Technology

Telemedicine is the combination of Medical-Science with Information & Communication Technology that improves access to healthcare and its delivery to mass people, especially to the underprivileged and underserved community in remote areas. In recent years, healthcare centers, laboratories and physicians through out the world have eliminated the barriers to the delivery of healthcare service across geographical borders using the telemedicine system, which is now proven a wise extension of medical science.

A telemedicine network requires 3 main components. The first component includes cameras and special diagnostic medical instruments. These are connected to a second component which is a computer or Codec equipment that has the ability to transfer voice, video and other data. Images and video captured by the camera or equipments are then transferred over the internet from one point to another. This may also be known as videoconferencing. The images may be real time or stored and forward. Using this phenomenon, a physician many miles away can evaluate a patient almost as if he or she were with the patient in the same room.

SDNP Tele-Health system is using its own internet backbone. It is using FTDMA Satellite Connections in its four regional nodes and Radio linked (wireless) connections in three other sub-nodes. More wireless networks are in the pipeline and they will be implemented very soon. The system can be accessed from any Desktop terminals with most commonly used web browsers and active internet connection.

An online (web based) database application has been developed by the SDNP web and software development team. Open Source Technologies are used for developing the system.
• Tele-Health Servers are located at SDNP head office and they are running on Red Hat Linux Operating Systems.
• Tomcat Application Server along with MySQL database servers are used to run the web based application.
• At the client end internet browsers are used to access the application.
• For Videoconference shareware software like "Skype", "Zoom call", etc are used.

Since telemedicine is all about communication between patients and doctors, a database system has been developed and maintained to store the profiles of these two members. And the patients complain and complete treatment process will be preserved in the system. Major modules of the system are described below.

Patient registration is the means by which all patients are entered in to the SDNP Healthcare system. Providing the following entities Patient can be registered to the system once at his/her first visit. Later, the exact electronic record can be found by using various selection criteria. When the patient comes to visit the rural center for the first time he/she have to provide few specific information base on which an Identification Card will be generated. Health related little information of the patient will be saved in the database. This ID card would contain a unique Medical Registration Number (MRN) and this will be the identification for all subsequent visits. Patients visit detail, complains, prescription and other medical records will be preserved in the SDNP Health Care database against this MRN.

When a patient will come to a center for telemedicine treatment, he will be registered first by a data entry operator from SDNP regional node. The registration will be undertaken according to the registration process as stated above. Then operator will process a visit entry for the patient’s current visit and will issue a visit slip. With the visit slip the patient will visit the physician at that rural center. The visit slip will contain detail about patients present complain and medical records.
There will be a questionnaire through which patients complains are entered in database against particular visit number.

Based on the present complain, local medical officer will decide whether a 2nd opinion from a specialist doctor is required or not. If the local medical officer is confident enough to issue a prescription with out a 2nd opinion from a specialist, he will do so. But the advised prescription along with complains, available medical records (if any) must be saved in the database. And if a 2nd opinion is required, expert doctors will be informed about it through a mail or any other messaging service. Various testing devices especially developed for Telemedicine are readily available in the market now in a day. In near future those will be adopted to enhance the investigation process. Most of these devices deliver electronic outputs of various medical tests and those can be stored and forward through computing machines.

Specialist doctors will be facilitated with internet connectivity and after investigating a case (Patients medical records, personal record and complains) specialist doctors put their expert opinion in SDNP database. After having a look at the available records and data if the expert physician still feels a need of video conferencing with the patient, SDNP regional nodes will arrange that using existing infrastructure. Patients will be informed in advance about the event from the SDNP regional node. These opinions and prescriptions are accessible to the SDNP regional operator from web. He/she is responsible to deliver that to respective patient or to their kin.

In most cases, a follow up of prescribed treatment may be required. For those patients a follow up database will be maintained and follow up record will be saved against a particular visit followed by subsequent complain number. At the follow up visit, if a change is made in the previously issued prescription, an entry will be maid for that with the same complains number. This will give a complete view of the treatment for any doctor. Standard format will be maintained for these records.

Records or reports of some pathological tests of follow up patients, who were requested for those, will be stored in the database with reference to that prescription and will be updated for the doctor’s attention. Depending on those reports a new prescription will be prepared. This prescription will be saved in the database as well, in reference to that particular complain.