Role of Telemedicine in Primary Healthcare and
Practical Aspects of Setting Up a Telemedicine Centre

MANU MANAMEL, ARIJIT SARKAR

Processes Involved in Setting up a Telemedicine Centre

Setting up a telemedicine centre can turn out to be a very complex process if proper planning is not done in terms of the infrastructure that has to be set up.

The client and the service provider identify the 4 stages in the setting up of a telemedicine centre.

  • Identification of the goals and objectives.
  • Pre-implementation phase.
  • Implementation phase.
  • Post-implementation phase.

Identification of the goals and objectives

In the first phase, inputs are taken from the client to identify their expectations from a telemedicine centre. The proposed site can be visited and an estimate regarding the following can be made.

  • Assessment of the requirement and viability.
  • Draw up a viable business plan.
  • Selection of the appropriate site.
  • Assessment of the human resources required.
  • Decide on the form of connectivity.
  • Selection of the appropriate diagnostic devices to be installed.
  • Detailed plan of the logistics involved.
  • Document the client’s responsibilities.
  • Draw a timeline for the project.
  • Draw a contingency plan in case of delays and obstacles.
  • Draw the detailed operational plan.

All the above detailed plans would be included in the ‘Project Proposal’. The client can suggest changes to be implemented on specific issues in the project proposal. After settling these issues through discussions, the MoU is signed if the client is satisfied with the proposal.

Pre-implementation phase

The client is informed of his responsibilities and the roadmap that the project would take. This would include:

  • Making arrangements for the local infrastructure like power, airconditioning, positioning of the devices in the rooms.
  • Documentation for transportation of the equipment and their installation.
  • Interaction with the authorities and local government.
  • Allocation of human resources such as TCC doctors, centre coordinators and technicians for the telemedicine centre.
  • Training of the above-said staff members.
  • Purchase of the equipment.
  • Getting the approval for connectivity.
  • Customize the software for the project.
  • Testing and cross checking of the hardware and the software.
  • Make connectivity available to the TSC or any other test site.
  • Double check the security protocols.
  • Monitor the progress made at the TCC site.
  • Pack the equipment for transportation.

Implementation phase

This phase includes the following activities.

  • Delivery of the equipment.
  • Installation of the equipment.

Generally the videoconferencing equipment (VCE) is installed first and the connectivity link made (via ISDN, VSAT, broadband). The rest of the equipment are also installed subsequently. At each stage, the functionality of the equipment must be cross-checked.

The interior of the telemedicine centre can vary from one place to another but the following guidelines act as a framework in designing a telemedicine centre.

General requirements

(As laid down by ISRO)

  • The room should be at least 250 – 450 sq feet big in area. It is preferable to have the room in a part of the hospital which handles less traffic and is less noisy. The telemedicine room should have facilities to accommodate 2 desktops of 17’’ monitor, printer and equipment for satellite connectivity. There should be adequate facilities to house the diagnostic equipment such as X-Ray scanner, ECG and pathological microscope. If the centre is to be used for CME, a bigger room may be required to accommodate all the participants and to install a bigger television (29" size).
  • The room at the patient end should be at least 15’ x 30’ in size. At the doctor’s end the size of the room should be at least 12’ x 20’. In case of Medical College Hospitals, the room should be the size of a classroom (30’ x 50’) with good audiovisual aids. The temperature should be maintained at 18 – 25° C preferably using split A/C to reduce the background noise.
  • There should be provision for power supply in emergency situations. The UPS should be of 3KVA capacity.
  • The room should have good sound absorbing properties for hassle-free videoconferencing.
  • The curtains and the walls should be light in colour, preferably light blue or gray, to provide good contrast during videoconferencing.
  • The room should be well-illuminated to provide good picture view during videoconferencing.
  • Whenever VSAT is used, the size of the antenna should be 1.8m in diameter for remote locations and 3.8m in diameter at specialist locations. The weight is 500 – 2000 kg. The antenna is mounted on the roof of the building within a distance of 40m cable length from the room. If it is not possible to mount the antenna on the roof, it can be installed on the floor on a concrete base.
  • There should be no obstruction in the field of view of the antenna. No HT/LT power cables should interfere in antenna’s field.

Once the equipment have been installed, try and establish the connection with the test centre. At least 10 consult requests have to be sent with different file sizes and the results analysed for errors. This ensures the readiness of the system for ‘store and forward’ mode. Next, the equipment for the real time viewing should be tested. The quality of the video as well as the frame rate and clarity of the sound have to be evaluated. The real time output of data from diagnostic devices such as ECG, microscope, ultrasound, X Ray scanner should also be tested.

The staff at the TCC can be trained on the equipment by doing several dry runs using patient and non-patient data.

Post-implementation phase

The telemedicine service provider (TSP) staff usually conducts a ‘hand holding period’ when they observe the TCC staff operate the devices and suggest corrections if necessary.

Telemedicine software is usually capable of connecting to most of the equipment. Some amount of training may be required to be given to operate such equipment.

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