Telemedicine uses telecommunication and information technologies to provide clinical healthcare remotely. It allows communication between patients and medical staff for both convenience and transmission of medical data. Telemedicine works through video conferencing systems between hub and remote sites connected by technologies like T1 lines, satellites, or the internet. It has benefits like improved access to care and quality of care through collaborative consultations, but faces barriers like costs of equipment and connectivity as well as reimbursement issues. The technologies and applications of telemedicine continue to evolve to better serve patients.

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

2. 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.

3. 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

4. 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

5. Hub Site
Remote
Site
T-1

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

7. The barriers
 Equipment costs
 Connectivity costs
 Reimbursement

8. Getting better
 Declining equipment costs
 Shared connectivity
 Enhanced reimbursement (still an issue for nursing homes)

9. 2-way Telemedicine
2 types
Store and forward
For non –
emergency
situations
Teleradiography,
teleradiopathy &
teledermatolgy
Two-way interactive
television
Video-conferencing.
Almost equivalent to a
face to face ‘real time’
consultation

10. Compression of bandwidth
Codecs compress the information to fit the
broadband connection

11. Evolution of Telemedicine
Point to
Point
•One patient connected
to one doctor
•Within same hospital
Point to
multipoint
•One patient end at a
time connected to many
specialist doctors
•Within the same hospital
Multipoint
to
multipoint
•Several patient ends
connected to several
different specialist doctors
•At different hospitals, in
different geographical
distances

12. Exchange of Information at a Distance
• Voice
• Image
• Video
• Graphics
• Elements of Medical Records
• Commands to a surgical robot

13. 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.

14. Medical Information and data
• Data: “Signature” of Information
• Information: Processed data
System Transducer
Signal
Processor Presentation

15. Waveform Acquisition Model

16. 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

17. 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

18. 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

19. 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

20. Communication Channels
Communication
Links
Satellite Wireles LAN GSM/CDMA/3GGPRS
Terrestrial
Wireless
POTS Leased lines ISDN LAN

21. 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.

22. Requirement Specification
Nodal Hospital
Referral Hospital
• A patient getting treated
• A Doctor
• A remote telemedicine console having audio
visual and data conferencing facilities
• An expert/ specialized doctor
• A central telemedicine server having
audio visual and data conferencing facility
POTS / ISDN

23. Sequence of Operation
PATIENT IN
Patient visits OPD
Local Doctor checks up
Patient receives local treatment
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
results, appointment date is fixed for online telemedicine
session
OUT
OUT
Offline Data transfer
from Nodal Centre

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

25. Hardware Configuration
Digital camera
Referral Hospital
Nodal Hospital
PSTN/ISDN/VSAT link
Scanner
PrinterModem
Modem
Microscope and other
medical instruments
Video Conference
Video Conference
Telephone
Telephone

26. Software Modules
Offline Activities
Online Activities

27. Doctor
Patient
Video and Data Conferencing

28. 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.
If required
concerned data
may be resent
to remote
hospital
Patient
Local
Hospital
Attending
local doctor Remote Hospital 1
Remote Hospital 2

29. Internet
Patient Console
Referral Hospital
Step 1.
Upload Information
step2.
Download Information
Step 3.
Post Suggestions
Telemedicine Server
Step 4.
Receive Suggestion
Telemedicine over web

30. Mobile Healthcare
• Client interfaces for PDA and mobile phone.
• SMS based Emergency messaging system.
• Developing instruments with mobile interfaces.

31. Use of Mobile Devices in Telemedicine

32. Limitations Of Handheld Devices
• Limitation of computational resources
a. Limited memory capacity
b. Slow execution speed
• Small screen size

33. Solutions
• Client Server based approach
• Data filtering
• Partitioned image display for large images
• Buffer management

34. Wireless Medical Information Access Server
• Patient data browsing
a. Text data
b. Image data
• Prescribing drugs and advice

35. Patient Queue in PDA
Patient Queue in Desktop Computer

36. Test Reports
Fragment 1 Fragment 2

37. Prescription Writing Form

38. Multimedia data in PDA
• Viewing & Marking of image
• Profile Marking application
• ECG Viewer application
• Display of Graphs and Charts

39. Zooming & Marking of Image

40. ECG Data Display

41. 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

42. 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.

43. 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.

45. 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

47. 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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