International Telemedicine Conference Held at Bangalore

An International Telemedicine Conference, INTELEMEDINDIA 2005, was held at Bangalore during March 17-19, 2005. Astronautical Society of India, supported mainly by the Indian Space Research Organisation (ISRO), organised the conference. Other Government of India Departments like Health and Family Welfare, Communications and IT, DRDO, Rural Development and Science and Technology also supported the conference.

At the inauguration, from left: Dr Devi Shetty, Managing Director, Narayana Hrudayalaya, Prof Yunkap Kwankam, WHO, Mr G Madhavan Nair, Chairman, ISRO, Mr T N Chaturvedi, Governor of Karnataka, Prof Rifat Latifi, University of Arizona , USA, Dr K N Shankara, Director, SAC, ISRO, Mr M N Sathyanarayan, Executive Director, Space Industry Development, ISRO, Mr B S Bedi, Senior Director, Dept of Information Techonology, Government of India

Mr T N Chaturvedi, Governor of Karnataka inaugurated the Conference on March 17, 2005. Presiding over the inauguration, Mr G Madhavan Nair, Chairman, ISRO, quoted ancient Indian texts to stress the importance of the physical body to achieve one’s goals in life. He also highlighted the astonishing medical advances in ancient India for preventing and curing diseases and preserving health. Specifically, he highlighted the advances in the areas of Ayurvedic treatment. He recalled that the earliest recorded treatise on medicine Sushruta Samahita was compiled in 8th century B C. Sushruta is considered one of the earliest surgeons who used to perform successful skin grafting and plastic surgery.

Mr Madhavan Nair said that in consonance with pursuing the objective of taking the benefit of space technology to the rural and remote area population, ISRO had taken the initiative to
establish a space-based telemedicine network in 2001. He added that the success achieved by India in telemedicine has drawn the attention of other countries and India’s experience could be valuable for many developing countries that share similar problems in reaching the benefits of
modern healthcare to the remote and rural areas.

Delivering the Keynote Address, Dr Devi Shetty, Managing Director, Narayana Hrudayalaya, Bangalore, highlighted as to how medical benefits could be extended to the poorer sections of the society at very nominal costs through cooperative schemes. Prof S Yunkap Kwankam of World Health Organisation (WHO), Geneva and Prof Rifat Latifi of the University of Arizona, USA were the Guests of Honour.

With 75 percent of the Indian population living in rural areas and more than 75 percent of the doctors practicing in urban areas, telemedicine, which is an emerging technology, appears to be the only way to bridge the rural-urban health divide. The same is true for many of the developing countries.

In pursuing its objectives of using space technology for societal benefits, ISRO initiated space-based telemedicine connecting Apollo Hospital, Chennai and a rural hospital at Argonda in Andhra Pradesh in November 2001. ISRO Telemedicine network has now expanded to 78 hospitals in remote rural areas including Jammu and Kashmir, Andaman and Nicobar and Lakshadweep islands, North Eastern Region and remote tribal areas in central and
southern Indian States which are connected to 22 specialty hospitals in major cities. The experience so far is encouraging and there is demand for such facilities to be established on a larger scale.

Telemedicine system is user friendly and is like any other computerised electronic system. Telemedicine ground systems mainly consist of customised medical software integrated with computer hardware along with medical diagnostic instruments connected through the satellite based Very Small Aperture Terminal (VSAT) or terrestrial communication link. Normally, the medical records of the patients can be sent to specialist doctors either in advance or on real time basis. Specialist doctors will, in turn study, diagnose and advise the course of treatment through video-conferencing with the patients and the local doctors. A short duration training is sufficient for both specialty hospital doctors and rural doctors to handle the system. Hospital technicians can take care of operation and maintenance.

Besides ISRO, several agencies like the Departments of IT, Science and Technology, State Governments and private institutions like Apollo Hospital Enterprises, Amrita Institute of Medical Sciences, Kochi, Sanjay Gandhi Post Graduate Institute for Medical Sciences at Lucknow and Asia Heart Foundation at Kolkata, Shankara Nethralaya at Chennai, Sri Ramachandra Medical College, Chennai, Escorts Heart Institute and Research Centre, New Delhi and several others are also involved in telemedicine.

Several countries in South East Asian Region and Africa have evinced keen interest for the establishment of telemedicine technology for improved healthcare delivery systems. Also, significant technological developments have taken place worldwide in this field and there is a need to ensure that the benefits of telemedicine reach the rural and remote population. It is expected that in future, telemedicine could be used for tele-surgery, robotic surgery, virtual
e-hospitals and medical universities including continuing medical education, tele-health monitoring of chronic patients, etc.

The main objective of the Bangalore conference was to create awareness on the technical, operational, social, ethical, financial and other related aspects of telemedicine. The conference provided a forum to discuss and arrive at appropriate recommendations for implementing telemedicine, particularly in developing countries, where the need is most felt.

In all, 36 invited lectures were delivered by national and international experts in the field of telemedicine and allied fields. Besides, 66 technical papers were presented in parallel sessions. A separate poster session was arranged, where about 40 papers were presented. The topics included Indian experience of telemedicine, interesting case studies like telemedicine in the American Prison System, Telemedicine’s role of US Army Medical Centers, Telemedicine in Space Medicine, Remote Tele-health to Mobile Tele-health, Tele-trauma and Tele-presence resuscitation, Social issues in Telemedicine, cost effectiveness, policy, regulatory, licencing and standardisation issues, etc. The future of telemedicine including rationale of robotic surgery, Tele-health in the care of patients with chronic diseases, mobile tele-health, etc., were also covered.

About 550 delegates including 40 from abroad attended the conference. Speakers from several countries including US, France, Germany, Belgium, Australia, Sri Lanka and Asia Pacific countries like Malaysia, Korea and Taiwan presented papers.

World Health Organisation and International Telecommunication Union were also represented in the conference. UN-ESCAP sponsored delegates from some of the developing countries in the region. Afghanistan and Bangladesh also sent delegates.

INTELEMEDINDIA 2005 was spread over three days with a regional workshop and the inauguration of the conference was on March 17, 2005 and the main conference on March 18th and 19th. The regional workshop was organised to create awareness and familiarise telemedicine techniques among the public, private and NGO healthcare providers, doctors, health administrators and others.

A corporate healthcare round table involving health care service providers, insurance companies, equipment manufacturers and business enterprises was organised to discuss on making telemedicine a viable business proposition so that the benefit can reach the rural and semi-urban population. A panel discussion was arranged for arriving at the recommendations based on the conference deliberations. The panelists included experts in the field, corporate, health, rural and planning sectors as well as NGOs. A Tele-demonstration from Europe was arranged during the conference. An exhibition depicting the latest in telemedicine hardware and services was also organised.

INTELEMEDINDIA 2005 provided valuable inputs regarding the steps to be initiated to introduce and expand telemedicine facilities catering to the needs of the society, especially to the rural and remote population and clinical, technical, operational, administrative expertise and facilities for effective functioning of the telemedicine system.

A view of the exhibition

 

Recommendations of INTELEMEDINDIA 2005 National Task Force • It is recommended that a National Task Force for Telemedicine be constituted. This Task Force would define standards and structures of electronic medical records and patient data bases which could be accessed on a National Telemedicine Grid • The Task Force would work towards definition of a National Telemedicine Grid and its standards and operational aspects. The Task Force should not merely be a recommending authority but should preferably have some say in the actual execution of decisions taken • The Task Force should have members from Ministry of IT, Ministry of Health, C-DAC, DOT, ICMR, ISRO, NGOs, corporate hospitals and organisations that already have done considerable work in the field of telemedicine • The task force or any other appropriate identified body could have association with International Telemedicine Society to look at the possibilities of a global exchange of information and views on all the aspects associated with Telemedicine Policy • There is need to define a policy framework to facilitate the introduction of Telemedicine and to give it a legitimate place in the Health plans, missions and infrastructure of the nation • Given the national priorities, it is essential that Telemedicine and Information and Communication Technology (ICT) play an important role in the primary and public health system. All efforts will be made to explore and promote this priority Interoperability • Efforts have already been made to define standards for Telemedicine software. However, there is need to promote these standards and ensure their compliance • Telemedicine software used in India should be globally compatible or at least scalable for global compatibility, so that telemedicine could be used in promoting medical tourism • It is recommended that NASSCOM and C-DAC arrange workshops to develop interoperability of all software packages • To enhance user friendliness, interaction between doctors and vendors will be encouraged by NASSCOM • Efforts will be made by ISRO to convert the existing terminals to interoperable standards Bandwidth • Bandwidth is the most important component of the recurring costs. All Telecom agencies should be encouraged to provide bandwidth at a lower rate for Telemedicine purposes • This should be applicable not only to space, but also, terrestrial links and mobile connection networks • Telecom agencies should be appraised of the national needs Cost Reduction • The IT Ministry would come out with the appropriate policy guidelines and methodologies for providing Telemedicine software and hardware at subsidised rates Awareness • There is great and urgent need to create awareness about Telemedicine in the community of medical practices. To achieve this the following is recommended: • All Medical Associations and other regional bodies will be encouraged to hold seminars and workshops on Telemedicine • In the next two years ten such conferences/workshops should be held in different parts of the country. These workshops would receive support from Ministry of Health/IT and ISRO • Articles would be published in all medical journals. All doctors presently using Telemedicine would be urged to write such articles • There are 100 locations in the country where Telemedicine has already been installed. Each of these institutions would organise a local workshop and share their experiences with the doctors/hospitals of the neighborhood • Telemedicine should be introduced as a topic in the curriculum of MBBS. This will increase the familiarity of the future generation of doctors with Telemedicine • Telemedicine (health informatics) should be introduced as a topic in the curriculum of engineering college students. This will enable future engineers / IT students to realise the importance of ICT in healthcare • A large number of states have Gramsat networks, which are being used for training of field staff. The training of health staff on the networks would cover Telemedicine aspects