December 2007

‘Space’ For Telemedicine

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Space Telemedicine
Space Telemedicine Network specializes in the areas of client-server, component bases models, web enabled applications and object oriented technologies. It links multiple hospitals with videoconferencing, telepathology and teleradiology facilities, to enable multidisciplinary diagnosis to be carried out with greater equality of access and to save traveling time for patients. Their objective is also to network rural, semi urban hospitals to provide specialist care and tertiary health care, enable low cost, 24x7x365 health care through telemedicine.

Space has already networked with 57 leading hospitals in India, with seven in Tamil Nadu. And now intends on bringing more mobile V-Sats to service the under-served.

Challenges
According to an NCAER study, 620 million people live in rural India and the bed-population ratio is today at 1:1333 as against an ideal of 1:500. Also, as against a two million hospital bed requirement, the availability is just 0.7 million.

The following are some of the criteria for success of telemedicine in Indian conditions according to Space:

  • It should benefit a larger community; especially the under-served
  • Medical data transfer be error-free and reliable
  • Medial technology should be user-friendly
  • There should be a complete system in place
  • There should be proper storage and retrieval system for the medical data
  • The medico-legal provisions should be thoroughly thought through
  • Its economic sustainability should be looked into from the beginning
  • Maintenance aspects are important but often neglected at the planning stage. This can lead early death of the project after birth

Business Model
The business model envisaged would neither fleece the end patient nor be fully charitable, thus maintaining the quality of healthcare.

A 'hub' where the specialists from various areas of medicine are available works round the clock in a typical 24 x 7 model. Thus participating hospitals need not worry about the time of receiving the patients since help is always available. All the telemedicine equipment are installed  by the company itself, therefore, the participating hospitals/nursing homes  incur no extra cost.

Space would depute its own technical staff for the operation of the telemedicine equipment in the participating hospitals, and the specialists in the hub interact with doctors of the participating hospitals directly, thus substantially reducing the medico-legal risks, in case of a difficult situation.

Hospital staff too would be trained by Space for using the telemedicine equipment and familiarizing with the connectivity procedures with the central hub for a nominal fee. The connectivity would be as simple as making a phone call. The hub would be situated in the heart of the city enabling easy access for the specialists. The hub would have top of the class connectivity infrastructure for video conferencing, image transmission etc.

System Architecture
Server End Operation: The central server stores all information like patient records, images and waveforms, electronically in the EHR system. The server also supports multiple access of remote ends to the speciality nodes. Software plug-ins like Cardiology, Radiology, ENT etc. are all integrated into server software, depending on the requirements.

Software Specifications

Software (Remote end)

  • Supports on any Windows environment.
  • Desktop or Laptop
  • Plug n play of medical devices.
  • Operates on internet explorer (IE 5 or above) browser.
  • Supports thru RS232, USB, SCSI, Parallel, PCMCIA,
  • Firewire, Infrared, Mic, SVHS, Video etc.,
  • Minimal downloads, installation and distribution of software upgrades.
  • Proper Login security
  • Integrated Video Conferencing system on international systems.
  • Easy to use Graphic User Interface ( GUI )

Remote End Operation: Remote locations here mean small hospital & diagnostic centers. The systems here are designed to be simple and requiring low maintenance. A standard IBM compatible PC is installed with the necessary operating system (windows or equivalent) along with a browser. The medical devices and the video conferencing system are integrated into one simple system via the PC to the server software. The Dial up, ISDN or DSL connectivity is used to connect the remote systems with the centralized server.

The doctor / technician at the remote center registers the patient into the system and appends all medical data pertaining to the patient to the server, which gets stored in the central server and through the Space Hospitals streamer, the same data is available for browsing / viewing by a specialist instantaneously.

Specialist End Operation: The specialist terminal, is an IBM compatible PC with a simple (Windows or equivalent OS software.) The medical data from the remote locations online or stored on the server is available to only specialists who have a secured login and password access. When a new patient is referred from remote to a specialist, alerts in the form of SMS, e mail or paging can be sent. Once the specialist logs in, a user-friendly scheduler tells of the pending cases. The specialist can then call upon the relevant records in the form of waveforms or images and type in his/her observations. The referring doctor can access the specialist observations via the server.

Unique Features
Video Conferencing System: Generally a super specialty hospital would use a stand-alone box which has high quality but requires good bandwidth and includes camera, microphone etc., and the remote nodes would use PC add on card, which uses the PC technology and software.

The standards that are used in video conferencing systems are ITU, H.320/. 323. The frame rate has to be anything between 15/30 frames per second.

Reporting: The report format is standardized and can be customized based on the inputs from the customer and will contain all the details pertaining to the EHR, like patient demographics, review of system, symptoms, treatment plan, medication etc.

The system is provided with a complete administration module with which the system administrator of the telemedicine network can perform certain tasks such as add new specialists to the network, or new remote nodes, schedule consultations, or edit/modify/delete nodes specialists, appointments etc.

“The initiative by Space Telemedicine to launch 600 mobile V-Sat units, to connect the smallest towns with major super speciality hospitals across India is waiting for funds anticipated to be available by March 2008. The western world is quite willing to invest in Indian telemedicine; in fact we hope to rope in a few associates shortly. So far there has been no Government contribution, but we are trying to get entries into Government CSC programmes. We have also successfully completed pilot projects of ONGC, Bombay and Sail, Calcutta, and are now waiting for their orders, anticipated by February  2008.”
Ganesan Annaswamy, Executive Director, Space Telemedicine

Security: This is the fundamental requirement for telemedicine applications. Security strategies, designed to protect the privacy, authenticate, authorize, and maintain integrity. These are necessary to protect against the threats of manipulation, impersonation and unauthorized access to health care information of individuals. A username and ID is given to the doctors in the remote node and the
specialists in the network. Security elements include storage security, network security, data encryption, audit trails etc. Networks should be reliable and secured to ensure user confidence, system and data integrity, and robust system operation.

Alerts: The specialist can be alerted through SMS or e-mail the moment a patient is referred. A message can also be sent to him/her when the ECG is being streamed so that the specialist can go online to see the ECG of the patient in Real time.  

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