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Telemedicine in a Disconnected Environment

TIDE. Telemedicine in a Disconnected Environment. Dr Sakti Srivastava, MBBS, MS Adjunct Professor Indian Institute of Technology, Delhi. Outline. Healthcare and Telemedicine in India Continuing Challenges Today Our Proposed Solution Results and Further Work. Background. Challenges.

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Telemedicine in a Disconnected Environment

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  1. TIDE Telemedicine in a Disconnected Environment Dr Sakti Srivastava, MBBS, MS Adjunct Professor Indian Institute of Technology, Delhi

  2. Outline • Healthcare and Telemedicine in India • Continuing Challenges Today • Our Proposed Solution • Results and Further Work Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  3. Healthcare in India • India spends <1% GDP on health • Urban/Rural mismatch of health professionals and population • >70% of India’s population is rural • Most lack access to basic health facilities Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  4. Telemedicine in India • Aravind Hospitals – Teleopthamology Network • Apollo Hospitals – Aragonda Project • OTRI (Online Telemedicine Research Institute) • Asia Heart Foundation • OncoNet (Kerala) • Common Service Centers e-governance Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  5. Telemedicine in India • VSAT based (ISRO) • Broadband based (BSNL) • High cost (setup and maintenance) • High technical expertise • Low bandwidth • Limited scalability Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  6. Continuing challenges • Remotest of remote • No connectivity • Limited infrastructure • “Bottom of Pyramid” (<$1 per day) • Landless farmers, illiterate Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  7. Criteria • Inexpensive and low maintenance • Easy and quick to setup • Robust and durable • Minimal new technology usage and skills requirement • User-friendly, able to cope with infrastructure • Support large datasets and scalable Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  8. Our proposed solution • Asynchronous (Store & Forward) • Delay tolerant network (DTN) • Large datasets • Several unique features • Highly scalable Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  9. Kiosk-PC Application overview Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  10. Case Flow 1 Background Challenges Health Care Worker Solution D1 (Neuro) DICOM Results D2 (Pediatrics) Dispatcher Radiology Equipment D3 (Ortho) Primary Healthcare Centre (Rural) D4 (Ortho) New Case Submission Path Reply from Doctor Internet Region TIDE project/ IIT Delhi / Srivastava

  11. Case Flow 2 Background Challenges Health Care Worker Solution D1 (Neuro) DICOM Results D2 (Pediatrics) Dispatcher Radiology Equipment D3 (Ortho) Primary Healthcare Centre (Rural) D4 (Ortho) New Case Submission Path Internet Region Reply from Doctor TIDE project/ IIT Delhi / Srivastava

  12. Case Flow 3 Background Challenges Health Care Worker Solution D1 (Neuro) DICOM Results D2 (Pediatrics) Dispatcher Radiology Equipment D3 (Ortho) Primary Healthcare Centre (Rural) D4 (Ortho) New Case Submission Path Referral to another Doctor Reply from Referred Doctor Internet Region TIDE project/ IIT Delhi / Srivastava

  13. Design Overview Background • Automatic Case • Allocation • Forwarding • Consolidation Challenges DICOM Interfacing Solution Results DTN – Communication Infrastructure Kiosknet Hardware TIDE project/ IIT Delhi / Srivastava

  14. Design Overview Decomposer DCMTK Creator Background GUI • Automatic Case • Allocation • Forwarding • Consolidation Challenges DICOM Viewer Solution Results DTN – Communication Infrastructure Kiosknet Hardware TIDE project/ IIT Delhi / Srivastava

  15. Design Overview DB Sender Consolidation DtnReceiver DocDBSync NetReceiver Decomposer DCMTK Creator Sender GUI Receiver Background GUI Challenges DICOM Viewer Solution Results DTN – Communication Infrastructure Kiosknet Hardware TIDE project/ IIT Delhi / Srivastava

  16. Automatic Case Allocation Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava • Physician database at proxy • Doctor’s Name, Specialty, Location, ID, IP, email address • Case specifies only specialty • Based on specialty and availability, allocation done • Any allocation algorithm can be implemented now

  17. Automatic Case Consolidation Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava • Unique Case ID assigned to a case at creation • One consolidated file per case ID maintained at the proxy • Consolidated file can be retrieved from any location

  18. Implementation Details • Components • Hardware • Software • Databases • Application level routing • Screenshots Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  19. Hardware Components Soekris 4801-60 Box, 256MB RAM, 40 GB HDD, Wireless Soekris 4801-60 Box, 256MB RAM, 40 GB HDD, Wireless Via Box, 512MB RAM, 40 GB HDD, Ethernet, Wireless PC, Low RAM, No HDD, Ethernet, Wireless PC (P4) , 512MB RAM, 80 GB HDD, Ethernet Wireless PC, 512MB RAM, 40 GB HDD, Ethernet Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  20. Software Components • Debian OS • dtnd • Debian OS • dtnd Debian OS dtnd, dcmtk toolkit, dhcp, nfs Creator, Decomposer (java modules) Linux OS Apache 2.2, PHP 5.2.6 Receiver, Sender (java modules) Debian OS dtnd, dcmtk toolkit, dhcp, nfs Creator, Decomposer (java modules) Debian OS Apache 2.2, PHP 5.2.6, DICOM Viewer Mricro Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  21. Screenshots Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  22. Results • 1 GB data bidirectional transfer • Measured time for link detection and transfer time • Time to link detection: Worst case – 10 mins • Throughput: 1 MBPS Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  23. Future Work • SMS integration • Call allocation methods • Enable querying • Security and privacy • Utility based routing Background Challenges Solution Results TIDE project/ IIT Delhi / Srivastava

  24. Acknowledgments • IIT Delhi • Prof Huzur Saran • Prof Sanjiva Prasad • Rohan Jain • Varun Sharma • CDAC • Mr B S Bedi TIDE project/ IIT Delhi / Srivastava

  25. ss@it.iitd.ac.in Thank You TIDE project/ IIT Delhi / Srivastava

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