TELEMEDICINE

PROJECTS
in
West Bengal
A Presentation by
Dr. Rajendra S. Shukla, Special Secretary,
H & FW Dept, Government of West Bengal
&
Dr. J. N. Maity, Director,
WEBEL ECS Ltd.
29th September 2006, Vigyan Bhawan, New Delhi

Outline of Presentation

Objectives & Relevance

Benefits
Model
Telemedicine Projects in West Bengal
Telemedicine & PPP
Images & Graphics
Awards
Challenges & Way Forward

Objectives of Telemedicine
Use of information and communication
technologies:
i) To provide specialized health care
consultation to patients in remote
locations,
ii) To facilitate video-conferencing among
health care experts for better treatment
& care,
iii) To provide opportunities for continuing
education of health care personnel.

Relevance of Telemedicine
Inadequate infrastructure in rural/district
hospitals
Large number of indoor/outdoor patients
requiring referral for specialized care
Low-availability of Health Experts in
district/remote hospitals
Dearth of adequate opportunities for training or
continuing Medical Education for Doctors in
Rural/Remote Health facilities.

Benefits of Telemedicine (I)

Benefits to Patients:
Access to specialized health care services to
under-served rural, semi-urban and remote
areas,
Access to expertise of Medical Specialists to a
larger population without physical referral,
Reduced visits to specialty hospitals for long
term follow-up care for the aged and terminally
ill patients.

Benefits of Telemedicine (II)

Benefits to Physicians:
Improved diagnosis and better treatment
management
Access to computerized, comprehensive data
(text, voice, images etc.) of patients offline
as well as real time
Quick and timely follow-up of patients
discharged after palliative care
Continuing education or training through
video conferencing periodically

Benefits of Telemedicine (III)

Hospital and Insurance Benefits:
Significant reduction in unnecessary visits &
hospitalization for specialized care at tertiary
hospitals,
Earlier discharge of patients leading to shorter
length of stay in hospitals,
Increase in the scope of services without
creating physical infrastructure in remote
hospitals

Telemedicine : The Model

Nodal Hospital

Patient under treatment

Physician treating the patient
A remote telemedicine console having
audio visual and data conferencing
facilities
PO
TS
/I
SD
N

/L
EA
SE
D
LI
NE
/V
SA
T

Referral Hospital
An expert / specialised doctor
A central telemedicine server having
audio visual and data conferencing
facility

System Schematic
Referral Center
Web Cam

Digital
Camera

Scanner

Printer

Specialist
Doctor

PSTN /
Leased Line
/ ISDN /
VSAT

Doctor /
Web Cam
Patient Electronics
Microscop
e

Scanner
Digital
camera

ECG
Machine

Printer
Electronics
Stethoscope

Nodal Center

Sequence of Tele-consultation
(I)

Step One

PATIENT IN

Patient visits OPD

Local Doctor checks up

Patient receives treatment

and is not referred to
telemedicine system

OUT

Patient referred to the Telemedicine system (some

special investigations may be suggested)
Patient visits Telemedicine data-entry console.
Operator enters patient record, data and images of
test results, appointment date is fixed for online
telemedicine session
Offline Data
transfer
from Nodal
Centre

OUT

Step Two

Sequence of Tele-consultation
(II)
Patient 1
Patient 2
Patient 3
Patient 4
.
.
.

IN

Patient queue

Online video conference &

tele-consultation for patients
between local doctors at the
nodal hospital and specialist
doctors at the referral
hospital

OUT

Health Infrastructure in West Bengal

(Government)

Medical College Hospitals

Dental College Hospitals
School of Tropical Medicine
District Hospitals
Sub-Divisional & State General Hospitals
Rural Hospitals
Block Primary Health Centres
Primary Health Centres
Sub-Centres

9
2
1
15
70
95
251
922
10,356

** Health on the March 2004-05 Gov. WB

Telemedicine in West Bengal (I)

Project Implementation by Webel ECS Ltd,
Kolkata (Dept of IT, Govt. West Bengal)
Software development by CS & E Dept. IIT,
Kharagpur
Project sponsored & funded by the Dept of IT,
Min. of Communications & IT, Govt. of India
Implementation and usage of facilities by the
Dept. of Health & FW, Govt. of West Bengal

Telemedicine in West Bengal (II)

PROJECT - I
Referral Center

: School of Tropical Medicine, Kolkata

Nodal Centers

: Habra State General Hospital, 24th

Parganas (North)
: MJN Hospital, Coochbehar

Connectivity: First with POTS, upgradation with ISDN, lastly

with 512 Kbps Leased Line using WBSWAN as backbone.
Disease Types: Skin Related and Blood Related
Diseases,Leprosy .
Project Completed: December 2003
DIT Sanction No.
Project Cost

: 2(5)/98-H&B Dated 21.01.1999

: Rs. 150 lakhs

Location of Centers
0f Project I
Koochbehar MJN

LEGEND
Habra SGH

128 KBPS ISDN Link

STM

PROJECT - II
Referral Center : NRS Medical College & Hospital, Kolkata
: Burdwan Medical College & Hospital, Burdwan

Nodal Centers : Purulia District Hospital, Purulia

: Suri District Hospital, Birbhum
: Baharampur District Hospital, Murshidabad
: Midnapur Medical College & Hospital, Midnapur

Connectivity: 512 Kbps Leased Line using WBSWAN as

backbone.
Disciplines: Cardiology, Radiology, Medicine, Pediatrics,
Pathology, Neurology, Dermatology etc.
Project Completed: December 2004
DIT Sanction No.
DIT, GOI Contribution

: 2(11)/2001-HBT, dated 31.03.2002

: Rs. 147 lakhs

Location of Centers
Of Project II

Behrampur DH

LEGEND`

Suri DH

Burdwan MC&H
Purulia DH
NRS MC&H
512 KBPS Leased Line
MidnapurMC&H

PROJECT - III
Referral Center : Calcutta Medical College, North Bengal Medical
College, Chittaranjan National Cancer Institute,
Kolkata

Nodal Centers : Darjeeling, Raigunj & Tamluk District Hospitals

: Arambag Sub. Div. Hospital, Hoogly

Connectivity: ISDN for Arambag Nodal center and 512

Kbps Leased Line using WBSWAN as backbone for other
centers.
Disciplines: Cardiology, Radiology, Medicine, Pediatrics,
Pathology, Neurology, Dermatology, Oncology etc.
DIT Sanction No.
DIT, GOI Contribution

: 2(20)/2003-Telemed Dt. 08.03.04

: Rs. 287 lakhs 0

Location of Centers
Of Project III

Darjeeling DH

NBMCH

Raiganj DH

LEGEND

Arambag SDH
512 KBPS Leased Line
CMC&H
128 KBPS ISDN Link

CNCI

Tamluk DH

Total Mapping of
The Nodal and
Referral Centers

Darjeeling DH
NBMCH
Koochbehar MJN

Raiganj DH

KOLKATA
NRS MC&H

Burdwan MCH

Behrampur DH

CMC&H
Suri DH
CNCI

Arambag SDH

STM

Habra SGH

LEGEND
Purulia DH

MidnapurMC&H
Tamluk DH

TelemediK Software (I)

Is a point-to-point telemedicine system
Symmetric
No distinction between nodal and referral centers
Any hospital can communicate to other hospitals
2nd level referral is allowed

Multi nodal, multi referral environment

Operates over a spectrum of low to high
bandwidth communication channels - POTS,
ISDN, leased line, VSAT and wireless media

TelemediK Software (II)

Store & Forward Technical information
Online video conferencing and data transfer
Electronics Medical Record (EMR) Supported
- Text, Image, Graphics, Audio, Video

Integration with different medical instrument

- EEG, ECG, USG, MRI, CT SCAN, Electronic
stethoscope, Microscope fitted with digital camera

Support of medical standards

Training
Training Provided
Provided
Tele-medicine Centers

Doctors

Paramedics

Habra SDH

03

12

Coochbehar DH

08

12

Midnapur MC & H

12

03

Behrampur DH

05

02

Purulia DH

18

08

Suri DH

15

02

NRS MC & H

03

01

Burdwan MC & H

15

07

STM, Kolkata

05

01

84

48

Total

Discipline wise Patient

Consultation

Pediatrics

75

Orthopedics

96

Neurology

34

Cardiovascular Medicine

27

Psychiatry

12

ENT

31

Urosurgery

11

Hematology, Dermatology, General Medicine,

OBG, Leprosy, etc

3300

Public-Private Partnership in
Tele-medicine
Integrated Tele-Cardiology & Tele-health Project
Govt. facilities covered - BSMCH & Siliguri SDH
Partnership with Asia Heart Foundation & RN
Tagore International Institute of Cardiac Sciences,
Kolkata
Connectivity through POTS & ISDN

Services Provided
Treatment of Acute Heart Attack cases as
evidenced by history and ECG,
Treatment by Thrombolysis
Referral & Tele-consultation & video
conferencing with RN Tagore International
Institute of Cardiac Sciences, Kolkata

Utilization of Tele-cardiology
Facilities

Patients Admitted
Thrombolysed
Tele-consultation

Bankura Sammilani
Medical College
1493
296
915

Siliguri SD
Hospital
2418
197
458

Live session using 512 Kbps

Leased Line

Images

Video Clip

Vector
Data

Awards Received
National e-Governance Award, 2004 from
Govt. of India under Category Outstanding
Performance in Service Delivery
Skoch Challenger Award, 2005
Manthan American India Foundation
Award, 2006 under e- Health Category

Challenges in Implementing
Telemedicine
1. Identification of a Suitable site and preparation of site
for Telemedicine facility.
2. Synchronization of civil, electrical and equipment
related works.
3. Identification of a nodal officer (Other than
Superintendent) for coordinating Telemedicine activities
in the hospital.
4. Sensitization and repeated hands-on training of
concerned Doctors, Technicians and Nurses.
5. Coordinating with referral centers to fix mutually
convenient tele-consultation sessions on a regular
basis.
6. Ensuring trouble free & smooth connectivity through
WAN (ISDN/Leased Line)

. way forward
1. Hand-holding support to Hospital administration for 3-4
years for stabilization of telemedicine services.
2. Integration of Telemedicine activities with Health
Management Information System for regular reporting
(preferably web-based)
3. Including Telemedicine activities in the performance
appraisal of individuals and institutions.
4. Introducing Telemedicine (concept, technical aspects
and implementation arrangements) as part of medical
education & continuing medical education.