Presentation  
 

National Conference on Medical Informatics and Telemedicine

Chennai, India
Keynote Speaker
The presenter 
Mr. Ragesh Shah
Chairman and Managing Director
Online Telemedicine Research Institute.
 
GENERATING A HEALTHY SCENARIO FOR COMPETITIVE TELEMEDICINE: INDIGENOUS EFFORTS & INTERNATIONAL ACCOMPLISHMENTS
The environments like highly competitive and deregulated telecommunication, and a range of models and solutions to make telehealth work in different health care situations in most rural, primitive and remote sites are covered in equity of care by Telemedicine
It has been with effectiveness, efficiency, and a sense of improving equity of access to health care services for all that we have been able to adopt an international culture of implementing telemedicine in India and South Asia for past many years and specially in one and a half years last. In addition, process for addressing issues as they emerge with changing technologies and practice patterns are not only recommended but also designed successfully.
Virtually capabilities of information technologies: software as much as hardware; competitive advantage as much as consumer expectation; security as much as storage and manipulation of data keep the trend alive of information technologies. 
Thus calculated Telemedicine ultimately includes the one-time expenditure for equipment, recurring expenditures for network services, maintenance, and personnel, and intangibles such as inconvenience to healthcare providers who may need to leave their offices (at least initially) to use the service. In C. Everett Koop's words, telemedicine is to "improve the quality of health care with equity of access and cost reduction.
ONLINE TELEMEDICINE RESEARCH INSTITUTE demonstrated a break-even analysis in 3.9 years, when different factors like the lower cost of treating in rural communities, travel time for physicians, and diluted opportunity" costs were considered. 
RE-ENGINEERING THROUGH DISASTER TELEMEDICINE SOLUTION
Telemedicine was used as a vital tool for re-engineering healthcare effectively during the recent Gujarat earthquake. A massive earthquake measuring 8.1 on Richter scale had covered as much as 660 Kms vast areas of destruction caused villages after villages, cities after cities, and buildings after buildings to be wiped out killing thousands of people. Hospitals ruined and even the Military Hospital Bhuj was just partly functional due to mass damage. with the objectives to provide Tele-Healthcare to the total Kutch area, Tele-consultation healthcare facilities with video conferencing, Information about medical needs, Computation of database on health problems, Tele-monitoring of all patients' care.
EXPEDITION AND TELEMEDICINE
At the height of more than 25000 ft above sea level, through inaccessible approaches and virtually no infrastructure right in the Himalayan Mountains the following was implemented. Kailash Mansarovar and Pithoragargh geographically difficult snowy mountainous regions showed the patients examined live and subsequently over video showed no changes in their diagnosis between methods. This strategic plan was for expanding telemedicine network in most alarming situations of avalanche, frost and snow. 
TELEMEDICNE FOR MASS GATHERING - MAHA KUMBH MELA
Maha Kumbh Fair in January-February 2001 the biggest religious fair on earth involving more than 1 crore people demonstrated savings of $ 150 per patient when the patient was treated locally instead of referred to specialty care centers. This is the first of its kind of Telemedicine projects in the world. The telemedicine is used for the sake of more than 5 crores pilgrims. 
TELEMEDICINE AT ALERT WITH DEFENSE SERVICES
Army needs specified health care for the reason of its scattered field positions in severe and extreme geographical conditions. Increasingly, whether Army is engaged in special operations units or not, the units are relatively small and modular. It is only natural that civil medicine will be submitted to similar changes under the influence of the modern capabilities generated by various advanced technologies such as remote sensing and imaging, telepresence surgery, virtual endoscopy and virtual reality (VR) surgical simulators.
ACCESSING INACCESSIBLE
In most deficient circumstances almost amidst the deep woods of Assam and Tripura, which are labeled as the most backward civil / tribal communities of North East India for the lack of public health care patients needing specialist consultation and service have to travel long distances to big cities. Today the presence of telemedicine has brought them at par with the any superspecialist protected patient in the world.
TELE MEDI EDUCATION
The system was not used to give lectures, since in those cases communication is entirely one sided and the interactive capabilities are wasted. In the present case the system was used for distributed working sessions, questions and answers, open discussions and references. 
EPIDEMIOLOGICAL SURVEILLANCE
1. Epidemiological surveillance through telemedicine
2. Preventive measures and diagnosis in the field of epidemiology
3. Role of a teritary cardiac care center in clinical Decision making using trans-telephonic ecg monitoring (ttem)
AN ADVANCED MATTER OF HEART
The most revolutionary and efficient telemedicine design for tele cardiology has been going on with the Dicom Pacs based 3.0 HL7 database standard tele cardiology is rendering services to more than 90 patients a day. OTRI enabled the angio transfer rate to be converted to 1.5 to 3 minutes from 1.5 hours.
Tele ophthalmology
Specially conceptualized tele opthalmology by OTRI has brought a new world in the field of digital opthalmological treatments. Connecting Bangalore with Chennai and Madurai at Narayan Sankara ophthalmology Institute OTRI has been creating a new world of revolutionary opthalmological solutions. A perpetual nature of project is going on. 
AS USUAL ALL RURAL and REMOTE
With telemedicine systems and solutions developed by OTRI the reach has been provided where the basic doctor cannot or does not visit all the villages falling under the jurisdiction of particular P.H.C. regularly in a scheduled manner and practice the health care measures. The proposition once mooted by the Union Government, as "Bare foot Doctors" as practiced in China had never been implemented so OTRI took the lead and offered Tele health to the villages as they can be connected to the specialist doctors / hospitals. 
Introducing the Concept of Tele-Consultation Centers
The concept of telemedicine centers to be connected with super specialist centers all over India and abroad is gripping the general healthcare industry. All sorts of medical data are to be transferred. Local doctors can access Telemedicine without personal investment. Patients save time, botheration of appointment and discomfort of journey Super specialists from all over the world can be approached at virtually no expenses.
COST EFFICIENT and USER FRIENDLY
With improved revenue, potential for reducing manpower costs by allowing support team to perform routine diagnosis and treatment aloof from specialists to perform more complex tasks the nature of the healthcare organization has also been demonstrated. The use of videoconferencing during assessment of a post-operative wound is an example of equity of care. Telemedicine can reduce costs by decreasing the duplication of services, technologies, and specialists. In addition, rural areas deprived of medical assistance have been able to reduce the costs of emergency transfer. The software is maintained and upgraded by central hub and can be handles by a mere technician.
Most of it the total concept of telemedicine is that it is no where competitive but complementary which has brought a high esteem to the technology.
INTERNATIONAL PERSPECTIVE
The International perspective can be drawn with special respect to the Indian scenario and thus can be transferred to the international vistas. The laces and events like Maha Kumbh Fair leads to the special attention to the segregated population due to certain circumstances. The events like WTC attack invite special attention for the rigorous implementation of telemedicine. The whole exercise not only cuts drastically the overall expenditure but also brings closer the concept of quality health care even in the most difficult circumstances. Even the executing agencies were relieved of physical running around and could concentrate upon other vital arrangements.
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Seminar/Papers   2    IT Kerala-The Event Kerala-The Opportunity
Keynote Speaker
The presenter 
Mr. Ragesh Shah
Chairman and Managing Director
Online Telemedicine Research Institute.
 
Took his degrees in Electrical Engineering (1981) and Bio-medical Engineering (1984). He worked in Punjab Biomedical Ltd. and UB Pickers Ltd., Bangalore and developed 50 products in Biotechnology including Uroflow machines, Urodynamic,Lithotripsy Equipments of a highly reduced cost and Telemedicine. 
OTRI develops the latest software for considering telemedicine application. Besides, the company also develops ERP and e-commerce solutions for local and foreign concerns.
OTRI  is engaged in manufacturing Telemedicine equipments. The company has its own design and R & D center in India.
OTRI  is active in R & D and manufacturing of medical equipments.
 
Telemedicine
Transferring of medical electronic data from one geographical location to another is known as Telemedicine. It means that all relevant medical opinions and investigations like ECG, X-ray, Sonography, CT scan, MRI, angiography's etc., could be transferred from one place to another by Telemedicine. In India, we have relatively less number of doctors compared to the population. In this medical population, there are also only few   specialized Doctors and most of them are concentrated in big cities. Thus a patient from rural, peripheral or mofusil areas has to go to major cities whenever such patient needs expert opinion. This involves a delay in the treatment which any mega city of our Country like Delhi from where just 100/200 kms. Away, there are areas where only skeleton medical services are available. Telemedicine is a great boon in such a situation because whenever an expert medical Doctor’s opinion is required, it can be obtained from such areas without actually visiting a major hospital. Several surveys indicate that in about 70 % to 80 % cases, it could save the time and money and still an expert’s guidance. Even in many district places some of the medical specialties like neurology, cancer care, interventional cardiology, etc. are not easily obtained. Telemedicine is a great help in this situation. 
 
Working system of Telemedicine
 
a. Transmitting Center

A Transmitting Center is generally is generally situated in the peripheral area of a town that generally connect 30/40 villages. Such towns have usually basic medical facilities like X-ray and laboratory investigations available.Whenever a patient needs an expert opinion or confirmation of at the local Doctors management is required, this data is transferred to the major city by a transmission unit. 

 
b. Receiving Unit 

The receiving unit is situated in a major hospital where most of the specialists are available. One receiving unit can cater a large number of transmitting centers. After receiving data from Transmitting Units, it is being transferred to the expert (panel doctors ).

 
C. Panel Expert Doctors 

They only require the personal computer to receive the data. On an average they can see four or five patients at the same time he could consult one patient. More over, he could see this at his convenient time. His opinion has been transferred directly or by receiving units to the town doctor with transmission centre.

 
d. Video Conferencing 

This advanced facility is associated with telemedicine alone with snap shots audio transmission. Hand –written notes are available in this system.

 
Special Features
The system works on ISDN, internet, wireless and satellite transmission. But the most important feature is that it can work on ordinary telephone line PSNL. This is the only system in the world to the best of our knowledge that works on the other modes of  transmission are not universally available, while six lakhs and thirty thousand villages out of seven lakhs in our country are  connected with telephone lines. This makes our system a unique one and user friendly. It has many other features for the convenience of doctors and patients alike.
 
Profile & Speech of Mr.Ragesh Shah
 
Telemedicine in India – Efforts in Gujarat
Telemedicine can be of great help in a country like India where 70% of the population live in villages, where basic infrastructure like power, roads, connectivity well equipped primary health centers, hospitals, Doctors paramedical staff are not in adequate number, Gujarat relatively has better health profile compared to the rest of the country. It has the population of 5 crores with life expectancy of 62 years. Its 27 District can be connected with District health quarters through Telemedicine. So far we have carried out three important Telemedicine projects in Gujarat, as under.
 
Jivan Nirmaya Pradarshan
During this 15 days’ project from 1st May, 1998 in civil hospitals located at Rajkot, Gandhinagar and Ahmedabad data of 550 patients were transferred. 
 
Indian Defense Service
In December 1999, we had installed Telemedicine System in the desert areas of Kutch, i.e. Military Hospital, Bhuj, which was connected with the receiving unit at the Main military Hospital at0 Ahmedabad and they are transferring the data and images for the different purposes. We have transmitted data of several patients successfully. This was later extended to Air Force Hospital at Gandhinagar. This pilot project was funded by Government of Gujarat. It has been very well received by Indian Defense forces and there are all indications tha they would like to extend the services to the entire country.
 
Earthquake in Gujarat
Immediately after the earthquake disaster in Gujarat, thousands of people have lost their lives and over 1,00,000 were injured on 26th January, 2001.On the very next day, i.e. 27th January, 2001, we had established our first communication system from Bhuj. Within next 4 days we could establish Disaster Management along with Telemedicine transmission from Bhachau, Rapar, Gandhidham, Anjar and Ahmedabad with control room at Gandhinagar. Through this system, we could transfer all important information, data, medical needs with video-conferencing very successfully.
Recently, we are in the process to establish a major Telemedicine Program with healthcare of entire district of Kutch where all 900 villages will be linked with Ahmedabad and Vadodara.By indigenous technology and economically viable, telemedicine healthcare may not be just a distant dream but a genuine reality.
 
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Seminar/Papers   3    Global Telemedicine Symposium S.G.P.G.I - Lucknow ,India
Keynote Speaker
The presenter 
Mr. Ragesh Shah
Chairman and Managing Director
Online Telemedicine Research Institute.
 
Cost Effectiveness of Telemedicine System
The Telemedicine system developed by Online Telemedicine Research Institute is unique in one of its kind not only regarding the features but of its Cost Effectiveness. 
Why Online Telemedicine System is cost effective than others?
 
The reasons are
The system has integrated software and hardware in one system for various branches like pathology, radiology, cardiology, ophthalmology, dermatology etc. By integrating all in one system makes the Software and Hardware cost effective. Telemedicine system by OTRI has been developed and manufactured indigenously, that gives advantage over international brand due to less labor and infrastructure cost. As the system can be utilized on a simple telephone line-, which is one of the only largest communication media available- the cost of developing, new infrastructure for the Telemedicine  system is, reduced.
The system has got unique features of Telemed Conferencing i.e. Medical Video conferencing and Medical Data transmission together The Doctor and Patient both save time and money by doing video talk as well as receiving the  documents at a time. This will prove effective and economical solution for telemedicine.
 
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Seminar/Papers   4    Global Telemedicine Symposium S.G.P.G.I - Lucknow
Keynote Speaker
The presenter 
Mr. Ragesh Shah
Chairman and Managing Director
Online Telemedicine Research Institute.
 
Disaster Management System An Indian Model
Natural calamities strike without any prior warning, amongst that too floods and earthquakes are the worst conditions with virtually no communication possible in the initial stages. The requirement of medical services increases in such cases. The gravity increases as neither the patient can approach the doctors nor the doctors can reach the patients. In this situation the Disaster Management system is proving a boon as it can operate without telephone lines or ISDN lines and electricity. The Online Telemedicine Research Institute had done a major exercise to make the system, called Disarmed 2000 useful in this situation. For that the need of electricity is fulfilled by handy genset and the required system is compatible to any satellite communication that is available. Disaster Management in Kumbh Mela.
This had been a most prestigious project. As you must be aware that over 5 crores of people attended Kumbh Mela between 9th January 2001 and 9th February 2001.there was a primary health center situated at the site of Kumbh Mela. Telemedicine transmission unit was established at the Primary Health Center- Kumbh mela site which was connected to five different units ( MLN Medical College ,Allahabad, SGPGI, Lucknow, Directorate General of Health, Lucknow and Secretary IT Lucknow). Routine cases were treated at the Primary Health Center, but for major health problem Online tele-consultation with Video-Conferencing was done between Kumbh Mela venue and SGPGI, Lucknow as well with Allahabad Medical College. Over 200 such major medical cases and problems were successfully transmitted and patients got the benefit of expert advice and treatment while at Kumbh Mela. We have received rave reviews on media as well as from Government of Uttar Pradesh. This has been a unique project in the world where such a grand festival has received the benefit of Telemedicine.
 
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Seminar/Papers   5    Global Telemedicine Symposium S.G.P.G.I : Lucknow
Keynote Speaker
The presenter 
Mr. Ragesh Shah
Chairman and Managing Director
Online Telemedicine Research Institute.
 
Disaster Management during devastating Gujarat Earthquake
Immediately after the earthquake disaster in Gujarat, thousands of people have lost their lives and over 1,00,000 were injured on 26th January, 2001. A day after the killer quake, there was no means of communication left in Bhuj. No lights, no phones, nothing. On the very next day, i.e. 27th January, 2001 we were the first to establish our first communication system from Bhuj.  Within next four days we could establish Disaster Management System along with Telemedicine transmission from Bhachau, Rapar, Gandhidham, Anjar and Ahmedabad with the control room at Gandhinagar. Through this system, we could transfer all important information, data, medical needs with video conferencing very successfully. The Online Disaster system comprises video-conferencing unit, video recorder scanner, private communication network (telephone, fax, Email, internet) electric power generator, in Telemedicine kit with electronic stethoscope , event recorder, portable X-ray machine, electronic microscope, blood pressure machine, ECG pulse, oxy meter and data display hand writer. Most important all this high tech equipment can be put in a couple of suitcases and can easily be transported to affected areas. The system is simple to the extent that just one person can run it.
The communication is established by satellite phone or satellite network on  availability of options. This system was operational from January 27th, 2001. When Swiss teams led by the sniffer dogs were looking for invisible signs for survival at the ill-fated Manasi on January 31st, the rescue operations were being monitored by none other than Prime Minister Atal Bihari Bajpai himself. This was widely received by the media too The system has proved to be very helpful in managing the disaster that took the state completely in a shocking state.
 
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Seminar/Papers   6    S.G.P.G.I - Lucknow ,India
Mobile Tele Hospital Inaugurated by
Dr. C. P. Thakur
 
Hon'ble Health Minister, Govt. of India
The mobile telemedicine unit developed for the first time in India by Online Telemedicine Research Institute, Ahmedabad was inaugurated by Dr. C.P. Thakur, Hon'ble Health Minister, Govt. of India on 4th January 2002 at the "TECH VISION 2002" exhibition held during the 89th Indian Science Congress, Lucknow. This unit is a complete integrated, mobile unit assembled in a multi-utility vehicle. The unit has facilities for online transmission of patient data, X-ray, ECG, microscopic images and vital parameters of patient to any part of the world. Communication can be established using a variety of options from ordinary telephone lines, mobile telephone, wireless local loop, ISDN or V-Sat. Thus it allows wide applications even from remote locations, which are not connected with telephone facilities. This unit can be fully operated on a diesel generator, battery or on a solar panel in the absence of electricity. The unit can also be used to conduct direct simultaneous video-conferencing between four different sites.
The unit has multiple utilities. It can be used to advance rural health care even to remote, inaccessible regions with the help of a general medical practitioner manning the unit and consulting specialists in major centers for expert opinion. The video-conferencing facility allows the doctor at the hospital to directly interrogate the patient with the help of the doctor in the van and provide opinion without having to be physically present. The consulting center can be in any part of the country since distance is not a barrier. Specialists can thus provide expert opinion to large number of such units spread far and wide where specialists are usually not available. The Minister spoke from the mobile telehospital at the exhibition site to Prof Mahendra Bhandari, Director SGPGI through Telemedicine videoconference. Dr Bhandari appraised him of the various applications of such a mobile unit. The Minister was happy with this novel new concept which has been developed for the first time in India with indigenous technology by the team headed by Mr. Ragesh Shah, Chairman, Online Telemedicine Research Institute. The Minister appreciated its utility and felt that it could be widely used in rural areas where it has been difficult to induce doctors to provide medical care.
The basic unit can be modified to suit various needs , such as transport of trauma and other medical emergencies and for enhancing capabilities of district level hospitals. A larger model with facilities for laboratory investigations and developing x-rays is being developed and can be used for community health work such as screening for common cancers, heart disease and other common diseases in the population. SGPGI has been actively involved in several Research and Development projects in the field of Telemedicine in collaboration with Online Telemedicine Research Institute(OTRI) under the sponsorship of Ministry of Information Technology, Government of India.
Date: 4th January, 2002
From: Prof S.K.Mishra,
           SGPGI, Lucknow
 
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