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Care Foundation

Experience of setting up Telemedicine projects

Public-private partnership model - Telemedicine Project with District Hospitals

With   the   goal   of   eventually   ensuring   delivery   of   quality   medical   care,   a   telemedicine   system   has   been designed   to   make   quality   health   care   accessible   at   an   affordable   rate   to   people   living   in   remote   areas.   The purpose   of   the   system   is   to   give   health   care   providers   at   remote   locations   the   ability   to   consult   with   specialists using   a   combination   of   video,   audio,   and   externally   acquired   medical   images.   The   system   can   also   be   used   for education   purposes   to   support   bi-directional   video/audio   communications   for   grand   round   lectures,   classes,   and case   conferences.   In   order   to   maximize   the   utilization   of   the   available   transmission   medium   (ranging   from   land- based   copper   and   fiber   optic   cable   to   satellite   link)   while   providing   the   best   possible   video   and   audio   quality,   the compression performed by the system is adaptable to a wide variety of bandwidths. Telemedicine    in    Mahabubnagar,    a    project    executed    by    CARE    Foundation    for    the    district    hospital    at Mahabubnagar   is   via   a   public-private   partnership,   with   the Andhra   Pradesh   Vaidya   Vidhana   Parishad   (APVVP) on   behalf   of   the   Government   of   Andhra   Pradesh.   The   APVVP   provided   a   facility   at   the   district   hospital   with   a fully   operational   CT,   X-ray,   ECG   and   Echocardiography   units.   Care   Foundation   was   in-charge   of   providing   in- house   developed   software,   dissemination   of   training   to   a   local   field   project   executive,   proving   timely   diagnosis with the help of the specialists at CARE hospitals and daily maintenance of the communication and IT network. The   ideology   behind   the   entire   set-up   was,   to   have   these   equipment’s   operational   at   the   primary health   care   centre   along   with   a   videoconferencing   equipment   and   a   computer   and   at   the   hub   centre   a sever   computer   with   a   teleconferencing   unit.   The   patients   availed   the   diagnostic   facilities   at   the   remote   site and    the    doctors    at    the    hub    centre    are    empowered    to    interact    with    the    patients    through    the videoconferencing unit. Along   with   delivery   of   timely   healthcare,   the   system   has   been   designed   to   cater   to   the   lower   economic strata   too.   Over   40,000   cases   from   Mahbubnagar   and   more   than   8000   cases   from   Tandur   have   so   far   been transmitted   and   diagnosis   /   treatment,   been   rendered   to   the   patients   without   them   having   to   travel   to cities.   The   strata   of   people   using   this   facility   were   distinguished   based   on   two   factors   namely,   white   card holders,   (WC)   people   below   the   poverty   line,   and   non-white   cardholders   (NWC)   and   accordingly   these   tests have been subsidized to ensure the affordability factor.  The costs of the tests were assigned by APVVP.

Telemedicine to diagnostic units abroad - Nigeria, Iraq

We   established   connectivity   with   Diagnostic   Center   at   Lagos,   Nigeria   for   facilitating   transmission   of   CT, MRI   and   CR   images   and   with   Medya   diagnostic   center   at   Iraq.      Broad   band   internet   connectivity   with   a bandwidth   of   2   Mbps   was   used   for   the   same.      The   application   software   was   developed   in   house   in   the   .Net platform.   CARE   has   developed   teleradiology   application   software   which   enables   transmission   of   DICOM compliant   CT   scan   images   through   a   DICOM   interface   to   a   PC.   The   software   enables   archival,   storage   and retrieval   of   the   transmitted   images.   The   software   enables   post   processing   of   the   image   such   as   grey   shade levelling,   calculation   of   area   and   volume   of   images,   Houndsfield   unit,   window   levelling   and   converting DICOM   images   to   various   other   video   file   formats.   The   software   has   been   created   on   a   .NET   platform   for uninterrupted   case   reporting   by   radiologists.      In   a   period   of   one   and   half   years   over   25,000   cases   have been done over the broadband network from Nigeria and more than 5000 cases from Iraq. Preliminary   reads   were   provided   for   non-emergency   and   emergency   cases   (STAT)   and   after   a   rigorous quality   check   the   reports   were   sent   as   the   official   patient   record.   The   preliminary   reports   included   all pertinent   findings   and   a   phone   call   was   made   in   case   of   any   critical   findings.   For   this   Teleradiology   service, the   turnaround   time   was   extremely   rapid   with   a   30   minute   standard   turnaround   and   expedited   for   critical and   stroke   studies.   For   a   routine   case,   the   turnaround   time   was   3   to   4   hours.   The   final   reports   that   were sent   as   feedback   for   each   case   included   all   findings   with   a   review   of   prior   studies   details   of   the   same patient and all relevant patient information for a complete diagnosis.

Telemedicine to PSU’s - The Singareni Collieries Company Limited (SCCL)

The   Singareni   collieries   are   a   government-owned   PSU   coal   mining   company   in   Pranhita-Godavari   Valley region,   Andhra   Pradesh,   India.   There   is   a   very   high   prevalence   of   respiratory   disorders   such   as   ARDS   (acute respiratory   distress   syndrome)   which   has   remained   unrecorded   and   untreated.   Telemedicine   between SCCL   and   Care   Foundation   via   CR   and   Echocardiography   units   was   established   in   2010.   Telemedicine   model was designed to address issues of lack accessibility due to paucity of nearby tertiary care units.
Inauguration of Telemedicine Link with Dist. Hosp.  Mahabubnagar - 25th Oct2001 Tele-echocardiography - Dr B Soma Raju explaining to  Dr A P J Abdul Kalam 5th May 2002 Live ECHO performed at District Hospital, Mahabubnagar & read by Cardiologist at CARE, Hyderabad Inauguration of Telemedicine Link MeCure Diagnostic Center,  Nigeria
Note: CT- Computed Tomography; MRI – Magnetic Resonance Imaging; CR – Computed Radiography