Contains reports on one research project.National Institutes of Health (Grant 5 P01 GM14940-06

Willemain, T. R.

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XII. COMMUNICATIONS BIOPHYSICSProf. L. D. BraidaProf. S. K. BurnsProf. H. S. ColburnftProf. L. S. FrishkopfProf. J. L. GoldsteintProf. J. J. Guinan, Jr.tProf. R. G. MarkjProf. W. T. PeaketProf. W. M. SiebertProf. T. F. Weiss **Dr. I. M. AsherttDr. J. S. BarlowjiK. O. Bayer, Jr.J. E. BerlinerJ. L. BonnT. R. BourkR. H. DomnitzP. EsquissaudD. E. GorelickZ. HasanB.L. HicksAcademic and Research StaffN. I. DurlachDr. R. D. HallDr. A. J. M. HoutsmaDr. N. Y. S. KiangTDr. L. U. E. K6hlloffel*':-*':-Dr. H. J. LiffDr. E. C. MoxontDr. M. J. Mulroyj"Dr. W. R. WebsterTfTD. W. AltmanntR. M. BrowntGraduate StudentsP. HochfeldD. H. JohnsonC. H. KaraianJ. I. KleinbaumM. C. Liberman**' ' **R. P. LippmannL. C. MakowskiS. L. MoshierJ. MyersS. NaganoD. J. CallahanC. H. ConradA. H. CristtF. N. CunninghamB. GaimanJ. L. HenleyTffP. W. Herman, Jr.W. F. KelleyElizabeth M. MarrtJ. M. Onorato, Jr.-L. H. SeifelJ. B. Walters, Jr.V. NedzelnitskyS. R. PurksW. M. RabinowitzJ. B. RobertsP. L. SmithD. L. SulmanL. TungR. G. Turner, Jr.T. R. WillemainA. PLANNING TELEMEDICINE SYSTEMSThe following report summarizes research submitted to the Department of Elec-trical Engineering on August 14, 1972, in partial fulfillment of the requirements for thedegree of Doctor of Philosophy.This work was supported by the National Institutes of Health (Grant 5 P01GM14940-06).tAlso at Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary, Cam-bridge, Mass.lAlso Instructor in Medicine, Harvard Medical School, Boston, Mass..Also Instructor in Preventive Medicine, Harvard Medical School, Boston, Mass."Also Visiting Lecturer in Physics, University of Massachusetts, Boston, Mass.Research Affiliate in Communication Sciences from the Neurophysiological Lab-oratory of the Neurology Service of the Massachusetts General Hospital, Boston, Mass.Visiting Scientist from University of Stuttgart, Germany.ftVisiting Scientist from Monash University, Australia.tttVisiting Scientist from Albert Einstein College of Medicine.Department of Physiology, Harvard University.QPR No. 107 113(XII. COMMUNICATIONS BIOPHYSICS)The shortage and maldistribution of primary-care physicians in the face of growingdemand for care motivate exploration of new care-delivery concepts. Telemedicine, thepractice of medicine by a physician who is physically remote from his patients, is onepromising response which seeks to exploit the use of physician-assistant personnel andcommunications technology. This thesis develops quantitative methods useful for sys-tematic planning and evaluation of telemedicine systems.Experience with physician-assistant personnel and with prototype telemedicinesystems is reviewed. Important unresolved issues in telemedicine planning are iden-tified, and the use of queueing theoretic techniques in resolving these issues is indicated.A telemedicine system can be viewed as a special case of the "hierarchical queueingnetwork." Approximate analysis of the hierarchical queueing network yields predictionsof telemedicine operational behavior in terms of patient waiting times, queue lengths,personnel utilization rates, response times to requests for remote-physician consul-tation, the maximum number of assistants that one doctor can supervise, and themaximum patient capacity of a system. Analysis is carried out for three alternativeoperating disciplines governing access to remote consultation, and it is shown thatchoice of operating discipline can strongly influence system performance. The approx-imate analytical results are verified and extended by use of a computer program thatsimulates the operation of a telemedicine network.Several hypothetical case studies illustrate application of the queueing models toimportant planning problems. Conditions are explored under which telemedicine offersgreater promptness of care than conventional patient transportation. The costs andperformance of telemedicine as a "physician expander" are investigated. Operationalcriteria are developed under which television communication is cost-justified vis-a-vistelephone. The applicability of these techniques to planning telemedicine systems forother clinical environments is noted. Finally, it is pointed out that the analysis of thehierarchical queueing network can be of use in planning many nonmedical systems thatshare this common structure with telemedicine.T. R. WillemainQPR No. 107 114

Communications Biophysics

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Communications Biophysics

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