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					                             PC-1
                    MoIT-HealthNET
      Telemedicine Project for Rural/Remote Areas in
                         PUNJAB
           (Holy Family Hospital Rawalpindi)

                 GOVERNMENT OF PAKISTAN
                Ministry of Information Technology
                      (IT & Telecom Division)

        ELECTRONIC GOVERNMENT DIRECTORATE




                           August 2006




TELEMEDICINE
                                                       -1-
                                                                               Revised 2005

                            GOVERNMENT OF PAKISTAN
                              PLANNING COMMISSION
                                    PC-1 FORM
                            (INFRASTRUCTURE SECTORS)

   1. Name of the project
      MoIT-HealthNET
      Telemedicine Project for Rural/Remote Areas in PUNJAB
      (Holy Family Hospital Rawalpindi)


   2. Location

   The project will be executed at the following locations comprising of Hub, Remotes and
   PMU:

            Hub                      Holy Family Hospital, Rawalpindi
                                       i.    Attock
                                      ii.    Pindi-Gheb
            Remote Sites
                                     iii.    D. G. Khan
                                     iv.     Khushab
            PMU                      Electronic Government Directorate (EGD)

   3. Authorities responsible for:

       Sponsoring                       Ministry of Information Technology
                                        Electronic Government Directorate,
       Execution
                                        Islamabad
       Operation and
                                        Holy Family Hospital, Rawalpindi
       Maintenance
       Concerned Federal
                                        Ministry of Information Technology
       Ministry

   4. Plan Provision
      (a)
        If the project is included in the
          medium term/five year plan,
                                           Not Applicable
          specify actual allocation

          If not included in the current The project is to be funded from the PSDP of
           plan, what warrants its inclusion the Ministry of Information Technology and
           and how is it now proposed to be Telecommunications

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             accommodated

            If the project is proposed to be financed out of block provision, indicate:

           Total Block          Amount already       Amount Proposed       Balance Available
           Provision            Committed            for this Project
                                           - Not Applicable -



       (b) Provision in the Current Year PSDP/ADP
              No explicit funding is available for telemedicine in FY 2006-07. The proposed
              project, however, falls under the category of Citizen Cervices for which funds
              have been allocated in PSDP 2006-07

   5. Project Objectives and its Relationship with Sector Objectives

      MoIT-HealthNET, telemedicine project is meant to assist the government in transforming
      delivery of healthcare services and making them available at the door-steps of a common
      man, through the use of Information and Communication Technology. The project will
      demonstrate the use of technology as a solution for overcoming the lack of quality
      healthcare infrastructure in rural/remote areas of Pakistan. The objective is to be
      achieved through setting up a telemedicine hub, in Holy Family Hospital Rawalpindi,
      connected via PAKSAT-1 to 4 telemedicine centers each to be set-up in rural hospitals, by
      utilizing and complementing available national resources and infrastructure.

      The project is being proposed with the objective to provide people living in rural/remote
      areas of Pakistan, cost effective means for seeking consultation, advice and treatment
      from specialist doctors based in big urban center hospitals, at their doorstep. The project
      will also contribute towards professional development of doctors working in
      rural/remote hospitals, who will be able to get guidance and training in advance
      diagnostics and treatment methods through interaction with specialist doctors in urban
      hospitals.

   6. Description, Justification, Technical Parameters and Technology Transfer Aspects

      6.1      Description
               People living in rural/remote areas struggle to access timely, quality specialty
               health care. Residents of these areas often have substandard access to specialty
               health care, primarily because specialist doctors are mainly available in big
               hospitals located in urban centers. Because of latest developments in computing
               and telecommunications technology, it is now possible to carry out many
               medical tasks like diagnostics, treatment, surgery, etc. remotely, where the
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               patient and health care specialists are geographically separated. They could be
               in different towns, province, or even countries. Telemedicine is defined as:

                      Use of information technology, including electronic information, imaging and
                      communication technology to provide and support health care when distance
                      separates the participants

               Type of health care services, offered through telemedicine, extends from basic
               to advance.
                      Basic services include
                            • Diagnosis/Consultation
                            • Tele-Treatment
                      Advanced services include
                            • Tele-Surgery
                            • Tele-Mentoring
                            • Tele-Critical Care (Emergency, ICU etc)

               Broadly defined, telemedicine is the transfer of electronic medical data (i.e. high
               resolution images, sounds, live video and patient records) from one location to
               another. This transfer of medical data may utilize a variety of
               telecommunications technology, including, but not limited to: ordinary
               telephone lines, Internet, intranets, and communication satellites. Telemedicine
               is being utilized to provide a growing number of specialist healthcare services,
               including, dermatology, oncology, radiology, surgery, cardiology, psychiatry
               and home health care.

               Both developed and developing countries around the world are using
               telemedicine for:
                      Fine-tuning the management and allocation of rural healthcare
                         services by transmitting images to key medical centers for long
                         distance evaluation/triage by appropriate medical specialists;
                      Permitting physicians doing clinical research to be linked together
                         despite geographical separation, sharing patient records and
                         diagnostic images;
                      Improving medical education for rural health care professionals,
                         where rotations are made possible by linking several community
                         hospitals together with the sponsoring medical school.

               In general, the numerous and ever expanding applications of telemedicine
               allows its users to reduce the burdens of inferior healthcare access through
               utilization of technology. Because of telemedicine, geographical isolation need
               no longer be an insurmountable obstacle to the basic needs of timely and
               quality medical care.


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      6.2      Existing Facilities
               6.2.1 Available Health Care Infrastructure
                   Health statistics prepared by Federal Bureau of Statistics reveal the
                   following
                        On average there are 67 Hospital beds available per 100,000 people
                        On average there are 69 qualified doctor per 100,000 people
                   Health care infrastructure in rural areas generally comprises of BHUs and
                   RHCs, while most specialist doctors and advanced diagnostic, treatment
                   and surgical facilities are available in hospitals which are mainly located in
                   urban centers

                  There is a dire need for extending quality and advanced health care services
                  available in urban centers to Pakistan’s rural areas which account for about
                  64% of total population

               6.2.2 Available Technological Resource
                   Telemedicine can be used to bridge the healthcare gap between
                   rural/remote areas and urban centers. Connecting rural/remote areas
                   scattered across the country is one of the major challenges for any
                   telemedicine initiative. Satellite technology can be used for expanding
                   healthcare infrastructure to rural/remote areas of Pakistan through
                   telemedicine infrastructure

                  PAKSAT-1: Pakistan has a ready resource available in the form of national
                  satellite, PAKSAT-1, which can be used to set-up a cost effective
                  telemedicine infrastructure across the country in a relatively short time

                  Telemedicine Software: Telemedicine software has been developed by the
                  Telemedicine Association of Pakistan which will be made available free of
                  cost to the proposed scheme.

      6.3      Proposed Facilities
               The project is designed to offer Basic telemedicine services including
                   Tele-Diagnosis/Consultations: Specialists in hub hospitals will be able
                     to examine patients remotely and provide diagnosis and consultation
                   Tele-Treatment: Patients diagnosed with a disease or their doctor will be
                     able to seek specialist advice on treatment to be offered

               Diseases covered will include ENT, Skin, Chest, Cardiology, and Psychiatry.
               Specialists will be able to examine the patients, their medical history, test results
               and vital signs like heartbeat, blood pressure, temperature, breathing etc by
               using information and communication technology and electronic medical
               facilities available at remotes


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               6.3.1   Network
                        Sites
                       MoIT-HealthNET is being designed as a pilot project to set-up a
                       telemedicine infrastructure linking Hub hospitals with four hospitals in
                       rural/remote areas each. Remote sites have been finalized based on
                       need, the availability of required medical staff support and physical
                       infrastructure. MoIT-HealthNET, under the proposed scheme, will
                       comprise of the following sites:

                           Hub                    Holy Family Hospital, Rawalpindi
                                                    i.  Attock
                                                   ii.  Pindi-Gheb
                           Remote Sites
                                                  iii.  D. G. Khan
                                                  iv.   Khushab

                       Note: The PMU (Project Management Unit) will be in Electronic Government
                       Directorate (EGD), Ministry of Information Technology

                        Architecture
                       MoIT-HealthNET will comprise of Holy Family Hospital Rawalpindi
                       acting as hub to be connected to 4 rural hospitals (remotes).
                       Holy Family hospital has been identified as hub because specialists
                       working there have the domain experience, thereby ensuring faster
                       ramp-up of the project by reducing training requirements at hub.
                       The remotes can be district or tehsil level hospitals




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               6.3.2   Infrastructure




                          Connectivity
                           The hubs will be connected to 4 remotes each through a full duplex
                           VSAT star network utilizing PAKSAT-1 Ku-band capacity
                                  o 512kbps full duplex data connectivity will be provided
                                     between remotes and the hub
                                  o PAKSAT bandwidth to be offered at 50% discount
                          Communication
                           Each site will be provided with
                                   Desktop Video conferencing set-up
                                   VPN based broadband data network for electronic transfer
                                     of video, voice, imaging and text data between remotes and
                                     the hub
                                  Note(s):
                                   Hub will be able to communicate with one remote at a time
                                   Each remote will be assigned specific days in week to connect
                                     with the hub as per schedule
                                   Hub will host the central server and patient database
                          Electronic Medical Facilities
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                    Each remote will be provided with
                        o 1 X Digital Stethoscope
                        o 1 X Digital ECG
                        o 1 X Digital Dermascope/Autoscope
                        o 1 X Digital Camera
                    These equipments will enable patient data to be monitored
                     remotely at the hub by a specialist, in real-time through VPN
                     based data network
                    Each Hub shall maintain 1 X of each item as spare for
                     maintenance purpose
                    Customized telemedicine software shall also be provided at
                     remotes and hubs
                  Medical and Support Staff
                    Medical specialists and support staff at the hub
                    At-least an MBBS doctor and support staff at the remote
                    IT support staff for operation and maintenance of electronic and
                     ICT equipment at hubs and remotes. This will be the
                     responsibility of the vendor to whom the project will be
                     outsourced on TURNKEY basis.

                      Note: The vendor firm will be engaged through an SLA-based contract
                      to ensure smooth operation of the system

                  Physical Infrastructure
                    At least one room at each location dedicated within the hospital
                      premises, which will be set-up as the telemedicine center.
                    Furniture and fixtures for the telemedicine center will be
                      provided.
                    Availability of electricity and telephone in the hospital premises
                      will also be ensured.




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      6.4      Justification

               MoIT-HealthNET, telemedicine project is meant to assist the government in
               transforming delivery of healthcare services and making them available at the
               door-steps of a common man, through the use of Information and
               Communication Technology. The project will demonstrate the use of technology
               as a solution for overcoming the lack of quality healthcare infrastructure in
               rural/remote areas of Pakistan. The objective is to be achieved through setting up
               a telemedicine hub, in Holy Family Hospital Rawalpindi, connected via PAKSAT-
               1 to 4 telemedicine centers each to be set-up in rural hospitals, by utilizing and
               complementing available national resources and infrastructure.

               The project is being proposed with the objective to provide people living in
               rural/remote areas of Pakistan, cost effective means for seeking consultation,
               advice and treatment from specialist doctors based in big urban center hospitals,
               at their doorstep. The project will also contribute towards professional
               development of doctors working in rural/remote hospitals, who will be able to
               get guidance and training in advance diagnostics and treatment methods through
               interaction with specialist doctors in urban hospitals.

      6.5      Technical Parameters
               -Not Applicable-

      6.6      Implementation Methodology

               The project will be divided into the following major activities, these activities may
               be performed sequentially or one activity can supersede another previous activity
               according to the requirements of the project (Please see Annexure-V for detailed
               Project Plan):

                Activity                           Description
                Recruitment/Hiring of Project Hiring of Project Director and project staff, as
                Staff                         per the requirement of the project, will be
                                                   carried out as first step. One Project Director
                                                   will be hired to execute the project. The
                                                   Project Director will be assisted by one Asst.
                                                   Project Coordinator/Manager to coordinate
                                                   with provincial health departments and other
                                                   agencies for smooth operations of the project.

                                                   (See Annexure-III for details)
                Identification of Remotes and Identification      of remote hospitals/sites
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                Hub (Building and other basic (Remotes) and Hub. Provision of basic
                facilities like Phone, electricity facilities like phone, air-conditioning and
                etc.)                              electricity will also be ensured. Concerned
                                                    provincial health department and hospitals
                                                    will be responsible for this provision.
                Customization of                    The telemedicine software will be customized
                Telemedicine Software               as per requirements of the system.
                Tendering Process for               It is proposed that the entire setup and
                Outsourcing of Project on           subsequent operations and maintenance of
                Turnkey Basis                       the subject scheme be outsourced on
                                                    TURNKEY basis to a vendor firm. Turnkey
                                                    vendor will be selected provided it can show
                                                    the capacity to setup and run the proposed
                                                    telemedicine scheme.

                                                    The same vendor will also be engaged,
                                                    through SLA-based contract, to operate and
                                                    maintain the entire infrastructure for the
                                                    remaining period of the project.
                Operations and Maintenance          As mentioned above.


      6.7      Details of Civil Work Required
               Concerned hospitals (Hub and Remotes) will be required to provide suitable
               building for the project along with basic amenities like electricity, telephone and
               air-conditioning etc. No funding will be provided under the proposed scheme to
               cover the cost of civil work required for the proposed setup.

      6.8      Governance issues of the sector relevant to the project and strategy to resolve
               them
               A team of professionals (comprising of a Project Director and an Asstt. Project
               Coordinator) will be hired to execute the project.

      6.9      Hardware Specification
               Please see Annexure-VI for details




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      6.10     Network / LAN Diagram




      6.11 Software Requirements
          Basic telemedicine software (customized) has already been developed by
          Telemedicine Association of Pakistan (See Annexure-IX for detailed specifications
          and features).

         The software will be provided free of cost. Customization cost will, however, be
         provisioned through the proposed PC-1 for its integration with the equipment.

         Please see Annexure-II for details costing requirements

      6.12 Availability of Services (DSL, Dialups, Wireless etc.)
          Remote sites (hospitals) will be connected through satellite link with the hub.
          Satellite bandwidth will be purchased from PAKSAT (@50% discounted rate) for
          the required connectivity.




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   7. Capital Cost Estimates

      7.1       Cost of the Project

                Local:                   Pak. Rs. 39.9490 million
                FEC:                     Nil
                Total:                   Pak Rs. 39.9490 million

                (Details are given in Annexure-I)

      7.2       Date of Estimation of Project Cost

                August-2006

      7.3       Basis of Determining the Capital Cost
                Extensive market survey was conducted by the Telecom wing of MoIT and
                PAKSAT International (Pvt) Limited to determine specs and cost of the
                equipment and other services.

      7.4       Year-Wise/Component-Wise Physical Activities

            Sr. No.                Description              Year-I    Year-II    Year-III   Total

            1            Satellite Connectivity Equipment     1.363      2.530      0.000     3.893


            2            IT & Telecom Equipment               2.778      5.160      0.000     7.938

            3            Medical Equipment                    8.944      2.981      0.000    11.925
            4            Software Services                    0.300      0.000      0.000     0.300
            5            Other Costs                          2.495      0.130      0.130     2.755

            6            Salaries & Allowances                1.020      1.320      1.320     3.660

            7            Operation & Maintenance Cost         2.976      2.976      2.976     8.928

            8            Miscellaneous & Contingencies        0.183      0.183      0.183     0.550

                         TOTAL (Rs.)                         20.059     15.281     4.6093    39.949


                Please see Annexure-IV for further details

      7.5       Annual Operating and Maintenance Cost

       Year-1:                                        Pak. Rs. 4.1960 million
       Year-2:                                        Pak. Rs. 4.1960 million
       Year-3:                                        Pak. Rs. 4.1960 million
       Total Recurring Cost:                          Pak. Rs. 12.5880 million

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      Note(s):
                   This cost will be used to provide O&M Support for the operations of the project for 3
                    years.
                   Total O&M Cost (for 3 years) has been included in the Total Cost of the Project
                    (Section 7.1)

      (Details are given in Annexure-III)

   8. Demand and Supply Analysis

      The Government has taken a bold initiative to utilize Information and Communication
      Technology for transforming delivery of public services by making such services more
      effective, inclusive, efficient and available at the door steps of common man. Offering
      quality advanced health care services to rural and remote areas of Pakistan through
      the use of telemedicine is one such endeavor in this direction. Setting up rural
      telemedicine centers will enable rural population to seek consultation, advice and
      treatment from specialist doctors in urban center hospitals, without having to travel
      hundreds of kilometers and spending their meager financial resources on related
      transportation and accommodation costs. The project will also provide training in
      advanced treatments and diagnostics to doctors working in rural/remote hospitals,
      through interaction with specialist doctors in urban hospitals. The project will
      demonstrate how technology can be utilized for socio-economic development and will
      lay foundations of a replicable model for integrating ICT with healthcare services to
      expand their reach and impact to rural areas of Pakistan. Telemedicine can offer a cost
      effective solution for lack of healthcare infrastructure and doctors in rural/remote
      areas of Pakistan.

   9. Financial Plan and Mode of Financing
      No explicit funding is available for telemedicine in FY 2006-07. The proposed project,
      however, falls under the category of Citizen Cervices for which funds have been
      allocated in PSDP 2006-07

   10. Project Benefits and Analysis

      11.1     Financial: -Not Applicable-

      11.2     Economic: -Not Applicable-

      11.3     Social Benefits with Indicators
               The project will bring qualitative improvement in healthcare facilities for the
               identified rural/remote areas. Availability of latest electronic medical
               equipment at remote hospitals identified for the project will facilitate early
               diagnosis of even complicated medical conditions and their effective treatment
               by specialist doctors without the need for patients to travel long distances just
               to seek consultations in urban centers. It will also enable real time monitoring of
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                                                                                                    - 13 -
               health problems and issues being faced by rural population which will allow
               the government to launch targeted and focused healthcare campaigns and
               programs. The project will also help enhance the professional capabilities of
               doctors serving in rural hospitals through frequent interaction with specialist
               doctors.

      11.4     Employment Generation (Direct and Indirect):

               Following professionals will be hired for the implementation of the proposed
               scheme:
                    Project Director                                    1
                    Asstt. Project Coordinator/Manager                  1
                    Total Staff                                         2


               Please see Annexure-VIII for detailed job description of each position.

      11.5     Environmental Impact: - Not Applicable -

      11.6    Impact of Delays on Project Cost and Viability:
             Please see Annexure-VII for a comprehensive risk analysis of the proposed
             projectImplementation Schedule:

      Total duration of the Project is 36 Months.

      See Project Plan at Annexure-V.

   12. Management Structure and Manpower Requirements including Specialized Skills
       during Construction and Operational phases:
       The project will be executed by Electronic Government Directorate (EGD), IT &
       Telecom Division. A PMU will be established with representation from EGD/MoIT,
       PAKSAT, Punjab Health Department and a specialist doctor from Holy Family
       Hospital, Rawalpindi having experience in telemedicine.

      Project will be outsourced on TURNKEY basis to a suitable vendor (having the
      capacity to execute projects of such nature) through open competitive bidding as per
      rules and regulations of Government of Pakistan.

      An overview of the project management set-up proposed is shown in chart below.




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   13. Additional Projects/Decisions required to Maximize Socio-Economic Benefits from
       the Proposed Project:
       -Not Applicable-

   14. Certified that the project proposal has been prepared on the basis of instructions
       provided by the Planning Commission for the preparation of PC-I for Infrastructure
       sector projects.




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                                                                                  - 15 -
                                   Signature
                  Fazal Rehman
                  Business Analyst, EGD


   Prepared by:
                  Mudassar Hussain
                  Senior Project Manager (Engg.)
                  IT & Telecom Division

                  Syed Raza Abbas
                  D.G. (Projects), EGD


   Checked by:
                  Noor-ud-Din Baqai
                  Member (Telecom)
                  IT & Telecom Division

   Approved by: Farrakh Qayyum
                Secretary, Ministry of IT




                                   August-2006




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               Annexures




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                           - 17 -
                                                                                  Annexure-I
                                       Summary of Total Cost
                                                                     Rs. (in      Annexure
Sr. No.   Description of Cost                           Rs.          million)     Reference

   1      Satellite Connectivity                      3,893,000.00       3.8930     II (a)

   2      IT & Telecom Equipment                      7,938,000.00       7.9380     II (b)

   3      Medical Equipment                          11,925,000.00      11.9250     II (c)

   4      Software Services                            300,000.00        0.3000     II (d)

   5      Other Costs                                 2,755,000.00       2.7550     II (e)

   6      Annual Recurring Expenditure (3-Years)     12,588,000.00      12.5880     III (a)

   7      Total                                      39,399,000.00      39.3990

   8      Contingencies & Misc.                        550,000.00        0.5500

   9      Grand Total                                39,949,000.00      39.9490




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                                                                               Annexure-II
                Hardware (Medical, Satellite, Computers and other Telecom Equipment)
         Item Description                                                 Unit Price    Quantity              Total
   (a)   Satellite Connectivity
         Antenna (1.8m)                                                   147,600.00       5            738,000.00
         BUC (2W)                                                          54,000.00       5            270,000.00
         LNB (PLL, Ku Band)                                               54,000.00        5         270,000.00
         Satellite Modem (512 Kpbs date rate)                            270,000.00        8        2,160,000.00
         Installation & Commissioning                                     81,000.00        5         405,000.00
         Cables & Connectors                                              10,000.00        5          50,000.00
                                                         Sub - Total                                3,893,000.00
   (b)   IT & Telecommunication Equipment
         Routers (1 Serial & 1 LAN Interface)                              63,000.00       5            315,000.00
         Hubs (8 Ports)                                                     9,000.00       5             45,000.00
         Server (for Hub)                                                 126,000.00       1            126,000.00
         Desktop PCs (P-IV with 19" LCD Monitors)                          67,500.00       10           675,000.00
         Video Conferencing Equipment (IP-based with People Plus          900,000.00       5          4,500,000.00
         Content)
         Document Cameras (1024x786 XGA/VGA)                              315,000.00       5          1,575,000.00
         Scanners                                                          45,000.00       5            225,000.00
         Printers (Laser Jet)                                              45,000.00       5            225,000.00
         Digital Camera                                                    63,000.00       4            252,000.00
                                                         Sub - Total                                  7,938,000.00
   (c)   Medical Equipment
         Digital Stethoscope                                               315,000.00      5          1,575,000.00
         Digital Deramscope/Autoscope                                      720,000.00      5          3,600,000.00
         Digital ECG                                                     1,350,000.00      5          6,750,000.00
                                                             Sub Total                             11,925,000.00
   (d)   Software Services
         Customization of Telemedicine Software (for Hub)                 200,000.00       1           200,000.00
         Customization of Telemedicine Software (for Remote Site)         100,000.00       1           100,000.00
                                                             Sub Total                                 300,000.00
   (e)   Other Costs
         Furniture & Fixtures (including Air-Conditioning)                150,000.00       5            750,000.00
         Generators (10 KVA)                                              207,000.00       5          1,035,000.00
         UPS                                                               36,000.00       5            180,000.00
         Training (Doctors & Staff)                                        20,000.00       5            100,000.00
         Stationary (for Project Staff)                                     2,500.00       36            90,000.00
         Traveling Expenses (for Project Staff)                           300,000.00       1            300,000.00
         Advertisements                                                   300,000.00       1            300,000.00
                                                                          Sub-Total                2,755,000.00

                                                                              Grand
                                                                               Total               26,811,000.00



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                                                                                                     - 19 -
                                                                                                                  Annexure-III
                                      Annual Recurring Cost of the Project (O & M)
(a)   Operations
      Item Description                                                   Quantity         Cost per     Duration            Total
                                                                                          Month        (Months)
      Satellite Bandwidth (to be purchased from PAKSAT on                                     40,200       12
      50% discounted rate)                                                   2.5                                   1,206,000.00
                                                                                              75,000       11
      Salary of Project Director                                              1                                    825,000.00
                                                                                              25,000       11
      Salary of Asstt. Project Coordinator/Manager                            1                                    275,000.00
      Project Allowance for Hub Incharge (Consultant of Hub                                   10,000       12
      Hospital)                                                               1                                    120,000.00
                                                                                              12,000       12
      Satellite Equipment O&M                                                 5                                    720,000.00
                                                                                               5,000       12
      Hardware (Servers + Desktops and Other Equipment)                       5                                    300,000.00
      Administrative & Misc.                                                                   2,500       12
                                                                              5                                    150,000.00
                                                                                              10,000       12
      Vendor O & M Support                                                    5                                    600,000.00

                                                                                             Total (1-Year)        4,196,000.00

                                                                                             Total (3-years)       12,588,000.00

      * Project staff will join after 3 months of the approval of the project. Thus they will remain on the project for 33
      months. The cost has been averaged out on 11 months per year
      .




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                                                                                                                                                           Annexure-IV
                                                            Annual/Quarterly Phasing of Expenditure
                                                  Year-1                                      Year-2                                      Year-3
   Sr.                            Q1 (Rs.    Q2 (Rs.    Q3 (Rs.    Q4 (Rs.    Q1 (Rs.    Q2 (Rs.    Q3 (Rs.    Q4 (Rs.    Q1 (Rs.    Q2 (Rs.    Q3 (Rs.    Q4 (Rs.
   No.         Description        Million)   Million)   Million)   Million)   Million)   Million)   Million)   Million)   Million)   Million)   Million)   Million)   Total

         Satellite Connectivity
    1    Equipment                   0.000      0.000      0.389      0.973      2.141      0.389      0.000      0.000      0.000      0.000      0.000      0.000    3.893


         IT & Telecom
    2    Equipment                   0.000      0.000      0.794      1.985      0.794      4.366      0.000      0.000      0.000      0.000      0.000      0.000    7.938


    3    Medical Equipment           0.000      0.000      5.963      2.981      2.981      0.000      0.000      0.000      0.000      0.000      0.000      0.000   11.925


    4    Software Services           0.000      0.000      0.000      0.300      0.000      0.000      0.000      0.000      0.000      0.000      0.000      0.000    0.300


    5    Other Costs                 2.098      0.133      0.133      0.133      0.033      0.033      0.033      0.033      0.033      0.033      0.033      0.033    2.755


    6    Salaries & Allowances       0.030      0.330      0.330      0.330      0.330      0.330      0.330      0.330      0.330      0.330      0.330      0.330    3.660


         Operation &
    7    Maintenance Cost            0.744      0.744      0.744      0.744      0.744      0.744      0.744      0.744      0.744      0.744      0.744      0.744    8.928


         Miscellaneous &
    8    Contingencies               0.046      0.046      0.046      0.046      0.046      0.046      0.046      0.046      0.046      0.046      0.046      0.046    0.550


         TOTAL (Rs.)                 2.917      1.252      8.398      7.491      7.069      5.908      1.152      1.152      1.152      1.152      1.152      1.152   39.949




TELEMEDICINE
                                                                                                                                                                      - 21 -
                                                                                                                                  Annexure-V
                                                              Project Plan
        Task                                                                                    Start        Finish       Pred. Task
         ID    Activity                                                              Duration   Dated        Date            ID
          1    MoIT-HealthNET (Telemedicine Project)                                 939 days   01.09.2006   31.08.2009
          2      Hiring of Project Staff                                             76 days    01.09.2006   28.11.2006
          3        Preparation of Advertisement for Recruitment of Project Staff      5 days    01.09.2006   06.09.2006
          4        Publication of Newspaper Advertisement                             1 day     07.09.2006   07.09.2006       3
          5        Submission of Application                                         15 days    08.09.2006   25.09.2006       4
          6        Initial Evaluation, Short listing and Interview Call              30 days    26.09.2006   30.10.2006       5
          7        Interviews/Tests of Applicants                                     5 days    31.10.2006   04.11.2006       6
          8        Final Selection & Issuance of Offer Letters                        5 days    06.11.2006   10.11.2006       7
          9        Staff Joining & Contract Signing                                  15 days    11.11.2006   28.11.2006       8
                 Identification of Remotes and Availability/Setup of Civil
         10    Infrastructure (Rooms etc.)                                           40 days    07.09.2006   23.10.2006
         11        Identification of Focal Person (Hub & Remotes)                    10 days    07.09.2006   18.09.2006      3
         12        Availability and Handing over of Rooms for Infrastructure Setup   20 days    19.09.2006   11.10.2006      11
         13        Purchase of Furniture                                             10 days    12.10.2006   23.10.2006      12
         14      Software Development/Customization of Telemedicine Software         221 days   29.11.2006   13.08.2007
         15        Requirements Study for Gap Analysis                                15 days   29.11.2006   15.12.2006      9
         16        Validation & Approval of Custom Requirements                       10 days   16.12.2006   27.12.2006      15
         17        Customization of Telemedicine Software                             3 mons    28.12.2006   07.03.2007      16
         18        Testing of and Final User Acceptance of Customized Software        15 days   08.03.2007   24.03.2007      17
         19        Pilot/Test Run of Software                                         15 days   16.07.2007   01.08.2007      31
         20        Final Rollout of Software                                          10 days   02.08.2007   13.08.2007      19
         21      Procurement of Hardware, Medical and Satellite Equipment            863 days   29.11.2006   31.08.2009
         22        Preparation of RFQ for Procurement of Equipment                    15 days   29.11.2006   15.12.2006      9
         23        Review & Approval of RFQ by EGD/MoIT                               5 days    16.12.2006   21.12.2006      22
         24        Preparation & Publication of Tenders                               10 days   22.12.2006   02.01.2007      23
         25        Submission of Bids & Clarification of Queries                      21 days   03.01.2007   26.01.2007      24
         26        Evaluation of Bids & Selection of Vendors                          30 days   27.01.2007   02.03.2007      25
         27        Preparation of Contracts for Vendors                               15 days   03.03.2007   20.03.2007      26

TELEMEDICINE
                                                                                                                                       - 22 -
         28      Approval & Award of LOI and/or Signing of Contract   10 days   21.03.2007   31.03.2007   27
         29      Supply of Equipment                                  15 days   02.04.2007   18.04.2007   28
         30      Installation of HW & Network                         3 mons    19.04.2007   27.06.2007   29
         31      Test/Pilot Run of Equipment                          15 days   28.06.2007   14.07.2007   30
         32      Roll Out of Network                                   1 mon    16.07.2007   07.08.2007   31
                                                                        32.35
         33      Operations & Maintenance of Telemedicine Network      mons     08.08.2007   31.08.2009   32
         34    Training of Staff                                      20 days   02.08.2007   24.08.2007
         35      Training of Staff at Hub and Remotes                  1 mon    02.08.2007   24.08.2007   19




TELEMEDICINE
                                                                                                               - 23 -
                                                                                         Annexure-VI
                                Standard Hardware Specifications
                                             Server Data Base
    Form Factor              Rack Mountable
    Processor                2 x Intel Xeon Processor 3.2GHz with 1 MB Cache and 800 MHz FSB
    Chipset                  Server Board with Intel 7201 chipset
    Memory Installed         4GB ECC reg. Memory
    Disk Controller          Integrated Single Channel Ulra 320 SCSI Controller
    RAID                     Integrated RAID 5, RAID controller with Ultra 320 SCSI channel
    Disk                     5 x 73 GB Hot swap HDD
    Floppy Drive             1.44MB
    Optical Drive            CD Writer
    Ethernet                 Minimum two 10/100/1000 Ethernet ports
    Power Supply             Dual redundant Power supplies
    Ports                    Minimum 3-USB, 1-Serial, 1-management ports
    Monitor                  17" LCD
    Diagnostics              LED based diagnostics (Failure alert)
    Pre-Failure Analysis     Processor, memory, Disk, Power Supplies & Fans

                                               Desktop PC
                             Intel Pentium Processor 630 (3.0 GHz, 2MB, 800MHz), Intel 945G Chipset
                             ATX Desktop Board with Giga Lan,
                             Intel Graphics Media Accelerator 900 (Integrated)
                             ATI 3D (Latest) Card
                             Expansion Slot: 2PCI Express X 1, 4 PCI
                             512MB RAM DDR2, 80GB Serial ATA Hard Drive, IDE 52X CD, Audio:
                             (Integerated), USB 2.0, 4 back ports, 2 Ports via internal Headers, 15"
                             Monitor, Proccessor Vendor cerified chassis with lock, Licensed Win XP-
                             Professional (SP2)
                                       Network Printer LaserJet
                             Network Printer, A4-22 PPM, minimum 16MB Ram, Minimum 1200 dpi
                             Minimum input capacity 250 Sheets, USB 2.0 Compatible port, IEEE
                             1284-B complaint parallel port, Windows Professional, 95, 98, 2000, XP,
                             NTA.0 Linux OS one
                             Single Toner Cartridge, USB cable (Yes), power Cord (Yes)

                                                 Scanner
    Resolution               Optical: Up to 4800 dpi, Enhanced: Up to 999999 dpi
    Bit depth                48-bit
    Maximum document         8.5 x 12.3 in
    size
    Input type               Flatbed
    Preview scan speed       Up to 6 sec
    Automatic document       N/A
    feeder
    Automatic photo feeder   N/A


TELEMEDICINE
                                                                                                       - 24 -
    Scannable media types   Paper (banner, inkjet, photo, plain), envelopes, labels, cards (greeting,
                            index), 3-D objects, 35-mm slides and negatives, medium format film, 4 x 5-
                            in film (using transparent materials adapter), iron-on transfers
    Control panel           4 front-panel buttons (Copy, Scan, Scan film, Scan to share)
    Connectivity            1 USB
    Supported operating     Windows 98, 98 SE, 2000, Me, XP Home, XP Professional; Mac OS X v 10.2
    systems
    Dimensions              19.88 x 11.81 x 4.21 in
    Weight                  11.6 lb
                                         DIGITAL CAMERA
    Sensor Type             1/1.8" 6.0 Megapixel CMOS Sensor
    Memory Type             512MB internal memory and SD expansion slot (SD card up to 1GB 1)
    Lens Aperture           F3.0/F8.0
    Lens Focal Length       Fixed Focus lens f=8.25mm
    Focus Range             Normal: 1.3m to infinity, Macro: 17-22cm
    Sensitivity             ISO 100
    Zoom                    4x Digital Zoom (10 steps)
    LCD                     2.0" LTPS High Resolution TFT
    Flash Modes             Auto/Off/Forced
    Flash Effective Range   1m-1.5m
    White Balance           Auto/Sunny/Tungsten/Fluorescent
    EV Compensation         -2.0EV to +2.0EV (in 0.5EV steps)
    Self Timer              10 sec
    PC Interface            USB 1.1
    Shutter Speed           1/4 to 1/500sec
    Auto Power Off          Off/1min/3min
    Image File Format       JPEG (DCF, DPOF, EXIF)
                            3680 x 2760 (10MP, interpolated), 2592 x 1944 (5MP), 2048 x 1536 (3MP) and
    Still Image             1280 x 960 (1.3MP)
    Video Clip              640 x 480 at 15fps max and 320 x 240, 20fps max
    Video File Format       AVI
    Power Supply            2 x AAA batteries2
                                                 UPS 4KVA
                            4 KVA, 10-15 minutes on full load
                            Pure Sinewave output with PWM and 3% THD
                            Built-in Stabilizer for enhanced line conditioning
                            Cold start the load during power failure
                            Digital LCD display provides for real time UPS status
                            True RS-232 interface; UPS Management software
                            Line interactive Topology
                            Input: 165-280 Vac, 50Hz
                            Out put: 4 x IEC and hard - wired screw terminals
                                                 UPS 1KVA
                            1KVA, 10-15 minutes on Full Load Micro-Controller Based intelligent UPS
                            Line Interactive Design for higher power efficiency and fast backup
                            operation
                            Built-in Stablizer for enhanced line conditioning
                            Intelligent charger for quick and reliablebattery charging
TELEMEDICINE
                                                                                                   - 25 -
               Able to cold start the load during power failure
               UPS Protection against overload, overloading and discharge battery
               Load Protection against mains noise, transients, surges, voltage fluctuation
               and power failures
               UPS Managemnet Software
               Dry Sealed battery, maintanance free operation and longer battery life
               Line Interactive Topology
               Voltage range 160-290 Vas, 50Hz
               4 x IEC socket output
               PWM for regulated output on backup
                                 UPS 1.5 KVA
               1.5 KVA, 10-15 minutes back up on full load Micro-Controller Based
               intelligent system
               PWM for regulated output on backup
               Builtin AVR for enhanced line conditioning
               Able to cold start during power failure
               Extensive LED display for real time UPS status
               True RS-232 interface; UPS Management software
               Line Interactive Topology
               Standard backup
               Voltage range: 165-275 Vac, 50 Hz




TELEMEDICINE
                                                                                        - 26 -
                                                                                     Annexure VII
                                    Project Risk Analysis
In the case of the present project, the common risks are identified at Table-I. Risks identified
are categorized as High, Medium and Low. EGD will work on the premise that it is
extremely expensive to try and mitigate all risks, hence EGD will try to plan for the Medium
to High risks.

Activities designed to mitigate the risks, identified in Table-I, are given in Table-II. The risk
identification and management process will be monitored throughout the life of the project as
over time new risks will be identified, older ones may loose their relevance and effectiveness
of the risk management process will be evaluated.

                                Table-I: Project Risk Factors
                                                           Medium
       Characteristic             Low Risk                                      High Risk
                                                             Risk
 1. The business benefit      Well defined                             Poorly    defined
    of the project is:
 2. The scope of the            Well defined                           Poorly    defined
    project is:
 3. The project sponsor     Identified,
                                                                       Not     identified or
    is:                     committed and                                    not enthusiastic
                            enthusiastic
 4. The end user           Passionate and                              Passive  and hard
     commitment level is:   enthusiastic                                  to engage
 5. The project            Similar experience                          Little experience
     management             on multiple                                   on similar projects
     experience is:         projects
 6. The project            Familiar and will                           Not     familiar and
     management             be utilized                                      will not be utilized
     processes and
     procedures are:
 7. The business           Understood and                              Very   vague or very
     requirements of the     straight forward                                complex
     project are:
 8. The technical          Similar to others in                        New     and complex
     requirements            company
     include:
 9. The data                Simple                                     Complex
     requirements are:
 10. The number of        One Hub with four                                More than four
     locations to deploy  remote sites
     is:                  (Remotes)
 11. The number of         One or none                                    More than five
TELEMEDICINE
                                                                                            - 27 -
     system interfaces
     are:
 12. The number of              One or two                     More than five
     organizations this
     will affect is:
 13. The total estimated       Less than 1,000               Greater   than 5,000
     effort hours are:
 14. The total estimated     Less than three                 Longer than one
     project duration is:     months                            year
 16. The subject matter      Well Known by                   Not well known by
     is:                      project team                      the project team
 17. The project is          Zero or one outside             Three or more
     dependent on:            project or team                   outside team and
                                                                projects
 18. Business, Processes,      Little or no change           Substantial Change
     Procedures, Policies
     require:
 19. Changes to                Little or no change           Substantial   Change
     organizational
     structure require:
 20. The technology                                            New       Software,
     being utilized         hardware, languages,                 hardware,
     consists of:           databases, and tools                 languages
                                                                 databases or tools
                                                                 (or new releases)
 21. If a package               No (or minimal)              Heavy
     implementation:             customization is               customization is
                                 needed                         needed
                                The product or                The product or
                                 release is stable              release is new to
                                The vendor is                  the market
                                 familiar in this              The vendor is new
                                 market                         to this market




TELEMEDICINE
                                                                                - 28 -
 High/Medium Risk Factors and Potential
                                                    Risk Management activities planned
               Problem Areas
 The project sponsor is not identified or not      The implementation of the E-
 enthusiastic                                       Government programme is under the
  Project may not get resources it needs           direct supervision of the Minister for IT
  Project may not have the long-term               and the Secretary IT.
    commitment needed                              A separate cell within the M/o IT,
  Political battles may delay the project          called the E-Government Directorate
  Issue and change requests may not be             (EGD), has been created for the
    solved in a timely manner                       implementation      of    E-Government
                                                    programme and its projects.
                                                   EGD will identify a team of Resource
                                                    Persons at Ministry/Division.        This
                                                    team     provides     inputs   for    the
                                                    customization as well as act as the
                                                    implementation agents.

 End-user     Commitment Level   is                After approval of the project briefings
 Passive/Hard to engage                             will be arranged for high level
  Harder to get end-user time and                  management at agencies who will
    resources                                       benefit from the proposed system.
  End-users may undermine or work                  They will be the Sponsors of the new
    against the project                             systems.




TELEMEDICINE
                                                                                       - 29 -
                                                                                             Annexure-VIII
    Sample Qualification, Experience and Job Description of Project Staff
      Project Director:
      Qualifications:
      MBA (IT) or Masters in any field of IT from some reputed foreign or UGC-/HEC-recognized
      university/institution.

      Experience:
      5 years of total IT experience with at least 2 years project management and monitoring experience of
      large IT projects. Professional experience will start after the completion of minimum
      qualification/degree(s) required for this position.

      Skills:
           In depth knowledge of the current leading Networking technologies, databases, development
            tools, middleware tools, hardware platforms and operating systems.
           Must be well versed with office productivity tools.
           Proficient in project management and monitoring tools and techniques, and knowledge of project
            management software.
           Well versed with contract management techniques.
           Aware of Government procedures and polices regarding public tendering and bidding processes.
           Must have managed multiple IT projects in similar capacity and role.

      Job Description:
           To manage the implementation of individual projects under the supervision of respective
            government office/department/ministry.
           To monitor the project through entire life cycle of the project.
           To manage the contracts with the implementing IT firms. This will involve establishing
            commitments with the contractor, and tracking and reviewing the contractor's performance and
            results. This exercise will cover the management of software-related contracts, as well as the
            management of the total project that includes hardware, Networking, Licensed software and
            possibly other system components.
           To interface with implementers/contractors as well as end-users for smooth execution of IT-
            related projects.
           To get input from IT Specialists about the on going projects and incorporate the same.
           Report regular progress to           the   senior   management     from   respective     government
            office/department/ministry.




TELEMEDICINE
                                                                                                        - 30 -
      Assistant Project Coordinator/Manager

      Qualifications:
      MBA (IT) or Masters in any field of IT from some reputed foreign or UGC-/HEC-recognized
      university/institution.

      Experience:
      2 years of total IT experience with at least 1 year project management and monitoring experience of
      large IT projects. Professional experience will start after the completion of minimum
      qualification/degree(s) required for this position.

      Skills:
           In depth knowledge of the current leading Networking technologies, databases, development
            tools, middleware tools, hardware platforms and operating systems.
           Must be well versed with office productivity tools.
           Proficient in project management tools and techniques and knowledge of PM software.
           Well versed with software contract management tools and techniques.
           Well versed about IT technology in general.
           Must have managed IT projects in the capacity of project manager.

      Job Description:
           To manage the implementation of IT-related projects under the supervision of Project Director
            from respective government office/department/ministry.
           To monitor and manage project activities during each phase of project life.
           To manage the contracts with the implementing IT firms. This will involve establishing
            commitments with the contractor, and tracking and reviewing the contractor's performance and
            results. This exercise will cover the management of software-related contracts, as well as the
            management of the total project that includes hardware, Networking, Licensed software and
            possibly other system components.
           To interface with implementers/contractors as well as end-users.
           To get input from IT Specialists about the on going projects and incorporate the same.
           Report regular progress to the Director.




TELEMEDICINE
                                                                                                     - 31 -
                                                                                                     Annexure-IX
  Detailed Features & Specifications of Customized Telemedicine Software

      Introduction
      Pakistan is a developing country where qualified and skilled human resources are
      scarce. In medical field Pakistan has high doctor to patient ratio. Especially rural
      population has few doctors and almost no specialist.

      This situation can be improved if we can manage to build a communication link
      between doctors sitting at these remote areas and specialists sitting at large hospitals.
      This way, patients will not have to travel to cities when they can be managed locally
      and they can benefit from the specialist opinions that otherwise, would not be
      possible.

      Telemedicine
                                              Remote     Remote          Remote             Remote
                                               Unit       Unit            Unit               Unit



                                                                  SERVER




                                               Hospita                                     Hospita
                                                l Unit                                      l Unit
                                               Serv                                        Serv
                                               Doctor                                      Doctor
                                                er                Admi                      er
                                                                                            Unit
                                                Unit
                                                Doctor                                     Doctor
                                                 Unit
                                                                  n                        Unit
                                                Doctor                                     Doctor
                                                Unit                                        Unit

                                                                           LEGEND
                                                                  Internet / Direct Link


      Telemedicine by definition is “The use of medical information exchanged from one site to
      another via electronic communication for the health and education of the patient or health care
      provider and for the purpose of improving patient care.” (The American Telemedicine
      Association)

      The practice of telemedicine may be as basic as doing consultations through telephonic
      conversation. In developed countries telemedicine and tele-surgery is mostly done
      real-time using live audio-video technologies. In developing countries like Pakistan
      the cost of live communication is mostly expensive and unaffordable. Thus there is a
      mandatory need to develop a customized software solution; developed while keeping
      in view the constraints and limitations of developing countries.

      Telemedicine Second Opinion Software
      Keeping in view the high requirements of live communication, we are developing
      store-and-forward system
TELEMEDICINE
                                                                                                         - 32 -
      that will require minimal resources. The software is made using the latest technologies
      in order to ensure that international standards are being met.

      The software establishes a network of remote unit, hospital unit and a central server to
      control the activities of the system. Following is the diagram of the system:


      Functionalities
      The software implements all the functions required to take second opinion. The
      software can also be used for educational purposes, statistical analysis, patient record
      management, live communication etc.

      To achieve the above mentioned goal, customized software is being developed in
      Pakistan. Following are the features of the software:

      Store-and-Forward System
      The term store-and-forward refers to asynchronous communication. This type of
      communication provides many benefits including low bandwidth requirements, less
      constraints on availability of specialists and intelligent intervention of the server.

      Live Communication Also Supported
      Along with store-and-forward; live communication is also provided within the
      software. This is typically beneficial when the bandwidth is not an issue i.e. in hospital
      units and large cities. Thus the software can be used to fullest extent as long as the
      resources are available.

      Wizard Based User Interface
      Most of the doctors and specialists are novice computer users and they do not even
      have understanding of basic computer concepts. In order to make system acceptable
      by the end user, the software must be easier to use, keeping in view the level of
      computer literacy of the end-user.

      The patient profile is composed using an easy-to-use wizard based input system. The
      software combines best user-interface practices used in the industry.

      Mini-HMIS Module
      This is a unique idea to combine the benefits of telemedicine and HMIS so that the
      software relieves the need for the users to use multiple computer systems. In most of
      the developing countries, the need to maintain patient records and overall statistics of
      patients is often overlooked resulting in overall inefficiency.

      This software provides features required to maintain “Electronic Health Records” of
      all the patients coming to the hospital while sending only the required patient data for
      purpose of taking consultations. Modules such as Lab, Radiology and Blood-Bank are
      thus built into the system.
TELEMEDICINE
                                                                                        - 33 -
      The software has following main modules:

       Remote Unit
         A remote unit is the module that is used by the healthcare provider who is the
         “seeker” of patient consultations. This can be a basic health unit, a small clinic or
         even a tertiary level healthcare facility.

         The remote unit provides following features to the users:

         Patient Profile Composition
         The user is presented with series of easy to use screens asking for various questions
         regarding patient demographics, history, findings etc. Thus at the end of wizard
         screens a comprehensive patient profile is made. A wizard screen is shows as
         follows:




         Patient Profile Viewer
         The patient profile viewer provides a familiar user interface to the user consisting
         of simple files. All of the patient data is categorized in these files (e.g. history,
         findings etc) and each file can be individually edited and managed as shown in the
         screen below:




         Communication Module


TELEMEDICINE
                                                                                      - 34 -
         The communication module shows all the remote and hospital units that are
         connected to the telemedicine software network. A user can chat with any unit,
         have video conferencing session, send a message or send the patient profile for the
         purpose of consultation.




         Mini-HMIS
         This module contains modules of Pathology Lab, Radiology and Patient Record
         Management. This will eventually be connected to larger HMIS systems using
         industry standards such as HL7.

       Main Server
         The main server is centrally placed and it connects the remote units with hospital
         units. The main server is fully automated and administrator controlled. The server
         uses intelligent algorithms to ensure the patient consultations are being provided
         in timely manner.

         The server maintains all the data of the patients that is being consulted through the
         Telemedicine Network. Thus later on this can be used for statistical analysis and
         educational references.

         The administrator is provided with detailed reports on the entire system thus
         providing him complete control to ensure its effective use.

         The server also keeps track of patient consultations, thus if any consultations of
         remote unit is not responded to within specified time, the server can re-route the
         consultations to other available specialists. The server keeps track of all the
         communication that happens between the units and facilitates and controls the
         entire telemedicine network.

         The server consists of FTP Server Software, Database Server Software (SQL Server)
         and Telemedicine server software developed by Digital Prodigy. This unit is
         always online and all the other remote/hospital units connect to this server for
         inter-communication. Thus the server acts as a bridge for communication between
         all the other units.

TELEMEDICINE
                                                                                      - 35 -
         Hospital Unit
         A hospital unit is the module that is used by the healthcare professionals who are
         the “provider” of patient consultations. This can be a specialty hospital in any of
         the major cities.

         The hospital unit incorporates all the features presented above in the remote unit.
         A specialist can also mark any image with textual or audio annotations as shown in
         image below:




         The specialists sitting at the hospital unit can also communicate with other hospital
         units for specialist consultations.

      Why Develop a Customized Solution?
      Following are the features of our customized software that are not currently available
      in any other off-the-shelf product.

              Wizard based input system
              HMIS module
              Intelligent monitoring server
              Special features to work under even the lowest quality dialup connections.
              Lower (Total Cost of Ownership) TCO as compared to other developing
               countries like India, Srilanka.

      Conclusion
      Software such as Telmed SOS can prove to be a major break-through for healthcare
      institutions of developing countries specially Pakistan and its neighboring countries.

      References:
            Project Proposal, “Telemedicine/E-Health Training Project”




TELEMEDICINE
                                                                                      - 36 -
                                                                               Annexure-X
 Responsibilities and Actions Required by Provincial Health Department &
                 Hospitals (Hubs) during Course of Project

      1. The Provincial Health Department (PHD) will nominate the focal person to
         manage the project at hub hospital within 7 days from the administrative approval
         of the project.
      2. The PHD will ensure that each location (Hub and Remotes) will provide a separate
         room for secure placement of equipment and operations. These dedicated rooms
         should have a capacity of 5-10 people to attend a telemedicine session. This room
         should be available by 3 months from the approval of project.
      3. PHD will nominate officials who will test the applications once the software is
         delivered (customization) by the software development vendor.
      4. PHD/Hub will be responsible for smooth operation of the new system within 1
         month of setup of entire infrastructure.
      5. The hub Incharge will be responsible for making sure staff remains available (both
         at hub and remotes) for telemedicine session as per agreed schedule. He/She will
         also maintain a close liaison with PHD and EGD/MoIT for smooth operations of
         the system by monthly progress reports to these agencies.




TELEMEDICINE
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