Transcript C-DAC, Trivandrum

APAN-Healthcare-2009
ICT
for Cancer Diagnosis,
Treatment and Management
1
Sudhamony S
Additional Director / Head,
Medical Informatics Section,
Centre for Development for Advanced
Computing (C-DAC),
Thiruvananthapuram, INDIA.
C-DAC
Centre for Development of Advanced Computing
APAN-Healthcare-2009
• A Scientific research organization of Ministry of
2
2
Communication
and Information
Technology,
Government of India
• Vision: To emerge as the premier R&D Institution for the
design, development and deployment of world class
electronic and IT solutions for economic and human
advancement
• Ten centres across India
• C-DAC, Thiruvananthapuram is in the state of Kerala
C-DAC Medical Informatics
3/4/2009
About ONCONET
APAN-Healthcare-2009
The first successful Tele-Oncology
Network in India
3
3
which provides
telemedicine services in early detection,
patient follow up and pain relief for
cancer patients from rural areas.
C-DAC Medical Informatics
3/4/2009
The Need
APAN-Healthcare-2009
Statistics from India :
4
4
1 million new cancer cases per annum
3 million cancer patients
Low socio-economic status and low literacy
rates in rural areas
Lack of infrastructure and expertise at Public
Health Centers in rural areas for early
detection of Cancer
Long and relatively expensive travel to reach
Cancer Care facility
30% of cancers can be prevented; 40% can
be cured C-DAC Medical Informatics
3/4/2009
ONCONET
 A research project funded by Govt. of India
APAN-Healthcare-2009
 Designed, developed, implemented and
supported by C-DAC, Thiruvananthapuram
5
5
 Implemented at Regional Cancer Centre
Thiruvananthapuram, Kerala, India and its
five peripheral clinics across the state
C-DAC Medical Informatics
3/4/2009
Regional Cancer Centre Trivandrum
(RCC)
 RCC is the only cancer hospital
in the Govt. sector catering to
the population of the state of
Kerala and neighboring states.
APAN-Healthcare-2009
 Approx. 12,000 new cases are
6
6
registered every year and the
annual follow-up visits reach
150,000 every year
C-DAC Medical Informatics
3/4/2009
Statistics from Kerala
Number of patients visiting
Cancer care facility
9000
8000
Kasargod
Kannur
Wayanad
Kozhikode
Malappuram
Palakkad
Thrissur
Ernakulam
Idukki
Kottayam
Alapuzha
Pathanamthitta
7000
6000
5000
4000
3000
2000
1000
0
Appointments during the year 2002
7
7
RCC, Thiruvananthapuram
C-DAC Medical Informatics
3/4/2009
Logistics
Distance Travelled
600
500
400
300
200
APAN-Healthcare-2009
100
8
8
0
Distance (km)
Travelled to the
Centre
C-DAC Medical Informatics
Kasargod
Kannur
Wayanad
Kozhikode
Malappuram
Palakkad
Thrissur
Ernakulam
Idukki
Kottayam
Alapuzha
Pathanathitta
Kollam
3/4/2009
Logistics
Cost of Travel
1800
1600
1400
1200
1000
800
600
APAN-Healthcare-2009
400
9
9
200
0
Total Expenses
for One Visit
(Rs)
C-DAC Medical Informatics
Kasargod
Kannur
Wayanad
Kozhikode
Malappuram
Palakkad
Thrissur
Ernakulam
Idukki
Kottayam
Alappuzha
Pathanamthitta
Kollam
3/4/2009
APAN-Healthcare-2009
How to provide
affordable cancer care
10
10
Reduce overhead on patients by bringing
Cancer care closer to them
Facility for Early Cancer detection and
diagnosis nearby
Health education and awareness camps for
the rural population
C-DAC Medical Informatics
3/4/2009
Tele ONCOlogy NETwork
Our Peripheral Clinics
1. Malabar Cancer care
Society, Kannur.
2. Early cancer detection
center, Palakkad.
APAN-Healthcare-2009
3. Early cancer detection
center, Kochi.
11
11
4. Early cancer detection
center, Kollam.
5. District cancer control
cente, Kozhencheri.
C-DAC Medical Informatics
3/4/2009
VSAT Network for
ONCONET
Satellite communication
link & Bandwidth provided
by ISRO (Totally free)
APAN-Healthcare-2009
Satellite : INSAT 3C
Antenna : 3.8 m
Carrier : Extended C Band
Bandwidth : 384 kbps
12
12
Failover mechanism
128 Kbps ISDN connection
C-DAC Medical Informatics
3/4/2009
APAN-Healthcare-2009
ONCONET
13
13
CDAC launched ONCONET in Sept. 2004 at
RCC and its peripheral clinics with
Bandwidth offered totally free by Indian
Space Research Organization (ISRO)
through its VSAT facility.
Currently RCC is linked with over a hundred
hospitals across the country including areas
with high military presence like Srinagar and
Ladakh
(2300
miles
North),
and
geographically
separated
areas
like
Andaman and Lakshadweep islands
C-DAC Medical Informatics
3/4/2009
APAN-Healthcare-2009
ONCONET - Features
14
14
Tele-medicine infrastructure at RCC and
five peripheral clinics
Tele-Pathology and Radiology systems
High bandwidth connection between these
centers ( 384 Kbps)
Backup arrangement for connectivity
through ISDN facility
C-DAC Medical Informatics
3/4/2009
APAN-Healthcare-2009
ONCONET – Features …
15
15
 Software - Web based Telemedicine
software
integrated
with
Hospital
Information System software (TEJHAS)
EHR, securely made available over the
network at remote centres
Oncology Resource Centre – Cancer
specific information made available at
remote centres through a Digital Library
C-DAC Medical Informatics
3/4/2009
TM Infrastructure
 Powerful Video Conferencing System
APAN-Healthcare-2009
 Server system with software for Creation,
16
16
storage, transfer and sharing of EHR of
patients, Telemedicine PCs at clinics
 Tele Pathology / Radiology System with
Digital Microscope, X Ray Film Scanner and
software for :
Capture , storage and uploading of medical
images
Sharing and annotation of image between
remote centres for discussion
C-DAC Medical Informatics
3/4/2009
System Architecture
SPECIALTY CENTRE
PERIPHERAL CENTRE
Videoconferencing
Videoconferencing
VSAT
Network
with
ISDN
(Backup)
TP / TR
Server
Tele-medicine PC
ROUTER
APAN-Healthcare-2009
Digital library
17
17
Telemedicine PC
ROUTER
X-Ray Film
Scanner
LAN
Database &
App.
Servers
Hospital
Information
System
Digital
RCC-Regional Cancer Centre
Microscope
ThiruvananthapuramC-DAC Medical Informatics
3/4/2009
Tele-Pathology and Radiology
systems
ECDC KANNUR
Network
Images received from remote
centres & stored in Server
Experts view the image through
viewing station at their department.
Microsco
pe
Experts prepare the report and send
to remote locations
Doctors share and view the images
online and discusses the case.
DICOM CD
Film / Document
SCANNER
DIAGNOSTIC Work Station cum
SERVER
Images captured from microscope
X-Rays & Documents scanned
Images locally stored
DICOM CD imported
Patient folder sent to RCC, TVM
Reports received from remote
expert doctor
18
18
WEB-Viewing Station @ Doctors desk
ECDC KOCHI
C-DAC Medical Informatics
RCC TRIVANDRUM
3/4/2009
ONCONET Software
Telemedicine Enabled Hospital
Automation System
(TEJHAS)
Comprises of all essential modules :
APAN-Healthcare-2009
Core Services
19
19
o
o
o
o
o
o
o
o
o
OP & IP Management
Consultation
Surgical Oncology
Resource Scheduling
Investigation
Nuclear Medicine
Radiation Oncology
Chemotherapy
Pharmacy
Support Services Back Office
o Cash & Billing
o Enquiry
o Central Stores
o Purchase
o Blood Bank
o Radiology
o Engineering
o C.S.S.D
o MIS
o Master Data
o Users
C-DAC Medical Informatics
3/4/2009
FINDINGS
APAN-Healthcare-2009
Patients
20
20
on
Chemotherapy
can
communicate with their physician regarding
blood count and seek advice
Early Intervention is facilitated
Initial patient presentation and diagnosis is
made in a primary sitting thereby avoiding
unnecessary patient referrals and reducing
patient load at RCC
For specialty care, appointment is fixed
through the system, thereby avoiding
unnecessary delay
C-DAC Medical Informatics
3/4/2009
Interpretation
Number of emergency visit to the hospital is
reduced
Unnecessary referrals and admissions are
avoided
APAN-Healthcare-2009
 Routine follow-up visits are limited to
21
21
peripheral clinics thereby avoiding unwanted
expense
C-DAC Medical Informatics
3/4/2009
Interpretation…
Saves cost to patient, provider and system
Palliative care through close interaction with
tertiary care physician
APAN-Healthcare-2009
Conduct distant medical education programs,
22
22
panel discussions, nurses training programs
and talks by doctors
C-DAC Medical Informatics
3/4/2009
Usage Statistics
APAN-Healthcare-2009
( from 2004 onwards)
(Available online at www.rcctvm.org )
23
23
Remote
Peripheral
Centres
No. of
follow up
Patients
Money
Saved by
Patients in
USD
KOCHI
9422
103950
KANNUR
3052
60650
PALAKKAD
262
4075
KOZHENCHERY
274
1575
KOLLAM
556
575
C-DAC Medical Informatics
3/4/2009
Usage for Tele Education
APAN-Healthcare-2009
( from 2004 onwards)
24
24
CME Programs
53
Panel Discussions
33
Nurses Training
programs
Didactic talks by
Academic staff
Public awareness
campaigns
41
C-DAC Medical Informatics
23
14
3/4/2009
APAN-Healthcare-2009
ONCONET
goes
National
(ONCONET India)
25
25
C-DAC Medical Informatics
3/4/2009
ONCONET India
( National Tele Oncology Network)
Establish
knowledge enabled
Oncology network in India
Tele
Connect 25 Regional Cancer Centres
APAN-Healthcare-2009
and 100 peripheral centres ( 4 for each
RCC) across the country
26
26
Project Report approved by Ministry of
Health, GOI; implementation to start
soon
C-DAC Medical Informatics
3/4/2009
Regional Cancer Centres
Shrinagar
Shimla
Shimla
ONCONET
INDIA
Chandigarh
Chandigarh
Rohtak
Rohtak
Delhi
Delhi
Lucknow
Lucknow
Bikaner
Bikaner
Gwalior
Gwalior
Guwahati
Guwahati
Allahabad
Allahabad
Patna
Patna
Imphal
Ahmadabad
Ahmadabad
Aizwal
Aizwal
Kolkata
Kolkata
Raipur
Raipur
Cuttak
Cuttak
Nagpur
Nagpur
Mumbai
Mumbai
APAN-Healthcare-2009
Hyderabad
Hyderabad
27
27
Bangalore
Bangalore
Chennai
Chennai
Kanchipuram
Pondicherry
Pondicherry
Thiruvananthapuram
Thiruvananthapuram
C-DAC Medical Informatics
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Trivandrum
Chennai
Bangalore
Mumbai
Hyderabad
Cuttack
Gwalior
Kolkata
New Delhi
Allahabad
Patna
Bikaner
Shimla
Rothak
Gauhati
Aizwal
Nagpur
Ahmadabad
Pondicherry
Lucknow
Chandigarh
Raipur
Imphal
Srinagar
Kancheepuram
3/4/2009
Telemedicine System
At RCCs
 Powerful Video Conferencing System & LCD TV
 Tele consultation system consisting of Telemedicine PC
with Telemedicine software which facilitates :
-- Creation, storage, transfer and sharing of Electronic Medical
Record of patients
 Tele-Pathology / Tele-Radiology System with Digital
APAN-Healthcare-2009
Microscope and Scanner/Digital Camera
28
28
-- Capture of medical images
-- Uploading image to remote end
-- Storage of image as part of EMR
-- Sharing of image between remote centres for discussion
C-DAC Medical Informatics
3/4/2009
System Configuration at RCC
Leased Line
(384Kbps
MPS L3 VPN)
Provided by BSNL
Digital
Microscope
Printer
Deliverables at
RCC
1. PC with software
384 Kbps
2. Video
Conferencing
System & TV
3. Film Scanner
VCS
APAN-Healthcare-2009
Scanner
29
29
4. Digital Microscope
5. UPS, Printer
ROUTER
Telemedicine PC
6. Networking items
LAN
Audio /Video
Television
Internet
USB
C-DAC Medical Informatics
3/4/2009
System Configuration at Peripheral
Centres
BB VPN
Provided by
BSNL
Scanner
(384 Kbps)
Deliverables at
Peripheral Centre
1. PC with software
2. Video
Conferencing
System and TV
384
Kbps
Printer
VC
S
4. UPS, Printer
APAN-Healthcare-2009
Switch
30
30
3. Film Scanner
5. Networking
equipments
Television
Tele Medicine PC
C-DAC Medical Informatics
3/4/2009
System Configuration at Hub location
256 Kbps
Internet
Leased
Line
Multi
Conferencing
Unit
Router
2 Mbps
Leased
Line
(MPLS L3
VPN)
Internet access to
all RCCs thru
MPLS VPN
APAN-Healthcare-2009
Services:
31
31
ONCONET India
Portal Server
Video Streaming Server
1. Portal
2. Internet Browsing
3. Multi Conferencing
C-DAC Medical Informatics
3/4/2009
NETWORK DIAGRAMS SHOWING
HOW THE PROPOSED NETWORK
MEETS ONCONET -India
APAN-Healthcare-2009
FUNCTIONAL REQUIREMENTS
32
32
C-DAC Medical Informatics
3/4/2009
Proposed MPLS Network
linking 25 RCCs
Chandigarh
Ahmedabad
Aizhwal Bikaner
Raipur
Srinagar
Rohtak
Kancheepuram
Bangalore
PE
PE
PE
PE
Patna
PE
PE
PE
Mumbai
PE
PE
PE
PE
Delhi
PE
MPLS L3 VPN
Backbone
PE
PE
Shimla
PE
PE
PE
Raipur
Trivandrum
PE
PE
PE
PE
PE
PE
384Kbps
PE
APAN-Healthcare-2009
Chennai
33
33
Guwahati
Allahabad
2Mbps
Cuttak
LEGEND
Lucknow
Gwalior
Implementing Agency
Pondicherry
Router
Imphal
HUB
C-DAC Medical Informatics
256 Kbps
Internet
3/4/2009
OVERALL ARCHITECTURE
of
ONCONET India network
Peripheral Centre 1
Peripheral Centre 4
Peripheral Centre 1
RCC1
Peripheral Centre 4
RCC3
RCC2
384 Kbps
BBVPN
APAN-Healthcare-2009
384 Kbps
BBVPN
384 Kbps
BBVPN
Peripheral Centre 1
34
34
Peripheral Centre 4
MPLS
BACKBONE
RCC4
384Kbps L3 VPN
Peripheral Centre 1
RCC25
Peripheral Centre 4
384 Kbps
BBVPN
384 Kbps
BBVPN
Peripheral Centre 1
Peripheral Centre 4
C-DAC Medical Informatics
3/4/2009
APAN-Healthcare-2009
Tele-consultation between one RCC and its
Peripheral center through Broadband VPN
35
35
C-DAC Medical Informatics
3/4/2009
TELE-CONSULTATION between one RCC and
its peripheral centre- data flow
256Kbps (1:1)
Internet
LL
Central HUB
MCU,
Video streamer
&
WEB
PORTAL
RCCs using MPLS VPN
Peripheral Centers using Broadband VPN
LL
PE
BSNL MPLS
PE
APAN-Healthcare-2009
PE
36
36
512Kbps
BBVPN
PE
PE
Backbone
Group1
PE
PE
E1 link
LL
RCC
Tele-consultation between a
RCC on MPLS VPN and a PC
on BB VPN
C-DAC Medical Informatics
3/4/2009
Conclusion
• By this proposed system, the cancer patients
from any part of India can get the consultation
and treatment from any RCC in India
• The rest of India will follow ONCONET-Kerala
pattern in the coming years
APAN-Healthcare-2009
• This ONCONET- India with appropriate low-
37
37
cost technology might be able to be
duplicated as a model for developing
countries with low capital inputs
C-DAC Medical Informatics
3/4/2009
CONTACT:
Sudhamony S
Additional Director / Head,
Medical Informatics Section
Centre for Development for Advanced
Computing (C-DAC),
Thiruvananthapuram-695033. Kerala
INDIA.
E-mail: [email protected]
Ph: 91- 471- 272 1042 (D) / 272 3333 Ext: 229
Mob. No: 91-98479 14872 (M)
Fax: 91-471- 272 3456 / 272 2230
38
38
C-DAC Medical Informatics
3/4/2009
Applying Advanced Computing for Human Advancement
39
39
C-DAC Medical Informatics
3/4/2009