A mobile teletrauma system using 3G networks

Exploring the Role of 6G Technology in Enhancing Quality of Experience for m-Health Multimedia Applications: A Comprehensive Survey

Mobile-health (m-health) is described as the application of medical sensors and mobile computing to the healthcare provision. While 5G networks can support a variety of m-health services, applications such as telesurgery, holographic communications, and augmented/virtual reality are already emphasizing their limitations. These limitations apply to both the Quality of Service (QoS) and the Quality of Experience (QoE). However, 6G mobile networks are predicted to proliferate over the next decade in order to solve these limitations, enabling high QoS and QoE. Currently, academia and industry are concentrating their efforts on the 6G network, which is expected to be the next major game-changer in the telecom industry and will significantly impact all other related verticals. The exponential growth of m-health multimedia traffic (e.g., audio, video, and images) creates additional challenges for service providers in delivering a suitable QoE to their customers. As QoS is insufficient to represent the expectations of m-health end-users, the QoE of the services is critical. In recent years, QoE has attracted considerable attention and has established itself as a critical component of network service and operation evaluation. This article aims to provide the first thorough survey on a promising research subject that exists at the intersection of two well-established domains, i.e., QoE and m-health, and is driven by the continuing efforts to define 6G. This survey, in particular, creates a link between these two seemingly distinct domains by identifying and discussing the role of 6G in m-health applications from a QoE viewpoint. We start by exploring the vital role of QoE in m-health multimedia transmission. Moreover, we examine how m-health and QoE have evolved over the cellular network's generations and then shed light on several critical 6G technologies that are projected to enable future m-health services and improve QoE, including reconfigurable intelligent surfaces, extended radio communications, terahertz communications, enormous ultra-reliable and low-latency communications, and blockchain. In contrast to earlier survey papers on the subject, we present an in-depth assessment of the functions of 6G in a variety of anticipated m-health applications via QoE. Multiple 6G-enabled m-health multimedia applications are reviewed, and various use cases are illustrated to demonstrate how 6G-enabled m-health applications are transforming human life. Finally, we discuss some of the intriguing research challenges associated with burgeoning multimedia m-health applications.

eHealth: A Survey of Architectures, Developments in mHealth, Security Concerns and Solutions

The ramifications of the COVID-19 pandemic have contributed in part to a recent upsurge in the study and development of eHealth systems. Although it is almost impossible to cover all aspects of eHealth in a single discussion, three critical areas have gained traction. These include the need for acceptable eHealth architectures, the development of mobile health (mHealth) technologies, and the need to address eHealth system security concerns. Existing survey articles lack a synthesis of the most recent advancements in the development of architectures, mHealth solutions, and innovative security measures, which are essential components of effective eHealth systems. Consequently, the present article aims at providing an encompassing survey of these three aspects towards the development of successful and efficient eHealth systems. Firstly, we discuss the most recent innovations in eHealth architectures, such as blockchain-, Internet of Things (IoT)-, and cloud-based architectures, focusing on their respective benefits and drawbacks while also providing an overview of how they might be implemented and used. Concerning mHealth and security, we focus on key developments in both areas while discussing other critical topics of importance for eHealth systems. We close with a discussion of the important research challenges and potential future directions as they pertain to architecture, mHealth, and security concerns. This survey gives a comprehensive overview, including the merits and limitations of several possible technologies for the development of eHealth systems. This endeavor offers researchers and developers a quick snapshot of the information necessary during the design and decision-making phases of the eHealth system development lifecycle. Furthermore, we conclude that building a unified architecture for eHealth systems would require combining several existing designs. It also points out that there are still a number of problems to be solved, so more research and investment are needed to develop and deploy functional eHealth systems.

Wireless Teleophthalmology: A Novel, Low-Cost, Flexible Network Architecture and Its Performance Evaluation for Remote Eye Care Solutions

INTRODUCTION

This article proposes a novel, cost-effective, flexible, and easy-to-deploy wireless teleophthalmology network architecture and performance evaluation for its potential use in remote areas. This study has used practical telecommunication standards, which is widely deployed throughout India.

METHODS

In the proposed scenario, patient's eye images are obtained using a specified imaging modality, and then sent to a server at the primary eye care centre (PECC) using ZigBee a short-range wireless network. It is linked to the main server at the base eye hospital (BEH) through a GSM/UMTS (3G)/WiMAX (Worldwide Interoperability for Microwave Access) network. After diagnostic evaluation of the eye image using various automated diagnostic software, data are sent to a physician in an urban center for further validation, which is connected through GSM/UMTS (3G)/WiMAX network. Performance evaluation of these wireless networks is carried out for their use in teleophthalmology application based on network parameters, namely throughput, average end-to-end delay, and average jitter. It is found that end-to-end delay is the most critical network parameter affecting overall quality of service (QoS) of the proposed teleophthalmology network.

RESULTS AND CONCLUSIONS

The results demonstrate that WiMAX is the most suitable network among the considered networks for connecting PECC nodes with BEH main server, and further connecting main server with a doctor on the move. It is also deduced that for a given set of QoS parameters, WiMAX supports a load capacity of 22,000 packets at center nodes and the main server and it performs well even when the mobility speed of doctor exceeds 200 KPH.

Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients' biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient's biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.

Real-time multimedia communications in medical emergency - the CONCERTO project solution

The management of medical emergency, in particular cardiac emergency, requests prompt intervention and the possibility to communicate in real time from the emergency area / ambulance to the hospital as much diagnostic information as possible about the patient. This would enable a prompt emergency diagnosis and operation and the possibility to prepare the appropriate actions in the suitable hospital department. To address this scenario, the CONCERTO European project proposed a wireless communication system based on a novel cross-layer architecture, including the integration of building blocks for medical media content fusion, delivery and access. This paper describes the proposed system architecture, outlining the developed components and mechanisms, and the evaluation of the proposed system, carried out in a hospital with the support of medical staff. The technical results and the feedback received highlight the impact of the CONCERTO approach in the healthcare domain, in particular in enabling a prompt and reliable diagnosis in challenging medical emergency scenarios.

The impact of telemedicine in cardiac critical care

Telemedicine was recognized in the 1970s as a legitimate entity for applying the use of modern information and communications technologies to the delivery of health services. Telecardiology is one of the fastest growing fields in telemedicine. The advancement of technologies and Web-based applications has allowed better transmission of health care delivery. This article discusses current advancements, the scope of telemedicine in cardiology, and its application to the critically ill. The impact of telecardiology consultation continues to evolve and includes many promising applications with potential positive implications for admission rates, morbidity, and mortality.

Wound Documentation by Using 3G Mobile as Acquisition Terminal

The increasing numbers of cases of wound disease are now posing a big challenge in China. For more convenience of wound patients, wound management in community health care centers under the supervision of a specialist at general hospitals is an ideal solution. To ensure an accurate diagnosis in community health clinics, it is important that “the same language” for wound description, which may be composed of unified format description, including wound image, must be achieved. We developed a wound information management system that was built up by acquisition terminal, wound description, data bank, and related software. In this system, a 3G mobile phone was applied as acquisition terminal, which could be used to access to the data bank. This documentation system was thought to be an appropriate proposal for community wound care because of its objectivity, uniformity, and facilitation. It also provides possibility for epidemiological study in the future.

Novel cloud and SOA-based framework for e-health monitoring using wireless biosensors

Various and independent studies are showing that an exponential increase of chronic diseases (CDs) is exhausting governmental and private healthcare systems to an extent that some countries allocate half of their budget to healthcare systems. To benefit from the IT development, e-health monitoring and prevention approaches revealed to be among top promising solutions. In fact, well-implemented monitoring and prevention schemes have reported a decent reduction of CDs risk and have narrowed their effects, on both patients' health conditions and on government budget spent on healthcare. In this paper, we propose a framework to collect patients' data in real time, perform appropriate nonintrusive monitoring, and propose medical and/or life style engagements, whenever needed and appropriate. The framework, which relies on service-oriented architecture (SOA) and the Cloud, allows a seamless integration of different technologies, applications, and services. It also integrates mobile technologies to smoothly collect and communicate vital data from a patient's wearable biosensors while considering the mobile devices' limited capabilities and power drainage in addition to intermittent network disconnections. Then, data are stored in the Cloud and made available via SOA to allow easy access by physicians, paramedics, or any other authorized entity. A case study has been developed to evaluate the usability of the framework, and the preliminary results that have been analyzed are showing very promising results.

A study to assess the feasibility of Text Messaging Service in delivering maternal and child healthcare messages in a rural area of Tamil Nadu, India

BACKGROUND

Mobile text messaging is a potentially powerful tool for behaviour change because it is widely available, inexpensive, and instant.

AIMS

To evaluate whether mobile Text Messaging Service is a feasible mode of raising knowledge regarding maternal and child health (MCH) and to explore issues related to mobile text messages as a mode of health education.

METHOD

A community-based intervention study was conducted from January to June 2013 in six randomly selected villages of Vellore district, Tamil Nadu. A multi-stage sampling technique was followed: 120 individuals from 120 households (30 clusters in six villages) were contacted. Data was collected using a pretested questionnaire by house-to-house visits in three phases: 1) baseline assessment of aptitude towards text messages; 2) intervention: sending MCH-related text messages; and 3) end-line assessment to evaluate the increase in knowledge level. Qualitative data regarding mobile text messages as a mode of health education was explored. Quantitative data was analysed using SPSS version 17.0 and qualitative data by Anthropac software.

RESULTS

Of the individuals surveyed, 69.17 per cent and 52.5 per cent were "able to read" and "type and send" text messages, respectively. Seventy per cent of individuals were willing to receive health information via text messages, and 98.33 per cent believed text messages could effectively spread health messages. A significant increase in knowledge was observed following text messages. Male gender and subjects' ability to read text messages were significantly associated. Factors related to mobile phone use include minimum economic burden, easy availability, portability, and ease of use. Factors related to mobile text messages as a mode of health message delivery include direct receipt of information, mass reach, the absence of regional language font in many handsets, and illiterate individuals being unable to read messages.

CONCLUSION

In rural areas, mobile text messages have the potential to deliver health messages regarding MCH.

Mobile, cloud, and big data computing: contributions, challenges, and new directions in telecardiology

Many studies have indicated that computing technology can enable off-site cardiologists to read patients’ electrocardiograph (ECG), echocardiography (ECHO), and relevant images via smart phones during pre-hospital, in-hospital, and post-hospital teleconsultation, which not only identifies emergency cases in need of immediate treatment, but also prevents the unnecessary re-hospitalizations. Meanwhile, several studies have combined cloud computing and mobile computing to facilitate better storage, delivery, retrieval, and management of medical files for telecardiology. In the future, the aggregated ECG and images from hospitals worldwide will become big data, which should be used to develop an e-consultation program helping on-site practitioners deliver appropriate treatment. With information technology, real-time tele-consultation and tele-diagnosis of ECG and images can be practiced via an e-platform for clinical, research, and educational purposes. While being devoted to promote the application of information technology onto telecardiology, we need to resolve several issues: (1) data confidentiality in the cloud, (2) data interoperability among hospitals, and (3) network latency and accessibility. If these challenges are overcome, tele-consultation will be ubiquitous, easy to perform, inexpensive, and beneficial. Most importantly, these services will increase global collaboration and advance clinical practice, education, and scientific research in cardiology.

Open-source telemedicine platform for wireless medical video communication

An m-health system for real-time wireless communication of medical video based on open-source software is presented. The objective is to deliver a low-cost telemedicine platform which will allow for reliable remote diagnosis m-health applications such as emergency incidents, mass population screening, and medical education purposes. The performance of the proposed system is demonstrated using five atherosclerotic plaque ultrasound videos. The videos are encoded at the clinically acquired resolution, in addition to lower, QCIF, and CIF resolutions, at different bitrates, and four different encoding structures. Commercially available wireless local area network (WLAN) and 3.5G high-speed packet access (HSPA) wireless channels are used to validate the developed platform. Objective video quality assessment is based on PSNR ratings, following calibration using the variable frame delay (VFD) algorithm that removes temporal mismatch between original and received videos. Clinical evaluation is based on atherosclerotic plaque ultrasound video assessment protocol. Experimental results show that adequate diagnostic quality wireless medical video communications are realized using the designed telemedicine platform. HSPA cellular networks provide for ultrasound video transmission at the acquired resolution, while VFD algorithm utilization bridges objective and subjective ratings.

Prehospital digital photography and automated image transmission in an emergency medical service - an ancillary retrospective analysis of a prospective controlled trial

BACKGROUND

Still picture transmission was performed using a telemedicine system in an Emergency Medical Service (EMS) during a prospective, controlled trial. In this ancillary, retrospective study the quality and content of the transmitted pictures and the possible influences of this application on prehospital time requirements were investigated.

METHODS

A digital camera was used with a telemedicine system enabling encrypted audio and data transmission between an ambulance and a remotely located physician. By default, images were compressed (jpeg, 640 x 480 pixels). On occasion, this compression was deactivated (3648 x 2736 pixels). Two independent investigators assessed all transmitted pictures according to predefined criteria. In cases of different ratings, a third investigator had final decision competence. Patient characteristics and time intervals were extracted from the EMS protocol sheets and dispatch centre reports.

RESULTS

Overall 314 pictures (mean 2.77 ± 2.42 pictures/mission) were transmitted during 113 missions (group 1). Pictures were not taken for 151 missions (group 2). Regarding picture quality, the content of 240 (76.4%) pictures was clearly identifiable; 45 (14.3%) pictures were considered "limited quality" and 29 (9.2%) pictures were deemed "not useful" due to not/hardly identifiable content. For pictures with file compression (n = 84 missions) and without (n = 17 missions), the content was clearly identifiable in 74% and 97% of the pictures, respectively (p = 0.003). Medical reports (n = 98, 32.8%), medication lists (n = 49, 16.4%) and 12-lead ECGs (n = 28, 9.4%) were most frequently photographed. The patient characteristics of group 1 vs. 2 were as follows: median age - 72.5 vs. 56.5 years, p = 0.001; frequency of acute coronary syndrome - 24/113 vs. 15/151, p = 0.014. The NACA scores and gender distribution were comparable. Median on-scene times were longer with picture transmission (26 vs. 22 min, p = 0.011), but ambulance arrival to hospital arrival intervals did not differ significantly (35 vs. 33 min, p = 0.054).

CONCLUSIONS

Picture transmission was used frequently and resulted in an acceptable picture quality, even with compressed files. In most cases, previously existing "paper data" was transmitted electronically. This application may offer an alternative to other modes of ECG transmission. Due to different patient characteristics no conclusions for a prolonged on-scene time can be drawn. Mobile picture transmission holds important opportunities for clinical handover procedures and teleconsultation.

Third generation cellular multimedia teleconsultations in plastic surgery

We conducted a study to test whether new third generation (3G) mobile phones could be integrated into service as a working tool between plastic surgeons. During an eight-month period, 58 multimedia consultations were performed involving 57 patients. The majority of the consultations were for trauma or wounds. All consultations comprised a digital photograph taken with the integrated camera and sent via the Multimedia Messaging Service (MMS). In 86% of the cases the residents reported that multimedia information contributed to their ability to independently handle similar cases in future. Satisfaction scores were high among all participants. We believe that a multimedia consultation in a hospital setting adds information to an ordinary telephone call, thus decreasing medico-legal risks. We recommend it for routine use.

eEmergency health care information systems

In this paper we provide an overview of the way that information and communication technologies have been used for emergency healthcare support. The paper provides a literature review of case studies exploring information systems for monitoring signals, images, medical videos, as well as information protocols used during emergency health care support, and describes future trends. We anticipate that eEmergency systems can significantly improve the delivery of healthcare during emergency cases. However, the monitoring and evaluation of these systems and especially their use in daily practice still remains a goal to be achieved.

On the Use of Home Node Bs for Emergency Telemedicine Applications in Various Indoor Environments

The use of emergency telemedicine applications at the site of a medical emergency event provides a multitude of benefits, both from the perspective of the patient and the emergency care providers. Innovations in rich multimedia telemedicine solutions further enhances the aforementioned benefits, but places more stringent quality-of-service demands on the underlying mobile networks. In this paper, the authors present a proposal for a complementary solution for rapid provisioning of mobile broadband data connectivity for emergency telemedicine applications in indoor environments. The proposed solution relies on the exploitation of existing femtocellular network resources available at emergency sites in various residential building types. Simulations carried out for a UMTS network environment demonstrate significant improvements in terms of achievable throughput for the emergency mobile terminal device when access to UMTS Home Node Bs available in the building is allowed for emergencies compared to macro Node B access only.

Analysis of QoS Requirements for e-Health Services and Mapping to Evolved Packet System QoS Classes

E-Health services comprise a broad range of healthcare services delivered by using information and communication technology. In order to support existing as well as emerging e-Health services over converged next generation network (NGN) architectures, there is a need for network QoS control mechanisms that meet the often stringent requirements of such services. In this paper, we evaluate the QoS support for e-Health services in the context of the Evolved Packet System (EPS), specified by the Third Generation Partnership Project (3GPP) as a multi-access all-IP NGN. We classify heterogeneous e-Health services based on context and network QoS requirements and propose a mapping to existing 3GPP QoS Class Identifiers (QCIs) that serve as a basis for the class-based QoS concept of the EPS. The proposed mapping aims to provide network operators with guidelines for meeting heterogeneous e-Health service requirements. As an example, we present the QoS requirements for a prototype e-Health service supporting tele-consultation between a patient and a doctor and illustrate the use of the proposed mapping to QCIs in standardized QoS control procedures.

Ambulance 12-lead electrocardiography transmission via cell phone technology to cardiologists

This study demonstrates transmission of 12-lead electrocardiography (ECG) in an ambulance to the cell phone of the attendant emergency medical technician and then to the hospital and to cell phones of off-site cardiologists. The emergency medical technician cell phone receives Extensible Markup Language files generated by a Phillips Extensible Markup Language ECG instrument via Wi-Fi-based wireless network and then sends them to an ECG-processing server at the hospital over the mobile telephone network. After reducing ECG noises and artifacts, the server converts files to Digital Imaging and Communications in Medicine-based ECG reports stored in Picture Archiving and Communication System. These reports are sent to the cell phones of off-site cardiologists. Consequently, on-site Emergency Department physicians and off-site cardiologists can discuss ECG reports via Picture Archiving and Communication System on their computers or cell phones to prepare for the most appropriate treatment while the patient is on the way to the hospital. In conclusion, this 12-lead ECG transmission e-technology expands the functions of a 12-lead ECG instrument and facilitates more efficient prehospital cardiac care.

Flexible Macroblock Ordering for Context-Aware Ultrasound Video Transmission over Mobile WiMAX

The most recent network technologies are enabling a variety of new applications, thanks to the provision of increased bandwidth and better management of Quality of Service. Nevertheless, telemedical services involving multimedia data are still lagging behind, due to the concern of the end users, that is, clinicians and also patients, about the low quality provided. Indeed, emerging network technologies should be appropriately exploited by designing the transmission strategy focusing on quality provision for end users. Stemming from this principle, we propose here a context-aware transmission strategy for medical video transmission over WiMAX systems. Context, in terms of regions of interest (ROI) in a specific session, is taken into account for the identification of multiple regions of interest, and compression/transmission strategies are tailored to such context information. We present a methodology based on H.264 medical video compression and Flexible Macroblock Ordering (FMO) for ROI identification. Two different unequal error protection methodologies, providing higher protection to the most diagnostically relevant data, are presented.

Mobile telemedicine: a survey study

Telemedicine involves the use of advanced and reliable communication techniques to deliver biomedical signals over long distances. In such systems, biomedical information is transmitted using wireline or wireless communication systems. Mobile telemedicine is an improved form of telemedicine, in which advanced wireless communication systems are used to deliver the biomedical signals of patients at any place and any time. Mobile telemedicine employs advanced concepts and techniques from the fields of electrical engineering, computer science, biomedical engineering, and medicine to overcome the restrictions involved in conventional telemedicine and realize an improvement in the quality of service of medicine. In this paper, we study several mobile telemedicine systems, and it is important to gain a good understanding of mobile telemedicine systems because in the further, such systems are expected to become ubiquitous for the delivery of biomedical signals for medicine.

An overview of recent health care support systems for eEmergency and mHealth applications

Advances in mobile communications and medical technologies facilitate the development of emerging mobile systems and applications for healthcare. The objective of this paper is to provide an overview and the current status of mobile health care systems (mHealth) and their applications for Emergency healthcare support (eEmergency). Our paper reports on journal papers that use wireless, emergency telemedicine systems that appeared since 2000. The majority of the applications are focused on the transmission of crucial biosignals (mainly ECG) for the support of heart-related healthcare. A limited number of new studies were focused on supporting emergency healthcare for trauma by facilitating both 2D image or video transmission (eg: ultrasound). Alternatively, new studies have focused on integrated systems for specialized emergency scenaria such as stroke. This paper is an extension of work previously published by our group [1].

An overview of recent end-to-end wireless medical video telemedicine systems using 3G

Advances in video compression, network technologies, and computer technologies have contributed to the rapid growth of mobile health (m-health) systems and services. Wide deployment of such systems and services is expected in the near future, and it's foreseen that they will soon be incorporated in daily clinical practice. This study focuses in describing the basic components of an end-to-end wireless medical video telemedicine system, providing a brief overview of the recent advances in the field, while it also highlights future trends in the design of telemedicine systems that are diagnostically driven.

Delivering Diagnostic Quality Video over Mobile Wireless Networks for Telemedicine

In real-time remote diagnosis of emergency medical events, mobility can be enabled by wireless video communications. However, clinical use of this potential advance will depend on definitive and compelling demonstrations of the reliability of diagnostic quality video. Because the medical domain has its own fidelity criteria, it is important to incorporate diagnostic video quality criteria into any video compression system design. To this end, we used flexible algorithms for region-of-interest (ROI) video compression and obtained feedback from medical experts to develop criteria for diagnostically lossless (DL) quality. The design of the system occurred in three steps-measurement of bit rate at which DL quality is achieved through evaluation of videos by medical experts, incorporation of that information into a flexible video encoder through the notion of encoder states, and an encoder state update option based on a built-in quality criterion. Medical experts then evaluated our system for the diagnostic quality of the video, allowing us to verify that it is possible to realize DL quality in the ROI at practical communication data transfer rates, enabling mobile medical assessment over bit-rate limited wireless channels. This work lays the scientific foundation for additional validation through prototyped technology, field testing, and clinical trials.

3.5G based mobile remote monitoring system

Low bandwidth has long been a reason for the unsuitability of wireless internet in telemedicine. However with the advent of extended third generation wireless as an economically accessible high speed network, more opportunities are being created in this area of telemedicine. This paper explores the opportunity created by the latest wireless broadband technology for remote monitoring of patients in the home.

A generic task-driven multi-agent telemedicine system

Pervasive Telemedicine is an emerging research discipline, which focuses on the development and the application of ubiquitous computing technology for healthcare purposes. However, the current telemedicine systems lack to be self adaptable to handle different types of data such as vital biosignals, images, video and textual data. In addition, they do not use the full capabilities of the computing devices on which they run. Unfortunately, the existing telemedicine systems do not pay enough attention to the quality level of their offered services nor offer adequate resources management for meeting bandwidth and end-to-end communication delays. In this paper we propose an information and communication architecture of a generic telemedicine system based on a knowledge base and intelligent agents interacting each with the other in a synergetic way to perform several medical tasks for a high level of quality of service (QoS). The medical assistance to skiers and high mountains resorts residents will be used in particular as an example of applicability scenario and models personalization.

An ontology-based telemedicine tasks management system architecture

The recent developments in ambient intelligence and ubiquitous computing offer new opportunities for the design of advanced Telemedicine systems providing high quality services, anywhere, anytime. In this paper we present an approach for building an ontology-based task-driven telemedicine system. The architecture is composed of a task management server, a communication server and a knowledge base for enabling decision makings taking account of different telemedical concepts such as actors, resources, services and the Electronic Health Record. The final objective is to provide an intelligent management of the different types of available human, material and communication resources.

Ubiquitous computing for remote cardiac patient monitoring: a survey

New wireless technologies, such as wireless LAN and sensor networks, for telecardiology purposes give new possibilities for monitoring vital parameters with wearable biomedical sensors, and give patients the freedom to be mobile and still be under continuous monitoring and thereby better quality of patient care. This paper will detail the architecture and quality-of-service (QoS) characteristics in integrated wireless telecardiology platforms. It will also discuss the current promising hardware/software platforms for wireless cardiac monitoring. The design methodology and challenges are provided for realistic implementation.

Development of an electronic medical report delivery system to 3G GSM mobile (cellular) phones for a medical imaging department

Medical practice is characterized by a high degree of heterogeneity in collaborative and cooperative patient care. Fast and effective communication between medical practitioners can improve patient care. In medical imaging, the fast delivery of medical reports to referring medical practitioners is a major component of cooperative patient care. Recently, mobile phones have been actively deployed in telemedicine applications. The mobile phone is an ideal medium to achieve faster delivery of reports to the referring medical practitioners. In this study, we developed an electronic medical report delivery system from a medical imaging department to the mobile phones of the referring doctors. The system extracts a text summary of medical report and a screen capture of diagnostic medical image in JPEG format, which are transmitted to 3G GSM mobile phones.

Delay-bounded semi-reliable vital sign transmission protocol for mobile telemedicine over a CDMA 1x EV-DO network

The reliable and instant transmission of vital signs is important for remote time-critical patient care through a telemedicine system. However, sometimes the reliability and instantaneity conditions cannot be satisfied simultaneously under a high-noise mobile network, because they are reciprocal to each other. In this paper, the vital sign transmission protocol (VSTP) running over a CDMA 1x EVDO (Code Division Multiple Access 1x Evolution Data Only) mobile network is proposed to comply with both the reliability and instantaneity requirements. The switching buffer management scheme is combined with a hybrid error control scheme, consisting of forward error correction (FEC) and automatic repeat request (ARQ). The CDMA 1x EVDO mobile network is modeled by two states using the Markov wireless channel model to test transmission performance under diverse network conditions. Throughout the noisy environment simulation, the performance of the VSTP is compared with the Transmission Control Protocol (TCP) and User Datagram Protocol (UDP) to demonstrate its efficacy over error-prone mobile network.

Development of a personal digital assistant-based wireless application in clinical practice

PURPOSE

Our study aims to develop a personal digital assistant (PDA)-based wireless application in medical information processing by using Bluetooth and IEEE 802.11b wireless standards and SyncML codes.

METHODS

In this study, an "integrated database access module" is used to provide a unified integrated access interface while consistency of wireless data transmission is achieved by using the standardized SyncML protocol. A prototype of the system has been developed, implemented, and tested for its mobility, usability, stability, and performance with questionnaire survey.

RESULTS

Response time for browsing/searching was usually less than 3s. The average time intervals needed for data transmissions were 68.6+/-8.5s for Bluetooth and 47.0+/-4.8s for 802.11b. The five-point Likert scale (from 1=least to 5=most) questionnaire survey of 30 medical professionals yielded a high degree of satisfaction with the system's mobility (4.18+/-0.89), usability (4.69+/-0.90), stability (3.81+/-0.94), and performance (3.97+/-0.88).

CONCLUSION

The results of our study suggested that PDA applications which exploit wireless communication are convenient and feasible in clinical practice.

Integration of Information Technology, Wireless Networks, and Personal Digital Assistants for Triage and Casualty

The purpose of this study was to evaluate a portable tool for use by first responders in documenting triage of victims in a mass casualty incident (MCI) more effectively. The tool presented in this study allows first responders to gather patients vital signs, injuries, and triage status in a prompt and accurate way, and enables first responders to wirelessly communicate vital health information throughout the entire care continuum. The architecture infrastructure for the portable device is called Triage and Casualty Informatics Technology (TACIT) and can expedite triage, transport and treatment procedures within an MCI. TACIT was developed by integrating handheld devices, wireless networks, global positioning system (GPS), digital cameras, and bar code scanners with customized triage software. Two MCI initial field trials verified that the TACIT software, battery life, data accuracy, and wireless transmission met the emergency response system requirements. Initial field trials also demonstrated robustness of operation, reduced triage collection time and improved collection accuracy. The TACIT system could work as an efficient prehospital response tool and platform.