15-03-2011, 03:33 PM
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1. INTRODUCTION:
In general, Telemedicine can be defined as the delivery of health care and sharing of medical knowledge over a distance using telecommunication means. Telemedicine provides medical information exchange at a distance, to support medical procedure, with the ultimate goal for improving community health care. The aims of telemedicine is also to provide expert-based health care to understaffed remote side and to provide advanced emergency care through modern telecommunication and information technology. Information technology has been confirmed as an effective and efficient tools for delivering health services to widely distributed population such as Indonesia. Under the full supports of the Asian Media Information & Communication Centre (AMIC), the International Development Research Centre (IDRC), Pan Asia Networking, Asia-Pacific Development Program (APDIP), and the Asia-Pacific Network Information Centre (APNIC), since November 2002, we have been developing Internet based telemedicine system. The system has been focused on primary Community Health Care with the aim for reducing Maternity Mortality Rate (MMR). At present, the system has been operated and continuously being self-developed, by Bandung Health Office and more and more Community Health Centres in Bandung. Unfortunately the existing system covers relatively small number of Community Health Centres (CHCs, Puskesmas). Since Indonesia has more than 7600 (seven thousand and six hundred) Community Health Centres to serve more than half of the total Indonesian population, therefore the existing telemedicine system is far from enough, compared to the whole national requirement. The developed system operation mostly relies on existing public communication infrastructure, i.e. fixed public phone. The problems with a non-mobile telemedicine system are: It is not easy to be developed and less flexible, particularly in areas where the communication and transportation infrastructure has not been available yet. Deployment of the system could be very problematic especially in case of emergency cases/natural Adisaster such as tsunami, earth quake, and flooding as just happened in Aceh, and Nabire. Indonesia has more than 220 millions population, spread out all over the country. Because of the demography condition of Indonesia, a mobile and/or movable system will be demanding because a fixed system is difficult to be reached by patient living in remote urban or rural area, so he or she can not be given proper health services.
In order to alleviate these problems and support different growing application of telemedicine, this project proposes the Development of ICT-Based Mobile Telemedicine Systems with Multi Communication Link. One of the crucial problem to deliver health services in Indonesia is the specific demography, and the availability of needed infrastructure. The proposed system will exploit the advantage of wireless technology and combine it with other communication . Mobile telemedicine is defined as the delivery of health care and sharing of medical knowledge over a distance using telecommunication means. Thus, the aim of telemedicine is to provide expert-based health care to understaffed remote sites and to provide advanced emergency care through modern telecommunication and information technologies. This integrated system can be used when handling emergency cases in ambulances, rural health centers (RHC) or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site. This enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital bio signals and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Today, mobile telemedicine systems are supported by State of the Art Technologies like Interactive video, high resolution monitors, high speed computer networks and switching systems, and telecommunications superhighways including fiber optics, satellites and cellular telephony.Critical care telemetry is another case of handling emergency situations. The main point is to monitor continuously intensive care units' (ICU) patients at a hospital and at the same time to display all telemetry information to the competent doctors anywhere, anytime.
1.1 Objective:
Effective emergency mobile telemedicine and home monitoring solutions are the thrust areas discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring.
In order to support the various growing application areas explained above a combined real-time store and forward facility that consists of a base unit and a telemedicine (mobile) unit is used. This integrated system can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site.
This enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital bio signals (ECG, SP02, NIBP, IBP, Temperature) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case.Develop an ICT-based mobile telemedicine system that can be functioned as an emergency health care unit for urban and rural area. The system consists of 2 (two) major parts. Firstly is a Telemedicine unit that may be portable (easily movable) and located at the patient’s site; and secondly is a base unit or doctor’s unit located in a medical monitoring centre/referral hospital. Communication between the two units can be established using wireless digital cellular, radio packet or ordinary fixed telephone lines.
1.2 Information Technology objectives:
Improve service and quality of the health services.
Improve productivity and efficiency in the health sector.
When meeting the aspects of security of privacy for the individual patient should be considered.
Use the opportunities of IT to distribute information to thegeneral public and the health care professionals and to increase the level of knowledge.
Improve working conditions and personal planning for healthcare professionals.
1.3 Telemedicine system objectives:
Patients should be treated as close to their homes as possible .
Medical expertise should be equally available independent of where the patient lives .
The quality of medical decisions should be improved by making existing information about patients more easily available.
Patients should get more information and better service .
The health services should improve efficiency and productivity by reducing unnecessary administrative work such as retyping information already existing in electronic form and by distributing tasks between health care institutions and health care personnel
All exchange of information needs to take into account the aspects of security of privacy for the individual patient medical knowledge should be more easily accessible
2.System Overview:
Telemedicine is defined as the delivery of health care and sharing of medical knowledge over a distance using telecommunication means. Thus, the aim of Telemedicine is to provide expert-based health care to understaffed remote sites and to provide advanced emergency care through modern telecommunication and information technologies. The concept of Telemedicine was introduced about 30 years ago through the use of nowadays-common technologies like telephone and facsimile machines. Today, Telemedicine systems are supported by State of the Art Technologies like Interactive video, high resolution monitors, high speed computer networks and switching systems, and telecommunications superhighways including fiber optics, satellites and cellular telephony .
The availability of prompt and expert medical care can meaningfully improve health care services at understaffed rural or remote areas. The provision of effective emergency Telemedicine and home monitoring solutions are the major fields of interest discussed in this study. There are a wide variety of examples where those fields are crucial. Nevertheless, Ambulances, Rural Health Centers (RHC) and Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and Telemedicine home follow-ups are important issues of telemonitoring. In emergency cases where immediate medical treatment is the issue, recent studies conclude that early and specialized pre-hospital patient management contributes to the patient's survival.Especially in cases of serious head injuries, spinal cord or internal organs trauma, the way the incidents are treated and transported is crucial for the future well being of the patients.
A quick look to past car accident statistics points out clearly the issue: During 1997, 6753500 incidents were reported in the United States from which about 42000 people lost their lives, 2182660 drivers and 1125890 passengers were injured. In Europe during the same period 50000 people died resulting of car crash injuries and about half a million were severely injured. Furthermore, studies completed in 1997 in Greece.a country with the world's third highest death rate due to car crashes, show that 77,4 % of the 2500 fatal injuries in accidents were injured far away from any competent healthcare institution, thus resulting in long response times. In addition, the same studies reported that 66% of deceased people passed away during the first 24 hours.
Coronary artery diseases is another common example of high death rates in emergency or home monitoring cases since still two thirds of all patients die before reaching the central hospital. In a study performed in the UK in 1998, it is sobering to see that among patient above 55 years old, who die from cardiac arrest, 91% do so outside hospital, due to a lack of immediate treatment. In cases where thrombolysis is required, survival is related to the "call to needle" time, which should be less than 60 minutes. Thus, time is the enemy in the acute treatment of heart attack or sudden cardiac death (SCD). Many studies worldwide have proven that a rapid response time in pre-hospital settings resulting from treatment of acute cardiac events decreases mortality and improves patient outcomes dramatically. In addition, other studies have shown that 12-lead ECG performed during transportation increase available time to perform thrombolytic therapy effectively, thus preventing death and maintaining heart muscle function.The reduction of all those high death rates is definitely achievable through strategies and measures, which improve access to care, administration of pre-hospital care and patient monitoring techniques.
Critical care telemetry is another case of handling emergency situations. The main point is to monitor continuously intensive care units' (ICU) patients at a hospital and at the same time to display all telemetry information to the competent doctors anywhere, anytime.In this pattern, the responsible doctor can be informed about the patient's condition at a 24-hour basis and provide vital consulting even if he's not physically present. This is feasible through advanced telecommunications means or in other words via Telemedicine.
Another important Telemedicine application field is home monitoring. Recent studies show that the number of patients being managed at home is increasing, in an effort to cut part of the high hospitalization's cost, while trying to increase patient's comfort. Using low-cost televideo equipment that runs over regular phone lines, providers are expanding the level while reducing the frequency of visits to healthcare institutions. In addition, a variety of diagnostic devices can be attached to the system giving to the physician the ability to see and interact directly with the patient. For example, pulse oximetry and respiratory flow data can be electronically transmitted (for patients with chronic obstructive pulmonary disease). Diabetes patients can have their blood glucose and insulin syringe monitored prior to injection for correct insulin dosage. Furthermore, obstetric patients can have their blood pressure and fetal heart pulses monitored remotely and stay at home rather than prematurely admitted to a hospital.
It is common knowledge that people that monitor patients at home or are the first to handle emergency situations do not always have the required advanced theoretical background and experience to manage properly all cases. Emergency Telemedicine and home monitoring can solve this problem by enabling experienced neurosurgeons, cardiologists, orthopedics and other skilled people to be virtually present in the emergency medical site. This is done through wireless transmission of vital biosignals and on scene images of the patient to the experienced doctor. A survey of the Telemedicine market states that emergency Telemedicine is the fourth most needed Telemedicine topic with 39.8% coverage of market requests while home healthcare covers 23.1%. The same survey also points out that the use of such state of the art technologies has 23% enhanced patient outcomes.
Several systems that could cover emergency cases ,home monitoring cases and critical care telemetry have been presented over the years. Recent developments in mobile telecommunications and information technology enhanced capability in development of telemedicine systems using wireless communication means .In most cases however only the store and forward procedure was successfully elaborated, while the great majority of emergency cases do require real time transmition of data.
In order to cover as much as possible of the above different growing demands we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine unit where this integrated system:
Can be used when handling emergency cases in ambulances, RHC or ships by using the Telemedicine unit at the emergency site and the expert's medical consulting at the base unit. Enhances intensive health care provision by giving the telemedicine unit to the ICU doctor Enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital.
2.1 Trends and needs of Telemedicine systems:
As mentioned above, scope of this study was to design and implement an integrated Telemedicine system, able to handle different Telemedicine needs especially in the fields of:
• Emergency health care provision in ambulances, Rural Hospital Centers (or any other remote located health center) and navigating Ships
• Intensive care patients monitoring
• Home telecare, especially for patients suffering from chronic and /or permanent diseases (like heart disease).
In each different application the Telemedicine unit is located at the patient's site, whereas the base unit (or doctor's unit) is located at the place where the signals and images of the patient are sent and monitored. The Telemedicine device is responsible to collect data (biosignals and images) from the patient and automatically transmit them to the base unit. The base unit is comprised of a set of user-friendly software modules, which can receive data from the Telemedicine device, transmit information back to it and store important data in a local database.
2.2 Applications:
The system has several different applications (with small changes each time), according to the current healthcare provision nature and needs Telemedicine system is able to handle different critical problems in the area of distant medication like:
Emergency health care provision in ambulances, Rural Hospital Centers ,
Intensive care patients monitoring Home telecare, especially for patients suffering from chronic or permanent diseases like heart diseases.
Mobile telemedicine is a "Multi-purpose" system consisting of two major units:
a) Telemedicine unit
b) base unit or doctors unit.
2.3 Architecture:
The Telemedicine unit is located at the patient's site, whereas the base unit (or doctor's unit) is located at the place where the signals and images of the patient are sent and monitored. The Telemedicine device is responsible to collect data (bio signals and images) from the patient and automatically transmit them to the base unit. The base unit is comprised of a set of user-friendly software modules, which can receive data from the Telemedicine device, transmit information back to it and store important data in a local database.
