EHealth Division Ministry o f Health amp Family Welfare 1 2 NATIONAL TELEMEDICINE NETWORK NTN MoHFW issued Guidelines to States Support to StatesUTs for Telemedicine under NHM PIP ID: 1009883
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1. PAN INDIA TELEMEDICINE NETWORKE-Health DivisionMinistry of Health & Family Welfare1
2. 2NATIONAL TELEMEDICINE NETWORK (NTN)MoHFW issued Guidelines to StatesSupport to States/UTs for Telemedicine under NHM – PIPVarious States like Rajasthan, Uttar Pradesh, Maharashtra, Punjab etc. implemented Telemedicine servicesSupport provided to 8 States with Rs. 253 Crores in 3 financial years Current ScenarioTELEMEDICINE GUIDELINES FOR HWCsGuidelines are framed to act as the “Base Document” for proposals by StatesProvided framework for infrastructure, manpower, implementation methodology and model to be adopted by StatesProposed Interoperable Telemedicine solution with integrated diagnostic devicesStates are being supported under NHM based on the proposals submitted for Telemedicine in HWCs.
3. Observations on State owned Telemedicine ProjectsS.No.StateE-Health Observations1Rajasthan Telemedicine Project(100 Centres)PPP ModeGlocal Telemedicine services as implementation agency100 Centers on Rental ModelCall Centre setup at Jaipur~Rs. 26000 per month per centre30587 consultations from June’17 to March’18Per Consultation Cost is Rs. 850 2Himachal Telemedicine Project(25 Centres)PPP ModePirmala Swasthya care as implementation agencyCall Centre setup at Solan23488 consultations till March 2018Overall Per Consultation Cost is approx. Rs. 7503Himachal Telemedicine Project(2 Centres Kaza & Keylong)PPP ModeApollo healthcare as implementation agencyCall Centre setup at Chennai20342 Consultations till March 2018Overall Per Consultation Cost is more than Rs. 1500
4. Observations on State owned Telemedicine ProjectsS.No.StateE-Health Observations4Maharashtra TelemedicinePPP ModeConsultation from 6 Government Medical CollegesTotal Expenditure since 2006 : 792.68 Lakhs1.85 Lakh consultations till March 2018Per Consultation Cost is Rs. 4255JharkhandPPP modeApollo healthcare as Private PartnerCall Centre based consultationCAPEX per Centre is Rs. 70,000Per Centre Cost per Month is quoted as Rs. 85,564 Estimated cost per consultation is Rs. 270 (provided 20 consultation per centre per day)
5. 2015-162016-172017-182018-19Total Allocation(Lakh)Total Expenditure(Lakh)Funds ApprovedExpenditureFunds ApprovedExpenditureFunds ApprovedExpenditureTripura594.72565.49707.76547.76593.71103.18211.142107.331216.43Andhra Pradesh262.0891.02436.8898.7310298.734985.00NIL10997.615974.75Himachal Pradesh37.5220.52244207.96233.6789.03236.39751.56517.51Maharashtra397.85338.69411.55340.38310.29113.61275.91395.59792.68Punjab68.4251.668.4256.320.0024.0163.12*136.84131.93RajasthanNILNIL1000.00NILNIL125.00NIL1000.00125.00BiharNILNILNILNIL200.00NILNIL200.000.00U.P.NILNILNILNILNILNIL728972890.00JharkhandNILNILNILNILNILNIL142414240.00West BengalNILNILNILNILNILNIL310.80*NILN/ATotal25301.938758.30* Proposals under examinationStates supported by NHM5
6. Problem Statements 6
7. Pan India Telemedicine concept Hub and Spoke model to be adoptedState 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 HUBsThere 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 systeme-Sanjeevani Dashboard will be integrated with HWCs master DashboardEarmarked Premier Govt. institutions as HUBs with States for HWCs (click for info)
8. Requirements from StateExisting Infrastructure under NHM Scheme to be utilized or upgraded New Infrastructure to be provisioned after Gap Assessment by StateState 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 LocationTo start with., a 5 seater (MBBS doctors) Call Centre to be provisioned for every 100 Spokes Proposed 3 specialities are Cardiology/Gynaecology/Pediatrics to start withState to propose their own requirement on additional specialitySpecialist doctors to be hired on “Daywise Remuneration” basis only. State to finalize the specialities and remuneration. Budgetary provision to be made in PIP.8
9. High Level ArchitectureCHC/PHCSpecialist Doctors stationed at HUB. Only referred patients from 1st levelMBBS Doctors at HUB for 1st level of consultation and creation of EHR SPOKES/HEALTH AND WELLNESS CENTRESSub CentreVideo ConsultationHUB (MC/DH)9
10. Implementation TimelineS.No.Activity Timelines (Days)1Approval of proposal in PIPT2Video Conference with MD (NHM) –AS&MD as Chair(to demonstrate Software + finalizing HUB location)T+10 3Procurement of equipment at Spokes (Desktop + Printer) T + 30(from GeM)4Setting up of HUB (Site preparation + Desktop + furniture)T + 45(from GeM)5Recruitment of MBBS Doctors + Specialists T + 606Handholding on e-Sanjeevani Application by CDAC(To be initiated by State) T + 307Training to staff (in-person training) (if required)T + 458Go-Live of ProjectT + 6010
11. Infrastructure requirement MatrixFacilityTypeIT InfraNetworkHuman ResourceMedical College HUB Desktop (with camera, Mic)4 mbps per Desktop Nodal OfficerMBBS DoctorsSpecialists District HospitalHUBDesktop (with camera, Mic)4 mbps per Desktop Nodal OfficerMBBS DoctorsSpecialists District HospitalSpokeDesktop (with camera, Mic)Diagnostic Device (optional)Printer4 mbps per Desktop MBBS DoctorCHCSpokeDesktop (with camera, Mic)Diagnostic Device (optional)Printer2 mbps per Desktop MBBS DoctorPHCSpokeDesktop (with camera, Mic)Diagnostic Device (optional)Printer2 mbps per Desktop MBBS DoctorSub CentreSpokeDesktop (with camera, Mic)Diagnostic Device (optional)Printer2 mbps per Desktop Mid Level Health Practitioner (MLHP)Nurse/ParamedicDetails
12. Monitoring FrameworkTeamConstitutionRolesReview Committee National Monitoring TeamA Review committee of JS-NHM, JS-eHealth and JS-Medical EducationTo review the performance of the tele-consultation through this programmeTo provide the necessary instructions to the Medical Colleges / Technical Teams / StatesQuarterly ReviewDirector (NHM) – HeadDirector (eHealth)-memberDirector (CHI) - memberAssisted by Senior Consultant –MoHFWTo monitor the overall functions of the programmeCoordinate with StatesReview of dashboard with KPIsState Monitoring TeamMission Director (NHM) – HeadState nominated Nodal officerNominated HUB In-chargeProject Monitoring Office (PMO)Operations Manager MIS expert To manage the overall operations of the project in StateCreation of MIS for State, based on the Key Performance Indicators (KPI) District Monitoring TeamChief Medical Officer (CMO) – HeadNominated District Level Nodal OfficerMIS data entry operator Implementation and operations of Telemedicine solution Updating progress in the Dashboard Submission of reports to the State / New Delhi12
13. Future ExpansionNational Medical College Network for Tele-EducationMoHFW 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 functionariesThe NMCN network will vertically integrate with HWCs for Tele-Education servicesField Level functionaries (ANM/ASHA) plays a vital role in delivery of services to this populationSince these functionaries works in direct contact with major population, the continues skill upgradation is utmost importantContinued 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 SetupLive surgery
14. Future ExpansionNMCN network is strengthened as “Content Generation platform” for medical education systemIn 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 languageServices like Continued Medical Education (CMEs), Massive Online Open Content (MooCs) etc. would made open for Field Level health workers on this platformDoctors 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.Live LecturesOnline Medical EducationSelf Paced LearningCertification coursesTraining ModulesInformation dissemination platform Live surgeryAnimated VideosM-eDX platform
15. Future Expansion50 MEDICAL COLLEGES (to be expanded) PAN INDIA COVERAGEGovernment Healthcare InstitutionsNMCN SchemeTele-RadiologySpecialtyTele-ConsultationTele-CMEsHealth & Wellness CentresState Medical CollegesDH/CHC/PHCAspirational DistrictsM-eDXLive LecturesOnline Medical EducationCertification coursesTraining ModulesInformation dissemination platform Live surgeryAnimated VideosGovt. Doctors/ANMs/ASHA/ParamedicsAYUSHServicesServicesServices
16. EXPECTED OUTCOMESImproved accessibility to quality health care Improved outreach of the specialist services to the rural part Reduction in the service delivery timeCreation 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 behaviourReduced burden on Secondary and Tertiary Healthcare System 16
17. THANK YOU17
18. Tentative earmarking of HUBs to be finalized in consultation with StatesCall Centre location Operational HWCs Total Nodes to be attached States Covered Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow2541558Uttar Pradesh (UP)IMS-BHU01500VSS Medical College, Sambalpur1581148Odisha Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh1034Chandigarh 1171033Punjab Indira Gandhi Medical College, Shimla2137Himachal PradeshPost Graduate Institute (PGI), Rohtak27408HaryanaGovernment Medical College, Jammu72380J&KAndhra Medical College and King George Hospital, Visakhapatnam3651050Andhra PradeshGandhi Medical College, Secunderabad138590TelanganaBACK
19. Tentative earmarking of HUBs to be finalized in consultation with StatesCall Centre location Operational HWCs Total Nodes to be attached States Covered Madras Medical College, Chennai9301915Tamil NaduAIIMS, Patna136534BiharPatliputra Medical College, Dhanbad47776JharkhandKing Edward Memorial (KEM), Mumbai201814Maharashtra95Goa122Daman n Diu2724Dadra n Nagar haveliB.J. Medical College, Asarwa, Ahmedabad1811645GujaratGovernment Medical College, Haldwani 44426UttarakhandSawai Man Singh Medical College, Jaipur255679RajasthanBACK
20. Tentative earmarking of HUBs to be finalized in consultation with StatesCall Centre location Operational HWCs Total Nodes to be attached States Covered All India Institute of Medical Science (AIIMS), Raipur719800ChhattisgarhNetaji Subhash Chandra Bose Medical College, Jabalpur62690Madhya PradeshNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong542Meghalaya239Sikkim132Mizoram3132Arunachal PradeshGuwahati Medical College, Guwahati113878AssamRegional Institute of Medical Sciences (RIMS), Imphal29103ManipurBACK
21. Tentative earmarking of HUBs to be finalized in consultation with StatesCall Centre location Operational HWCs Total Nodes to be attached States Covered Agartala Government Medical College, Agartala3146TripuraChristian Institute of Nursing Science & Research, Dimapur563NagalandTrivandrum Medical College, Thiruvananthapuram177671KeralaKarnataka Institute of Medical Sciences, Hubli5601142KarnatakaJIPMER - Pudducherry234Andaman & Nicobar (UT)03Lakshadweep (UT)121Puducherry (UT)BACK
22. Minimum requirement @SpokeS. No.Item DescriptionEstimated Cost /HWCRemarks1Telemedicine Diagnostic KitTo be provisioned as per choice of State2Desktop with headphone , microphone and HD web Camera60,000New equipment to be provisioned under PIP in case these equipment are not available at HWCs.Should be met from the HWC budget including the untied funds.3Printer5,0004Miscellaneous 5,0005Last mile connectivity To be provisioned in PIP as per actuals(Min. 2Mbps)22BACK
23. Minimum requirement @5 seater HUB for 100 SpokesS. No.Item DescriptionQtyEstimated unit costRemarks Desktop with headphone , microphone and HD web Camera 660,000New equipment to be provisioned under PIP in case equipment are not available at HUB2.MBBS Doctor5As per NHM guidelinesTo be provisioned in PIP as per actuals.If the number of HWCs increases the number of MBBS doctors may be increased proportionately3.Specialist Doctors (On Daily remuneration basis) 3As per NHM guidelinesTo start with, a Specialist in General Medicine will be able to coordinate the HUB initially till other specialists are co-opted.4.Last mile connectivity -To be provisioned in PIP as per actuals(Min 2 mbps)23BACK
24. E-Sanjeevani Application & TrainingS. No.Item DescriptionEstimated Cost 1Development and Hosting of e-Sanjeevani ApplicationTo be provided by MoHFW to all States/UTs 2Servers for Database, Backup, Application, Load balancers etc.To be provisioned in PIP as per requirement of State/UT Training CostStates 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 stakeholdersCDAC-Mohali would prepare the e-Training modules in application for continuous learning of staff at HWCs24BACK