TELEMEDICINE

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

 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
 Hub Site
Remote
Site

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

 Equipment costs

 Connectivity costs
 Reimbursement
 Getting better

 Declining equipment costs

 Shared connectivity

 Enhanced reimbursement (still an issue for nursing homes)

 2-way Telemedicine

For non –
emergency
situations
Store and forward
Teleradiography,
teleradiopathy &
2 types teledermatolgy

Video-conferencing.
Two-way interactive Almost equivalent to a
television face to face ‘real time’
consultation
 Compression of bandwidth

Codecs compress the information to fit the

broadband connection
Evolution of Telemedicine

• One patient connected

Point to to one doctor
Point
• Within same hospital

• One patient end at a

time connected to many
Point to specialist doctors
multipoint
• Within the same hospital

• Several patient ends

connected to several
Multipoint different specialist doctors
to
multipoint • At different hospitals, in
different geographical
distances
 Exchange of Information at a Distance

• Voice
• Image
• Video
• Graphics
• Elements of Medical Records
• Commands to a surgical robot
 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.
 Medical Information and data

• Data: “Signature” of Information

• Information: Processed data

System Transducer Processor Presentation

Signal
Waveform Acquisition Model
 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
 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
 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
 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
 Communication Channels

Communication
Links

Terrestrial
Wireless

POTS Leased lines ISDN LAN

Satellite Wireles LAN GPRS GSM/CDMA/3G

 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.
 Requirement Specification

• A patient getting treated

Nodal Hospital • A Doctor
• A remote telemedicine console having audio
visual and data conferencing facilities

POTS / ISDN

• An expert/ specialized doctor

Referral Hospital • A central telemedicine server having
audio visual and data conferencing facility
 Sequence of Operation
PATIENT IN

Patient visits OPD Patient receives local treatment

OUT
Local Doctor checks up 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 OUT
results, appointment date is fixed for online telemedicine
session

Offline Data transfer

from Nodal Centre
 Sequence of Operation

Patient 1
Patient 2
Patient 3 Online conference for the patient.
Patient 4
. IN Patient, local doctors at the nodal hospital OUT
. and specialist doctors at the referral
. hospital

Patient queue
 Hardware Configuration

Video Conference

Modem Telephone
Referral Hospital Microscope and other
medical instruments
Video Conference
PSTN/ISDN/VSAT link

Digital camera
Scanner

Telephone Modem Printer

Nodal Hospital
Software Modules

Offline Activities

Online Activities
 Video and Data Conferencing

Doctor
Patient
 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.

Attending
local doctor Remote Hospital 1
Remote Hospital 2

If required
concerned data
Local may be resent
Patient Hospital to remote
hospital
 Telemedicine over web

Telemedicine Server

Internet
Step 1. step2.
Upload Information Download Information
Step 4.
Receive Suggestion Step 3.
Post Suggestions

Referral Hospital
Patient Console
 Mobile Healthcare

• Client interfaces for PDA and mobile phone.

• SMS based Emergency messaging system.

• Developing instruments with mobile interfaces.

Use of Mobile Devices in Telemedicine
 Limitations Of Handheld Devices

• Limitation of computational resources

a. Limited memory capacity
b. Slow execution speed

• Small screen size

 Solutions

• Client Server based approach

• Data filtering
• Partitioned image display for large images
• Buffer management
Wireless Medical Information Access Server

• Patient data browsing

a. Text data
b. Image data
• Prescribing drugs and advice
 Patient Queue in Desktop Computer

Patient Queue in PDA

 Test Reports

Fragment 1 Fragment 2
Prescription Writing Form
 Multimedia data in PDA

• Viewing & Marking of image

• Profile Marking application
• ECG Viewer application
• Display of Graphs and Charts
Zooming & Marking of Image
ECG Data Display
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
 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.
 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.
 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
 References
 www.facweb.iitkgp.ernet.in/~jay/JMANU221003.ppt

 http://www.telemedicine.com/whatis.html

 https://www.ttuhsc.edu/telemedicine/documents/telemedicine_
aahsa.ppt

 www.fgse.nova.edu/itde/faculty/simonson/ppt/telemedicine.ppt

 www.powershow.com/.../Telemedicine_System_powerpoint_ppt
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