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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

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

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

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

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.

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

Telemedicine- non 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

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

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

SAGA Medical School

SAGA University

(Engineering)

Faculty of Dental Sciences- Peradeniya

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

Realtime image transferusing a dedicated software

Basic requirements

Requirements:Videoconferencing 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

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,

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

Software Overview

Image Transceiver software developed in SAGA

IP

PreviewTransmitReceivingwindows

Shared Board

WEBFile transfer

Transmit from

Remote centre

Receiving from

Expert 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• 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

Thank You!

• JapanProfessor 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