Applying telecommunication technology to health-care delivery

A "matter of communication": A new classification to compare and evaluate telehealth and telemedicine interventions and understand their effectiveness as a communication process

This article attempts to define functions and applications of telemedicine and telehealth in order to achieve a simplified and comprehensive taxonomy. This may be used as a tool to evaluate their efficacy and to address health policies from the perspective of the centrality of information in the healthcare. Starting from a lexical frame, telemedicine or telehealth is conceived as a communication means and their action as a communication process. As a performance, the communication is related to the health outcome. Three functions ( telemetry, telephasis, and telepraxis) and nine applications are identified. Understanding the mechanisms of telemedicine and telehealth effectiveness is crucial for a value-driven healthcare system. This new classification-focusing on the end effect of telemedicine and telehealth and on the type of interactions between involved actors-moves toward a new and simplified methodology to compare different studies and practices, design future researches, classify new technologies and guide their development, and finally address health policies and the healthcare provision.

Communication technologies through an etymological lens: looking for a classification, reflections about health, medicine and care

Information and communication technologies are widely used in healthcare. However, there is not still a unified taxonomy for them. The lack of understanding of this phenomenon implies theoretical and ethical issues. This paper attempts to find out the basis for a classification, starting from a new perspective: the structural elements are obtained from the etymologies of the lexicon commonly used, that is words like telemedicine, telehealth, telecare and telecure. This will promote a better understanding of communication technologies; at the same time, it will allow to draw some reflection about health, medicine and care, and their semantic and relational nature.

A simple and reliable health monitoring system for shoulder health: proposal

Background

The current health care system is complex and inefficient. A simple and reliable health monitoring system that can help patients perform medical self-diagnosis is seldom readily available. Because the medical system is vast and complex, it has hampered or delayed patients in seeking medical advice or treatment in a timely manner, which may potentially affect the patient’s chances of recovery, especially those with severe sicknesses such as cancer, and heart disease.

Objective

The purpose of this paper is to propose a methodology in designing a simple, low cost, Internet-based health-screening platform.

Methods

This health-screening platform will enable patients to perform medical self-diagnosis over the Internet. Historical data has shown the importance of early detection to ensure patients receive proper treatment and speedy recovery.

Results

The platform is designed with special emphasis on the user interface. Standard Web-based user-interface design is adopted so the user feels ease to operate in a familiar Web environment. In addition, graphics such as charts and graphs are used generously to help users visualize and understand the result of the diagnostic. The system is developed using hypertext preprocessor (PHP) programming language. One important feature of this system platform is that it is built to be a stand-alone platform, which tends to have better user privacy security. The prototype system platform was developed by the National Cheng Kung University Ergonomic and Design Laboratory.

Conclusions

The completed prototype of this system platform was submitted to the Taiwan Medical Institute for evaluation. The evaluation of 120 participants showed that this platform system is a highly effective tool in health-screening applications, and has great potential for improving the medical care quality for the general public.

EMERGENCY HEALTH CARE AND FOLLOW-UP TELEMEDICINE SYSTEM FOR RURAL AREAS BASED ON LABVIEW

This paper presents the design and development of a prototype for remote ECG data transmission based on Internet-enabled health care services and telemedicine fundamentals. An ECG acquisition system developed by the authors is used to acquire the ECG signal in lead-II configuration from patient and store it in .lvm format in a PC interfaced to patient module through RS232. This unit (data server) on the patient side then transfers the data to a remote client (on doctor's side) using TCP/IP as network protocol on LabVIEW 8.20 environment. Using this device, a specialist doctor can telematically move to the patient site and instruct medical personnel when handling a patient. During the last years, more and more modern tools have found their ways to different tasks during the design, the realization, and data processing in the area of Internet access to the e-health services. The telemedicine system demonstrated in this work is a combined real-time and store-and-forward facility.

Cooperative remote video consultation on demand for e-patients

With the advent of high-speed internet band-width consuming video conferencing applications will rapidly become attractive to e-patients seeking real-time video consultations from e-doctors. In a conventional system patients connect to a known server in a medical center of his choice. If the server (i.e. a server via which a medical consultant communicates with a patient) is busy, the patient must wait before the server becomes free. Such a system is not efficient as many patients in medical centers with busy servers may either have to wait long, or are simply turned away. Patients may also leave when they become impatient. Not only the patients suffer due to server unavailability, medical service providers also incur revenue losses due to lost patients. To counter these problems, we propose a distributed cooperative Video Consultation on Demand (VCoD) system where servers are located in many different medical centers in different neighbourhoods close to patient concentrations. In such a cooperative system if patients find their nearby servers under heavy load they are automatically directed to servers that are least loaded by using efficient server selection method (also called anycasting). Simple numerical analysis shows that this not only maximizes revenues for medical service providers by reducing number of lost patients, but also improves average response time for e-patients.

An informatics model for guiding assembly of telemicrobiology workstations for malaria collaborative diagnostics using commodity products and open-source software

BACKGROUND

Deficits in clinical microbiology infrastructure exacerbate global infectious disease burdens. This paper examines how commodity computation, communication, and measurement products combined with open-source analysis and communication applications can be incorporated into laboratory medicine microbiology protocols. Those commodity components are all now sourceable globally. An informatics model is presented for guiding the use of low-cost commodity components and free software in the assembly of clinically useful and usable telemicrobiology workstations.

METHODS

The model incorporates two general principles: 1) collaborative diagnostics, where free and open communication and networking applications are used to link distributed collaborators for reciprocal assistance in organizing and interpreting digital diagnostic data; and 2) commodity engineering, which leverages globally available consumer electronics and open-source informatics applications, to build generic open systems that measure needed information in ways substantially equivalent to more complex proprietary systems. Routine microscopic examination of Giemsa and fluorescently stained blood smears for diagnosing malaria is used as an example to validate the model.

RESULTS

The model is used as a constraint-based guide for the design, assembly, and testing of a functioning, open, and commoditized telemicroscopy system that supports distributed acquisition, exploration, analysis, interpretation, and reporting of digital microscopy images of stained malarial blood smears while also supporting remote diagnostic tracking, quality assessment and diagnostic process development.

CONCLUSION

The open telemicroscopy workstation design and use-process described here can address clinical microbiology infrastructure deficits in an economically sound and sustainable manner. It can boost capacity to deal with comprehensive measurement of disease and care outcomes in individuals and groups in a distributed and collaborative fashion. The workstation enables local control over the creation and use of diagnostic data, while allowing for remote collaborative support of diagnostic data interpretation and tracking. It can enable global pooling of malaria disease information and the development of open, participatory, and adaptable laboratory medicine practices. The informatic model highlights how the larger issue of access to generic commoditized measurement, information processing, and communication technology in both high- and low-income countries can enable diagnostic services that are much less expensive, but substantially equivalent to those currently in use in high-income countries.

Adaptive transmit diversity with orthogonal space-time block coding for telemedicine application

Recently an adaptive transmit eigenbeamforming with orthogonal space-time block coding (Eigen-OSTBC) has been proposed. This model was simulated over macrocell environment with a uniform linear array (ULA) at the base station (BS) for next-generation (NG) wireless/mobile network. In this paper, we introduce a telemedicine simulation framework employing the Eigen-OSTBC scheme for the investigation of communication system characteristics in the application of biological data such as electrocardiogram (ECG). The geometrical-based hyperbolically distributed scatterers (GBHDS) channel model for macrocell environments was simulated with angular spreads (AS) taken from measurement data. Simulation results showed that the performance improvement introduced by the Eigen-OSTBC scheme can be observed even without extensive numerical analysis as traditionally expected. It is also showed that the received signal is highly correlated with the original transmitted signal.

Mobile telemedicine system for home care and patient monitoring

Home care services are growing up in the past years. Contemplating the patient/family pair, it represents a solution to the medical problems of the modern life. With the social trends, the senior population has been increasing in the last years. However, as living is more stressful than ever, there are more cases of chronic diseases. The difficulties of transport in the big cities and the scarcity of hospital streambeds turn the home care an attractive solution. However, its routines can be switched by telemedicine. This paper describes the implementation of a telemedicine system for patient monitoring using mobile telephony. The major aspect about this application is its generality, which allows the use of any patient monitor with a RS-232 interface. The system proved to be quick and reliable. Therefore, it represents an applicable solution to telehomecare.

A Computer Based Telemedicine Protocol to Predict Acute Coronary Syndrome in Patients With Chest Pain at Home

The decision to admit a patient to a coronary care unit for acute coronary syndrome (ACS) has serious medical and financial consequences. In this study, we aimed to develop a computer program to predict the existence of ACS in patients with chest pain at home; it is intended that patients will be able to access the program via the website to test its validity. This study proceeded in two phases. In the first phase, a computer-based decision protocol was developed using recursive-partitioning analysis to predict ACS in 250 patients with chest pain on the basis of their historical data. In the second phase, this protocol was tested in 115 patients for diagnosis of ACS prospectively. Thirty-two of the patients answered the algorithm questions on the website. All of the patients who visited the website of this study were advised to go to the emergency department. Although the algorithm showed the presence of ACS in 82 of 115 patients, 60 of 115 patients were diagnosed as having ACS in the emergency department (n = 55) or at follow-up. The agreement between the diagnosis of the algorithm and the true diagnosis was moderate and statistically significant (Kappa coefficient 0.61, P < 0.001). The sensitivity of the algorithm was 100%, although its specificity was 60%. The accuracy of the algorithm in diagnosing ACS was 81%. The algorithm diagnoses patients with ACS at a high ratio and decreases the number of patients being unnecessarily admitted to the emergency with non-ACS.

Recording of time-varying back-pain data: a wireless solution

Chronic back pain is a debilitating experience for a considerable proportion of the adult population, with a significant impact on countries' economies and health systems. While there has been increasing anecdotal evidence to support the fact that for certain categories of patients (such as wheelchair users), the back pain experienced is dynamically varying with time, there is a relative scarcity of data to support and document this observation, with consequential impact upon such patients' treatment and care. Part of the reason behind this state of affairs is the relative difficulty in gathering pain measurements at precisely defined moments in time. In this paper, we describe a wireless-enabled solution that collects both questionnaire and diagrammatic, visual-based data, via a pain drawing, which overcomes such limitations, enabling seamless data collection and its upload to a hospital server using existing wireless fidelity technology. Results show that it is generally perceived to be an easy-to-use and convenient solution to the challenges of anywhere/anytime data collection.

Bluetooth telemedicine processor for multichannel biomedical signal transmission via mobile cellular networks

One of the emerging issues in m-Health is how best to exploit the mobile communications technologies that are now almost globally available. The challenge is to produce a system to transmit a patient's biomedical signals directly to a hospital for monitoring or diagnosis, using an unmodified mobile telephone. The paper focuses on the design of a processor, which samples signals from sensors on the patient. It then transmits digital data over a Bluetooth link to a mobile telephone that uses the General Packet Radio Service. The modular design adopted is intended to provide a "future-proofed" system, whose functionality may be upgraded by modifying the software.

Studies on microwaves in medicine and biology: from snails to humans

This d'Arsonval Medal acceptance presentation highlights several research themes selected from Dr. Lin's published works, focusing on the microwave portion of the nonionizing electromagnetic spectrum. The topics discussed include investigation of microwave effects on the spontaneous action potentials and membrane resistance of isolated snail neurons, effects on the permeability of blood brain barriers in rats, the phenomenon and interaction mechanism for the microwave auditory effect (the hearing of microwave pulses by animals and humans), the development of miniature catheter antennas for microwave interstitial hyperthermia treatment of cancer, the application of transcatheter microwave ablation for treatment of cardiac arrhythmias, and the use of noninvasive wireless technology for sensing of human vital signs and blood pressure pulse waves. The paper concludes with some observations on research and other endeavors in the interdisciplinary field of bioelectromagnetics.

Implementation of a WAP-based telemedicine system for patient monitoring

Many parties have already demonstrated telemedicine applications that use cellular phones and the Internet. A current trend in telecommunication is the convergence of wireless communication and computer network technologies, and the emergence of wireless application protocol (WAP) devices is an example. Since WAP will also be a common feature found in future mobile communication devices, it is worthwhile to investigate its use in telemedicine. This paper describes the implementation and experiences with a WAP-based telemedicine system for patient-monitoring that has been developed in our laboratory. It utilizes WAP devices as mobile access terminals for general inquiry and patient-monitoring services. Authorized users can browse the patients' general data, monitored blood pressure (BP), and electrocardiogram (ECG) on WAP devices in store-and-forward mode. The applications, written in wireless markup language (WML), WMLScript, and Perl, resided in a content server. A MySQL relational database system was set up to store the BP readings, ECG data, patient records, clinic and hospital information, and doctors' appointments with patients. A wireless ECG subsystem was built for recording ambulatory ECG in an indoor environment and for storing ECG data into the database. For testing, a WAP phone compliant with WAP 1.1 was used at GSM 1800 MHz by circuit-switched data (CSD) to connect to the content server through a WAP gateway, which was provided by a mobile phone service provider in Hong Kong. Data were successfully retrieved from the database and displayed on the WAP phone. The system shows how WAP can be feasible in remote patient-monitoring and patient data retrieval.

Multi-purpose HealthCare Telemedicine Systems with mobile communication link support

The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3-12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a standardized medical protocol.

Scalable medical data compression and transmission using wavelet transform for telemedicine applications

In this paper, a novel medical data compression algorithm, termed layered set partitioning in hierarchical trees (LSPIHT) algorithm, is presented for telemedicine applications. In the LSPIHT, the encoded bit streams are divided into a number of layers for transmission and reconstruction. Starting from the base layer, by accumulating bit streams up to different enhancement layers, we can reconstruct medical data with various signal-to-noise ratios (SNRs) and/or resolutions. Receivers with distinct specifications can then share the same source encoder to reduce the complexity of telecommunication networks for telemedicine applications. Numerical results show that, besides having low network complexity, the LSPIHT attains better rate-distortion performance as compared with other algorithms for encoding medical data.

Three novel lossless image compression schemes for medical image archiving and telemedicine

In this article, three novel lossless image compression schemes, hybrid predictive/vector quantization lossless image coding (HPVQ), shape-adaptive differential pulse code modulation (DPCM) (SADPCM), and shape-VQ-based hybrid ADPCM/DCT (ADPCMDCT) are introduced. All are based on the lossy coder, VQ. However, VQ is used in these new schemes as a tool to improve the decorrelation efficiency of those traditional lossless predictive coders such as DPCM, adaptive DPCM (ADPCM), and multiplicative autoregressive coding (MAR). A new kind of VQ, shape-VQ, is also introduced in this article. It provides predictive coders useful information regarding the shape characters of image block. These enhance the performance of predictive coders in the context of lossless coding. Simulation results of the proposed coders applied in lossless medical image compression are presented. Some leading lossless techniques such as DPCM, hierarchical interfold (HINT), CALIC, and the standard lossless JPEG are included in the tests. Promising results show that all these three methods are good candidates for lossless medical image compression.