Healthcare PANs: Personal Area Networks for trauma care and home care

The first hour following the trauma is of crucial importance in trauma care. The sooner treatment begins, the better the ultimate outcome for the patient. Generally the initial treatment is handled by paramedical personnel arriving at the site of the accident with an ambulance. There is evidence to show that if the expertise of the on-site paramedic team can be supported by immediate and continuous access to and communication with the expert medical team at the hospital, patient outcomes can be improved. After care also influences the ultimate recovery of the patient. After-treatment follow up often occurs in-hospital in spite of the fact that care at home can offer more advantages and can accelerate recovery. Based on emerging and future wireless communication technologies, in a previous paper [1] we presented an initial vision of two future healthcare settings, supported by applications which we call Virtual Trauma Team and Virtual Homecare Team. The Virtual Trauma Team application involves high quality wireless multimedia communications between ambulance paramedics and the hospital facilitated by paramedic Body Area Networks (BANs) [2] and an ambulance-based Vehicle Area Network (VAN). The VAN supports bi-directional streaming audio and video communication between the ambulance and the hospital even when moving at speed. The clinical motivation for Virtual Trauma Team is to increase survival rates in trauma care. The Virtual Homecare Team application enables homecare coordinated by home nursing services and supported by the patient's PAN which consists of a patient BAN in combination with an ambient intelligent home environment. The homecare PAN provides intelligent monitoring and support functions and the possibility to ad hoc network to the visiting health professionals’ own BANs as well as high quality multimedia communication links to remote members of the virtual team. The motivation for Virtual Homecare Team is to improve quality of life and independence for patients by supporting care at home; the economic motivation is to replace expensive hospital-based care with homecare by virtual teams using wireless technology to support the patient and the carers. In this paper we develop the vision further and focus in particular on the concepts of personal and body area networks

Using a Mobile Multimedia System to Improve Information Exchange in EMS.

This research uses multiple research methodologies guided by Information Systems Design Theory (ISDT) to design and evaluate a mobile multimedia information system for Emergency Medical Services (EMS). We examined the impact of multimedia information for EMS information exchange and decision-making. A field study was designed and conducted in the Boise, Idaho region for three months to evaluate the system and validate ISDT design propositions. Findings from qualitative analysis illustrated the value of digital images and audio recordings for improving information exchange and augmenting medical decision-making. This paper describes the problem and justification, presents the system design, the pilot test methodology and findings and overall implications and future research directions

Tavarua : a mobile telemedicine system using WWAN striping

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2007.Includes bibliographical references (p. 69-78).Tavarua is a platform designed to support mobile telemedicine systems over wireless wide area networks, WWANs. It utilizes network striping and other complementary techniques to send uni-directional near real time video and audio data streams from a imobile node to a stationary location. The key technical challenge is transmitting high-bandwidth, loss-sensitive data over multiple low-bandwidth, lossy channels. We overcome these challenges using dynamic adjustment of the encoding parameters and a novel video encoding technique (grid encoding) that minimizes the impact of packet losses. Using five WWAN interfaces, our system reliably and consistently transmits audio and diagnostic quality video, with median PSNR values that range from 33.716dB to 36.670dB, with near real-time latencies. We present a study of the characteristic behavior of WWANs, and a description of our system architecture based in part on the lessons gleaned from that study. Through a set of experiments where we transmit video and audio data from a moving vehicle we evaluate the system, focusing on consistency, reliability, and the quality of the audio and video streams. These experiments demonstrate that we can transmit high quality video and audio in varying conditions and even in the presence of hardware failures.by Jennifer Carlisle.S.M

Determining optimal flight paths for cellular network connectivity for the transmission of real-time physiological data in support of big data analytics during airborne critical care transport

This thesis presents a methodology for determining the optimal flight paths between two geographical points based on distance and cellular reception over the path. This methodology consists of two main concepts: coverage map generation, and path planning. Coverage map generation creates a grid map of the total planning space that contains coverage information for each grid point. Coverage is calculated based on geographical and technical information regarding each cell tower in the planning area. The planning step utilises the coverage map to plan a route based on minimum distance and maximum coverage, which is then smoothed into a feasible route for an aircraft to follow. This methodology is demonstrated in an airborne critical care transport within the Province of Ontario in Canada context. Leveraging available cellular information, this methodology is used to determine optimal paths between various care centres or their closest airport. Evaluation reveals that optimal routes can be found through this methodology

Flexible application driven network striping over Wireless Wide Area Networks

Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2005.Includes bibliographical references (p. 157-161).Inverse multiplexing, or network striping, allows the construction of a high-bandwidth virtual channel from a collection of multiple low-bandwidth network channels. Striping systems usually employ a packet scheduling policy that allows applications to be oblivious of the way in which packets are routed to specific network channels. Though this is appropriate for many applications, many other applications can benefit from an approach that explicitly involves the application in the determination of the striping policy. Horde is middleware that facilitates flexible striping over Wireless Wide Area Network (WWAN) channels. Horde is unusual in that it separates the striping policy from the striping mechanism. It allows applications to describe network Quality-of-Service (QoS) objectives that the striping mechanism attempts to satisfy. Horde can be used by a set of data streams, each with its own QoS policy, to stripe data over a set of WWAN channels. The WWAN QoS variations observed across different channels and in time, provide opportunities to modulate stream QoS through scheduling. The key technical challenge in Horde is giving applications control over certain aspects of the data striping operation while at the same time shielding the application from low-level details. Horde exports a set of flexible abstractions replacing the application's network stack. Horde allows applications to express their policy goals as succinct network-QoS objectives. Each objective says something, relatively simple, about the sort of network QoS an application would like for some data stream(s). We present the Horde architecture, describe an early implementation, and examine how different policies can be used to modulate the quality-of-service observed across different independent data streams. Through experiments conducted on real and simulated network channels, we confirm our belief that the kind of QoS modulation Horde aims to achieve is realistic for actual applications.by Asfandyar Qureshi.M.Eng

Human Factors Considerations in a Telemedicine-Integrated Ambulance-Based Caregiving Environment for Stroke Care

Telemedicine, the use of communications technology to connect patients to medical professionals remotely, can be applied to a variety of settings, for example connecting older adults with their physicians from home, specialists to rural county hospitals or patients to physicians for emergency care. This dissertation focuses on the use of telemedicine for ambulance-based care for stroke patients, including how the design of this system impacts caregivers. The initial study investigated both the usability of a telemedicine system implemented in ambulances for stroke care as well as the possibility of human error when using it. The heuristic evaluation of usability violations found several issues that needed to be addressed, including the lack of clarity in the tab structure and the lack of suggestions for correct data inputs. Similarly, the analysis of possible errors also determined several issues with this system, with the two most common being miscommunication and difficulty in locating data input or selecting an incorrect option. Several remediations strategies were recommended based on this study: improvement of the labelling of the tab structure, consistent formatting, rigid or suggested formatting for data input, automation of task structure and camera movement, and audio/visual improvements to support communication. The second study investigated the experience of caregivers with the ambulance-based stroke telemedicine system, focusing on the support of the distributed cognition of the caregiving teams. Teams comprised of a neurologist, nurse, and paramedic were observed conducting 13 simulated stroke consults, after which each caregiver completed a survey on the perceived workload, usability, and teamwork during the session and an interview about their experience with the telemedicine system. In total, thirty-nine caregivers were interviewed, and the data collected were analyzed for themes. The themes that emerged identified such barriers to and facilitators for using telemedicine for ambulance-based stroke caregiving as training and experience, technical difficulty barriers, and patient care and efficiency improvement facilitators. The findings from this study resulted in design recommendations for supporting healthcare professionals during caregiving, especially ones that support their distributed cognition when using ambulance-based telemedicine for stroke care. The final study evaluated the effect of design recommendations implemented in a new telemedicine system on the neurologist’s workload, situation awareness, and task performance in addition to evaluating the perceived usability of this new design and its support of distributed cognition. For this study based on a within-subjects experimental design, 20 neurologists completed simulated stroke assessments using both the new design and the design investigated in the two previous studies and evaluated each system. Overall, the results found that the neurologists experienced a lower workload, performed better in their task, exhibited higher situation awareness, and rated usability highly in the new design. In addition, most participants thought that the new design better supported distributed cognition principles and preferred the new system for ambulance-based stroke consults

Rural-urban TBI outcomes : system design, experience and paramedic intervention

The results of this research suggest that outcomes following severe TBI are similar between rural and urban locations, and that paramedics face unique challenges when managing high-acuity low-frequency cases in rural areas