National Medical College Telemedicine Network

Transcription

1 National Medical College Telemedicine Network S K Mishra, MS, FACS Head, Dept. of Endocrine Surgery & Faculty I/C, SGPGI Telemedicine Program Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) Lucknow, India skmishra@sgpgi.ac.in

2 National Network of Medical College Need Diversity in the standard of Quality of Teachers Availability of Educational Tools (slide projectors, projecting microscope, still and moving digital images) Books and Journals Quality and type of patient materials (geographical difference in the incidences of various diseases) Rural, Urban and Semi urban patients Diversity in the quality of students because of entry and exit parameters 2

3 Introduction Networking of medical colleges can bridge distance between Student & Teacher Quality of Postgraduate education in Indian Medical colleges needs improvement Tertiary academic medical centers can provide additional inputs through networking 3

4 Objectives 1 Improving quality of medical / paramedical education and meeting the educational needs of the students despite paucity of teachers Facilitating cognitive component of learning by providing interactive teaching material online developed by a group of competent teachers at undergraduate, postgraduate and super-specialty levels To promote psychomotor skill development through tele-mentoring 4

5 Objectives 2 To link Medical Libraries with adequate stock of books and journals for access to all thereby reducing state expenditure on medical college libraries (Digital Library Network) To promote medical research by providing infrastructure for quick exchange of ideas and co-ordination with group of researchers involved in collaborative multicentre studies and facilitating current information access through digital library network Online Continuing Medical Education (e CME) to enhance knowledge and teaching skill and possible Accreditation of Medical Teachers and Health Care Professionals 5

6 Objectives 3 Implementing uniform examination pattern and evaluation. Coaching students with online and offline in MCQs Enhancing computer literacy among medical students and teachers Facilitating ehealth Governance Sharing of resources and establishing effective communication between the medical colleges and its faculty Providing educational material & tools to medical teachers Improving quality and reducing the cost of health care delivery by tele-consultation and tele-follow up 6

7 Road Map 1 Identification of a National Telemedicine Resource Center which will be connected with high speed fiber network with few selected apex medical institutions which in turn will be networked with medical colleges in the region Identification of few apex medical academic institutions region wise (Regional Telemedicine Resource Center) and networking each with medical colleges in the region covering few states. MPLS-VPN Network backbone to provide bandwidth 10 Mbps to start with (ultimately 1G) at Regional & 2 Mbps at medical college telemedicine nodes. Each medical college telemedicine node to be linked with district hospitals in their perimeter. 7

8 Road Map 2 One lecture theatre of each medical college will be converted to digital integrated medical lecture theater providing necessary infra structure. Each resource center will have facility for multimedia education content development. All the medical education knowledge content will be stored in the central repository located at the data center of national resource center with a backup facility at disaster site. 8

9 Expected Outcome 1 The network will support multimedia data exchange, multi-point video conference, both in interactive and video broadcast mode. Central Repository of Medical Education Content will do live transmission of the content on day to day basis. 9

10 Expected Outcome 2 Entire network will provide a platform for interactive distance learning and adaptive environment for medical students, teachers and health care professionals. It will also support digital library network. Ultimately Virtual Medical University can be established at National Level. 10

11 Tele-consultation Case Study-1 Medical Colleges of Orissa State (n=620pts) Orissa Telemedicine Project (ISRO) - Sept 03- Sept 09 SCB Medical College Cuttack (1500) kms MKCG Medical College, Berhampur (1800 kms) VSS Medical College, Burla (1500 kms.) Technology Real time Telecommunication link- VSAT 11

12 Tele-consultation Case Study-2 District Hospitals Balrampur and Civil Hospital, Lucknow (20 kms) Year 2000 using PSTN Pithoragarh District Hospital, Pithoragarh (500 kms. Hilly area) & Sushila Tewari Forest Hospital, Haldwani (250 kms base of the hill) in Northern India Year 2000 (n=30 pts as Proof of Concept using PSTN) Uttaranchal Telemedicine Network Apr 04-Mar 08-(Two district hospitals: n=265 pts using ISDN) Raebareli Telemedicine Network Project Oct 06-ongoing (n=50 pts) Technology - Store & Forward Technology,Real time (On demand) Screen Shot of one of the Tele-radiology Opinion transmitted to one of District Hospital in Uttaranchal region 12

13 Tele-follow up Case-study-3 (March 2004 ~ Ongoing) Patients from the Orissa state ( Eastern Coast) Technology - Real time Telecommunication - VSAT Departments Endocrine Surgery (n=50 pts) Nuclear medicine (n=127 pts) Rheumatology(n=60 pts) Average visit 1-12 Anjali Mishra, Lily Kapoor, Saroj Kanta Mishra, Post-operative care through tele-follow up visits in patients undergoing thyroidectomy and parathyroidectomy in a resource-constrained environment, J Telemed Telecare; 2009,15:

14 Tele-follow up Snap Shots Dept of Nuclear Medicine Dept of Endocrine Surgery Dept of Rheumatology 14

15 Case Study-1Post-graduate Students of Medical Colleges Sept 2001-ongoing Orissa Telemedicine Network Project Clarified problems in management of difficult and complicated cases Funding Agency - Indian Space Research Organisation Guidelines for management of complicated cases Network Partners Good interesting and illustrative SCB Medical College, Cuttack cases MKCG Medical College, Berhampur Keep them abreast of the recent VSS Medical College, Burla advances in medical field No. of Tele-education sessions 720 sessions Optimal utilization of existing resources 15

16 Post-graduate students of medical colleges-snap shots - Virtual Classroom 16

17 Case study-2 -Medical Education for District Hospitals doctors - n=293 National Informatics Centre (NIC) (Jul 03 Oct 04) (n=13) Enhancing medical, Point to multipoint Uttaranchal Telemedicine Network Project (Apr04- Mar08) (n=104), Point to multipoint Getting expert opinions knowledge in the management of common medical problems Improving consultation skill Raibareli Telemedicine Network Project (Apr06- Aug 09) (n=176) Continuing education 17

18 District Hospital Doctors Snap shots 18 Mahapatra AK, Mishra SK, Bridging the Knowledge and Skill Gap in Healthcare: SGPGIMS, Lucknow, India Initiative Journal of ehealth Technology and Application; 5(2):67-69,, June 2007

19 Para-medical Healthcare Professionals-Case Study-3 - n=106 sessions Orissa Telemedicine Network Project Uttaranchal Telemedicine Network Project Raebareli Telemedicine Network Project Participants - Nurses, Hospital Administrators, Lab Technicians, Dieticians, Physiotherapists Enhancing nursing skills Better patient care Continuing education Exposure to new techniques and equipments Better hospital administration 19

20 Para-medical Healthcare Professionals 20

21 Case Study-4 Knowledge Sharing Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala (n=132) All India Institute of Medical Sciences, New Delhi & Postgraduate Institute of Medical Education and Research, Chandigarh (n=23) Christian Medical College, Vellore (n=83) Sri Ramchandra Medical College, Chennai (n=6) Regional Institute of Medical Sciences, Imphal (n=2) Share interesting and complicated cases Peer opinion and consultation 21

22 Knowledge Sharing - Snap Shots 22

23 Case Study-5- Tele-mentoring Emergency situations Skill development Laparoscopic surgery Complex surgical procedures Institutions Involved SGPGIMS, Lucknow AIMS, Kochi Telecommunication link VAST 512 kbps 23 Telementoring in Endocrine Surgery, Mishra SK, Mishra A, Pradeep PV; Chapter 11,Telesurgery Book, Edited by Kumar S/ Marescaux J Springer-Verlag GmbH, Heidelberg/Germany. ISBN no , 2007

24 Tele-mentoring 512 Kbps Video conferencing unit Local Cable network 512 Kbps AIMS, Kochi 2500 Km SGPGIMS, Lko

25 Tele-mentoring Snap shots of surgical field

26 Case Study-6 Sub-specialty Development Endocrine Surgery Rare specialty Few centers Few faculty Few opportunity SCB Medical College, Cuttack Tele-communication link VSAT To assess the feasibility and impact of telemedicine in reinforcement of endocrine surgery training at distant places to develop this subspecialty in a developing country like India

27 Sub-specialty Development

28 Case Study on web based medical education around the world Based on Case based Learning & Problem based Learning 28

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30 Weblink:

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32 Case Study Uttar Pradesh Telemedicine Network Project 32

33 Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) Initiatives Patient-care, teaching and research Institutes with tradition of excellence have demonstrated abundantly that research enhances the vitality of teaching, teaching lifts the standards of service, and service opens new avenues of investigation. 33

34 1. SGPGIMS, Lucknow 2. CSMMU, Lucknow 3. MLN Medical College, Allahabad 4. GSVM Medical College, Gorakhpur 5. J. K. Cancer Institute, Kanpur 6. L.P.S. Institute of Cardiology, Kanpur 7. B.R.D. Medical College, Gorakhpur 8. R.L.B. Medical College, Jhansi 9. L.L.R.M. Medical College, Meerut 10. S.N. Medical College, Agra 11. UPRIMS, Saifai 12. IMS, BHU, Varanasi 13. JN Medical College, AMU, Aligarh 14. RML institute of Medical Sciences, Lucknow 15. RML Hospital, Lucknow 16. Balrampur Hospital, Lucknow 34

35 Block Diagram for UP Medical College & District Telemedicine Network WAN Connectivity 35

36 UP Medical College Network Block Diagram for Medical College Level : WAN & LAN Connectivity Digital Lecture Theater Tele-Consultation Facility elearning & Digital Library 36

37 UP Medical College Network Block Diagram of Digital Library at Medical College 37

38 School of Telemedicine & Biomedical Informatics 38

39 Knowledge STBMI Harvesting Editing Storage Sharing Professional Camera Green Valley Edius Data Center Online sharing Video Conference FCP(final cut Pro) Rack Servers Streaming Hitech Digital Lecture Theater Adobe Premiere Streaming Server Video Conferencing Integrated Operation Theater Maya Offline Sharing Developed Content Website 39

40 Hi-Tech Lecture Theatre Broadcast Quality Studio Camera Network Monitoring Hub Integrated Operation Theatre Production Control Unit (PCR) Video Conferencing Suite Edit Stations Data Server 40

41 Knowledge Resources Digital Medical Lecture Theatre Video Conferencing Suite Integrated Digital Operation Theatre 41

42 Content Development Facility Production Control Room PCR Voice Over Station Sound Proof Edit Rooms Large screen flat monitors 42

43 Edit Stations FCP (Final Cut Pro) Apple Platform Edius Edit Station Windows Platform 43

44 Data Center (Health Knowledge Park) & U.P. State Telemedicine Network Monitoring Stations Data Center (Health Knowledge Park) U.P. State Telemedicine Network Monitoring Stations 44

45 Proposed National Medical College Telemedicine Network Architecture 45

46 National Resource Center Apex Medical Institutions Medical Colleges 46

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48 Thank you