Technology in the middle of Nowhere

/

I recently visited the Akhand Jyoti Eye Hospital(AJEH) in Mastichak, Bihar.  A big part of visiting the hospital was to help them improve their technology infrastructure. While i was at the hospital, i spent a lot of time understanding the challenges they have to deal with and also look at a proposal they got from Sify (an Indian ISP and IT company) for the IT upgrade.

Let me start by describing what they have in terms of infrastructure

  • The hospital is located in a fairly rural area in India which is not yet connected to the country's power grid, so it has to run 24/7 on diesel generators  
  • The hospital has no phone lines and relies purely on mobile phones (thankfully they get cell coverage from a few telco's)
  • They have not internet connectivity, they best they can do is to use 2G/EDGE connectivity offered by the cellphone telco. They use 2G USB sticks to allow a few necessary computers to connect to the internet. 
  • The internal networking infrastructure is basic with cat5 cabling to a handful of rooms with a cheap Dlink 24p gigabit switch serving as the core switch and a spattering of edge switch  (24 port and 8 port). Look at the image below to see the state of the core switch.
  • They have a basic analog PBX systems serving about 30 lines to analog phones. 
  • They have about 30 computers in the hospital used for processes like Patient registration, Stock maintenance of supplies, Accountancy systems and machines connected to various medical equipment
  • They do have one server running Microsoft SQL Server which is the backend for their hospital management software called IHMS (Integrated Hospital Management Software). 
  • They run Tally as their main accounting software
  • They also have 2 branch hospitals in Patna and Siwan, which often refer patients to them. But due to the lack of connectivity it means patient records cant be transferred and accounting processes need to be duplicated. 
  • One of the departments in the hospital, which is responsible for processing online verifications for patient insurance, has to work 24/7. The slow internet speeds causes each transaction of verification to take 15 min (yes you read that right). They need to run this verification 4 times per patient and they need to process over 450 patients per day during their busy period.

The Core Switch

Now given the above challenges they are still able to conduct 55,000 eye surgeries per year. They have a target of hitting 100,000 by the end of 2013. Even getting to do 55,000 surgeries per year is an amazing feat for a hospital which has no connected electrical supply.

Some of the goals:

  • They want to be able to do 100,000 surgeries a year
  • Become the nations top charitable eye hospitals
  • They want to be able to conduct remote training for their doctors using Video Conferencing
  • They want to setup a education division to train students in Optometry and other related fields (they already have something started in this area )
  • They want to have their other branches in Patna and Siwan integrated into a common hospital management and accounting system
  • They envision moving some of their infrastructure to cloud based services so that they can offload some of the infrastructure support and allow for remote collaboration
  • They have outreach eye camps that go to remote villages to help people that cant travel to the hospital. For this they need their some sort of mobile patient registration and information collection system.

These are just some of the ambitious goals that they have setup for themselves. 

Over the years the hospital management has been trying to bring in some sort of internet connectivity. They approached various ISP's but none of them had fiber in the area and weren't motivated to bring in any. Finally they got in touch with Sify, who has proposed to give them a 4Mbps Internet link deliver over a Radio connection beamed from Patna and bounced off another tower that they need to build mid way to the hospital.

Sify has also proposed a complete IT upgrade for the hospital apart from the Internet Connection, including things like VOIP services, Video Conferencing equipment, Cloud services and Network upgrade. The proposal is fairly expensive and elaborate and I am helping them evaluate the proposal and maybe amend it in certain areas to help bring down costs. 

After spending the weekend at the hospital and understanding all the challenges and the vision that they have set for themselves i started to devise a strategy for their infrastructure road map.  

Stage 1 - Networking and Communication Infrastructure

Internet Connection

This by far is the most critical component needed at the hospital at the moment. This will add the ability for remote support, cross hospital collaboration and speeding up the processing of Insurance transactions. The proposal from Sify is the only real option at the moment and investing in this absolutely necessary.

Networking Infrastructure

  • Data Networking : The current networking infrastructure is basic and i believe investing in a better wired network with some managed switches is worth it. The current proposal from Sify includes a bunch of Avaya switches and some Fiber and Copper networking. The proposal is sound, but might be a little too expensive at the moment.
  • Voice Networking : The hospital has a basic hardware analog PBX system which has been serving it well and for the most part works as expected. I think for the first stage, we continue to use this. Sify has proposed a Avaya PBX system with VOIP and other teleconferencing features. We can probably do something much cheaper with a Asterisk box and some analog cards. I propose for stage-1 we leave this as is.
  • Wireless Networking : Sify has not mentioned any wireless networking in their proposal. I believe putting in some basic wireless networking gear is important as it allows doctors to use mobile devices to work with the hospital management system and even mobile video conferencing.

Video Conferencing

Sify in its proposal for Video Conferencing infrastcuture for the studio had included a traditional H.323 Radvision solution. While i believe this is a good solution, there are plenty of other options from Lifesize and Vidyo. Vidyo has some great online case studies of how its technology is being used in Telemedicine and i believe would be great for this hospital as well.

This is what i think the hospital should do for the first stage of its upgrade. This also a good point to end this blog post. I will add further blog posts detailing some of the other stages of the upgrade.