Telemedicine Systems

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Telemedicine Systems

• Rohitash Gupta
• 2007A8TS442U

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What are Telemedicine Systems?

• Replacement for older versions of home care
• Integration of communication and medicinal
  technology
• Solution to the difficulties of transport for the
  elderly and too sick
• Bypasses physical hospital restrictions
• Top 3 Current Uses Radiology, Dermatology,
  Psychiatry

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Advantages

• More efficient use of a doctors time
• Ensures 1 to 1 care of every patient
• Initial setup followed by easy maintenance
• Can be used through a mobile phone
• No human error in dosage
• Benefiting the society economically as well

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Disadvantages

• High maintenance, training and initial setup cost
• Complex training requirements
• People may not like the idea of a computer
  holding their life in its digital hands
• Technical Breakdown
• Overdependence on electricity and internet

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Pictorial Representation of a Telemedicine System
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The ECG (Electrocardiogram)

• aka Heart Rate Monitor
• Measures multiple patient vitals
• Heart Rate, Blood Pressure, Respiration,
  Temperature and SPO2 levels
• With this information, diagnosis is easily made

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How does an ECG work?

• Interprets electrical signals produced by heart
• Recorded via electrodes attached to the skin
• 12 leads, 6 limb leads, 6 precordial leads
• Each lead is bipolar, 1 negative, 1 positive end

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Elements of the ECG
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Elements of the ECG (contd)

• P wave represents depolarization of both atria
• PR interval is generally about 0.12-2 seconds
• QRS complex Usually 0.08-0.12 seconds
• Many different types of QRS complex

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Interpreting the ECG

• Heart rate to measure heart rate, we need to
  consider the duration between two consecutive
  waveforms such as the R-R duration
• Rate 60/(R-R Interval)
• There are a lot more functions, but since the
  focus is on the ECG as it pertains to the
  telemedicine system, the focus is kept to its
  most common functions

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Common output of an ECG
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Telecardiology

• Is one of the main uses of telemedicine
• Treats many illnesses such as congenital heart
  disease, myocardial infarction MI, angina
• Cardiovascular disease is the single leading
  cause of death in the US
• Telecardiology helps many hospital lower the
  amount of legal ramifications of missed MIs or
  misdiagnoses

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ECG Process without Telecardiology
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ECG with Telecardiology
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Goldman Risk Score
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Building a Telemedicine System

• It is a monumental task that requires a whole
  host of factors to be considered
• Type of equipment being used
• Networking operations
• Expenses involved
• Demographic of location
• Selection of an appropriate site
• Plans for staff training, delays, emergencies
• Client responsibilities
• Manpower requirements

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Selection of size of system

• To keep it simple, I decided to go for a
  small-scale telemedicine system
• It will be a compact system with the host being
  in a small hospital and the client-side
  counter-part in a patients home
• Staff involved will simply be the 2 doctors
  assigned to the patient and the contracted
  technicians for setup of the equipment at both of
  the sites

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Site Assessment

• The patient lives in a fairly wealthy
  neighborhood
• The clients area allows for fiber-optic cables
  and flawless wireless internet at high-speeds
• The hospital is located about 40km away in a
  slightly less affluent area however, the internet
  is comparable to the clients
• Nothing in the locations seems to indicate that
  reliability will be an issue

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Cost of Equipment

• Price of a decent, small scale ECG 15,000
• Setting up a WWAN network with equipment and
  installation charges 12,000
• Training of staff and clients 8000
• Ensuring QoS and maintenance 2000
• Setup of ECG and other overhead 30,000
• Fairly expensive process, casual estimates.
• In the long run it may actually save the client
  money if he has to visit the hospital frequently

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Ensuring Basic Implementation

• On top of staff training, I will have to ensure
  that the client is fully informed about the
  process and that he is cognizant of his
  responsibilities in the telemedicine system
• Since telemedicine systems have high bandwidth
  requirements that cant be provided by a singular
  network, methods such as network striping to
  combine several networks to form 1 high speed
  upload link to ensure maximum performance will be
  needed

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Equipment Specifics

• GE MAC 5500 EKG Machine
• Has 12/15 lead analysis
• Network used is going to be a dual-lane DSL
  connection which usually limits upload speeds to
  256k but by using network striping and QoS
  handling, it can be boosted up to approximately
  1Mbps which is just about enough for high
  definition video conferencing
• Cisco equipment used for network propagation

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Equipment Specifics (contd)

• This system consists of a lightweight and
  power-saving wireless ECG device equipped with a
  built-in automatic warning expert system.
• Device is connected to a mobile, real-time
  display platform.
• The acquired ECG signals are instantaneously
  transmitted to mobile devices, such as netbooks
  or mobile phones through Bluetooth, and then,
  processed by the expert system.
• An alert signal is sent to the remote database
  server, which can be accessed by an Internet
  browser, once an abnormal ECG is detected.
• The current version of the expert system can
  identify five types of abnormal cardiac rhythms
  in real-time, including sinus tachycardia, sinus
  bradycardia, wide QRS complex, atrial
  fibrillation (AF), and cardiac asystole, which is
  very important for both the subjects who are
  being monitored and the healthcare personnel
  tracking cardiac-rhythm disorders.
• The proposed system also activates an emergency
  medical alarm system when problems occur.
  Clinical testing reveals that the proposed system
  is approximately 94 accurate, with high
  sensitivity, specificity, and positive prediction
  rates for ten normal subjects.

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Basic information flow
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Pictorial representation of the System
Internet transmission from the mobile phone to
the network setup at the health care center to
receive and store the information output from the
ECG
Patient (Client Side)
Mobile receiver
Ge MAC 5500 receives input and sends it through
wireless internet to a mobile phone
Doctor receives and processes the information,
then sends back the diagnosis
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