Telehealth and TelemedicineTelehealth and Telemedicine

Jayantha U. Weerasinghe (Faculty of Dental Sciences, Peradeniya)

Academic Sessions - SLMA and Ruhuna Clinical Society - 2002

Telehealth and Telemedicine

• Telehealth

• Telemedicine

• exchange of material offline

• Real-time (online) image transfer

• commercial software available

• SAGA and Peradeniya Activity

Telehealth

• Telehealth is using technology to provide medical care over distance

• non-clinical services such as distance medical education and research

• It will allow information to be received by remote centres

TelemedicineTelemedicine

• Telemedicine typically involves medical personnel using   images, video and audio facilities either non-real-time (off line) or real-time (on line) for remote consultations. 

• An expert physician far away can guide the local medical personnel in treatment planning remotely

TelemedicineTelemedicine exchange of material offline

Store and Forward method• Local physician sending digital images of

pictures, x-rays, and other patient information directly to the computer of a specialist.

• After reviewing that information, the specialist then sends the diagnosis back to the local doctor, who treats the patient and provides follow-up care.

TelemedicineTelemedicine- - non realtimenon realtimestore and forward method

Usage

• Teleradiology

• Telepathology

• Teledermatology

Telemedicine- non realtimestore and forward method

Advantages• Minimum resources needed• Regular email attachments could be used

Disadvantages• Time delay in response• Limitation of image quality and size• Cross checking and feedback will take more

time

TelemedicineTelemedicine real-time (online) image transfer

• Exchange of high quality still images, video clips between the remote center and   the experts using videoconferencing equipment.

• experts outside will be able to guide the remote center in realtime

Telemedicine : real- timeAdvantages

• Used in many areas of medicine, surgery, dentistry• accessibility of expert help in remote areas• Saves time of an expert in frequent travel to remote

areas• permits Continuing Education and training for

practitioners in remote areas

Disadvantages

• Non availability of appropriate technology and adequate bandwidth in the network

• Lack of funds for equipment and software• Lack of technical help

Basic requirementsBasic requirements

Requirements: Videoconferencing equipment • A Digital Video (DV) camcorder (IEEE1394 interface)

OR Digital camera with USB connection• microphone and speakers• Desktop/ Laptop computerInternet access - leased line/ Local Area NetworkDedicated software

Shortcomings of commercial software

Eg:- Messenger. CuSeeMe, Netmeeting,, freetalk,

• Poor quality of images at low speed networks

• not suitable for medical collaboration activities– image manipulation, tele-pointing facility on the image canvas, shared-

board

• clinicians would prefer a user-friendly operating environment specifically designed for medical applications.

Sri Lankan Experience of high quality medical image and

voice transfer through internet

Between

Medical School & Faculty of Engineering

SAGA University-Japan

And

Faculty of Dental Sciences - Peradeniya

Department of Oral Surgery

Faculty of Dental Sciences,

University of Peradeniya

Previously used method - Store and ForwardStore and Forward

• Images of patients- photographs and radiographs were exchanged

• Non real time method

• Disadvantages-– Delay in receiving and responding– Delay in decision making at the remote centre

since they await advice from the expert outside– limitations of commercial email software for

sending large data files

SAGA Medical School

SAGA University

(Engineering)

Faculty of Dental Sciences- Peradeniya

http://turkey.fu.is.saga-u.ac.jp/education/project/Collabo1.asp

Realtime image transferRealtime image transferusing a dedicated software

Dedicated SoftwareDedicated Software developed by SAGA

• Connections made by ‘dialing’ IP address• Voice transfer full duplex• Image transfer with following facilities

– Sender and receiving windows– Shared board facility for image canvas– Accessing shared files on each computer– Transfer of powerpoint presentations and

playback– Recording facility of the images received– User-friendly

Software OverviewSoftware Overview

Image transmission Voice transmission

IP

PreviewTransmitReceivingwindows

Shared Board

WEBFile transfer

Transmit from

Remote centre

Receiving from

Expert centre abroad

Software Overview• Transmission of Video as a Series of JPEG Images• interactive full-duplex voice• Image quality and image rate can be adjusted• User Friendly Graphic User Interface• Shared Board Facility

Shared Board Facility

• Both parties can use markers on the same image canvas

• Allow common base for discussions• Text typing facility

Marker from expert

Marker from local team

WEB Facility

• File transfer facility• Powerpoint presentations can be

transferred and run as a lecture from the remote location

• Ideal tool for CME

presentation

Advantages of the System

Eeconomical and freely available components,Operated in both low speed and high speed

networks User-friendly easy to install and operate

image software has a Graphical user interface customized for medical personnel with facilities such as shared board, transmitting powerpoint files and multiple image windows.

Application of the technique

• Between Faculty of Dental Sciences Peradeniya and SAGA Medical School

• An interactive session for JICA trainees in SAGA was conducted

Application of the technique locally

Tested between Faculty of Dental Sciences Peradeniya and

• Faculty of Medicine Peradeniya

• Genetics Unit, Faculty of Medicine- – University of Colombo

• Community health and Family Medicine - – University of Kelaniya

Summary• System developed for Real-time

Telemedicine which has been tested locally with a dedicated software designed in JAPAN

• It is suitable for low speed networks

• It could be used for Information exchange and Continuing Education sessions

Telehealth and TelemedicineTelehealth and Telemedicine

Thank You!Japan

Professor Nobumichi Sako - former President of Saga University

Mr. Minoru Tanaka - Chairman of NetCom Saga Association

Venture Business Laboratory (VBL) - Saga University

Prof Takeshi Katsuki - Oral & Maxillofacial Surgeon,

SAGA Medical School

Sri Lanka• Prof N A de S Amaratunga - Dean, Faculty of Dental Sciences, Peradeniya

• Dr. Nimal Ratanayaka- Director of the Internet/communication unit, Faculty of Engineering, Peradeniya

• Dr Toru Nagao- JICA Chief Advisor, Faculty of Dental Sciences

• Mr. Ranjith Abeyratne- Technical Officer, Faculty of Dental Sciences

• Dr Kumara Mendis - Dept of Community Medicine and Family Health Faculty of Medicine, University of Kelaniya