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Part I Introduction
1.1.Introduction to telemedicine
Telemedicine is the delivery of health care services, where distance is critical factor, by the healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities. It is as defined by WHO (World Health Organization). Telemedicine has no geographical boundary. It can be carried between any two cited or two countries. It scope increasing day by day.

1.2.History of Telemedicine
The truth is that telemedicine has been around since the 1960s, when astronauts first went into space. In fact, NASA built telemedicine technology into early spacecraft and spacesuits to monitor astronauts' physiological parameters. C.L. Wittson and his colleagues at University of Nebraska College of Medicine are credited with the first telemedicine project. The project took place in 1959 and involved a microwave connection between Nebraskas state mental hospital and the Nebraska psychiatry Institute over 100 miles away. In 1964, under a grant from the U.S. National institute for Mental Health (NHM), the Nebraska Psychiatric Institute began using a two-way closed TV link between the Institute itself and Norfolk state Hospital about 112 miles away. The link was used for education and consultations between specialists and general practitioners. Now days, advanced technological tools are used. Computer, TV, Cameras, Telecommunication link, Telemedicine software, Tele-imaging tools like Digital Transparence Scanner, Digital Microscope, Digital ECG are some of the tools used in Telemedicine.

1.3.Types of Telemedicine
Telemedicine can be broken down into three main categories. 1.3.1. Store-and-Forward It involves acquiring medical data (like medical images, bio-signals etc.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline. 1.3.2. Remote Monitoring It enables medical professionals to monitor a patient of heart disease, diabetes mellitus, or asthma remotely using various technological tools. 1.3.3. Interactive
It provides real-time interactions between patient and provider, to include phone conversations, online communication.

1.4. Process in Telemedicine

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The patients are diagnosed and the medical data are transferred to the server and are stored there. Then the experts or doctors check the medical reports. Then the final diagnosed reports are transmitted to the patients after storing them in the server.The Datas or reports are shared with the medical personal via video or audio conferencing too.

fig. Diagrama showing process of Telemedicine

1.5.Pros and Cons

Telemedicine has both, positive as well as negative aspects but the positive aspects win the negative aspects. 1.5.1. Advantage a. It is versatile and effective. b. It has crossed the regional boundaries. c. It increases health condition of people. d. It provides cost effective health check-up. e. Datas in server can be of help in future. 1.1.1. Drawback a. Doctors touching, talking to the patients provides more details than via the images or videos. b. Skilled staffs think that they will become no more than a technicians, acting solely at the guidance of the remote specialist. c. Organization problems like fear of uncertainty, lack of trained work force, possessiveness among organizations arises continuously.
1.1.Objective

Following were the objective of our project:-

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a) Research one of the Indian projects and find out about the technological implement b) Prepare a proposal about Telemedicine in Nepal c) Dig out activities run by Mahabir Pun

1.1.Research Methodology
Information is the main source of acquiring knowledge and data. The first step in preparation of smart report is to design the framework of the research. The task begins with the collection of necessary data and information concerning the study. The data and information collected has been studied carefully and presented them systematically and get them analyzed so as to meet the objective of the smart report. All data provided has been thoroughly studied and then search design was planned.

1.1.1. Secondary Source

Secondary source are those sources, which quotes or references a primary source. These data are originally presented elsewhere. For the preparation of this report, mainly secondary data is used. Especially web sites were useful source of secondary data.
1.2.Limitations

of the Study

1. Geographical Boundary 2. Lack of projects running in country 3. Lack of resources to find out about the telemedicine being run in country 4. As it was our first time to study and prepare proposal, we were unable make our task 100% efficient. 5. We were unable to interview top associates of telemedicine in Nepal. 6. Due to the secrecy of the performance evaluation, the exact data is not available. 7. Some of the information was extracted from the website, magazines so that data may not be accurate and updated.

Part II Analysis and interpretation

3.1.Indian

Project-Sanjeeva

Sanjeeva, the telemedicine project was held by Care Hospital situated in Hyderabad incorporation with different three companies namely Andhra Pradesh Vaidhya Vidhana Parishad, Karishma Software Ltd. and Siemens & Philips. The telemedicine service was provided to the rural people of Mahaboobnagae of Andhra Pradesh. The companies and their functions during the project are:a) Care Hospital: - Consultancy Service, Medical Equipment interface, System Integration and Second Opinion b) Andhra Pradesh Vaidhya Vidhana Parishad:- Infrastructure arrangement c) Karishma Software Ltd.:- Software for data transmission and training services d) Siemens and Philips:- Medical Equipments
3.1.1. Process in Sanjeeva

The demographic, historical, and current medical related details are registered after a patient is given a registration number. After the registration, a visit ID was generated and was called a Case. The cases were transferred to the server, the medical administrators classified the case, and decisions for the workflow of the case were made. A specialist talked either to the medical personnel at PHC (Primary Health Care) or to straight the patient.

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Fig. PHC to Expert Center-Network Setup

3.1.2. Technological Infrastructures Karishma Software Ltd. provided the infrastructures used in the project. The basic technical requirements that are attached with the Sanjeeva include: Software a) Medical Imaging Medical imaging is the technique and process used to create images of the human body (or parts and function thereof) for clinical purposes (medical procedures seeking to reveal, diagnose or examine disease). b) Data Transfer to the Expert Center Datas like historical, diagnosis of medical reports were transferred to expert center via the software provided by Karishma Software Ltd. c) User Registration and Maintenance The patients were given a registration numbers, which were systematically stored and were maintained via software. d) Video Conferencing A videoconference or video conference (also known as a video teleconference) is a set of interactive telecommunication technologies, which allow two or more locations to interact via two-way video and audio transmissions simultaneously. It is also been called 'visual collaboration' and is a type of groupware. e) Billing The patients were billed using a computer system which helped in directly recording about the money related things from the patients.

Hardware a) Video Camera Used of video camera for transfer of the digital pictures of the patients infected areas and for video conferencing. b) Network Connectivity Devices such as Modem and LAN Cards Network Connectivity Devices used to provide quality internet service for data transmission and communication. c) Computer Systems d) Medical Equipment

e) Voice and Video Output Devices

3.1.

Proposal for Nepal

Nepal is a developing country and it is obvious that people of this type of country will have poor health condition.. Especially there are many health related problems in the rural parts of Nepal. One of such place is Humla. 3.1.1. Problem Nepal as a developing country has the gross national product of $300; gross national income of $1180 and the lowest literacy rate of 50% amongst the south Asian countries. The people and the doctor ration in Nepal is 6000:1. These factors have contributed to the prevalence of communicable, respiratory and nutrition deficiency diseases, which are among the most common disorders seen in hospital outpatient departments. Telemedicine is therefore an attractive potential means of improving health services. In industrialized countries, real-time telemedicine is commonly used. However, this modality is not applicable in a developing country, like Nepal, because of the high cost of bandwidth and the poor telecommunication infrastructure. The alternative to the high cost bandwidth and poor telecommunication infrastructure is store-and-forward telemedicine.

Distribution of cause of Death in children under 5 (2008, WHO)

About 17% of the children under five die because of diarrhea, 16% due to Birth Asphyxia and Pneumonia, and 3% due to injuries. These can be stopped if there is good health facility.

Distribution of years of life lost by cause (2008, WHO)

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About 60% of the people die due to communicable disease, 31% due to Non-communicable diseases, and 10% due to injuries. Many of the communicable as well as non-communicable disease can be cured in the proper care of medical personal. 3.1.2. Action Following are the plan of action that will be carried out once the project starts.
1. First, the interested doctors, medical personal and other members will gather together 2. They will have a training session and will discuss about the actions that will be carried

during the project run time. 3. Then the Equipments will be shipped to the destination and will be installed by technician 4. The specification of the equipments are:Hardware Processor Memory Hard Disk Camera Pentium IV 512 MB 320 GB Nikon Operating System Web Server Database Software Software Open Source(Linux) Apache MySql Perl Software

After the project starts, the following procedure will be implied.

1. Patients will be diagnosed using medical equipment 2. The details of the patients will be recorded in the server via the communication service

(email) using the software and the software provides a registration number. 3. The diagnosed reports, images, videos etc will also be uploaded to the server along with the registration number. 4. The experts will check the diagnosed report and further study of the reports is done. 5. After that, doctors/ experts directly talk to the patient via the video conference or they talk to the health personal and then the health personal talk to the patients.

Work Flow of telemedicine process

3.1. Works

of Mahabir Pun

Mahabir Pun is a Nepalese teacher known for his extensive work in applying wireless technologies to develop remote areas of the Himalayas, also known as the Nepal Wireless Networking Project. He is a widely known figure in Nepal, and his work has been recognized by the Ashoka Foundation, the Raymod Magsaysay Foundation, University of Nebraska, and

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Global Ideas Bank Mahabir Pun have started the telemedicine program in three villages as a pilot project. Nangi, Ramche and Tikot, all of Myagdi District Myagdi District

Pilot telemedicine program set up in Nangi village. Roughly 200villagers treated to date in consultation with Dr. Gita Pun, who havebeen working voluntarily for NWP from here Nursing home in Pokhara.

Part III Summary and Conclusion

Appendix Reference
1. www.himanchal.org

2. 3. 4. 5.

www.nepalwireless.net www.who.int www.wikipedai.com www.nep.searo.who.int 6. prem raj panta books 7. pc quest magazine