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.
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 Observations on State owned Telemedicine Projects
S.No. State E-Health Observations

1 Rajasthan • PPP Mode

Telemedicine Project • Glocal Telemedicine services as implementation agency
(100 Centres) • 100 Centers on Rental Model
• Call Centre setup at Jaipur
• ~Rs. 26000 per month per centre
• 30587 consultations from June’17 to March’18
• Per Consultation Cost is Rs. 850

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
3 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
 Observations on State owned Telemedicine Projects
S.No. State E-Health Observations

4 Maharashtra • PPP Mode

Telemedicine • 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 Total
Allocation Expenditur
Funds (Lakh) e
Approv Expendit Funds Expendit Funds Expendi (Lakh)
ure Approved ure Approved ture
ed

Tripura 594.72 565.49 707.76 547.76 593.71 103.18 211.14 2107.33 1216.43

Andhra 262.08 91.02 436.8 898.73 10298.73 4985.00 NIL 10997.61 5974.75
Pradesh

Himachal 37.5 220.52 244 207.96 233.67 89.03 236.39 751.56 517.51
Pradesh
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

* Proposals under examination Total 25301.93 8758.30

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 Problem Statements

States Telemedicine are

operational under
Public Private
Partnership Mode (PPP)

No skill development Limited ownership by

of Government State Administration in
Doctors operations

Consultation Services
provided by Private No interoperability of
Partners from their EHR
own Call Centre setup

Telemedicine services
Few States covered all
implemented as Pilot
DH but real need is at
projects not covering
CHC/PHC/SC
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.
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 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

SPOKES/
HEALTH AND WELLNESS
CHC/PHC Sub Centre CENTRES

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 Implementation Timeline
S.No. Activity Timelines (Days)
1 Approval of proposal in PIP T

2 T+10
Video Conference with MD (NHM) –AS&MD as Chair
(to demonstrate Software + finalizing HUB location)

3 Procurement of equipment at Spokes T + 30

(Desktop + Printer) (from GeM)

4 Setting up of HUB T + 45
(Site preparation + Desktop + furniture) (from GeM)

5 Recruitment of MBBS Doctors + Specialists T + 60

6 Handholding on e-Sanjeevani Application by CDAC T + 30

(To be initiated by State)

7 Training to staff (in-person training) (if required) T + 45

8 Go-Live of Project T + 60
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 Infrastructure requirement Matrix
Facility Type IT Infra Network Human Resource
Medical HUB • Desktop (with camera, Mic) 4 mbps per • Nodal Officer
College Desktop • MBBS Doctors
• Specialists
District HUB • Desktop (with camera, Mic) 4 mbps per • Nodal Officer
Hospital Desktop • MBBS Doctors
• Specialists
District Spoke • Desktop (with camera, Mic) 4 mbps per • MBBS Doctor
Hospital • Diagnostic Device (optional) Desktop
• Printer

CHC Spoke • Desktop (with camera, Mic) 2 mbps per • MBBS Doctor
• Diagnostic Device (optional) Desktop
• Printer

PHC Spoke • Desktop (with camera, Mic) 2 mbps per • MBBS Doctor
• Diagnostic Device (optional) Desktop
• Printer

Sub Centre Spoke • Desktop (with camera, Mic) 2 mbps per • Mid Level Health
• Diagnostic Device (optional) Desktop Practitioner (MLHP)
• Printer • Nurse/Paramedic

Details
 Monitoring Framework
Team Constitution Roles
• A Review committee of JS-NHM, • To review the performance of the tele-
Review Committee JS-eHealth and JS-Medical consultation through this programme
Education • To provide the necessary instructions to the
Medical Colleges / Technical Teams / States
• Quarterly Review
National Monitoring • Director (NHM) – Head • To monitor the overall functions of the
Team • Director (eHealth)-member programme
• Director (CHI) - member • Coordinate with States
 Assisted by Senior Consultant • Review of dashboard with KPIs
–MoHFW
• Mission Director (NHM) – Head • To manage the overall operations of the
State Monitoring • State nominated Nodal officer project in State
Team • Nominated HUB In-charge • Creation of MIS for State, based on the Key
• Project Monitoring Office (PMO) Performance Indicators (KPI)
 Operations Manager
 MIS expert
• Chief Medical Officer (CMO) – • Implementation and operations of
District Monitoring Head Telemedicine solution
Team • Nominated District Level Nodal • Updating progress in the Dashboard
Officer • Submission of reports to the State / New Delhi
 MIS data entry operator

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 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-Classroom Setup
e-Content and a portal for students/filed level functionaries
• 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
Live surgery
management of new diseases, quick action to contain any outbreaks and
educate people on preventive actions
 Future Expansion
• NMCN network is strengthened as “Content Generation platform” for medical
education system M-eDX platform
• In line with popular eDX platform of Open Learning, a MeDX platform will be • Live Lectures
• Online Medical
developed specifically for Medical Education over ONLINE mode with integration of Education
• Self Paced Learning
National Digital Medical Library(NDML) • Certification courses
• Training Modules
• Institutes like AIIMSs , PGIs will be designated as “Centre of Excellence(CoE)” • Information
dissemination
assigning responsibility of eContent generation and approval for Online Medical platform
• Live surgery
Education courses • Animated Videos
• 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.
 Future Expansion

NMCN
Scheme M-eDX
• Live Lectures
50 MEDICAL COLLEGES (to be expanded) • Online Medical Education
• Certification courses
•

Services
Services

Services
Training Modules
• Information dissemination
platform
• Live surgery
Specialty • Animated Videos
Tele-Radiology Tele-CMEs
Tele-Consultation
PAN INDIA COVERAGE
Government Healthcare Institutions
Govt.
Health & State
DH/CHC/ Aspirational Doctors/AN
Wellness Medical AYUSH
PHC Districts Ms/ASHA/
Centres Colleges
Paramedics
 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

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THANK YOU

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 Tentative earmarking of HUBs to be finalized
in consultation with States
Operational Total Nodes to be
Call Centre location HWCs attached States Covered

Sanjay Gandhi Post Graduate Institute of 254 1558

Medical Sciences (SGPGIMS), Lucknow
Uttar Pradesh (UP)
IMS-BHU 0 1500

VSS Medical College, Sambalpur 158 1148 Odisha

Postgraduate Institute of Medical 10 34 Chandigarh

Education & Research
(PGIMER), 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 365 1050 Andhra Pradesh
Hospital, Visakhapatnam
Gandhi  Medical College, Secunderabad 138 590 Telangana

BACK
 Tentative earmarking of HUBs to be finalized
in consultation with States
Total Nodes to be
Call Centre location Operational HWCs 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
King Edward Memorial (KEM), Mumbai
1 22 Daman n Diu
27 24 Dadra n Nagar haveli
B.J. Medical College,
Asarwa, Ahmedabad 181 1645 Gujarat

Government Medical 44 426 Uttarakhand

College, Haldwani

Sawai Man Singh Medical College,

255 679 Rajasthan
Jaipur

BACK
 Tentative earmarking of HUBs to be finalized
in consultation with States
Call Centre location Operational HWCs Total Nodes to be States Covered
attached

All India Institute of Medical  Science

719 800 Chhattisgarh
(AIIMS), Raipur

Netaji Subhash Chandra Bose Medical

College, Jabalpur 62 690 Madhya Pradesh

5 42 Meghalaya

North Eastern Indira Gandhi Regional 2 39 Sikkim

Institute of  Health and Medical Sciences
(NEIGRIHMS), Shillong
1 32 Mizoram

3 132 Arunachal Pradesh

Guwahati Medical College, Guwahati 113 878 Assam

Regional Institute of Medical Sciences

(RIMS), Imphal 29 103 Manipur

BACK
 Tentative earmarking of HUBs to be finalized
in consultation with States
Operational Total Nodes to
Call Centre location States Covered
HWCs be attached

Agartala Government Medical 31 46 Tripura

College, Agartala

Christian Institute of Nursing Science &

Research, Dimapur 5 63 Nagaland

Trivandrum Medical College,

Thiruvananthapuram 177 671 Kerala

Karnataka Institute of  Medical

560 1142 Karnataka
Sciences, Hubli

Andaman &
2 34
Nicobar (UT)
JIPMER - Pudducherry
0 3 Lakshadweep (UT)
1 21 Puducherry (UT)

BACK
 Minimum requirement @Spoke

S. Item Description Estimated Remarks

No. Cost /HWC

1 Telemedicine Diagnostic Kit To be provisioned as per choice of State

2 Desktop with headphone , 60,000

microphone and HD web Camera New equipment to be provisioned under
PIP in case these equipment are not
available at HWCs.
3 Printer 5,000
Should be met from the HWC budget
including the untied funds.

4 Miscellaneous 5,000

5 Last mile connectivity To be provisioned in PIP as per actuals

(Min. 2Mbps)

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BACK
 Minimum requirement @5 seater HUB for 100 Spokes
S. Item Description Qty Estimated unit Remarks
No cost
.
1. Desktop with 6 60,000
headphone , New equipment to be provisioned under
microphone and HD PIP in case equipment are not available
web Camera at HUB

2. MBBS Doctor 5 As per NHM To be provisioned in PIP as per actuals.

If the number of HWCs increases the number
guidelines of MBBS doctors may be increased
proportionately

3. Specialist Doctors 3 As per NHM

(On Daily remuneration To start with, a Specialist in General Medicine
guidelines will be able to coordinate the HUB initially till
basis) other specialists are co-opted.

4. Last mile connectivity - To be provisioned in PIP as per actuals

(Min 2 mbps)

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BACK
 E-Sanjeevani Application & Training

S. No. Item Description Estimated Cost

1 Development and Hosting of e-Sanjeevani To be provided by MoHFW to all
Application States/UTs

2 Servers for Database, Backup, Application, To be provisioned in PIP as per

Load balancers etc. 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

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