Project HopeProject Hope::Telemedical Linkage between District and Teaching

Hospitals in Sind.

Dr. Mohammad Ali Malik

Jinnah Postgraduate Medical Centre

Karachi, Pakistan.

Total area: (803,940 sq km)

Population (2006 est.): 165,830,560 (growth rate : 201% about 60% population is rural

Population density per sq mi:551 (asymmetric spread)

Basic Health UnitTehsil Heath UnitTalqa Hospital District Health UnitTertiary Hospital

No of Doctors 128,.000No of Specialist 18,500Distribution uneven

Pakistan: Geography, Demographics andHealth Scenario

Table of Contents

� Telemedicine an Hope

� History of Telemedicine in Pakistan/Sindh

� Network

� Sites

� Connectivity/Communication

� Infrastructure

� Technical Facilities

� Method Adopted

� Project Management

� Sources/Progress of TM

� Future of Telemedicine

Telemedicine an Hope

� Telemedicine projects are meant to assist the government in Transforming delivery of healthcare services and making them available at the door-steps of common man, through the use of information and communicating technology as a solution. The project proposed with the objective to provide people lining in rural,. Remote areas of Pakistan. By consultation, advice and treatment form specialist doctors based in urban center hospitals, through Tele-Diagnosis/Consultation and Tele-Treatment.

History of Telemedicine in Pakistan/Sindh

� Initiative of Telemedicine in Pakistan

� The concept introduced by NGO’s as a partners in local hospitals.

� To expend healthcare in rural/remote area government focused on Telemedicine in year 2000.

� In commencement store and forward system applied

� On availability of multiple sources of bandwidth including national satllite the Ministry of IT interest started in 2005.

� At moment Pakistan is conducting Telemedicine via satllite as wall as landline (ISDN BRI)

� In Sindh pilot project launched in 31st April 2005 with collaboration of Sindh Government, Engro Chemical. Under the chairmanship of Prof. Rashid Jooma head of Neurosurgery JPMC Karachi at present DG Health Islamabad Pakistan.

Network

� PAKSAT – HealthNET

� Sites: PAKSAT HealthNET is designed as a pilot project has infrastructure linking three urban hospitals with twelve hospitals in rural/remote areas.

� Number of rural sites are covered in each province under this project are as follows:

� Sindh (JPMC)� Shikarpur, Gambat, Jacobabad, Mithi

� Punjab I (Holy Family Rawlapindi)� Attock, Khoshab, D.G Khan & Pindigheb

� Punjab 2 (Meo Hospital Lahore)� Jhang, Gujrat, Sahiwal & Rajanpur

Technical Facilities

1- D.G. Khan2- Pindi Gheb3- Attock4-Khushab

1- Sahiwal2- Rajanpur3- Jhang4- Gujrat

1- Mithi2- Jacoabad3- Shikarpur4- Gambat

Holy Family HospitalRawalpindi

Mayo Hospital Lahore

Jinnah Hospital Karachi

Holy Family HospitalRawalpindi

Mayo Hospital Lahore

Jinnah Hospital Karachi

30:70 Divide

30% Urban Area

Concentrated Healthcare Resources

Majority of the population without health services

70% Rural Area

Connectivity/Communication Sindh

� JPMC as a Hub is connected with referral spokes by:

PakSAT 1 ku band

Landline ISDN BRI

� 4 spokes are connected by PakSAT connectivity like

Jacobabad, Shikarpur, Gambat, & Mithi

� Rest 4 are on ISDN BRI line like Ghotki, Mirpurkhas, Sanghar

& Shadadpur

� 512 kbps full duplex data connectivity being provided

between Hub & Remotes.

� PakSAT bandwidth offering by Ministry of Information &

Technology services free of coast for all 4 spokes

Internet

Telemedicine Referral Unit

Gambat Institute of Medical

Sciences (GIMS)

Telemedicine Referral Unit

District Headquarter Hospital Shikarpur

(DHQHS)

Telemedicine Center

Jinnah Post Medical Center

Karachi

(JPMC)

First Telemedicine Pilot Project

For Sindh on Internet

HUB

Spoke 01

Spoke 02

Ranking of

Sindh District

Telemedicine Center

J P M C, Karachi

First Telemedicine Pilot Project

For Sindh on (ISDN BRI)

HUB

Our 08 Spokes

Shikarpur June 2005

Gimbat June 2005

Jacobabad June 2006

Ghotki June 2006

Mirpur Khas July 2006

Sanghar February 2007

Shahdadpur February 2007

Mithi January 2008

Hub with

Referral Units

Technical Facilities Hub/Sites

� Server Dell PowerEdge 2950

� Desktop computer Dell Core Duel Intel R

� TM software for database of Patients

� Digital ECG Machine

� Digital stethoscope

� Compaq video Otoscope

� Digital Camera

� X-ray scanner

� High Definition Video conference

equipment (Router, Pollycom cameras

VSX 7000, LCD Screen 32”

� ISDN lines linking sites

� TM software for database of Patients

� Digital ECG Machine

� Digital stethoscope

� Compaq video Otoscope

� Digital Camera

� X-ray scanner

� High Defination Video conference

equipment (Router, Pollycom cameras

VSX 7000, LCD Screen 32”

� ISDN lines linking sites

� Sites� Hub

In telemedicine, information moves rather than the patient

Video conference between Hub and referral spoke

Prof. Rashid JoomaProf. Rashid Jooma

1st Referral spoke Shikarpur

“Referral Connectivity ”

Regular Consultant forVideo Conference

Medicine Prof. Muneer AhmedDr. Qurban SheikhDr. Kirpal Das Makheja

Dermatology Prof. Azam SamdaniDr. Nadeem AhmedDr. Samira RizwanDr. Sobia Liaquat

Neuro Medicine Dr. Shaukat AliDr. Khalid SherDr. Santosh Kumar

Epilepsy: Dr. Fozia Siddiqui

Pediatric Prof. Zeenat EssaniProf. Afroz RamzanProf. Abdul Ghaffar NagiDr. Khalid MehmoodDr. Deedar JunejoDr. Aatif Saeed Anjum

Gynae & Obst. Dr. Razia Kirojo

Dr. Haleema

Dr. Pakeeza

Chest Medicine Dr. Nasir Hussain

Psychiatry Dr. Iqbal Afridi

Neuro Surgery Prof. Rashid Jooma

Dr. Sattar Hashim

Nephrology Dr. Manohar Lal

Dr. Manan Juneju

Dr. Kaneez Zehra

Total Numbers of Patient, 2005 to2007

4612

3212

0

1000

2000

3000

4000

5000

1

Male Patient

Female Patient

Dermatology

Dermatology

25

2100

5200

0

500

1000

1500

2000

2500

3000

3500

4000

4500

2005 2006 2007

Dermatology

6000

Medicine

Medicine

13

580

1230

0

200

400

600

800

1000

1200

1400

2005 2006 2007

Medicine

Neurology

Neurology

8

97

488

0

100

200

300

400

500

600

2005 2006 2007

Pediatric

Paeds

35

74

339

0

50

100

150

200

250

300

2005 2006 2007

400

TELEMEDICINE CENTRE,JPMC. NUMBER OF PATIENTSJAN TO DEC 2007

0

200

400

600

800

1000

1200

1400

1600

1800

RBUT GIMS MPK JCD GHK SNG SHD

Referred case from spoke to tertiary hospital

Achievement

Project Management

Future plan TelemedicineSindh

Province

Sub HubNAWABSHAHKandyaroNow Shero FerozSakrandMoro

JAMSHORODadoSehwanUmerkotBadin

LARAKANAShahdadkotNow DeroRato DeroDokri

CME

Prof. Elahi Bux Soomro HOD, Medicine, Civil Hospital,Karachi.

Prof. Zeent Essani Ex. Director, NICH

Prof. Muneer Ahmed HOD, Medicine, JPMC

Dr. Waqaruddin Ahmed PMRC

Dr. Asghar Channa Deptt of Surgery

Dr. Ahmed Usman Deptt. Of

Dr. Rizwan Memon L.N.H

Dr. Azam Shafquat NICVD

Dr. Huma Qurashi PMRC

Major Achievements through Telemedicine

� Teleconsultation

Bridging the gap between highly trained healthcare

providers and patients & local healthcare providers

CME

By educating the physicians at the spokes in remote

areas raising their level of competence & expertise

allowing them to provide healthcare services at a

better level than before.

Conclusion

Telemedicine holds an exciting promise of improving healthcare in lesser developed medical systems by linking outlying and referral centers in a network of information flow directed to enhanced service provision to the patient and continuing education for the physician.