Agartala: The Tripura Vision Centre project has been instrumental in effectively utilising the benefits of information and communication technologies to reach rural masses.

The project aims at improving access to quality health care in rural areas of Tripura by adopting emerging developments in both ICT and medical technologies.  

The Vision Centre project aims at providing quality eye care services to rural patients in districts of Tripura through Tele-opthalmology in an integrated manner where by every case is accounted, classified and closed with a proper solution.

Besides, it is also expected to cater to a population of 3,432,000 spread across 40 blocks in four districts.  

A total of 40 Vision Centres have been planned to be deployed in three phases to render Tele-ophthalmology service across that Tripura.  



In Phase I, the first pilot Vision Centre was set up in Melaghar block on April ’07 and is operational till date. The centre has screened more than 4,800 patients and has made significant impact in the local community in terms of visual impairment.

Based on the progress made in Melaghar and significant insight learnt on the local demographics, the project was scaled in phase-II.

The Phase II comprised of scaling the vision centre network to 10 blocks in West Tripura District covering a population of approximately 15,32,982 citizens.

The second phase also comprised of the utility of digital patient medical records in the Vision Centres using database management solution Vision Centre Management System (VCMS).

It also included setting up of an independent wireless network with bandwidth of 256 Kbps to be expanded up to 2Mbps. The 10 Vision Centres that were commissioned in August and September 2008 are presently screening over eight patients per day.

The third phase is still continuing and deployment is happening in another 29 locations.      

In all the 11 sites completed, approximately 250 sq ft to 800 sq ft of covered premises where allocated by the Block Development Officer on the request of the Health Department, Government of Tripura.

On taking over the sites in West Tripura, IL&FS-ETS made the site ready for installation of medical and ICT infrastructure at the site.

Sites were assessed for power availability with required input voltage, power stability, earthing for the building and mean sea level for planning and establishing wireless network in all the 10+1 locations were carried out and completed.

The list of medical equipments and the vendors for supplying the same was decided in conjunction with Aravind Eye Care based on the field trials conducted by Aravind at their Vision Centers in Madurai district of Tamil Nadu.

The equipments where are also further evaluated based on their performance at the Melaghar Vision Centre in Tripura (West district) over a period of six months.

All 11 locations inclusive of the pilot have been installed and commissioned to conduct basic screening and to support capture of data for remote diagnostics and prescription from the doctor.

To enable capturing of patient records at source through the online VCMS Module to conduct seamless real time consultation with patients using the video conferencing tool was deployed at 11 vision centers across the west district of Tripura.  

The Technology
The connectivity network built for the Vision Centre includes a number of base stations that are installed on top of PoP’s in every cluster covered by the network. The wireless network is deployed to operate with near Line of Sight (LoS) in most areas and non Line of Sight in some areas.

This enables to connect Vision Centres by mounting the customer premises equipment on a less than 30 meter tower at all locations have been erected to connect to the NOC and the data centre at IGM Agartala.

The MPLS VPN Network supports both Layer 3 and Layer 2 tunneling methods such as IPSec and MPLS for creation of VPNs. IPSec tunnels are CPE based, and the tunnels originate at one customer site, and are terminated at the other end.

MPLS is a network based tunneling method that labels, categorizes and monitors each packet as it traverses the network. Since MPLS is an overlay protocol it can operate on top of the IP protocol in the same network without interference.

When a customer packet comes to the edge router (Label Edge Router) on MPLS enabled network, the packet is encapsulated and tagged with a label (also called MPLS shim header, and is 32 bits long), which is removed only when the packet exits the network.

As the packet travels through network, the routers in the core (Label Switch Routers) switch, rather than route the packets, there by greatly reducing latency in the network.  

From a Vision centre perspective, MPLS VPNs enable network routing to be simplified. For example, rather than having to manage routing over a complex virtual backbone composed of many Permanent Virtual Connections (PVCs), an MPLS VPN user can generally employ backbone as the default route in communicating with all of the other VPN sites.

The use of MPLS for VPNs provides an attractive alternative to both Frame Relay and ATM PVC- based of VPNs and IP sec tunneling to interconnect routers at customer sites. The MPLS VPN model supports "any-to-any" communication between VPN sites without requiring a full mesh.



In order to facilitate seamless online consultation with patients from Vision Centres across 11 locations a real time consultation facility was established in the outpatient doctor consultation room at IGM-Hospital with required video conferencing software and access to VCMS module for doctor validation and sending the signed prescription online.

Apart from setting up Vision Centre infrastructure on the ground in 10 locations, the integrator also set up a core mini data centre for maintaining electronic medical records and connectivity network operations centre (NOC) at IGM with an ICT enabled real time doctor consultation, facility at the Ophthalmology OPD counter at IGM.

The Vision Centre database server is located in the Indira Gandhi Memorial Hospital premise at Agartala, the state capital.

The server acts as a NOC for the entire state. The server machine is required to be continuously operational and the video conferencing tool and the Vision Centre application will be run from the server. Two such servers have been made operational where one will act as the back up server for the other.

The server is also used to run Argusoft's Communicate@work audio-video chat service. The video conferencing tool is required for authentication purpose and helps in establishing a peer to peer link between the respective machines.

Though the application provides the option to record real time sessions between the doctor and patient, the model currently does not require the sessions to be stored as archives.



The Vision Centre application has a customised application designed and developed by Arvind Eye Care. This web enabled module allows the paramedic to capture all the information relevant to the eye screening of the patient (may include pictures of the eye in some cases).

The patient case history can be seamlessly escalated between the secondary and tertiary care hospital as when required.

Seeing the success of Vision Centres, the government is planning to equip the centre to provide treatment for other diseases.

The treatment for general medical issues will be provided through a telemedicine model where the doctors will be connected through the same network.

The remedy diagnostic tool will be used to capture the following patient details at source—ECG, auscultation sounds (Stethoscope), temperature, heart rate and others.

The kit will be connected to the software that will capture the information digitally and flash the information at the doctors' system enabling them to diagnose and advise the patient.

All this will help in remote diagnosis of disease and also improve health condition of people staying in West Tripura.