Telemedicine in a Disconnected Environment
Dr Sakti Srivastava, MBBS, MSAdjunct Professor
Indian Institute of Technology, Delhi
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Outline Healthcare and Telemedicine in
India Continuing Challenges Today Our Proposed Solution Results and Further Work
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Healthcare in India India spends <1% GDP on
health Urban/Rural mismatch of health
professionals and population >70% of India’s population is
rural Most lack access to basic health
facilities
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Telemedicine in India Aravind Hospitals –
Teleopthamology Network Apollo Hospitals – Aragonda Project OTRI (Online Telemedicine
Research Institute) Asia Heart Foundation OncoNet (Kerala) Common Service Centers e-
governance
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Telemedicine in India VSAT based (ISRO) Broadband based (BSNL) High cost (setup and
maintenance) High technical expertise Low bandwidth Limited scalability
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Continuing challenges Remotest of remote No connectivity Limited infrastructure “Bottom of Pyramid” (<$1 per
day) Landless farmers, illiterate
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Criteria Inexpensive and low maintenance Easy and quick to setup Robust and durable Minimal new technology usage and
skills requirement User-friendly, able to cope with
infrastructure Support large datasets and scalable
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Our proposed solution Asynchronous (Store &
Forward) Delay tolerant network (DTN) Large datasets Several unique features Highly scalable
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Application overview
Background
Challenges
Solution
ResultsKiosk-PC
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Case Flow 1
Internet Region
D1(Neuro)
D2(Pediatrics)
D3(Ortho)
D4(Ortho)
Dispatcher
New Case Submission Path
Reply from Doctor
Health Care Worker
Primary Healthcare Centre (Rural)
RadiologyEquipment
DICOM
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Case Flow 2
Internet Region
D1(Neuro)
D2(Pediatrics)
D3(Ortho)
D4(Ortho)
Dispatcher
New Case Submission Path
Reply from Doctor
Health Care Worker
Primary Healthcare Centre (Rural)
RadiologyEquipment
DICOM
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
DICOM
Internet Region
D1(Neuro)
D2(Pediatrics)
D3(Ortho)
D4(Ortho)
Dispatcher
New Case Submission Path
Reply from Referred Doctor
Referral to another Doctor
Health Care Worker
Primary Healthcare Centre (Rural)
RadiologyEquipment
Background
Challenges
Solution
Results
Case Flow 3
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Design Overview
Kiosknet Hardware
DTN – Communication Infrastructure
DICOM Interfacing
Automatic Case
• Allocation
• Forwarding
• Consolidation
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Design Overview
Kiosknet Hardware
DTN – Communication Infrastructure
Automatic Case
• Allocation
• Forwarding
• Consolidation
Background
Challenges
Solution
Results
DCMTK
CreatorDecomposer
GUI
DICOM Viewer
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Design Overview
Kiosknet Hardware
DTN – Communication Infrastructure
Background
Challenges
Solution
Results
DCMTK
CreatorDecomposer
GUI
DICOM Viewer
DtnReceiver
DocDBSync
DB
NetReceiver
Consolidation
Sender
Sender
Receiver
GUI
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Automatic Case Allocation
Physician database at proxy Doctor’s Name, Specialty,
Location, ID, IP, email address Case specifies only specialty Based on specialty and
availability, allocation done Any allocation algorithm can
be implemented now
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Automatic Case Consolidation
Unique Case ID assigned to a case at creation
One consolidated file per case ID maintained at the proxy
Consolidated file can be retrieved from any location
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Implementation Details
Components Hardware Software
Databases Application level routing Screenshots
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Hardware Components
Background
Challenges
Solution
Results Via Box, 512MB RAM, 40 GB HDD, Ethernet, Wireless
PC, Low RAM, No HDD, Ethernet,Wireless
Soekris 4801-60 Box, 256MB RAM, 40 GB HDD, Wireless
Soekris 4801-60 Box, 256MB RAM, 40 GB HDD, Wireless
PC (P4) , 512MB RAM, 80 GB HDD, EthernetWireless
PC, 512MB RAM, 40 GB HDD, Ethernet
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Software Components
Background
Challenges
Solution
Results Debian OSApache 2.2, PHP 5.2.6, DICOM Viewer Mricro
Debian OSdtnd, dcmtk toolkit, dhcp, nfsCreator, Decomposer (java modules)
Debian OSdtnd
Linux OSApache 2.2, PHP 5.2.6Receiver, Sender(java modules)
Debian OSdtnd
Debian OSdtnd, dcmtk toolkit, dhcp, nfsCreator, Decomposer (java modules)
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Screenshots
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Results
1 GB data bidirectional transfer
Measured time for link detection and transfer time Time to link detection: Worst
case – 10 mins Throughput: 1 MBPS
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Future Work
SMS integration Call allocation methods Enable querying Security and privacy Utility based routing
Background
Challenges
Solution
Results
August 06, 2008 TIDE project/ IIT Delhi / Srivastava
Acknowledgments
IIT Delhi Prof Huzur Saran Prof Sanjiva Prasad Rohan Jain Varun Sharma
CDAC Mr B S Bedi