Personal Health Systems Prototype PHS regulatory challenges Lack of acceptance Cultural barriers

1. 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 engineeringASSISTANT PROFESSOR, Sasurie college of engineering --
Vijayamangalam, Tirupur DistrictVijayamangalam, Tirupur District
ec2reach@gmail.com Mob: 0- 8907305642ec2reach@gmail.com Mob: 0- 8907305642

2. Telemedicine

3. MAJOR PARTS OF THE
PRESENTATION
PART 1:
THE
CONTEXT
PART 2:
THE
INITIATIVES
PART 3:
POSSIBILITIES

4. 1. Describe TeleMedicine
2. Describe the types of Telemedicine
3. List Advantages/Disadvantages
4. Legal/Ethical Issues
5. Statistics
OBJECTIVES

5. What is Telemedicine?What is Telemedicine?
. . . the use of electronic information. . . the use of electronic information
and communication technologies toand communication technologies to
provide and support health care whenprovide and support health care when
distance separates the participants . . .distance separates the participants . . .
Telecommunications Technology
+
Medicine

6. Telemedicine began .Telemedicine began . . .. .
 In 1924, with the concept of a physicianIn 1924, with the concept of a physician
seeing his patient over the radio using aseeing his patient over the radio using a
television screentelevision screen
 First wave of telemedicine programsFirst 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 1960s-Most programs that began in the 1960s-
1980s no longer exist, due to1980s no longer exist, due to
dependence on external fundingdependence on external funding

8. Compression ofCompression of
bandwidthbandwidth
Codecs compress the information to fit the
broadband connection

9. Region 3
Hospita
l
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

10. Sensors for
multi-parametric
monitoring
Hospita
l
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[msec]
Tilt
Sympthoms
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
50
100
150
t [sec]
SBP[mmHg]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
0
50
100
SCMI[%]
t [sec]
200 400 600 800 1000 1200 1400 1600 1800 2000 2200
-0.5
0
0.5
Risk[--]
t [sec]
Positive VVSRisk
Other data:
clinical, images,
lab, genomics
Intelligent
analysis
Support to diagnosis
decision & treatment
Treatment,
Rehabilitation
Medical
expertise
Personal Health Systems:
the bigger picture

11. Prototype PHS
Examples
 Wrist-worn devices
 Body Sensor Networks
 Biomedical clothes
MOBIHEALTH
AMON
MYHEART
WEALTHY

12. 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

13. 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.

16. 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.

17. 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.

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

19. Types of telemedicine
• Telemedicine can be broken into three main
categories:
(asynchronous).
• store-and-forward services.
• remote monitoring services.
(synchronous)
• (real-time) interactive services.

20. Emergency telemedicine
• regulatory challenges
• Lack of acceptance
• Cultural barriers

21. TeleMedicine Transfers Medical Information through
technology
Transfer By:
•Telephone/Cell Phone
•Internet
•Video Conferencing
•Satellite

22. Wireless Broadband InitiativeWireless Broadband Initiative
22
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 :
 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

23. 23
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

24. Other Target Markets
24
DISASTER SITES
HOSPITALS
FACTORIESRURAL NETWORKSSHIPS
DEFENCE & RAPID DEPLOYMENT SITES
HOUSING COMPLEXES
CORPORATES & ENTERPRISES
Wimax enabled
applications / services

25. 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.

26. ““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.

30. 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.

31. 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 Care
Agency
Nurse Visits
Physician Visits
TeleVisits
Patient Roster
Clinics
HospitalsPlan of Care

32. ASP
Gateway
ALH
TV
earplug Internet
WMAN
(e.g. IEEE 802.16)
Network Architecture
Peripheral
Bluetooth
Network
Internet-capable
Medical
Meters

33. J2ME API for Accessing
BT Nodes and Internet
Passive Application A
BT Stack
Fixed
ALH
OS
TCP/IP
Comm.
API
ALSP Server
TCP/IP
Stack
ALSP
Server
OS
Cellphone
Network
+
Internet
Bluetooth
TCP/IP
Stack
802.16
Wireline
MAC
IP Routing Service
802.11
MAC
Gateway
Dumb Dev
PC IP: 128.174.11.11
Under Normal Situation
When the Gateway is Available
Networked Software Architecture

34. ASP
ALH
TV
earplug Internet
WMAN
(e.g. IEEE 802.16)
Networked Software Architecture
Peripheral
Bluetooth
Network
When the Gateway is Not
Available
Internet-capable
Medical
Meters
Base Station
cellphone
GPRS network
or WiFi
mobile medical
devices

35. How Medical Data Can Be Securely
Transmitted ?
SOAP Envelope
Header
Medical
Information
SOAP Envelope
Header
Medical
Information
Sign. on Msg.
Sign. on Key
PubC KF
PubC/PrivC
KFPWAP
PWAP
PubAS/PrivAS
SOAP Envelope
Header
Medical
Information
Sign. on Msg.
PubAS
PWAP
[Michael et al. 06]

36. PubC/PrivC
Sign. on Msg.
KFPWAP
PubAS/PrivAS
SOAP Envelope
Header
Medical
Information
Sign. on Msg.
PubAS
Sign. on KeyPWAP
SOAP Envelope
Header
Medical
Information
PubAS/PrivAS
PubC KF
PWAP
PWAP
PWAP
How Medical Data Can Be Securely
Transmitted ?

37. PubC/PrivC
KFPWAP
PubAS/PrivAS
SOAP Envelope
Header
Medical
Information
PubAS/PrivAS
PubC KF
PWAP
PWAP
Sign. on Msg.PrivAS
SOAP Envelope
Header
Medical
Information
Sign. on Msg.
PubC
Sign. on KeyPrivAS
How Medical Data Can Be Securely
Transmitted ?

38. PubC/PrivC
KFPWAP
PubAS/PrivAS
SOAP Envelope
Header
Medical
Information
PubAS/PrivAS
PubC KF
PWAP
PWAP
PubAS
SOAP Envelope
Header
Medical
Information
Sign. on Msg.
PubC
Sign. on KeyPrivAS
PubC/PrivC
SOAP Envelope
Header
Medical
Information
PubC
Sign. on Msg.PrivAS
SOAP Envelope
Header
Medical
Information
PubC KF
PubAS PubC/PrivC
Medical
Information
PubAS
How Medical Data Can Be Securely
Transmitted ?

40. ALSP
mobile medical
devices
earplug Internet
WMAN
(e.g. IEEE 802.16)
Networked Software Architecture
Peripheral
Bluetooth
Network
When cell phone takes
the roll of ALH
Internet-capable
Medical
Meters
Base Station
GPRS /
WiFi / wimaxCellphone

41. Partnership : Partnering with Mobile Network Operators
Operators, Mobile content and the Long tail
1/12

42. Remaining ChallengesRemaining Challenges
42
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

43. 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

44. 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

45. 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

46. Store and Forward Software
What 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.

47. 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

48. Telemedicine interoperable
Architecture

49. 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.

50. 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

51. 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.

52. 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.

53. Disadvantages
1. 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.

54. 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.

55. Definitions of Telehealth Nursing
• Telehealth nursing is the practice of nursing over distance using
telecommunications 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).

56. Functions And Responsibilities
of the Informatics Nurse
1.
Leveraging
technology and
nursing expertise
to provide quality
nursing care, to
delivering
nursing
expertise 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/
medical
devices
3.
Enhanced
communication
skills
4.
Adhere to
existing
regulations of
the jurisdiction in
which they
practice,
including
licensure and
regulatory
requirements.

57. Related activities
• Telenursing
• Telepharmacy
• Telerehabilitation
• Teletrauma
• Telecardiology
• Telepsychiatry
• Teleradiology
Telepathology
Teledermatology
Teledentistry
Tele-audiology

58. Telemedicine website visits/yearTelemedicine website visits/year

59. 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

60. Way forward
Development 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.

61. Summary
Telemedicine 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!

62. 62
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

63. 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.

65. ??? QUESTIONS ???

66. THANK YOU….
For more information on
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67. Telemedicine, legal issuesTelemedicine, legal issues
Back up slidesBack up slides

68. AuthorityAuthority
 Any medical or health advice provided andAny medical or health advice provided and
hosted on the website will only be given byhosted on the website will only be given by
medically trained and qualifiedmedically trained and qualified
professionals unless a clear statement isprofessionals unless a clear statement is
made that a piece of advice offered is frommade that a piece of advice offered is from
a non-medically qualified individual ora non-medically qualified individual or
organisationorganisation

69. ComplementarityComplementarity
 The information provided on the website isThe information provided on the website is
designed to support, not replace, thedesigned to support, not replace, the
relationship that exists between arelationship that exists between a
patient/site visitor and his/her existingpatient/site visitor and his/her existing
physicianphysician

70. ConfidentialityConfidentiality
 Confidentiality of data relating to individualConfidentiality of data relating to individual
patients and visitors to a medical/healthpatients and visitors to a medical/health
website, including their identity, iswebsite, including their identity, is
respectedrespected

71. AttributionAttribution
 Where appropriate, information containedWhere appropriate, information contained
on this site will be supported by clearon this site will be supported by clear
references to source data and, wherereferences to source data and, where
possible, have specific HTML links to thatpossible, have specific HTML links to that
datadata
 The date when a clinical page was lastThe date when a clinical page was last
modified will be clearly displayed (e.g. atmodified will be clearly displayed (e.g. at
the bottom of the page)the bottom of the page)

72. JustifiabilityJustifiability
 Any claims relating to theAny claims relating to the
benefits/performance of a specificbenefits/performance of a specific
treatment, commercial product or servicetreatment, commercial product or service
will be supported by appropriate, balancedwill be supported by appropriate, balanced
evidence in the mannerevidence in the manner

73. Transparency of authorshipTransparency of authorship
 The designers of the website will seek toThe designers of the website will seek to
provide information in the clearestprovide information in the clearest
possible manner and provide contactpossible manner and provide contact
addresses for visitors that seek furtheraddresses for visitors that seek further
information or supportinformation or support
 The Webmaster displays his/her E-mailThe Webmaster displays his/her E-mail
address clearly throughout the websiteaddress clearly throughout the website

74. Transparency of sponsorshipTransparency of sponsorship
 Support for the website will be clearlySupport for the website will be clearly
identified, including the identities ofidentified, including the identities of
commercial and non-commercialcommercial and non-commercial
organisations that have contributedorganisations that have contributed
funding, services or material for the sitefunding, services or material for the site