Overview
The goal of the telemedicine and consultation program is to develop, test, and utilize innovative applications of conventional and next generation Internet and other related technologies for medical consultation. An important sub-goal is to test the viability of Internet technology for deliverying varied clinical content and to explore network quality of service issues associated with its delivery. A related goal is disseminate knowledge about the the use of computing and communication technology for healthcare practice and research that has emerged from iniatives in telemedicine and Next Generation Internet that have been sponsored by the National Library of Medicine's (NLM) Office of High Performance Computing and Communication (OHPCC). Another sub-goal is to explore the usefullness of palmtop computers and other nomadic computing devices in clinical care and education.
The telemedicine and consultation and the distance learning and collaboration R & D programs of the OHPCC are integrated closely. Both programs share much of the same technology infrastructure in the collab and common assumptions about the relationships between telemedicine and distance learning in health care practice. Both programs are predicated on the notion that telemedicine involves consulting online information and education resources as well as other professionals and that learning is an important outcome of the consultative process. When practioners interact with information resources and each other, they acquire new knowledge as a result. Information about related distance learning and collaboration R and D activities can be found at the Distance Learning and Collaboration Page.
Areas of Experimentation
Testbed for Collaborative Videoconferencing in Medical Education and Consultation
A testbed environment demonstrating use of MPEG2 videoconferencing and NTSC quality video over Internet2 and Next Generation Internet has been developed for use in the telemedicine/consultation and distance learning/collaboration programs. The technology allows point to point and multi-point videoconferencing (via multicast) between the collab and remote sites. The testbed environment allows transmission of a range of medical content from varied sources, including presentation stands, videomicroscopes, videotape, digital stethoscopes, and so forth. Demonstrations of the technology are ongoing and configuration of the testbed continues to evolve. A configuration used in an early test is shown below with a description of the specific devices used at NLM and a remote site. Various levels of encoding were employed ranging from 1.5 to 15 mbps. No transmission artifacts were observed at bit rates of 7.5 mbps. Subsequent test have involved using Welch-Allen otoscopes, ophthalmoscopes, and digital stethoscopes to transmit clinical information. The plan is to test other devices and types of clinical content.
Equipment configuration employed at NLM:
1. Sony Video Presentation Stand VID-P100 backlit for showing slides and 3-D images.
2. Olympus BX40 microscope with 3 chip S-Video CCD camera (OLY 750) for showing pathology slides.
(www.olympusamerica.com)
3. Pentium computer with a S3 TrioVision2 video capture card for sharing images captured with the microscope and interacting with
them. (The signal from the microscope is directed to both the computer and MPEG2 encoder.)
4. ImageQuest imaging software. (www.visual-med.com)
5. Standard VHS S-Video videotape player for showing motion images of disease symptoms.
6. S-Video camera, microphone, and monitor for NLM to communicate with remote site.
7. Litton Network Access Systems CAMVision2 MPEG2 encoder/decoder for real time interaction/consultation between NLM and
remote site.
8. Switcher box enabling NLM staff to direct output from the various camera and tape sources to the encoder/decoder.
Equipment employed at remote site:
1. Litton Network Access Systems CAMVision2 MPEG2 encoder/decoder for real time interaction/consultation between NLM and
remote site.
2. S-Video camera, microphone, and monitor for remote site to communicate with NLM.
3. Pentium computer for sharing captured images and interacting with them.
Web-Based, Portable, Handheld Devices and Personal Digital Appliants
Wireless devices and wireless access to the Internet may surpass desktop computers in five years. These handheld devices can perform tasks, like e-mail, access the Internet and organizational networks. Although portable computers provide mobility, they are not as convenient. PCs need recharging after several hours, whereas portable digital assistants (PDAs) can last for weeks with daily use. Wireless PDAs can provide clinicians with real-time access to patient data and other healthcare resources. Clinicians can also retrieve authoritative medical information, such as MEDLINE anytime. This focuses on how web-based applications can be developed for handheld devices.
Resources
Online resources have been create by OHPCC and NLM staff related to using the Internet for telemedicine that eventually will be accessible online.
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