SIV 864: Special Module on Multimedia ApplicationsSIV 864 Srivastava / SIV864 / School of IT / Nov...
Transcript of SIV 864: Special Module on Multimedia ApplicationsSIV 864 Srivastava / SIV864 / School of IT / Nov...
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Sakti Srivastava, MBBS, MS
Adjunct Professor, School of IT and
Centre for BioMedical Engineering
Indian Institute of Technology, Delhi
SIV 864: Special Module on SIV 864: Special Module on Multimedia ApplicationsMultimedia Applications
TelemedicineTelemedicine
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Definition
TelemedicineTelemedicine
At a distance Delivery of clinical service
Telehealth Telehealth
Preventive and promotive
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
The earliest attempts….
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
The first modern attempts…
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
The next milestone…
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
The Internet changed everything…
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
The Physician of 2020 ?
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
ElectronicElectronic
MedicalMedical
RecordRecord
DigitalDigital
ImagingImaging
Lab testsLab tests
PatientPatient
MonitoringMonitoring
ComputerComputer--basedbased
teachingteaching SimulatorsSimulators
Robotic SurgeryRobotic Surgery
Decision Decision
SupportSupport
Treatment Treatment
protocolsprotocols
TelemedicineTelemedicine
The Physician of 2020 !
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
“Building Bridges”
Medical Technical
Needs SolutionsApplications
Speak the same “language” Understand each other
Work together
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Physicians
Engineers
Education experts
Computer professionals
Graphic designers
Industry
The coming together of …
Governments
Voluntaryorganizations
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Types
Synchronous
Asynchronous
� Real-time
� Store & Forward
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Synchronous Telemedicine
� Real-time
� Requires both parties to be present at same time
� Telephone consultation
� Videoconference
� Extendable peripheral devices (tele-stethoscope, tele-otoscope)
� High bandwidth utilization
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Synchronous Telemedicine (2)
� Client-server or peer-to-peer architecture
� May be recorded or not
� Phone lines / ISDN / Satellite / Broadband
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Asynchronous Telemedicine
� Store and Forward
� Does not require both parties to be present at same time
� Capture text / audio / image / bio-signal data
� Requires some form of electronic medical record (EMR)
� Low bandwidth utilization
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Asynchronous Telemedicine (2)
� Postal system / Letter / Fax / Email
� Network connectivity
� Databases
� Scheduling of offline activity
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Standards
Medical Standards
Technical Standards
� International Classification of Disease
� Clinical Procedural Terminology
� Unified Language of Medical Sciences
� Accredited Standards Committee (ASC) X12N
� Digital Imaging and Communications in Medicine HL7
� International Telecommunications Union H.320
� Association for Advancement of Medical Instrumentation
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Non technological issues
Medical Issues
Implementaiton Issues
� Security and Privacy
� Clinical Quality Assurance
� Education and Training
� Business models / reimbursements
� Portability and Inter-communicability
� Reliability / Technology support
� Scalability
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Case Study
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Healthcare Scenario in India
� India spends <1% GDP on health
� Urban/Rural mismatch of health professionals and population
� >70% rural population
� Most lack access to
basic health facilities
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Telemedicine in India
� Aravind Hospitals – Teleopthamology Network
� Apollo Hospitals – Aragonda Project
� OTRI (Online Telemedicine Research Institute)
� Asia Heart Foundation
� OncoNet (Kerala)
� Common Service Centers e-governance
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Telemedicine in India
� VSAT based (ISRO)
� Broadband based (BSNL)
� High cost (setup and maintenance)
� High technical expertise
� Low bandwidth
� Limited scalability
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Continuing challenges
� Remotest of remote
� No connectivity
� Limited infrastructure
� “Bottom of Pyramid” (<$1 per day)
� Landless farmers, illiterate
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Criteria
� Inexpensive and low maintenance
� Easy and quick to setup
� Robust and durable
� Minimal new technology usage and skills requirement
� User-friendly, able to cope with infrastructure
� Support large datasets and scalable
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Our proposed solution
� Asynchronous (Store & Forward)
� Delay tolerant network (DTN)
� Large datasets
� Several unique features
� Highly scalable
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Application overview
Kiosk-
PC
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Case Flow 1
Internet Region
D1(Neuro)
D2(Pediatrics)
D3
(Ortho)D4
(Ortho)
Dispatcher
New Case Submission Path
Reply from Doctor
Health Care
Worker
Primary Healthcare Centre (Rural)
RadiologyEquipment
DICOM
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Case Flow 2
Internet Region
D1(Neuro)
D2(Pediatrics)
D3
(Ortho)D4
(Ortho)
Dispatcher
New Case Submission Path
Reply from Doctor
Health Care
Worker
Primary Healthcare Centre (Rural)
RadiologyEquipment
DICOM
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
DICOM
Internet Region
D1
(Neuro)
D2
(Pediatrics)
D3(Ortho)
D4
(Ortho)
Dispatcher
New Case Submission Path
Reply from Referred Doctor
Referral to another Doctor
Health Care Worker
Primary Healthcare Centre (Rural)
RadiologyEquipment
Case Flow 3
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Design Overview
Kiosknet Hardware
DTN – Communication Infrastructure
DICOM
Interfacing
Automatic Case
• Allocation
• Forwarding
• Consolidation
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Design Overview
Kiosknet Hardware
DTN – Communication Infrastructure
Automatic Case
• Allocation
• Forwarding
• Consolidation
DCMTK
CreatorDecomposer
GUI
DICOM
Viewer
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Design Overview
Kiosknet Hardware
DTN – Communication Infrastructure
DCMTK
CreatorDecomposer
GUI
DICOM
Viewer
DtnReceiver
DocDBSync
DB
NetReceiver
Consolidation
Sender
Sender
Receiver
GUI
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Automatic Case Allocation
� Physician database at proxy
� Doctor’s Name, Specialty, Location, ID, IP, email address
� Case specifies only specialty
� Based on specialty and availability, allocation done
� Any allocation algorithm can be implemented now
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Automatic Case Consolidation
� Unique Case ID assigned to a case at creation
� One consolidated file per case ID maintained at the proxy
� Consolidated file can be retrieved from any location
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Implementation Details
� Components
� Hardware
� Software
� Databases
� Application level routing
� Screenshots
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Hardware Components
Via Box, 512MB RAM, 40 GB HDD, Ethernet, Wireless
PC, Low RAM, No HDD, Ethernet,Wireless
Soekris 4801-60 Box, 256MB RAM, 40 GB HDD, Wireless
Soekris 4801-60 Box, 256MB RAM, 40 GB HDD, Wireless
PC (P4) , 512MB RAM, 80 GB HDD, EthernetWireless
PC, 512MB RAM, 40 GB HDD, Ethernet
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Software Components
Debian OS
Apache 2.2, PHP 5.2.6, DICOM ViewerMricro
Debian OS
dtnd, dcmtktoolkit, dhcp, nfs
Creator, Decomposer (java modules)
Debian OS
dtnd
Linux OS
Apache 2.2, PHP 5.2.6
Receiver, Sender
(java modules)
Debian OS
dtnd
Debian OS
dtnd, dcmtktoolkit, dhcp, nfs
Creator, Decomposer (java modules)
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Screenshots
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Results
� 1 GB data bidirectional transfer
� Measured time for link detection and transfer time
� Time to link detection: Worst case – 10 mins
� Throughput: 1 MBPS
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Future Work
� SMS integration
� Call allocation methods
� Enable querying
� Security and privacy
� Utility based routing
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Summary
� Rapidly evolving field
� Many needs and many solutions
� Success is not dependant on technology alone
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008
Summary
SIV 864
Srivastava / SIV864 / School of IT / Nov 2008