1. ICT for Cancer Diagnosis, Treatment and Management
Sudhamony S
Additional Director / Head,
Medical Informatics Section, Centre for Development for Advanced Computing (C-DAC), Thiruvananthapuram, INDIA.
APAN-Healthcare-2009

2. Centre for Development of Advanced Computing
C-DAC
A Scientific research organization of Ministry of Communication and Information Technology, Government of India
Vision: To emerge as the premier R&D Institution for the design, development and deployment of world class electronic and IT solutions for economic and human advancement
Ten centres across India
C-DAC, Thiruvananthapuram is in the state of Kerala
Centre for Development of Advanced Computing
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

3. About ONCONET The first successful Tele-Oncology Network in India
which provides
telemedicine services in early detection, patient follow up and pain relief for cancer patients from rural areas.
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

4. C-DAC Medical Informatics
The Need
Statistics from India :
1 million new cancer cases per annum
3 million cancer patients
Low socio-economic status and low literacy rates in rural areas
Lack of infrastructure and expertise at Public Health Centers in rural areas for early detection of Cancer
Long and relatively expensive travel to reach Cancer Care facility
30% of cancers can be prevented; 40% can be cured
APAN-Healthcare-2009
Cancer statistics demonstrate that cancers frequently observed in India are lifestyle dependent, with offending factors such as tobacco usage, low socio- economic status, multiple pregnancies and poor sexual hygiene.
These factors are closely related to the population living in rural surroundings and they are targets for cancer prevention. Low socio-economic status and low literacy rates ensure that most patients are diagnosed at an advanced stage of the disease. It is very difficult for these patients to achieve a cure and they are always treated by palliative care with much cost and morbidity. Therefore, it is reasonable to postulate that the strategy for cancer control in India should be focused on health education for the rural population and the creation of an infrastructure for cancer management. These systems with appropriate low-cost technology might be able to be duplicated as a model for developing countries with low capital inputs.
C-DAC Medical Informatics
3/4/2009

5. C-DAC Medical Informatics
ONCONET
A research project funded by Govt. of India
Designed, developed, implemented and supported by C-DAC, Thiruvananthapuram
Implemented at Regional Cancer Centre Thiruvananthapuram, Kerala, India and its five peripheral clinics across the state
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

6. Regional Cancer Centre Trivandrum (RCC)
RCC is the only cancer hospital in the Govt. sector catering to the population of the state of Kerala and neighboring states.
Approx. 12,000 new cases are registered every year and the annual follow-up visits reach 150,000 every year
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

7. C-DAC Medical Informatics
Statistics from Kerala Number of patients visiting Cancer care facility
RCC, Thiruvananthapuram
C-DAC Medical Informatics
3/4/2009

8. Logistics Distance Travelled
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C-DAC Medical Informatics
3/4/2009

9. Logistics Cost of Travel
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C-DAC Medical Informatics
3/4/2009

10. How to provide affordable cancer care
Reduce overhead on patients by bringing Cancer care closer to them
Facility for Early Cancer detection and diagnosis nearby
Health education and awareness camps for the rural population
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C-DAC Medical Informatics
3/4/2009

11. C-DAC Medical Informatics
Tele ONCOlogy NETwork
Our Peripheral Clinics
Malabar Cancer care Society, Kannur.
Early cancer detection center, Palakkad.
Early cancer detection center, Kochi.
Early cancer detection center, Kollam.
District cancer control cente, Kozhencheri.
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

12. VSAT Network for ONCONET
Satellite communication link & Bandwidth provided by ISRO (Totally free)
Satellite : INSAT 3C Antenna : 3.8 m
Carrier : Extended C Band
Bandwidth : 384 kbps
Failover mechanism
128 Kbps ISDN connection
APAN-Healthcare-2009
Establishing high bandwidth connectivity between RCC and its five nodal centres at Kochi, Kannur, Palakkad, Kozhenchery and Kannur through satellite link
C-DAC Medical Informatics
3/4/2009

13. C-DAC Medical Informatics
ONCONET
CDAC launched ONCONET in Sept at RCC and its peripheral clinics with Bandwidth offered totally free by Indian Space Research Organization (ISRO) through its VSAT facility.
Currently RCC is linked with over a hundred hospitals across the country including areas with high military presence like Srinagar and Ladakh (2300 miles North), and geographically separated areas like Andaman and Lakshadweep islands
APAN-Healthcare-2009
Establishing high bandwidth connectivity between RCC and its five nodal centres at Kochi, Kannur, Palakkad, Kozhenchery and Kannur through satellite link
Setting up of Tele-consultation clinics at RCC and its peripheral centers by providing high quality Video Conferencing systems, Patient Follow-up Management System for Remote Expert Consultation which includes on-line patient data transfer
Implementing Tele Pathology / Radiology System at RCC and two nodes for capture, storage, transmission and online sharing of histopathology and radiology images which facilitates the nodal centres with the expertise of pathologist / radiologist at RCC
Web based Telemedicine system with Hospital Information System as the back end
Web based Hospital Information system includes modules like Out-patient management, Consultation Room, Admission, Discharge & Transfer, Cash & Billing, Investigations, Nursing & Wards, Surgical Oncology, Blood Bank, Pharmacy, Central Stores, Purchase, Engineering, Radiation Oncology, Nuclear Medicine, Chemotherapy, Pathology, Radiology, Central Sterile Department, Information Desk and Master Management
Oncology Resource Centre, which provides cancer related information to clinicians, researchers, health planners and administrators on the telemedicine network and Intranet
C-DAC Medical Informatics
3/4/2009

14. C-DAC Medical Informatics
ONCONET - Features
Tele-medicine infrastructure at RCC and five peripheral clinics
Tele-Pathology and Radiology systems
High bandwidth connection between these centers ( 384 Kbps)
Backup arrangement for connectivity through ISDN facility
APAN-Healthcare-2009
Establishing high bandwidth connectivity between RCC and its five nodal centres at Kochi, Kannur, Palakkad, Kozhenchery and Kannur through satellite link
Setting up of Tele-consultation clinics at RCC and its peripheral centers by providing high quality Video Conferencing systems, Patient Follow-up Management System for Remote Expert Consultation which includes on-line patient data transfer
Implementing Tele Pathology / Radiology System at RCC and two nodes for capture, storage, transmission and online sharing of histopathology and radiology images which facilitates the nodal centres with the expertise of pathologist / radiologist at RCC
Web based Telemedicine system with Hospital Information System as the back end
Web based Hospital Information system includes modules like Out-patient management, Consultation Room, Admission, Discharge & Transfer, Cash & Billing, Investigations, Nursing & Wards, Surgical Oncology, Blood Bank, Pharmacy, Central Stores, Purchase, Engineering, Radiation Oncology, Nuclear Medicine, Chemotherapy, Pathology, Radiology, Central Sterile Department, Information Desk and Master Management
Oncology Resource Centre, which provides cancer related information to clinicians, researchers, health planners and administrators on the telemedicine network and Intranet
C-DAC Medical Informatics
3/4/2009

15. C-DAC Medical Informatics
ONCONET – Features …
Software - Web based Telemedicine software integrated with Hospital Information System software (TEJHAS)
EHR, securely made available over the network at remote centres
Oncology Resource Centre – Cancer specific information made available at remote centres through a Digital Library
APAN-Healthcare-2009
Establishing high bandwidth connectivity between RCC and its five nodal centres at Kochi, Kannur, Palakkad, Kozhenchery and Kannur through satellite link
Setting up of Tele-consultation clinics at RCC and its peripheral centers by providing high quality Video Conferencing systems, Patient Follow-up Management System for Remote Expert Consultation which includes on-line patient data transfer
Implementing Tele Pathology / Radiology System at RCC and two nodes for capture, storage, transmission and online sharing of histopathology and radiology images which facilitates the nodal centres with the expertise of pathologist / radiologist at RCC
Web based Telemedicine system with Hospital Information System as the back end
Web based Hospital Information system includes modules like Out-patient management, Consultation Room, Admission, Discharge & Transfer, Cash & Billing, Investigations, Nursing & Wards, Surgical Oncology, Blood Bank, Pharmacy, Central Stores, Purchase, Engineering, Radiation Oncology, Nuclear Medicine, Chemotherapy, Pathology, Radiology, Central Sterile Department, Information Desk and Master Management
Oncology Resource Centre, which provides cancer related information to clinicians, researchers, health planners and administrators on the telemedicine network and Intranet
C-DAC Medical Informatics
3/4/2009

16. C-DAC Medical Informatics
TM Infrastructure
Powerful Video Conferencing System
Server system with software for Creation, storage, transfer and sharing of EHR of patients, Telemedicine PCs at clinics
Tele Pathology / Radiology System with Digital Microscope, X Ray Film Scanner and software for :
Capture , storage and uploading of medical images
Sharing and annotation of image between remote centres for discussion
APAN-Healthcare-2009
Establishing high bandwidth connectivity between RCC and its five nodal centres at Kochi, Kannur, Palakkad, Kozhenchery and Kannur through satellite link
Setting up of Tele-consultation clinics at RCC and its peripheral centers by providing high quality Video Conferencing systems, Patient Follow-up Management System for Remote Expert Consultation which includes on-line patient data transfer
Implementing Tele Pathology / Radiology System at RCC and two nodes for capture, storage, transmission and online sharing of histopathology and radiology images which facilitates the nodal centres with the expertise of pathologist / radiologist at RCC
Web based Telemedicine system with Hospital Information System as the back end
Web based Hospital Information system includes modules like Out-patient management, Consultation Room, Admission, Discharge & Transfer, Cash & Billing, Investigations, Nursing & Wards, Surgical Oncology, Blood Bank, Pharmacy, Central Stores, Purchase, Engineering, Radiation Oncology, Nuclear Medicine, Chemotherapy, Pathology, Radiology, Central Sterile Department, Information Desk and Master Management
Oncology Resource Centre, which provides cancer related information to clinicians, researchers, health planners and administrators on the telemedicine network and Intranet
C-DAC Medical Informatics
3/4/2009

17. Hospital Information System
System Architecture
SPECIALTY CENTRE
PERIPHERAL CENTRE
Video-conferencing
Video-
conferencing
VSAT Network
with
ISDN
(Backup)
Telemedicine PC
TP / TR Server
Tele-medicine PC
ROUTER
ROUTER
Digital library
X-Ray Film Scanner
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LAN
Database &
App. Servers
Hospital Information System
Digital Microscope
RCC-Regional Cancer Centre Thiruvananthapuram
C-DAC Medical Informatics
3/4/2009

18. Tele-Pathology and Radiology systems
ECDC KANNUR
Images received from remote centres & stored in Server
Experts view the image through viewing station at their department.
Experts prepare the report and send to remote locations
Doctors share and view the images online and discusses the case.
Network
Microscope
DICOM CD
Film / Document SCANNER
DIAGNOSTIC Work Station cum SERVER
WEB-Viewing Doctors desk
Images captured from microscope
X-Rays & Documents scanned
Images locally stored
DICOM CD imported
Patient folder sent to RCC, TVM
Reports received from remote expert doctor
ECDC KOCHI
RCC TRIVANDRUM
C-DAC Medical Informatics
3/4/2009

19. C-DAC Medical Informatics
ONCONET Software Telemedicine Enabled Hospital Automation System (TEJHAS)
Comprises of all essential modules :
Core Services
OP & IP Management
Consultation
Surgical Oncology
Resource Scheduling
Investigation
Nuclear Medicine
Radiation Oncology
Chemotherapy
Pharmacy
Support Services
Cash & Billing
Central Stores
Purchase
Blood Bank
Radiology
Engineering
C.S.S.D
Back Office
Enquiry
MIS
Master Data
Users
APAN-Healthcare-2009
TEJHAS - Web based Telemedicine system with Hospital Information System as the back end. It includes modules like Out-patient management, Consultation Room, Admission, Discharge & Transfer, Cash & Billing, Investigations, Nursing & Wards, Surgical Oncology, Blood Bank, Pharmacy, Central Stores, Purchase, Engineering, Radiation Oncology, Nuclear Medicine, Chemotherapy, Pathology, Radiology, Central Sterile Department, Information Desk and Master Management
C-DAC Medical Informatics
3/4/2009

20. C-DAC Medical Informatics
FINDINGS
Patients on Chemotherapy can communicate with their physician regarding blood count and seek advice
Early Intervention is facilitated
Initial patient presentation and diagnosis is made in a primary sitting thereby avoiding unnecessary patient referrals and reducing patient load at RCC
For specialty care, appointment is fixed through the system, thereby avoiding unnecessary delay
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

21. C-DAC Medical Informatics
Interpretation
Number of emergency visit to the hospital is reduced
Unnecessary referrals and admissions are avoided
Routine follow-up visits are limited to peripheral clinics thereby avoiding unwanted expense
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

22. C-DAC Medical Informatics
Interpretation…
Saves cost to patient, provider and system
Palliative care through close interaction with tertiary care physician
Conduct distant medical education programs, panel discussions, nurses training programs and talks by doctors
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

23. Usage Statistics ( from 2004 onwards) (Available online at www. rcctvm
Usage Statistics ( from 2004 onwards) (Available online at )
Remote Peripheral Centres
No. of follow up Patients
Money Saved by Patients in USD
KOCHI
9422
103950
KANNUR
3052
60650
PALAKKAD
262
4075
KOZHENCHERY
274
1575
KOLLAM
556
575
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

24. Usage for Tele Education ( from 2004 onwards)
CME Programs 53
Panel Discussions 33
Nurses Training programs 41
Didactic talks by Academic staff 23
Public awareness campaigns 14
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

25. C-DAC Medical Informatics
ONCONET
goes
National
(ONCONET India)
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

26. ONCONET India ( National Tele Oncology Network)
Establish knowledge enabled Tele Oncology network in India
Connect 25 Regional Cancer Centres and 100 peripheral centres ( 4 for each RCC) across the country
Project Report approved by Ministry of Health, GOI; implementation to start soon
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

27. Regional Cancer Centres
ONCONET INDIA
Regional Cancer Centres
Trivandrum
Chennai
Bangalore
Mumbai
Hyderabad
Cuttack
Gwalior
Kolkata
New Delhi
Allahabad
Patna
Bikaner
Shimla
Rothak
Gauhati
Aizwal
Nagpur
Ahmadabad
Pondicherry
Lucknow
Chandigarh
Raipur
Imphal
Srinagar
Kancheepuram
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

28. C-DAC Medical Informatics
Telemedicine System
At RCCs
Powerful Video Conferencing System & LCD TV
Tele consultation system consisting of Telemedicine PC with Telemedicine software which facilitates :
-- Creation, storage, transfer and sharing of Electronic Medical Record of patients
Tele-Pathology / Tele-Radiology System with Digital Microscope and Scanner/Digital Camera
-- Capture of medical images
-- Uploading image to remote end
-- Storage of image as part of EMR
-- Sharing of image between remote centres for discussion
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

29. System Configuration at RCC
Leased Line
(384Kbps
MPS L3 VPN)
Provided by BSNL
Deliverables at RCC
PC with software
Video Conferencing System & TV
Film Scanner
Digital Microscope
UPS, Printer
Networking items
Digital
Microscope
Printer
384 Kbps
VCS
ROUTER
Scanner
Telemedicine PC
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LAN
Audio /Video
USB
Television
Internet
C-DAC Medical Informatics
3/4/2009

30. System Configuration at Peripheral Centres
BB VPN
(384 Kbps)
Provided by BSNL
Deliverables at Peripheral Centre
PC with software
Video Conferencing System and TV
Film Scanner
UPS, Printer
Networking equipments
Scanner
384 Kbps
Printer
VCS
APAN-Healthcare-2009
Switch
Tele Medicine PC
Television
C-DAC Medical Informatics
3/4/2009

31. System Configuration at Hub location
2 Mbps Leased Line
(MPLS L3 VPN)
256 Kbps Internet Leased Line
Multi Conferencing Unit
Internet access to all RCCs thru MPLS VPN
Router
Services:
Portal
Internet Browsing
Multi Conferencing
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Video Streaming Server
ONCONET India Portal Server
C-DAC Medical Informatics
3/4/2009

32. NETWORK DIAGRAMS SHOWING HOW THE PROPOSED NETWORK MEETS ONCONET -India
FUNCTIONAL REQUIREMENTS
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

33. C-DAC Medical Informatics
Proposed MPLS Network
linking 25 RCCs PE
Mumbai
Delhi
Lucknow
Raipur
Guwahati
Cuttak
Chennai
Shimla
Chandigarh
Bangalore
Ahmedabad
Gwalior
Trivandrum
Router
LEGEND
Kancheepuram
Pondicherry
Rohtak
Implementing Agency
Patna
Imphal
Bikaner
Srinagar
Aizhwal
Allahabad
HUB
MPLS L3 VPN Backbone
2Mbps
384Kbps
256 Kbps
Internet
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

34. OVERALL ARCHITECTURE of ONCONET India network
Peripheral Centre 1
Peripheral Centre 4
Peripheral Centre 4
384 Kbps
BBVPN
384 Kbps
BBVPN
Peripheral Centre 1
Peripheral Centre 1
RCC2
RCC3
Peripheral Centre 4
384 Kbps
BBVPN
MPLS BACKBONE
384 Kbps
BBVPN
RCC1
RCC4
384Kbps L3 VPN
Peripheral Centre 1
APAN-Healthcare-2009
RCC25
Peripheral Centre 4
384 Kbps
BBVPN
Peripheral Centre 1
Peripheral Centre 4
C-DAC Medical Informatics
3/4/2009

35. C-DAC Medical Informatics
Tele-consultation between one RCC and its Peripheral center through Broadband VPN
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C-DAC Medical Informatics
3/4/2009

36. TELE-CONSULTATION between one RCC and its peripheral centre- data flow
BSNL MPLS
Backbone
RCC
512Kbps
BBVPN PE
E1 link
MCU,
Video streamer
&
WEB
PORTAL
Group1
256Kbps (1:1)
Internet LL
TELE-CONSULTATION between one RCC and its peripheral centre- data flow
Tele-consultation between a RCC on MPLS VPN and a PC on BB VPN
RCCs using MPLS VPN
Peripheral Centers using Broadband VPN
Central HUB
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

37. C-DAC Medical Informatics
Conclusion
By this proposed system, the cancer patients from any part of India can get the consultation and treatment from any RCC in India
The rest of India will follow ONCONET-Kerala pattern in the coming years
This ONCONET- India with appropriate low-cost technology might be able to be duplicated as a model for developing countries with low capital inputs
APAN-Healthcare-2009
C-DAC Medical Informatics
3/4/2009

38. C-DAC Medical Informatics
CONTACT:
Sudhamony S
Additional Director / Head,
Medical Informatics Section Centre for Development for Advanced Computing (C-DAC), Thiruvananthapuram Kerala
INDIA.
Ph:   (D) / Ext: 229
Mob. No: (M)
Fax: /
C-DAC Medical Informatics
3/4/2009

39. Applying Advanced Computing for Human Advancement
Thank You
C-DAC Medical Informatics
3/4/2009