Telemedicine – Network Implementation

The Patient End

The patient end has to prepare an electronic file of the patient’s history and his radiological and pathological reports and forward to specialists. The hardware requirement at the patient end includes various medical equipments like ECG, X-Ray/MRI,Scanner, Ultrasound etc., interfaced with a computer which has the Telemedicine software for preparing and tranfering the patient file.

The Specialist Link

The specialist end has to receive the patient file and display the patients records properly on the monitor in order to enable the specialist doctor make a diagnosis.

This process can be done in an “offline” mode, i.e. without the patient and the specialist simultaneously being present and talking to each other or in “online” mode where simultaneous data tranfer & videoconferencing take place.

The Communication Link

The speed and quality of flow will depend upon the bandwidth available. The link could be a simple telephone line (providing 64kbps) Internet or ISDN line(provides 128or 384 kbps) or fibre optic or satellite link.

Satellite terminals can also be made “Mobile Unit” . Such vans can visit rural areas, establish connectivity and provide consultation from a speciality end and then move on to another location.

Cost and Operability Considerations – Patient end

Besides the medical equipment for collecting patient data like ECG, X-RAY etc, the most important element at the patient end is the Telemedicine software. The cost of this software can be an important consideration in setting up Telemedicine software. The total telemedicine software consists of several packages, with several features and uses certain standards. The cost also depends upon the standards used and licensed for. It may not be necessary to follow all the prescribed international standards. For this purpose, the Ministry of Information Technology in India has defined Indian standards for Telemedicine packages.

Guidelines and Standards

Telemedicine platform

Depending on the application and space constraints, the platform can also be of different types like mobile systems, handheld system or system for home use, the hardware platform can also be a laptop or palmtop computer, a PDA (Personal Digital Assistant) or even a dedicated box (set-top-box) with a processor.

Clinical Devices

These include digital ECG, X-ray Digitizer, Ultra sound (sonography machine), Glucometer, portable X-ray machine, Pulmonary function Test (PFT) machine, Fetal heart rate (FHR) Monitor, Telepathology Microscope(and trinocular tube) etc. for use in different applications like teleradiology ,tele-cardiology, telepathology and tele-ophthalmology

Video-conferencing units

A stand alone box with a network interface with camera, microphone and display and may be sharing the same communication channel.

Communication hardware

The hardware for terrestrial links can be further divided into three major Categories- PSTN/POTS, ISDN, LAN.

Data interchange/exchange Standards-DICOM

DICOM (Digital Imaging and Communications in Medicine) is an industry standard widely recognized for Medical Imaging Communication.

Exchange of clinical messages among systems – HL

HL7 stands for Health Level Seven; the term “Leve7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). H.324 level needs to be maintained, for air-conditioning and illumination of the video conferencing room.