Sanjay Gandhi Postgraduate Institute of Medical Sciences
Professor Samir(Claremont Graduate University) and Professor Mishra(SGPIMS)
1) Overview
A trip to India from 08/03/2008 to 08/11/2008 gave me a lot of insight learning in telemedicine and how it was used to help to provide better services to client in India. It also showed us in the hospital the technology was used for consultation, education, live operation, and even research. Even the technology still facing with issues like privacy, bandwidth, building trust between patient and doctors., the telemedicine is growing fast in India and was widely adopted through the whole country for serving its citizen and bringing healthier lifestyles for people there. Our trip was lead by Dr. Samir Chatterjee of Claremont Graduate University with eight people including me and we visited the Sanjay Gandhi Postgraduate Institute of Medical Sciences lead by professor S.K. Mishra.My classmates are Ana Ojo, Stuart Fermenick, Will Garand, me(Cuong Nguyen), John Burgos , Sabera Arastu, and Ed Mossley(friend of Dr. Samir). You can see the pictue of all of us standing in front of the Lotus Temple in the beggining of the web page.
Here is the information for number of teleconsulation based on different specialties
2) Why was telemedicine used in India?
Because it provided a better access for patients and particularly for patients living in the rural areas. Moreover, telemedicine help people save time and money. For India’s culture, if a mother was sick, there will be four or more of people escort her to the hospital. Therefore, the cost of commute from village to hospital was high and not affordable for people with low income. With the help of video conferencing technology, it reduces number of visits from the village to the doctor’s offices that will save a lot of money for train and airplane tickets.
The telemedicine was also used as a way to help to improve the productivity of physicians. Doctors now in India will be able to schedule to examine patients in local village in a certain time. After they finished examine the patient by nurses or their assistants, patients will be able to schedule to see the doctor for treatment in the main hospitals. It improves the productivity of nurses and saves doctor’s time for other main activities.
Video conferencing is also help to train young doctors, nurses, and even administrator for different activates like diagnosis, teleconsulation and treatment planning, new process or guidelines for monitoring public health, preparedness for mitigation of public health disaster.
“A small outbreak of cholera was aborted efficiently by timely diagnosis and proper preventive measures promptly taken with on line consultation”
3) Technology (all the in formation from this section come from the web site http://www.telemedindia.org/)
Here are equipments are used in SGPIMS for telemedicine. It was divided in to five different categories: IT equipments, Medical Diagnostic Equipment, Video conferencing Equipment. Telecommunication Equipment and Telemedicine software
a) IT Equipments
Hardware:
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 | Software:
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b) Medical Diagnostic Equipment
| X- Ray Digitizer / Scanner: |  |
| Tele-Patholgy System |  |
| Tele-ECG System (8/12 Lead) |  |
| Digital Stethoscope |  |
c) Video conferencing Equipment
- Full ITU-T H.323 Standards-compliant for interoperability
- Multi Network connectivity (IP and ISDN)
- H.261 and H.263 video compression standard
- Data Collaboration with XGA Input and Output port
- QCIF – 176 x 144, FCIF – 352 x 288 video resolutions
- Video Frame Rate Up to15- 30 fps
- Audio Compression Standard G.711: 3.4 kHz @ 64 kbps/G.722: 7.1 kHz @ 48 / 56 / 64 kbps/ G.728: 3.4 kHz @ 16 kbps
- Audio Performance 100-7100 Hz frequency response with Full duplex
- 64 kbps to 384/512 kbps Data Rates
- Automatic Noise Suppression
- Acoustical echo cancellation
- 42” Display Panel with RCA and X-VGA port Optional
d) Telemedicine software
a) Mercury Integrated Telemedicine Solution
b) Sanjeevani Integrated Telemedicine Solution
c) TELEMED integrated Telemedicine Solutions
d) Televital integrated Telemedicine Solutions
If you want to know more about the software, please connect to the following link http://www.telemedindia.org/telemedicine_software.html  | VSAT
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  | Terrestrial
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  | ISDN
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There are so many factors to help to make the telemedicine project in India succeed. Those are : leaderships(got a strong support from the government), well-established infrastructure, Also, according to Dr. Mishra any telemedicine project needs a “champion” to lead the project from start to finish. Those CSFs are identified for telemedicine project are : accessibility, Satisfactory, Quality, Security and Performance.
• Satisfactory : Doctors, patients are happy with the technology
• Accessibility: convenience of participation(during all the video conference all the participants seems to be happy with the technology)
• Quality : clear pictures and images
• Security: using VPN or https to protect patient’s information
• Performance : have some interruption during the first conference but it would be able to reconnect again(more problem if we use MCP(multiple control point)
5) Issues:
During some of the teleconsulation, we experimented some issues related to the technology like loosing connections between location/nodes during the conference, consultation/meeting due to the limited bandwidth. In addition, according to doctors there were some concern related to privacy raising by patients and their families. They are still working on guideline and standardization for procedures and methods related to telemedicine project.
They are not ready for telehome and just start on telepsytriachy based on our interviewed with them.
6) Social Activities:
In this trip, we also have a chance to learn about India culture by visting Tajmahal, India Gate, Kutab Minar….We also had the opportunity to enjoy India cuisine by trying different dishes in local restaurants. All the dishes are delicious. The services provided by local restaurant, hotel seemed to be good and tried to be please customers as much as they could. Even we were having problem like water leaking at the hotel room on the first day at New Delhi and the hot weather caused us got sweat all the time. We all had the good feeling about the trip and all activities that we were involved as a group during the trip(like using the train to go from New Delhi to Lucknow). It helped to create a good bond between us(among the travelers)
At the final day at Lucknow, we were invited to have dinner with Dr. Mishra and his staffs. It was a pleasant feeling to me because we were welcome by SGPIMS and its staff. It also made me surprise by seeing people from different classes from the society seems to be happy even they are poor and living in the difficult condition.
And the sad thing as we had to leave and went back to the USA. We said goodbye to everyone and hope might be back in the future( for visiting or working). It was a wonderful learning experience for me because I get to know more about the other culture and made new friends. However, it’s nice to be back to the USA(home). I missed my kids!!!!
7) ConclusionEven with the differences in social structure and regulation in practicing telemedicine between India and USA, I feel that telemedicine will be widely adopted in USA if we are able to resolve issues related to confidentiality and privacy in the USA. We also need to address issues related to malpractice in medicine and working on standardization. However, there will be more and more people move forward to understand/learn/educate and practice telemedicine.
To be able to succeed in any future telemedicine project, we need good funding, leaderships, well- established infrastructure, a champion on any project and a good vision. Those are required the participation from different level of government (both local and federal), research institute, medical practitioner (doctors, nurses…), and the good infrastructure (fiber optics, equipments….).
There are still many challenges ahead of us for practicing telemedicine in USA but I have a strong belief in the technology for helping us to bring the access of health care services for underserved population, monitoring public health services and help us for preventing outbreak in the public. Finally, I would like to express my many thanks for the warm welcome from Dr. Mishra and his staff from SGPIMS and all the presentation and knowledge that they are willing and enthusiasm sharing with us during our visit to their facilities from August 03. 2008 to August 13, 2008. I also would like to say so many thanks to Professor Samir for organized the trip and guided us through the tour. Without you, we would not have a pleasant trip with extensive learning telemedicine, India culture, social networking, and so on.
References
http://www.telemedindia.org/comhardware.html
http://www.telemedindia.org/equipments.html
http://www.telemedindia.org/med_equip.html
http://www.telemedindia.org/videoconf.htmlKeywords: Critical success factor, Medical Sciences, Telemedicine