Creation of A Cyber-Hospital: IT Considerations

Ralph Madeb, MDRalph Madeb, MDDirector of Telemedicine

Assistant Professor of UrologyRochester General Hospitaloc este Ge e a osp ta

Rochester, NY

Static and Dynamic SettingsStatic and Dynamic Settings

St ti D iStatic• Outpatient Clinics

N i

Dynamic• Assisted Living and

Nursing Homes• Non-patient encounters• Radiology

Nursing Homes• Wards

ICU• Radiology• Pathology

• LCA ICU

• ICU• ED and Triage

T d OR• LCA ICU • Trauma and OR• HCA for Clinic

BasicsBasics

• ISDN• ISDN• ITU standard (H.320)• Integrated Services Digital Network• Integrated Services Digital Network• Secure digital circuit – it’s a digital phone

lineline• Therefore looks like a phone number

(888)-888-8888( )• Two types BRI(basic rate) and PRI

(primary rate interface)

BasicsBasics

• IP • IP • Internet Protocol• ITU standard (H 323)• ITU standard (H.323)• IP address (192.168.2.4)• Method of addressing network devices• Method of addressing network devices• IP can be transmitted over T1, DSL, cable,• Advantages: leverage infrastructure • Advantages: leverage infrastructure,

reliability, enhanced manageability, simplicity, decreased cost, predictable

f h dusage fees, enhanced security

CORE NETWORK

EXAM ROOM SYSTEM

General Exam Camera

WIRELESS MOBILE SYSTEM @ PATIENT END

Hi Def Camera with Hi-Def. Camera with far-end control

Monitor with split-screen viewingscreen viewing

Wireless laptop with

UPS B tt k ith

p pclinical care data/EMR

UPS Battery-pack with 6 hours of operating time

SYSTEM @ CONSULTANT END

Hi Def Camera with Hi-Def Camera with far-end control

Hi-Def Monitor with split-screen viewingsplit-screen viewing

Doubles as PC-monitor

IMAGES

WIRELESS ROBOTIC SYSTEM @ PATIENT END

IP-Network

The RP Robots

Control Station

Doctor-Robot-Patient RelationshipRelationship

Robot BasicsRobot Basics

• Runs on wireless 802 11 a/b/g• Runs on wireless: 802.11 a/b/g• Ability to roam: follow SSID from one

Access Point to the nextAccess Point to the next• Network Quality:

B d id h id l b d id h i d i • Bandwidth: ideal bandwidth required is 600 kbps in both directions, can run on as little as 200 kbpslittle as 200 kbps

• Latency: latency should be < 400 ms• Quality of Service (QoS) a.k.a. variation in Q y (Q )

latency – poor QoS is bad for the system

SecuritySecurity• Encryption: • Encryption:

• encryption methodology utilizing a combination of RSA public/private key and DES 56 bit t i tiDES 56-bit symmetric encryption

• Key System: • Control stations and robots contain their own • Control stations and robots contain their own

unique private keys • They also contain public keys for all systems

they are allowed to connect tothey are allowed to connect to• Rochester user is only able to connect to Rochester

robots and not UCLA (user must request permission to be able to connect to other health permission to be able to connect to other health network robots)

Video InformationVideo Information

F t • Frame rate: • Video is captured at 30 frames per second

• Codec (video and audio compression): • InTouch Health uses proprietary video and y

audio codecs

Integrated System

Main ConsiderationMain Consideration

Cli i l li ti h ld d i • Clinical applications should drive technology – NOT vice versa

• “One-size-fits-all” won’t work –Customize technology to meet clinical needs

IT CONSIDERATIONS

• Standards-based• Interoperable• TransparentTransparent• User-friendly – for clinical staff NOT for

IT staffIT staff• “Kick-the-tires” – use before purchase• Low-cost approach

“Imagination is more important than “Imagination is more important than knowledge”knowledge”