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Virtual Eye Care

Spanco has assisted the Government of Mizoram in rolling out Tele-ophthalmology centers in remote areas of the state. These centers are designed to leverage software solutions that can transmit digital images even over low bandwidth links. By Heena Jhingan

In absence of a strong eye care system in India, nearly 20 mn people are blinded due to age-related conditions such as cataract. Considering the deplorable state of rural healthcare in the country, the Society for Administration of Telemedicine and Healthcare Informatics (SATHI) and the Government of Mizoram have come together to deploy Tele-ophthalmology services for preventive and primary eye care in three districts of the state.

These centers are envisaged as the next generation delivery points for eye care services provided by the state. They are part of an outreach program to provide medical help to citizens in remote areas and specialized support for improvements in overall health. Citizens do not have to travel far to avail of primary healthcare services. The project caters to a population of about 10,88,573 spread across 26 Blocks. A total of eight Tele-Ophthalmology centers are planned to be set up in Aizawl, Champai, Lunglei, Serchhip, Lawngtlai, Saiha, Kolasib, and Mamit in the first phase, of which three have already been rolled out.

"We use software to compress images that can easily be sent using basic data card connectivity." Rajiv Aggarwal CEO, E-Governance, Spanco

“The Tele-ophthalmology center facilitates eye examination for the rural citizen. Over the next few months, with an increase in awareness, these centers will help screen 5,200 citizens every day. Ophthalmologists at the central facility of the State Government will provide specialized care by catering to the needs of these rural citizens from the telemedicine OPD at Aizawl,” informed Rajiv Aggarwal, CEO, E-Governance, Spanco.

Spanco will be providing both the physical and the IT infrastructure that is needed to run the centers.

Dr. SB Gogia, President, SATHI, said that government had an outlay of nearly Rs 200 crores for Telemedicine but that most initiatives were designed to suit the comfort of the doctor rather than that of the patients.

“Technology contributes just 20% to the success of a telemedicine project. The rest depends on the operations and processes. The system has to be grounded,” he stressed.

That’s why the Spanco-Sathi team decided to not to invest in sophisticated imaging devices, which require high bandwidth for data transmission. “The spirit of the project is to take eye care services to areas battling with connectivity issues. We use software solutions to compress images that can easily be sent using basic data card connectivity and what sets this move apart from the other initiatives is the fact that this is a statewide system, which can be scaled up to the cover the entire country,” explained Aggarwal.

There are basically two ways to share data—live transmission or using it offline. A videoconferencing or telepresence solution would be a costly solution requiring a great deal of bandwidth making it inappropriate for a connectivity starved rural region. For live transmission, the teams are using Web sites such as teamviewer.com and livestreaming.com and other data is stored on the desktop for offline usage. The images are compressed to the JPG2000 format, which is a world standard that is good enough for consultation.

“The government has long term plans to connect far-flung areas. There are plans to use WiMAX and Fiber Optic connectivity for remote areas. “However, these projects will take another three to five years to deliver results. We intend to present this initiative as a case to the government that telemedicine delivery is possible using simple solutions and that, once the connectivity issues are resolved, these centers can be upgraded to sophisticated equipment. Meanwhile, centers like these can help raise awareness of Telemedicine and give healthcare services a taste of the technology,” Aggarwal reasoned.

As most Indian states were coming up with SWANs, the centers could be connected using these networks once they were in place.

A large number of link workers are required to raise awareness amongst people in these districts. Some of these have already been identified. Most are workers who are active in the women and child care space; it will be much easier for them to reach out to the people in the district.

Aggarwal of Spanco explained that a center of this kind was quite similar to a Common Services Center conceived under the Government's National e-Governance Program ( NeGP). The idea behind the NeGP is basically to develop a pure-play services distribution network. So, the thought behind this kind of a Tele-ophthalmology center is to develop it in to a delivery point of health and other related services.

“Centers like these will create a huge pool of data about patients, this data mine can open newer avenues for other stakeholders like health insurance companies, pharmaceutical companies and private healthcare institutions,” he said.

“Besides, these centers can be become a frontline system to tackle disaster situations,” he added.

As of now, the team is using the Sybase database engine to meet its storage requirements and this will consider consolidation depending upon the storage requirements.

At present the Government has extended Rs 65 lakhs and the premises to set up the three centers. Going forward, the Spanco-Sathi alliance has plans to scale the project to other areas including dermatology and Oncology, particularly in Aizwal, which is India's cancer capital. At present, Aizawl district has the maximum number of cancer cases in the country at 249.5 per 100,000 in males and 210 per 100,000 in females, and proper screening infrastructure for the disease is yet to take off. Centers of this kind can go a long way towards meeting the screening requirements.

heena.jhingan@expressindia.com