siv 864: special module on multimedia applicationssiv 864 srivastava / siv864 / school of it / nov...

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Sakti Srivastava, MBBS, MS

Adjunct Professor, School of IT and

Centre for BioMedical Engineering

Indian Institute of Technology, Delhi

SIV 864: Special Module on SIV 864: Special Module on Multimedia ApplicationsMultimedia Applications

TelemedicineTelemedicine

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Definition

TelemedicineTelemedicine

At a distance Delivery of clinical service

Telehealth Telehealth

Preventive and promotive

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

The earliest attempts….

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

The first modern attempts…

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

The next milestone…

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

The Internet changed everything…

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

The Physician of 2020 ?

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

ElectronicElectronic

MedicalMedical

RecordRecord

DigitalDigital

ImagingImaging

Lab testsLab tests

PatientPatient

MonitoringMonitoring

ComputerComputer--basedbased

teachingteaching SimulatorsSimulators

Robotic SurgeryRobotic Surgery

Decision Decision

SupportSupport

Treatment Treatment

protocolsprotocols

TelemedicineTelemedicine

The Physician of 2020 !

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

“Building Bridges”

Medical Technical

Needs SolutionsApplications

Speak the same “language” Understand each other

Work together

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Physicians

Engineers

Education experts

Computer professionals

Graphic designers

Industry

The coming together of …

Governments

Voluntaryorganizations

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Types

Synchronous

Asynchronous

� Real-time

� Store & Forward

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Synchronous Telemedicine

� Real-time

� Requires both parties to be present at same time

� Telephone consultation

� Videoconference

� Extendable peripheral devices (tele-stethoscope, tele-otoscope)

� High bandwidth utilization

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Synchronous Telemedicine (2)

� Client-server or peer-to-peer architecture

� May be recorded or not

� Phone lines / ISDN / Satellite / Broadband

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Asynchronous Telemedicine

� Store and Forward

� Does not require both parties to be present at same time

� Capture text / audio / image / bio-signal data

� Requires some form of electronic medical record (EMR)

� Low bandwidth utilization

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Asynchronous Telemedicine (2)

� Postal system / Letter / Fax / Email

� Network connectivity

� Databases

� Scheduling of offline activity

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Standards

Medical Standards

Technical Standards

� International Classification of Disease

� Clinical Procedural Terminology

� Unified Language of Medical Sciences

� Accredited Standards Committee (ASC) X12N

� Digital Imaging and Communications in Medicine HL7

� International Telecommunications Union H.320

� Association for Advancement of Medical Instrumentation

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Non technological issues

Medical Issues

Implementaiton Issues

� Security and Privacy

� Clinical Quality Assurance

� Education and Training

� Business models / reimbursements

� Portability and Inter-communicability

� Reliability / Technology support

� Scalability

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Case Study

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Healthcare Scenario in India

� India spends <1% GDP on health

� Urban/Rural mismatch of health professionals and population

� >70% rural population

� Most lack access to

basic health facilities

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Telemedicine in India

� Aravind Hospitals – Teleopthamology Network

� Apollo Hospitals – Aragonda Project

� OTRI (Online Telemedicine Research Institute)

� Asia Heart Foundation

� OncoNet (Kerala)

� Common Service Centers e-governance

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Telemedicine in India

� VSAT based (ISRO)

� Broadband based (BSNL)

� High cost (setup and maintenance)

� High technical expertise

� Low bandwidth

� Limited scalability

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Continuing challenges

� Remotest of remote

� No connectivity

� Limited infrastructure

� “Bottom of Pyramid” (<$1 per day)

� Landless farmers, illiterate

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Criteria

� Inexpensive and low maintenance

� Easy and quick to setup

� Robust and durable

� Minimal new technology usage and skills requirement

� User-friendly, able to cope with infrastructure

� Support large datasets and scalable

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Our proposed solution

� Asynchronous (Store & Forward)

� Delay tolerant network (DTN)

� Large datasets

� Several unique features

� Highly scalable

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Application overview

Kiosk-

PC

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Case Flow 1

Internet Region

D1(Neuro)

D2(Pediatrics)

D3

(Ortho)D4

(Ortho)

Dispatcher

New Case Submission Path

Reply from Doctor

Health Care

Worker

Primary Healthcare Centre (Rural)

RadiologyEquipment

DICOM

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Case Flow 2

Internet Region

D1(Neuro)

D2(Pediatrics)

D3

(Ortho)D4

(Ortho)

Dispatcher

New Case Submission Path

Reply from Doctor

Health Care

Worker

Primary Healthcare Centre (Rural)

RadiologyEquipment

DICOM

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

DICOM

Internet Region

D1

(Neuro)

D2

(Pediatrics)

D3(Ortho)

D4

(Ortho)

Dispatcher

New Case Submission Path

Reply from Referred Doctor

Referral to another Doctor

Health Care Worker

Primary Healthcare Centre (Rural)

RadiologyEquipment

Case Flow 3

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Design Overview

Kiosknet Hardware

DTN – Communication Infrastructure

DICOM

Interfacing

Automatic Case

• Allocation

• Forwarding

• Consolidation

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Design Overview

Kiosknet Hardware

DTN – Communication Infrastructure

Automatic Case

• Allocation

• Forwarding

• Consolidation

DCMTK

CreatorDecomposer

GUI

DICOM

Viewer

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Design Overview

Kiosknet Hardware

DTN – Communication Infrastructure

DCMTK

CreatorDecomposer

GUI

DICOM

Viewer

DtnReceiver

DocDBSync

DB

NetReceiver

Consolidation

Sender

Sender

Receiver

GUI

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Automatic Case Allocation

� Physician database at proxy

� Doctor’s Name, Specialty, Location, ID, IP, email address

� Case specifies only specialty

� Based on specialty and availability, allocation done

� Any allocation algorithm can be implemented now

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Automatic Case Consolidation

� Unique Case ID assigned to a case at creation

� One consolidated file per case ID maintained at the proxy

� Consolidated file can be retrieved from any location

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Implementation Details

� Components

� Hardware

� Software

� Databases

� Application level routing

� Screenshots

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Hardware Components

Via Box, 512MB RAM, 40 GB HDD, Ethernet, Wireless

PC, Low RAM, No HDD, Ethernet,Wireless

Soekris 4801-60 Box, 256MB RAM, 40 GB HDD, Wireless

Soekris 4801-60 Box, 256MB RAM, 40 GB HDD, Wireless

PC (P4) , 512MB RAM, 80 GB HDD, EthernetWireless

PC, 512MB RAM, 40 GB HDD, Ethernet

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Software Components

Debian OS

Apache 2.2, PHP 5.2.6, DICOM ViewerMricro

Debian OS

dtnd, dcmtktoolkit, dhcp, nfs

Creator, Decomposer (java modules)

Debian OS

dtnd

Linux OS

Apache 2.2, PHP 5.2.6

Receiver, Sender

(java modules)

Debian OS

dtnd

Debian OS

dtnd, dcmtktoolkit, dhcp, nfs

Creator, Decomposer (java modules)

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Screenshots

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Results

� 1 GB data bidirectional transfer

� Measured time for link detection and transfer time

� Time to link detection: Worst case – 10 mins

� Throughput: 1 MBPS

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Future Work

� SMS integration

� Call allocation methods

� Enable querying

� Security and privacy

� Utility based routing

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Summary

� Rapidly evolving field

� Many needs and many solutions

� Success is not dependant on technology alone

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008

Summary

SIV 864

Srivastava / SIV864 / School of IT / Nov 2008