Transcript Telemedicine

Arab Open University
Faculty of Computer Studies
Computing and Information Technology Department
T175 B: Networked living: Exploring Information and
Communication technologies
Study Lecture 1:
Block 4 part1 study session 3
Block 4 part1 study session 4
1
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3.1 Introduction
•
How ICT systems can be used to communicate information about the
health of a patient to a medical professional so that treatment can
be provided at a distance.
•
Telemedicine can even include surgery at a distance (telesurgery),
where it’s crucial that the surgeon gets information back quickly
about his or her actions.
•
Telemedicine: literally means medicine at a distance.
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Telemedicine: ‘the application of information and communication
technologies to the practice of healthcare’
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Benefits:
1.
Medical assistance and expertise can be brought to individuals
2.
Reducing or even removing the need to transport people to medical
centres and hospitals (save time and cost)
3.
Provide medical assistance in some countries which has no medical
infrastructure to move patients for treatment.
4.
Reducing the number of people needing to visit centres such as
clinics and hospitals (more quality)
5.
Offer a means by which a doctor’s skills are not tied to the physical
presence of the doctor
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Technological implications:
1) sound files:
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A transducer (to convert the audible signal to an electrical signal)
with an amplifier (to make it sufficiently loud) could allow sounds to
be fed into a standard telephone circuit directly
•
The quality of sound is restricted by the limited bandwidth of the
telephone channel
•
We’ll have to ensure that low-frequency thuds (heartbeats) and
high-frequency wheezes (lungs) could still be detected
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2) capturing and sending images:
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Digital cameras: comparatively inexpensive digital cameras can now
produce quite high-quality images
•
Mobile phones:

Lower-quality pictures produced by mobile phones can assist in
some diagnosis.

Mobile phones can even be used to send the results of tests
carried out by the patient at home to a doctor or hospital
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•
•
Webcam:

It provide low- to medium quality images for web pages

Allow a level of video conferencing if a connection with a
sufficiently high bit rate is available (A doctor monitoring a
remote patient’s heartbeat or blood pressure might need to
check for correct positioning of the chest or arm probes)
Text messages: can be sent to remind patients of appointments, or
to communicate test results
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3.2 Telemedicine on a budget
An example: an extract from the paper (India: Telemedicine’s Great New Frontier)
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Can telemedicine really make a difference in India?
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First event The Gujurat earthquake on 27 January 2001 devastated the western
city of Bhuj and left thousands of dead and many more homeless
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Within 24 hours the Online Telemedicine Research Institute (OTRI) in Ahmedabad,
about 300 km from Bhuj, had established satellite telephone links between an
emergency command center in neighbouring Ghandinaghar and various facilities
around Bhuj
•
Second event the OTRI and the Sanjay Gandhi Post Graduate Institute
established a station under the sponsorship of the Ministry of Information
Technology to monitor levels of cholera-causing bacteria in the river water.
Microscope images of samples of microorganisms from the river were transmitted
to the Institute’s experts in pathology and microbiology for identification and
analysis
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•
The extract is about:

Classic cases of ICT systems playing the role of reducing or
removing constraints imposed by distance and time

Much of the diagnostic work was achieved by transmitting
images, which could be done without the extremely hightech equipment

The extract described the use of fairly standard ICT devices
and systems for the purposes of telemedicine, in
combination with specialized medical equipment at
temporary or permanent clinics
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Equipment that is specifically designed for medical monitoring:
1) reminds the client to take
medication and asks questions about
his/her condition
2) After the client completes a
session, the CareCompanion
automatically delivers its data to the
operating company or clinic
3) blood pressure monitor, weight
scale, pulse, oximeter (measures
blood oxygen level), glucometer
(measures blood sugar level)
4) A link a stethoscope from patient
to doctor via a communications link
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Examples of telemedicine:
•
Extending back over many years. For example, in the early years of space
exploration there was much interest in the effects of weightlessness on astronauts
during prolonged periods of space travel
Activity 20:
Find some recent applications of telemedicine across the world. You could find many
examples through BBC News online……
One final point:
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Telemedicine is not simply about the technology; there are also important human
issues. For example, a relationship.
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It remains to be seen whether patients’ confidence and trust can be established
where ICT networks are used to give treatment by people that they may never
meet ??
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3.3 Telesurgery
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Specialized area of telemedicine - surgery at a distance.
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Telesurgery is closely related to robotic surgery.
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Robotic mechanisms under direct human supervision rather than
robots that can carry out activities autonomously.
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This sort of operation is an alternative to conventional surgery that is
named ‘minimally invasive’ surgery or ‘keyhole’ surgery.
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Minimally invasive surgery has developed significantly over
recent decades:

It uses only small access areas (referred to as ‘ports’) so that
the physical and emotional disturbances associated with
conventional surgery are minimised (no large incision)

The use of robotic assemblies and control systems that
allow a surgeon to carry out precise manoeuvres of the
miniaturised surgical instruments (micromanipulation)

The surgeon’s view is limited to images obtained from
endoscopes (the use of optical fibre probe, for display on a
video monitor)
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Surgeons working in this field already work in a ‘remote’ manner.
•
Extending the distances involved from a meter or two to thousands
of kilometers would allow a surgeon on one side of the world to
operate on a patient on the other
•
In effect, the robot-assisted system is divided into two parts,
interconnected by a telecommunications channel
Stop watch
video 1
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Latency  means total delay.
Latency = travelling time of a signal (propagation delay) + manipulation delay (exp.
during compression and decompression) + delay due to the temporary storage.
Latency sometimes used to describe total one-way delay.
And sometimes to describe total round-trip delay.
Activity:
Assume that the distance from London to Leeds is about 400 km, and the driving speed by a car is
120 km/hour. Find the time of the round trip?
Answer:
distance = time X speed then time= distance/ speed
time= 400/120 = 3.3 hours (this is from London to Leeds)
Round trip time = 3.3 + 3.3 = 6.6 hours
0.6 hour = 60 X 0.6 = 36 minutes
Round trip time = 6.6 hours = 6 hours and 36 minutes.
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Activity 21 (self-assessment)
Assume that the round trip from Strasbourg to New York is 10 000 km
and that the telesurgery signals propagate through optical fibres at
2X10^8 m/s. Work out the proportion of the quoted latency (total
round-trip delay) that was taken up by the propagation delay and the
proportion that was taken up by the video coding/decoding. (given:
Latency = 155 ms video processing 70 ms)
Answer:
1) Proportion of video processing = 70/155 = 0.452 = 45%
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Proportion of propagation= ??
Distance = 10 000 km = 10 000 000 m
Speed = 2 X 10^8 = 2 0000 0000 m/s
Time = distance / speed = 10 000 000/2 0000 0000 = 0.05 second
= 50 ms
2) Proportion of propagation = 50/155 = 0.322 = 32%
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Feedback:
Stop
watch
video 2
By feedback I mean checking the result of an action, and then applying the information
to subsequent actions -- either explicitly, or as part of our bodies’ innate mechanisms.
Closed-loop control: Monitoring the result of an action and then using the information
to modify what is going on. (Part 2 of this block)
Activity 22 (exploratory)
Imagine that you are a surgeon who, on being newly introduced to robot-assisted
surgery of the type that I have described, is thinking about the feedback problem.
What major worries might you have?
Answer:
A surgeon would need to be able to perceive the force being applied by the surgical
tools without direct contact with them (force feedback), in order to do that we need to
study ‘tactile sensing’ -- in effect, the measurement and control of touch.
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Vision and depth
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Being able to see clearly what is being carried out is crucial. This
needs well-thought-out arrangements for presenting the best views
to a surgeon
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In a three-dimensional world this is not normally a problem, but
when a view is presented on a flat display screen this sort of detail
could be difficult to detect
•
One possible approach is to create stereoscopic views by separating
the image information for one eye from the image information for
the other eye (Virtual-reality systems use this type of approach)
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The reliability of the network connection would be of critical
importance over the duration of the procedure, which could be
several hours.
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There should ideally be a fall-back arrangement or contingency plan,
in which human beings close to the patient could take over to cope
with any necessary changes.
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1) surgeon training
Stop
watch
video 3
2) battlefield situations (Trauma Pod project, at the conceptual stage in 2005, has
been conceived by the US military under the Defense Advanced Research Projects
Agency (the same agency that was involved in the forerunner of the internet))
Conceptual design of Raven (mini surgical robot) - CAD drawings
Reference: bionics.soe.ucsc.edu/.../surgery_device_4.html
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3.4 Broadband for telemedicine
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Many applications using ICTs, especially those in which real-time (or
‘live’) image data is sent, require network connections that can
handle a high data rates. Such connections are called broadband
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Early broadband standards were based upon the Integrated Services
Digital Network (ISDN) which provided data rates in multiples of 64
kbps
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In contrast to traditional modems, broadband connections are
generally ‘always on’, which avoids the inherent unreliability and
inconvenient delays of telephone ‘dial-up’ connections
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Activity 24:
What is the time taken to send the following files across a 128 kbps
link? 280 KB, 980 KB, 420 KB and 730 KB
Answer:
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Note that terms like ‘high speed’, ‘fast’ or ‘slow’, which you will often
find used in the context of broadband, can sometimes mislead
•
The speed of a signal down a copper wire, through an optical fibre or
through free space will be a known value depending upon the
medium
•
It will normally lie between 2 X 10^8 and 3 X 10^8 m/s
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The data rate will be determined by how fast the signal can change
to represent successive bits. For example, signals can change much
faster in an optical cable than in a copper cable of the same length
without losing quality in the received data
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Technologies which are available for the provision of broadband:
a)
Digital Subscriber Line (DSL): achieve high data rates by reducing
the effects of noise, using advanced error detection and correction
b)
Asymmetric Digital Subscriber Line (ADSL): is a version of DSL that
became the most common broadband technology for home access
in the UK
‘asymmetric’ is used because the bit rate is significantly greater for data
being sent to a user compared with data sent from the user.
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Broadband to mobile phones
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3G (third generation) handsets are capable of downloading data at
broadband data rates of around 2 Mbps. This is achieved by:
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A technique called ‘Multiple Input, Multiple Output (MIMO)’. This is
like combining the performance of several individual handsets to
achieve a high data rate, but using only a single handset.
•
Multiple antennas are needed in these handsets to allow the
necessary data streams to be transmitted or received at the same
time. A data rate of 10 Mbps can be achieved using this approach -at a price!
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Activity 25:
Look back at the telemedicine applications described in this section
(including my examples in the Activity 20 question and comments).
Find one application that falls into each of the following categories:
a.
Can operate over a standard telephone line
b.
Needs a data rate of 5 Mbps or more.
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Answer
(a) The only example that is definitely stated to operate using only a
standard telephone line is the basic form of the CareCompanion
described in Section 3.2. It may also be possible to implement the
cystic fibrosis example (Activity 20) and to send the X-ray and other
images in the Bhuj example (Section 3.2) over a normal telephone
line.
(b) The transatlantic gall bladder operation (Section 3.3) used a 10
Mbps link. Although it is not stated directly, a rate of over 5 Mbps
would also probably be needed for the Guam heart-surgery example
in my comments on Activity 20 (high-resolution video was used).
Trauma Pod, too, will almost certainly need high-bit-rate (wireless)
links.
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4.1 Introduction
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This section concentrates on the UK’s National Programme for
Information Technology (a large-scale project to use modern ICT
systems for medical information and communications within the
National Health Service (NHS))
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In ‘e-Health Action Plan’ the European countries produce plans to
deliver better-quality healthcare to European citizens
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Each citizen of the European Union (EU) would carry a smart health
card that would uniquely identify them
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The smart card would provide access to the citizen’s electronic
patient record on a database from anywhere within the EU, and
allow the citizen to obtain medication from any pharmacy in the EU
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4.2 National Programme for Information Technology (NPfIT)
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It encompasses the creation of a database of medical records of all
UK citizens, called the Care Records Service
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Care Records Service holds a summary of care and clinical history for
each patient. This is known as the ‘spine’. It includes name, address,
NHS number and date of birth, and information about allergies,
adverse reactions to drugs, etc.
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Benefits or advantages of (NPfIT):

Brings modern computer systems into the NHS to improve patient
care and services.
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Give patients access to their personal health and care
information.

Transforming the way the NHS works.

Information will move around more quickly with health care
records, appointments, prescription information, and up-to-date
research into illnesses and treatments accessible to patients and
health professionals
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4.3 Scale of the NHS
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Scale here means size
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Statistics that shows that NHS is a large organisation and,
significantly, some patients are making use of ICT as one means of
accessing health information
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4.4 Components of the NPfIT:
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Care Records Service
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Contact
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Choose and Book
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Electronic Transmission of Prescriptions

New National Network (N3)
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Picture Archiving and Communications Systems (PACS)
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Secondary Uses Service (SUS)
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National Library for Health (NLH)

GP2GP. A system for transferring medical records from one general
practitioner to another.
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4.5 The N3 communication network
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N3 (New National Network)
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N3 is the data network to link doctors, hospitals, consultants and all
other sections of the health service in England and Scotland
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N3 as a broadband network specially for all parts of the health
service
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N3 is a system of agreements and contracts between the NHS and
(ultimately) a range of broadband suppliers, to supply a broadband
network for the NHS
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The previous : NHSnet was a similar type of network, but had a
lower bandwidth and was less extensive
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Why the NHS’s broadband provision is specially managed?
1.
The kinds of bandwidth required go beyond what is offered to
domestic consumers
2.
Security
3.
Availability (ensure that the network meets certain minimum
standards of availability)
4.
Cost. By centralising its dealings with broadband suppliers, the
NHS is likely to get services more cheaply than it would otherwise
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The N3 provides managed network support by:
1.
It offers a range of bandwidths for different parts of the network,
as already mentioned.
2.
It guarantees a particular level of service, notably a particular
level of ‘availability’ (explained later)
3.
It is a virtual private network (explained later)
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4.6 Virtual private networks
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To understand what a virtual private network is, let’s first think what
we mean by a private network
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Very often each shop, supermarket or bank will have its own LAN
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A large organisation needs to join up its LANs for data
communications
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The organisation would have a private network, which is a data
network for the exclusive use of the organisation, joining its LANs
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In order to create private network connecting the branches for large
organization we can use the following options:
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Lay down cables or fibres between outlying parts of the organisation
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Lease lines from a telecommunications company to join outlying
parts of the organisation
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Create wireless links (possibly using microwaves or satellite
communications).
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All of the above are extremely expensive
•
Alternative strategy is a virtual private network (VPN)
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Several techniques exist for creating virtual private networks, and
usually they involve the internet protocol (IP).
•
In VPN the system is ‘transparent’. VPN’s users can access the
servers and networked computers within the organisation from their
own computer, even if they are in another part of the country or in a
different country.
•
Because VPN traffic passes over a shared network  concern about
security. The solution:

Encryption

Authentication
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Encryption: is the process of scrambling text to make it
incomprehensible to unauthorised recipients.
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Authentication: users need to demonstrate that they are entitled to
use the network, and the data to which it provides access.
•
Passwords are an example of authentication.
Benefits:
•
Cost of creating a VPN should be independent of the geographical
size of the network. This is because it would share data links that
already exist.
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4.7 Availability
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Availability is the proportion of time, on average, for which a system is available
for use.
•
Suppose that, on average, in a period of 100 hours a system is available for 99.2
hours  the availability is 99.2%.
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The system will be unavailable for 0.8 hours in every 100 hours, which amounts to
48 minutes.
•
48 minutes should not be continuous.
•
Availability and probability: availability is a way of expressing, as a percentage, the
probability of a system working at any given time
•
An availability of 90% means that the probability of the system working at any
randomly chosen time is 0.9
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Availability and probability
•
Availability is a way of expressing, as a percentage, the probability of a
system working at any randomly chosen time.
•
An availability of 90% means that the probability of the system working at
any randomly chosen time is 0.9
E ND OF THIS PART
Using ICTS to communicate
health information
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