Designing Multimedia Quality-based Advanced Videoconferencing Applications for Telemedicine over the Internet

Telemedicine and related healthcare technologies aim to provide efficient healthcare to improve the well being of patients and bring medical expertise at a lower cost to people who are geographically separated. This field has evolved over the past thirty years and today most telemedicine applications still use expensive leased telecommunication circuits to provide secured reliable connections. With the ubiquity of the Internet, it is now possible to deliver healthcare through Internet-based telemedicine applications to a wider population. However, the unreliable connection properties of packet-based systems and their vulnerability to various impairments that can occur at the physical, network, and application levels hamper the quality of Internet-based telemedicine applications. This research developed a taxonomy that identifies several key telemedicine dimensions to help patients, providers and program administrators understand the effort. The next phases of the study will create new objective/subjective multimedia quality models exclusively for telemedicine over the Internet using an experimental design over an emulated testbed. These models will be developed for telediagnosis in ophthalmology and mental health with extensive experiments using real-world telemedicine multimedia sessions obtained from the Regenstrief Institute for Health Care and VA. Finally, an intelligent videoconferencing software will be developed with real-time quality feedback functionality based on the quality models developed during this study. This new artifact will help practitioners in the field to pursue telemedicine confidently with the knowledge of real-time quality conditions under which they operate

Evaluating a Web-Based Interface for Internet Telemedicine

The objective is to introduce the usability engineering methodology, heuristic evaluation, to the design and development of a web-based telemedicine system. Using a set of usability criteria, or heuristics, one evaluator examined the Spacebridge to Russia web-site for usability problems. Thirty-four usability problems were found in this preliminary study and all were assigned a severity rating. The value of heuristic analysis in the iterative design of a system is shown because the problems can be fixed before deployment of a system and the problems are of a different nature than those found by actual users of the system. It was therefore determined that there is potential value of heuristic evaluation paired with user testing as a strategy for optimal system performance design

Collaborative and Adaptive Framework for Telediagnosis and Prescriptions in Herbal Medicine

Herbal medicine has been an age long tradition for the treatment and cure of diseases globally. Previous researches on telediagnosis and prescriptions in orthodox medicine studied applications of modern technological devices which could improve health care services. However, there is yet to be an exhaustive study on the audio-visual technological framework for telediagnosis and prescription in herbal medicine.  Hence, the research developed a collaborative and adaptive framework for telediagnosis and prescriptions in herbal medicine. The framework and its system were developed consisting of multimedia features for videoconferencing; ability to record, capture and replay consultations; and capacity for editing, data compression and short message service amongst herbal tele-consultants. The system was experimented on Ladoke Akintola University of Technology hotspot network for a period of twenty one days in order to determine the system’s average packet loss rate and packet transmitted with five herbal tele-consultant nodes (node-1, node2, node3, node4 and node5). All nodes were allotted Internet Protocol addresses through which the intending herbal tele-consultant(s) could be connected to the telediagnosis videoconference session. Three performance metrics, System Reliability Index (SRI), System Degree of Relevance (SDR), and System Ease of Usage (SEU) were used to carry out subject to the evaluation of the system by administering one hundred questionnaires herbal consultants to harvest users’ perception of the system based on a Likert rating scale. The results obtained from telediagnosis session showed that the system recorded packet loss rates of 3.46, 3.13, 3.42, 3.61 and 3.36% at node1, node2, node3, node4 and node5, respectively. Also, the average packets of 3123.2, 5017.6, 5683.2, 4454.4 and 4249.6 bits were obtained at node1, node2, node3, node4 and node5, respectively. The summary of the subjected evaluation of the system indicate that the respondent’s response means of 3.20, 2.88. and 3.42 were obtained for the SRI, SDR and SEU, respectively on a rating scale of 1 to 5

Telerehabilitation Clinical and Vocational Applications for Assistive Technology: Research, Opportunities, and Challenges

Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent in coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise may be troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation. This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications; pressure ulcer prevention; virtual reality applications; speech-language pathology applications; seating and wheeled mobility applications; vocational rehabilitation applications; and cost effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper. Keywords: Telerehabilitation, Telehealth, Telemedicine, Telepractic

Development of an Integrated Telerehabilitation Information Management System to Support Remote Wheelchair Prescription

Information technology (IT) is central in providing Telerehabilitation (TR), which enables people with disabilities access to limited number of qualified practitioners with specialty expertise, especially at rural areas. Prior to 2008, most TR utilized non-integrated IT systems to provide its basic infrastructure. Using this approach, data management has to be done manually over multiple non-integrated systems, increasing the possibility of outdated or missing data. An integrated system that is open, flexible, extensible, and cost-effective was designed and developed as a solution to mitigate this problem. The work described in this dissertation elaborates the process of developing such system, called the Versatile and Integrated System for Telerehabilitation (VISYTER). VISYTER was intended to become a platform that is capable of delivering any TR, and was first used to support Remote Wheelchair Prescription (RWP), a TR effort to support clinicians in rural Pennsylvania to prescribe wheeled mobility and seating devices. The development process of VISYTER consisted of three main phases: identification and verification of requirements, validation, and evaluation. The requirement identification and verification phase involved a group of expert clinicians from RWP with the purpose of identifying the requirement of the system to support RWP: a system that can provide real-time teleconsultation and documentation support for prescribing a wheeled mobility intervention. Validation studies were conducted with help from ten individuals, including physicians, clinicians, and suppliers participated to validate VISYTER in their workplaces. All participants agreed that VISYTER can be used to properly support both the teleconsultation and documentation phase of RWP. Afterward, the usability of VISYTER was evaluated through a comparison study with a commonly utilized videoconferencing system in TR, POLYCOM. Twenty-six clinicians participated in a counterbalanced experimental study to measure the difference in usability for completing client assessment tasks using both systems. The study found VISYTER to be more efficient and less prone to error when compared to POLYCOM. Based on these findings, the study concluded that an integrated system could improve the usability TR delivery when compared to non-integrated systems approach

Development of a 3G Authentication Based Mobile Access of Health Records: A Mobile Telemedicine Application

As our country progresses in its aim to be a developed country by the Year 2020, the field of Information and Communications Technology or ICT is fast becoming the forerunner for the vision. The Internet is used in almost all aspects of life. As for the communications sector, according to Global Mobile Subscriber Database December 2002 report, there are 8,814,700 mobile subscribers in Malaysia with an Annual Growth of 16.6%. Withthe adoption of 3G-communication technology in the coming years, compelling high speed services, reaching up to 2 Mb/s together with improved security features would soon be possible. Through these years in the mobile industry, the health sector has always been neglected. Reason being, the technology could not support the application and it is not so much of a revenue generating business compared to mobile games or sports news. With globalization where the society is always on the move across borders, together with degrading environment conditions and the need for time, instant health services are becoming crucial. Looking into these conditions of mobile adoption and health status, the author intends to develop a solution for a mobile telemedicine application. Kevin Hung (2003) defines telemedicine as the utilization of telecommunication technology for medical diagnosis, treatment and patient care. Thus, the main aim of this project was to develop an application that could be used for medical purposes. This project integrates the latest mobile telecommunication technologies together with medical services with the idea of providing a highly secured personalize medical system and database query as mobile handsets are becoming a necessity to individuals. This would make updating and retrieving medical health records hassle free, anytime and anywhere. This project has also laid the groundwork for future expansion by incorporating the basic audio and video streaming features. This report accounts for all the concepts, design works and results of the mobile telemedicine application that has been developed successfully

MedLAN: Compact mobile computing system for wireless information access in emergency hospital wards

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.As the need for faster, safer and more efficient healthcare delivery increases, medical consultants seek new ways of implementing a high quality telemedical system, using innovative technology. Until today, teleconsultation (the most common application of Telemedicine) was performed by transferring the patient from the Accidents and Emergency ward, to a specially equipped room, or by moving large and heavy machinery to the place where the patient resided. Both these solutions were unpractical, uneconomical and potentially dangerous. At the same time wireless networks became increasingly useful in point-of-care areas such as hospitals, because of their ease of use, low cost of installation and increased flexibility. This thesis presents an integrated system called MedLAN dedicated for use inside the A&E hospital wards. Its purpose is to wirelessly support high-quality live video, audio, high-resolution still images and networks support from anywhere there is WLAN coverage. It is capable of transmitting all of the above to a consultant residing either inside or outside the hospital, or even to an external place, thorough the use of the Internet. To implement that, it makes use of the existing IEEE 802.11b wireless technology. Initially, this thesis demonstrates that for specific scenarios (such as when using WLANs), DICOM specifications should be adjusted to accommodate for the reduced WLAN bandwidth. Near lossless compression has been used to send still images through the WLANs and the results have been evaluated by a number of consultants to decide whether they retain their diagnostic value. The thesis further suggests improvements on the existing 802.11b protocol. In particular, as the typical hospital environment suffers from heavy RF reflections, it suggests that an alternative method of modulation (OFDM) can be embedded in the 802.11b hardware to reduce the multipath effect, increase the throughput and thus the video quality sent by the MedLAN system. Finally, realising that the trust between a patient and a doctor is fundamental this thesis proposes a series of simple actions aiming at securing the MedLAN system. Additionally, a concrete security system is suggested, that encapsulates the existing WEP security protocol, over IPSec

Telesurgery information management systems in university hospitals of Tehran

    This is a descriptive study with research population coming from "telesurgery information management systems" in 23 teaching hospitals  of  Shahid  Beheshti and Tehran universities of medical sciences in 2011.The study used stratified and simple random sampling methods for subject selection, followed by observation and interview for data collection.  According to the results, video camera with 100%  application, was the most frequently used equipment in the hospitals for telesurgery data gathering.  Visual data analysis for developing three dimensional models was common just in 10% of hospitals.  Fiber Optic and satellite, with 40% application rate, were the most frequently used telecommunication equipments in the hospitals. The study indicated the significance of accurate and appropriate management of telesurgery information as the first step for appropriate implementation of telesurgery programs in Iran

Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios