Telehealth and Telemedicine Sri Lankan Experience of high quality medical image and voice transfer t

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Telehealth and Telemedicine Sri Lankan
Experience of high quality medical image and
voice transfer through internet

• J.U Weerasinghe (Faculty of Dental Sciences,
  Peradeniya)
• Vajira Dissanayaka (Faculty of Medicine, Colombo)
• Duminda Nishantha, Yukuo Hayashida (SAGA
  University, Japan),  

WONCA-MESA Informatics Symposium Colombo, 9th
November 2002
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Telehealth and Telemedicine Sri Lankan
Experience of high quality medical image and
voice transfer through internet

• Telehealth
• Telemedicine
• exchange of material offline
• realtime (online) image transfer
• SAGA and Peradeniya
• commercial software

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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

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Telemedicine

• Telemedicine typically involves medical personnel
  using   images, video and audio facilities either
  non-real-time or real-time (online) for remote
  consultations. 
• An expert physician far away can guide the local
  medical personnel in treatment planning remotely

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Telemedicine -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 patients and provides
  follow-up care.

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Telemedicine -realtime (online) image transfer

• need for high quality still images, video and
  audio and other electronic material to be
  exchanged between the remote center and   the
  experts using videoconferencing equipment.
• experts outside will be able to guide the remote
  center

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Telemedicine- non realtimestore and forward
method

• Usage
• Teleradiology
• Telepathology
• Teledermatology

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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

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Telemedicine -realtime

• Advantages
• 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 bandwith in the network
• Lack of funds for equipment and software
• Lack of technical help

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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
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SAGA Medical School
SAGA University (Engineering)
Faculty of Dental Sciences- Peradeniya
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Previously used method - Store 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

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Realtime image transferusing a dedicated software
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Basic requirements

• RequirementsVideoconferencing equipment
• A Digital Video (DV) camcorder (IEEE1394
  interface)
• OR Digital camera with USB connection
• with microphone and speakers
• Desktop/ Laptop computer
• Internet access - leased line/ Local Area
  Network
• Dedicated software

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Shortcomings of commercial software

• The existing commercial applications do not
  guarantee the quality of images at low speed
  networks because of the streaming technology
  employed. only concerns the maintenance of
  continuity of images rather than the quality.
• such applications do not support an integrated
  environment with all the functions required to
  carry out medical collaboration
• image manipulation, tele-pointing facility on
  the image canvas, shared-board
• clinicians would prefer a user-friendly operating
  environment specifically designed for medical
  applications.
• Eg- Messenger. Netmeeting, CuSeeMe, freetalk,

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Dedicated 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

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Software Overview
WEB File transfer
IP
Preview Transmit Receiving windows
Transmit from Remote centre
Receiving from Expert abroad
Shared Board

• Image Transceiver software developed in SAGA

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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

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Shared Board Facility
Marker from expert
Marker from local team

• Both parties can use markers on the same image
  canvas
• Allow common base for discussions
• Text typing facility

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WEB Facility
presentation

• File transfer facility
• Powerpoint presentations can be
• transferred and run as a lecture from
• the remote location
• Ideal tool for CME

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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.

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Application of the technique

• Between Faculty of Dental Sciences Peradeniya and
  SAGA Medical School
• An interactive session for JICA trainees in SAGA
  was conducted

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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

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Summary

• This system is for Realtime 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

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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 University
• Sri Lanka
• Prof N A de S Amaratunga - Dean, Faculty of
  Dental Sciences, Peradeniya
• Dr. Nimal Ratanayaka- the 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 - Community Medicine and Family
  Health Faculty of Medicine, University of
  Kelaniya