Telemedicine, EMR & Remote Connectivity

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1 Telemedicine, EMR & Remote Connectivity Saroj Mishra, MS, FACS Prof & Head, Dept. of Endocrine Surgery & Faculty I/C, SGPGI Telemedicine Program Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) Lucknow, India 2 nd International Conference on Medical Electronics FICCI 2009, New Delhi 1 19 & 20 February 2009

2 WHO definition of Telemedicine The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities. 2

3 EMR An electronic medical record(emr) is a medical record in digital format. In general usage EMR and electronic health record (EHR) are synonymous. 3

4 Remote Connectivity The use of telecommunications technology to provide, enhance, or expedite health care services, as by accessing off-site databases, linking clinics or physicians' offices to central hospitals, or transmitting x- rays or other diagnostic images for examination at another site. 4

5 Tele-imaging Tele-imaging is an important part of telemedicine: it includes the transmission of medical digital images and plays a role in all fields of telemedicine, such as expertise, consultation, teaching and research. Tele-imaging requires telemedicine as well as image acquiring tools 5

6 Telemedicine Tools Telemedicine tools consist of hardware platform, telecommunication and medical electronics devices Hardware platform IT Equipments Videoconferencing kit Telemedicine Software Telecommunication Satellite Lease Line ISDN PSTN 6

7 Telemedicine Tools CPU Display Device VC Camera Tele-communication Link Telemedicine Software 7

8 Tele-imaging Tools Medical Electronics Digital Microscope Digital X-Ray Digital Mammography Digital Transparency Scanner Digital ECG Digital Ultra Sound 8

9 Tele-imaging Tools Medical Electronics Digital Transparency Scanner Digital Microscope Digital ECG 9

10 Applications of Tele-imaging Tele-radiology used in all specialties Tele-pathology used in all specialties Tele-cardiology Tele-dermatology Tele-surgery 10

11 Tele-imaging Facilitating Quality Digitalization of medical images is required for tele-imaging in two ways digitalization of medical imaging direct acquisition of digital images To obtain good quality of image compression of the data - without loss of information transmission requires a high data rate 11

12 Tele-imaging Facilitating Quality Transmission of good quality images required high-speed network an image database system, a super-high-definition imaging system a video conference system 12

13 Tele-imaging Scope Tele-diagnosis Tele-consultation Tele-follow up Tele-education Tele-CME 13

14 Out sourcing Tele-radiology Services Number one service outsourced in the field of telemedicine ( KPO) India becoming a hub: Bangalore & Pune Hospitals / Diagnostic Centers lacking Radiologist will benefit Revenue model needs to be developed 14

15 Out sourcing Tele-radiology Services Provider of off site Teleradiology Services Radiology reporting services on following modalities MRI Scans, CT Scans, Computed Radiography / Digital Radiography, Ultrasound, Mammography, Plain Films, Nuclear Medicine Scans Other Players in outsourcing in tele-imaging Apollo Fortis Wockhardt Source:

16 School of Telemedicine & Biomedical Informatics, SGPGIMS, Lucknow Remote Partners SCBMedical College, Cuttack Base Hospitals, Almora, Srinagar Telecommunicati on link Specialties (no. of patients) VSAT Radilogy 72 Pathology - 46 ISDN Radiology 161 Cardiology 43 Pathology - 3 Types ofimages transferred X-ray, CT, pathological slides X-ray, CT, ECG, pathological slides District Hospital, Raibareli Fiber Optic Cable Network Radiology 31 Pathology - 3 X-ray, CT, pathological slides Field Applications (temporary nodes) Kailash Mansarover Yatra Kumbh Mela Cardiology 140 Cardiology 64 Radiology 32 Pathology - 10 ECG ECG, X-ray, Pathological slides 16

17 School of Telemedicine & Biomedical Informatics, SGPGIMS, Lucknow 17

18 Tele-imaging Work Flow Hospital Level State Level National Level Global Level

19 Stake Holders EMR Network DICOM Doctors / Clinicians, Health Administrators, Policy Makers, Industry IT Platform Medical Equipments Surgical PACS / TIMMS

20 Goal of Clinical Standard To Facilitate access to and retrieval of clinical data to provide safer, efficient, effective, equitable, more timely, portable, interoperable, patient-centered care

21 Current Industry Standard in Health ICT Health Level 7 (HL7) National Council for Prescription Drug Programs (NCPDP) Digital Imaging and Communications in Medicine (DICOM) Logical Observation Identifiers Names and Codes (LOINC) Institute of Electrical and Electronics Engineers 1073 (IEEE 1073)

22 Clinical Data (Image) Exchange Big Challenge E x c h. D a t a Common Model D a t a E x c h.

23 MRI CT San X-ray USG Patient Registration Pathological Microbiologi cal, etc Clinical Diagnostics Doctors Laboratory Test Nursing Care Anesthesia Nursing Care P. Admit EMR Needs to Discharge define high standard OR Post-OP Transmissi on of live surgical procedure Preoperation Telepresence Suite Ward Live Transmission Archive Server P. Dis. With smart Card Telemedicine Partner Nods

24 Computer Assisted Digital OR Suit Video Endoscopy Monitor Image Manager -Report C-Arms Images ECG Monitoring MRI Images- PACS Left Side OR C-Arm Fluoroscopy Laser Generator Image view Boxes IMG Monitoring Teleconferencing - telesurgery

25 Peri-Operative Patient Flow Fig. Peri-operative patient flow and personnel utilization. Source: Workflow in the operating room: Heinz U. Lemke, et al

26 Therapy Imaging and Model Management System (TIMMS) Source: The operating room and the need for an IT infrastructure and Standards: Heinz U. Lemke, et al.

27 Video (and Data Routing), Access to Patient Data/ Records, Recording / Capture of Clinical Images, Remote Clinical Consultation

28

29 Complexity in Surgical Environment

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31

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33 Challenges Complex Data Structure generating from complex environment in complex formats exchanged between complex stake holders Security and Privacy concern more than other scenario Integration with Network / Medical Equipments Meet specific needs of stake holders Simplest solution desired Evolving standards in some specific areas UNIFORM GLOBALLY ACCEPTED NORMS???

34 Thank You

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