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    • Telehealth and Telemedicine Sri Lankan Experience of high quality medical image and voice transfer through internet
      • J.U Weerasinghe (Faculty of Dental Sciences, Peradeniya)
      • Vajira Dissanayaka (Faculty of Medicine, Colombo)
      • Duminda Nishantha, Yukuo Hayashida (SAGA University, Japan),  
      WONCA-MESA Informatics Symposium Colombo, 9 th November 2002
    • Telehealth and Telemedicine Sri Lankan Experience of high quality medical image and voice transfer through internet
      • Telehealth
      • Telemedicine
      • exchange of material offline
      • realtime (online) image transfer
      • SAGA and Peradeniya
      • commercial software
    • Telehealth
      • Telehealth is using technology to provide medical care over distance
      • non-clinical services such as distance medical education and research
      • It will allow information to be received by remote centres
    • Telemedicine
      • Telemedicine typically involves medical personnel using   images, video and audio facilities either non-real-time or real-time (online) for remote consultations. 
      • An expert physician far away can guide the local medical personnel in treatment planning remotely
    • Telemedicine -exchange of material offline
      • Store and Forward method
      • Local physician sending digital images of pictures, x-rays, and other patient information directly to the computer of a specialist.
      • After reviewing that information, the specialist then sends the diagnosis back to the local doctor, who treats the patients and provides follow-up care.
    • Telemedicine -realtime (online) image transfer
      • need for high quality still images, video and audio and other electronic material to be exchanged between the remote center and   the experts using videoconferencing equipment.
      • experts outside will be able to guide the remote center
    • Telemedicine- non realtime store and forward method
      • Usage
      • Teleradiology
      • Telepathology
      • Teledermatology
    • Telemedicine- non realtime store and forward method
      • Advantages
      • Minimum resources needed
      • Regular email attachments could be used
      • Disadvantages
      • Time delay in response
      • Limitation of image quality and size
      • Cross checking and feedback will take more time
    • Telemedicine -realtime
      • Advantages
      • Used in many areas of medicine, surgery, dentistry
      • accessibility of expert help in remote areas
      • Saves time of an expert in frequent travel to remote areas
      • permits Continuing Education and training for practitioners in remote areas
      • Disadvantages
      • Non availability of appropriate technology and adequate bandwith in the network
      • Lack of funds for equipment and software
      • Lack of technical help
    • Sri Lankan Experience of high quality medical image and voice transfer through internet Between Medical School & Faculty of Engineering SAGA University-Japan And Faculty of Dental Sciences - Peradeniya Department of Oral Surgery Faculty of Dental Sciences, University of Peradeniya
    • SAGA Medical School SAGA University (Engineering) Faculty of Dental Sciences- Peradeniya
    • Previously used method - Store and Forward
      • Images of patients- photographs and radiographs were exchanged
      • Non real time method
      • Disadvantages-
        • Delay in receiving and responding
        • Delay in decision making at the remote centre since they await advice from the expert outside
        • limitations of commercial email software for sending large data files
    • Realtime image transfer using a dedicated software
    • Basic requirements
      • Requirements: Videoconferencing equipment
      • A Digital Video (DV) camcorder ( IEEE1394 interface)
      • OR Digital camera with USB connection
      • with microphone and speakers
      • Desktop/ Laptop computer
      • Internet access - leased line/ Local Area Network
      • Dedicated software
    •  
    • Shortcomings of commercial software
      • T he existing commercial applications do not guarantee the quality of images at low speed networks because of the streaming technology employed. only concerns the maintenance of continuity of images rather than the quality.
      • such applications do not support an integrated environment with all the functions required to carry out medical collaboration
        • image manipulation, tele-pointing facility on the image canvas, shared-board
      • clinicians would prefer a user-friendly operating environment specifically designed for medical applications .
      • Eg:- Messenger. Netmeeting, CuSeeMe, freetalk,
    • Dedicated Software developed by SAGA
      • Connections made by ‘dialing’ IP address
      • Voice transfer full duplex
      • Image transfer with following facilities
        • Sender and receiving windows
        • Shared board facility for image canvas
        • Accessing shared files on each computer
        • Transfer of powerpoint presentations and playback
        • Recording facility of the images received
        • User-friendly
    • Software Overview
      • Image Transceiver software developed in SAGA
      IP Preview Transmit Receiving windows Shared Board WEB File transfer Transmit from Remote centre Receiving from Expert abroad
    • Software Overview
      • Transmission of Video as a Series of JPEG Images
      • interactive full-duplex voice
      • Image quality and image rate can be adjusted
      • User Friendly Graphic User Interface
      • Shared Board Facility
    • Shared Board Facility
      • Both parties can use markers on the same image canvas
      • Allow common base for discussions
      • Text typing facility
      Marker from expert Marker from local team
    • WEB Facility
      • File transfer facility
      • Powerpoint presentations can be
      • transferred and run as a lecture from
      • the remote location
      • Ideal tool for CME
      presentation
    • Advantages of the system
      • Eeconomical and freely available components,
      • Operated in both low speed and high speed networks
      • User-friendly easy to install and operate
      • image software has a Graphical user interface customized for medical personnel with facilities such as shared board, transmitting powerpoint files and multiple image windows.
    • Application of the technique
      • Between Faculty of Dental Sciences Peradeniya and SAGA Medical School
      • An interactive session for JICA trainees in SAGA was conducted
    • Application of the technique locally
      • Tested between Faculty of Dental Sciences Peradeniya and
      • Faculty of Medicine Peradeniya
      • Genetics Unit, Faculty of Medicine- University of Colombo
      • Community health and Family Medicine - University of Kelaniya
    • Summary
      • This system is for Realtime Telemedicine which has been tested locally with a dedicated software designed in JAPAN
      • It is suitable for low speed networks
      • It could be used for Information exchange and Continuing Education sessions
    • Thank You!
      • Japan
      • Professor Nobumichi Sako - former President of Saga University
      • Mr. Minoru Tanaka - Chairman of NetCom Saga Association
      • Venture Business Laboratory (VBL) - Saga University
      • Prof Takeshi Katsuki - Oral & Maxillofacial Surgeon, SAGA University
      • Sri Lanka
      • Prof N A de S Amaratunga - Dean, Faculty of Dental Sciences, Peradeniya
      • Dr. Nimal Ratanayaka- the director of the Internet/communication unit, Faculty of Engineering, Peradeniya
      • Dr Toru Nagao- JICA Chief Advisor, Faculty of Dental Sciences
      • Mr. Ranjith Abeyratne- Technical Officer, Faculty of Dental Sciences
      • Dr Kumara Mendis - Community Medicine and Family Health Faculty of Medicine, University of Kelaniya