Workshop on "Telemedicine for India" DEC 15,2011

Health has become a major issue of concern with rising population, rising middle class segment, rising diseases and deteriorating infrastructures in India. 25% of the Indian population has access to Western (allopathic) medicine, which is practiced mainly in urban areas, where two-thirds of India’s hospitals and health centers are located. Many of the rural poor must rely on alternative forms of treatment, such as ayurvedic medicine, unani and acupuncture.

25% of India’s specialist physicians reside in semi-urban areas and a mere 3 % live in rural areas. As a result, rural areas, with a population approaching 700 million, continue to be deprived of proper healthcare facilities.. Percolation of health care services in India is, perhaps, following the foot prints of cellular services rollout (between 1995-2005) where most of the telecom service providers concentrated their resources in urban and Semi urban areas with “areas’ revenue generation capability” as single major factor. Increasing middle class population with their improved economic conditions has increased heath care demand in urban and semi urban area which has further resulted into increased “health care service delivery gap” between urban and rural. India’s healthcare infrastructure has not kept pace with the economy’s growth.

The physical infrastructure for health serive delivery in India is woefully inadequate to meet today’s healthcare demands, much less tomorrow’s and will need finite time to reach a reasonable level. But, there is an urgent need to identify and implement required resources and strategy for bridging health care service delivery gap in urban & rural area.

One solution is telemedicine— the remote consultation, diagnosis, monitoring and treatment of patients via videoconferencing or the Internet, training/education and management of medical service providers in rural area. The exponential growth in the country’s information and communications technology (ICT) sector, and plummeting telecom costs has made telemedicine as one of the viable strategy for bridging health service delivery gap between urban and rural.

Thus a logic consequence is having a common communication plate-form for health professionals, Governance, and technocrats to deliberate on the best practices and customize befitting telemedicine solution for India – a role RESPECT will play again in workshop on “teledicine for India” on 15th Dec 2011.

PROGRAM SCHEDULE

15TH Dec 2011 : 1030 AM Inauguration & Tea
1045 AM: Keynote - Sh. Rajesh Kishore, IAS, Principle Secretary (Health)
1115 – 1315: AM Brain storming session on “Telemedicine in India” – what we have and
what we Need!

Expert Contributors:

Prof.K.V.Ramani,(IIM-A),Prof.Dilip Mavlankar(TBC*), Rama Subramanian (BioPure HealthCare), S.N.Gupta (British Telecom), Dr R K Dave, Dr. Tejas, Dr. Anil N Ved, Mr. A K Gupta, Mr. Chandira, Dr. Srikant (A3 RMT), Monika setia (IIPHG ), Mr. A K Kaul, Devan Parikh, Shard Raval, and other invited exerts and officials from health care and Governance

Subjects / issues

Current approach to Telemedicine, learning’s from experimentations done
so far, Emerging Trends, Bottlenecks and limitations, possible approach of
“Telemedicine for India with Gujarat as a pilot state”

1315 PM Recommendations / Conclusion
1330 PM Vote of Thanks
1330 PM Lunch
1430 PM On wards - Technology Display / Demonstration

*TBC- To be confirmed

“Neighborhood Watch” - A New Role of Community’s in Managing Terrorism

Increased sensitivity to terrorism has changed vulnerability map of each state in India, specifically Gujarat, Maharastra, Andhra, Tamilnadu, Kerala, Orissa and Goa. These states already have undue share of natural hazards and suffered maximum compared to any other state in India.

The current situation demands extensive intelligence information on “suspected elements” from every where in the state as a “preventive measure”. Although state and central agencies has their intelligence gathering system, but such systems suffers from physical limitation and can not cover each and every corner of state geography. We need to cover one and all at this point for identification and early interception of unwanted.

As a patriotic citizen and knowledge expert clandestine operations, (physical safety, security and emergency management) – I consider it my duty and feel obliged to submit my thoughts and perception of the current situation, as given below.

Each State should announce / notify state wide “Neighborhood watch”
Involving “community” is the only way for gathering information from each street in any city / town and I submit that – state wide announcement / notification should be made requesting one and all to start “neighborhood watch” and report unusual activity / movement of unknown person in their respective area to the “District fusion center” on given numbers.

In addition to radio and TV announcement for “neighborhood watch” – posters should also be pasted in street corners for “neighborhood watch” and instructions.

Establish “District Fusion center”
All district police control should also work as “district fusion center” with a toll free number or even they can use exiting number 100 for reporting unusual activity or person seen in neighborhood. Based on the size and complexity of district geography – the competent authority may plan and establish a “validation mechanism (intelligence acquisition, analysis, decision and dissemination)” for all incoming calls.

The “State fusion center’ at capital HQ should get all incoming calls through a mirrored recording system from all district. The state fusion center should also have “hot line (no dialing)” connection with the districts fusion centers.

Enforce “enhanced check post surveillance”
Strict boarder securities and surveillance is the first step for intercepting unwanted elements early. Check post surveillance is easy to enforce and manage and perhaps the nest way to ensure safety and security of people and property in the state. My suggestion would be that – video surveillance system with programmed analytic application be installed at all strategic points connected with district fusion centers.

This is important that effective information validation mechanism is planned and put in place so as people can be cleared quickly at entry points and do not feel harassed. State wide – “Neighborhood watch program” will not only enhance and improve overall resiliency of the state, but will provide an opportunity to common man to inculcate much needed awareness on the subject of terrorism.

Best regards.

State Wide Area Network (SWAN) vs State Emergency Response Management ICT Networks

SWAN BACKGROUND:

State Wide Area Network (SWAN) has been identified as one of the Mission Mode Projects under the National e-Governance Plan by Department of Information Technology, Govt. of India (DIT, GoI) to increase transparency, efficient and effectiveness for delivery of citizen services.

Under the central guidelines State Wide Area Network (SWAN) is to be designed to works on the PSTN leased circuits for vertical / horizontal connectivity at State HQ, District HQ and Taluka HQ level. DIT, GOI, support will cover the entire cost of establishment, operation and maintenance of the SWAN for a period of five years on 100% grant basis. The State Wide Area Network (SWAN), under the policy announced by Government of India, are implemented on PPP model (BOO, BOOT etc.) by selecting an appropriate agency through a suitable competitive process for outsourcing establishment, operation and maintenance of the Network under appropriate SLA (service Level Agreement).

SLA typically guarantee availability as the percentage of time a circuit or a link is up over a specified time period. If the SLA specifies 99 % uptime averaged over a month, for instance, circuit or link can be down for seven hours before the service provider can be accused of SLA non compliance.

Typically Sate WAN – SLA allows network outages during natural and other disasters. Events of Force Majeure defined in the State Wide Area Network SLA generally include:

(i) Blockade, Revolution, Riot, Bombs, Religious strife or Civil commotion;
(ii) Strikes, lock-outs or other industrial action (other than those involving
primarily Service Provider’s own employees or any of the contractors, sub-contractors, etc. directly associated with the provision of Services under this Agreement)
(iii) Act of war (whether declared or undeclared), terrorist or military action,
politically motivated sabotage;
(iv) A decision or the order of a court or tribunal, which has the effect of
restraining or delaying the provision of Services;
(v) Explosions, accident, breakage of facilities, plant or equipment, structural
collapse, fire chemical or radio active contamination (other than resulting from an act of war, terrorism or sabotage), caused by a person not being the affected Party or one of its contractors or sub-contractors, sub-lessees or any other agencies of the affected Party or any of their respective employees, and not being due to inherent defects of the affected facility of the failure to properly operate the affected facility;
(vi) Fire, lightening, earthquake, tempest, cyclone, hurricane, whirlwind, flood,
landslide or any such natural disaster;
(vii) Epidemic or plague;
(viii) Any event or circumstance of a nature analogous to any of the above or any natural disaster.

The State Wide Area Network design allows service disruptions during above exceptional emergencies or events. Design criteria for disaster response communication network are absolutely different from the criteria adopted for SWAN design as “continuous availability of communication channels” is more crucial during Force Majeure conditions then that of normal or study state situation.

ICT INFRASTRUCTURES FOR EMERGENCY RESPONSE MANAGEMENT:

The basic necessarily for effective functioning of network of EOCs – is the robust and fail safe communication network which can sustain blows of sever incidents and in case of outages can be turned around in bare minimum time. These networks are immune to disasters. In addition – portability should be inherent character of the emergency response communication system. PSTN: The weakness and vulnerabilities of Public switched terrestrial mobile and broad band networks, faced with disaster, have been reveled in natural and man made crises.

PSTN backbones are designed to work under normal circumstances and fails with even minor environmental stress – viz- prolonged power outages, water flooding or fire. SWAN: State WAN works on PSTN backbone and hence are equally vulnerable to sever incidents. SWAN is designed to work during normal conditions and such designs are not resilient to disasters due to economic and other considerations. In addition the existing SWAN design does not offers “assured portability in WAN environment”. These networks can be used for day-to-day operations by the emergency management agencies but can not be relied for their usages during emergency response.

ICT NETWORK FOR DISASTER MANAGEMENT:

State Disaster management agencies, thus, would need to plan, design and establish satellite based WAN meeting - portability, reliability, scalability criteria which are crucial to emergency and disaster response management. Both – existing state wide area networks and the satellite based state emergency response communication network would be cascaded bringing synergies into system.

Development of State Network of Emergency Operation Center (EOCs) is mandated under national disaster Response guidelines - Incident Response system notified by National Disaster Management Authority in July 2010. State EOC is a secured physical facility to accommodate all line departments with specific role during emergencies, with fail safe local and wide area communication connectivity, impact analysis and decision support system. EOC’s are off-site facilities for situation assessment /analysis coordination and collaboration of resources in most effective and efficient possible and are to be connected with both existing SWAN and the Satellite based emergency response communication network. Emerging composition of EOC’s also integrates - Intelligent decision support system (DSS) – viz- Incident Management Application, simulation models into overall disaster management ICT infrastructure design.

Japan - An example of Most "Resilient Selfless Society"

No amount of “material preparedness” works during the extreme incident. Backup(s) communication, power generators or storage of emergency inventories are good in pre-disaster senerio. Everything will stop working at the site of incident after impact, even with hundreds of cascaded and co-located redundancies !

Support has to flow-in from the nearest unaffected locations. There are numerous lesions attesting and re-attesting several of the critical “preparedness issues” but unfortunately learning’s are not proportional.

The first and most critical factor in the equation of “resilience” is the “human factor”. “Selfless attitude” and ability to understand and act on receiving “alerts and warning” are major contributors in saving lives and property. Finding of my research attests “increase in selfishness increases with severity of incident and environmental stresses”.

Increased “selfishness” during crisis impacts emergency response management adversely where as “endurance and cooperative attitude” is extremely helpful in restoring the situation. You have pointed out very important “character” of “resilient society” . But this need to be highlighted and presented in many ways all through the world, specifically in the vulnerable countries, that “resilience” starts with “selflessness”.

The first responder in any situation is the person next to you and that is why – ability to understand alert/warning and attitude to react in a selfless manner is more crucial then a high-tech support reaching to you after a laps of one hour.

I congratulate all Japanes for their endurance and selflessness and wish them a quick recovery.

Tsunami Management in India

Managing Tsunami in India - By Dr R K Dave
Tsunamis consist of a series of very long waves generated by any rapid, large-scale disturbance of the sea. Most are generated by sea floor displacements from large undersea earthquakes. Tsunamis can cause great destruction and loss of lives within minutes on shores near the source, and some tsunamis can cause destruction within hours across an entire ocean basin.
Most tsunamis occur in the Pacific region but they are known to happen in every ocean and sea. Although infrequent, tsunamis are a significant natural hazard with great destructive potential. They can only be dealt with effectively through efficient detection, monitoring, measuring system cascaded with alert and warning, mitigation, and education.

Deep Ocean Assessment and Reporting of Tsunamis (DART) system is commonly used for monitoring and measuring Tsunamis. DART system consists of an anchored seafloor bottom pressure transducer and a companion moored surface buoy for real-time communications.
A powerful acoustic radio modem transmits data from the submerged platform to the surface buoy. The data are then relayed via Inmarsat-C satellite link to Land stations, which forward the signals for immediate dissemination to Warning Centers. There are 32 sensor buoys in the Pacific working round the clock. Each deep sea station is designed to detect and report tsunamis on its own, without instructions from land.

Monitoring deep ocean earthquakes using modern technology tsunameter and conveying it to Tsunami warning center is not enough. For saving lives and property – the Tsunami alert must reach to the people along with required support in identified risk zone as quickly as possible so as they can take shelter at high altitude locations.

National EOC, State EOC and District EOC play a crucial role in the in-land management of Tsunami warnings. National network of EOC(s) connected with remotely manageable national grid of coastal area alert and warning system is the only way for in-land management of such hazards. RESPECT(WWW.respect.org.in) has recently organized a National Conference on EOC & Disaster Response Operation.

EOC and Disaster Response Operations

Recommendations /outcome of EOC and Disaster Response Operations Conference held on14-15th Feb 2011, at the initiatives of RESPECT (Renewing and Empowering Society’s Progress & Enhancing capacities Through Technologies) an NGO in knowledge collaboration with Illinois Fire Service Institute (IFSI), USA

Conference Objectives: “EOC & Disaster Response Operation” Conference was an attempt to sensitize administration and emergency management practitioners on issues relating to Design, Functional, operational and management aspects of Emergency Operation Center (EOC), connectivity with Incident Command Systems and the Global best practices.

Recommendations

Two days extensive deliberation during the conference were focused on

Day – 1
Seven Critical Capabilities required (1.Pre-event Intelligence Fusion and Information Exchange, 2. Adequate Staffing, 3. Knowledge, 4. Detection, 5. Unified Incident Command & Communications, 6. Specialized Equipment and 7. Inter-agency Response) for enabling Effective Disaster Mitigation, Planning, Response and Recovery considering Seven critical threat i.e. Human+ BNICE+ Cyber: (1) Human threat, (2) Biological, (3) Nuclear / radiological, (4) Incendiary, (5) Chemical, (6) Explosive, and (7) Cyber against information and data systems. At least seven elements were distilled from summit discussions as essential for first responders to operate effectively and safely against these seven threats at a catastrophic hazardous event.

Day-2 EOC facility design, operation and management considerations.

Summery of the recommendations emerged out of discussion deliberation are as given below, marked with the attention of concerning agency below each.

General recommendation

1. Need for a consistent State-level statutory framework for implementation of the National Disaster Response System (NDRS). (Applies to National, State levels)
2. Need for consistent training and education for key disaster responders. (Applies to National, State, province, local and first responder agency levels)
3. Need to develop and implement programs that will help make citizens an effective part of the NDRS at the local level. (Applies to National, State, province, local and first responder agency
levels)
4. Need an established mechanism for dynamic validation, maintenance and sharing of emergency response Plans and resource databases .(Applies to National, State, province, local and first responder agency levels)
5. Need to design and establish an EOC and disaster response system performance audit to identify strength and weaknesses on regular basis. (Applies to State, province, local and first responder agency levels)
6. There needs to design and establish a “national system of disaster response Lessons Learned and Best Practices” which is accessible to administrations and responders at all levels. This will also provide the basis for responder training and education through the country. (Applies to National, State, province, local and first responder agency levels)
7. Need to plan, design and establish Integeration mechanism for linking national and state disaster intelligence fusion centers and enable local and province responders access to and communications reporting to them. (Applies to National, State, province, local and first responder agency levels)
8. Need to plan, design and establish a system to integrate Local, State, District, and Federal plans dynamically. (Applies to National, State, province, local and first responder agency levels)
9. Need to plan and establish a mechanism which will enable mandatory participation of Key officials and decision-makers in pre-event training, planning and exercises. (Applies to National, State, province, local and first responder agency levels)
10. Need for planning and establishing a training mechanism for Emergency responder’s n the use of The Indian Disaster Resource Network (IDRN), state disaster resource networks and other relevant disaster response support systems. (Applies to National, State, province, local and first responder agency levels)
11. Need to plan, design and establish a CIKR (critical infrastructures and key resources) directory with adequate monitoring system in place. The CIKR director may include -
Protecting and ensuring the resilience of the National critical infrastructure and key resources (CIKR) is essential to the nation’s security, public health and safety, economic vitality and the way of life. India, urgently, needs a national policy program for preventing, deterring, neutralizing, or mitigating the effects of deliberate efforts by terrorist to destroy, incapacitate, or exploit elements of our Nation’s CIKR. (Applies to National, State, province levels)

Recommendations on - Emergency Operation center (EOC) – design, implementation, operation and management
21. Need to plan and establish system to ensure that State EOC networks ICT infrastructures are compatible in each state for seamless sharing of databases and applications during planning, response and recovery. (Applies to National, State, province, local and first responder agency levels)
22. Uniform and compatible State EOC ICT infrastructures design consideration should include
a. Standardized spatial data infrastructure (SDI);(Applies to National, and State agency levels)

b. State wide area network for steady-state communication linkages ;(Applies to National, and State agency levels)
c. Standardized VSAT based communication network for emergency communication. There should be a single VSAT based National network of emergency communication and alls states should subscribed to that. This will avoid duplication of Hub resources in each state. (Applies to National, and State agency levels)
d. Standardized Decision support system in each state so as common pool of prediction model (simulation model) for cyclone, earthquake, flood and gas leakages can be used by all states. (Applies to National, and State agency levels)
e. Uniform and compatible mass messaging system for each state so as resources from across the state can also be alerted during certain critical incidents. (Applies to National, and State agency levels)
f. Each state EOC should have compatible (IP based) be Unified communication infrastructures for seamless Integeration of voice communication or call centers. (Applies to National, and State agency levels)
g. Each state EOC should have compatible (IP based) be Unified communication infrastructures for seamless Integeration of voice communication or call centers. India needs a Unified Emergency Call Center with unique calling number for through the country and creation of unified communication infrastructures will be enabler for a national emergency service call center. (Applies to National, and State agency levels)
h. Uniform public alert and warning system working on Common Alert protocol (CAP). Alert and warning system created in each state should have manageability from any level (national, state and local). (Applies to National, and State agency levels)
i. EOC facility management on PPP Model – Looking to the low ICT skill set available in the Government system and the frequently changing technology scenario, PPP (private-public-partnership) model would suite best for planning, designing, implementation and management of EOC (s) ICT infrastructures in each state. Central Government should draw standard based policy guidelines on EOC(s) technical and management specifications to be followed by each state, in order to ensure that system installed in different states talk to each other. (Applies to National, and State agency levels)