using technology in urban areas: preparing for the future
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Using Technology in Urban Areas: Preparing for the Future. April 26, 1999 Frank Ferrante Senior Manager Mitretek Systems, Inc. Presented to The Emerging Health Information Infrastructure Conference (HII99) Improving Health in a Digital World - PowerPoint PPT PresentationTRANSCRIPT
Using Technology in Urban Areas: Preparing for the Future
April 26, 1999
Frank FerranteSenior Manager
Mitretek Systems, Inc.
Presented to
The Emerging Health Information Infrastructure Conference (HII99)
Improving Health in a Digital World
Sponsored by the Friends of the National Library of Medicine (FNLM)
Washington, D.C.
2
Agenda
Technology: Changes and Trends Digital Healthcare Products Applications Current and Future Technologies Summary
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Technology: Changes Exponential
Multimedia applications:Messaging, documents, desktop conferencing, image storage/retrieval,TV distribution
• ISDN
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
75 bps
300 bps
1200 bps
Data Rates
IBM's Token Ring16 Mbps
Ethernet(IEEE 802.3)
10 Mbps
Direct Access
Dial-Up
Early Modem Access
100 Mbps
10 bps
100 bps
1 Kbps
10 Kbps
100 Kbps
1 Mbps
10 Mbps
1 Gbps
10 Gbps
ATM/SONET Networks1 Gbps+
9.6 KbpsModem Access
IP Switching1 Gbps
Fast Ethernet100 Mbps
FDDI100 Mbps
X.2556 Kbps
ATM/SONET WDM Networks
100+ Gbps
100+ Gbps
4
Technology:Internet Trends
Internet consumer market to reach 43 million in 2000 from 30+ million households in 1998 {INTERNET2 reaching Gbps Rates)
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
$5,000
Inte
rnet
Mar
ket
in M
illio
ns
1995 1996 1997 1998 1999 2000Source: The Age of Internet: Capitalization on the Data Opportunity, Information and Interactive Service Report, January 9, 1998
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Technology:Bandwidth Cost Trends
Source: NGN - 1998 Conference Proceedings
Legend: OC - Optical Carrier Rates (155 Mbps to 4.8 Gbps) WDM - Wavelength Division Multiplexing TDM - Time Division Multiplexing
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Technology: Digital Healthcare Products Digital Blood Pressure Monitor (Sphygmonometer) - less than 10 Kbits of
data per second (required transmission rates)
Digital Thermometer - less than 10 Kbits of data (required transmission rates)
Digital Audio Stethoscope and integrated electrocardiogram - less than 10 Kbits of data (required transmission rates)
Ultrasound, Angiograph, - 256 Kbytes (image size)
Magnetic Resonance Image - 384 Kbytes (image size)
Scanned X-Ray - 1.8 Mbytes (image size)
Digital Radiolography - 6 Mbytes (image size)
Mamogram - 24 Mbytes (image size)
Compressed and full motion video (e.g., Nasopharyngoscope, Opthalmoscope, Proctoscope, Episcope, ENT Scope) - 384 Kb/s to 1.544 Mb/s (speed)
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Technology:Teleradiology Applications - Imaging
8 to 24 bits per pixel
512 to 4096 pixels
512 to 4096 pixels
Image Type Image Resolution Image SizeSpatial Contrast
Ultrasound 512x512 x8 256 KbytesOther (Angiography, Endoscopy, Nuclear Med., Cardiology, Radiology)
512x512 x8 256 Kbytes
Computed Tomography 512x512 x12 384 Kbytes
Magnetic Resonance Imaging512x512 x12 384 Kbytes
Digitized (Scanned) X-ray 1024x1250 x12 1.8 MbytesDigital Radiography 1024x1024 x8 1 Mbyte
2048x2048 x12 6 Mbytes
Mammography 4096x4096 x12 24 Mbytes
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Technology:Image Transmission Times
Slow-Speed Services
Medium-Speed Services
(384 Kb/s - 45 Mb/s)
Medical Images
High-Speed Services
(45 Mb/s - 4.8+ Gb/s)
Medical/Scientific
Visualization
29.1 min.
15.0 min.
1.1 sec. 325 ms
28.8 Kb/s(Modem)
56 Kb/s(Modem)
10 Mb/s(Ethernet)
45 Mb/s(T3)
155 Mb/s(ATM OC-3)
1.544 Kb/s(T1)
2048 x 2048x 12 bit image No compression
Assumptions:
Coaxial Modem Range
10.5 ms
4.8 Gb/s(ATM OC-96)
32.6 sec. 5.0 sec. 21 ms
2.4 Gb/s(ATM OC-48)
Note: Service classes changing faster than ever
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Technology:ATM Collaborative Computing
Live or stored video image transfer
Desktop VideoTeleconference
Collaborative Work Board
{Sample: discussing telemedical application}
{Sample: tissue sample from patient}
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WDM Technology Pre-WDM:
– On a single strand of fiber, a point-to-point backbone link would carry an OC-48 SONET signal at a single wavelength
With WDM:– On a single strand of fiber, a point-to-point backbone link
could carry multiple wavelengths (color bands) each wavelength capable of carrying an OC-48 SONET signal
– Point-to-point throughput increases by a factor equal to number of wavelengths accommodated by the WDM equipment (4-8 in 1995)
– Next development trend in WDM is true optical networking via optical cross connects where direct switching of optical signals rather than time slots are performed• Technology trend towards direct IP over WDM (bypassing
SONET equipment)
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Dense Wave Division Multiplexing (DWDM) Cost Savings Versus SONET Take advantage of DWDM bit-rate independence and lack of
scaling capital expenditure as compared to SONET
Source: NGN - 1998 Conference Proceedings
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Technology:Smart Cards Definition
– Plastic card with embedded silicon chip, 1 to 8 kilobytes of memory, microprocessor, operating system in ROM (Read Only Memory).
Capabilities– Typical 1- 8Kbytes storage memory– 32kByte chips being developed– Price range now $2 to $25 per card (8Kb cards @$2)
Medical Applications– Military experimenting in triage situations (Dog Tag replacements)– Insurance firms considering usage to
• reduce cost of accounting for medical• future storage of patient records (assuming medical records policy
changes takes place) Progress
– Slow, with focus on billing/accounting– Expected to take off in near future if policy on records change
Future– Could be useful in remote areas given inexpensive readers available
(current readers cost $300 +)
Reference: 3GI home page -http://www.3GI.com/
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Technology:Wireless
Today’s Services Basic voice service Fax / Paging (one-way, two-way) Limited e-mail and internet access
9.6 Kbps to 14.4 Kbps
Base StationBSC
VLR/HLR/
AUC/E IR
M SC(Circuit Sw itched Cards)
ISP
PST N
AUC Authentication CenterBSC Base Station ControllerEIR Equipment Identification RegisterHLR Home Location RegisterISP Internet Service ProviderMSC Mobile Switching CenterPSTN Public Switched Telephone NetworkVLR Visitor Location Register
Key:
Base Station
H.320
BSC
VLR/HLR/AUC/EIR
MSC
IP Network
PSTNn X DS1 or DS-3
IP Gateway
Corporate Intranet
VideoServer
3G Wireless Switch
Air Interface: 3G CDMA Based 5 MHz RF Channels
Future
Future Services Digital Voice and Data services Fax / Paging (two-way) Full High Speed E-mail / internet access
28.8 Kbps to n x 1.5 Mbps
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Technology: Other Available Services Supporting Telemedical Applications
Digital Subscriber Loop Services Cable Modems Frame Relay (predecessor for IP networks) Wireless services (cellular, satellite, other) Faster CPUs and memory storage explosion Future growth of digital record keeping acceptance
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Technology: Summary Technology is changing exponentially Internet services in urban areas represent a possible
outreach approach to the public with high bandwidth offerings and ubiquity of the services
Cost of bandwidth is dropping rapidly Telemedicine requires bandwidth which is now becoming
more affordable and available in urban areas Urban areas are ripe for considering new technology
applications as never before (e.g., wireless beyond the pager and cell phone explosion
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Technology:Recommendations
Perform the cost-benefit tradeoff studies now to identify longer term applications of new technologies in telemedicine
Due to the explosive nature of technology changes be flexible in buying into the new offerings (2 to 3 year contracts with options to change or get out; lease as much as possible, don’t own your systems)
Finally, encourage changes in insurance and legal restrictions to allow more telemedicine as facts prove their benefits.
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Contact Information
Frank E. Ferrante
Mitretek Systems, Inc.
Senior Manager, Systems Engineering and Acquisition
Center for Telecommunications and Advanced Technology
7525 Colshire Drive
McLean, VA 22102-7400
[email protected] Tel: (703) 610-2905 fax: (703) 610-2984