Seminar Report

On

MOBILE TELEMEDICINE SYSTEM

Submitted in partial fulfillment of the requirements for the award of the degree of

Bachelor of Technology

in

COMPUTER SCIENCE AND ENGINEERING

by

DRISHYA A.GOPAKUMAR

November 2006

Department of Computer Science and Engineering

Sree Narayana Gurukulam College of Engineering, Kolenchery
 Department of Computer Science and Engineering

A Sree Narayana Gurukulam College of Engineering, Kolenchery

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CERTIFICATE

This is to certify that the seminar report titled MOBILE TELEMEDICINE

n SYSTEM submitted by DRISHYA A. GOPAKUMAR is a bonafide work done

A by her under our supervision.

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 ACKNOWLEDGEMENT

Firstly I would like to express my sincere gratitude to the Almighty for His
solemn presence throughout the seminar study .I would also like to express my special
thanks to the Principal Prof. K. Rajendran for providing an opportunity to undertake this
seminar .I am deeply indebted to our seminar coordinator Mr. Saini Jacob, Assistant
Professor in the Department of Computer Science and Engineering for providing me
with valuable advice and guidance during the course of the study.

I would like to extend my heartfelt gratitude to the Faculty of the Department

of Computer Science and Engineering for their constructive support and cooperation at
each and every juncture of the seminar study.

Finally I would like to express my gratitude to Sree Narayana Gurukulam

College of Engineering for providing me with all the required facilities without which
the seminar study would not have been possible.
Mobile telemedicine system

ABSTRACT

Effective emergency mobile telemedicine and home monitoring solutions are the thrust
areas discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health
location such as ships navigating in wide seas are common examples of possible emergency
sites, while critical care telemetry and telemedicine home follow-ups are important issues of
telemonitoring. In order to support the various growing application areas explained above a
combined real-time store and forward facility that consists of a base unit and a telemedicine
(mobile) unit is used. This integrated system can be used when handling emergency cases in
ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a
base unit at the hospital-expert's site. This enhances intensive health care provision by giving a
mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site
and enables home telemonitoring, by installing the telemedicine unit at the patient's home
while the base unit remains at the physician's office or hospital. The system allows the
transmission of vital bio signals (ECG, SPO2, NIBP, IBP, Temperature) and still images of the
patient. The transmission is performed through GSM mobile telecommunication network,
through satellite links (where GSM is not available) or through Plain Old Telephony Systems
(POTS) where available. Using this device a specialist doctor can telematically "move" to the
patient's site and instruct unspecialized personnel when handling an emergency or
telemonitoring case.

Dept. of C.S.E S.N.G.C.E Kolenchery
 CONTENTS

Page No:

INTRODUCTION 01

)=. TRENDS AND NEEDS OF THE SYSTEM 02

SYSTEM DESIGN AND TECHNICAL IMPLEMENTATION 04

TELEMEDICINEUNIT 05

BASEUNIT 07

IMAGETRANSMISSION 09

WAVEFORMSTRANSMISSION 09

COMPRESSION & ENCRYPTION 10

CLINICAL TESTS 11

FUTURE SCOPE 12

)=. CONCLUSION 13

BIBLIOGRAPHY 14
Mobile telemedicine system

INTRODUCTION

Mobile telemedicine is defined as the delivery of health care and sharing of medical
knowledge over a distance using telecommunication means. Thus, the aim of telemedicine is to
provide expert-based health care to understaffed remote sites and to provide advanced
emergency care through modern telecommunication and information technologies. This
integrated system can be used when handling emergency cases in ambulances, rural health
centers (RHC) or ships by using a mobile telemedicine unit at the emergency site and a base
unit at the hospital-expert's site. This enhances intensive health care provision by giving a
mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site
and enables home telemonitoring, by installing the telemedicine unit at the patient's home
while the base unit remains at the physician's office or hospital. The system allows the
transmission of vital bio signals and still images of the patient. The transmission is performed
through GSM mobile telecommunication network, through satellite links (where GSM is not
available) or through Plain Old Telephony Systems (POTS) where available. Using this device
a specialist doctor can telematically "move" to the patient's site and instruct unspecialized
personnel when handling an emergency or telemonitoring case. Today, mobile telemedicine
systems are supported by State of the Art Technologies like Interactive video, high resolution
monitors, high speed computer networks and switching systems, and telecommunications
superhighways including fiber optics, satellites and cellular telephony

Critical care telemetry is another case of handling emergency situations. The main
point is to monitor continuously intensive care units' (ICU) patients at a hospital and at the
same time to display all telemetry information to the competent doctors anywhere, anytime. In
this pattern, the responsible doctor can be informed about the patient's condition at a 24-hour
basis and provide vital consulting even if he's not physically present. This is feasible through
advanced telecommunications means or in other words via telemedicine. Another important
telemedicine application area is home monitoring.

Dept. of C.S.E S.N.G.C.E Koknchery
Mobile telemedicine system

TRENDS AND NEEDS OF

MOBILE TELEMEDICINE SYSTEMS
Telemedicine system is able to handle different critical problems in the area of distant
medication like:
Emergency health care provision in ambulances, Rural Hospital Centers (or any other
remote located health center) and navigating Ships
Intensive care patients monitoring
Home telecare, especially for patients suffering from chronic or permanent diseases
(like heart disease).
Mobile telemedicine is a "Multi-purpose" system consisting of two major parts:
a) Telemedicine unit and b) Base unit or doctor's unit
Figure 1 describes the overall system architecture. The Telemedicine unit is
located at the patient's site, whereas the base unit (or doctor's unit) is located at the place where
the signals and images of the patient are sent and monitored. The Telemedicine device is
responsible to collect data (bio signals and images) from the patient and automatically transmit
them to the base unit. The base unit is comprised of a set of user-friendly software modules,
which can receive data from the Telemedicine device, transmit information back to it and store
important data in a local database. The system has several different applications, according to
the current healthcare provision nature and needs.

Before the system's technical implementation, an overview of the current

trends and needs in the aforementioned Telemedicine applications was made, so that the
different requirements are taken into account during design and development, thus ensuring
maximum applicability and usability of the final system in distinct environments and
situations. Table provides the results of this overview, which was done towards a predefined
list of criteria that usually influence a Telemedicine application implementation (cost,
portability, autonomy, weight and size of Telemedicine device, type and quality of PC and
camera, communication means used).

Dept. of C.S.E 2 Kolenchery

Mobile telemedicine system

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Figure 1: Overall system architecture

Dept. of C.S.E 3 S.N.G.C.E Kolenchery

Mobile telemedicine system
SYSTEM DESIGN AND TECHNICAL
IMPLEMENTATION

As mentioned above, the system consists of two separate modules (Figure 1): a) the
unit located at the patient's site called "Telemedicine unit" and b) the unit located at doctor's
site called "Base Unit". The doctor might be using the system either in an emergency case or
when monitoring a patient from a remote place. The design and implementation of the system
was based on a detailed user requirements analysis, as well as the corresponding system
functional specifications. The Telemedicine unit is responsible for collecting and transmitting
bio signals and still images of the patients from the incident place to the doctor's location while
the doctor's unit is responsible for receiving and displaying incoming data.
The information flow between the two sites can be seen in Figure 2. The software
design and implementation follows the client server model. The Telemedicine unit site is the
client while the Base unit site is the server. Communication between the two parts is achieved
using TCP/IP as network protocol, which ensures safe data.

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Figure 2: Information Flow within the Telemedicine system (Telemedicine and base
units)

Dept. of C.S.E 4 S.N.G.C.E Kolenchery
Mobile telemedicine system

TELEMEDICINE UNIT

The Telemedicine unit mainly consists of four modules, the bio signal acquisition
module, which is responsible for bio signals acquisition, a digital camera responsible for image
capturing, a processing unit, which is basically a Personal Computer, and a communication
module (GSM, Satellite or POTS modem).
The bio signals collected by the patient (and then transmitted to the Base Unit) are:
ECG
Oxygen Saturation (Sp02).
Heart Rate (HR).
Non-Invasive Blood Pressure (NIBP).
Invasive blood Pressure (IP).
Temperature (Temp)
Respiration (Resp)

Data interchange is done using the TCP/IP network protocol, which

allows operation over several communication means. The PC is equipped with the proper
modem for each case, i.e. GSM, Satellite or POTS. The design was done for standard Hayes
modems. Several modems types were used for testing:
GSM 900 modem-for GSM NW
POTS modem 56K-for telephone nw
The Telemedicine unit is also responsible for the collection and
transmission of images of the patient to the base unit,a digital camera responsible for image
capturing. Several cameras were used while testing the system:
ZOOM digital camera connected to the PC's parallel port model 1585.
ZOOM digital camera connected to the PC's usb port model 1595.
c) Creative camera connected to usb .

Dept. of C.S.E 5 S.N.G.C.E Kolenchery
Mobile telemedicine system

The control of the Telemedicine unit is fully automatic.

The only thing the telemedicine unit user has to do is connect the bio signal monitor to the
patient and turn on the PC. The PC then performs the connection to the base unit automatically.
Although the base unit basically controls the overall system operation, the Telemedicine unit
user can also execute a number of commands. This option is useful when the system is used in
a distance health center or in a ship and a conversation between the two sites takes place.

Figure 3 Picture of telemedicine mobile unit (monitor Propaq 2xx is used)

Dept. of C.S.E 6 S.N.G.C.E Kolenchery

Mobile telemedicine system

BASE UNIT (OR DOCTOR'S UNIT)

The base unit mainly consists of a dedicated PC equipped with a modem,

which is responsible for data interchange. In addition the base unit pc is responsible for
displaying incoming signals from the Telemedicine unit. When an expert doctor uses the base
unit located outside the hospital area, a portable PC equipped with a GSM modem or a desktop
PC equipped with a POTS modem is used. When the base unit is located in the hospital, a
desktop PC connected to the Hospital Information Network (HIS) equipped with a POTS
modem can additionally be used; the expert doctor uses it as a processing terminal.

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Figure 5: Telemedicine Network control — Base Unit

Dept. of C.S.E 7 S.1V.G.C.E Kolenchety

Mobile telemedicine system

The user is able to monitor the connection with a client

(telemedicine unit), send commands to the telemedicine unit such as the operation mode (bio
signals or images) Figure 4. In cases were the base station is connected to a Hospital LAN the
user can choose to which of the telemedicine units to connect to, as shown in Figure 5 the user
of the base unit is able to choose and connect to anyone of the telemedicine units connected on
the network.
Figure 6 presents a typical bio signal-receiving window
(continuous operation). When the system operates on still image mode, the doctor can draw-
annotate on the image and send the annotations back to the Telemedicine unit. When operating
on bio signal mode (Figure 6), the transmission of vital bio signals can be done in two ways,
continuous way or store and forward way, depending on the ECG waveform channels which
are transmitted and the telecommunication channel data transfer rate. In continuous operation,
the Base Unit user can send commands to the Telemedicine Unit monitor, such as lead change
or blood pressure determination; the user can also pause incoming ECG, move it forward or
backward and perform some measurements on the waveform.

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Figure 6 Bio signal receiving window at Base Unit

Dept. of C.S.E 8 S.N.G.C.E Kolenchery
Mobile telemedicine system

IMAGE TRANSMISSION

Images captured by the Telemedicine unit's camera have resolution 320 x 240 pixel and
are compressed using the JPEG compression algorithm; the resulting data set is approximately
5-6 KB depending on the compression rate used for the JPEG algorithm .

WAVEFORMS TRANSMISSION

Two major portable monitors firms were used in this study, which can provide three to
twelve leads waveform of ECG and numeric data from other bio signals (HR, Sp02, NIBP, IP,
Temp). The first of the monitors used, CRITIKON DINAMAP PLUS Monitor has a digital
output of a continuous one channel ECG plus bio signals such as NIBP, Sp02, HR, IP and data
concerning monitor alarms etc.

The second of the monitors used, PROTOCOL Propaq Monitor has a digital output of a
continuous one (model I xx) or two (model 2xx) channels ECG, plus another waveform such as
SpO2 or Co2; plus bio signals trends such as NIBP, Sp02, FIR, IP and data concerning monitor
alarms etc. All above information can be transferred using up to 2400 BPS for one channel
ECG, up to 4400 for two channels of ECG or up to 5400 for two channels of ECG plus another
waveform (SpO2 or Co2). For this reason, the continuous transmission of signals from this
monitor can be done when using GSM and POTS but only one lead ECG when using 2400
BPS satellite links.

Dept. of C.S.E 9 S.N.G.C.E Kolenchery
Mobile telemedicine system

COMPRESSION & ENCRYPTION

In order to decrease data size, a lossless ECG compression algorithm based on Huffman
coding algorithm is implemented in the system and can be applied on transmitted signals,
when needed by the Base Unit user.
An encryption algorithm was implemented in the system and can be used when
needed by the hospital unit user. The system can encrypt interchanged data using the Blowfish
cipher algorithm . The use of encryption is optional and can be selected by the user;
authentication and connection between base and telemedicine units is done using encrypted
messages.

Dept. of C.S.E 10 S.N.G.C.E Kolenchery
Mobile telemedicine system

CLINICAL TESTS
The system has been clinically tested through installation and extended validation of
the system in a number of distinct demonstration sites across Europe. More specifically the use
of the developed system in emergency cases handling in ambulances has been extensively
demonstrated in Greece, Cyprus, Italy and Sweden. The initial demonstration of the system for
ambulance emergency cases was performed on 100 emergency cases for each hospital.

The use of system in Rural Health Centers has been tested extensively tested in Cyprus.
The use of the system in a Ship is currently being used in Athens Greece and finally the use in
home telecare is also being tested in Athens Greece. The system is currently installed and
being used in two different countries, Greece and Cyprus.

Dept. of C.S.E 11 S.N.G.C.E Kolenchery
Mobile telemedicine system

FUTURE SCOPE
Current technology has severe inadequacies that need addressing. Firstly the capability of
current system is limited by the bandwidth availability of the data transmission tools like GSM.
Future work would concentrate on improving the message transmission making the system
response fast. This would enhance the current technology to reach people at a much larger
scale.

Dept. of C.S.E 12 S.N.G.C.E Kolenchery

Mobile telemedicine system

CONCLUSION

We have developed a medical device for telemedicine applications. The device uses
GSM mobile telephony links, Satellite links or POTS links and allows the collection and
transmission of vital bio signals, still images of the patient and bi-directional telepointing
capability. The advance man-machine interface enhances the system functionality by allowing
the users to operate in hands-free mode while receiving data and communicating with
specialists. The final system is currently installed and used in two different countries Greece
and Cyprus. Results from the system use are very promising thus encouraging us to continue
the development and improvement of the system in order to be able to cover additional future
needs.

Dept. of C.S.E 13 S.N.G.C.E Kolenchery
Mobile telemedicine system

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Dept. of C.S.E 14 S.N.G.C.E Kolenchery