WIMAX - WIMAX - A Solution for Tele -MedicineA Solution for Tele -Medicine

† † Ajal.A.J,Ajal.A.J, * * R.KandasamyR.Kandasamy††ASSISTANT PROFESSOR, FISAT – KOCHI , KeralaASSISTANT PROFESSOR, FISAT – KOCHI , Kerala

** ASSISTANT PROFESSOR, Sasurie college of engineering ASSISTANT PROFESSOR, Sasurie college of engineering - - Vijayamangalam, Tirupur DistrictVijayamangalam, Tirupur District

ec2reach@gmail.com Mob: 0- 8907305642ec2reach@gmail.com Mob: 0- 8907305642

Telemedicine

MAJOR PARTS OF THE PRESENTATION

PART 1: THE

CONTEXT

PART 1: THE

CONTEXT

PART 2: THE

INITIATIVES

PART 2: THE

INITIATIVES

PART 3: POSSIBILITIES

PART 3: POSSIBILITIES

1. Describe TeleMedicine

2. Describe the types of Telemedicine

3. List Advantages/Disadvantages

4. Legal/Ethical Issues

5. Statistics

OBJECTIVES

What is Telemedicine?What is Telemedicine? . . . the use of electronic . . . the use of electronic

information and communication information and communication technologies to provide and technologies to provide and support health care when support health care when distance separates the distance separates the participants . . .participants . . .Telecommunications

Technology

+

Medicine

Telemedicine began .Telemedicine began . . . . . In 1924, with the concept of a In 1924, with the concept of a

physician seeing his patient over physician seeing his patient over the radio using a television screenthe radio using a television screen

First wave of telemedicine programs First wave of telemedicine programs started in the 1950sstarted in the 1950s

Now in the third waveNow in the third wave Most programs that began in the Most programs that began in the

1960s-1980s no longer exist, due to 1960s-1980s no longer exist, due to dependence on external fundingdependence on external funding

Compression of Compression of bandwidthbandwidth

Codecs compress the information to fit the broadband connection

Region 3

Hospital

Home

Pharmacy

Health Centre

mobile PC

Mobile, Wireless

&Broadband

Emergency

Region 2

Mobility

Region 1

Personal Health Systems: Connecting individuals with Health Information Networks

Secure Networks

Sensors for multi-parametric monitoring

Hospital

Health / call Centre

Data communication and feedback

Data processing & analysisData acquisition

200 400 600 800 1000 1200 1400 1600 1800 2000 2200

500

1000

1500

t [sec]

RR

[m

sec]

TiltSympthoms

200 400 600 800 1000 1200 1400 1600 1800 2000 220050

100

150

t [sec]

SB

P [

mm

Hg]

200 400 600 800 1000 1200 1400 1600 1800 2000 22000

50

100

SC

MI

[%]

t [sec]

200 400 600 800 1000 1200 1400 1600 1800 2000 2200-0.5

0

0.5

Ris

k [

--]

t [sec]

Positive VVS Risk

Other data: clinical, images, lab, genomics

Intelligent analysis

Support to diagnosis decision & treatment

Treatment,Rehabilitation

Medical expertise

Personal Health Systems:

the bigger picture

Prototype PHS

Examples Wrist-worn devices Body Sensor Networks Biomedical clothes

MOBIHEALTH

AMON

MYHEART

WEALTHY

High-Speed Applications

Transport Protocols be able to transfer a large amount of data

over a long distance within a short amount of time

High-Speed Networks

High-Speed Applications

Weather Simulation Video Conference Telemedicine

Telemedicine

• Telemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.

Disambiguation

• Other expressions similar to telemedicine

are the terms "telehealth" and

"eHealth", which are frequently used to denote broader definitions of remote healthcare not always involving active clinical treatments.

Early precursors

• In its early manifestations, African villagers used smoke signals to warn people to stay away from the village in case of serious disease .

• In the early 1900s, people living in remote areas of Australia used two-way radios, powered by a dynamo driven by a set of bicycle pedals, to communicate with the Royal Flying Doctor Service of Australia.

• Telephone• Telehealth hardware• PC or laptop computer• Power supply• Web access

Types of telemedicine

• Telemedicine can be broken into three main categories: 

(asynchronous).

• store-and-forward services.

• remote monitoring  services.

(synchronous)

• (real-time) interactive services.

Emergency telemedicine

• regulatory challenges

• Lack of acceptance

• Cultural barriers

TeleMedicine Transfers Medical Information through technology

Transfer By:•Telephone/Cell Phone•Internet•Video Conferencing•Satellite

Wireless Broadband InitiativeWireless Broadband Initiative

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Objective :Objective :

Ambitious ITU initiative to expand broadband access in underserved areas of Africa

ITU’s initiative: ITU is working with governments and other partners

Expected outcomes :Expected outcomes :

Develop and deploy wireless networks

Guarantee capacity for schools and hospitals

Train local experts and build human capacity

Develop ICT Applications: e-health, e-education, e-government

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Mobile clinics &

Portable eHealth terminals

Mobile Health Information Services

Telemedicine services in remote areas

(Telediagnostics, Teleconsultations, Telecare, etc.)

Health Education (Health awareness campaigns, tips, quizzes, games, etc.)

Health Data gathering (surveys, disease surveillance, research trials, etc.)

Training for Health Workers

Remote Patient Management & Monitoring (helpline, alerts, reminders, access to patient record, history, medication plan, tracking, Remote sensors, etc.)

Dignostics and Treatment Decision Support Systems

(2 ways SMS, , DSS software)

Emergency Telemedicine services

m-Health supportm-Health support

Other Target Markets

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DISASTER SITES

HOSPITALS

FACTORIESRURAL NETWORKSSHIPS

DEFENCE & RAPID DEPLOYMENT SITES

HOUSING COMPLEXESCORPORATES & ENTERPRISES

Wimax enabled applications / services

Telemedicine may be as simple as two health

professionals discussing a case over the telephone, or as

complex as using satellite technology and video-

conferencing equipment to conduct a real-time

consultation between medical specialists in two different

countries.

““Doctor On Call” (DOC)Doctor On Call” (DOC) Telephone MedicineTelephone Medicine

Immediate 24 hour telephone access of patients to Drs. On call.

Services include: Emergency medical advice.

Emergency medical telephone screening. Emergency medical dispatch.

Non-emergency medical information. Non-emergency medical counseling.

Non-emergency general medical advice.

Real Time Telemedicine

Video Conferencing equipment is one of the most common forms of technologies used in Real Time telemedicine

It requires the presence of both parties at the same time and a communications link between them that allows a real-time interaction to take place.

Telemedicine in Home CareTelemedicine in Home Care

Goal - Replace some physical visits by nurses by ‘Tele-visits’:• Visits of a supervisory nature

• Visits to check vital signs

• Visits for information and reassurance

• Visits of a ‘compassionate’ non-reimbursable nature

Home CareAgency

Nurse Visits

Physician VisitsTeleVisits

Patient Roster

Clinics

HospitalsPlan of Care

ASP

Gateway

ALH

TV

earplug Internet

WMAN(e.g. IEEE 802.16)

Network Architecture Peripheral Bluetooth Network

Internet-capableMedicalMeters

J2ME API for AccessingBT Nodes and Internet

Passive Application A

BT StackFixedALHOS

TCP/IPComm.

API

ALSP Server

TCP/IP Stack

ALSPServer

OS

Cellphone Network

+ Internet

Bluetooth

TCP/IP Stack

802.16Wireline

MAC

IP Routing Service

802.11MAC

Gateway

Dumb Dev

PC IP: 128.174.11.11

Under Normal Situation

When the Gateway is Available

Networked Software Architecture

ASP

ALH

TV

earplug Internet

WMAN(e.g. IEEE 802.16)

Networked Software Architecture

Peripheral Bluetooth Network

When the Gateway is Not Available

Internet-capableMedicalMeters

Base Station

cellphone

GPRS network

or WiFi

mobile medicaldevices

How Medical Data Can Be Securely Transmitted ?

SOAP Envelope

Header

MedicalInformation

SOAP Envelope

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MedicalInformation

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Sign. on Key

PubC KF

PubC/PrivC

KFPWAP

PWAP

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PubAS

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[Michael et al. 06]

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How Medical Data Can Be Securely Transmitted ?

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How Medical Data Can Be Securely Transmitted ?

PubC/PrivC

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Header

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How Medical Data Can Be Securely Transmitted ?

ALSP

mobile medicaldevices

earplug Internet

WMAN(e.g. IEEE 802.16)

Networked Software Architecture

Peripheral Bluetooth Network

When cell phone takes the roll of ALH

Internet-capableMedicalMeters

Base Station

GPRS / WiFi / wimaxCellphone

Partnership : Partnering with Mobile Network Operators

Operators, Mobile content and the Long tail

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Remaining ChallengesRemaining Challenges

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Problems achieving interoperable e-Health applications and standardization

Need for improved evidence of the economic and social benefits of e-Health

Many pilots for e-Health projects exist, but scalability is an issue

Improved communication between telecom and health sectors

Video Conferencing Equipment•Tele-Otoscope-allows a remote physician to 'see' inside a patient's ear

•Tele-stethoscope- allows the consulting remote physician to hear the patient's heartbeat

Store-and-Forward Telemedicine

•Involves acquiring medical data (like medical images) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline

•Advantages of this method are that it does not demand the presence of both parties at the same time and does not usually require expensive equipment

Necessary Equipment for Store and Forward

•Camera- to take the picture of the medical problem

•A Way of Transmitting the image via Cell Phone, PDA, Email

Store and Forward SoftwareWhat is CapSure?CapSure is a remarkable store-and-forward software designed specifically for the professional inspection and imaging world.

What does CapSure do?With CapSure, you work with real-time video on your computer. It captures and converts raw data into the high-quality .jpg or .png formats. Create session folders and file names - CapSure automatically numbers the snapshots and remembers where they’re stored so you don’t have to spend time searching for missing files. You can even publish a session on a server or share a real-time image with a client. Best of all, CapSure provides you with a virtual environment that allows you to work the way you want to work.

Definition of Telehealth/Telemedicine and Research Information

Mission statement: Telehealth is used to provide total solutions for the needs of healthcare facilities.

Telehealth is…

the delivery of health-related services and information via

telecommunications technologies. Telehealth allows patients to be

seen when traditional health care cannot be given due to distance, location, or lack of medical centers.

Telehealth is a broader view of telemedicine, which views specifically on curative measures.

It combines preventive, promotive, and curative

aspects.

Seeing telehealth in action: http://www.youtube.com/watch?v

=MmKNv9detu8

Telemedicine interoperable Architecture

Clinical Information System

• The Clinical System is best used for Telemedicine and Telehealth software.

Clinical information systems consist of information technology that is applied at the point of clinical care.

This includes medical records for immediate access, clinical data from assessing the patient, and viewing laboratory/diagnostic studies for instant results.

This system also involves being about to access the data from any device at the office, hospital, or home.

Clinical System Review

• Telehealth is used by physicians, nurses, and can be a way of communicating to specialists as well.

• This system is used to assess, diagnose, and document. It is for preventive and curative aspects of healthcare.

• Telehealth software can all come together in a mainframe, where all the medical centers that use this program can securely store all patient information for it to be easily accessed from anywhere or any technological product.

• Though, the telehealth system uses other configurations under and within the mainframe. These configurations include but are not limited to:

Minicomputer Microcomputers Point of care

Local area networks , Metropolitan area Networks. Other systems

Clinical System Review

• There are many data standards used within telehealth so it can be used internationally as well as from one hospital to another.

• Some standards used would be the

1. ANSI, American National Standards Institute

2. International Standards Organization,

3. Workgroup for electronic data exchange, etc.

Advantages of Telemedicine• Helped to make doctor’s offices and medical facilities as close to one another as the nearest computer screen.

• Can be used in the remotest parts of the world or in places as close as a correctional facility, helping to eliminate the dangers and costs associated with the transportation of prisoners to a medical center

• Allows a surgeon to be in 2 places at once.

•Allows homebound to receive treatment.

Disadvantages1. many states wont allow out-of-state physicians to practice medicine unless they’re licensed in that state

3. The Centers for Medicare and Medicaid (CMS) have placed restrictions on the amount given in reimbursements for telemedicine procedures, and many private insurance companies will not reimburse at all for this technology.

2.underlying fears of malpractice suits for physicians engaged in telemedicine because there is a lack of hands-on interaction with patients.

4. Technological problems. Telephone lines and rural areas not having cable.

Ethical/Legal Issues

Security, privacy and confidentiality, in telemedicine consultation, Are the concerned Ethical Issues.

• Advocate for safe and effective use of telehealth technology.

• Serve as well informed resources for consumers and technology developers for the safe use of technology to meet healthcare needs.

• Monitor outcomes of care resulting from telehealth nursing practice.

• Ensure confidentiality and patient privacy in all telehealth encounters.

Definitions of Telehealth Nursing• Telehealth nursing is the practice of nursing over distance usingtelecommunications technology (National Council of State Boards of Nursing(NCSBN), 1997).

• Telehealth nursing is the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing (American Association of Ambulatory Care Nursing (AAACN), 2004).

• Telehealth nursing is the use of telecommunications technology in nursing to enhance patient care. It involves the use of electromagnetic channels (e.g., wire, radio, and optical) to transmit voice, data, and video communications signals. It is defined as distance communications, using electrical or optical transmissions,between humans and/or computers (Skiba, D.J. & Barton, A.J., 2000).

Functions And Responsibilities of the Informatics Nurse

1.Leveraging technology and nursing expertise to

provide quality nursing care, to delivering

nursingexpertise to those who

need care, and to improving health and patients’

outcomes.

Telehealth nurses are committed to:

2. appropriate, effective, proficient, and safe use of

telehealth technologies/medicaldevices

3.Enhanced

communication skills

4.Adhere to existing

regulations of the jurisdiction

inwhich they practice, including

licensure and regulatory

requirements.

Related activities

• Telenursing

• Telepharmacy

• Telerehabilitation

• Teletrauma

• Telecardiology

• Telepsychiatry

• Teleradiology

Telepathology

Teledermatology

Teledentistry

Tele-audiology

Telemedicine website visits/yearTelemedicine website visits/year

Why isn’t demand escalating?

Free telemedicine service not valued? Cultural problem? Inappropriate experts? Referrers too busy? Perceived loss of control?

•Digital divide•Computer literacy•Intuitive/user friendly interphase

Way forwardDevelopment of intra-country networks:

(1) demonstrably alter health outcomes; (2) can be shown to be cost-effective and sustainable; (3) will act as a model for other countries to copy.

Successful implementation would result in one or more successful telemedicine that could be replicated widely.

SummaryTelemedicine is a growing new way of medicine that may be the new way of the future. It brings medical offices, Doctors and specialists that may be oceans apart together as if they were in the same facility. It allows homebound to get medical treatment. It allows a surgeon to be in 2 places at once.

There are many advantages and disadvantages to telemedicine. The advantages outweigh the disadvantages and the disadvantages will soon be resolved. Telemedicine is the way of the future!

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ConclusionsConclusions

The telecommunication and health care sectors have to work together in developing national e-Health strategies

The telecommunication and health care sectors have to work together in developing national e-Health strategies

Developing countries urgently need a strategic document – eHealth Master Plan and a Roadmap

Developing countries urgently need a strategic document – eHealth Master Plan and a Roadmap

Successful e-Health services require commitment to promote national strategies and facilitate capacity building

Successful e-Health services require commitment to promote national strategies and facilitate capacity building

References• [1] Sonnenberg, F. (2007). Clinical System. Retrieved

December 1, 2008, from Clinical Information System

• [2] Ebbers, M. (2005, July). Mainframe Computers. Retrieved December 1, 2008,

• [3] Gibson, H. (2008). Medicine + Technology + Telecommunications. Retrieved December 16, 2008 from Todays Caregiver: Antoniotti, N. (2008). Telehealth Nursing.

• [4] S. Tachkara, and R. S. H. Istepanian, “Mobile E-health; The Unwired Evolution of Telemedicine”. Telemedicine and E-Health Journal, Vol. 9,No. 3,2003.

• [5] C. S. Pattichis, E. Kyriacou, S. Voskarides, and R. S. H. Istepanian. “Wireless Telemedicine Systems: An Overview”, IEEE Antennas and Propagation, Vol. 44, 2, pp. 143-153, 2002.

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