• Data related to a patients medical information
• Data for patient management in Telemedicine
• Data related to the doctors
• Data for system management

31. Images

32. Vector Data

33. Graphics

34. Video Clip for second opinion

36. Data related to the doctors
• Doctor’s personal
information
• Unique Identification
key

37. Medical information on Internet
• Gives valuable on-line access to
huge medical knowledge &
databases.
• Lack of quality control
-> www.hon.ch
• Language barrier.
-> www.etho.org
ITU-T Workshop on Standardization in E-Health, Geneva, 23-25 May 2003 38

38. Schematic Diagram for Proposed Telemedicine using WBSWAN
Writers Bldg.
State
Referral Centre
Switching Centre
DM OFFICE
District
Switch Centre
Nodal Hospital

39. Telemedicine for Tropical Diseases

40. …. 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.

41. Paraphrasing Neil Armstrong,

42. At raibbow hospitals Agra , we are in the process of establishing a tele med deptt
for second opinions and for reportings
THANK YOU FOR HEARING ME OUT