Role of Telemedicine in Health Wellness

Presented By

​

Dr. S.N Kumar

Assistant professor

Department of EEE

Amal Jyothi College of Engineering

What are biosignals?

• All types of biomedical systems either generate the signals to influence the human body, or analyze biosignals to extract useful information about functioning of human body.

​

• Signal – is the parameter that is observable from the object.

​

• Biosignal is a description of physiological phenomenon of any nature.
• Bio+Signal = “living object” + “function that carries information about the behavior or state”.
• Biosignals are the key objects in Biosystems.

Why bio-signals?

• Bio-signal carries all information about the living object. We analyze signals which are coming from the body (ECG, EEG etc.) or are connected to the body (X- ray images, ultrasonic images).
• Bio-signal can be used to understand the underlying physiological mechanisms of a specific biological event or system.

Bio-signals through centuries

Hippocrates palpating a young patient (500 BC)

ICU in modern hospital (2016 AD)

Classification of bio-signals

According to the physical nature of bio-signals

Electric Signal

Mechanical Signal

Magnetic Signal

Chemical Signal

Thermal Signal

Optical Signal

Electric signals

Electric field is generated in cells (nerve and muscle) and organs because of intra- and extracellular ionic currents. They are the results of electrochemical processes in the single ionic channels.

Types of electrical signals

Neural cells

ENG – Electroneurogram

EEG – Electroencephalogram ERG – electroretinogram

Muscle cells

ECG – Electrocardiogram EMG – Electromyogram

​

Other cells

EOG – Electrooculogram

GSR – Galvanic skin response

ECG Generation

Magnetic bio-signals

Weak magnetic fields are generated by different organs and cells

​

Neural cells

MNG – Magneto neurogram

MEG – Magneto encephalogram

​

Muscle cells

MCG – Magneto cardiogram

MMG – Magnetomyogram

Phonocardiogram (PCG)

PCG reflects sounds of heartbeats, produced by heart sounds corresponding to two consecutive heart valve closures. Indicates closure strength and the valve’s stiffness.

Respiratory sounds

Reflect normal breathing sounds superimposed with crackles, cough sounds, rhonchus, snoring, squawk, stridor and wheeze sounds, which are associated with pulmonary disorders.

Thermal bio-signals

Body temperature in the point and temperature maps, may describe heat loss and heat absorption in the body, or temperature distribution over the body surface.

Thermography ( Temperature maps)

• Cancer
• Varicose veins
• Osteochondrosis, osteoporosis

Body Area Network

• A body area network (BAN) is a network that includes a collection of wearable devices. It is a specific type of wireless network with a very particular use and scope

​

​

• Sensors used in MBAN are classified by two main categories:

​

• A wearable BAN -for physiological monitoring

​

• An implantable BAN diabetes management, drug delivery through a micro-pump or micro-port, insulin.

MBAN sensors

BAN Target area -Data rate vs Power

BAN Architecture

Hardware Architecture of BAN

Devices used:

• Sensor node
• Actuator node
• Personal device

Software Architecture

Software have a well-defined interface to integrate hardware and application programs

Software include three levels:

​

​

​

• Firmware
• OS
• Application Software Stacks

Sensor Node

Gathers data on physical stimuli, processes the data if necessary and reports this information wirelessly.

​

Consists of several components:

​

• Sensor hardware
• A power unit
• A processor, memory and
• A transmitter or transceiver.

​

Example: i Rhythm

Actuator node

Acts according to data received from sensors / through interaction with the user.

​

​

Components similar to sensors:

• Actuator hardware (e.g. hardware for medicine administration, including a reservoir to hold the medicine)
• A power unit, a processor, memory and
• A receiver or transceiver

Personal Device

Gathers all the information acquired by the sensors and actuators

Informs User (i.e. the patient, a nurse, a doc etc.) via an external gateway, an actuator or a display/LEDS on the device.

​

Components:

A power unit, a (large) processor, memory and a transceiver.

Body Control Unit (BCU) , body gateway or a sink.

​

Example: PDA

BAN Medical Devices

• Pacemaker
• Implantable Cardioverter Defibrillator (ICD)
• Spinal Actuators
• Insulin pump
• Continuous Glucose Monitoring
• Deep brain stimulator
• External & Implantable Hearing Aids - cochlear implant
• Retina implants
• Muscular signal replacement

Mobile Health

Telemedicine

• Means "distance healing“.
• Derived from a Greek word "Tele" meaning "distance" and a Latin word "mederi" meaning "to heal“.
• Is not one specific technology but a way of providing healthcare services at a distance using telecommunications technology, medical expertise & computer science.
• Telemedicine is the future of global healthcare.

Definition: Telehealth

A tool for enhancing health care, public health, and health education delivery and support, using electronic communication and information.

​

​

Providing/receiving health care services at a distance.

Telehealth:

• Telemedicine
• Remote Monitoring
• Store-and-Forward
• Direct-to-Consumer/Primary Care
• Mobile Health (apps-based)

Telehealth @ Nebraska Medicine

Types of Telemedicine

Realtime (synchronous)

• Could be as simple as a telephone call or as complex as robotic surgery.
• Requires the presence of both parties at the same time.
• E.g. : Video-conferencing equipment
• There are also peripheral devices which can be attached to computers or the video-conferencing equipment which can aid in an interactive examination.
• For instance, a tele-otoscope allows a remote physician to 'see' inside a patient's ear; a tele-stethoscope allows the consulting remote physician to hear the patient's heartbeat

Store and Forward (asynchronous)

• Involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline.
• Does not require the presence of both parties at the same time.
• Dermatology, radiology, and pathology.
• A properly structured Medical Record preferably in electronic form should be a component of this transfer.
• Teleradiology, the sending of x-rays, CT scans, or MRIs (store-and-forward images).
• Many radiologists are installing appropriate computer technology in their homes, so they can have images sent directly to them for diagnosis, instead of making an off-hours trip to a hospital or clinic.

​

Application Adopted

• Most beneficial for populations living in isolated communities and remote regions and is currently being applied in virtually all medical domains.
• Use a "tele-" prefix;
• Useful as a communication tool between a general practitioner and a specialist available at a remote location.
• Telepathology
• Telecardiology
• Teleradiology
• Telesurgery
• Teleopthalmology

​

Advantages of Telemedicine

• Resource utilization
• Early intervention
• Avoids unnecessary transportation
• Community based care
• Medical education and research
• Cost saving
• Improved patient documentation
• Increased range of care and education.

​

Resource Utilization

• In India doctor population ratio is 1:15000 in comparison to 1:500 in developed nations, and these doctors are not distributed equally.
• 80% Indian population lives in rural and semi urban areas.
• Telemedicine can help in cost effective utilization of meager resources and of the same time can decrease patient work load on few referral centers.

​

Early Intervention

• There are factors that inhibit the continuity of care. Issues such as geographic location, inclement weather, socioeconomic barriers.
• Patient apathy are significant factors that delay and even prevent the specialty care.
• By providing these primary cure sites with the ability to quickly access specialty consultation services.
• Patients are able to reap the benefits of early intervention while the health care system maintains quality service and clinical efficiency.

​

Avoids Unnecessary transportation

• Patient can discuss the issues on Video Conferencing with the consultant.
• Even the vital parameters and be captured with the help of devices and sent to doctor.
• Unnecessary referral and patient transport can be definitely avoided.

​

Community base Care

• People like to receive high quality care in their local community.
• This reduces travel time and related stresses associate with many referrals.

​

Medical Education and Research

• When medical students are posted in rural area they can be linked to medical college for grand rounds and they can also do case presentation �to teachers in medical colleges.
• Physicians living in different parts of the world also use telemedicine in collaborative research, they can also share data or can discuses current �trends.

​

Cost Saving

• Reduced physician’s fees and cost of medicine.
• Reduced visits to special hospitals.
• Reduced travel expenses.

​

Telemedicine System

• ACTUALLY WHAT HAPPENS DURING A TELEMEDICINE PROGRAM?

​

Telemedicine Infrastructure

• This will include minimum standards for all the hardware and software used in a telemedicine system.

​

• Under hardware it will include standards and guidelines for basic telemedicine platform, servers, clinical devices, video conferencing system, communication hardware and power support.

​

• The software standards address operating system, telemedicine software, and server software.

​

Hardware

• Telemedicine platform:
• This will include minimum standards for type of platform to be used, processor/minimum speed, memory requirements, interfaces, and peripherals.
• Clinical devices
• This will include minimum standards for all the clinical devices to be interfaced or integrated with the telemedicine system, including performance specifications for devices measuring diagnostic parameters, imaging devices, compression, and their safety requirements.
• Video conferencing units
• This will include minimum standards for video conferencing system, including data rate, picture resolution, frame rate, type of camera, audio quality etc.
• Communication hardware
• This will include minimum standards for various hardware used for interfacing the telemedicine system with the communication network, including all types of terrestrial and satellite based networks.

​

​

Software

• An operating system
• Licensed telemedicine S/W with appropriate User Interface(UI)
• Back-end Data Base with the mandatory tables/ fields (if applicable)

​

Connectivity

• Options for telemedicine services
• VSAT
• PSTN
• ISDN
• Leased Line
• Wireless LAN /WAN

​

Telemedicine Tools

Barriers of Telecommunication

• Low or small bandwidth.
• Neither telephone lines nor electricity in rural and remote areas.
• Satellite transmission can help but it is very costly.
• Unstable electricity supply.
• Patient’s fear and unfamiliarity.
• Financial unavailability.
• Lack of basic amenities.
• Literacy rate and diversity in languages.
• Quality aspect.
• Government support.

Need of Telemedicine in India

• The advances in Medical science, biomedical engineering on one side and Telecommunication and Information Technology on the other side are offering wide opportunities for improved health care.
• Health coverage to majority of our population is still a distant dream.
• India is a vast country gifted with rich and ancient historic background and geographically the nature has provided India with all the varieties like the mountain regions like Ladakh, deserts, green planes and far flung areas in the north east and offshore islands of Andaman’s and Lakshadweep.
• 1 billion population.
• Predominantly rural and distributed in distant geographical locations.

​

​

Need of Telemedicine in India

• Further this is compounded by the following factors like:

​

• High cost of health care and lack of investment for health care in rural areas.
• Inadequate medical facilities in rural & inaccessible areas.
• Problem of retaining doctors in rural areas where they are required to serve & propagate widespread health awareness.

​

​

Need of Telemedicine in India

• A recent survey by the Indian Medical society has found
• 75% of qualified consulting doctors practice in urban centers and
• 23% in semi urban areas and
• only 2% from rural areas whereas majority of the patients come from rural areas.
• Hospital beds / 1000 people is 0.19 in rural and
• 2.2 in urban areas.
• This calls for innovative methods of utilization of science and technology for the benefit, of our society and telemedicine assumes a great significance to revolutionize the health care system in India.

Telemedicine in Kerala

• Telemedicine

The RCC established Telemedicine in September 2004 with the help of Indian Space Research Organisation (ISRO) and CDAC, Trivandrum.

​

• ACHIEVEMENTS

​

Established high bandwidth connectivity between Regional Cancer Centre, Thiruvananthapuram and its peripheral centres at Kollam, Kozhencherry, Ernakulam, Palakkad and Kannur using satellite communication. High quality Video Conferencing, Tele-pathology and Tele-radiology equipment and software required for interfacing these equipment have been developed.

​

• Follow-up of Patients through Telemedicine

​

Cancer is a disease, which needs prolonged treatment and lifelong follow-up. To avoid unnecessary patient travel, RCC has introduced monthly follow-up clinics at its five sub-centres. Patients returning home after the initial treatment at the RCC can communicate their post-treatment problems and results of investigations from nodal centres. The doctors at the RCC also render advice for terminally ill patients who require only palliative care. The RCC has 5 peripheral centres with essential infrastructure at Kollam, Ernakulam (Kochi), Palakkad, Kozhencherry and Kannur. Besides helping patients for follow-up, the online facility also provides counseling. Apart from RCC patients, the public as well as doctors of other institutions can also avail themselves of ONCONET services.

​

Tele-pathology Clinic�

​

• Tele-pathology uses telecommunication technology to transmit data and pathology images to and from remote centres for diagnosis, education and consultation.
• A tele pathology system consists of a high-resolution video camera mounted on conventional microscope to capture digital images of pathologic slides and a telecommunication set-up to transmit images to a remote centre.
• The RCC conducts regular tele-pathologic consultations between Kannur and Kochi Early Cancer Detection Centres.
• RCC also seeks expert opinions on pathology from expert centres in USA like Mayo Clinic, UICC, Armed Forces Institute of Pathology and Tata Memorial Centre, Mumbai.

Available today

• mHealth

Wi-Fi Smart Scale

Otoscope

Blood Pressure Monitor

Bluetooth Stethoscope

Blood Glucose Meter

Digital Thermometer

Robotics

Remote Surgery

Live Monitoring via Cell Phones

At Home, at the Office, �on the Go, at a Kiosk�

Case Study -1

Development of a portable instrument for medical image analysing, Compression and transmission compatible for CT/MRI low slice thickness images

• Develop a portable embedded system based instrument for analyzing, compression and transmission of medical DICOM images.
• Develop an improved restoration model for the removal of noise and intensity in homogeneity acquired during the CT/MR image acquisition.
• Develop an efficient and robust software system for the extraction of region of interest in CT/MR medical image modalities.
• Develop an optimum Neuro fuzzy classifier for the classification of stages of tumor and other anomalies.
• Develop an efficient lossless algorithm for region of interest (ROI) and lossy algorithm for non ROI regions in CT/MR images for effective compression.
• Efficient data transfer with minimum traffic through telemedicine network by a hybrid compression algorithm.

Embedded device for Telemedicine Application

Thank You