Emergency Telemedicine in Indoor Multiple Dwelling Environments

Emergency Telemedicine in Indoor Multiple Dwelling Environments Edward Mutafungwa and Zhong Zheng Department of Communications and Networks Aalto School of Science and Technology A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Outline Background on emergency telemedicine Why focus on indoor operating environment? Example case studies Introduce femtocellular approach for emergency telemedicine – Limitation of existing networks – Potential benefits A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Background UBI-SERV Project WP Structure Ref: http://www.ubi-serv.org/ A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Positioning of Emergency Telemedicine Health Continuum Care by Emergency care, Pre- Professionals hospital trauma care Elective care Home care, Ambient Assisted living Disease management, Elevated Risk factors, Rehabilitation Wellness management Fitness Self Care Proactive Reactive Ref: http://feelgood.vtt.fi/ Healthcare Provisioning Continuum A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Emergency Telemedicine in Indoor Environments A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Emergency Telemedicine in Indoor Environments Prehospital care for cardiac arrest, Accident and Emergency Department, Queen Mary Hospital, Hong Kong (1999) A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Helsinki EMS Case Study Serve over 0,5m people – Handle over 40000 emergency calls per year Introduced Electronic Patient Records (EPRs) January 2007 – Merlot Medi system (Logica) – Rapid information sharing between paramedics at scene and hospital A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Helsinki EMS Case Study Helsinki EMS EPR system Ref: Kuisma et al. A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Helsinki EMS Case Study Current possible setup at emergency site (data info) Mobile networks (GPRS) USB, Bluetooth, WiFi (IEEE 802.11x), IEEE 1394, RS232 etc. Vital signs monitor Portable printer Paramedic’s Tablet PC A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Some Examples of Multimedia Services for Emergency Telemedicine Southern Arizona Teletrauma and Telepresence Program (SATT) Ref: Latifi et al. A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Helsinki EMS Case Study Possible future upgrade (data Mobile networks (3G or beyond) plus images and video) USB, Bluetooth, WiFi (IEEE 802.11x), IEEE 1394, RS232 etc. Vital signs monitor Portable printer Paramedic’s Tablet PC Image/video capture Portable device ultrasound A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Indoor Emergency Telemedicine via Mobile Networks (Macrocellular) Subscriber and Location Centers, Equipment Registers Application Servers MGW/ GGSN Mobile Operator Core Network MGW/SGSN Internet, PSTN, EUE Uplink Connectivity Options Other Mobile Network EUE uplink via MBS RNC Emergency Site MBS EUE Patient Records, Resource Planning, Decision Support etc. Physician/ Paramedic Emergency Department MUE MUE Medical Facility, Remote Consultation Site Notes: EUE = Emergency User Equipment, GGSN = Gateway GPRS Support Node, GPRS = General Packet Radio Service, MBS = Macrocellular Multiple Dwelling Unit Base Station, MGW = Media Gateway, MUE = Macrocellular User Equipment, RNC = Radio Network Controller, PSTN = Public Switched Telephone Network, SGSN = Serving GPRS Support Node. A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Requirements Imposed on Mobile System by Emergency Telemecine App Performance – Coverage/availability – Accessibility and prioritization – Perceived user experience • Throughput (kbps), video/picture quality, service outage/retainability etc. Mobility Usability/convenience – Automatic service discovery – Automatic service configuration Security A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Performance Limitations in Mobile Networks Achievable throughput (kbps) < advertised throughput Poor coverage in indoor environments For emergency telemedicine – Intolerable interruptions or delays in information transfer – Reduced video/image quality (possible clinical errors) Ref: Kim et al. A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Performance Improvement with Femtocells Home base stations deployed independently by subscribers Benefit for mobile operators – Performance improvement with minor CAPEX Benefit for subscribers – Performance improvement with cheaper service fees Benefit for emergency services – Emergency calls for all – Multimedia services for emergencies?! A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Indoor Emergency Telemedicine via Mobile Networks (Macro- and Femtocellular) A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Performance Studies System simulation of emergency telemedicine use case – Model multiple dwelling unit (MDU) building layouts – Random location of home base stations (HBS) and user equipment (UE), random interference levels 16 12 meters 8 4 0 0 5 10 15 20 meters HBS Outer wall UE Internal wall Detached houses Light wall A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Performance Studies Study performance improvements enabled by access to femtocell resources Outage Rates (%) Experienced by Emergency User Equipment: Case of High- Rise MDU Building 90 80 70 60 Femto and Macro BS 50 Macro BS 40 30 20 10 0 0.2 0.5 0.8 0.2 0.5 0.8 Home (or Femto) Base Station Penetration A! Aalto University Cell interior (D = 100 m) MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Cell edge (D = 300 m) Comnet

Conclusions Femtocellular approach shows significant potential for emergency purposes More studies necessary to further unlock hidden benefits of femtocells A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

Thank you for your attention! Edward Mutafungwa Aalto University Department of communications and networking P.O. Box 13000 00076 Aalto Espoo, Finland Tel: +358 9 470 22318, +358 40 7333397 Email: edward.mutafungwa@tkk.fi A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET 20 Comnet

References • M. Kuisma and T. Väyrynen and T. Hiltunen and K. Porthan and J. Aaltonen, “Effect of introduction of electronic patient reporting on the duration of ambulance calls,” American Journal of Emergency Medicine, vol. 27, pp. 948-955, 2009. • R. Karlsten and B. A. Sjöqvist, “Telemedicine and decision support in emergency ambulances in Uppsala,” J. Telemed Telecare, vol. 6, pp. 1-7, 2000. • R. Latifi et al, “Telemedicine and Telepresence for Trauma and emergency care management” Scandinavian Journal of Surgery, pp. 281– 289, Vol. 96, 2007. • M. G. Keane, “A review of the role of telemedicine in the accident and emergency department,” J. Telemed. Telecare, vol. 15, pp. 132- 134, 2009. • C. S. Pattichis and E. Kyriacou and S. Voskaride, “Wireless telemedicine systems: an overview,” IEEE Ant. Prop. Mag., vol. 44, pp. 143- 153, Apr. 2002. • L. P. Leung and C. M. Lo and H. K. Tong, “Prehospital resuscitation of out-of-hospital cardia carrest in Queen Mary Hospital,” Hong Kong J. Emerg. Med., vol. 7, pp. 191-196, 2000. • D. K. Kim and S. K. Yoo and H. H. Kang, “Evaluation of compressed video-images for emergency telemedicine work with trauma patients,” J. Telemed Telecare, vol. 10, pp. 64-66, 2004. • D. –K. Kim et al, “A mobile telemedicine system for remote consultation in cases of acute stroke” Journal of Telemedicine and Telecare, pp. 102–107, 2009. • J. R. Gállego and A. Hernández-Solana and M. Canales and J. Lafuente and A. Valdovinos and J. Fernández-Navajas, “Performance analysis of multiplexed medical data transmission for mobile emergency care over the UMTS channel,” IEEE Trans. Inform. Technol. Biomed., vol. 9, pp. 13-22, 2005. • Y. Chu and A. Ganz, “A mobile teletrauma system using 3G networks,” IEEE Trans. Inform. Technol. Biomed., vol. 2, pp. 456-462, 2004. • H. Holma and A. Toskala, WCDMA for UMTS: HSPA Evolution and LTE. John Wiley & Sons Ltd, 2007. • V. Chandrasekhar and J. G. Andrews, “Femtocell networks: a survey,” IEEE Comm. Mag., vol. 46, pp. 59-67, 2008. • R. Martin, “3G home base stations: Femto cells & FMC for the masses,” Unstrung Insider, vol. 6, Jan. 2007. A! Aalto University MOTIVE UBI-SERV Workshop 03/02/2010_EMU_COMNET Comnet

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Emergency Telemedicine in Indoor Multiple Dwelling Environments

by Iiro Jantunen on Feb 08, 2010

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