Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), is situated in Lucknow, the capital of the state of Uttar Pradesh in northern part of India. The foundation stone of SGPGIMS was laid on 14th December, 1980 by the then President of India, Shri Neelam Sanjeeva Reddy. It is a tertiary level referral medical institution with objective to create a center of excellence for providing state-of the-art patient care, high quality medical education, training and conduct research in the relevant disciplines of medicine and other allied sciences. A national peer group recommended the development of the Institute in three phases of six super specialties each. At present this super specialty hospital has 695 beds and 30 academic departments (www.sgpgi.ac.in). The institute has been innovative starting from the beginning of it’s concept e.g. introducing new disciplines, new courses and duration of training etc.
SGPGIMS Telemedicine Programme
Telemedicine activities at SGPGIMS were initiated in the year 1999 in the form of testing the concept of information and communication technology in the field of medicine. Telemedicine, as defined by WHO, is delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technology for exchange of valid information for diagnosis, treatment and prevention of diseases and injuries, research and evaluation, and for continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.
Evolution of Telemedicine Programme at SGPGIMS
At SGPGIMS, telemedicine activities started from the office of the Head of the Department of Endocrine Surgery in August 2000 during Kailash Mansarover Yatra Project. Then from September 2001 till July 2006, all telemedicine activities were carried out in a hall located near the operation theater complex and was called Telemedicine Resource Center. The first research grant received in 2001, which helped in creating an infrastructure for telemedicine here.
Telemedicine Infrastructure (1999-2006)
The technical infrastructure at the SGPGIMS Telemedicine Resource Center was built on gradually with sponsored research grants consisted of several independent telemedicine workstations equipped with tele-radiology, tele-pathology, tele-cardiology and videoconferencing units with large display devices. It could carry out medical data transfer and videoconference with six remote locations simultaneously. The communication set-up consisted of six Integrated Services Digital Network (ISDN) telephone lines, one Ku band Demand Assigned Multiple Access (DAMA) satellite, one extended C band Very Small Aperture Terminal (VSAT) based on flexi DAMA satellite supported by Indian Space Research Organization and Fiber optic cable network supported by Gas Authority of India Ltd. Later in the year 2003 with the support of Government of Uttar Pradesh. All telemedicine sessions are real time and interactive in nature except some of the tele-consultation with rural nodes based in Uttaranchal state. The operation theatres of SGPGIMS are equipped with high-resolution video camera to transmit live telecast of surgical procedures. Two auditoria of 700 and 120 seating capacity are networked through optic fiber backbone to the telemedicine center to enable interactive live telecast of proceedings of seminars, workshops and conferences to different locations in India and abroad. With the completion of intra-hospital telemedicine network as an infrastructure component of upcoming School of Telemedicine, all HIS nodes will be made potential telemedicine nodes. Construction of the first two floors of the school has been complete; the other two floors will be completed in December 2008. All the telemedicine activities have been shifted to the new school complex in August 2006. Additional technical infrastructure is getting added to equip various laboratories and other facilities in the complex.
SGPGI Telemedicine Programme organization and management:
In year 2006, all the telemedicine activities shifted to School of Telemedicine & Biomedical Informatics (Estd. 2006). Project Staff managed the facility under the supervision of a Nodal Officer under the guidance of “SGPGI Telemedicine Programme Management Committee” as approved by Academic Board and Governing Body of the Institute. Faculty members, Residents of different departments, Specialists of General Hospital, Nursing staff, Laboratory Technologist, and Hospital Administration department take part in daily telemedicine activities in a schedule manner.
Mobile Telemedicine System (MTS)
School of Telemedicine & Biomedical Informatics (STBMI) designed and managed Mobile Telemedicine System with the support Dr. K. L. Garg Memorial Charitable Trust, Gomti Nagar, Lucknow. Initial equipments were purchased in the funding received from Department of DIT later-on Ministry of Health and Family Welfare (MoH&FW), GoI supports it.
Devotees thronging the famous Kashi Vishwanath Temple in Prime Minister Narendra Modi’s Parliamentary Constituency, Varanasi and Vidhyanchal temple in Mirjapur, both in poll-bound Uttar Pradesh will soon be able to access emergency healthcare through satellite-based telemedicine facilities. The Union Health Ministry has asked the Indian Space Research Organisation (ISRO) to provide satellite communication systems at the two temples at the earliest to connect them with the centrally administered hospital in the Banaras Hindu University.
The move is part of the Government’s e-health initiatives to ensure better primary health services in rural and underserved areas including pilgrimage centres across the country. Under the pilgrimage category, the Ministry has identified Rameshwaram, Kedarnath, Amarnath and Jagannathpuri besides Dwarka, Badrinath, Sabrimala and Vaishnodevi religious sites to be connected with satellites.
The Health Ministry has already kick-started the project by covering two pilgrimage centres, the Lord Ayyappa temple with telemedicine node at Pampa Hospital and Sheshnag base camp on way to Amarnath Shrine which is located at a height of over 13,000 feet.Kashi Vishvanath temple and Vidhyanchal temple in Varanasi and Mirjapur respectively, both in Uttar Pradesh were included under the project recently at the initiation of Health Minister JP Nadda. Similar telemedicine hubs have also been proposed in a district each in Odisha, Arunachal Pradesh and Meghalaya, all States with difficult terrain while in Himachal Pradesh, the Ministry has already set up such facility projected a telemedicine project at the Community Health Centre at Pooh in Kinnaur district. The centre has been connected to the PGIMER, Chandigarh which was inaugurated by Nadda recently.During the tele-consultation, doctor can ask the paramedic staff to again take the vital stats of the patient and the same data is then transmitted to doctor’s screen who will then provide the diagnosis/instructions via telemedicine software to patient in consultation with patient node staff.
TeleHealth Services Operational at KumbhMela Region at Ujjain
In compliance with the directive of Telemedicine Division, Ministry of Health & Family Welfare (MOHFW), Govt. of India for setting up the Mobile Telemedicine Van in KumbhMela at Ujjain, National Resource Center (NRC), Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI) Lucknow took steps to implement this project in collaboration with Development Education Communication Unit (DECU), Indian Space Research Organisation (ISRO), Ahmadabad. The KumbhMela is being organised from April 22, 2016 to May 21, 2016.
A team from DECU visited NRC, SGPGI Lucknow and tested the feasibility of the satellite connectivity and telemedicine software interoperability between Mobile Telemedicine van, AIIMS Bhopal and NRC. Detailed deliberation and planning were carried out with the Nodal Officer, Telemedicine at AIIMS Bhopal to organise the Telemedicine platform functionality, technical manpower and provision of medical professional towards offering Tele-health services for the pilgrims of Kumbhmela at Ujjain.
All the required formalities were completed and planning was carried out to depute manpower and organise logistics at mela site. Road permit and other requisites were provided by Telemedicine Division, MOHFW and Mobile van reached in Ujjain on April 20, 2016. Government of Madhya Pradesh facilitated the deployment of the Mobile telemedicine van along with satellite antenna in the mela complex in coordination with Zonal Magistrate. The Mobile Telemedicine Van was stationed at Bhukhi Mata Sector, Dutta Akhara area of SimhasthaKumbh near the temporarily established Government Hospital. NRC team visited all sector hospital and created awareness about the potential and services of Telemedicine among the doctors and staff in coordination with Zonal Health Officer of Dutta Akhara zone.Meeting was held with SimhashtaMela Officer to get support and coordination from the local authorities. A team of ISRO empanelled vendors installed the satellite antenna at identified location on April 21, 2016 night and tested the link with ISRO hub and SGPGI Lucknow. Subsequently, ISRO team visited AIIMS Bhopal and made site operational on the same day. The technical testing with AIIMS Bhopal, SGPGI Lucknow and Mobile Telemedicine van was also carried out successfully. The tele-health services were made operational for the devotees on April 22, 2016. An information flyer in Hindi was distributed among the devotees for creating the awareness.
Mobile telemedicine system (MTS) has been fairly popular among Mela visitors at the ongoing Maha Kumbh. Till date, over 1,000 pilgrims and devotees have visited the hub and taken part in wellness programmes.Blueprint of the system was developed and designed under the supervision of S K Mishra nodal officer of School of Telemedicine & Biomedical Informatics & Head, Department of Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. It is also supported by Moti Lal Nehru Medical College, Allahabad associated with SRN Hospital and Ministry of Health & Family Welfare supports staff.MTS has four sections, one for driver and passenger seats, second for ICT section equipped with video conferencing system for visual communication with doctors in remote places, a public address system used for mass awareness among rural population using projection system and external tuning with projectors.The third section has X-ray units and an operation table to perform minor surgical operations.Section IV has a laboratory equipped with devices used for capturing vital parameters and ophthalmic imaging and for laboratory tests. It is a fully independent unit equipped with generator and UPS, apart from regular power source.It has multiple connectivity options and has BSNL WIMAX connectivity linkage and can connect to any of the telemedicine-enabled medical hospital and super-specialty hospital for expert opinion and follow up of patients from the KumbhMela region. Mass awareness programmes developed by the School of Telemedicine and Doctors of SGPGIMS were shown during the entire period. Live streaming of videos from KumbhMela region to other places and streaming operation theatre videos from SGPGIMS and multipoint conferencing were made possible through the school of telemedicine hub.
Banaras Hindu University (BHU) is one of the Regional Resource Center i.e RRC-East in Ministry of Health and Family Welfare (MOH&FW), Govt. of India funded Telemedicine Project called National Medical College Network (NMCN). Soon it will be connected to with identified district hospitals in the state of Uttar Pradesh through telemedicine network to enable access to super-specialty Tertiary health care facility.
Department of Medical Education, Govt. of Uttar Pradesh entrusted the job of implementing the U.P. Medical College Network to it’sempanelled agency National Co operative Consumer Federation of India Ltd. School of Telemedicine & Biomedical Informatics was given directive to design the technical architecture, identify equipment with appropriate technical specification and supervise the technical deployment, evaluate the quality of technical infrastructure and impart training. The pilot phase has been completed with deployment of telemedicine infrastructure in Medical Colleges at Allahabad, Kanpur and Meerut. After technical trials and training the project is operational since September 2010. The Clinical Grand Round held every week at SGPGI and other CMEs programme are getting shared simultaneously with all three medical colleges by interactive real time videoconferencing.
Combined Pre-Medical Test (CPMT) Counselling 2011 & onward is being carried out using this network for the first time by the Department of Director General Medical Education, U.P.. Earlier this activity was carried out through online data management system which had limitations of using low bandwidth internet with the uncertain connectivity and lack of system for interactivity. The current systems not only made the system fast but also ensure the candidates to choose option on the spot through visual communication which was simultaneously archive for future record. For the first time imposters could be caught with proof. Archived videoconferencing records could be proved to the investigating agencies.
Currently, the infrastructure is being used for the annual CPMT counselling only due to lack of maintenance and manpower support.
Telemedicine Center was inaugurated on Monday, May 26,2014 at Ram Manohar Lohiya Hospital in the presence of VC Prof. Ravi Kant, Director Prof. N. Hussain and SGPGI Director Prof. R. K. Sharma. Every Saturday at 08:00 AM Tele-CGR was transmitted from SGPGIMS, Lucknow to RML, Hospital
With an aim to develop and improve the professional career and consultation skill of the rural and remote doctors, SGPGIMS used telemedicine technology in various projects. In these programs, the specialties and topics chosen for these programs were based on the needs and demands of the users at the remote end which they thought would be helpful in their day-to-day clinical work. Between 2004 -2007 SGPGI carried out a telemedicine project with support of Government of Uttaranchal state to facilitate specialty consultation and distant learning for the doctors and paramedical professionals of two district hospitals of Uttaranchal . Base Hospitals Almora and Srinagar in the remote hilly areas were linked to SGPGIMS through ISDN media. In April 2006 under the Corporate Social Responsibility (CSR) program of Gas Authority of India Limited (GAIL), a telemedicine project was started linking SGPGIMS with District Hospital of Raibareli, located at a distance of 80 km, with fiber optic cable network.
Era's Lucknow Medical College & Hospital has been entered into MOU with TARAHAAT supported by Indian Space Research Organisation (ISRO) and has been established as an 'Expert Telemedicine Center' through which the college is linked with various Villages of North India as Village Resource Centers through the satellite provided by (ISRO). On a scheduled time-table which is circulated on monthly basis, the Senior Doctors and their staff of different disciplines help and educate the patients /persons of different villages on health care issue.
In 2003, a presentation was made by department to the Department of Science and Technology (Govt. of India), regarding the healthcare needs pertaining to oncology in the state of Uttar Pradesh. The members were apprised of the usefulness of telemedicine as a tool to disseminate knowledge and skills to various teaching hospitals of the state to produce competent specialists, for teleconsultation, for tele-followup of cancer patients leading to possible benefits for the health delivery system for the citizens of the state. The technical, medical, and financial issues relating to telemedicine were also deliberated. The project was approved in 2004. A grant of 75 lakh Indian rupees (approximately 1.6 lakh USD) was granted for this project towards cost of hardware and software including intradepartmental network. It was recommended that for phase I of this project, successful telelinks between departments of radiotherapy of SGPGIMS and CSMMU should be first established before establishing tele-links with medical colleges in other cities of the state. The department of radiotherapy of the CSMMU was chosen as the remote center for telelink up in the first phase of this project. With the help of the School of Telemedicine of our institute the concept was translated to designing and developing an exclusive Telemedicine Network for specific application for Radiotherapy. The organizational aspects both technical and administrative were addressed before implementing the project. The technical part of the project was implemented through technical partner, Online Telemedicine Research Institute, Ahmedabad (OTRI) and the network architecture, hardware and software for the telemedicine platform were worked out. Polycom (Model: VSX 5000) PAL camera-based video conferencing equipment and 42′′ Plasma monitor with a screen resolution of 1024 × 768 for display was installed at both the nodes. The software used to establish the video-conferencing connectivity is People + Content IP supplied by Polycom. An integrated services digital network (ISDN) telecommunication media (128 Kbps) with static IP was chosen for the network. The telemedicine platform so created at both the nodes is shown in Figure
Ref. Research Paper:Training the Trainees in Radiation Oncology with Telemedicine as a Tool in a Developing Country: A Two-Year Audit https://www.hindawi.com/journals/ijta/2011/230670/
CSSMU was one of the node under Tele-Radiotherapy Network. Instrastructure was built with a support of Department of Science and Technology. SGPGIMS, Lucknow and Tata Center Hospital are the regular Telemedicine Partners.
Bihar's telemedicine model may help treat patients in over 200 villages of UP. Prof. G K Singh, former director of AIIMS Patna, who successfully ran the project in Bihar and now heads the department of orthpaedic surgery at the Kind George's Medical University has requested Direct, CSSMU to start the project on campus.
KGMC to begin telemedicine activities with JIPMER Pudducherry
World Health Partners is an Noida based NGO. The project started implementation under a $23 million grant from the Bill and Melinda Gates Foundation in 2007. The project is slated to conclude in 2018. WHP currently administers a network of – rural entrepreneurs in 13 districts of Bihar (Begusarai, Bhagalpur, East Champaran, Gopalganj, Khagaria, Muzzafurpur, Nalanda, Patna, Saharsa, Samastipur, Siwan, Vaishali, West Champaran ) and eight districts of UP (15 million). The entrepreneurs, who are local inhabitants fully attuned with the social, financial and religious norms of their community, bear the full investment to join the network. Branded and promoted as ‘Sky Centres’, the providers are able to able to screen patients and to facilitate real time consultations with city based medical doctors. The skills needed at the village end are minimal. Since the equipment works wherever 2G phones work, the network can serve even deep interior parts.
Telemedicine Social Franchising in Rural Uttar Pradesh, India