Medical Knowledge Management over NKN

Infrastructure & Process

SGPGI, Lucknow Case Study

Prof. S K Mishra, MS, FACS

Head, Dept. of Endocrine Surgery &
Faculty I/C, SGPGI Telemedicine Programme
Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS)
Lucknow, India
Email: skmishra@sgpgi.ac.in or skmishra_1956@yahoo.com

www.sgpgi-telemedicine.org | www.stbmi.ac.in | www.nrct.in

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Agenda
• Infrastructure & Operation
– Physical (Collaborative Knowledge Exchange Environment)
– Technical (ICT, A/V, Content Development)
– Human Resources
• Knowledge Management Modules
• SGPGI Knowledge Management SOP
• Usage Statistics (1999 ~ 2012) – NKN
Component (2010 ~ 2012)
• Conclusion

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 SGPGIMS – National Knowledge Network Partners

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 International Partners

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 SAARC Telemedicine Network

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 PAN Africa e-Network

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Technical Infrastructure
• Video Conference Suites (Point to Point & Point to Multi-
point)
• Integrated Networked Lecture Theatre/ Auditorium
• Surgical Telepresence Suite
• Digital, Integrated Operation Theatre
• Desktop Videoconference Enterprise
• Mobile Telemedicine Kiosk
• Telemedicine Network Operating Center
• Studio
• Knowledge Processing Edit/Voice Over
• Medical Data Center
• Advance Multimedia & Animation Lab

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Point to point Video Conferencing Suite

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Point to Multipoint Video conferencing Suite

Ongoing conference using TEIN Network with

Dept. of Medical Genetics in Multi party session
Nepal & Thailand

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Integrated Networked Lecture Theatre/ Auditorium

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Production Control Room & Master control Room

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Surgical Telepresence Suite

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Digital, Integrated Operation Theatre

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Desktop Videoconference Enterprise

Participation in Asia Pacific Advanced Network (APAN) using

Software based Video Conferencing
© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Mobile Telemedicine Kiosk
(Operation using Hospital LAN)

Mobile kiosk @ Patient’s bedside Doctor’s Duty Room

Department’s Seminar Room Tele-Clinic in Out Patient Department

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Telemedicine Network Operating Center

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Studio & Production Control Room

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 PAN Africa eNetwork

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 SAARC Telemedicine Network

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Knowledge Processing : Editing/Voice Over

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 SGPGI Knowledge Engineering Architecture

Knowledge Processing Edit/Voice Over

Broadcast Quality Studio Camera
Hi-Tech Lecture Theatre

Network Monitoring Hub

Integrated Operation Theatre

Production Control Unit (PCR)

© SGPGI, Lucknow First NKN Annual Workshop Edit

Video Conferencing Suite "The e-Infrastructure of India" ; 31-1Data
Stations November
Server 2012
 Data Center (National Resource Center)
Hospital Backup Servers

Web Servers, Mail Servers

Proxy Servers

Application Servers

Data & Video Storage

Video Bridge RMX 2000

Streaming Server RSS 2000

Video Scheduler

Wide Area Application Server (WAAS)

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Intra-Hospital Telemedicine Network

• Riding over Hospital Information System Network

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Nephrology Endocrine Surgery Radiology Tele-Clinic

SGPGIMS
Telemedicine
Neurology Mobile Kiosk @ WARD
HUB at
School of Telemedicine &
Biomedical Informatics
(STBMI) Mobile Kiosk @ Doctor’s Duty
Nuclear Medicine Room

OT Cafeteria Immunology Pathology Radiotherapy

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Human Resources
Designation Current Positions at STBMI

Telemedicine Network Manager 01

Telemedicine Program Manager 01
Telemedicine Program Coordinator 01
Web Designer & Developer 02
Digital Medical Illustrator 01
Content Developer 02
Network Engineer 02
Human Resource Manager 01
Assistant Librarian 01
Telemedicine Technical Assistant 06
Tele-Communication Assistant 02
Driver 01
Office Assistant (Multi-tasking) 03

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Knowledge Management Modules
• Knowledge Portal
• Tele CME
• Tele-Surgery, Tele-Pathology, Tele-Radiology etc
• Tele-Conference/ Workshop/ Seminar
• Departmental Knowledge Content Storage & Archive
• Clinical Decision Support System (CDSS)
• Remote Assistance in Pre-intervention Plan & Intra-
intervention Mentoring

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Process
• Scheduled Basis
– National , SAARC, Pan-Africa
• Real Time & Interactive
• Webcasting, Video on Demand
• Web-Streaming
• Webinar

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Live streaming of surgical video

Live streaming of surgical video at doctor’s workplace

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Mobile Learning

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Evolution of telecom infrastructure at
SGPGI Telemedicine programme
Communication Bandwidth Year Network / Source
ISDN Lines 384 Kbps 1999 Institute Resource
ISRO VSAT 256 Kbps 2003 Orissa Telemedicine
Reliance 1 Mbps 2006 Raibareli District Hospital under
GAIL CSR
BSNL 512 Kbps 2008 SAARC Telemedicine
Railtel 1 Gbps 2010 National Knowledge Network
BSNL- Fiber to 100 Mbps 2010 Institute Resource
Home (FTTH)
AirTel 2 Mbps 2011 Pan-African eNetwork

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 SGPGI Knowledge Management SOP
• Agreement with partner on schedule and content
• Daily Testing of the network & Platform with
partners
• Reminder to both remote partners and the SGPGI
Faculty a day before
• Archival of the content
• User feedback session wise both in technical and
content quality and benefit thereof
• Maintenance of the Log Book & Weekly review

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Usage Statistics (1999 ~ 2012)
from 1999-2012 (without NKN) using NKN (2010-2012)
600 572
550
500
450
400
349
350
300
250 205
200
150
100
51
50 27
8
0
Tele-Education Teleconsultation & CME Transmission
Followup

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Statistics in Detail (1999- Aug. 2012)

Activities Number of Sessions

Tele-Education 572
Tele-Followup & Consultation 205
CME Transmission 27
Total Sessions 804

Description Number of Hours

VC hrs for Trial Testing 1500 Hrs

Session hrs 1824 Hrs

Total Hrs 3324 Hrs

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Usage Statistics with NKN (2010-2012)
Activities Number of Sessions
Tele-Education 349
Tele-Consultation & Tele-followup 6
CME Transmission 51
Total Sessions 406

Description Number of Hours

VC hrs for Trial Testing 740 Hrs

Session hrs 865 Hrs

Total Hrs 1605 Hrs

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 E-governance
(UP CPMT Counseling)
Year First Phase Second Phase Third Phase Days Hours of Video
conferencing in
Multi Point Conferencing
2011 12 -28 July 05- 13 Sept 17 to 18 Nov 26 Days 260 Hrs
(16) (08) (02)

2012 16 -24 July 5 – 18 Sept 21 Days 210 Hrs

(08) (13)

470 Hrs.

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 CPMT 2012 Counseling

© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Conclusion
• Knowledge engineering and technology infrastructure constitute one of the major
component of Knowledge creation and it’s usage in an institutional set up
• Content development starting from capture to final product involves complex interplay of
actors and network
• Managing the content in an enterprise involves issues beyond technology e.g. social, ethical,
ownership etc.
• SGPGI case study aims at sharing the journey over a decade in developing knowledge
management infrastructure which is still in progress
• Provision of high internet bandwidth from NKN is facilitating the institution vision in
knowledge sharing
• As the infrastructure is getting ready in managing big data (medical image, skill videos, 3D
animated contents for VR & simulation based learning, Avatar and games for health
technology adoption for e-learning) high performance computing and network would be
needed
• Though cloud based e-learning technology is coming up in health domain, GRID is still
needed for managing big data of medical educational content over an enterprise such as
national medical college network
© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012
 Thank You
www.sgpgi-telemedicine.org | www.stbmi.ac.in | www.nrct.in
© SGPGI, Lucknow First NKN Annual Workshop "The e-Infrastructure of India" ; 31-1 November 2012