0 E-health is medical activity by cooperation of medical institutes in different areas, which is realized by computer technology and telecommunication technology. Typical solution of e-health is by satellite communications system, ISDN or telephone facilities. In an e-health system using satellite, the communication links are realized by satellites, in despite of the disadvantage of e-health using terrestrial facilities. Typically, an e-health system using satellite is comprised of a telecommunication satellite, main teleport, a quantity of terminals, related software and protocols.
Larger service area: Satellite communications system could provide large coverage that even rural and wild areas can be included, so the problem of sharing and equity of health resources in developing and developed areas are easier to resolve.
Wide bandwidth: Until now, the bandwidth of one channel of broad band telecommunication satellite could reach as much as 200 MHz, it is a big advantage comparing to the bandwidth of terrestrial communication systems, especially in developing countries.
Flexibility and extensibility: No matter it is in deserts, oceans, mountains, or hills, an e-health system is possible to be operated if it’s in the service area of a satellite.
Hard to break down: Terrestrial communication systems are always destroyed when disasters such as earthquake or tsunami happens. At this time, e-health systems based on satellites is the only communication way for rescue and rebuilding in disaster area.
Cheaper, shorter construction period: Compared to other communication system, the prices of system infrastructure and user terminal are cheaper, the constructing is easier and its period is shorter.
In a point-to-point health service, experts could use health data collecting and diagnosing devices, such as digital imaging instrument, ultrasonic detection automatic recording instrument, to collect high resolution CT scanning figures, X-ray images. In the diagnosing process, real-time telecommunication is feasible. Despite of remote diagnosing, doctors could use remote control system to operate mechanic arms to conduct a surgery, in which the communication link is built by satellites.
Once consultation is needed, video conference may be supported by the point-to-point health system. Using satellites communication links, any terminal could be used as the main terminal and the other terminals are used as sub-terminals. Any links between different terminals are in two-direction pattern. Real-time connection is realized between them and in this way medical institutes in different sites could deal with business simultaneously.
3.2 Education for e-Health
In disaster or epidemic areas, an e-health system by satellites could improve the medical level much rapidly. For example, one expert provides lectures at the main terminal and other people could receive information and reply by their local terminals. By this way, some emergent knowledge about first aid and epidemic prevention is transmitted and broadcasted.
3.3 Data and Information Sharing for e-Health
In every dispersive area, hospitals can found local information centre and expert database, collect local health requirements and upload them to expert service centre of e-health system. The expert service centre of e-health system could provide proposals and methods according to the requirements and realize the sharing of software and data through health information broadcasting by satellites.
Huge investment is needed for any space telecommunication system, and permanent maintenance is also necessary. For a developing country with limited financial ability, it’s a good way to build up its e-health system using satellite according to the specified situation in this country.
In primary phase, it’s better to build up an e-health system by renting transponders of civil or other countries’ satellite. When the requirements are mature and the fund is sufficient, one country can build up a new satellite system aimed at public service, in which e-health is one of the main purposes.
The scale of satellite multimedia service is increasing all over the world, so are the user’s requirements. Under this situation, broad band satellites technology is becoming one of the trends of satellite telecommunication in the future. By the way, it’s necessary to consider the compatibility between current satellite facilities and the future satellite system, such as the broad band satellite system.
It is suggested to conduct the satellite hardware construction, the telecommunication system research, and business mode exploring synchronously.
0 The contribution is a case on implementation of Tele-Medicine project through Pan – African E-Network Project by M/s Telecom Consultants of India Limited, a Government of India Enterprise. The project has been very successful and won several awards for innovation. This model could be used as an example for providing Health services through ICTs in the developing countries.
1 Introduction/Background: TCIL Experience of Design, Development and Operations of Tele-medicine Networks
TCIL has implemented and operating Tele-education and Tele-medicine network projects of pan African e-Network Project, wherein 5 reputed Indian universities and 12 Indian super specialty hospitals are connected to 48 of the 54 member countries of African union for providing Tele-education and Tele-medicine. TCIL is implementing agency on turnkey basis covering design, development, supply, installation, commissioning and operations of the network.
The network is operating for more than 5 years and African countries have benefitted from the medical expertise and know how in India via this network. The CME sessions conducted from India on daily basis have helped the medical professionals in education and sharing of experiences. TCIL is implementing agency on turnkey basis covering design, development, supply, installation, commissioning and operations of the network including providing education and medical services through the Indian universities and hospitals. TCIL has also implemented SAARC telemedicine network spread across for the SAARC nations.
Pan African e-Network Project has been awarded of “Best Development Initiative in Africa – 2009” and “Hermes International Award for Innovation”.
2 TCIL Proposal
The aim of this service is to provide health checkups and diagnosis for non-emergency medical conditions and thus eliminating the need to travel to cities for treatment of minor ailments. This service would enable the rural population to demand medical services at their door steps. A medical call center would be established which can be contacted over a toll free number. This service would bridge the gap between the rural population and specialty medical care and thus benefitting both.
These services would be provided either through paramedics or general practitioners. Medical Diagnostic kit can help in providing the Frontline Health worker to perform diagnostics tests and then employ decision support system to offer care to all primary care patients. In the case of emergency or situations where further consults are required, the medical officer can use the Satellite or Broadband connectivity to offer telemedicine facility.
Paramedics are one of the first points of contact for many populations. Empowering them with Medical Diagnostic Kit, the on-the-spot recommendation system and guidance by physicians through the phone/videoconferencing will allow them to monitor patient health and also identify high risk cases which need immediate care by physicians. In this way, such a system could help better care delivery and a more efficient system for rural population.
Figure 33: Rural tele-medicine network
Workflow of the rural tele-health services
1 Services shall operate through the call center for providing the medical assistance to the patients in the rural areas.
2 Call Center would be equipped to receive the help calls by following means:
a. Helpline telephone numbers;
b. Web-based access.
3 Residents can register their requests for medical services by approaching the call center by available communication means.
4 The call center shall alert the paramedic near to the location of the caller or service seeker and forward him the request details for attending the patient.
5 Paramedic is equipped with sufficient diagnostic equipment to examine the patient.
6 Paramedic on examining of the patient shall report the details through internet and seek an appointment with a doctor from Primary Health Centers (PHCs).
7 PHCs doctor list and contact details would be available in the data base and paramedic can contact the doctor of the particular PHC for getting medical support.
8 The entire diagnosis and medical history shall be available to the doctor by accessing the central server.
9 Doctor shall provide the necessary prescription online into the system which shall also be available to paramedic for handing over the same to the patient.
10 The medicine shall be arranged by the patient separately from PHCs or chemists.
11 The Call Center and Data Center would be located at a mutually agreed upon location.
3 Proposed Technical Solution
Components of the rural tele-medicine solutions and their roles for delivery of rural tele-medicine services:
a) Role and responsibilities of 24X7 Toll free helpline/call center
i. The patients from rural areas can call the helpline for immediate medical assistance for an emergency or to request for a health checkup. Depending on the call it may be forwarded directly to a physician for immediate advice.
ii. Initially a call center with a staff of 5 agents and 2 doctors may be setup for the pilot project. The call center’s call handling capacity would be increased as per the increase in the call traffic.
iii. The call center would inform the callers about the schedule for paramedic staff visiting their area and also accept request for health checkup.
b) Role and responsibilities of paramedic staff
i. Paramedics would be hired to travel to various regions of the targeted area to provide health check up and medical assistance. Paramedics would be equipped with a medical diagnostic kit and medical vehicle to carry the patient to a Specialty Hospitals if required.
iii. The paramedic visiting a patient would prepare and upload the EMR online on the central server.
iv. The paramedic would also transfer the medical reports generated over the medical kit to the centralized server.
v. The paramedic can also communicate with a specialist using the medical kit’s Video Conferencing facility.
vi. Paramedic staff would be provided with a mobile phone with GPS facility.
c) Role and responsibilities of primary healthcare centres
i. Primary health centers may play a key role in this network. They may also initiate a call to the call center for tele-consultation with a specialist as needed. They may also act as the health checkup center when the paramedic with medical diagnostic kit arrives in that area.
ii. Primary Health Centres may also appoint doctors to take calls from Paramedic Staff and to assist them remotely.
d) Role and responsibilities of doctors in the virtual pool
i. A pool of doctors from various Primary Health Centres would be enabled to connect in the network over internet.
ii. These doctors would help the paramedic personnel in the rural area visiting the patient and give a prescription.
iii. The doctors would be able to see the Patient record online from login into the Central Server.
e) Medical kit
The medical kit is a revolutionary device that enables remote diagnostics and care employing state of the art mobile system. It would allow any Android Phone or Tablet to perform following diagnostics tests:
i. Blood Pressure.
ii. Blood Sugar.
iii. Heart Rate and Heart Rate Variability.
v. Urine Protein.
vi. Urine Sugar.
vii. Blood Hemoglobin.
viii. Body Temperature.
‒ Participating interested countries.
‒ TCIL as implementing agency for the project.
‒ Participating Hospitals for delivery of Tele-medicine sessions and CME programs.
‒ Beneficiaries patients.
5 Approach for Project Implementation
Approach and methodology:
After intent of countries to implement Rural Tele-medicine network, TCIL shall carry out detailed meetings into the country for implementation of the Rural Tele-medicine solutions whereby it will do the following:
‒ TCIL shall identify in association with stake holders the Medical treatments at site to be covered, identification and finalization of Super Specialty Hospitals, Primary Health Centres etc. for delivery of Tele-medicine services.
‒ TCIL shall carry out a sample survey of few locations.
‒ TCIL shall design the network for setting up the required infrastructure.
‒ TCIL shall finalise Bill of Materials (BoM), Bill of Quantities (BoQ), availability/ coverage of public network etc.
‒ TCIL shall develop the framework of implementations of Tele-medicine as per the countries requirements.
‒ TCIL shall train the countries’ manpower for operations & management of the network.
‒ A project monitoring team will monitor the different activities of the project.
Responsibility of countries:
‒ Network for Tele-medicine such a leased lines, internet, MPLS shall be provided by the interested country.
‒ Space, power/electricity shall be provided by respective countries.
‒ Site preparation shall be provided by the respective country.
‒ Man power for operation and maintenance shall be provided by the respective countries.
‒ Any other local assistance regarding clearance, Visa, survey etc.
‒ Exemptions such as taxes, custom duties will be provided by the country.
‒ Day to day Consumables at respective sites will be provided the respective country.
TCIL, Telecommunications Consultants India Limited, a prime engineering and consultancy company, is a wholly owned Government of India Public Sector Enterprise under the administrative control of the Department of Telecommunications (DOT), Ministry of Communications and Information Technology, Government of India. TCIL was set up in 1978 for providing Indian telecom expertise in all fields of telecom, Civil and IT to developing countries around the world. Company's core competence is in the fields of Switching, Transmission Systems, Cellular services, Rural Telecommunication, Optical fibre based backbone transmission systems, IT & Networking Solutions, Application Software, e-Governance, 3G Network, WIMAX Technology and also Civil construction projects. http://www.tcil-india.com/new/
For more details on Pan African E Network Project: http://www.panafricanenetwork.com/
Contact Details: Mr E.M. Venkatesh, General Manager (TS), Telecommunications Consultants India Limited, Tel.: +91 11 2620 2590, E-mail: firstname.lastname@example.org