Telemedicine

Information about Telemedicine and I-medic.

1. TELEMEDICINE Presented By: Darshil Shah (IU1241090051) Sachin Jain (IU1241090018)

2. What is Telemedicine? Telemedicine  is use of   telecommunication  and information technologies in order to provide  clinical health care at a distance. These technologies allow communications between patient and medical staff with both convenience as well as the transmission of medical,  imaging   and health informatics data from one site to another.  It is also used to save lives in critical care and  emergency situations .

3. Core principles of telemedicine Is only a tool (like a stethoscope ) Must be physician directed Must be integrated into established clinical operations and routines Physician-patient relationships must be preserved

4. How it works Video conference system Cameras each end TV screens/computers each end Various medical peripherals Video connection T-1 line Satellite Phone line (POTS) Internet

5. ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) Hub Site Remote Site T-1

6. Connectivity T-1 dedicated phone line Satellite ISDN High speed DSL/Cable ATM POTS LAN/WAN Internet, or IP-based

7. The barriers Equipment costs Connectivity costs Reimbursement

8. Getting better Declining equipment costs Shared connectivity Enhanced reimbursement (still an issue for nursing homes)

9. 2-way Telemedicine

10. Compression of bandwidth Codecs compress the information to fit the broadband connection

11. Evolution of Telemedicine Telemedicine : Way of communication

12. Exchange of Information at a Distance Voice Image Video Graphics Elements of Medical Records Commands to a surgical robot

13. Personnel Involved Referral end A group of specialist doctors System Administrator Studio technician Nodal end A group of general physicians System administrator Data entry operator Studio technician Patients

14. Technologies Involved Medical Instrumentation Sensing Bio-medical Signals, Medical Imaging, Measurement of Physical Parameters e.g. Body Temperature, Pressure etc. Telecommunication Technology Trans-receiver on different communication channels and network such as, on wired network, wireless medium etc. Information Technology Information representation, storage, retrieval, processing, and presentation.

15. Medical Information and data Data: “Signature” of Information Information: Processed data System Transducer Signal Processor Presentation

16. Waveform Acquisition Model

17. Data Size: Voice Band width: ~ 4 Khz Minimum Sampling Frequency: 8 Khz Bits per sample: 8 bits (for 256 levels) Minmum data rate: 8000x8 bits per second = 64 Kbps

18. Data Size: ECG B.W. ~ 100 Hz. Minimum Sampling Frequency: 200 Hz. Bits per sample: 8 (for representing 256 levels) Data rate: 200x8 bits per second = 1.6 Kbps

19. Data Size: Video Number of frames per second: 15 fps Resolution of a frame: 480 x 640 pixels Bits per pixel: 24 bits (for colored video) Data Rate: 480x640x15x24 bits per second = 110.6 Mbps

20. Band-width requirements of different compressed multimedia data Type of Multimedia Data Bandwidth Usual data 100bps~2kbps Image 40 Kbps~150 Kbps Voice 4 Kbps~80 Kbps Stereo Audio 125 Kbps~700 Kbps VCR quality video 1.5 Mbps~4Mbps 3D medical images 6 Mbps~120 Mbps HDTV 110 Mbps~800 Mbps Scientific Visualisation 200 Mbps~1000Mbps

21. Communication Channels Communication Links Satellite Wireles LAN GSM/CDMA/3G GPRS Terrestrial Wireless POTS Leased lines ISDN LAN

22. Applications Information exchange between Hospitals and Physicians. Networking of group of hospitals, research centers. Linking rural health clinics to a central hospital. Videoconferencing between a patient and doctor, among members of healthcare teams. Training of healthcare professionals in widely distributed or remote clinical settings. Instant access to medical knowledgebase, technical papers etc.

23. Requirement Specification Nodal Hospital Referral Hospital A patient getting treated A Doctor A remote telemedicine console having audio visual and data conferencing facilities An expert/ specialized doctor A central telemedicine server having audio visual and data conferencing facility POTS / ISDN

24. Sequence of Operation PATIENT IN Patient visits OPD Local Doctor checks up Patient receives local treatment and not referred to telemedicine system Patient referred to the Telemedicine system (some special investigations may be suggested) Patient visits Telemedicine data-entry console. Operator entries patient record, data and images of test results, appointment date is fixed for online telemedicine session OUT OUT Offline Data transfer from Nodal Centre Day One

25. Sequence of Operation Patient 1 Patient 2 Patient 3 Patient 4 . . . Online conference for the patient. Patient, local doctors at the nodal hospital and specialist doctors at the referral hospital Patient queue IN OUT Day Two

26. Hardware Configuration Digital camera Referral Hospital Nodal Hospital PSTN/ISDN/VSAT link Scanner Printer Modem Modem Microscope and other medical instruments Video Conference Video Conference Telephone Telephone

27. Software Modules Offline Activities Online Activities

28. Offline Module Data Acquisition Data Distributor Temp Files Local DB Data Encryption Data Sender Data Receiver Data Distributor Patient data Browser User Interface Data Decryption Master Database Temp Files D A T A Acknowledgement NODAL CENTRE REFERRAL CENTRE Data Flow Diagram For Off line Communication

29. Online Module Data Acquisition Online Session Coordinator and communicator Local DB Online Session Coordinator and communicator Master DB Secure Communication Channel NODAL CENTRE REFERRAL CENTRE Data Flow Diagram For Online Communication Video Conferencing Video Conferencing

30. Doctor Patient Video and Data Conferencing

31. Multi-Reference in Tele-consultation A center acting as local asks for tele-consultation with a remote center which can again be able to consult with another remote center. If required concerned data may be resent to remote hospital Patient Local Hospital Attending local doctor Remote Hospital 1 Remote Hospital 2

32. Internet Patient Console Referral Hospital Step 1. Upload Information step2. Download Information Step 3. Post Suggestions Telemedicine Server Step 4. Receive Suggestion Telemedicine over web

33. Mobile Healthcare Client interfaces for PDA and mobile phone. SMS based Emergency messaging system. Developing instruments with mobile interfaces.

34. Use of Mobile Devices in Telemedicine

35. Limitations Of Handheld Devices Limitation of computational resources a. Limited memory capacity b. Slow execution speed Small screen size

36. Solutions Client Server based approach Data filtering Partitioned image display for large images Buffer management

37. Wireless Medical Information Access Server Patient data browsing a. Text data b. Image data Prescribing drugs and advice

38. Patient Queue in PDA Patient Queue in Desktop Computer

39. Test Reports Fragment 1 Fragment 2

40. Prescription Writing Form

41. Multimedia data in PDA Viewing & Marking of image Profile Marking application ECG Viewer application Display of Graphs and Charts

42. Zooming & Marking of Image

43. ECG Data Display

44. Emergency Messaging Service using i- medik Sends SMS to doctors’ cell phones to inform him/her about any emergency or patient referral. Follows the same multi-tier architecture EMS server resides outside the firewall intercepting incoming -outgoing messages

45. Teleconsultation Form SMS alert after Telereference

46. Benefits of Telemedicine Improved Access Covers previously unserved or underserved areas. Improved quality of care Enhanced decision making through collaborative efforts. Reduced isolation of healthcare professionals Peer and professional contacts for patient consultations and continuing education. Reduced costs Decreased necessity for travel and optimum uses of resources.

47. Conclusion Telemedicine being increasingly used for providing health care services. Effective and efficient in managing resources and time for delivery of health care. Telemedicine systems are evolving: Peer to peer ► Centralized Server based ► Distributed Systems. Looking for a great healthy future of our public health care system in our country.

48. SUPPORT In India, telemedicine programs are being actively supported by: Department of Information Technology (DIT) Indian Space Research Organization NEC Telemedicine program for North-Eastern states Apollo Hospitals Asia Heart Foundation State governments Telemedicine technology also supported by some other private organizations