Telemedicine and Main Issues in Developing Countries: A General Review

Mehrdad Jabbarzadeh Gangeh

Dr. Edmond Zahedi

Dr. Mohd. Alauddin Mohd. ALi

Department of Electrical, Electronics and Systems Engineering Faculty of Engineering

Universiti Kebangsaan Malaysia

Is telemedicine and its deployment in developing

countries effective?

• Improving the quality of health care

• Simplifying access to health care

• Decreasing costs

Issues:

• Difficulties of Health Care in Developing Countries

• Definition of Telemedicine

• Different Types of Telemedicine Systems

• Hardware, Software, and Bandwidth Requirement for the Different Types of Telemedicine Systems

• Potential of Telemedicine to Improve Health Care in Developing Countries

• Expected Problems with Telemedicine

Introduction to the Difficulties of Health Care in Developing Countries

• Few number of doctors

• Access to local health services

• Shortage of high level hospital infrastructure

• The geographical distribution of existing hospital and health services

In Short:

1) Limited medical expertise and resources

2) Concentration of facilities in metropolitan areas

Telemedicine Definition According to ITU

• Use of telecommunications and medical technologies

• Exchange data, audio and/or visual

• Between physician and patient or between physician and health

care professional

• Geographically separate locations

• On-line or off-line

Different types of Telemedicine Systems According to Their Use in Health Care

• Teleconsultation

• Telediagnosis

• Tele-education

• Medical emergencies and distant relief

• Telesurgery and virtual reality

Distance Learning and Teletraining

ISDN-NETWORKSATELLITE

Multi-point videoconferencing

Videoconferenceunit

Different types of Telemedicine Systems According to the Medical Applications

• Teleradiology : X- Ray CT MRI NM (Nuclear Medicine) Fluoroscopy Angiography Ultrasound Thermography

• Telepathology

• Teledermatology

• Tele-endoscopy

• Telecardiology

• Telepsychiatry

• Telepharmacy

• Telemetry

Different Applications of Telemedicine Systems: Definition, Transfer Need and Required Stream

Application Definition Transfer Need Kind of Service Required Stream

Teleradiology The practice of radiology ata distance using medical im-ages acquired from radio-logical modalities includingX-ray, MRI, CT, NM, etc.

X-ray: still images (size varies from mo-dality to modality, but typical size is:2048x2048 pels, 8-16 bits/pel; sometimes 2or more images are needed for a patient).

CT, MR, NM: series of images that de-scribe a 3D volume or a time, varyingcross-section.

CT: 512x512 pels, 11-13 bits/pel, 30 slices.MR: 256x256 pels, 10 bits/pel, 20 slices.NM: 128x128 pels, 8 bits/pel.

Off-line Image transfer

Telepathology A form of telemedicine usedby pathologists to examinetissues & cells under a mi-croscope.

Control signals to remotely control the mi-croscope (focus, stage movement, andmagnification).

Still images with high resolution.

Off-line orOn-line

Control signals Image transfer

Teledermatology Transfer of images/video ofskin for making diagnosison skin diseases.

High quality colour still image or video. On-line Audio & videoconferencing

Diagnostic videoor image transfer

Telecardiology The transmission of images,video and perhaps thesounds of heart using tele-medicine.

High quality video. High quality heart sound.

On-line Audio & videoconferencing

Diagnostic videoand perhaps audio

Tele-endoscopy Refers to the transmission ofthe images acquired by anendoscope which is used toproduce the image of struc-tures inside the body.

High quality video. On-line Audio & videoconferencing

Diagnostic video

Telephsychiatry A form of telemedicine sup-porting the remote practiceof phsychiatry.

Videoconferencing including synchronisedtwo way audio & video.

Control signals for camera adjustment.

On-line Audio & videoconferencing

Telemetry Providing a means formonitoring and studyinghuman & animal physio-logical functions from a re-mote site.

Biomedical signals (e.g. ECG, PPG). Perhaps videoconferencing.

On-line Data transfer Perhaps audio &

videoconferencing

Multimedia Stream and Their Bandwidth Requirement

Multimedia Stream Description Real Time Bandwidth Requirement

Control signals Session connec-

tion/disconnection, micro-

scope/camera adjustment

No Negligible

Data transfer Biomedical signals transfer,

patient records.

May or may

not

9.6 Kbps

Audio conferencing Full duplex, G72x audio codec

standards.

Yes 10-128 Kbps

Diagnostic audio One-way, CD quality, stereo

audio.

Yes 37-768 Kbps

Video conferencing Two-way, H.261 video codec

standard.

Yes 64 Kbps-1.92 Mbps

Diagnostic video One-way MPEG-2 Yes 3-15 Mbps

Image transfer Image transmission for consul-

tation

No Depends upon how fast the im-

age(s) is (are) going to be trans-

ferred.

Bandwidth Requirement for Telemedicine Systems and Telecommunication Networks

Factors influencing the choice of a special telecommunication service are: Necessary bandwidth

the volume of data to be transferred (depends on the type of service, application and the quality of service)

required transfer speed Infrastructure and telecommunication facilities available in rural parts Price of the service Required interfaces of the equipment in use to the telecommunication network

Telecommunication Service Accessible Band-

width

Required Transfer Time

without compression

Required transfer

time with compression

POTS using V.34 Modem 28.8 Kbps 37 min. 1 min 51 sec.

N-ISDN : BRI (2B + 1D)

PRI (30B + 1D)

128 Kbps + 16 Kbps

1.92 Mbps + 16 Kbps

8.3 min.

33 sec.

25 sec.

1.7 sec.

B-ISDN & ATM 155 Mbps 0.4 sec. 0.02 sec.

Cellular Radio 9.6 Kbps 1 h 50 min. 5.5 min.

Mobile Satellite Communica-

tion (MSC)

10 - 100 Kbps 1 h 46 min. – 10 min. 5.3 min – 32 sec.

Required transfer time of an X-ray image with the size of 64 Mb

Hardware and Software Required for Different Types of Telemedicine Systems

• Central Processing Unit:

• Media Acquisition

– Image

– Video

– Audio

• Media Storage

• Compression/Decompression Algorithms/Standards

• Image and/or Video Processing

• User Interface

• Communication Media/Interface

• Special Medical Equipment

Potential Improvements (Non Financial)

• Long distance consultation

• Quality health care in remote areas

• New ways for education and training

• Improvement in qualification of national specialists and health technicians

• Second opinion and centralisation of resources (specialists, hardware, and software packages)

• Reduction of waiting times for consultation

For patients:

• Cutting down on journeys to major health centres or for specialist consultation

• Reduction of length of stay, and therefore cost of hospitalisation

Cost reduction

For providers of health services:

• Reduction in operating costs

• Reduction in travel cost and time

for specialist visiting other hospitals

• Reduction in costs of training

Potential Improvements (Financial)

Expected Problems with Telemedicine in Third World Countries (1)

1) Financial:

• Increase of costs because of improving the quality of service through providing second opinion

• They are not used very often

• Who pays for the expenses

• Cost effectiveness assessment

2) Liability:

• Who is responsible for the patient?

• Anyone can establish a web site to offer consulting

Expected Problems with Telemedicine in Third World Countries (2)

3) Acceptance:

• Physicians resist to use a new technology that they do not understand

• Patients and doctors are accustomed to personal visits and are reluctant to alter the traditional method of care

• Privacy and confidentiality of information• Insurance

4) Technology:

• Scarcity of high-bandwidth telecommunication networks in rural areas

• Compatibility of old equipment with telemedicine

Conclusion (1)

Telemedicine can potentially improve health care in developing countries through:

• Providing the services in rural and difficult to access parts of the country

• Providing the possibility of concentration of expertise and resources

• Reduction of costs for both patients and providers of health services in some aspects

However, the acceptance and further development of telemedicine

depends on factors among them are:

• Some cost/benefit analysis

• Types of telemedicine systems and applications that are mostly required in a special country

Conclusion (2)

• The cost/benefit analysis can be carried out by the ministry of health and finance ministry

• Close cooperation between the medical society and engineers

• Pilot projects

• Education

Telemedicine and Main Issues in Developing Countries: A General Review

Mehrdad Jabbarzadeh Gangeh

Dr. Edmond Zahedi

Dr. Mohd. Alauddin Mohd. ALi

Department of Electrical, Electronics and Systems Engineering Faculty of Engineering

Universiti Kebangsaan Malaysia