E-Health Division Ministry o f Health & Family Welfare

1. E-Health DivisionMinistry of Health & Family Welfare PAN INDIA TELEMEDICINE NETWORK

2. Current Scenario • NATIONAL TELEMEDICINE NETWORK (NTN) • MoHFW issued Guidelines to States • Support to States/UTs for Telemedicine under NHM – PIP • Various States like Rajasthan, Uttar Pradesh, Maharashtra, Punjab etc. implemented Telemedicine services • Support provided to 8 States with Rs. 253 Crores in 3 financial years • TELEMEDICINE GUIDELINES FOR HWCs • Guidelines are framed to act as the “Base Document” for proposals by States • Provided framework for infrastructure, manpower, implementation methodology and model to be adopted by States • Proposed Interoperable Telemedicine solution with integrated diagnostic devices • States are being supported under NHM based on the proposals submitted for Telemedicine in HWCs.

3. Observations on State owned Telemedicine Projects

4. Observations on State owned Telemedicine Projects

5. States supported by NHM * Proposals under examination

6. Problem Statements

7. Pan India Telemedicine concept • Hub and Spoke model to be adopted • State Medical Colleges/District Hospitals shall be upgraded as HUB for providing Doctors/Specialist and Super-Specialty consultation to spokes DH/SDH/CHC/PHC/SC • The spokes shall be upgraded with required infrastructure for conducting the Tele-medicine session with doctors/specialists at HUBs • There will be 3 layered structure for Telemedicine services : • Layer : I – HUBs at Medical College/District Hospital (Doctors/Specialist consultation) • Layer: II – Spoke @DH/CHC/PHC (interlinked with HUBs for specialist consultation) • Layer: III - Spoke @SC (Connect to PHC or HUB for General/ Specialist consultation) • e-Sanjeevani” Telemedicine application developed by CDAC –Mohali will be implemented uniformly in health facilities • The existing manpower at spokes shall be trained to use the system • e-Sanjeevani Dashboard will be integrated with HWCs master Dashboard • Earmarked Premier Govt. institutions as HUBs with States for HWCs (click for info)

8. Requirements from State • Existing Infrastructure under NHM Scheme to be utilized or upgraded • New Infrastructure to be provisioned after Gap Assessment by State • State to opt for following Server deployment methodology : • Option: I – Servers could be located in State Data Centre (SDC) • Option: II – The State may host in a Central Cloud Location • To start with., a 5 seater (MBBS doctors) Call Centre to be provisioned for every 100 Spokes • Proposed 3 specialities are Cardiology/Gynaecology/Pediatricsto start with • State to propose their own requirement on additional speciality • Specialist doctors to be hired on “Daywise Remuneration” basis only. • State to finalize the specialities and remuneration. Budgetary provision to be made in PIP.

9. High Level Architecture HUB (MC/DH) Specialist Doctors stationed at HUB. Only referred patients from 1st level MBBS Doctors at HUB for 1st level of consultation and creation of EHR Video Consultation SPOKES/ HEALTH AND WELLNESS CENTRES Sub Centre CHC/PHC

10. Implementation Timeline

11. Infrastructure requirement Matrix Details

12. Monitoring Framework

13. Future Expansion National Medical College Network for Tele-Education • MoHFW has created e-Classrooms in 50 Medical Colleges of country including AIIMS-Delhi, PGIMER-Chandigarh, SGPGI-Lucknow, JIPMER etc. for providing Tele-Education and Continued Medical Education(CMEs) services • The network Is operational on high bandwidth National Knowledge Network (NKN) • The NMCN network is created with the vision to provide collaborative ecosystem for Students for lecture sharing, e-Content generation , Storage and retrieval of e-Content and a portal for students/filed level functionaries • The NMCN network will vertically integrate with HWCs for Tele-Education services • Field Level functionaries (ANM/ASHA) plays a vital role in delivery of services to this population • Since these functionaries works in direct contact with major population, the continues skill upgradation is utmost important • Continued Medical Education (CME) of Field level functionaries can help in management of new diseases, quick action to contain any outbreaks and educate people on preventive actions E-Classroom Setup Live surgery

14. Future Expansion • NMCN network is strengthened as “Content Generation platform” for medical education system • In line with popular eDX platform of Open Learning, a MeDX platform will be developed specifically for Medical Education over ONLINE mode with integration of National Digital Medical Library(NDML) • Institutes like AIIMSs , PGIs will be designated as “Centre of Excellence(CoE)” assigning responsibility of eContent generation and approval for Online Medical Education courses • Customized Online Certification Courses will be made available for ANMs/ASHAs/Anganwadi workers etc. in local language • Services like Continued Medical Education (CMEs), Massive Online Open Content (MooCs) etc. would made open for Field Level health workers on this platform • Doctors at District Hospitals/CHC/PHCs would be covered for enhancing their skilled and for Continued Medical Education (CME) • Special short term courses would be designed for emergency diseases like ZIKA/NIPAH/EBOLA etc. M-eDXplatform • Live Lectures • Online Medical Education • Self Paced Learning • Certification courses • Training Modules • Information dissemination platform • Live surgery • Animated Videos

15. Future Expansion NMCN Scheme • M-eDX • Live Lectures • Online Medical Education • Certification courses • Training Modules • Information dissemination platform • Live surgery • Animated Videos 50 MEDICAL COLLEGES (to be expanded) Services Services Services Specialty Tele-Consultation Tele-Radiology Tele-CMEs PAN INDIA COVERAGE Government Healthcare Institutions Govt. Doctors/ANMs/ASHA/ Paramedics AYUSH State Medical Colleges DH/CHC/ PHC Aspirational Districts Health & Wellness Centres

16. EXPECTED OUTCOMES • Improved accessibility to quality health care • Improved outreach of the specialist services to the rural part • Reduction in the service delivery time • Creation and transmission of Electronic Health Record (EHR) • Timely access to the right clinician resulting in cost reduction • Creation of database for disease patterns • Promoting healthy lifestyle and behaviour • Reduced burden on Secondary and Tertiary Healthcare System

17. THANK YOU

18. Tentative earmarking of HUBs to be finalized in consultation with States BACK

19. Tentative earmarking of HUBs to be finalized in consultation with States BACK

20. Tentative earmarking of HUBs to be finalized in consultation with States BACK

21. Tentative earmarking of HUBs to be finalized in consultation with States BACK

22. Minimum requirement @Spoke BACK

23. Minimum requirement @5 seater HUB for 100 Spokes BACK

24. E-Sanjeevani Application & Training • Training Cost • States to include the cost associated with Training of staff in the PIP proposals as per actuals (NHM guidelines) • A Handholding training to be organized in State Capital for all stakeholders • CDAC-Mohali would prepare the e-Training modules in application for continuous learning of staff at HWCs BACK