2. 2
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
Current Scenario
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.
3. Observations on State owned Telemedicine Projects
S.No. State E-Health Observations
1 Rajasthan
Telemedicine Project
(100 Centres)
• 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 June’17 to March’18
• Per Consultation Cost is Rs. 850
2 Himachal Telemedicine
Project
(25 Centres)
• PPP Mode
• Pirmala Swasthya care as implementation agency
• Call Centre setup at Solan
• 23488 consultations till March 2018
• Overall Per Consultation Cost is approx. Rs. 750
3 Himachal Telemedicine
Project
(2 Centres Kaza &
Keylong)
• PPP Mode
• Apollo healthcare as implementation agency
• Call Centre setup at Chennai
• 20342 Consultations till March 2018
• Overall Per Consultation Cost is more than Rs. 1500
4. 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)
6. Problem Statements
States Telemedicine are
operational under
Public Private
Partnership Mode (PPP)
Limited ownership by
State Administration in
operations
No interoperability of
EHR
Telemedicine services
implemented as Pilot
projects not covering
whole State
Few States covered all
DH but real need is at
CHC/PHC/SC
Consultation Services
provided by Private
Partners from their
own Call Centre setup
No skill development
of Government
Doctors
6
7. 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)
8. 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
9. High Level Architecture
CHC/PHC
Specialist Doctors
stationed at HUB.
Only referred patients
from 1st level
MBBS Doctors at HUB
for 1st level of
consultation and
creation of EHR
SPOKES/
HEALTH AND WELLNESS
CENTRES
Sub Centre
Video Consultation
HUB
(MC/DH)
9
10. Implementation Timeline
S.No. Activity Timelines (Days)
1 Approval of proposal in PIP T
2 Video Conference with MD (NHM) –AS&MD as Chair
(to demonstrate Software + finalizing HUB location)
T+10
3 Procurement of equipment at Spokes
(Desktop + Printer)
T + 30
(from GeM)
4 Setting up of HUB
(Site preparation + Desktop + furniture)
T + 45
(from GeM)
5 Recruitment of MBBS Doctors + Specialists T + 60
6 Handholding on e-Sanjeevani Application by CDAC
(To be initiated by State)
T + 30
7 Training to staff (in-person training) (if required) T + 45
8 Go-Live of Project T + 60
10
11. 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
12. Monitoring Framework
Team Constitution Roles
Review Committee
National Monitoring
Team
• A Review committee of JS-NHM,
JS-eHealth and JS-Medical
Education
• To review the performance of the tele-
consultation through this programme
• To provide the necessary instructions to the
Medical Colleges / Technical Teams / States
• Quarterly Review
• Director (NHM) – Head
• Director (eHealth)-member
• Director (CHI) - member
Assisted by Senior Consultant
–MoHFW
• To monitor the overall functions of the
programme
• Coordinate with States
• Review of dashboard with KPIs
State Monitoring
Team
• Mission Director (NHM) – Head
• State nominated Nodal officer
• Nominated HUB In-charge
• Project Monitoring Office (PMO)
Operations Manager
MIS expert
• To manage the overall operations of the
project in State
• Creation of MIS for State, based on the Key
Performance Indicators (KPI)
District Monitoring
Team
• Chief Medical Officer (CMO) –
Head
• Nominated District Level Nodal
Officer
MIS data entry operator
• Implementation and operations of
Telemedicine solution
• Updating progress in the Dashboard
• Submission of reports to the State / New Delhi
12
13. 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
• 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
E-Classroom Setup
Live surgery
14. 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)”
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
M-eDX platform
15. Future Expansion
50 MEDICAL COLLEGES (to be expanded)
PAN INDIA COVERAGE
Government Healthcare Institutions
NMCN
Scheme
Tele-Radiology Specialty
Tele-Consultation
Tele-CMEs
Health &
Wellness
Centres
State
Medical
Colleges
DH/CHC/
PHC
Aspirational
Districts
M-eDX
• Live Lectures
• Online Medical Education
• Certification courses
• Training Modules
• Information dissemination
platform
• Live surgery
• Animated Videos
Govt.
Doctors/AN
Ms/ASHA/
Paramedics
AYUSH
Services
Services
Services
16. 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
18. Tentative earmarking of HUBs to be finalized
in consultation with States
Call Centre location
Operational
HWCs
Total Nodes to be
attached
States Covered
Sanjay Gandhi Post Graduate Institute of
Medical Sciences (SGPGIMS), Lucknow
254 1558
Uttar Pradesh (UP)
IMS-BHU 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
19. Tentative earmarking of HUBs to be finalized
in consultation with States
Call Centre location 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
King Edward Memorial (KEM), Mumbai
20 1814 Maharashtra
9 5 Goa
1 22 Daman n Diu
27 24 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
BACK
20. Tentative earmarking of HUBs to be finalized
in consultation with States
Call Centre location 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
North Eastern Indira Gandhi Regional
Institute of Health and Medical Sciences
(NEIGRIHMS), Shillong
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
BACK
21. Tentative earmarking of HUBs to be finalized
in consultation with States
Call Centre location
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
JIPMER - Pudducherry
2 34
Andaman &
Nicobar (UT)
0 3 Lakshadweep (UT)
1 21 Puducherry (UT)
BACK
22. Minimum requirement @Spoke
S.
No.
Item Description Estimated
Cost /HWC
Remarks
1 Telemedicine Diagnostic Kit To be provisioned as per choice of State
2 Desktop with headphone ,
microphone and HD web Camera
60,000
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.
3 Printer 5,000
4 Miscellaneous 5,000
5 Last mile connectivity To be provisioned in PIP as per actuals
(Min. 2Mbps)
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23. Minimum requirement @5 seater HUB for 100 Spokes
S.
No
.
Item Description Qty Estimated unit
cost
Remarks
1. Desktop with
headphone ,
microphone and HD
web Camera
6 60,000
New equipment to be provisioned under
PIP in case equipment are not available
at HUB
2. MBBS Doctor 5 As per NHM
guidelines
To be provisioned in PIP as per actuals.
If the number of HWCs increases the number
of MBBS doctors may be increased
proportionately
3. Specialist Doctors
(On Daily remuneration
basis)
3 As per NHM
guidelines
To 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)
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BACK
24. 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
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