Telemedicine system is an application of improved telecommunication systems to exchange health information and offer medical services throughout cultural, social, time, and geographic walls by medical practitioners during their daily activities. Developments in Information Technology (IT) overwhelm the way of life, with the health care field influenced just like all other fields.
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The increasing demands of our health care system, particularly regarding availability of care and supply of health care workforce, demand the reconsideration and reorganization of the health care system. Likewise, the integration of advanced Information Technology as a way of managing the significant challenges experienced by the health care system appears expected and telemedicine is very important to solve these challenges (Bellazzi, 2008).
Telemedicine systems should first be included in health care providers’ daily activities, acting as devices to improve the provider-patient relation. The way telemedicine is growing is undesired since it is growing at a somewhat slow and measured rate. The implementation of telemedicine systems will likely transform people’s way of operation, not just at the personal level, but also at the health care providers and organizational levels in general.
Previous to its wide implementation, every telemedicine system should be authorized so that people may be alert to requirements, essential contributors, possible services provided, technologies needed, and the impact on care and services.
Additionally, when applying telemedicine applications, it is very vital to be alert to the provisions needed for implementation concerning the users, health care providers and organizations in general. The issues engaged in the implementation are technological, organizational, and professional concerns, as well as issues concerning privacy and protection of data transfer.
Advanced technology helps the doctors and nurses to achieve a successful operation in remote environment or inside the hospital. Some devices and application such as ISO model, satellites, PDAs, mobile phones, RTB2400 wireless router, IP Phone 323, internet application, among other usable applications are very important in maintaining reliable and trustworthy healthcare services. This paper discusses some important elements in implementation of telemedicine and implications for the future.
A Telemedicine System over the Internet
Telemedicine is considered a new, seductive, and accessible medical technology and most health care providers believe that it can just be created reachable to clinicians who will directly accept and apply this advance technology.
With improvement of communication and information technology in various sectors around the world, the roles of internet networks in connecting people globally have been getting increasingly accepted lately. Computer networks have allowed various health care providers to transfer or receive electronic medical records and to receive health proficiency through remote consultation (Kim, 2001, p. 35).
Existing information systems do not adequately support these features of telemedicine because they exist in record-oriented rather than case-oriented and most consumers or operators do not openly observe an explicative and associative image of a case. Internet telemedicine systems have been tried by several studies and most tests are conducted with the application of videoconferencing for remote consultation.
Nevertheless, current telemedicine systems are commonly presented for medical practitioners to do a case study and consultation in various health care centers. It is practicable for patients to consult medical professions at home through the internet and this could serve as a way of life in some years to come.
The Main Features of the System
The main features of internet networks in medical field are provided below (Kim, 2001, p. 35):
- Give resourceful and reliable means for patients and doctors to communicate with one another and enable patients to transfer their health records via the internet, which is cheap and fast.
- Enables simpler access to more information concerning a patient compared with what the doctors either require or request.
- Internet network provides computer-based patient information and other electronic facts that offer somewhat simple and quick access to big databases. It also allows the use of strong statistical means for assessing and presenting the data.
- Provide quick and secure transfer of information from remote areas during emergency conditions by doctors or nurses to consult for more information from other practitioners located in different areas.
In this telemedicine application, web server controls the entire system that contains database management and System Management required for daily operation by doctors (Kim, 2001, p. 35).
System Management may be described as a grouping of various systems in medical fields that include Department Administration, Security, Payment, Entertainment, Information, and Service systems, which depend directly or indirectly on one another (Kim, 2001, p. 35). Every system provides distinct roles and the discussion below will provide brief explanation about the two main systems, Security System and Service System.
Kim (2001, p. 35) stated that “Service System is considered the most major section of the entire system since it contains modules for Case consultation, Case presentation, Case diagnosis, Medical Image upload, Case Submission.” These modules give resourceful means for consultants, patients, and doctors to transfer information and communicate with one another via the internet system and to change basically the current face-to-face connection that has been the representation for health care system for decades.
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Case Submission module fulfills the medical requirements internationally, in the health care business, and inside health care center. Generally, a patient with the need for consultation can submit a case showing medical issues to be addressed. In this module of Case Submission, all electronic health information, such as digital health pictures and text-based information can be transferred through the internet without necessarily using any cost.
The Case Presentation is a tool for medical practitioners and used to support the features of human ideas and communication, and this helps the consultants to have an inclusive, explicative, and associative image of a case presented to them (Kim, 2001, p. 35).
After receiving all the information and records for a patient, the professionals chosen may begin their consultation or communication with the patients. This module should not just be where consultants produce consultation information and transfer them to the primary care physician, but also enables the consultations of the medical case provided among different consultants.
The medical case consultation might either be synchronized or asynchronous and must be available during all text-based consultations among consultants. The outcomes of the discussion will be recorded into the patient database or internet-based records and will be examined in the Outcome Assessment module to provide continuous and effective process of consultations.
Privacy and security are listed among the most significant concerns of telemedicine technology applications over the online networks, and they have to be analyzed appropriately before telemedicine application on the WWW turns into common practice.
Health care units should consider revising security and privacy concerns in all operations through implementing telemedicine technology into health care system. Security here is end-point security and network security in a dispersed health care settings or when transferring patients information and medical records from different areas.
Network security issue is because of a third party between user and server, and network security can be addressed effectively through the application of key algorithms. JAVA and ASP computer programs can provide an opportunity to address end-point security concern across the medical environments to secure safe and reliable transfer of information through internet network.
Medical field should apply these technologies to provide safe storage of medical records and transfer through the network, and information technology experts should be employed to control and maintain the system.
Determining the Functioning and the Influence on Other Services
Various means of communication are chosen, in line with the field of application and technological options on hand. While every application should be reviewed individually, the technological possibilities may be broken up into three wide groups (Bos, 2008, p. 23):
- Synchronized dynamic imaging; and
- Non-synchronized static imaging, in which case images are transferred and later interpreted by a professional, which can be ‘stored-and-forward’ process.
Transmission of X-ray images is turning to be progressively extensive and files may be transferred directly to specialists. For instance, the files may be transferred to orthopedists in a certain hospital and this transfer decreases the time of obtaining a diagnosis, which often takes some days, but at present taking only some minutes.
For example, through the transmission of dynamic images in the situation of a fetal ultrasound, a review of an obstetrician of the fitness of the fetus may be received instantly in the assessment, and the obstetrician may relate with the patient once the assessment is concluded. Videoconferencing continues to be an important device for applications, such as genetics, plastic surgery, psychiatry, and speech pathology, that need observation, hearing, and relating with the person in concern.
Fast Deployable Telemedicine Technology
Telemedicine covers a wide variety of mobile technologies that are applied to deliver medical services and can serve as a vital clinical support when carrying out medical functions during medical operations outside hospital setting. Without the implementation of such tools and wireless communication systems to help doctors, telemedicine would be almost impracticable in unreceptive settings like disaster regions.
Transferable medical imaging tools contain similar elements that the current imaging tools contain, but are reduced to enable simple transfer by doctors and nurses. These tools enable a physician to carry out health imaging in a remote environment without forgoing any elements or features of a full-size tool. The application of mobile ultrasound for sonography has improved because it is affordable and has increased its function as the main imaging equipment in severe and remote settings.
An example of portable telemedicine computing is PDA that has been used in health care centers as telemedicine application (Dolk & Granat, 2012, p. 169). There is a difference between PDAs and laptops since PDAs serves as a scaled-down model of complete operating system and uses a minor processor than laptops.
PDAs have few ports (such as DV-ROM and USB ports) that are available on laptops, but it can manage essential tasks such as connecting to internet, operating a document, carrying out certain video conferencing, gathering some basic signs, chatting and emailing. PDA devices are intended to be small enough to feature in the pocket of the nurses or doctors for simple access and transportation.
There are several kinds of wireless connectivity and some function in a short distance data transfer and others for long-distance data transfer. Bluetooth is a major example of short-distance wireless technology that facilitates the transmission of medical records by substituting the traditional cables that were formerly required in connecting medical appliances to computers.
However, it is not intended for connecting several workstations, but relatively connecting medical appliances or peripheral tools that are near the user. Bluetooth has changed to offer a higher range and less power usage by establishing new series (ultra-wideband) and this can simply go through walls to a distance of 10 meters (Dolk & Granat, 2012, p. 169).
Wireless broadband (WiBro) is an example of internet networking that is simply derived from the application of cellular data connectivity through enabling people to use internet via their mobile phones (Latifi, 2010, p. 67). If a person does not have a mobile phone, he also has the option of accessing cellular connectivity via a USB model that is connected into any computer and serves as an important device when all clinicians have their own mobile phones.
In remote environments where the communications are already in position, this can be arranged and will be ready to be applied for telemedicine. A major disadvantage is that the cellular infrastructure is required to be in position and another drawback is that applying these cellular data connectivity is very expensive since a third-party carrier is included in the system.
Satellites are another kind of wireless networking where they offer the most extensive kind of exposure, which is called a broadband global area network (BGAN). Geostationary earth orbit (GEO), mid earth orbit (MEO), and low earth orbit (LEO) are the only three sorts of satellites in orbit and are very vital in medical communication in remote areas and within the hospital (Latif, 2004).
Low earth orbit (LEO) satellites offer small latency times and can provide an essential low bandwidth. There is absence of low latency measures in geostationary earth orbit (GEO) used in telesurgery, but adequate for medical communication and does not contain measures for bandwidth. Mid earth orbit (MEO) satellites offer low latency times but merely offers adequate bandwidth if it has been designed to the medical or other communication connections.
Satellites are the major supply when certain region lack communication channels since it has a capacity of giving major coverage more than other networks, such as wide local area network (WLAN). Satellites can give adequate bandwidth for data transfer, medical management, low bandwidth teleconsultation, and HER transmission, but are not preferred or recommended when carrying out telesurgical processes (Latifi, 2010, p. 67).
Satellite technologies are needed to be enhanced or upgraded so that they can be applied in different areas in medical field. Currently, satellites are used merely as a backup when alternative communication network is absent or inaccessible.
Wireless IP for Telemedicine
The change of telemedicine to Internet Protocol (IP) and wireless-based systems is coming up in the future and are preferred since it is inexpensive and quickest means of communication and transfer of medical records. This transition from desktop applications to mobile and wireless designs will have a major influence on medical functions in some years to come.
IP and wireless-based telecommunication systems will notably improve the existing processes of telemedicine and telehealth applications that are nearly impossible with conventional telephony (Fong, 2011, p. 57). The expected step in the transition of telemedicine will be wireless telemedicine applications and the benefits in these significant telemedicine applications will allow quick and advance healthcare delivery, regardless of time, geographical, and mobility limitations during medical operations.
The OSI Model
Open System Interconnection (OSI) model is a better example of application required for effective execution of medical processes or telemedicine technology. ISO standard for global communication that describes networking structure for establishing protocols in seven layers followed in ISO model (Fong, 2011, p. 57). Control or data transfer processes are transmitted from the first layer to the last layer.
The process starts at the application layer and end at physical layer, making it the most applicable application to be recommended in medical services. It serves as an important example of telemedicine application. To understand more about this model, we will discuss the processes and functions of each layer in ISO standard model.
Layer 1: Physical
Physical layer defines physical way of transferring medical records or data over computer network appliances. All channels are functionally corresponding and the major variations are in expense and expediency of maintenance and installation of this model. Converters from one media to other media take place at physical layer, and physical layer defines mechanical, electrical, and optical features available in the data being transferred as well.
Layer 2: Data Link Layer
Data link layer defines processes for controlling communication connection and the biggest packet that may be transferred via this level defines the MTU (Maximum Transmission Unit). This level manages the logical and physical networks to the packet’s destination, with support from a network interface. A host linked to Ethernet should have the Ethernet interface to control connections to the external channels and even loop-back interface to transfer data to its own system.
Layer 3: Network
Network layer defines the way medical records are transmitted through network appliances and controls the flow and jam to protect network resources or data being transferred. IP can be established in this layer, which is responsible for directing and routing data being transferred from one connection to another connection. This level should split datagrams into minor packets, and the datagrams that have been broken can be rebuilt by the receiving host.
Layer 4: Transport Layer
Transport layer controls end-to-end data delivery in the system and offers dependable and arranged packet delivery via flow controls and error methods. It also gives connectionless-based packet delivery, and User Datagram Protocol (UDP) and Transmission Control Protocol (TCP) are found in this level of communication system. Dependability and speed are the main variations between UDP and TCP (Fong, 2011, p. 57).
Layer 5: Session Layer
Session layer has a role of determining the process-to-process communication among the hosts receiving the datagrams in the system and has a function of determining and terminating the sessions throughout the network. The main example of the functions offered by this level is interactive login where the connective is reattached to prevent unexpected interruption across the network. This layer also controls user sessions and conversations, and manages implementation and termination of logic connections among network users.
Layer 6: Presentation Layer
This level manages the protocol conversion, date compression, data encoding/decoding, data decompressions/compressions, extending graphics command, and date decryption/ encryption. Presentation layer creates the communications between the two receiving ends and establishes the dissimilarities of data formats among different networks (Fong, 2011, p. 57).
Layer 7: Application Layer
Application layer determines interface to user procedures for data, medical records, and communication transfer in the connectivity and initiates the processes found in ISO model.
The RTB2400 Wireless Router
The primary benefit of wireless IP telephony application used in medical field is the integrated transfer of demographic records, patients’ pictures, and voice traffic to provide an effective and efficient telemedicine technology system. A free wireless IP wide area network (WAN) has been suggested and examined for medical operations and most studies have found this application effective in providing services to doctors inside and outside the hospital.
The RTB2400 wireless router operates as a receiver, transmitter, and repeater workstation and covers wide area of roughly 3000 meters in radius or 5000 meters applying unidirectional antenna (Latif, 2004).
These measurements are taken relative to Japanese measures on frequency application and highest transmission power, and if advanced power is enabled, the wireless applications are received in a greater distance. Another advantage of RTB2400 router is that it may obtain a maximum of 2Mbit/s with a TCP/IP platform and this makes it an important application for telemedicine technology application (Latif, 2004).
These wireless applications, proposed to be used as telemedicine application, cover an area with a radius of 15km and have the capacity of adopting a flat connectivity among spreading nodes in the communication channel. The topology of this system that supports telemedicine application enables various path alternatives between the nodes to transfer medical records and voice traffic. This method of wireless communication contradicts the wireless local area network that adopts a hierarchical connectivity.
This advancement provides more flexible, higher resiliency and effective traffic delivery than the traditional wireless network topology that covers less distance and limited applications in medical field. The network power has been developed with advanced effectiveness.
Wireless wide area network can be simply interconnected through a gateway with all assigned and public networks since the wireless wide-area (WAN) is IP-based, and these networks may contain internet, satellite link, ISDN, PSTN, and intranets. Global connection, greater radius, and local video conferencing or telephone may be performed via the gateway to the public telephone systems or the internet networks, and this network contributes to the success of the telemedicine technology applications.
IP Phone 323
IP Phone 323 is installed in an office or home computer server and the application can counter easily to the requirements of the medical network operations. Multimedia computers may be installed in every node to act as a communication channel to incorporate the information and voice traffic, and transfer these data via the wireless IP telemedicine application (Latif, 2004). If just voice communication is favored, a simple telephone system is adequate for the function.
The device used at every site takes minimal space and can be placed on an ambulance to provide services in remote areas. Therefore, the ambulance is converted into a portable Client Station to provide support during disasters. The system configuration is easy, flexible, and do not need more capital investment compared with any other applications.
Implications for the Future
Telemedicine systems, including home-based system, are rising as a strong and effective application that can enhance access to care for health care users with chronic states residing in all regions, mostly from medically derived regions. It also has the capacity of supporting prevention of expensive treatment of health problems in the future. To identify this capability, planners and directors of telemedicine applications for patients and other users should devote their time and finances required to create the technology interesting and available.
In the interest of permanence, latest operations and newly established systems must be implemented in the same approach throughout various target populations. Any field of applications should be flexible to be applied by other programs or attain other demands, or other factors of telemedicine, including training.
Telemedicine has shown positive effects on the organizational system and daily activities, and intensive research and continuous training should be used to provide exact significance and relevance of telemedicine implementation. More organizations are expected to implement telemedicine system to enhance daily operation and should frequently evaluate the processes of telemedicine application to assure the existence of this system.
Quality is probably the most important feature in providing reliable and responsible healthcare services and most medical centers should invest and implement telemedicine technology to fulfill these requirements. Advanced technology has entered medical field, and implementation is one challenge that needs to be addressed with a lot of consideration.
There are different devices and applications that are very important when considering the implementation of telemedicine. These devices and applications include ISO model, satellites, PDAs, mobile phones, RTB2400 wireless router, IP Phone 323, internet application, among other usable applications.
We have seen that telemedicine play an important role in the processes of all organization. It enables all users to simplify their daily tasks and even reduce the cost of operation. Some steps should be followed to evaluate the importance of this application and readiness of the organization to adopt telemedicine application.
Most organizations are expected to implement this application to allow them to increase their expected services and reduce the cost of services they are providing. Management plays a critical role in this process and is supposed to follow the guide for the implementation of telemedicine.
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