The Spectrum and Potential of Telecommunications Technology in Telemedicine

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The Spectrum and Potential of Telecommunications
Technology in Telemedicine

• Ronald Merrell, MD
• Professor of Surgery
• Virginia Commonwealth University
• Richmond, Virginia, USA

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Telecommunications

• Telephone (signal fires,drums,couriers, etc.)
• Radio
• Television
• Satellite
• Fiber
• Wireless
• Capture an event and transmit its essence with
  fidelity and credibility to another site for
  consideration

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BEEP, BEEP, BEEP
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Behold, the Earth

• Weather, acute
• Weather, chronic trends
• Seismic
• War preparations

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Betsiboka River Delta Madagascar
The Niger River Delta - Nigeria
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Distance vs Time

• There is no prospect of travel in time to earlier
  events in an illness or injury
• Distance on the other hand offers some
  possibilities

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Bandwidth Examples

• 33.6 k modem 33,600 bits per second
• 56 k modem 56,000 bits per second
• ISDN BRI 128,000 bits per second
• ISDN PRI 1,536,000 bits per second ( to a T1)
• T1 1.54 megabits per second (millions of bits)
• T3 45 megabits per second (millions of bits)

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Bandwidth Costs, 2007

• FiOS (Fiber phone) 30 Mbps
• FiOS 15Mbps
• FiOS 5 Mbps
• Cable 8Mbps
• Cable 6 Mbps
• Digital Subscriber Line (DSL) copper wire phone
  line 780KBpS to 3 Mbps
• Wireless 400 Kbps -1.5 Mbps
• Dial-up Modem 56 Kbps

• 180/200 iTune album 15sec
• 50/58 29sec
• 40/48 1min, 26 sec
• 53/58 54 sec
• 343/58 1 min, 11 sec
• 15-40 2 min, 23 sec
• 30-80 4 min, 45 sec
• 10-15 2 hr, 7 min

Richmond Times Dispatch July 9, 2007
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Internet Service Costs (basic)

• US 15/month
• South Africa 33/month
• Tanzania 117/month
• Africa as whole 55/month
• Annual Internet cost/year for Africa is 4 times
  the GDP per capita.

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LOW bandwidthDial-up, Basic Internet56 kbps on
a good day
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Low Bandwidth in a Primary Care Clinic

• Electronic Health Record
• Database and periodic analysis
• LAN to ultrasound, camera, laboratory, microscopy
• Dial-up for consultation using e-mail and
  attachments
• Scheduling basic and intermittent visitor care
• Use camera and DVD burn to produce educational
  materials

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Satellite Phone 64 kbpsgeostationaryLEOS
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Kenya
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Kenya
Mobile Disease Management

• Power
• Sensors
• Telecommunications
• Information Management
• Assisted Autonomy

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Pakistan
Training
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Telemedicine Efforts for Danube Delta
Mobile Telemedicine
Delta Project a case study
Danube Delta
Tulcea
Black Sea
Constanta
Bucharest
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T1 Phone Line Secure point to point
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VCU Telemedicine Suit(Stationary Unit)
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Topologies and Systems
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Star Topology
Typical Small Business or Home Network
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Hub-and-Spoke
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IP Fiber connection

• Asymmetric ( webcast )
• Two way (videoconference)
• Cable, telephony, etc.

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Orlando, Florida
High School, Virginia
Russia
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Romania VR Coach
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Project Lindbergh Worlds First Telesurgery
New York
Strasbourg, France
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