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The advent of Information Technology has revolutionised the field of Healthcare. C-DAC’s Integrated Telemedicine solution: Mercury, is an initiative in this field.

Telemedicine is the use of Information Technologies and Telecommunication to provide clinical care at a distance. Consider a typical Telemedicine interaction. The Patient goes to a Doctor, who after examination of the patient’s file, feels the need for a second opinion. The Doctor then consolidates the relevant clinical data into the patient’s Electronic Medical Record (EMR) and then seeks an opinion of the Specialist using TeleConsultation. A connection to the Specialist’s workstation is initiated, and the patient’s data uploaded. The Specialist then examines the data to make a diagnosis, to provide advice and suggest a course of action. The two Doctors get on to a videoconference to jointly arrive at the diagnosis and the course of treatment. This advice is then transmitted back to the presenting Doctor who takes appropriate action.

This essentially avoided the patient, the discomfort of having to travel to the Specialist‘s office/ clinic or the Specialist having to visit the patient; this is especially important if the patient is in trauma. The right care was provided at the right place at the right time with minimal discomfort to all concerned. This sort of interaction is quite possible and is becoming quite common. C-DAC’s Integrated Telemedicine Solution, Mercury, provides an Integrated Solution to make such interactions possible and more. Mercury can be used to provide Tele-medicine Consultation for various fields of medicine - TeleRadiology, TeleCardiology ... TeleJustAboutAnything.

On closer examination of the interaction, we find that there are two main aspects viz. making & managing the EMR and the actual TeleConsultation. Let us see how Mercury facilitates these two aspects.

Usually the Patient Record (PR) is available in the hardcopy form (papers, celluloid films, ECG strips, etc.). Mercury allows the Doctor to quickly put these together into the patients EMR and classify them. Data of various types like celluloid films, hardcopies, can be scanned in; ECGs, video-clips of endoscopies, angiographies, etc. can be made a part of the EMR (using direct interface to the devices), as can be audio-clips of electronic stethoscopes, dictations, etc. All such documents and images are stored in an encrypted form.

Once the EMR is consolidated, the Physician can quickly navigate through the EMR. Mercury provides means to view data in a Classified view, with a tab for every type of data present eg. Xray, ECG, Reports, Advice, etc. Mercury also provides a Catalog view that lists the various documents, images, etc. in the EMR with a short summary.

Mercury equips the physician with a rich toolset to examine different data. It supports tools to pan, zoom, rotate, mark Regions of Interest (ROI) and to annotate the data. Extensive Image Processing features are also provided.

Using Mercury’s user-friendly interface, the Physician can also quickly add notes on the patient’s progress, can create reports, advice, etc. To seek the opinion of a Specialist, using TeleConsultation, the Doctor can connect to the Specialist’s PC from within Mercury. The presenting Physician uploads the relevant portions of the EMR to the Specialist PC. They can exchange Text messages to confer about aspects that are not brought out by the presented EMR. They can even get into a Videoconference. The Advice, Reports, etc. that are the outcomes of the TeleConsultation are sent back to the Presenting Doctor, to print and pass on to the Patient.

There are times when the Specialist would work alone, Mercury also provides for offline editing of the EMR and subsequent data upload to the peer. For connectivity, Mercury uses any existing connectivity means that support TCP/IP protocol such as Dial up connectivity over telephone lines (POTS) or ISDN, etc. For videoconferencing, Mercury interfaces with any standard videoconferencing equipment that supports MS NetMeeting 3.0.

Mercury can interface with a range of equipment, providing users the freedom to choose the best suited option for their requirements. C-DAC helps in evaluating specific clinical requirements and recommends suitable equipment.

Apart from the features of the standard version of Mercury, the following is an indicative list highlighting the range of customizations:

DICOM support
Support for specific HL7 messaging.
Customized generation and printing of forms that include various parameters, reports, etc.
Specific authentication support including Smartcards, Biometrics, etc.
Integration with existing HIS, PACS or other Clinical Support System.
Interface with various specialty devices.

Mercury requires a Pentium II 350MHz or better with Multimedia capabilities running MS Win98/ Win2000, with 64MB RAM or more with Minimum 500MB free disk space, a 17" SVGA Monitor, a POTS/ ISDN modem and a TWAIN compliant scanner with backlighting arrangement. Video capture card and video-conferencing equipment are highly recommended.

Salient features of Mercury

Consolidated EMR
Authenticated access to EMR
Easy to install, configure and use
Comprehensive suite of toolsl Well Documented with easy to follow instructions
Optimal Bandwidth utilization reduces cost of ownership
Open Architecture
Supports hybrid model of ‘Store & forward and on-line Telemedicine’
Industry Standards Compliant
Interfaces with Industry Standard devices like Scanners, Camera, etc.
Customization support provided

Mercury is developed by C-DAC’s Medical Informatics Group under a project of the Department of Information Technology, Government of India in collaboration with Centre for Electronics Design & Technology (CEDTI), Mohali, All India Institute of Medical Sciences (AIIMS), New Delhi, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh and Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow.

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