Telemedicine Systems

Rohitash Gupta2007A8TS442U

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

What are Telemedicine Systems?

More efficient use of a doctor’s 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

Advantages

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

Disadvantages

Pictorial Representation of a Telemedicine System

aka Heart Rate Monitor Measures multiple patient vitals Heart Rate, Blood Pressure, Respiration,

Temperature and SPO2 levels With this information, diagnosis is easily

made

The ECG (Electrocardiogram)

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

How does an ECG work?

Elements of the ECG

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

Elements of the ECG (contd)

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 it’s most common functions

Interpreting the ECG

Common output of an ECG

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 MI’s or misdiagnoses

Telecardiology

ECG Process without Telecardiology

ECG with Telecardiology

Goldman Risk Score

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

Building a Telemedicine 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 patient’s 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

Selection of size of system

The patient lives in a fairly wealthy neighborhood

The client’s 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

Site Assessment

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

Cost of Equipment

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 can’t 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

Ensuring Basic Implementation

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

Equipment Specifics

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.

Equipment Specifics (contd…)

Basic information flow

Pictorial representation of the System

Ge MAC 5500 receives input and sends it through wireless internet to a mobile phone

Patient (Client Side)

Mobile receiver

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

Doctor receives and processes the information, then sends back the diagnosis

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