Transcript Rheumatoid Hand

Telemedicine in a
Disconnected Environment
Dr Sakti Srivastava, MBBS, MS
Adjunct Professor
Indian Institute of Technology, Delhi
Outline
Background

Challenges

Solution

Results

August 06, 2008
Healthcare and Telemedicine in India
Continuing Challenges Today
Our Proposed Solution
Results and Further Work
TIDE project/ IIT Delhi / Srivastava
Healthcare in India
Background

Challenges

Solution
Results


August 06, 2008
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
TIDE project/ IIT Delhi / Srivastava
Telemedicine in India
Background

Challenges
Solution

Results




August 06, 2008
Aravind Hospitals – Teleopthamology
Network
Apollo Hospitals – Aragonda Project
OTRI (Online Telemedicine Research
Institute)
Asia Heart Foundation
OncoNet (Kerala)
Common Service Centers e-governance
TIDE project/ IIT Delhi / Srivastava
Telemedicine in India
Background

Challenges

Solution

Results



August 06, 2008
VSAT based (ISRO)
Broadband based (BSNL)
High cost (setup and maintenance)
High technical expertise
Low bandwidth
Limited scalability
TIDE project/ IIT Delhi / Srivastava
Continuing challenges
Background

Challenges

Solution

Results


August 06, 2008
Remotest of remote
No connectivity
Limited infrastructure
“Bottom of Pyramid” (<$1 per day)
Landless farmers, illiterate
TIDE project/ IIT Delhi / Srivastava
Criteria
Background

Challenges

Solution

Results



August 06, 2008
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
TIDE project/ IIT Delhi / Srivastava
Our proposed solution
Background

Challenges

Solution

Results


August 06, 2008
Asynchronous (Store & Forward)
Delay tolerant network (DTN)
Large datasets
Several unique features
Highly scalable
TIDE project/ IIT Delhi / Srivastava
Application overview
Background
Challenges
Solution
Results
August 06, 2008
KioskPC
TIDE project/ IIT Delhi / Srivastava
Case Flow 1
Background
Challenges
Solution
Health Care
Worker
D1
(Neuro)
DICOM
Results
D2
(Pediatrics)
Dispatcher
Radiology
Equipment
Primary Healthcare
Centre (Rural)
D4
(Ortho)
New Case Submission Path
Reply from Doctor
August 06, 2008
D3
(Ortho)
Internet Region
TIDE project/ IIT Delhi / Srivastava
Case Flow 2
Background
Challenges
Solution
Health Care
Worker
D1
(Neuro)
DICOM
Results
D2
(Pediatrics)
Dispatcher
Radiology
Equipment
Primary Healthcare
Centre (Rural)
D4
(Ortho)
New Case Submission Path
Reply from Doctor
August 06, 2008
D3
(Ortho)
Internet Region
TIDE project/ IIT Delhi / Srivastava
Case Flow 3
Background
Challenges
Solution
Health Care
Worker
D1
(Neuro)
DICOM
Results
D2
(Pediatrics)
Dispatcher
Radiology
Equipment
Primary Healthcare
Centre (Rural)
D4
(Ortho)
D3
(Ortho)
New Case Submission Path
Referral to another Doctor
Reply from Referred Doctor
August 06, 2008
Internet Region
TIDE project/ IIT Delhi / Srivastava
Design Overview
Background
Automatic Case
Challenges
Solution
DICOM
Interfacing
• Allocation
• Forwarding
• Consolidation
Results
DTN – Communication Infrastructure
Kiosknet Hardware
August 06, 2008
TIDE project/ IIT Delhi / Srivastava
Design Overview
Background
GUI
Automatic Case
Challenges
Solution
• Allocation
DICOM
Viewer
Creator
• Forwarding
Decomposer
DCMTK
• Consolidation
Results
DTN – Communication Infrastructure
Kiosknet Hardware
August 06, 2008
TIDE project/ IIT Delhi / Srivastava
Design Overview
Background
Challenges
Solution
Results
GUI
GUI
DB
DICOM
Viewer
DocDBSync
Creator
DCMTK
Decomposer
DtnReceiver
NetReceiver
Sender
Sender
Receiver
Consolidation
DTN – Communication Infrastructure
Kiosknet Hardware
August 06, 2008
TIDE project/ IIT Delhi / Srivastava
Automatic Case Allocation
Background

 Doctor’s
Name, Specialty,
Location, ID, IP, email address
Challenges
Solution
Results
Physician database at proxy
Case specifies only specialty
 Based on specialty and
availability, allocation done

 Any
allocation algorithm can be
implemented now
August 06, 2008
TIDE project/ IIT Delhi / Srivastava
Automatic Case Consolidation
Background

Challenges
Solution

Results

August 06, 2008
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
TIDE project/ IIT Delhi / Srivastava
Implementation Details
Background

 Hardware
Challenges
 Software
Solution
Results
August 06, 2008
Components
Databases
 Application level routing
 Screenshots

TIDE project/ IIT Delhi / Srivastava
Hardware Components
Background
Challenges
Solution
Results
August 06, 2008
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) ,
PC,
512MB RAM, 512MB RAM,
80 GB HDD, 40 GB HDD,
Ethernet
Ethernet
Wireless
TIDE project/ IIT Delhi / Srivastava
Software Components
Background
Challenges
Solution
Results
August 06, 2008
Debian OS
Apache 2.2,
PHP 5.2.6,
DICOM
Viewer
Mricro
Debian OS
dtnd, dcmtk
toolkit, dhcp,
nfs
Creator,
Decomposer
(java
modules)
Debian OS
dtnd
Debian OS
dtnd
Debian OS Linux OS
dtnd, dcmtk Apache 2.2,
toolkit, dhcp, PHP 5.2.6
nfs
Receiver,
Creator,
Sender
Decomposer (java
(java
modules)
modules)
TIDE project/ IIT Delhi / Srivastava
Screenshots
Background
Challenges
Solution
Results
August 06, 2008
TIDE project/ IIT Delhi / Srivastava
Results
Background
Challenges
Solution
Results
August 06, 2008
1 GB data bidirectional transfer
 Measured time for link detection
and transfer time

 Time
to link detection: Worst case
– 10 mins
 Throughput: 1 MBPS
TIDE project/ IIT Delhi / Srivastava
Future Work
Background
Challenges
Solution
Results
August 06, 2008
SMS integration
 Call allocation methods
 Enable querying
 Security and privacy
 Utility based routing

TIDE project/ IIT Delhi / Srivastava
Acknowledgments

IIT Delhi
 Prof
Huzur Saran
 Prof Sanjiva Prasad
 Rohan Jain
 Varun Sharma

CDAC
 Mr
August 06, 2008
B S Bedi
TIDE project/ IIT Delhi / Srivastava
[email protected]
August 06, 2008
TIDE project/ IIT Delhi / Srivastava