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Sudhamony S Additional Director / Head,

ICT for Cancer Diagnosis, Treatment and Management. Sudhamony S Additional Director / Head, Medical Informatics Section, Centre for Development for Advanced Computing (C-DAC), Thiruvananthapuram , INDIA.

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Sudhamony S Additional Director / Head,

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  1. ICT for Cancer Diagnosis, Treatment and Management Sudhamony S Additional Director / Head, Medical Informatics Section, Centre for Development for Advanced Computing (C-DAC),Thiruvananthapuram, INDIA. APAN-Healthcare-2009

  2. C-DAC • A Scientific research organization of Ministry of Communication and Information Technology, Government of India • Vision: To emerge as the premier R&D Institution for the design, development and deployment of world class electronic and IT solutions for economic and human advancement • Ten centres across India • C-DAC, Thiruvananthapuram is in the state of Kerala Centre for Development of Advanced Computing APAN-Healthcare-2009 C-DAC Medical Informatics

  3. About ONCONET The first successful Tele-Oncology Network in India which provides telemedicine services in early detection, patient follow up and pain relief for cancer patients from rural areas. APAN-Healthcare-2009 C-DAC Medical Informatics

  4. TheNeed Statistics from India : 1 million new cancer cases per annum 3 million cancer patients Low socio-economic status and low literacy rates in rural areas Lack of infrastructure and expertise at Public Health Centers in rural areas for early detection of Cancer Long and relatively expensive travel to reach Cancer Care facility 30% of cancers can be prevented; 40% can be cured APAN-Healthcare-2009 C-DAC Medical Informatics

  5. A research project funded by Govt. of India Designed, developed, implemented and supported by C-DAC, Thiruvananthapuram Implemented at Regional Cancer Centre Thiruvananthapuram, Kerala, India and its five peripheral clinics across the state ONCONET APAN-Healthcare-2009 C-DAC Medical Informatics

  6. Regional Cancer Centre Trivandrum (RCC) • RCC is the only cancer hospital in the Govt. sector catering to the population of the state of Kerala and neighboring states. • Approx. 12,000 new cases are registered every year and the annual follow-up visits reach 150,000 every year APAN-Healthcare-2009 C-DAC Medical Informatics

  7. Statistics from KeralaNumber of patients visiting Cancer care facility RCC, Thiruvananthapuram C-DAC Medical Informatics

  8. Logistics Distance Travelled APAN-Healthcare-2009 C-DAC Medical Informatics

  9. Logistics Cost of Travel APAN-Healthcare-2009 C-DAC Medical Informatics

  10. How to provide affordable cancer care Reduce overhead on patients by bringing Cancer care closer to them Facility for Early Cancer detection and diagnosis nearby Health education and awareness camps for the rural population APAN-Healthcare-2009 C-DAC Medical Informatics

  11. Tele ONCOlogy NETwork Our Peripheral Clinics • Malabar Cancer care Society, Kannur. • Early cancer detection center, Palakkad. • Early cancer detection center, Kochi. • Early cancer detection center, Kollam. • District cancer control cente, Kozhencheri. APAN-Healthcare-2009 C-DAC Medical Informatics

  12. VSAT Network forONCONET Satellite communication link & Bandwidth provided by ISRO (Totally free) Satellite : INSAT 3C Antenna : 3.8 m Carrier : Extended C Band Bandwidth : 384 kbps Failover mechanism 128 Kbps ISDN connection APAN-Healthcare-2009 C-DAC Medical Informatics

  13. ONCONET CDAC launched ONCONET in Sept. 2004 at RCC and its peripheral clinics with Bandwidth offered totally free by Indian Space Research Organization (ISRO) through its VSAT facility. Currently RCC is linked with over a hundred hospitals across the country including areas with high military presence like Srinagar and Ladakh (2300 miles North), and geographically separated areas like Andaman and Lakshadweep islands APAN-Healthcare-2009 C-DAC Medical Informatics

  14. ONCONET - Features Tele-medicine infrastructure at RCC and five peripheral clinics Tele-Pathology and Radiology systems High bandwidth connection between these centers ( 384 Kbps) Backup arrangement for connectivity through ISDN facility APAN-Healthcare-2009 C-DAC Medical Informatics

  15. ONCONET – Features … Software - Web based Telemedicine software integrated with Hospital Information System software (TEJHAS) EHR, securely made available over the network at remote centres Oncology Resource Centre – Cancer specific information made available at remote centres through a Digital Library APAN-Healthcare-2009 C-DAC Medical Informatics

  16. TM Infrastructure Powerful Video Conferencing System Server system with software for Creation, storage, transfer and sharing of EHR of patients, Telemedicine PCs at clinics Tele Pathology / Radiology System with Digital Microscope, X Ray Film Scanner and software for : Capture , storage and uploading of medical images Sharing and annotation of image between remote centres for discussion APAN-Healthcare-2009 C-DAC Medical Informatics

  17. System Architecture SPECIALTY CENTRE PERIPHERAL CENTRE Video- conferencing Video-conferencing VSAT Network with ISDN (Backup) Telemedicine PC TP / TR Server ROUTER Tele-medicine PC ROUTER Digital library X-Ray Film Scanner APAN-Healthcare-2009 LAN Database & App. Servers Hospital Information System Digital Microscope RCC-Regional Cancer Centre Thiruvananthapuram C-DAC Medical Informatics

  18. Tele-Pathology and Radiology systems Microscope Film / Document SCANNER DICOM CD DIAGNOSTIC Work Station cum SERVER WEB-Viewing Station @ Doctors desk ECDC KANNUR Images received from remote centres & stored in Server Experts view the image through viewing station at their department. Experts prepare the report and send to remote locations Doctors share and view the images online and discusses the case. Network Images captured from microscope X-Rays & Documents scanned Images locally stored DICOM CD imported Patient folder sent to RCC, TVM Reports received from remote expert doctor ECDC KOCHI RCC TRIVANDRUM C-DAC Medical Informatics

  19. ONCONET SoftwareTelemedicine Enabled Hospital Automation System (TEJHAS) Core Services • OP & IP Management • Consultation • Surgical Oncology • Resource Scheduling • Investigation • Nuclear Medicine • Radiation Oncology • Chemotherapy • Pharmacy Comprises of all essential modules : Back Office • Enquiry • MIS • Master Data • Users Support Services • Cash & Billing • Central Stores • Purchase • Blood Bank • Radiology • Engineering • C.S.S.D APAN-Healthcare-2009 C-DAC Medical Informatics

  20. FINDINGS Patients on Chemotherapy can communicate with their physician regarding blood count and seek advice Early Intervention is facilitated Initial patient presentation and diagnosis is made in a primary sitting thereby avoiding unnecessary patient referrals and reducing patient load at RCC For specialty care, appointment is fixed through the system, thereby avoiding unnecessary delay APAN-Healthcare-2009 C-DAC Medical Informatics

  21. Interpretation Number of emergency visit to the hospital is reduced Unnecessary referrals and admissions are avoided Routine follow-up visits are limited to peripheral clinics thereby avoiding unwanted expense APAN-Healthcare-2009 C-DAC Medical Informatics

  22. Saves cost to patient, provider and system Palliative care through close interaction with tertiary care physician Conduct distant medical education programs, panel discussions, nurses training programs and talks by doctors Interpretation… APAN-Healthcare-2009 C-DAC Medical Informatics

  23. Usage Statistics( from 2004 onwards)(Available online at www.rcctvm.org ) APAN-Healthcare-2009 C-DAC Medical Informatics

  24. Usage for Tele Education ( from 2004 onwards) APAN-Healthcare-2009 C-DAC Medical Informatics

  25. ONCONET goes National (ONCONET India) APAN-Healthcare-2009 C-DAC Medical Informatics

  26. ONCONET India( National Tele Oncology Network) • Establish knowledge enabled Tele Oncology network in India • Connect 25 Regional Cancer Centres and 100 peripheral centres ( 4 for each RCC) across the country • Project Report approved by Ministry of Health, GOI; implementation to start soon APAN-Healthcare-2009 C-DAC Medical Informatics

  27. ONCONET INDIA Regional Cancer Centres • Trivandrum • Chennai • Bangalore • Mumbai • Hyderabad • Cuttack • Gwalior • Kolkata • New Delhi • Allahabad • Patna • Bikaner • Shimla • Rothak • Gauhati • Aizwal • Nagpur • Ahmadabad • Pondicherry • Lucknow • Chandigarh • Raipur • Imphal • Srinagar • Kancheepuram APAN-Healthcare-2009 C-DAC Medical Informatics

  28. Telemedicine System Powerful Video Conferencing System & LCD TV Tele consultation system consisting of Telemedicine PC with Telemedicine software which facilitates : -- Creation, storage, transfer and sharing of Electronic Medical Record of patients Tele-Pathology / Tele-Radiology System with Digital Microscope and Scanner/Digital Camera -- Capture of medical images -- Uploading image to remote end -- Storage of image as part of EMR -- Sharing of image between remote centres for discussion At RCCs APAN-Healthcare-2009 C-DAC Medical Informatics

  29. System Configuration at RCC LAN Audio /Video USB Leased Line (384Kbps MPS L3 VPN) Provided by BSNL Deliverables at RCC PC with software Video Conferencing System & TV Film Scanner Digital Microscope UPS, Printer Networking items Digital Microscope Printer 384 Kbps VCS ROUTER Scanner Telemedicine PC APAN-Healthcare-2009 Television Internet C-DAC Medical Informatics

  30. System Configuration at Peripheral Centres BB VPN (384 Kbps) Provided by BSNL Deliverables at Peripheral Centre PC with software Video Conferencing System and TV Film Scanner UPS, Printer Networking equipments Scanner 384 Kbps Printer VCS APAN-Healthcare-2009 Switch Tele Medicine PC Television C-DAC Medical Informatics

  31. System Configuration at Hub location 2 Mbps Leased Line (MPLS L3 VPN) 256 Kbps Internet Leased Line Multi Conferencing Unit Internet access to all RCCs thru MPLS VPN Router Services: Portal Internet Browsing Multi Conferencing APAN-Healthcare-2009 Video Streaming Server ONCONET India Portal Server C-DAC Medical Informatics

  32. NETWORK DIAGRAMS SHOWING HOW THE PROPOSED NETWORK MEETS ONCONET -India FUNCTIONAL REQUIREMENTS APAN-Healthcare-2009 C-DAC Medical Informatics

  33. Aizhwal Bikaner Chandigarh Raipur Ahmedabad Srinagar Rohtak Kancheepuram Bangalore Patna PE PE PE PE PE PE PE PE Mumbai PE PE PE MPLS L3 VPN Backbone PE Trivandrum Delhi PE PE Shimla PE PE Raipur PE PE 384Kbps PE PE PE PE PE PE Chennai Guwahati Allahabad 2Mbps Cuttak Lucknow LEGEND Gwalior Implementing Agency Imphal Pondicherry 256 Kbps Internet Router HUB Proposed MPLS Network linking 25 RCCs APAN-Healthcare-2009 C-DAC Medical Informatics

  34. OVERALL ARCHITECTURE of ONCONET India network 384 Kbps BBVPN 384 Kbps BBVPN 384 Kbps BBVPN 384 Kbps BBVPN 384 Kbps BBVPN RCC1 RCC3 RCC2 RCC4 Peripheral Centre 1 Peripheral Centre 4 Peripheral Centre 4 Peripheral Centre 1 Peripheral Centre 1 Peripheral Centre 4 MPLS BACKBONE 384Kbps L3 VPN Peripheral Centre 1 APAN-Healthcare-2009 RCC25 Peripheral Centre 4 Peripheral Centre 1 Peripheral Centre 4 C-DAC Medical Informatics

  35. Tele-consultation between one RCC and its Peripheral center through Broadband VPN APAN-Healthcare-2009 C-DAC Medical Informatics

  36. TELE-CONSULTATIONbetween one RCC and its peripheral centre- data flow 256Kbps (1:1) Internet Central HUB LL MCU, Video streamer & WEB PORTAL RCCs using MPLS VPN Peripheral Centers using Broadband VPN LL PE PE BSNL MPLS Backbone PE PE Group1 PE PE PE E1 link LL RCC Tele-consultation between a RCC on MPLS VPN and a PC on BB VPN 512Kbps BBVPN APAN-Healthcare-2009 C-DAC Medical Informatics

  37. Conclusion • By this proposed system, the cancer patients from any part of India can get the consultation and treatment from any RCC in India • The rest of India will follow ONCONET-Kerala pattern in the coming years • This ONCONET- India with appropriate low-cost technology might be able to be duplicated as a model for developing countries with low capital inputs APAN-Healthcare-2009 C-DAC Medical Informatics

  38. CONTACT: Sudhamony S Additional Director / Head, Medical Informatics Section Centre for Development for Advanced Computing (C-DAC), Thiruvananthapuram-695033. Kerala INDIA. E-mail: sudha@cdactvm.in Ph: 91- 471- 272 1042  (D) / 272 3333 Ext: 229 Mob. No: 91-98479 14872 (M) Fax: 91-471- 272 3456 / 272 2230 C-DAC Medical Informatics

  39. Applying Advanced Computing for Human Advancement Thank You C-DAC Medical Informatics

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