PAN INDIA TELEMEDICINE NETWORK E-Health Division Ministry of

PAN INDIA TELEMEDICINE NETWORK E-Health Division Ministry of

PAN INDIA TELEMEDICINE NETWORK E-Health Division Ministry of Health & Family Welfare 1 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. 2 Observations on State owned Telemedicine Projects S.No. State E-Health Observations 1 Rajasthan Telemedicine Project (100 Centres) 2 Himachal Telemedicine PPP Mode Project Pirmala Swasthya care as implementation agency (25 Centres) Call Centre setup at Solan 23488 consultations till March 2018 Overall Per Consultation Cost is approx. Rs. 750 Himachal Telemedicine PPP Mode Project Apollo healthcare as implementation agency (2 Centres Kaza & Call Centre setup at Chennai Keylong)

20342 Consultations till March 2018 Overall Per Consultation Cost is more than Rs. 1500 3 PPP Mode Glocal Telemedicine services as implementation agency 100 Centers on Rental Model Call Centre setup at Jaipur ~Rs. 26000 per month per centre 30587 consultations from June17 to March18 Per Consultation Cost is Rs. 850 Observations on State owned Telemedicine Projects S.No. State E-Health Observations 4 Maharashtra Telemedicine PPP Mode Consultation from 6 Government Medical Colleges Total Expenditure since 2006 : 792.68 Lakhs 1.85 Lakh consultations till March 2018 Per Consultation Cost is Rs. 425 5 Jharkhand PPP mode Apollo healthcare as Private Partner Call Centre based consultation CAPEX per Centre is Rs. 70,000 Per Centre Cost per Month is quoted as Rs. 85,564 Estimated cost per consultation is Rs. 270 (provided 20 consultation per centre per day) States supported by NHM 2015-16

2016-17 2017-18 2018-19 Total Allocation (Lakh) Total Expenditur e (Lakh) Funds Approv ed Expendit ure Funds Approved Expendit Funds Expendi ure Approved ture Tripura 594.72 565.49 707.76 547.76 593.71 103.18 211.14 2107.33 1216.43 Andhra Pradesh 262.08

91.02 436.8 898.73 10298.73 4985.00 NIL 10997.61 5974.75 Himachal Pradesh 37.5 220.52 244 207.96 233.67 89.03 236.39 751.56 517.51 Maharashtra 397.85 338.69 411.55 340.38 310.29 113.61 275.9 1395.59 792.68 Punjab 68.42

51.6 68.42 56.32 0.00 24.01 63.12* 136.84 131.93 Rajasthan NIL NIL 1000.00 NIL NIL 125.00 NIL 1000.00 125.00 Bihar NIL NIL NIL NIL 200.00 NIL NIL 200.00 0.00 U.P.

NIL NIL NIL NIL NIL NIL 7289 7289 0.00 Jharkhand NIL NIL NIL NIL NIL NIL 1424 1424 0.00 West Bengal NIL NIL NIL NIL NIL NIL 310.80* NIL N/A

Total 25301.93 5 8758.30 * Proposals under examination Problem Statements States Telemedicine are operational under Public Private Partnership Mode (PPP) No skill development of Government Doctors Consultation Services provided by Private Partners from their own Call Centre setup Few States covered all DH but real need is at CHC/PHC/SC Limited ownership by State Administration in operations No interoperability of EHR Telemedicine services implemented as Pilot projects not covering whole State 6 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) 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/Pediatrics to 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. 8 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 CHC/PHC Sub Centre SPOKES/ HEALTH AND WELLNESS CENTRES 9 Implementation Timeline S.No. Activity 1 Approval of proposal in PIP

2 Video Conference with MD (NHM) AS&MD as Chair Timelines (Days) T T+10 (to demonstrate Software + finalizing HUB location) 3 Procurement of equipment at Spokes (Desktop + Printer) 4 Setting up of HUB (Site preparation + Desktop + furniture) T + 30 (from GeM) T + 45 (from GeM) 5 Recruitment of MBBS Doctors + Specialists T + 60 6 Handholding on e-Sanjeevani Application by CDAC T + 30 7 Training to staff (in-person training) (if required) T + 45 8 Go-Live of Project T + 60 (To be initiated by State) 10 Infrastructure requirement Matrix Facility Type

IT Infra Network Human Resource Medical College HUB Desktop (with camera, Mic) 4 mbps per Desktop Nodal Officer MBBS Doctors Specialists District Hospital HUB Desktop (with camera, Mic) 4 mbps per Desktop Nodal Officer MBBS Doctors Specialists District Hospital Spoke Desktop (with camera, Mic) Diagnostic Device (optional)

Printer 4 mbps per Desktop MBBS Doctor CHC Spoke Desktop (with camera, Mic) Diagnostic Device (optional) Printer 2 mbps per Desktop MBBS Doctor PHC Spoke Desktop (with camera, Mic) Diagnostic Device (optional) Printer 2 mbps per Desktop MBBS Doctor Sub Centre Spoke Desktop (with camera, Mic) Diagnostic Device (optional) Printer

2 mbps per Desktop Mid Level Health Practitioner (MLHP) Nurse/Paramedic Details Monitoring Framework Team Review Committee National Monitoring Team State Monitoring Team District Monitoring Team Constitution A Review committee of JS-NHM, JS-eHealth and JS-Medical Education Director (NHM) Head Director (eHealth)-member Director (CHI) - member Mission Director (NHM) Head State nominated Nodal officer Nominated HUB In-charge Project Monitoring Office (PMO) Chief Medical Officer (CMO) Head Nominated District Level Nodal Officer

Assisted by Senior Consultant MoHFW Roles To review the performance of the teleconsultation through this programme To provide the necessary instructions to the Medical Colleges / Technical Teams / States Quarterly Review To monitor the overall functions of the programme Coordinate with States Review of dashboard with KPIs To manage the overall operations of the project in State Creation of MIS for State, based on the Key Performance Indicators (KPI) Operations Manager MIS expert MIS data entry operator Implementation and operations of Telemedicine solution Updating progress in the Dashboard Submission of reports to the State / New Delhi 12 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 E-Classroom Setup 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 Live surgery 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) M-eDX platform 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.

Live Lectures Online Medical Education Self Paced Learning Certification courses Training Modules Information dissemination platform Live surgery Animated Videos Future Expansion NMCN Scheme Services Services Services 50 MEDICAL COLLEGES (to be expanded) Tele-Radiology Specialty Tele-Consultation Tele-CMEs M-eDX Live Lectures Online Medical Education Certification courses Training Modules Information dissemination platform Live surgery Animated Videos PAN INDIA COVERAGE Government Healthcare Institutions Health & Wellness Centres

State Medical Colleges DH/CHC/ PHC Aspirational Districts Govt. Doctors/AN Ms/ASHA/ Paramedics AYUSH EXPECTED OUTCOMES a) Improved accessibility to quality health care b) Improved outreach of the specialist services to the rural part c) Reduction in the service delivery time d) Creation and transmission of Electronic Health Record (EHR) e) Timely access to the right clinician resulting in cost reduction f) Creation of database for disease patterns g) Promoting healthy lifestyle and behaviour h) Reduced burden on Secondary and Tertiary Healthcare System 16 THANK YOU 17 Tentative earmarking of HUBs to be finalized in consultation with States Call Centre location Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow IMS-BHU Operational HWCs Total Nodes to be attached 254 1558 States Covered Uttar Pradesh (UP) 0 1500

VSS Medical College, Sambalpur 158 1148 Odisha Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh 10 34 Chandigarh 117 1033 Punjab Indira Gandhi Medical College, Shimla 2 137 Himachal Pradesh Post Graduate Institute (PGI), Rohtak 27 408 Haryana Government Medical College, Jammu 72 380 J&K Andhra Medical College and King George Hospital, Visakhapatnam 365 1050 Andhra Pradesh Gandhi Medical College, Secunderabad

138 590 Telangana BACK Tentative earmarking of HUBs to be finalized in consultation with States Operational HWCs Total Nodes to be attached States Covered Madras Medical College, Chennai 930 1915 Tamil Nadu AIIMS, Patna 136 534 Bihar Patliputra Medical College, Dhanbad 47 776 Jharkhand 20 1814 Maharashtra 9 5 Goa 1 27 22 24

Daman n Diu Dadra n Nagar haveli B.J. Medical College, Asarwa, Ahmedabad 181 1645 Gujarat Government Medical College, Haldwani 44 426 Uttarakhand Sawai Man Singh Medical College, Jaipur 255 679 Rajasthan Call Centre location King Edward Memorial (KEM), Mumbai BACK Tentative earmarking of HUBs to be finalized in consultation with States Operational HWCs Total Nodes to be attached States Covered All India Institute of Medical Science (AIIMS), Raipur 719 800 Chhattisgarh Netaji Subhash Chandra Bose Medical College, Jabalpur

62 690 Madhya Pradesh 5 42 Meghalaya 2 39 Sikkim 1 32 Mizoram 3 132 Arunachal Pradesh Guwahati Medical College, Guwahati 113 878 Assam Regional Institute of Medical Sciences (RIMS), Imphal 29 103 Manipur Call Centre location North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong BACK Tentative earmarking of HUBs to be finalized in consultation with States Operational

HWCs Total Nodes to be attached States Covered Agartala Government Medical College, Agartala 31 46 Tripura Christian Institute of Nursing Science & Research, Dimapur 5 63 Nagaland Trivandrum Medical College, Thiruvananthapuram 177 671 Kerala Karnataka Institute of Medical Sciences, Hubli 560 1142 Karnataka 2 34 Andaman & Nicobar (UT) 0 3 Lakshadweep (UT) 1

21 Puducherry (UT) Call Centre location JIPMER - Pudducherry BACK Minimum requirement @Spoke S. No. Item Description Estimated Cost /HWC 1 Telemedicine Diagnostic Kit 2 Desktop with headphone , microphone and HD web Camera 60,000 3 Printer 5,000 4 Miscellaneous 5,000 5 Last mile connectivity Remarks To be provisioned as per choice of State New 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. To be provisioned in PIP as per actuals (Min. 2Mbps)

22 BACK Minimum requirement @5 seater HUB for 100 Spokes S. No . Qty Estimated unit cost 6 60,000 2. MBBS Doctor 5 As per NHM guidelines 3. Specialist Doctors 3 As per NHM guidelines 1. Item Description Desktop with headphone , microphone and HD web Camera (On Daily remuneration basis) 4. Last mile connectivity - Remarks New equipment to be provisioned under PIP in case equipment are not available at HUB To be provisioned in PIP as per actuals. If the number of HWCs increases the number of MBBS doctors may be increased proportionately

To start with, a Specialist in General Medicine will be able to coordinate the HUB initially till other specialists are co-opted. To be provisioned in PIP as per actuals (Min 2 mbps) 23 BACK E-Sanjeevani Application & Training S. No. Item Description Estimated Cost 1 Development and Hosting of e-Sanjeevani Application To be provided by MoHFW to all States/UTs 2 Servers for Database, Backup, Application, Load balancers etc. To be provisioned in PIP as per requirement of State/UT 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 24 BACK

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