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ISRO’s TELEMEDICINE PROGRAMME


ISRO’s TELEMEDICINE PROGRAMME- THE PATH WAY FOR A TECHNOLOGY BASEDHEALTH CARE DELIVERY SYSTEM FOR THE RURAL AND REMOTEPOPULATION OF INDIA

Satyamurthy L.S.



Introduction:

ISRO’s Telemedicine Programme is an innovative process of synergizing benefits of Communication and Information technology with Biomedical Engineering and Medical Sciences to deliver the health care services to the remote, distant and underserved regions of the country.

The medical practice has been in existence for centuries in various forms right from the times of Charaka and Shushrutha in India.  The   communication technology has been available for many a decades and the information technology has witnessed tremendous growth and development in the last   decade. However, it is the introduction of Telemedicine that has promised a revolutionary change in the delivery of   basic health care to the remote rural population. This has come as a novel use of Technology for a beneficial change in the practice of medicine in this country.
The main drivers for this initiative in telemedicine for ISRO are the capability and aspiration to better the world for which ISRO has been striving since its inception. Creating value chain out of new ideas, services and new ways of doing things using the existing as well as newly developed products is the hallmark of ISRO’s Telemedicine programme. While the provision of healthcare services to each and every citizen irrespective of his or her geographical location is the obligatory responsibility of the governments (both at the center and state) the same is not feasible practically even if the health care delivery infrastructure is expanded ten fold from that of present availability.  Such expansion of augmenting the infrastructure has to be applicable for both the primary and secondary levels of the 3 tier Indian Health Care System which is a cost intensive endeavor in itself, let alone its serving the true purpose.  Further this problem is compounded by the inherent dicotomy of urban/rural divide in terms of Healthcare distribution itself.
 ISRO Telemedicine Programme: 
Taking note of this well recognized problems, ISRO has taken up the innovative application of Telemedicine which can offset intense effort and investment into a technological solution for the socio-economic development. It is in this context that the “Infostructure” created for Telemedicine is a viable alternative for the large “Infrastructure” ought to be in place to meet the demands.
The Space Research Organisation (ISRO) as a part of application of space technology for Health care and education, under GRAMSAT (rural satellite) Programme, has initiated number of Telemedicine pilot projects that are very specific to the needs of development of the society. ISRO Telemedicine initiative consist of linking through INSAT / EDUSAT satellites, the remote rural district hospitals in different states like Jammu, Kashmir & Ladakh in north, Offshore Islands of Andaman and Lakshadweep, North Eastern States, various states of Rajasthan, Maharashtra, Orrisa, Chattisgarh including some of the remote and tribal districts in the main land States across the country.

ISRO’s Telemedicine initiatives have been broadly divided into the following areas:

a)      Providing Telemedicine Technology & connectivity between remote/rural hospital and Super Speciality Hospital for Teleconsultation, Treatment & Training of doctors & paramedics.

b)      Providing the Technology & connectivity for Continuing Medical Education (CME) between Medical Colleges & Post Graduate Medical Institutions/Hospitals.

c)      Providing Technology & connectivity for Mobile Telemedicine units for rural health camps especially in the areas of ophthalmology and community health.

d)      Providing technology and connectivity for Disaster Management Support and Relief.

ISRO’s telemedicine pilot project was started in the year 2001 with the aim of introducing the telemedicine facility to the grass root level population as a part of proof of concept technology demonstration. The telemedicine facility connects the remote District Hospitals/Health Centres with Super Speciality Hospitals in cities for providing expert consultation to the needy and underserved population.

Technology of Telemedicine   consists of customized medical software integrated with computer hardware, along with medical diagnostic instruments connected to the commercial VSAT (Very Small Aperture Terminal) at each location.  Generally, the medical record/history of the patient is sent to the Specialist Doctors, who will in-turn study and provide diagnosis and treatment during videoconference with the patient’s end.  The video conferencing system is the mainstay of Teleconsultation between the remote hospital and the specialist hospital that creates a virtual environment for emotionally connecting the patient and doctor in a true sense.

The Telemedicine system configured for the ISRO’s Telemedicine project initially started with  “point to point” system between the patient end, which is a general hospital located in a district/town and expert doctors end which is a speciality hospital situated in a city.  Subsequently the need for Server/Browser based Telemedicine system was evolved for multipoint to multipoint connectivity and the same is adopted for several remote and rural hospital with Super Speciality Hospital located in different Towns/Cities.

 Considering the importance of the healthcare system and also taking into account the international practices, the necessary guidelines and standards for the telemedicine system, network / connectivity, interoperability of telemedicine systems and standards for security & process guidelines have also been drawn up by the Ministry of IT (GoI).  The healthcare data has also been standardized through use of DICOM and HL7 standards.

Forrmation of National Task Force (NTF)

Based on the major recommendations of the International Telemedicine Conference (INTELEMEDINDIA-2005) organised in Bangalore by ISRO and sponsored by Department of Health, Department of IT and participated by major hospitals in the country during March 2005, a National Task Force has been constituted by the Ministry of Health under the chairmanship of Union Secretary, Health & Family Welfare, Govt. of India to work out the various aspects of implementing Telemedicine in the country’s Healthcare system including a draft national policy on “Telemedicine and Tele medical education” and prepare a central scheme for the 11th Five Year Plan. The NTF has submitted a detailed proposal to the union Ministry of Health & Family Welfare, about forming a National telemedicine Grid (NTG) for a nation wide connectivity and an e-health web portal as a national repository of health/medical information generally not available in the Internet as highlighted below :
Proposed Constituents of National Telemedicine Grid
A National telemedicine Grid (NTG) is envisaged to have two important functions related to (a) Connectivity for Telemedicine, Medical Education and Medical Training and (b) Health care information service for the administrators/decision makers.
Part-A: National Telemedicine / e-Health Network: 
·       Selected District Hospitals of the country Connected to speciality hospitals,   Telemedicine Grids of Different States (current nodes)
·        Identified Speciality Hospitals 
·        Premier National Medical institutions
·        National Medical Training Institutions providing medical/ health care training
·        National and Regional Cancer centres involved in cancer care, research and training

Part – B: e-Health Web portal
e-Health Web portal of MoH&FW connecting different departments providing all information related to health informatics and Telemedicine, disease surveillance data, Educational material/ information related to specific Indian health care system including AYUSH, which may not be available internet, with hyperlinks to existing resources/data bases.
The second phase of the NTG can carry forward the broader initial phase developments and expand the Telemedicine network to include the following additional constituents into the web portal.
          1.      Association/society /health portals (ICMR, IMA…)
2.    National Disease Surveillance  information (like IDSP)
3.    Digital Library & Medical Informatics
 Also, various operational Disaster Management Support (DMS) systems/centres can be brought under the Telemedicine /eHealth Network of the NTG.
 Conclusion:
ISRO’s Telemedicine Project has gained more acceptability over the years and has potential to open up new frontiers for the rural and urban health care in India. Some States have been successfully using Telemedicine in an operational mode and have prepared the District Hospitals with Telemedicine facility both for ambulatory & Intensive care for cardiac related treatment. States of Karnataka, Kerala, Chhattisgarh, Rajasthan Maharashtra have been in the forefront of adopting SatCom Based Telemedicine facility in all their district hospitals that will be connected to different Specialty Hospitals in the major cities. States like, Gujarat, Himachal Pradesh, Madhya Pradesh and Uttharakhand have also followed the trail. 

To bring the Telemedicine and e-Health into the mainstream of Healthcare system, very diligent effort and necessary plans are required to be worked out for implementation by various government and private agencies towards reaching this goal.  The vision is that all the district hospitals in the country should be linked for Telemedicine using combination of communication technologies of terrestrial/ wireless and SATCOM for different state and national networks, national super specialty hospital network and network for medical education connecting various medical colleges in different states and to some of the premier medical institutions.  This should eventually result in National and State Telemedicine grid managed and operated by the respective agencies with proper methods of adaptation of suitable business model in association with Insurance Industry. 

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Location: Tanjore Main Road, National Highway 67, Near BHEL Trichy, Tiruchirappalli, Tamil Nadu 620015, India

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