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

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Personal Health Systems

Personal Health Systems
Prototype PHS
regulatory challenges

Lack of acceptance

Cultural barriers

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  • A Doctor performs operations on a patient located in another hospital - even in another country. A large amount of video data has to be quickly transferred from the patient site to the Doctor site. <br />
  • Picture shows how video conferencing transfers patient medical information. <br />
  • There are two solutions: <br /> Mobile phone can be used for management and consultations related to medical services. <br /> Mobile eHealth care clinics/units traveling in rural areas from one village to another and connected to nearby hospital by wireless communication for consultations. <br /> Medical professionals : <br /> Second opinion to doctors on primary diagnosis <br /> Enable trained medical personnel (nurse) to provide quality primary care to patients <br /> Reduce errors in diagnosis across the healthcare delivery system <br /> Patients : <br /> Access quality medical information on mobile application <br /> Get diagnosis from signs and symptoms <br /> Understand their diseases and conditions better <br /> Act as a 24x7 medical advice system and management of medical emergencies <br />
  • Cell phone is connected to PC using bluetooth instead of WLAN <br /> Then msg is transtered to nearest base station by GPRS (like normal phone call) or WiFi (If there’s hotspot set up by carriers nearby) <br /> Red words is modification by Qixin. <br />
  • This scenario is using cellphone instead of butler PC when the user is not at home (on travel for example. ) <br /> Here TV may be not used in mobile environment, so I put “mobile medical devices” instead of “TV” there <br />
  • eHealth could make a huge contribution to maternal and child health and even immunization; but the message has not been accepted so far. <br />
  • -To use the Tele-Otoscope you need the wireless otoscope, the wireless receiver, and television with video input. <br /> - To use the Tele- Stethoscope you need the wireless stethoscope, the wireless receiver, and television with video Input. <br />
  • Most used way of sending medical images is via Email and Cell phone. <br />
  • Though, the telehealth system uses other configurations such as minicomputers, microcomputers, point of care, local area networks, and other systems to transmit and receive information immediately. This may be through a television, cell phone, pda, or computer. <br />
  • ***These are used to transmit and receive information immediately. This is done through a television, cell phone, PDA, or computer <br />
  • The telecommunication and health care sectors have to work together in developing national e-Health strategies <br /> Successful e-Health services require more than just technology: Committed policymakers who promote national strategies and facilitate capacity building are essential for the e-Health system to work in practice. <br /> Developing countries can not speed up the implementation of badly needed eHealth services without close cooperation with telecom sector. <br /> Developing countries urgently need a strategic document – eHealth Master Plan <br /> ITU-D is ready to assist its Member State in strengthening their in e-Health capacity to increase the impact and effectiveness of their investment in this field. <br />

WIMAX -  A Solution for Tele -Medicine WIMAX - A Solution for Tele -Medicine Presentation Transcript

  • 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
  • Telemedicine
  • MAJOR PARTS OF THE PRESENTATION PART 1: THE CONTEXT PART 2: THE INITIATIVES 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 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
  • 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
  • Compression ofCompression of bandwidthbandwidth Codecs compress the information to fit the broadband connection
  • 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
  • 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
  • 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 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 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 24 DISASTER SITES HOSPITALS FACTORIESRURAL NETWORKSSHIPS DEFENCE & RAPID DEPLOYMENT SITES HOUSING COMPLEXES CORPORATES & 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 Care Agency Nurse Visits Physician Visits TeleVisits Patient Roster Clinics HospitalsPlan of Care
  • ASP Gateway ALH TV earplug Internet WMAN (e.g. IEEE 802.16) Network Architecture Peripheral Bluetooth Network Internet-capable Medical Meters
  • 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
  • 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
  • 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]
  • 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 ?
  • 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 ?
  • 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 ?
  • 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
  • Partnership : Partnering with Mobile Network Operators Operators, Mobile content and the Long tail 1/12
  • 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
  • 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 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.
  • 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.
  • 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.
  • 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 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).
  • 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.
  • 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 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.
  • 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 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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  • THANK YOU…. For more information on catch me at: ec2reach@gmail.com Or http://www.facebook.com/ajal4u
  • Telemedicine, legal issuesTelemedicine, legal issues Back up slidesBack up slides
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