Advanced Communication Technologies for Collaborative Learning in Telemedicine and Tele-care

Telemedicine is the use of Information and Communication Technology (ICT) in health ecosystem with a provision of visual communication, patient data transfer & collaborative learning. Government of India is actively taking initiatives for establishing digital high-speed internet connectivity though National Knowledge Network (NKN), State Wide Application Network (SWAN) & National Optical Fiber Network (NOFN) to super-specialist center, medical colleges, research organizations, Primary Health Center (PHC)/ Community Health Center (CHCs) up to block level and panchayat levels. Wellness centers and 'DigiGaon' bring digital inclusion and it enables people in rural areas to be able to access services like telemedicine and skill enhancement with the use of digital technologies. High-speed fiber-optic based internet bandwidth has deployed under NKN in as many as 250 medical colleges around the country. Many medical institutions have migrated to NKN to enhance their capacity of telemedicine activity using telemedicine platform funded by central and state government agencies. Majority of telemedicine in India funded by Ministry of Health & Family Welfare (MOH&FW) for interlinking Medical Colleges across the country with the purpose of education and National Rural Telemedicine Network (NRTN) for Healthcare delivery under National Health Mission (NHM), National Medical College Network (NMCN) and other public private partnership (PPP) models. Medical super-specialty institutes for the National Resource Centers (NRCs) and Regional Resource Centers (RRCs) for NMCN has defined and medical colleges will soon link to RRCs. India has diversified geographical region with availability of variable bandwidth in different part. Remote PHC/CHCs located outside city has bandwidth issue whereas majority of medical hospitals in the city has high-speed internet bandwidth. Video solutions given by hardware vendors and software vendors needs to be collaborate centrally which enables users to connect even with lower bandwidth or with the use of high-speed broadband (HSB) mobile dongle. It increases the reach to the remotest place in India through any of the available platform (Desktop, H.323 device, Android or IOS smart phone etc). Recording and streaming integration with video collaboration enhances the purpose of sharing the medical educational content during or after e-CME/ workshops/ seminars with remote doctors. Entire collaboration solution thus need direct content sharing, mobility, recording and reporting with support for multiple input sources from cameras, X-Ray, CT-SCAN, fundus camera, ultrasonography etc. Broadcast link needs to share simultaneously to multiple users and connectivity thus follow confidentiality, security and traceability with the usage of video firewall in data center. Traffic routed from outside the institute needs to convert in local IP pool through port address translation called Network Address Translation (NAT) for allowing traffic from known protocols like Internet Control Message Protocol (ICMP), Transmission Control Protocol/Internet Protocol (TCP/IP) and User Datagram Protocol (UDP). The video collaboration telemedicine infrastructure were created at STBMI, SGPGIMS, Lucknow internetworking with Integrated Operation Theatre for live sharing, Medical Telepresence Room for sharing live surgical skill during workshop, e-Tumour Board for discussion between multiple specialties departments from different hospitals, 3D Lecture Theater for sharing medical CMEs created for sharing knowledge resources with networked institutions.