National Rural Telemedicine Network

Suggested Architecture and Guidelines

Draft Proposal Version 1.0

Ministry of Health & Family Welfare Government of India

Content
1.E e!"tive #"mmary....................................................................................................$ %.Introd"!tion.................................................................................................................$ $.&a!'(ro"nd.................................................................................................................$ ).*"rrent #!enario..........................................................................................................) +.#!ope of the Pro,e!t....................................................................................................-.E pe!ted &enefits..........................................................................................................Proposed G"idelines / Frame0or' for Indian 1"ral 2elemedi!ine 3et0or'............... ..1.Definin( a 3ational 1"ral 2elemedi!ine 3et0or'................................................ ..%.#tandardi4ation 5First #tep 2o0ards 3ational 1"ral 2elemedi!ine 3et0or'......6 ..$.*onstit"ents of 2elemedi!ine 3et0or'.................................................................6 ..$.1.7EVE7819 Primary Health *enter :PH*; / *omm"nity Health *enter :*H*; / Villa(e <nit............................................................................................................6 ..$.%.7EVE78%9 Distri!t Hospital ...........................................................................6 ..$.$.7EVE78$9 #tate Hospital / 3ational #"per #pe!ialty Hospital.......................= ..$.).7EVE78M9 Mo>ile 2elemedi!ine <nit ?........................................................= ..$.+.31HM #mart *ard.......................................................................................10 ..).Pro!ess and Infrastr"!t"re G"idelines at Different 7ayers of Hierar!hy............10 ..).1.2elemedi!ine Pro!ess for 7EVE78M and 7EVE781 "nits...........................10 ..).%.2elemedi!ine Pro!ess for 7EVE78% and 7EVE78$ "nits.............................11 ..).$.2elemedi!ine Hard0are / #oft0are 1e@"irement at 7EVE78M and 7EVE78 1 1% ..).).2elemedi!ine Hard0are / #oft0are 1e@"irement at 7EVE78%....................1$ ..).+.2elemedi!ine Hard0are / #oft0are 1e@"irement at 7EVE78$....................1+ ..+.Proposed Ar(ani4ational Plan.............................................................................1..+.1.Preparation of Infrastr"!t"reB E8Health Ed"!ation and 2rainin(..................1..+.%.#ettin( G"idelines for Cdministration and *lini!alB Ed"!ational and Governan!e 2elemedi!ine Pra!ti!es......................................................................1..+.$.Identifi!ation of Vendor for Pro,e!t Implementation....................................1. ..+.).1e!r"itment of 2e!hni!al / Medi!al Manpo0er...........................................1. ..+.+.Installation of E@"ipmentsB 3et0or' MediaB 2estin(B 2rainin( and Hand8 Holdin(...................................................................................................................1. ..+.-.Periodi! Monitorin( and Preparation of Interim 1eport...............................1. ..+...Impa!t Eval"ation at the End of Ea!h Dear and Cfter Five Dear.................1. 6.&"d(et re@"irement...................................................................................................16 6.1.Finan!ial 1e@"irement for Phase8I......................................................................16 6.%.7EVE781 :PH* / *H* / Villa(e; <nits.............................................................16 6.$.7EVE78M :Mo>ile 2elemedi!ine Van;..............................................................%1 6.).7EVE78% :Distri!t Hospitals;.............................................................................%$ 6.+.7EVE78$ :#tate Hospital /#"per #pe!ialist Hospitals;.......................................%+ 6.-.Finan!ial #"mmary.............................................................................................%.

1. EXECUTI E SU!!AR"

#. INTR$%UCTI$N India is the se!ond most pop"lo"s !o"ntry of the 0orld and has !han(in( so!io8 politi!al8demo(raphi! and mor>idity patterns that have >een dra0in( (lo>al attention in re!ent years. Despite several (ro0th8orientated poli!ies adopted >y the (overnmentB the 0idenin( e!onomi!B re(ional and (ender disparities are posin( !hallen(es for the health se!tor. C>o"t .+E of health infrastr"!t"reB medi!al man po0er and other health reso"r!es are !on!entrated in "r>an areas 0here %.E of the pop"lations live. *onta(io"sB infe!tio"s and 0ater>orne diseases s"!h as diarrhea, amoebiasis, typhoid, infectious hepatitis, worm infestations, measles, malaria, tuberculosis, whooping cough, respiratory infections, pneumonia and reproductive tract infections dominate the mor>idity patternB espe!ially in r"ral areas. Ho0everB non8!omm"ni!a>le diseases s"!h as cancer, blindness, mental illness, hypertension, cardio vascular disorders, diabetes, HIV/AIDS, accidents and injuries are also on the rise. 2he health stat"s of IndiansB is still a !a"se for (rave !on!ernB espe!ially that of the r"ral pop"lation. 2his is refle!ted in the life e pe!tan!y :-$ years;B infant mortality rate :60/1000 live >irths;B maternal mortality rate :)$6/100 000 live >irths;F ho0everB over a period some pro(ress has >een made. 2o improve the prevailin( sit"ationB the pro>lem of r"ral health is to >e addressed at >oth ma!ro :national and state; and mi!ro :distri!t and re(ional; levels. 2his is to >e done in a holisti! 0ayB 0ith a (en"ine effort to >rin( the poorest of the pop"lation to the !entre of the fis!al poli!ies. C paradi(m shift from the !"rrent G>iomedi!al modelG to a Gso!io8!"lt"ral modelGB 0hi!h sho"ld >rid(e the (aps and improve @"ality of r"ral lifeB is the !"rrent need. C revised 3ational Health Poli!y addressin( the prevailin( ine@"alitiesB and 0or'in( to0ards promotin( a lon(8term perspe!tive planB mainly for r"ral healthB is imperative. 1e!ent la"n!h of 3ational 1"ral Health Mission :3H1M; >y the Ministry of Health & Family Welfare is a step in this dire!tion. &. 'AC(GR$UN% India lives in its villa(esB so said Mahatma GandhiB Father of the 3ationB >"t the !o"ntry todayB after -0 years of independen!eB is !hara!teri4ed >y lo0 penetration of health!are servi!es to its villa(e pop"lation. Even tho"(h there have >een several initiatives ta'en >y >oth the Government and the Private se!torB the r"ral and remote areas !ontin"e to s"ffer from a>sen!e of @"ality health!are servi!es. 2he health indi!ators of the nation are in dismal sit"ation even after implementation of several nation0ide pro,e!ts to improve it. 1e!entlyB the "nion (overnment has adopted a mission approa!h to >oost the p">li! health for the masses >y la"n!hin( 3ational 1"ral Health Mission :31HM;. Ane of the o>,e!tives of the 31HM is to provide the r"ral pop"lation a!!ess to health!are servi!es. In this !onte tB 2elemedi!ineB an information and !omm"ni!ation te!hnolo(y >ased toolB has the potential to assist in $

ele!troni! delivery of dia(nosti! and health!are servi!es to remote r"ral pop"lation even in the a>sen!e of physi!al infrastr"!t"re in pla!e th"s !an !reate a platform to net0or' India. 2elemedi!ine helps to provide health!are 0here there is none and improve health!are 0here there is some. 2he fa!t is that 0hile .0E of o"r pop"lation lives in r"ral IndiaF =0E of se!ondary & tertiary !are fa!ilities are in the !ities and to0ns far a0ay from the r"ral India. Ct the same timeB it is also a fa!t that a si(nifi!ant proportion of patients in these remote lo!ations !o"ld >e s"!!essf"lly mana(ed 0ith some advi!e and ("idan!e from spe!ialists and s"per8spe!ialists in the !ities and to0ns. 2his is the po0er of 2elemedi!ine. It is no s"rprise that 2elemedi!ine is playin( an in!reasin(ly important role in not only providin( dia(nosti! and !ons"ltation servi!es >"t also in fa!ilitatin( 2ele8ed"!ation and trainin( of personnel a!ross the !o"ntry. ). CURRENT SCENARI$ C n"m>er of initiatives are "nder0ay in the area of telemedi!ine 0ith the o>,e!tive for providin( @"ality !ons"ltation and !arin( for patients in areas 0here spe!iali4ed patient !are is not availa>le. Cltho"(h telemedi!ine implementation remains in its infan!yB interest and a!tivity appears to >e (ro0in( to provide !ons"ltation of a #"per8spe!ialty do!tor from a distan!e thro"(h video!onferen!in( alon( 0ith e !han(e of medi!al re!ords online. In addition to ma,or s"pport and thr"st provided >y DI2 thro"(h pro,e!ts and systemsB or(ani4ations li'e I#1AB rep"ted a!ademi! medi!al instit"tions li'e #GPGIB CIIM#B PGIME1B CIM#B #1M* and !orporate hospitals li'e Csia Heart Fo"ndationB Cpollo HospitalsB #G1HB FortisB Ma et!. have ta'en and !ontin"in( to ta'e si(nifi!ant initiatives for installation of telemedi!ine systems at different parts of the !o"ntry. 2he Department of Information 2e!hnolo(y :"nder M*I2; has ta'en a pivotal role in definin( and shapin( the f"t"re of 2elemedi!ine appli!ation in India. &a!'ed >y a stron( vision to >"ild a national 2elemedi!ine 3et0or' in IndiaB DI2 has >een involved at m"ltiple levels 5 this in!l"des Development of 2e!hnolo(yB Initiation of pilot s!hemes and standardi4ation of 2elemedi!ine in the !o"ntry. #ome of these are >riefly des!ri>ed >elo0. DI2 has f"nded development of 2elemedi!ine soft0are systems8 the prominent ones >ein( Mer!"ry and #an,eevani soft0are >y *8DC*. DI2 has also sponsored the telemedi!ine pro,e!t !onne!tin( three premier medi!al instit"tions8 vi4. #GPGIB 7"!'no0B CIIM#B 3e0 DelhiB and PGIME1B *handi(arh8 "sin( I#D3 !onne!tivity. 2hese hospitals as in t"rn !onne!ted to other state level hospitals. DI2 Implemented 2ele8medi!ine foe Dia(nosis & Monitorin( of tropi!al diseases in West &en(al "sin( lo0 speed WC3B developed >y We>el :Hol'ata;B II2B Hhara(p"r and #!hool of 2ropi!al Medi!ineB Hol'ata. 2he system has >een installed in #!hool of 2ropi!al Medi!ine Hol'ata and t0o Distri!t Hospitals. #imilarlyB DI2 has f"nded esta>lishment of an An!olo(y 3et0or' for providin( 2elemedi!ine servi!es in !an!er dete!tionB treatmentB pain reliefB patient follo08"p and !ontin"ity of !are in peripheral hospitals :nodal !enters; of 1**. 2he pro,e!t 0as implemented >y *8DC*B 2rivandr"m and 1e(ional *an!er *enter :1**;B 2rivandr"m. 2he Herala An!o3E2 model has >een repli!ated >y DI2 at 1**B Cdiyar )

in *hennai 0ith *8DC*Is Mer!"ry 2elemedi!ine #ol"tion. #"!!ess of the !an!er net0or' in Herala has >een adopted >y the Ministry of Health & Family WelfareB Government of India to ta'e ma,or step to0ards la"n!hin( 3ational *an!er *are 3et0or'. Clso pro,e!ts on settin( "p of telemedi!ine fa!ilities at t0o referral hospitals and fo"r Distri!t hospitals "sin( West &en(al #tate Wide area net0or' of % M>psB and settin( "p 2elemedi!ine and 2ele8ed"!ation :!ontin"in( Medi!al Ed"!ation ; fa!ilities in Herala !onne!tin( 1e(ional *an!er *enter :1**;B #ri *hitra 2hir"nal Instit"te of Medi!al #!ien!es:#*2IM#2;B Medi!al *olle(e Hospital :M*H; and 2rivandr"m Medi!al *olle(e :2M*;. 2rivandr"m 0ith fo"r hospitals at 2al"' and Distri!t level "sin( I#D3 !onne!tivity is implemented 0ith *8DC*Is Mer!"ry 2elemedi!ine #ol"tion. #everal state level 2elemedi!ine net0or' li'e Herala state 2elemedi!ine 3et0or'B 2amilnad" state 2elemedi!ine 3et0or'B Haryana & Pan,a> state 2elemedi!ine 3et0or'B et!. are !omin( "p as pilot pro,e!t and have sho0n promisin( res"lts. In additionB three state !apital distri!t level hospitals in north eastern states of India are (ettin( !onne!ted 0ith s"per8 spe!ialty hospitalsB one at HohimaB 3a(aland already >ein( operational. Cnother one lin'in( one ea!h state level hospital in #i''im and Mi4oram 0ith Indraprastha Cpollo Hospital is e ample of P">li!8Private 2elemedi!ine 3et0or' in pla!e and "nder effe!tive "se. In a short span of timeB some si(nifi!ant pro(ress has >een a!hieved in the field of 2elemedi!ine in India. Ho0everB there is still a lon( 0ay to (o. While there are over %0B000 PH*Is providin( primary !are servi!es in the r"ral areasB and a>o"t +00 distri!t hospitalsB 2elemedi!ine has rea!hed to a>o"t 100 !enters and more +0E of them are in the "r>an !enters only. If 0e 0ere to loo' at a five8 year hori4on for 2elemedi!ine in IndiaB efforts 0o"ld >e !onsidered s"!!essf"l only if 0e have 2elemedi!ine rea!hin( o"t to at least all distri!t and 2al"' level hospitals thro"(ho"t the !o"ntry. &"t for this to >e a realityB 0e need a ma,or thr"st not from the Government and Private #e!tor >"t also help from International a(en!iesB 0hi!h 0ill (o a lon( 0ay in a!hievin( this o>,e!tive. Ane of the 'ey fa!tors to s"!!ess of 2elemedi!ine in India is (oin( to >e the relia>ility of tele!omm"ni!ation lin'. In this !onte tB it is of !onsidera>le si(nifi!an!e the !ommitment made >y I#1A *hairman to provide free >and0idth for the p"rpose of 2elemedi!ine and 2ele8ed"!ation. I#1A has >een deployin( satellite >ased telemedi!ine nodes in !olla>oration 0ith state (overnments. #o far it has deployed aro"nd %+0 nodes a!ross the !o"ntry. Ministry of Health and Family Welfare has set "p a 3ational 2as' For!e to address vario"s iss"es to promote telemedi!ine in the !o"ntry and has la"n!hed a ma,or !o"ntry 0ide net0or' of distri!t hospitals and medi!al !olle(es "nder the Inte(rated Disease #"rveillan!e Pro,e!t. 3ational *an!er *are 3et0or' and Medi!al *olle(es net0or' are (oin( to >e implemented in the near f"t"re. In vie0 of a n"m>er of la"da>le >"t disparate efforts and initiativesB need for an over ar!hin( ar!hite!t"re/ frame0or' for the !o"ntry !overin( $ levelsB namelyB PH* to Distri!tB Distri!t to referral/ #"per8spe!ialty hospitals and also !overin( +

hard0are/soft0are re@"irementsB >and0idth and !onne!tivity iss"es has >een felt. 2his paves the 0ay for introd"!tion of inte(rated telemedi!ine net0or' in India. Fi>er opti! net0or' a!ross the !o"ntry has >een laid do0n >y >oth (overnment / p">li! se!tor and private tele!omm"ni!ation servi!e providers pavin( the 0ay for availa>ility of hi(h >and0idth terrestrial !onne!tivity to >"ild ">i@"ito"s health net0or' for telemedi!ine !o"ntry 0ide 0ith !ompetin( pri!e. What started as appli!ation of s!ien!e and te!hnolo(y in the field of telemedi!ine >y the MinistryB it has no0 (ot a si(nifi!ant attention as an important national pro(ramme *. SC$+E $, T-E +R$.ECT Desi(nB development and implementation of lo0 !ost r"ral telemedi!ine infrastr"!t"re !onsistin( of fi edB mo>ile and hand8held platforms and 0e> te!hnolo(y >ased >road >and 0ired / 0ireless 0ide area net0or' !enterin( aro"nd the distri!t hospital a!tin( as h">. Desi(n and development of JVilla(e 2ele8am>"lan!e #ystem and r"ral emer(en!y health!are servi!es / 2ra"ma !are mod"leKB a ne0 !on!eptB thro"(h mo>ile telemedi!ine net0or' >ased on Wi8MCL 0ireless mesh net0or' Development of 1"ral Health Hno0led(e 1eso"r!e thro"(h 0e> portal on p">li! health domain and !reation of e8*ME mod"le for itIs a!!ess >y the sta'e holders thro"(h e8learnin( te!hnolo(y on the telemedi!ine platform Development of te!hnolo(y platform for harvestB !ompilationB stora(e :Data &ase; at re(ional distri!t h"> and !entral Data *enter at MAH & FWB ar!hive and distri>"tion a!ross net0or'.

/. EX+ECTE% 'ENE,ITS 2imely a!!ess to dia(nosti!B spe!ialty health!are advi!e at the (rass root level thro"(h the lo0 !ost telemedi!ine net0or' !enterin( aro"nd the distri!t hospital as the servi!e provider C"(mented r"ral health!are delivery system >y inte(ration of lo0 !ostB s"staina>leB s!ala>le fi edB mo>ile and hand8held telemedi!ine te!hnolo(y platform into e istin( r"ral health!are servi!es infrastr"!t"re *reation of a model for 1"ral Emer(en!y / 2ra"ma servi!es on 2elemedi!ine infrastr"!t"re Improvement on 'no0led(e >ase of the r"ral pop"lation :to empo0er the r"ral fol's on self health!are 5 disease prevention & health promotion; 1emote ed"!ationB trainin( / retrainin( and s'ill development of (rass root health!are 0or'ers and professionals "nder 31HM

Ens"rin( p">li! health related data :as has >een in!orporated "nder 31HM; harvest B !ompilationB stora(e at distri!t h">B ar!hive and distri>"tion a!ross net0or' to fa!ilitate ele!troni! (overnan!e of 31HM.

0. +R$+$SE% GUI%E1INES 2 ,RA!E3$R( ,$R IN%IAN RURA1 TE1E!E%ICINE NET3$R( 0.1. %e4ining a National Rural Telemedicine Network While I#1A is providin( free >and0idth thro"(h V #C2 !onne!tivityB 0e are also loo'in( for0ard to definin( a modal for a 3ational 2elemedi!ine !onne!tivity G1ID on hy>rid model "tili4in( e istin( terrestrial fi>er opti! and "p!omin( 0ireless media te!hnolo(y. 2his 0o"ld loo' at "tili4in( >and0idth a!ross different !omm"ni!ation lin's dependin( on the appli!ation and the investment !onsiderations. 2he spe!ifi! str"!t"re of any parti!"lar telemedi!ine !enter of the net0or' 0o"ld depend on the (eo(raphi! fa!tors of the area that 0ill >e servi!ed >y the net0or'B and the type of lo!al "sers there. We vis"ali4e the 3ational 1"ral 2elemedi!ine 3et0or' to >e a tiered hierar!hi!al str"!t"re. 2his 0o"ld in!l"de9 1E E1516 Primary Health *enter :PH*; / *omm"nity Health *enter :*H*; connected to a District Hospital 1E E15#6 Distri!t Hospital connected to a State Hospital / ational Super Specialty Hospital 1E E15&6 #tate Hospital / 3ational #"per #pe!ialty Hospital connected to each other 1E E15!6 Mo>ile 2elemedi!ine <nit !overin( fe0 villa(es connected to nearest !H" / "H" or directly to District Hospital

With spe!ial referen!e to 31HM the PH*s !an >e s!aled do0n to villa(e level "nits "p to Villa(e health 0or'er in the proposed net0or' 2he 7EVE781 "nits are referrin( in nat"re and 0ill !onne!t to a pre#designated 7EVE78% "nit that is referral in nat"re. It is possi>le that 7EVE78% "nit may also a!t as a referrin( "nit and refer to 7EVE78$ "nit. In s"!h a !aseB 7EVE78% "nit 0ill also re@"ire some medi!al e@"ipment. 7EVE78$ "nits are p"rely referral in nat"re and 0ill >e a>le to !ons"lt 0ith ea!h other or refer a !ase to ea!h other on >asis of spe!ialty and re@"irement of se!ond / third / nth opinion. In definin( the 3ational 1"ral 2elemedi!ine 3et0or'B sele!tin( the !onne!tivity 0ill >e definin( fa!tor in rea!hin( o"t to distant lo!ations in!l"din( 0here traditional land >ased !omm"ni!ation systems have not yet rea!hed or are pla("ed >y poor !onne!tivity. 2his net0or' needs to >e >ased on open platform and on open ar!hite!t"re standards that ma'e it a!!essi>le to one and all. It 0o"ld not >e restri!tive in any 0ay 5 and any party interested to !ontri>"te to or >enefit from this no>le appli!ation 0o"ld >e a>le to do so. Developin( an ade@"ate and afforda>le telemedi!ine infrastr"!t"re !an help to !lose the (ap >et0een the haves and the have8nots in health !are.

0.#. Standardi7ation 8,irst Ste9 Towards National Rural Telemedicine Network Cs a startin( point of >"ildin( the 3ational 1"ral 2elemedi!ine 3et0or'B MoH&FW has initiated definin( the national standards and ("idelines for 2elemedi!ine appli!ation in IndiaB in !ons"ltation 0ith DI2B M*I2. 2elemedi!ine 0or'in( (ro"p set"p has already finali4ed a n"!le"s frame0or' J $ecommendation on %uidelines, Standards and !ractices for &elemedicine in India.K Definin( standards no0 0ill ins"re that all o"r systems are interoperable and are a>le to !omm"ni!ate 0ith ea!h other instead of >ein( restri!tive and limited to a parti!"lar provider net0or'. What this means is that if a !enter has a 2elemedi!ine system already implementedB it !an tal' to another !enter 0ith different 2elemedi!ine #ystem as lon( as they adhere to the defined standards. 2his 0ill also form the >asis of !olla>orations 8 >et0een the (overnment and private players as 0ell as >et0een different private players 5 0ith the patients >ein( the final >enefi!iaries. 0.&. Constituents o4 Telemedicine Network C telemedi!ine net0or' in!orporates follo0in( !omponents in addition to *ons"ltin( Do!tors and #"per #pe!ialty *ons"ltants at >oth re!ipient and referral hospitals9 0.&.1. 1E E1516 +rimar: -ealth Center ;+-C< 2 Communit: -ealth Center ;C-C< 2 illage Unit 2ele8!ons"ltation room Patient en(a(ement fa!ilities :>edB s!opesB et!.; 2elemedi!ine Platform o #ele!tive medi!al and medi!o8I2 e@"ipmentsB prefera>ly I2 !ompati>leB 0ith interfa!e to 2elemedi!ine and/or other soft0are / hard0are o *omp"ter hard0are / soft0are platform :P*B s0it!hB et!.; and I2 ele!troni!s e@"ipments *onne!tivity / >and0idth re@"irements :e.(. I#D3B 7eased lineB V#C2B &road>andB Wireless; Point8to8Point video8!onferen!in( system :may >e porta>le; 0.&.#. 1E E15#6 %istrict -os9ital 2elemedi!ine room Patient en(a(ement fa!ilities :>edB s!opesB et!.; 2elemedi!ine Platform o #ele!tive medi!al and medi!o8I2 e@"ipmentsB prefera>ly I2 !ompati>leB 0ith interfa!e to 2elemedi!ine and/or other I2 soft0are / hard0are o *omp"ter hard0are / soft0are platform :P*B serverB s0it!hB et!.; and I2 ele!troni!s e@"ipments *onne!tivity / >and0idth re@"irements :e.(. I#D3B 7eased lineB V#C2B &road >andB Wireless; M"lti8point video !onferen!in( system Aptional telemedi!ine soft0are a!!ess fa!ility at !ons"ltantIs room thro"(h Hospital87C3 6

Aptional se!"re !entrali4ed lon(8term ele!troni! re!ord stora(e for assi(ned 7EVE781 and 7EVE78M "nits *onne!tivity / >and0idth re@"irements :e.(. I#D3B 7eased lineB V#C2B &road>andB Wireless; 3ote that9 o Distri!t Hospital may a!t as referrin(/!ons"ltin( "nit as 0ell and may have some medi!al e@"ipments for tele8!ons"ltation 0ith #tate Hospital / 3ational #"per #pe!ialty Hospital o Cll "nits 0ill re@"ire m"ltiple telemedi!ine stations for sim"ltaneo"s tele8 !ons"ltation 0ith referrin( "nits 0.&.&. 1E E15&6 State -os9ital 2 National Su9er S9ecialt: -os9ital 2elemedi!ine room 2elemedi!ine Platform o *omp"ter hard0are / soft0are platform :P*B serverB s0it!hB et!.; and I2 ele!troni!s e@"ipments *onne!tivity / >and0idth re@"irements :e.(. I#D3B 7eased lineB V#C2B &road >andB Wireless; M"lti8point video !onferen!in( system Aptional telemedi!ine soft0are a!!ess fa!ility at !ons"ltantIs room thro"(h Hospital87C3 Aptional se!"re !entrali4ed lon(8term ele!troni! re!ord stora(e for assi(ned 7EVE781B 7EVE78%B and 7EVE78M "nits *onne!tivity / >and0idth re@"irements :e.(. I#D3B 7eased lineB V#C2B &road>andB Wireless; 3ote that9 o Cll "nits 0ill re@"ire m"ltiple telemedi!ine stations for sim"ltaneo"s tele8 !ons"ltation 0ith referrin( "nits

0.&.). 1E E15!6 !o=ile Telemedicine Unit > C"tomo>ile Vehi!le o *hasis #i4e9 +...= L %.166 L 1.=00 mts o *"stomi4ed fa>ri!ation to a!!ommodate I2 and medi!al e@"ipments o Inte(rated DG set o #pa!e for tele8!ons"ltationB patient e amination o #pa!e for !arryin( o"t investi(ation pro!ed"res li'e <ltra8sono(raphy and L8ray 2elemedi!ine Platform o #ele!tive medi!al and medi!o8I2 e@"ipmentsB prefera>ly I2 !ompati>leB 0ith interfa!e to 2elemedi!ine and/or other I2 soft0are / hard0are o *omp"ter hard0are / soft0are platform :P*B serverB s0it!hB et!.; and I2 ele!troni!s e@"ipments *onne!tivity / >and0idth re@"irements :e.(. I#D3B 7eased lineB V#C2B &road>andB Wireless; Point8to8Point video8!onferen!in( system :may >e porta>le; =

&esides vansB Mo>ile 2elemedi!ine "nits !an >e !"stomi4ed for deployment in any of the follo0in(9 o &oat :e.(. for appli!ation on >a!' 0ater re(ions in Herala or in &rahmap"tra in Cssam; o *hha'ras :e.(. "sed in G",arat; o *amel *arts :e.(. in deserts of 1a,asthan; Cppli!ation spe!ifi! mo>ile "nits !an >e !onfi("red9 o 2ele8ophthalmolo(y o 2ele8*an!er !are o 2ele8Cm>"lan!e for 2ra"ma 3et0or' and 1"ral Emer(en!y system o #"it!ase8>ased 2elemedi!ine mod"le for Disaster8hit areaB et!. o Mo>ile hand held "nits to a!t as data harvestin( point for 31HM at the (rass8root level ? Ea!h state 0ill have initially 0%80) "nits dependin( on the si4e and pop"lation. ClternativelyB the mo>ile vans pro!"red "nder 31HM may >e made telemedi!ine8 ena>led 0ith s"ita>le modifi!ations and installations. 0.&.*. NR-! Smart Card Ct lo0 investmentB 0e !an have the r"ral !iti4en health re!ord in!orporatin( life time health events startin( from !radle to (rave. Hen!eB this devi!e inte(ration "nder 1"ral 2elemedi!ine net0or' may >e !onsidered. 0.). +rocess and In4rastructure Guidelines at %i44erent 1a:ers o4 -ierarch: 0.).1. Telemedicine +rocess 4or 1E E15! and 1E E151 units 2he proposed Mo>ile 2elemedi!ine <nitB Primary Health *enter :PH*; / 2al"' Hospital are r"ral >ased health !enter !aterin( to r"ral pop"lation. 2he Mo>ile 2elemedi!ine <nit is "nderstanda>ly mo>ile version of similar set"p at PH* / *H*. 2hro"(h 7EVE78M and 7EVE781 telemedi!ine !ons"ltation !enterB patientsI data and reports !an >e sent to Distri!t Hospital and (et the se!ond / e pert opinion. 2ypi!allyB these !enters do not have very (ood dia(nosti! fa!ilitiesB hen!eB some >asi! e@"ipment o"tlined >elo0 needs to >e installed 0herever not present. *omm"ni!ation lin' >et0een 7EVE781 and Distri!t Hospital :7EVE78%; !o"ld >e thro"(h Wi8MCLB &road>andB or V8#C2 !onne!tivity dependin( on availa>ility. C s"stained >and0idth of +1% '>ps or more for video!onferen!e and data transmission is deemed s"ffi!ient. &asi! set"p 0ill have a sin(le m"ltimedia !omp"ter system and IP8>ased Video !onferen!e system 0ith P2M fa!ility. Dia(nosti! reports of the patient are for0arded to Distri!t Hospital "sin( the telemedi!ine soft0are system. Film #!anner may >e "sed for sendin( L8ray / *2 / M1I ima(es and 2ele8mi!ros!opy system to send smear for parasite in >lood and "rine for >a!teriolo(i!al st"dies. CdditionallyB a di(ital E*G devi!e may also >e provided. C >asi! printer may also >e provided for printin( report and re!ords for distri>"tion to patient. 10

2he telemedi!ine f"n!tionality at these "nits may >e either9 C self8s"ffi!ient system 0ith a>ility to !reate and maintain lon(8term ele!troni! medi!al re!ord :EM1; of patientB vie0B !onne!tB transmitB and retrieve e pert opinion. 2his model s"pports offlineB onlineB and intera!tive telemedi!ine !reatin( !omplete te!hnolo(i!al >ase of all types of servi!es / modalities. C 0e>8>ased / thin8!lient a!!ess to #ervers at 7EVE78%. 2his model s"pports offlineB and 0e>8>ased telemedi!ine !reatin( s"ffi!ient and !ost8 effe!tive te!hnolo(i!al >ase of all types of servi!es / modalities. Ho0everB in this modelB the "nit sho"ld >e a>le to lo!ally !reate ne0 re!ord of ne0 patient :some type of red"!ed f"n!tion >"t still "sa>le; in !ase of dis!onne!tion 0ith 7EVE78% servers. 2he lo!ally !reated re!ords sho"ld >e "ploaded to 7EVE78% server 0hen !onne!tivity is restored. 0.).#. Telemedicine +rocess 4or 1E E15# and 1E E15& units 2he proposed set"p at Distri!t Hospital :7EVE78%; has d"al p"rpose. It a!ts as a referral "nit for all 7EVE781 and 7EVE78M "nits assi(ned to it. It also a!ts as a data !olle!tion and referrin( "nit for 7EVE78$ "nits. Film #!anner may >e "sed for sendin( L8ray / *2 / M1I ima(es and 2ele8mi!ros!opy system to send smear for parasite in >lood and "rine for >a!teriolo(i!al st"dies. CdditionallyB a di(ital E*G devi!e may also >e provided. C mid8si4e printer may also >e provided for printin( report and re!ords for distri>"tion to patient and provide hard8!opy reports to e perts / spe!ialist for dis!"ssion / deli>eration. 2he 7EVE78$ "nits are p"rely referral in nat"re and provide e pert opinion on data sent from Distri!t Hospitals or those (enerated at PH* level and then for0arded >y Distri!t Hospitals assi(ned to it. D"e to nat"re of these "nits >ein( referral in nat"reB 0ith m"ltiple lo0er level "nits !onne!tin(B transmittin( dataB and re@"irin( e pert opinion / interventionB it is ne!essary to provide m"ltiple telemedi!ine stations at these lo!ations. 2hese "nits 0ill have m"lti8point video8!onferen!in( system so that it !an !ater to vario"s lo!ations at a time. *omm"ni!ation lin' >et0een 7EVE78% and 7EVE78$ "nits !an >e over terrestrial fi>er opti! !a>lesB Wi8MCLB &road>andB I#D3B or V8#C2 !onne!tivity dependin( on availa>ility. C s"stained >and0idth of +1% '>ps or more for video!onferen!e and %+'>ps per sim"ltaneo"s data transmission is deemed s"ffi!ient. #et"p at ea!h s"!h lo!ation 0ill !onsist of a #erver :or a #erver farm in !ase of lar(e load; 0ith m"ltiple !lient / a!!ess "nits for telemedi!ine. Fail8safe lon(8term data stora(e servers to store data (enerated at lo!al lo!ation and lo0er8levels need to >e esta>lished. 2o promote anytime/any0here telemedi!ine a!!essB all !ons"ltants in the pro(ram sho"ld >e provided 0ith a!!ess s"pport at their room in hospital thro"(h hospital 7C3. CdditionallyB some a!tive !ons"ltants may >e provided dial8"p or Wi8 Fi a!!ess from a laptop dependin( on nearness to the fa!ility. 2he telemedi!ine f"n!tionality at these "nits may >e either9 C #erver / *lient system 0ith a>ility to !reate and maintain lon(8term ele!troni! medi!al re!ord :EM1; of patientB vie0B !onne!tB 11

re!eive/transmitB and retrieve/send e pert opinion. 2his model s"pports offlineB onlineB and intera!tive telemedi!ine !reatin( !omplete te!hnolo(i!al >ase of all types of servi!es / modalities. C 0e>8>ased a!!ess system for !ons"ltant from their room or via laptop/home may also >e provided. C 0e>8>ased #erver system havin( all fa!ility to allo0 lo!al !ons"ltant and remote 7EVE781 and 7EVE78M do!tors to !onne!tB !reateB storeB retrieve EM1 and provide/retrieve e pert opinion. 2his model s"pports offlineB and 0e>8>ased telemedi!ine !reatin( s"ffi!ient and !ost8effe!tive te!hnolo(i!al >ase of all types of servi!es / modalities.

0.).&. Telemedicine -ardware 2 So4tware Re?uirement at 1E E15! and 1E E151 S.N. 1. Item Des'top P* platform Intel *ore% %.)GH4 :or e@"ivalent;B 10%)M& 1CMB )00G& #C2C% HDDB DVD81W DriveB 10/100/1000 3I* Cppropriate $rd party #oft0are :CVB personal data>ase; Windo0s LP ProfessionalB M# Affi!e #tandard Hard0are C!!elerator Graphi!s *ard :dedi!ated %+-M& on>oard 1CM; Hey>oard and mo"se '(ptionally )ireless* 1=K 2F2 7*D monitor #"ita>le We>8*amera for intera!tion d"rin( Anline 2ele8*ons"ltation Mi!rophoneB #tereo #pea'ers and Headset Peripherals 5 7aser PrinterB )8port <#& H">B et!. 3et0or' devi!e 5 6 port 10/100/1000 M>ps s0it!h and pat!h !a>les 1 HVC 7ine8intera!tive <P# IP Video *onferen!in( Hit 1%6 H>ps IP >ased V* "nit %=K 7*D 2V 'with wall mounting +it* 2elemedi!ine soft0are :either of follo0in(; Intera!tive #elf8s"ffi!ient 'with remote interactive connect to ,-V-,#. units* 7o!al We>8>ased red"!ed8f"n!tionality mod"le 'with connectivity to remote )eb#based Server* Di(ital E*G C$ Film #!anner Di(ital Mi!ros!ope Di(ital *amera Gl"!ometer 3on8invasive P"lse & &lood Press"re "nit Cdditionally Mo>ile Van 0ill have @t: 01

%.

01

$.

01

).

01

+.

01

1%

-.

..

o Aphthalmos!ope o Mo>ile <#G o Porta>le L8ray <nit 0ith *1 o Haemato(ram Cnalyser *onne!tivity devi!e :either of them; I#D3 Modem :0ith 32; CD#7%N / *DMC / P#23 Modem V#C2 #'yIP "nit Wi8MCL *PE Fi>er Apti! *PE Aptionally %/) mod"le ro"ter 0ith items in #.3. 'in case of multiple connectivity medium* In case of ISD lines, dial#up router must be ta+en

01

01

0.).). Telemedicine -ardware 2 So4tware Re?uirement at 1E E15# S.N. 1. Item @t: 2elemedi!ine #erver Platform 01 % D"al *ore Intel Leon $.% GH4 :or e@"ivalent;B )0=-M& 1CMB DVD81W DriveB D"al 10/100/1000 3I*B 1emote mana(ement Cppropriate $rd party #oft0are :CV; Aperatin( #ystem :dependin( on telemedi!ine sol"tion !hosen;9 o Windo0s %00$ 1% #tandard #erverB M# Affi!e #tandardB M# #O7 #erver o 1edHat Enterprise 7in" + #tandardB Post(re#O7 Inte(rated Graphi!s *ard Wireless Hey>oard and mo"se 1=K 2F2 7*D monitor An>oard 1CID *ontroller and Hot8s0ap dis's o % $- G& #*#I / #C# 1CID81 for (S o ) $00 G& #*#I / #C# 1CID8(ptional 2elemedi!ine *entral Data #tora(e #erver 01 'may be combined with S/ / 0 with spec increase* D"al *ore Intel Leon $.% GH4 :or e@"ivalent;B %0=-M& 1CMB DVD81W DriveB D"al 10/100/1000 3I*B 1emote mana(ement Cppropriate $rd party #oft0are :CVB Data>ase; Aperatin( #ystem :dependin( on telemedi!ine sol"tion !hosen;9 o Windo0s %00$ 1% #tandard #erver o 1edHat Enterprise 7in" + #tandard Inte(rated Graphi!s *ard Wireless Hey>oard and mo"se 1=K 2F2 7*D monitor An>oard 1CID *ontroller and Hot8s0ap dis's 'may be on separate enclosure* 1$

%.

$.

).

+.

-.

..

6.

=.

10.

o % 60 G& #C2C% 1CID81 for (S o 1% +00 G& #C2C% 1CID8(ptional 2ape 7i>rary and &a!'"p system <ltri"m $ 2e!hnolo(y - 2& 3ative &a!'"p !apa!ity #*#I Interfa!e &a!'"p soft0are 0ith appropriate a(ents Des'top P* platform Intel *ore% %.)GH4 :or e@"ivalent;B 10%)M& 1CMB )00G& HDDB DVD81AM DriveB 10/100 3I* Cppropriate $rd party #oft0are :CVB Data>ase; Windo0s LP ProfessionalB M# Affi!e #tandard Hard0are C!!elerator Graphi!s *ard :dedi!ated %+-M& on>oard 1CM; Wireless Hey>oard and mo"se 1=K 2F2 7*D monitor #"ita>le We>8*amera for intera!tion d"rin( Anline 2ele8*ons"ltation Mi!rophoneB #tereo #pea'ers and Headset Peripherals 5 7aser PrinterB )8port <#& H">B et!. 3et0or' devi!e 5 6 port 10/100 M>ps s0it!h and pat!h !a>les ) HVC An87ine <P# IP Video *onferen!in( Hit +1% H>ps IP >ased V* "nit $%K 7*D 2V 'with wall mounting +it* 2elemedi!ine *lient soft0are :either of follo0in(; Intera!tive 2elemedi!ine *lient 'with interactive connect to &elemedicine Server* 7o!al We>8>ased a!!ess 'with connectivity to )eb# based Server* 2elemedi!ine #erver soft0are :either of follo0in(; Intera!tive 2elemedi!ine #erve 0ith We> a!!ess mod"le We>8>ased 2elemedi!ine #erve Di(ital E*G C$ Film #!anner Di(ital Mi!ros!ope Di(ital *amera Gl"!ometer 3on8invasive P"lse & &lood Press"re "nit *onne!tivity devi!e :either of them; I#D3 Modem :0ith 32; CD#7%N / *DMC / P#23 Modem V#C2 #'yIP "nit Wi8MCL *PE Fi>er Apti! *PE

01

0$

01

01

01

01

01

1)

11.

Aptionally %/) mod"le ro"ter 0ith items in #.3. 'in case of multiple connectivity medium* In case of ISD lines, dial#up router must be ta+en

01

0.).*. Telemedicine -ardware 2 So4tware Re?uirement at 1E E15& S.N. 1. Item 2elemedi!ine #erver Platform % D"al *ore Intel Leon $.% GH4 :or e@"ivalent;B )0=-M& 1CMB DVD81W DriveB D"al 10/100/1000 3I*B 1emote mana(ement Cppropriate $rd party #oft0are :CV; Aperatin( #ystem :dependin( on telemedi!ine sol"tion !hosen;9 o Windo0s %00$ 1% #tandard #erverB M# Affi!e #tandardB M# #O7 #erver o 1edHat Enterprise 7in" + #tandardB Post(re#O7 Inte(rated Graphi!s *ard Wireless Hey>oard and mo"se 1=K 2F2 7*D monitor An>oard 1CID *ontroller and Hot8s0ap dis's o % $- G& #*#I / #C# 1CID81 for (S o ) $00 G& #*#I / #C# 1CID8Des'top P* platform Intel *ore% %.)GH4 :or e@"ivalent;B 10%)M& 1CMB )00G& HDDB DVD81AM DriveB 10/100 3I* Cppropriate $rd party #oft0are :CVB Data>ase; Windo0s LP ProfessionalB M# Affi!e #tandard Hard0are C!!elerator Graphi!s *ard :dedi!ated %+-M& on>oard 1CM; Wireless Hey>oard and mo"se 1=K 2F2 7*D monitor #"ita>le We>8*amera for intera!tion d"rin( Anline 2ele8*ons"ltation Mi!rophoneB #tereo #pea'ers and Headset Peripherals 5 7aser PrinterB )8port <#& H">B et!. 3et0or' devi!e 5 6 port 10/100 M>ps s0it!h and pat!h !a>les % HVC An87ine <P# IP Video *onferen!in( Hit +1% H>ps IP >ased V* "nit $%K 7*D 2V 'with wall mounting +it* 2elemedi!ine *lient soft0are :either of follo0in(; Intera!tive 2elemedi!ine *lient 'with interactive connect to &elemedicine Server* 7o!al We>8>ased a!!ess 'with connectivity to )eb# based Server* 2elemedi!ine #erver soft0are :either of follo0in(; @t: 01

%.

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6.

Intera!tive 2elemedi!ine #erve 0ith We> a!!ess mod"le We>8>ased 2elemedi!ine #erve *onne!tivity devi!e :either of them; I#D3 Modem :0ith 32; CD#7%N / *DMC / P#23 Modem V#C2 #'yIP "nit Wi8MCL *PE Fi>er Apti! *PE Aptionally %/) mod"le ro"ter 0ith items in #.3. 'in case of multiple connectivity medium* In case of ISD lines, dial#up router must be ta+en

01

01

0.*. +ro9osed $rgani7ational +lan 0.*.1. +re9aration o4 In4rastructureA E5-ealth Education and Training Cde@"ate physi!al infrastr"!t"re is no0 made availa>le in many of the r"ral PH*s / *H*s and Distri!t hospitals 0ith World &an' aid "nder Health #ystem Development pro,e!t. Even many distri!t hospitals have no0 advan!ed medi!al e@"ipments in!l"din( *2 s!anB *olo"red Doppler et!. <nder 31HM health 0or'er and professional !apa!ity is >"ildin( "p. Ho0everB Ministry of Health & Family Welfare has to play the 'ey role in ens"rin( e8readiness >oth in terms of physi!al infrastr"!t"re and e health ed"!ation & trainin( at all levels of hospitals >efore startin( !lini!al telemedi!ine pro!ess. 2he >and0idth and !omm"ni!ation infrastr"!t"re is !r"!ial for the s"!!ess of the pro(ram. *omm"ni!ation a(en!ies that have nation0ide footprint :e.(. &#37; need to >e roped in for providin( !onne!tivity at all lo!ation 0ith internal virt"al ro"tes >et0een all "nits. In s"!h a s!enarioB only Jlast mileK !onne!tivity is to >e provided 0hile a nation0ide net0or' is already in pla!e. #im"ltaneo"slyB some Medi!al trainin( instit"te sho"ld also >e made part of the pro(ram to promote *ME and self8pa!ed trainin( pro(ram for Cn(an0adi / lo!al health 0or'ers and do!tors at 7EVE78MB 7EVE781B and 7EVE78%. 2he trainin( !an >e delivered over the same net0or'. 0.*.#. Setting Guidelines 4or Administration and ClinicalA Educational and GoBernance Telemedicine +ractices 2he MoH&FW sho"ld appoint a National %irector :0ith ade@"ate seniority level; for the pro(ram advised / assisted >y a n"!lear e pert panel of people / or(ani4ational representatives e perien!ed in 2elemedi!ine pro(ram plannin( and role8o"t. #imilarlyB a State %irector :0ith ade@"ate seniority level; reportin( to the 3ational Dire!tor sho"ld >e appointed to ens"re smooth role8o"t and f"n!tionin( of the pro(ram. C %istrict %irector at 7EVE781 and 7EVE78M shall ens"re pro(ramIs s"!!ess. 1-

2he n"!le"s frame0or' J$ecommendation on %uidelines, Standards and !ractices for &elemedicine in India.K #pe!ifies vario"s ("idelines that need to >e follo0ed >y all "nits for proper f"n!tionin(. 0.*.&. Identi4ication o4 endor 4or +roCect Im9lementation 2here are vario"s 2elemedi!ine te!hnolo(y providers in the !o"ntry. DI2B M*I2 has f"nded some very s"!!essf"l 2elemedi!ine pro(rams in the nation and may >e !ons"lted on sele!tin( a s"ita>le 2elemedi!ine te!hnolo(y platform for adaptation in the pro(ram. It is important that !hosen te!hnolo(y is s"pported and s"stainedB prefera>ly >y a national te!hnolo(y a(en!yB for the period of pro(ram and >eyond it. An!e the 2elemedi!ine te!hnolo(y platform is identifiedB then sele!tion of other hard0are and soft0are sho"ld >e done in !lose !ons"ltation 0ith !hosen te!hnolo(y provider. Ho0everB a me!hanism of open tender sho"ld >e en!o"ra(ed in p"r!hase of identified hard0are and soft0are. 2he implementin( a(en!y need to have national rea!h and e perien!e in e e!"tin( 2elemedi!ine pro,e!t. 0.*.). Recruitment o4 Technical 2 !edical !an9ower 2he manpo0er employed for the pro(ram are very !r"!ial to the s"!!ess of pro(ram. In !ase manpo0er is dra0n from e istin( stren(th / positionsB a me!hanism of in!entives need to >e p"t in pla!e that 0ill en!o"ra(e staff to en(a(e fr"itf"lly. Cll appointments !an >e on term !ontra!t >asis 0ith periodi! performan!e revie0. 0.*.*. Installation o4 E?ui9mentsA Network !ediaA TestingA Training and -and5 -olding #ite identifi!ationB preparationB and installation 0ill >e ta'en in phased manner. 2he implementer shall provide for at least - months of hand8holdin( to the deployed lo!ation. Hand8holdin( !an >e done remotely. C trainin(B as appropriate a!!ordin( to f"n!tion / roleB need to >e provided to staff on the pro(ram >y implementin( a(en!y. 0.*./. +eriodic !onitoring and +re9aration o4 Interim Re9ort 2he pro(ram dire!tors 0ill >e responsi>le for monitorin( the pro(ram thro"(ho"t its implementation and "se period. 0.*.0. Im9act EBaluation at the End o4 Each "ear and A4ter ,iBe "ear C s"ita>le me!hanism to revie0 effe!tiveness of pro(ram at end of ea!h year and a >road revie0 at the end of + year period need to >e done >y pro(ram dire!tors and report >e prepared for pla!in( >efore MoH&FW.

1.

D. 'U%GET RE@UIRE!ENT 2he pro,e!t needs to >e implemented in phases. D.1. ,inancial Re?uirement 4or +hase5I D"rin( the first phase of the pro,e!tB it is proposed to lin' "p follo0in( in Phase8I9 100 7EVE781 :PH* / *H* / Villa(e; "nits +0 7EVE78% :Distri!t Hospitals; "nits + 7EVE78$ :#tate Hospitals / #"per #pe!ialty Hospitals; "nits +0 Mo>ile 2elemedi!ine Van '10 per District Hospital in program*

2he finan!ial re@"irement of Phase8I 0ill !onsist of the !ost for settin( "p 2elemedi!ine fa!ilitiesB re!"rrin( !ost for operation and maintenan!eB and their !onne!tivity !har(es. D.#. 1E E151 ;+-C 2 C-C 2 illage< Units ,iEed Costs

16

Sl. No. 1. %. $.

Item %escri9tion 1e!ommended E@"ipment

Estimated ;In Ru9ees< Medi!al -B00B000

alue Remarks 2he list of e@"ipment are (iven at #e! ..) May varyB Intera!tive #elf8 #"ffi!ient is ass"med. We>8 >ased mod"le may >e !heaper. May varyB &road>and set"p !har(e ass"med. 2o >e provided >y the hospital !on!erned 2o >e provided >y vendorB hospital >ears !ost of its staff. 2o >e !ond"!ted >y vario"s vendors.

Hard0are / #oft0are :in!l"din( $B+0B00 P* serverB et!.; 2elemedi!ine *ons"ltin( *enter %B00B000 :2** ; soft0are

). +. -. ..

Video *onferen!in( Hit 2errestrial IP :+1% '>ps; s!ala>le

%B +0B000 10B000

7andB >"ildin(B f"rnit"re 0 ele!tri!al fittin(sB fi t"res or any other non ele!troni! item 2rainin( !osts +0B000

6.

Installation & *ommissionin( Total

1B00B000 1*A/FAFFF

Annual Recurring Costs #l.3o 1. Item Des!ription #ite Cdministrator N 2e!hni!ian Cppro imate *ost 1emar's :in 1"pees; $B+0B000 CdministratorP 1s%B00B000 2e!hni!ian P 1# 1B+0B000 1B06B000 Do!tors :01 nos; P +000/month Medi!al staff :0% nos; P %000/month %B00B000 Css"min( 1+E of E@"ipment !osts N s/0 s">s!ription / "pdate )0B000 Css"min( %0E of !osts Css"med &road>and 2o >e provided >y the hospital 1=

%.

Medi!al staff allo0an!e

in!entive

%.

Cnn"al Maintenan!e *har(es Hard0are/soft0are per node Cnn"al <pdate *har(es of soft0are Cnn"al >and0idth per node Ele!tri!ityB other et! / #"pport 2elemedi!ine

$. $. ).

!ost per year +0B 000 !ons"ma>lesB 0

Total ;with incentiBes< Total ;without incentiBes<

0A)DAFFF /A)FAFFF

%0

D.&. 1E E15! ;!o=ile Telemedicine an< ,iEed Costs Sl. No. 1. %. $. ). Item %escri9tion Estimated ;In Ru9ees< C"tomo>ile Van 0ith inte(rated %+B00B000 DG setB >ed and other provisions 1e!ommended Medi!al $-B00B000 E@"ipment Hard0are / #oft0are :in!l"din( $B+0B00 P* serverB et!.; 2elemedi!ine *ons"ltin( *enter %B00B000 :2** ; soft0are alue Remarks

2he list of e@"ipment are (iven at #e! ..) May varyB Intera!tive #elf8 #"ffi!ient is ass"med. We>8 >ased mod"le may >e !heaper. May varyB &road>and set"p !har(e ass"med. 2o >e provided >y vendorB hospital >ears !ost of its staff. 2o >e !ond"!ted >y vario"s vendors.

+. -. .. 6.

Video *onferen!in( Hit 2errestrial IP :+1% '>ps; s!ala>le Van E@"ipment inte(ration 2rainin( !osts

%B +0B000 10B000 1B00B000 +0B000

=.

Installation & *ommissionin( Total

1B00B000 01A/FAFFF

Annual Recurring Costs #l.3o 1. Item Des!ription Cppro imate *ost 1emar's :in 1"pees; #ite Cdministrator N 2e!hni!ian )B)-B000 CdministratorP N Van operator %B00B000 2e!hni!ian P 1# 1B+0B000 AperatorP=-B000 Medi!al staff in!entive / 1B+-B000 Do!tors :01 nos; P allo0an!e 6000/month Medi!al staff :0% nos; P %+00/month Cnn"al Maintenan!e *har(es -B$0B000 Css"min( 1+E of Hard0are/soft0are per node E@"ipment !osts N s/0 s">s!ription / "pdate Cnn"al <pdate / #"pport )0B000 Css"min( %0E of %1

%.

%.

$.

$. ).

*har(es of 2elemedi!ine soft0are Cnn"al >and0idth !ost per year +0B 000 per node F"elB Van maintenan!e 0 Total ;with incentiBes< 2otal ;without incentiBes< 1&A##AFFF 11A//AFFF

!osts Css"med &road>and 2o >e provided >y the hospital

%%

D.). 1E E15# ;%istrict -os9itals< ,iEed Cost Sl. No. 1. %. $. ). Item %escri9tion Estimated Remarks alue ;In Ru9ees< 1e!ommended Medi!al -B00B000 2he list of e@"ipment are E@"ipment (iven at #e! ..) Hard0are / #oft0are 11B+0B00 :in!l"din( P*B serversB et!.; Aptional #tora(e #erver N 6B00B000 &a!'"p 2elemedi!ine *ons"ltin( .B+0B000 May varyB Intera!tive *enter :2** ; soft0are *lient is ass"med. We>8 >ased mod"le may >e !heaper. 2elemedi!ine #erver #oft0are +B00B000 Video *onferen!in( Hit 6B +0B000 2errestrial IP :% m>ps; s!ala>le 10B000 May varyB &road>and set"p !har(e ass"med. 7andB >"ildin(B f"rnit"re 0 2o >e provided >y the ele!tri!al fittin(sB fi t"res or hospital !on!erned any other non ele!troni! item 2rainin( !osts 1B00B000 2o >e provided >y vendorB hospital >ears !ost of its staff. Installation & *ommissionin( %B00B000 2o >e !ond"!ted >y vario"s vendors. Total ;with o9tional items< )GA/FAFFF Total ;without o9tional item< )1A/FAFFF

+. ). +. -. .. 6.

Annual Recurring Costs #l.3o 1. Item Des!ription #ite Cdministrator N 2e!hni!ian Cppro imate *ost 1emar's :in 1"pees; $B+0B000 CdministratorP 1s%B00B000 2e!hni!ian P 1# 1B+0B000 1B06B000 Do!tors :01 nos; P +000/month Medi!al staff :0% nos; P %000/month +B+-B+00 Css"min( 1+E of E@"ipment !osts N s/0 s">s!ription / "pdate %B+0B000 Css"min( %0E of !osts %$

%.

Medi!al staff allo0an!e

in!entive

%.

Cnn"al Maintenan!e *har(es Hard0are/soft0are per node Cnn"al *har(es <pdate / #"pport of 2elemedi!ine

$.

$. ).

soft0are Cnn"al >and0idth !ost per year per node Ele!tri!ityB other !ons"ma>lesB et! Total ;with incentiBes< Total ;without incentiBes<

1B+0B 000 0 1)A1)A*FF 1&AF/A*FF

Css"med &road>and 2o >e provided >y the hospital

%)

D.*. 1E E15& ;State -os9ital 2Su9er S9ecialist -os9itals< ,iEed Cost Sl. No. 1. %. $. Item %escri9tion Estimated Remarks alue ;In Ru9ees< Medi!al 0 3o medi!al e@"ipment

1e!ommended E@"ipment Hard0are / #oft0are 11B00B00 :in!l"din( P*B serversB et!.; 2elemedi!ine *ons"ltin( .B+0B000 *enter :2** ; soft0are

May varyB Intera!tive *lient is ass"med. We>8 >ased mod"le may >e !heaper. May varyB &road>and set"p !har(e ass"med. 2o >e provided >y the hospital !on!erned 2o >e provided >y vendorB hospital >ears !ost of its staff. 2o >e !ond"!ted >y vario"s vendors.

). +. -. .. 6. =.

2elemedi!ine #erver #oft0are +B00B000 Video *onferen!in( Hit 6B +0B000 2errestrial IP :% m>ps; s!ala>le 10B000 7andB >"ildin(B f"rnit"re 0 ele!tri!al fittin(sB fi t"res or any other non ele!troni! item 2rainin( !osts 1B00B000 Installation & *ommissionin( Total %B00B000 &*A1FAFFF

Annual Recurring Costs #l.3o 1. Item Des!ription #ite Cdministrator N 2e!hni!ian Cppro imate *ost 1emar's :in 1"pees; $B+0B000 CdministratorP 1s%B00B000 2e!hni!ian P 1# 1B+0B000 1B06B000 Do!tors :01 nos; P +000/month Medi!al staff :0% nos; P %000/month $B$=B000 Css"min( 1+E of E@"ipment !osts N s/0 s">s!ription / "pdate %B+0B000 Css"min( %0E of !osts Css"med &road>and %+

%.

Medi!al staff allo0an!e

in!entive

%.

Cnn"al Maintenan!e *har(es Hard0are/soft0are per node

$. $.

Cnn"al <pdate / #"pport *har(es of 2elemedi!ine soft0are Cnn"al >and0idth !ost per year 1B+0B 000 per node

).

Ele!tri!ityB other !ons"ma>lesB 0 et! Total ;with incentiBes< 11AG0AFFF Total ;without incentiBes< 1FADGAFFF

2o >e provided >y the hospital

%-

D./. ,inancial Summar: Cltho"(h there are vario"s varyin( !omponents in the tentative >"d(et provisions (iven a>oveB here the ma im"m val"e per "nit is ta'en to 'no0 the e tent of >"d(et. *omm"ni!ation set"p and r"nnin( !ost may !han(e !ompletely dependin( on the type of !onne!tivity !hosen finally. Unit 7EVE78M 7EVE781 7EVE78% 7EVE78$ Total ,iEed .1B-0B000 1+B-0B00 )=B-0B000 $+B10B000 Recurring 1$B%%B000 0.B)6B000 1)B1)B+00 11B=.B000 @t: +0 100 +0 + #F* Total )%B)1B00B000 0=B0)B00B000 $1B6.B%+B000 0%B$+B$+B000 D*A/0A/FAFFF

2he total >"d(et :"sin( ma im"m !omponent valveB e !ept !onne!tivity; !ome to aro"nd Ru9ees Eight5,iBe Crore SiEt:5SeBen 1akhs SiEt: Thousand onl:.

%.