T175 (B)Session (03)

Block 4 Health, transport and

government

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Components of Block 4

• Part 1 Health:- how ICTs can be used in three main areas:• Dissemination{distribution}of information about health• telemedicine• UK National Health Service’s scheme for electronic storage and

accessing of medical records and other data.

• Part 2 Road transport• Looks at the potential for ICTs to enable better use of the road network.

• Part 3 E-government• it refers to the idea of making government services available

online, and using ICTs for new government-related services.

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Topics covered in this session

• Telemedicine

• Networking health

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3 Telemedicine• 3.1 Introduction• How in the field of medicine, ICTs can make the world seem

a smaller place.

Definition of Telemedicine

means medicine at a distance• Telemedicine is a rapidly developing application of

clinical medicine where medical information is transferred via telephone, the Internet or other networks for the purpose of consulting, and sometimes remote medical procedures or examinations

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Benefits of Telemedicine

• ICT systems can bring medical assistance and expertise to individuals, reducing or even removing the need to transport people to medical centres and hospitals.

• reducing the number of people needing to visit centres such as clinics and hospitals.

• a doctor’s skills are not tied to the physical presence of the doctor. It can also provide some automated medical options such as the remote monitoring of a patient’s condition. 5

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Routine visit Teleconsultation Technological implication for teleconsultation

Face to face description Telephone call , email

In surgery use of stethoscope

sensitive microphone, sound can be recorded as a computer file and attached to an email message

if we are to transmit the sounds normally picked up by stethoscope via some sort of communications link, we’ll have to ensure that low-frequency thuds (heartbeats) and high-frequency wheezes (lungs) could still be detected

Checking blood pressure is another routine procedure

This could only be done remotely if I had more specialised equipment, and felt competent to use it.

a doctor monitoring a remote patient’s heartbeat or blood pressure might need to check for correct positioning of the chest or arm probes.

Doctors also carry out visual inspections to search for evidence of problems

A digital camera and webcam could be used to capture images that may be relevant to my concern. These can be stored as graphics files and transferred over communication networks.

so images suitable for medical examination could be loaded onto a computer for transmitting to a doctor (bearing in mind any safety implications, such as avoiding flash for close-up pictures of faces)

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Aim of discussion• to encourage you to think about possibilities.

In the rest of this section we will discuss in more detail at how ICT systems in practice are bringing together medical specialists, patients, and others at a distance. I shall begin with two contrasting examples that make fairly modest demands on the ICT infrastructure --one from India, one from the UK. Then we will briefly consider the ‘higher tech’ end of the spectrum: robotic ‘telesurgery’. Finally we will review some of the ICT network implications for telemedicine.

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3.2 Telemedicine on a budget • read the following extract. Note that it refers to

ISDN (Integrated Services Digital Network), which is an early form of broadband provision .

• Broadband: A type of data transmission in which a single medium (wire) can carry several channels at once. Cable TV, for example, uses broadband transmission. Broadband technology can transmit data, audio, and video all at once over long distances.

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Care companion equipment

With such equipment the demand on the general ICT infrastructure can be minimal, even though quite sophisticated ICT equipment may be required at the patient end

Features: 1 Patient assessment questionnaire 2 Patient medication and event reminder 3 Questions and reminders can be changed by the healthcare provider remotely 4 Simple installation and easy to use 5 Minimal training 6 Uses standard PSTN (analogue) telephone line 7 Portable 8 No messy wires (except NIBP) 9 Designed for home use. 12

• One CareCompanion option, not described in the extract but shown in Figure 13, is to link a stethoscope from patient to doctor via a communications link. In effect, the stethoscope has been divided into two parts, connected by the network. This idea of ‘dividing’ medical equipment into two parts --one part at the patient end, and one part with the doctor, surgeon or nurse --and using an ICT communications link or network to interconnect them, is an important principle of telemedicine

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CareCompanion Home Monitoring system

meter measures your ability to push air out of your

lungs

Non-Invasive Blood

Pressure (NIBP) is

widely used for routine BP measurement

measures the oxygen

saturation of a patient's

blood

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An example of telemedicine in the news

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3.3 Telesurgery• Telesurgery, as you will have probably guessed, is

surgery at a distance• Telesurgery is closely related to robotic surgery --though you should be clear

that here we are talking about robotic mechanisms under direct human supervision rather than robots that can carry out activities autonomously.

• for much of the operating time doctor will be relying on intermediate, robot-assisted systems rather than on direct physical contact with the part of the patient they are operating on. Extending the distances involved from a metre or two to thousands of kilometres would allow a surgeon on one side of the world to operate on a patient on the other

http://www.youtube.com/watch?v=81J2dFChZMghttp://www.youtube.com/watch?v=nPk90YCpqFg&feature=related

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• Experiments by Marescaux’s group found that any latency greater than 250 ms was dangerous, but engineers at Computer Motions and France Telecom compressed it to just 155 ms [...] A full 70 ms of the latency was taken up by the video coding and decoding from the endoscopic camera

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Difference between delay and latency

Delay latency

1 delay refers to a lapse of time.2 Network delay, the delay of an IP packet within an IP network

1‘latency’ means the total delay along a signal’s path. This total delay will include the travelling time of the signal, known as the ‘propagation delay’, and any delay due to the data being manipulated (for example during compression and decompression)2 latency will be the total round-trip delay 18

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Feedback

• checking the result of an action, and then applying the information to subsequent actions -either explicitly, or as part of our bodies’ innate {natural} mechanisms example page#56

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Vision and depth• This needs well-thought-out arrangements

for presenting the best views to a surgeon. For example when performing a cut, can its depth be accurately gauged?{measured}

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4 Networking health• how national health provision is being reshaped around

the opportunities provided by ICT systems

• The plan envisaged{ imagine} that each citizen of the European Union (EU) would carry a smart health card that would uniquely identify them

• Advantage of smart card

• provide access to the citizen’s electronic patient record on a database from anywhere within the EU, and allow the citizen to obtain medication from any pharmacy in the EU.

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4.2 National Programme for Information Technology

• It encompasses {covers} the creation of a database of medical records of all UK citizens, called the Care Records Service.

• ‘spine’:The national database of the Care Records Service holds a summary of care and clinical history for each patient

• It includes

• 1: name 2: Address 3: NHS number 4: date of birth 5: information about allergies etc

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Links from summary information in the spine enable the locally held information to be

accessed

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4.3 Scale of the NHS

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4.4 Components of the NPfIT• The major parts of the NPfIT are as follows, starting with the Care

Records Service

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4.5 The N3 communication network

• One of the most important parts of the NPfIT project is the New National Network, or N3. this is the data network to link doctors, hospitals, consultants and all other sections of the health service in England and Scotland

• the N3 is not a new physical network (in the sense of new wires and cables) but a system of agreements and contracts between the NHS and (ultimately) a range of broadband suppliers, to supply a broadband network for the NHS

• The data rates available within the N3 range from 100 Mbps (envisaged for large hospitals) down to 2 Mbps for (typically) links to general practitioners’ surgeries.

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There are several reasons why the NHS’s broadband provision is specially managed

• Firstly, there is the question of bandwidth

• Secondly, there is the question of security

• Thirdly, there is the question of availability

• Fourthly, there is cost.

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4.6 Virtual private networks• private network example of Al- rajhi bank

• Def of Private network

a private network, which is a data network for the exclusive use of the organisation, joining its LANs

• Typically a large organisation needs to join up its LANs for data communications

• Usually, however, large organisations have more complex data requirements than simply e-mail

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private network• Figure 15 shows, to the

left, a private network for part of a health service.

• Such a private network is separate from the internet. However, a large organisation would almost certainly need access to the internet from its own private network

The gateway is, of course, a potential vulnerability { weakness} as far as keeping the network private is concerned, but with good firewalls and other security the organisation’s own network should be essentially private.

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VPN

• The VPN is changing the way that businesses communicate. Traditionally, in order to deploy a wide area network, organisations would need to procure expensive leased line technology to connect their offices. The VPN however has the ability to run over public networks (like the Internet) whilst providing security and integrity for your data.

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VPN

• The key benefits that VPN technologies provide are:

• Extend geographic connectivity

• Greatly reduce operational costs when compared to traditional WAN technologies

• Improve productivity

• Provide support for home/remote working

• Integrate well with existing broadband access technologies 34

VPN

They key functions which make VPN technologies secure are the following:

Authentication - Ensuring the communication is from a trusted source Access Control - Preventing unauthorised users from accessing the network Confidentiality - Preventing the reading or copying of data as it travels across the public network Data integrity - Ensuring the data has not been tampered with as it travels across the public network

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Encryption and Decryption

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Def of Encryption and Decryption

• Def of Encryption• a process of disguising a

message in such a way as to hide its contents

• Def of Decryption–a process of undoing encryption

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4.7 Availability

• Availability is simply the proportion of time, on average, for which a system is available for use

• Availability is closely related to the concept of probability.

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4.8 Confidentiality

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