Telemedicine Systems

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Many patients with diseases difficult to diagnose and treat come to hospitals for medical help, and the cost of traveling and accommodation is high for them, especially for those from the poor or remote border areas.
As networks become more advanced and increase in speed, various energetic activities have begun to emerge. New networks will cause a major revolution in society, and one area, which is expected to be an effective application of new networks, is telemedicine. In general, Telemedicine can be defined as the delivery of health care and sharing of medical knowledge over a distance using telecommunication means. Telemedicine provides medical information exchange at a distance, to support medical procedure, with the ultimate goal for improving community health care. In these experiments, integrated functions such as the transmission of medical images, collaboration and video conferencing, and provided superb human interfaces for telemedicine.
As high-speed broadband networks spread, telemedicine support functions and areas where telemedicine services are available will increase. In the medical field, the emergence of a new format for medicine is expected, to include an equalization of opportunities to receive advanced medical treatment, and providing exacting medical care by linking hospitals and clinics.

? 1. INTRODUCTION:

???????????? Telemedicine system is one of the major forces shaping the future of healthcare. People who overreact to telemedicine’s early difficulties or underestimate its scope will be surprised by its real power.? Telemedicine will ultimately revolutionize healthcare ? restructuring virtually every relationship and activity that define late twentieth century medicine.

?????????????? While they are very likely correct in their assertions, telemedicine is still a fledgling industry. Today, a lot of the technical activity in the telemedicine industry consists of vendors integrating suites of components to create turnkey solutions for specific clinical settings .This system allows you to regularly monitor a patient’s vital signs and glucose levels without you having to see them in person. This system let’s you capture a series of images and send them off to a specialist for review.? Even though some of the systems that have been produced in this way have achieved stunning clinical successes, the industry has not yet “arrived” ? there is more that can be done from a technical viewpoint that is worth pursuing.
Telemedicine system is supported by the applications range from exchange of clinical chemistry laboratory results to interactive radiology consultations. All the applications have a common objective to improve efficiency and quality of the healthcare with use of technology.
This paper defines a set of objectives for introducing telemedicine in the health sector. It also outlines?? the structure of the regional health care system, which will be the scope for this paper. Communication needs within a typical health care region is analyzed. Later, telemedicine applications which meet these?? needs are described? by scenarios. Finally, the applications are integrated to form an example of a regional health care network. This extends from a simple phone call between a doctor and his patient to remote surgery using robotic equipment.

In some countries telemedicine is already applied in actual medical practice, the scope is still limited though2. The telemedicine system requires healthcare networks allowing physicians from more than one place to join a meeting at a time and these networks should have a capacity to transfer high quality images rapidly. Information technology is now becoming the most popular technology every field should consider. To make telemedicine an effective medical practice it is essential to have inclusive telemedicine system. That means it should be used easily in any departments and connected hospital information system quite easily. Until now most telemedicine systems are designed only for some departments. There are two types of telemedicine system. One is a telemedicine system, which can be used between long distance hospitals, and the other is a home care system through which patients at home can see doctors.

 

 

2. Objective :

 

?????????????????????? One of the basic ideas of telemedicine can be expressed by the saying: "Move the information, not the patient". When a patient needs to consult a specialist, information about the patient could be obtained locally and exchanged through a network to a specialist. In many situations this can replace transporting the patient or the specialist to a given location. This exchange of information for medical diagnosing and treatment is a basic concept of telemedicine using the technology like image processing and video-processing.

 

????????????????? The investigation, monitoring and management of patients and the education of patients and staff using systems which allow ready access to expert advice and patient information no matter where the patient or relevant information is located. Telemedicine may therefore be seen as all situations where information is exchanged electronically between health care parties that collaborate in treating patients.

 

 

?Ministry of Health defined 5 information technology (IT) objectives for the health care sector:

IT1:??? Improve service and quality of the health services.
IT2:??? Improve productivity and efficiency in the health sector.
IT3:??? When meeting IT1 and IT2 the aspects of security of privacy for the
individual patient should be considered.
IT4:??? Use the opportunities of IT to distribute information to the general
public and the health care professionals and to increase the level of
knowledge.
IT5:?? Improve working conditions and personal planning for healthcare
professionals.

 

These objectives relate to the whole of the health sector not only telemedicine. However, those objectives directly related to patient care may be used to form similar objectives of telemedicine. By combing IT1-5 objectives and the previous definition of telemedicine we have defined the following 7 objectives of telemedicine:


TM1:?? Patients should be treated as close to their homes as possible (IT1).
TM2:?? Medical expertise should be equally available independent of where
the patient lives (IT1).
TM3:?? The quality of medical decisions should be improved by making
existing information about patients more easily available (IT1).
TM4:?? Patients should get more information and better service (IT1).
TM5:?? The health services should improve efficiency and productivity by
reducing unnecessary administrative work such as retyping
information already existing in electronic form and by distributing
tasks between health care institutions and health care personnel
(IT2).
TM6:?? All exchange of information needs to take into account the aspects of
security of privacy for the individual patient (IT3).
TM7:??? Medical knowledge should be more easily accessible (IT 4).

 

 

3. Features of the system:

?????? The major features of the system are described as following:

  • ?Provides the efficient and convenient methods for patients and doctors to communicate with each other and allows patients to send their medical data/image through the Internet.
  • Provides a circumtance for "Case Diagnosis" and "Case Consultation" on the remote situation.
  • Build computer-based patient records and other? electronic information systems that provide? relatively easy and fast access to large databases? and that permit the application of powerful? statistical methods for analyzing? and displaying those data;
  • ?Formulates strategies for proving information to patients, clinicians, and others in ways that promote informed decisions and stimulate desired changes in behaviors and outcomes;
  • Potentially allows easier access to more information about a patient than the user either requests or needs.
  • Automatically produces a payment including types of telemedicine services and would be divided into professional and facility components.
  • Provides a secure web payment system and authentication procedures to ensure that messages are received from the stated source exactly as they were sent.

 

4. BENEFICIARIES:

4.1. Benefits to patient:
Patients who live in rural area or far from hospital could be given a routine check up by using mobile phone. In addition, severely injured patients can be managed locally and access to medical specialist accessed by wireless telemedicine, hence the system may provide fast response to critical medical care in spite of geographic barriers.

  • Patient can get experts' opinion without leaving familiar surroundings.
  • Patient can save time and cost as well as avoid trauma of travel and accommodation to meet the specialist.
  • Patient can get opinions from more than one specialist.
  • Telemedicine can be used to find latest method for treatment.
  • In a remote area where there is no doctor available, Telemedicine is the only solution.
  • Telemedicine has been proved life saving.

4.2. Benefits to expert doctor:
Local hospitals usually they do not have enough medical expert and nursing staff who are able to manage seriously ill patient. By using these technologies, such kind of problems may be alleviated.

  • Wide variety of cases
  • Expand practice online
  • Serve large unprivileged population
  • Time saving as case is in structured format

4.3. Benefits to referring doctor:

  • Patient saves time and money as well as he is free from hassle of traveling.
  • Wider range of medical advice from number of experts.
  • Latest and best treatment for patient.
  • Doctor can suggest treatment to the patient who avoids meeting specialists due to some reason.
  • Doctor can increase his/her knowledge base.
  • Can do follow-up with expert from patient's place.

 

4.4. Benefits to Local authority:
Since this project can support a program for reducing Maternal Mortality Rate (MMR) and improving Mother and Child Health which has to be served by local authority.

5. METHODOLOGY:
The developed system operation mostly relies on existing public communication infrastructure, i.e. fixed public phone. The problems with a non-mobile telemedicine system are:

  • It is not easy to be developed and less flexible, particularly in areas where the communication and transportation infrastructure has not been available yet.
  • Deployment of the system could be very problematic especially in case of emergency cases/natural disaster such as tsunami, earth quake, and flooding.
  • India has more than 100 crores population, spread out all over the country. Because of the demography condition of India, a mobile and/or movable system will be demanding because a fixed system is difficult to be reached by patient living in remote urban or rural area, so he or she can not be given proper health services.

??????????????????????????????? In order to alleviate these problems and support different growing application of telemedicine, this project proposes the Development of ICT-Based Mobile Telemedicine Systems with Multi Communication Link. One of the crucial problems to deliver health services in India is the specific demography, and the availability of needed infrastructure. The proposed system will exploit the advantage of wireless technology and combine it with other communication technologies such as wide band radio packet to satisfy different locals and demographic requirements.
The system can be operated in both on-line mode and the indirect mode (data is stored and forwarded later on). The data can be transmitted in different mode of communication links, and the system will be ‘bandwidth independent’. As a result, the system should be able to be employed effectively even if only the lowest bandwidth is available in the local area. To achieve this objective, the system will be provided with options of variety communication links from ordinary telephone lines, mobile telephone both GSM and CDMA, and packet radio. Depending on the geographic location, a user can determine the mode of communication that suits his or her requirement.

The following methodologies will be carried out to implement the project:

    • Assessing the available communication means within the area of interest.?
    • Doing a comparative study to selected Asia Pacific countries, i.e. India, Australia, to learn from their experience in developing a mobile telemedicine system.
    • Developing the hardware and software communication interface module to perform voice, data transaction and video for telemedicine purposes.
    • Developing the hardware and software platform for telemedicine including the telemedicine data base.
    • Integration of the developed modules into the telemedicine system
    • Identify the information and service needed by the doctor side including the medical data base.
    • Development of the required hardware and software platform for the doctor site.
    • Field test of the telemedicine system, analysis, and reporting.

The most important aspect to be considered is the real application of the system which will define feasibility of technical constraints.

 

 

5.1. System Decomposition:
Mobile telemedicine directs a mobility aspect of patient, medical data, health services, and emergency team mobility. The system is based on the deployment of a mobile unit provided with computer, and diagnostic devices and processes. The unit is called Telemedicine (mobile/movable) unit, and supported by specially designed hardware and software. To match the Telemedicine Mobile Unit, the project will also develop a Base unit or Doctor unit that is placed in Medical centre or any reference hospital.
According to the most needed requirement of health services in India, the design system will be focused on application telemedicine for:

  • Tele diagnostics 
  • Tele consultation 
  • Recording and reporting 
  • Distance education 
  • Other service applications.

A proposed system of the Mobile Telemedicine Unit is depicted in Figure 1, while Figure 2 describes a Hospital or Doctor unit.
5.1.1. The Mobile Telemedicine Unit
Basically the Mobile Telemedicine Unit consist of three blocks i.e. the medical devices that performs measurement and acquisition of medical data/information including a set of video camera equipment; the communication block , and a processing data unit.

Mobile Telemedicine Unit

Figure 1: Mobile Telemedicine Unit

 

Medical devices block
Medical devices which are equipped in the unit may vary, according to the urgent medical services that mostly demanded by the community within the area of interest. Each of medical devices is connected to a Telemedicine Arbiter that functions as an interface between the equipments and the local PC. Moreover, the telemedicine arbiter is also applied as a control unit for communication transaction to local PC and the communication manager.
Communication block
The communication block consists of two main parts, namely:

  • Telemedicine Arbiter 
  • Communication manager.

??????????? The arbiter is responsible for data acquisition and or polling of medical record from various medical devices. Data will be saved in a Medical Data Base. One of the most important factor has to be taken into account is the possibility of serving wide range of data format. A special purpose software must be designed as a protocol for data exchange, and biosignals acquisition modules to support the required system has to be developed as well.
Communication between the Mobile Telemedicine Unit and the Hospital Unit is implemented by using different communication mode. In order to carry this task, a communication module, viz. Communication Manager will be designed. This module provides an option for data transmitting according to the available communication link infrastructure, and consists of multi modem (radio, GSM, CDMA, Fibre optic). Operation of the module will be controlled by predefined software communication protocol to manage data transaction (data flow in ? data flow out) that matches to format data based on available communication link, determine a kind of communication link, and maintain connection between the Units.
Processing Data Unit
A personal computer is used as a processing data unit. The selection of the computer depends on the application of the Telemedicine Unit, i.e. connection parameters to a high speed computer network that translate different data format ( patient record, image, multimedia), efficient storage of data, and effective handling of growing number of system and user.
5.1.2. The Hospital Unit :
As shown in Figure 2, the Hospital Unit consists of a dedicated PC and a Communication Manager. The PC is used for monitoring signals and data coming from the Telemedicine Unit. Incoming signals are biosignals measured by medical devices within the Telemedicine Unit. Data may be in a various format, and the data transaction is controlled by the Communication Manager.

Hospital or Doctor  Telemedicine  Unit

Figure 2: Hospital / Doctor Unit

 

5.2. System design and technical implementation
Mobile Telemedicine Unit is created to be expandable and flexible according to the user requirements. Hence, the unit is designed in modular form, The mobile telemedicine unit will be provided with both hardware and software. The minimum hardware contains a PC or laptop, a digital camera, power source, and medical devices. Based on the most needed requirement, the medical devices included are:

  • Blood Pressure 
  • ECG machine 
  • Doppler Fetal monitor.

It is desirable to use only digital instrument and medical devices, although analog instrument may also be used if needed. The main consideration which must be taken into account are the accuracy level of biosignal and data required by doctor for diagnosis, portability, and robustness means the devices can operate in almost any circumstances area. In addition, the mobile unit will also be provided with image processing software and a scanner for digitizing resulted image.
This system contains also Patient Information Record (PIR) that is needed for providing health care using telemedicine. The medical information consists of clinical as well as non clinical data. Clinical information is health information of a patient, viz.:

  • the illness he or she is suffering for
  • the physician?s observation of the patient?s illness
  • the diagnostic test to be carried out to determine the patient illness 
  • the result of the diagnostic test 
  • the kind of treatment to be given 
  • the method of treatment should be given to him or her.

Moreover, the non-clinical information is about the patient?s environment, such as address, occupation, spouse, age, etc.

5.2.1. The Mobile Telemedicine Platform :
The telemedicine system will be designed to be used in a hospital , or in a mobile place. Depending on the application and space constraint, the platform of H/W and S/W for telemedicine system may vary. For this project, the hardware platform is determined as follows:
5.3. Hardware :
5.3.1. PC specification

  • Intel Pentium-IV, 2.4 GHz with appropriate mother board 
  • Appropriate number of Serial, parallel & USB ports 
  • Interface for Digital camera 
  • 40 GB (minimum) or more HDD 
  • 1,44 MB FDD 
  • 256 MB DD RAM, up-gradable to 1 GB 
  • High-resolution colour monitor for displaying medical data/images.

5.3.2. Laptop specification
Processor Intel Centrino is prefer, and other specification of a laptop PC are similar to the desktop PC.

5.3.3. Power source
The power requirements for computer, and other medical devices are common, i.e. 220 volt, 50 Hz. In addition, a number of equipments must be provided with appropriate batteries.
5.3.4. Printer
Any appropriate standard printer for high quality printing
5.3.5. Digital camera
Digital camera system provided with resolution at least 2.1 mega pixel or better, with minimum illumination of 5 lux, with an interface to the computer.

5.4. Medical Equipment :
As mentioned earlier required minimum configuration for telemedicine diagnostic equipment in India are as follows :
5.4.1. Digital ECG Specifications :

  • Leads : standard 12 leads 
  • Freq. response : 0.5 ? 125 Hz, or better 
  • Leakage current : < 10 Micro amps 
  • Input impedance : > 20 M Ohms

5.4.2. Fetal Heart Rate Monitor Specification :

  • Technique : Continuous Doppler with Auto Correlation 
  • Frequency : 2.5 MHz 
  • Range : 0 ? 100 units 
  • Bandwidth : 0 ? 0.2 Hz

5.4.3. Blood Pressure Checker
Any appropriate standard.

 

?5.5. Software :
To implement the mobile telemedicine system, a dedicated software will be developed. The software should be able to perform the functions as follows:

  • acquisition of patient related information 
  • store of the patient information 
  • display of patient information 
  • transmit the information over a communication link 
  • scheduling of doctor appointments 
  • capture image / document from scanner 
  • capture of video / other data from the output out the medical equipment .

a. Software types. Generally, development of an integrated telemedicine system involves a number of software issues.

  • Applications Software - Telemedicine programs often use business or clinical applications software to manage program operations. This software often associates data with a particular patient, and then manages transmission of data to various parties.
  • Device interfaces - Frequently, devices are designed using proprietary software or systems which do not readily interface to applications software. Device interfaces may be required to assure the flow of information.

 

  • Interface to database/other applications - Quite often, the telemedicine system sponsor would like the program applications to interface with the sponsor's database systems or with other specific applications (e.g. financial reporting, billing, physician scheduling). Because the goal is to mainstream telemedicine, operating software must interface to other software systems customarily used in the operation of health care providers.

?b. Software specification

  • Operating System : Under Windows Xp
  • Nain program : Delphi + VB 
  • Web server : Apache 
  • Data base server : MySQL 
  • Security software : Firewall, anti Virus, C/C++ based software 
  • Communication s/w : TCP/IP

The expected system is a low cost and easy to deploy solution hence during the development the system the use of low cost and general purpose components will be suggested.

6. Output:
As described earlier that the objectives of the project is to develop an ICT-based mobile telemedicine system with multi communication links. The project would deliver a working user tested ICT-based mobile telemedicine system that support community health services. Also the project will produce report and recommendation of the application of telemedicine infrastructure for rural community.

7. Monitoring:

?7.1. Monitoring:
Monitoring is carried out in order to maintain the project milestones meet to the project time-line. Monitoring will be done as follows:

  • Regular team supervisions (meeting/discussion) every week 
  • Set up project log book for each team member 
  • Coordination (coordinative team meeting) every two weeks, and as necessary 
  • Periodic meeting with associated policy authorities 
  • Periodic progress report every month.

7.2. Evaluation:
Project evaluation will be conducted based on technical performance, clinical evaluation and user survey.
7.2.1. Technical performance
Technical performance evaluation consists of parameters, such as:

  • Technology applied selection, concerning to compatibility, scalability, interoperability, and reliability of equipment and systems used that meet these requirements 
  • System design regarding to low-cost, high coverage, and secure data transmission. This system will be implemented over public wireless phone networks . On the other hand, sending a video and data stream through low bandwidth and low reliability media is another technical challenge which has to be overcome instead of connectivity and quality of service.

7.2.2. Clinical evaluation
Clinical evaluation of the system will be implemented on the subject of the accuracy of the diagnosis which depends on the quality of transmitting data whether bio signals or images.
7.2.3. User survey
To gather data and/or opinion of the users of the mobile telemedicine, a questionnaire will be designed which covers areas concerned, i.e.
(1) data security,
(2) usability,
(3) effectiveness,
(4) interference.

 

8. Abreviations & acronyms? :

 

ICT??????????? : Information communication and technology.
GSM????????? : Global System Mobile.
CDMA?????? : Code Division and Multiple Access.
F.O???????????? : Fibre Optic.
ECG?????????? : Electrocardiography.
Modem????? : Modulator Demodulator.
PIR??????????? : Patient Information Report.
VB???????????? : Visual Basic
PC????????????? : Personal Computer.
Transceiver: Transmitter and Receiver?

 

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