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Int. J. Advanced Networking and Applications
Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290
2300
Implementation of Remote Health Monitoring in
Medical Rural Clinics for Web Telemedicine
System
Hafez Fouad,
Microelectronics Dept, Electronics Research Institute, Cairo, Egypt,
Email: hafez@eri.sci.eg
-----------------------------------------------------------------------ABSTRACT--------------------------------------------------------------------
The problem with limited numbers of physicians, nurses, and other healthcare providers is expected to exacerbate. Health
care must be as efficient as possible. This situation provides an opportunity for the application of telehealth clinics. It is
time for organizations providing health care to objectively consider telehealth clinics. Information and communication
technologies (ICTs) have great potential to address some of the challenges faced by both developed and developing
countries in providing accessible, cost-effective, high-quality health care services. Telemedical clinics use ICTs to
overcome geographical barriers, and increase access to healthcare services. This is particularly beneficial for rural and
underserved communities in developing countries – groups that traditionally suffer from lack of access to health care. In
this work we propose an equipped system with new technology to provide wide range of services in Telemedical clinics
which facilitates the provision of medical aids from a distance. It is an effective solution for providing specialty healthcare
in the form of improved access and reduced cost to the rural patients and the reduced professional isolation of the rural
doctors. Telemedical clinics can enable ordinary doctors to perform extra-ordinary tasks.
Keywords—Telemedicine, ehealth, Healthcare webportal, Medical Center, ICT, Rural Health Clinics.
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Date of Submission: October 10, 2014 Date of Acceptance: November 30, 2014
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I. INTRODUCTION
More than urban areas, rural communities depend on a
system of small clinics and health centers to provide primary
care services, often utilizing non-physician health
professionals. This system consists of rural health clinics
(RHCs). Rural areas are facing a limited supply of
pharmacists, dentists and mental health professionals.
Because training programs have not kept pace with the rapid
and growing demand for pharmacists, there are relatively few
pharmacists available to serve rural areas [1]. Likewise, the
availability of dental care is much lower in rural areas than in
cities. Overall, we found that measured performance of rural
physicians tended to be lower than performance of physicians
in urban or suburban areas.
To better understand the health issues facing rural
communities, we asked physicians and consumers about their
views on the most pressing health challenges in their
communities and found that chronic conditions were major
concerns for both groups. Primary care physicians in both
urban and rural areas identify diabetes, cardiovascular disease
and cancer as major challenges, as shown in Figure 1.
Additionally, drug abuse and teen pregnancy were
significantly higher concerns of primary care physicians in
rural areas.
II. RURAL CLINICS AND HEALTH CENTERS
The role telemedicine can play helping clinics expand
services in rural areas by connecting patients to specialists.
Mobile clinics equipped with new technology can move
beyond traditional functions and provide broader range of
services.
Figure 1.“What would you say are the major health problems
affecting your community today?”[1]
Advances in communications and information technology are
transforming medical care by changing the way care is
delivered and how people access medical services. One
technology driving these improvements is telemedicine: the
provision of clinical services using the electronic exchange of
Int. J. Advanced Networking and Applications
Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290
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medical information, cross-site transmission of digital images
and electronic communications (e.g., physicianpatient email,
remote monitoring of vital signs and video patient consults
with physicians). Rapidly emerging as a component of
telemedicine is medical care that relies on mobile devices
such as cellular phones, personal digital assistants and laptops
(often referred to as mHealth). High resolution cameras,
digital imaging, the use of smart phones and broadband high-
speed connections have dramatically improved the scope and
scale of telemedicine’s applicability. The concept of
telehealth, often used interchangeably with telemedicine,
refers to a broader set of uses of the technology that includes
but also extends beyond the delivery of medical care.
Telehealth involves using technology to support activities
such as remote medical education, health services research
and some administrative functions [2].
III. HOW IS TELEMEDICINE USED IN RURAL?
By diminishing the impact of distance and time, telemedicine
can in theory expand capacity, foster coordinated care,
improvethe quality and efficiency of the delivery system and
support more patient self-management. Figure 2 shows the
types of telemedicine that are most functional today primarily
expand the capacity of the rural health care delivery system,
making it easier for patients to be seen and treated, especially
by specialists. These types of telemedicine include:
Figure 2.Telemedicine Usage in Rural [3]
• Transmission of data or images for analysis. The
transmission of images or clinical data from an electronic
device to a medical center is known as “store and forward.”
Clinical information is “stored” with a patient record and then
forwarded to a provider for further review. Dermatologists
and radiologists increasingly use this technology as do
emergency medical personnel who can transfer medical
information and images from ambulances to hospital
emergency rooms. Store and forward technology also
supports ongoing remote patient monitoring and management
of key medical indicators (e.g., blood glucose levels) in
patients with chronic illness.
• Facilitation of consultations between patients and
providers. These consultations, commonly conducted over
the Internet using secure live connections and Web cams, can
either substitute for in-person visits or support care between
appointments. Audio and online approaches may also be used.
In rural areas, video consultations extend the reach of scarce
specialists; some federally qualified health centers use video
technology for this purpose. The interactive capabilities
provided by video also support the technology’s use in
behavioral health care; federal veterans hospitals use
telemedicine to facilitate treatment for Post-Traumatic Stress
Disorder. Online care is well-suited to conditions where a
one-on-one consult could result in a quick diagnosis, such as
respiratory infections, urinary tract infections, acute
conjunctivitis and hypertension. Current technology allows
patients to connect to more than one provider at a time: a
primary care physician can join with a specialist, for example,
to confer with a patient. If physicians and patients are not
available at the same time, either one can prepare a video
report that can be accessed at a later time by the other [3].
• Support for patients managing their own health. Patients
can use the Internet to obtain specialized health information
and to access online discussion groups for peer-to-peer
support. Surveys show that patients are often willing to
manage their personal health information over smart phones
and are interested in pursuing other types of care delivery via
mobile devices [2]. Phones now have the ability to store
health information like immunizations and prescriptions.
When connected to portable medical devices, phones can
capture blood glucose levels, blood pressure values and vitals,
and transfer information to personal health records. These
tools can help people address their health and wellness needs
through online care management and wellness programs that
teach positive long-term behavior change.
• Remote monitoring. Providers use remote monitoring to
track changes in important patient vital signs such as weight,
body temperature, blood pressure and heart rhythms. Patients
wear monitors or use devices such as scales located in their
own homes but connected to their physicians’ offices, making
it possible to monitor a patient’s health without an office visit.
This remote monitoring supports the early detection of
possible health problems (for example, patients with
congestive heart failure who suddenly gain weight may be
retaining water, a sign of decreased heart function that can be
treated with medication). Pharmacists may use information
from remote monitoring to counsel patients on the effective
and safe use of medications [2].
• Intensive care unit (ICU) telemonitoring (e-ICUs). These
programs extend the reach of critical care providers.
Specialist physicians and critical care nurses staff round-the-
clock tele-ICU centers (or tele-hubs) that receive data from
monitoring devices tracking patients in ICUs in small
hospitals, including those in rural areas. The ICU specialists
Int. J. Advanced Networking and Applications
Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290
2302
in the tele-hub can support the care given on-site by providers
who may have less critical care expertise.
• Telepharmacy. Remote, rural clinics may not be able to
provide a full-scale pharmacy, but access to an electronic
connection to a pharmacy and a pharmacist can help patients
receive both medications and medication counseling
(ultimately improving medication compliance). By connecting
pharmacies at urban hospitals to small rural hospitals,
pharmacists can guide dispensing technicians to fill
prescriptions [3]. In some cases, however, legal requirements
that pharmacists be present for the dispensing of medication
may complicate this practice [4].
IV. TELEMEDICINE’S EFFECTS ON COST AND OUTCOMES
Harnessing telemedicine technology to reduce readmissions to
hospitals, avoid unnecessary visits to physician offices,
improve medication compliance and strengthen
communication between patients and health care professionals
holds significant promise in practice. Policymakers,
researchers, health care professionals and consumers are
interested in whether in practice, and to what extent, the
widespread adoption of telemedicine technology can reduce
costs and improve outcomes.
The deployment of telemedicine is still in its early stages and
varies greatly in its use, location, technology, specialty and
objectives. As a result of this variation, local travel costs,
prices and investments in technology/infrastructure must all
be considered in estimations of economic benefit. The wide
range of metrics used to measure cost-savings and efficacy
across studies currently limits the ability to draw
generalizable conclusions about full deployment.
Additionally, much of the research on telemedicine originates
from small demonstration projects. Recent legislation
includes telemedicine in a list of potential delivery reform
ideas for the Centers for Medicare and Medicaid Services to
test through its new innovation center. The law specifically
identifies the technology’s use to treat chronic conditions and
behavioral health issues in medically-underserved areas and at
Health Service facilities. Research on cost-effectiveness and
health outcomes is, however, starting to generate some initial
results:
• An extensive literature review reported that telemedicine
reduced time-to-diagnosis, improved access to care for
patients in remote areas and improved patient satisfaction [5].
• A 2005 Veterans Affairs study in Florida showed a 50
percent reduction in hospital admissions and an 11 percent
reduction in emergency room services using home telehealth
services [6].
• A review of 13 tele-ICU studies found that telemedicine in
the e-ICU reduced ICU mortality by 20 percent and reduced
the average length of ICU stays by an average of 1.26 days.
However, the use of telemedicine did not reduce hospital
mortality or overall length of stay [7].
• An Agency for Healthcare Research and Quality (AHRQ)
review of 97 articles revealed that much of the literature on
effectiveness is focused on the practice of dermatology. While
the literature shows that the accuracy of diagnosis in store-
and-forward teledermatology is comparable to in-person
encounters, some studies have shown interactive
teledermatology to be inferior to in-person diagnosis, though
health outcomes are comparable. These results may be due to
the use of outdated technology [8].
• The Veterans Administration (VA) found that veterans who
used text messaging to report blood pressure readings taken at
home to their care providers achieved blood pressure goals
sooner than those using other methods [9].
• Researchers are also identifying organizational and staffing
benefits from telemedicine, especially in ICUs. A recent study
found that when e-ICU staff monitored patients virtually,
bedside staff had more time to spend with families and to
perform tasks such as tracking data [10].
• A recent study of the Health-e-Access web portal, which
connects pediatric patients in child care centers, schools or
community centers with their own providers at local pediatric
centers, reported a 22 percent reduction in emergency
department visits among children with telemedicine access
over a seven-year period [11].
V. APPROACHES TO INCREASE AND IMPROVE THE USE OF
TELEMEDICINE IN RURAL AREAS
While telemedicine technologies can be deployed across
different geographic areas and care settings, they are
particularly well-suited to rural areas, where distances, low
patient density and low provider density contribute to
challenges in accessing and providing care. Here we discuss
six strategies to make fuller use of this potential.
1. Expand broadband connectivity to enable growth of
telemedicine adoption.
To successfully engage in telemedicine, physicians must have
the necessary infrastructure access to broadband, video-
conferencing technology and telemetry-enabled medical-
devices.
2. Encourage physicians to incorporate telemedicine into
their practice.
Many physicians remain uncomfortable with telemedicine
[22]. The technology requires a shift in the practice of
medicine. While telemedicine has the potential to benefit
physicians and their patients, education and support are
needed to ease the transition for many providers. As with
electronic health record adoption, the adoption of
telemedicine will also require structural changes in many
practices: staff composition, work schedules and record
Int. J. Advanced Networking and Applications
Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290
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keeping are all likely to evolve in practices that use
telemedicine extensively [23]. Health plans, employers and
public purchasers of care can all encourage providers in their
networks to use telemedicine by educating them about its
ability to serve patients better by combining telemedicine
encounters with face-to-face care. Demonstrations of the
technology and its capabilities tailored to physicians in small
practices may also help. To encourage specialists in urban
areas to participate in telemedicine referrals, similar
approaches should be deployed.
3. Use telemedicine to build primary care capacity in rural
areas.
Telemedicine builds capacity in rural areas by making it
easier for primary care physicians to connect with and
monitor their patients; allowing nurse practitioners and
physician assistants to practice in more areas while still being
advised by physicians; and increasing the availability of
specialists. Rural areas without ease of access to specialists
use telemedicine to provide care without the need for
transporting patients from small hospitals or physician offices
to urban centers. Through video conferencing, physicians
located in urban hubs can visit with, treat and prescribe
medications for patients in distant rural locations. New
telemedicine systems can capture radiology images and
eliminate the need for local film processing and reading.
Telemedicine makes mobile care units more functional and
versatile. Health plans and employers can collaborate with
providers to deploy telemedicine in ways that enhance
primary care needs in local areas. Ensuring that there are
clinical partners to connect to is crucial to the success of this
technology in expanding primary care capacity.
4. Increase access choices for rural beneficiaries.
Employers and other purchasers can provide greater choices
for rural residents in how they communicate with health care
professionals by making available telemedicine applications,
such as video consultations, online care and patient kiosks.
Telemedicine broadens the scope of care and types of
provider networks available to rural residents and makes it
more convenient to access services. Telephonic and web-
based primary care referral programs can be used to direct
patients to appropriate care.
5. Raise patient comfort levels with telemedicine
technology and encourage its use in rural care models.
Patients who are not accustomed to technology may resist
using telemedicine devices. However, given the general
advancement in society’s overall comfort with technology
over the past decade, combined with the convenience of
gaining access to services remotely, we may in the future see
more patients select this mode of care delivery. Providers can
encourage patients to use telemedicine tools, such as remote
monitoring, as part of their care. These tools are especially
helpful to rural residents with chronic illness who need to
track this information to stay healthy, and can lead to greater
engagement by patients in the management of their own
health.
6. Improve care coordination and patient safety in rural
areas.
Providers should consider adopting telemedicine to aide in
efforts to improve patient safety and care coordination.
Telemedicine can improve health system efficiency by
connecting professionals to each other and to pertinent data
(medical records, data from remote monitoring systems, and
images). It can also enable greater follow-up with patients
post-surgery. Remote patient monitoring in ICUs can improve
patient safety and reduce the need for patient transfers. Data
transfers from ambulances to hospitals can improve the speed
and effectiveness of emergency care. The federal government
should encourage adoption of telemedicine in new payment
reform models, such as the patient-centered medical home
and accountable care organizations [11].
VI. PRINCIPLE APPLICATIONS OF TELEMEDICINE USED IN
TELEHEALTH MEDICAL CENTERS
A. Telecardiology
Figure 3.Telecardiology-how it works [12,13]
ECG or electrocardiograph can be transmitted using telephone
and wireless. Teletransmission of ECG using indigenous
methods. One of the oldest known telecardiology system .This
system enabled wireless transmission of ECG from the
moving ICU van or the patients home to the central station in
ICU of the department of Medicine. Transmission using
wireless was done using frequency modulation which
eliminated noise. Transmission was also done through
telephone lines. The ECG output was connected to the
telephone input using a modulator which converted ECG into
high frequency sound. At the other end a demodulator
reconverted the sound into ECG with a good gain accuracy.
The ECG was converted to sound waves with a frequency
varying from 500 Hz to 2500 Hz with 1500 Hz at
baseline.This system was also used to monitor patients with
pacemakers in remote areas. The central control unit at the
ICU was able to correctly interpret arrhythmia. This technique
helped medical aid reach in remote areas.
Int. J. Advanced Networking and Applications
Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290
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B. Teleradiology
Teleradiology is the ability to send radiographic images (x-
rays) from one location to another. For this process to be
implemented, three essential components are required, an
image sending station, a transmission network, and a
receiving / image review station.
The most typical implementation is two computers connected
via Internet. The computer at the receiving end will need to
have a high-quality display screen that has been tested and
cleared for clinical purposes. Sometimes the receiving
computer will have a printer so that images can be printed for
convenience.
Figure 4.Teleradiology [14]
The teleradiology process begins at the image sending station.
The radiographic image and a modem or other connection are
required for this first step. The image is scanned and then sent
via the network connection to the receiving computer.
VII. MEDICAL DEVICES USED IN HEALTHCARE CENTERS
A. LifeGuard :NASA developed the wireless LifeGuard
system [15], a lightweight, portable device that enables
physicians to monitor the health and safety of explorers in
remote locations. The system allows real-time monitoring of
vital parameters such as heart rate, blood pressure,
electrocardiogram (EKG), breathing rate, and temperature.
The LifeGuard’s button sensors stick to the skin to take EKG
and breathing rate. The system’s sensors connect to the
LifeGuard by wires. LifeGuard’s data logger has a transmitter
that radios collected data by satellite to a base station
computer. This is a good example of a system that could be
used in telemedicine.
Figure 5. Digital Otoscope [16]
B. Digital Otoscope
With Digital Otoscope, you can conduct a full range of ear,
nose and throat examinations that provide the remote
physician with clear, live and still images of the ear canal and
tympanic membrane. This features an insufflation port for a
pneumatic otoscopy exam.
C. Digital stethoscope
A digital stethoscope can be used to assist physicians in
analyzing cardiac signals in real time during auscultation to
reduce the risks of not detecting certain conditions. digital
stethoscope used to serve as a platform for potential computer
aided diagnosis (CAD) applications for the detection of
cardiac murmurs. The system uses a custom-built sensor to
capture heart sounds at 8 kHz and converts them to electrical
signals to be processed by an ATmega644 microcontroller.
The captured signals are outputted via pulse-width
modulation to a standard 3.5 mm audio socket for real-time
auscultation. In addition, the stethoscope uses a 1MB external
Flash memory chip to record and playback audio waveforms.
For the user interface, the system includes a 4-line 20-
character wide LCD display and a 16-button keypad. Real-
time and recorded data can also be visualized using a
MATLAB interface that runs on a separate PC and connects
to the stethoscope system via the USART interface on the
microcontroller. The MATLAB interface also uses the
transmitted data to calculate and display the patient’s average
heart rate in beats per minute.
Figure 6. Digital Stethoscope System [17]
D. Tele-Echo System
A new "Tele-Echo System" for real-time telediagnosis using
medical ultrasound (US) image sequences on a public digital
network has been implemented and evaluated. The Tele-Echo
System compresses and transmits US image sequences in
real-time using a network bandwidth up to 1.5 Mbps. This
system compresses US image sequences with Motion Picture
Experts Group (MPEG) compression algorithm and transmits
with Internet protocol (IP) and user datagram protocol (UDP).
Experiments were conducted on the Tele-Echo System for US
image sequences of the heart. The transmitted US image
sequences contained 9% root-mean-square-error (RMSE) and
a 30-dB peak signal-to-noise ratio (PSNR) when the size of
images was 352 X 240 pixels, and the speed was about 27
frames per second. The experiments confirmed the clinical
Int. J. Advanced Networking and Applications
Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290
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effectiveness of the Tele-Echo System for remote diagnosis.
The transmission of US image sequences was conducted in a
few seconds, and some contained noise. The "Tele-Echo
System" enables real-time ultrasound image sequences on the
network.
Figure 7. Tele-Echo system [18]
VIII. PROPOSED IMPLEMENTATION OF REMOTE HEALTH
MONITORING CENTER FOR WEB TELEMEDICINE SYSTEM
Figure8 indicates that the telemedicine process through
Medical center is implemented through 4 main stages as
follow:
First: Registration
Medical center Representative can register in Ain Medical
portal by entering his/her information (name, address, e-mail,
user name and password and specialty), the center's
information (center's name, address, image, specialty and
Commercial Registration No.), and doctors' information who
work in the center (names, graduation year, e-mails,
specialties and Trade union figure).
The site sends confirmation e-mail to confirm the registration
then the site will include this medical center to his database
then center will appear to all users in search.
Second: Doctor Addition
The medical center can search for doctor by (name, specialty,
graduation year, experience, ……..)
Then can see doctor's profile then he can book an interval of
time and if the doctor confirms that, the site will send
confirmation message to the medical center.
Third: Booking an appointment
The medical center can search for doctor by (name, specialty,
graduation year, experience,……..)
Then can see doctor's profile and see available timeslots and if
these suitable to the patient ,he will insert patient's
information and book a timeslot and if the doctor confirm that
,the site will send confirmation message to the medical center
and doctor including the video conference link as shown in
the screenshot in figure (9).
Figure 8.Proposed Implementation of Remote Health
Monitoring center for Telemedicine system
Figure.9 Video Web-conference between doctor and patient
Fourth: Make visit
First the medical center will review today's reservations and if
it's the 2nd time for patient and he has required examinations
or digital data so he will insert them and send them to the
doctor then open the link of video conference and when the
reservation ends the site will send a file contains the status of
this patient, the required examinations, X-rays and drugs.
IX. REQUIREMENTS IN MEDICAL CENTERS
Tele-consultation room
Patient engagement facilities (bed, scopes, etc.)
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Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290
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Selective medical and medico-IT equipments, preferably
IT compatible, with interface to Telemedicine and/or
other software / hardware
Computer hardware / software platform (PC, switch,
etc.) and IT electronics equipments
Mobile vans are a part of telemedicine service
Desktop PC platform with Laser Print
IP Video Conferencing Kit
Tele medicine software
Digital ECG
A3 Film Scanner
Digital Microscope & Camera
Glucometer &Haemogram analyzer
Non-invasive Pulse & Blood Pressure unit
Connectivity device & Router
Figure.10 Requirements in Medical Centers
Looking to the past experience for success of telemedicine:
Video conferencing
Accompanied by data and image transfer (live)
Common software usage at both ends, thus globalization
of a single database software
Role of trained technical personnel is equally important
and necessary at the patient end.
Successful remuneration system to attract private
practitioners
Distant Site:
The Centers for Medicare and Medicaid Services (CMS)
define the distant site as the telehealth site where the
provider/specialist is seeing the patient at a distance or
consulting with a patient’s provider. Others common names
for this term include – hub site, specialty site,
provider/physician site and referral site. Figure (11-a).
Digital Camera (still images):
A digital camera is typically used to take still images of a
patient. General uses for this type of camera include
dermatology and wound care. This camera produces images
that can be downloaded to a PC and sent to a
provider/consultant over a network.
Document Camera:
A camera that can display written or typed information (e.g.,
lab results), photographs, graphics (e.g., EKG strips) and in
some cases X-Rays. Figure (11-b).
Figure.11 (a) Digital Camera (b) Document Camera (c) Patient Exam
Camera [19-21]
Patient Exam Camera (video):
This is the camera typically used to examine the general
condition of the patient. Types of cameras include those that
may be embedded with set-top videoconferencing units,
handheld video cameras, gooseneck cameras, camcorders, etc.
The camera may be analog or digital depending upon the
connection to the videoconferencing unit. Figure (11-c).
X. CONCLUSION
The Proposed Implementation of Remote Healthcare
Monitoring center for Telemedicine system through
www.AinMedical.com web-Portal is achieved and running.
The equipped system with new technology is used to provide
wide range of services in Telemedical center which facilitates
the provision of medical aids from a distance. It is an effective
solution for providing specialty healthcare in the form of
improved access and reduced cost to the rural patients and the
reduced professional isolation of the rural doctors.
Telemedical centers can enable ordinary doctors to perform
extra-ordinary tasks. While some forms of telemedicine, such
as store and forward applications for imaging reads, are
commonly in use, other uses of the technology are still in
developing. Among rural hospitals, about one-fourth
participated in tele-cardiology and video teleconferencing for
consultations and about 10 percent used tele-emergency
services. Steady growth is occurring with e-ICU hubs and
their use is increasing in small critical care hospitals.
FUTURE WORK
Other telemedicine technologies hold promise for the future,
although their full realization may be some way off , These
include:
• Telehealth services. This approach to telemedicine uses
cloud computing — servers hosted on the Internet — to allow
providers to connect with systems from different
Int. J. Advanced Networking and Applicatio
Volume: 6 Issue: 3 Pages: 2300-2307 (20
organizations and share health data generate
remotely. It can, for example, link remote he
electronic health records and services such
centers. This approach removes the burden of
in telemedicine infrastructure and distribut
multiple parties.
• Robotics. Telemedicine robots allow do
virtually to a patient’s bedside. Robots are a
be used in remote surgery, although most ro
still carried out by on-site surgeons.
• Clinical kiosks. These care sites may becom
medical care directly to patients and help in
areas with limited broadband connectivit
realized, clinical kiosks should be capable of
readings and allowing individuals to upload
the eventual aim of providing a full diagnosti
recommendations for treatment without the
personnel.
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[16]http://www.amdtelemedicine.co
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BasedTelemedicine.html
[17]http://people.ece.cornell.edu/lan
rojects/s2012/myw9_gdd9/myw
[18]http://online.liebertpub.com/doi
00311860
[19]http://www.flagstaffmedicalcen
medicine/Telemedicine101/tme
[20]http://www.maximed.pro/en/
[21]http://www.amdtelemedicine.co
equipment/clinical-configuratio
case.html
[22]Chen P (2010). Are Doctors
New York Times, January 7, 20
[23]Edwards J, et al (2009). Hype
Gartner Industry Research. Pub
Authors Biography
Hafez Fouad, A
degree in Electro
engineering in 1
his M.Sc. and
Shams Universit
Ph.D. is ded
Optimization of CMOS RF Pow
Communication systems. The M.
and Optimization of Silicon RF
Communication Systems. He wor
Electronics Research Institute (E
Research since 1994, Cairo, Eg
interests are Telemedicine Sy
network for Telemedicine and
Bioelectronics, Bioinformatics an
2307
, 28.5: w937 – w947. DOI:
009). Acute Illness Care
f Telemedicine, Pediatrics
542/peds.2008-2698).
health/What-is-
103/11/442/F1.expansion.h
health/What-is-
com/2011/06/gps-found-its-
om/telemedicine-
ons/ TelemedEDforSchool-
nd/courses/ece4760/FinalP
w9_gdd9/
i/abs/10.1089%2F1078302
nter.com/OurServices/Tele
edterms
om/telemedicine-
ons/amd-3000-dispatch-
Ready for Virtual Visits?
010.
e Cycle for Telemedicine,
lication G00169011.
uthor, he received his BSc.
onics and communications
993, EGYPT and received
Ph.D. degrees from Ain
ty in 2001 and 2008. His
dicated to Performance
wer Amplifiers for Mobile
.Sc. is dedicated to Design
F Front-ends For Mobile
rks as Ass Professor at the
RI), Ministry of Scientific
gypt. His current research
ystems, wireless sensors
d Industrial Applications,
d their applications.

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Implementation of Remote Health Monitoring in Medical Rural Clinics for Web Telemedicine System

  • 1. Int. J. Advanced Networking and Applications Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290 2300 Implementation of Remote Health Monitoring in Medical Rural Clinics for Web Telemedicine System Hafez Fouad, Microelectronics Dept, Electronics Research Institute, Cairo, Egypt, Email: hafez@eri.sci.eg -----------------------------------------------------------------------ABSTRACT-------------------------------------------------------------------- The problem with limited numbers of physicians, nurses, and other healthcare providers is expected to exacerbate. Health care must be as efficient as possible. This situation provides an opportunity for the application of telehealth clinics. It is time for organizations providing health care to objectively consider telehealth clinics. Information and communication technologies (ICTs) have great potential to address some of the challenges faced by both developed and developing countries in providing accessible, cost-effective, high-quality health care services. Telemedical clinics use ICTs to overcome geographical barriers, and increase access to healthcare services. This is particularly beneficial for rural and underserved communities in developing countries – groups that traditionally suffer from lack of access to health care. In this work we propose an equipped system with new technology to provide wide range of services in Telemedical clinics which facilitates the provision of medical aids from a distance. It is an effective solution for providing specialty healthcare in the form of improved access and reduced cost to the rural patients and the reduced professional isolation of the rural doctors. Telemedical clinics can enable ordinary doctors to perform extra-ordinary tasks. Keywords—Telemedicine, ehealth, Healthcare webportal, Medical Center, ICT, Rural Health Clinics. ------------------------------------------------------------------------------------------------------------------------------------------------------------ Date of Submission: October 10, 2014 Date of Acceptance: November 30, 2014 ------------------------------------------------------------------------------------------------------------------------------------------------------------ I. INTRODUCTION More than urban areas, rural communities depend on a system of small clinics and health centers to provide primary care services, often utilizing non-physician health professionals. This system consists of rural health clinics (RHCs). Rural areas are facing a limited supply of pharmacists, dentists and mental health professionals. Because training programs have not kept pace with the rapid and growing demand for pharmacists, there are relatively few pharmacists available to serve rural areas [1]. Likewise, the availability of dental care is much lower in rural areas than in cities. Overall, we found that measured performance of rural physicians tended to be lower than performance of physicians in urban or suburban areas. To better understand the health issues facing rural communities, we asked physicians and consumers about their views on the most pressing health challenges in their communities and found that chronic conditions were major concerns for both groups. Primary care physicians in both urban and rural areas identify diabetes, cardiovascular disease and cancer as major challenges, as shown in Figure 1. Additionally, drug abuse and teen pregnancy were significantly higher concerns of primary care physicians in rural areas. II. RURAL CLINICS AND HEALTH CENTERS The role telemedicine can play helping clinics expand services in rural areas by connecting patients to specialists. Mobile clinics equipped with new technology can move beyond traditional functions and provide broader range of services. Figure 1.“What would you say are the major health problems affecting your community today?”[1] Advances in communications and information technology are transforming medical care by changing the way care is delivered and how people access medical services. One technology driving these improvements is telemedicine: the provision of clinical services using the electronic exchange of
  • 2. Int. J. Advanced Networking and Applications Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290 2301 medical information, cross-site transmission of digital images and electronic communications (e.g., physicianpatient email, remote monitoring of vital signs and video patient consults with physicians). Rapidly emerging as a component of telemedicine is medical care that relies on mobile devices such as cellular phones, personal digital assistants and laptops (often referred to as mHealth). High resolution cameras, digital imaging, the use of smart phones and broadband high- speed connections have dramatically improved the scope and scale of telemedicine’s applicability. The concept of telehealth, often used interchangeably with telemedicine, refers to a broader set of uses of the technology that includes but also extends beyond the delivery of medical care. Telehealth involves using technology to support activities such as remote medical education, health services research and some administrative functions [2]. III. HOW IS TELEMEDICINE USED IN RURAL? By diminishing the impact of distance and time, telemedicine can in theory expand capacity, foster coordinated care, improvethe quality and efficiency of the delivery system and support more patient self-management. Figure 2 shows the types of telemedicine that are most functional today primarily expand the capacity of the rural health care delivery system, making it easier for patients to be seen and treated, especially by specialists. These types of telemedicine include: Figure 2.Telemedicine Usage in Rural [3] • Transmission of data or images for analysis. The transmission of images or clinical data from an electronic device to a medical center is known as “store and forward.” Clinical information is “stored” with a patient record and then forwarded to a provider for further review. Dermatologists and radiologists increasingly use this technology as do emergency medical personnel who can transfer medical information and images from ambulances to hospital emergency rooms. Store and forward technology also supports ongoing remote patient monitoring and management of key medical indicators (e.g., blood glucose levels) in patients with chronic illness. • Facilitation of consultations between patients and providers. These consultations, commonly conducted over the Internet using secure live connections and Web cams, can either substitute for in-person visits or support care between appointments. Audio and online approaches may also be used. In rural areas, video consultations extend the reach of scarce specialists; some federally qualified health centers use video technology for this purpose. The interactive capabilities provided by video also support the technology’s use in behavioral health care; federal veterans hospitals use telemedicine to facilitate treatment for Post-Traumatic Stress Disorder. Online care is well-suited to conditions where a one-on-one consult could result in a quick diagnosis, such as respiratory infections, urinary tract infections, acute conjunctivitis and hypertension. Current technology allows patients to connect to more than one provider at a time: a primary care physician can join with a specialist, for example, to confer with a patient. If physicians and patients are not available at the same time, either one can prepare a video report that can be accessed at a later time by the other [3]. • Support for patients managing their own health. Patients can use the Internet to obtain specialized health information and to access online discussion groups for peer-to-peer support. Surveys show that patients are often willing to manage their personal health information over smart phones and are interested in pursuing other types of care delivery via mobile devices [2]. Phones now have the ability to store health information like immunizations and prescriptions. When connected to portable medical devices, phones can capture blood glucose levels, blood pressure values and vitals, and transfer information to personal health records. These tools can help people address their health and wellness needs through online care management and wellness programs that teach positive long-term behavior change. • Remote monitoring. Providers use remote monitoring to track changes in important patient vital signs such as weight, body temperature, blood pressure and heart rhythms. Patients wear monitors or use devices such as scales located in their own homes but connected to their physicians’ offices, making it possible to monitor a patient’s health without an office visit. This remote monitoring supports the early detection of possible health problems (for example, patients with congestive heart failure who suddenly gain weight may be retaining water, a sign of decreased heart function that can be treated with medication). Pharmacists may use information from remote monitoring to counsel patients on the effective and safe use of medications [2]. • Intensive care unit (ICU) telemonitoring (e-ICUs). These programs extend the reach of critical care providers. Specialist physicians and critical care nurses staff round-the- clock tele-ICU centers (or tele-hubs) that receive data from monitoring devices tracking patients in ICUs in small hospitals, including those in rural areas. The ICU specialists
  • 3. Int. J. Advanced Networking and Applications Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290 2302 in the tele-hub can support the care given on-site by providers who may have less critical care expertise. • Telepharmacy. Remote, rural clinics may not be able to provide a full-scale pharmacy, but access to an electronic connection to a pharmacy and a pharmacist can help patients receive both medications and medication counseling (ultimately improving medication compliance). By connecting pharmacies at urban hospitals to small rural hospitals, pharmacists can guide dispensing technicians to fill prescriptions [3]. In some cases, however, legal requirements that pharmacists be present for the dispensing of medication may complicate this practice [4]. IV. TELEMEDICINE’S EFFECTS ON COST AND OUTCOMES Harnessing telemedicine technology to reduce readmissions to hospitals, avoid unnecessary visits to physician offices, improve medication compliance and strengthen communication between patients and health care professionals holds significant promise in practice. Policymakers, researchers, health care professionals and consumers are interested in whether in practice, and to what extent, the widespread adoption of telemedicine technology can reduce costs and improve outcomes. The deployment of telemedicine is still in its early stages and varies greatly in its use, location, technology, specialty and objectives. As a result of this variation, local travel costs, prices and investments in technology/infrastructure must all be considered in estimations of economic benefit. The wide range of metrics used to measure cost-savings and efficacy across studies currently limits the ability to draw generalizable conclusions about full deployment. Additionally, much of the research on telemedicine originates from small demonstration projects. Recent legislation includes telemedicine in a list of potential delivery reform ideas for the Centers for Medicare and Medicaid Services to test through its new innovation center. The law specifically identifies the technology’s use to treat chronic conditions and behavioral health issues in medically-underserved areas and at Health Service facilities. Research on cost-effectiveness and health outcomes is, however, starting to generate some initial results: • An extensive literature review reported that telemedicine reduced time-to-diagnosis, improved access to care for patients in remote areas and improved patient satisfaction [5]. • A 2005 Veterans Affairs study in Florida showed a 50 percent reduction in hospital admissions and an 11 percent reduction in emergency room services using home telehealth services [6]. • A review of 13 tele-ICU studies found that telemedicine in the e-ICU reduced ICU mortality by 20 percent and reduced the average length of ICU stays by an average of 1.26 days. However, the use of telemedicine did not reduce hospital mortality or overall length of stay [7]. • An Agency for Healthcare Research and Quality (AHRQ) review of 97 articles revealed that much of the literature on effectiveness is focused on the practice of dermatology. While the literature shows that the accuracy of diagnosis in store- and-forward teledermatology is comparable to in-person encounters, some studies have shown interactive teledermatology to be inferior to in-person diagnosis, though health outcomes are comparable. These results may be due to the use of outdated technology [8]. • The Veterans Administration (VA) found that veterans who used text messaging to report blood pressure readings taken at home to their care providers achieved blood pressure goals sooner than those using other methods [9]. • Researchers are also identifying organizational and staffing benefits from telemedicine, especially in ICUs. A recent study found that when e-ICU staff monitored patients virtually, bedside staff had more time to spend with families and to perform tasks such as tracking data [10]. • A recent study of the Health-e-Access web portal, which connects pediatric patients in child care centers, schools or community centers with their own providers at local pediatric centers, reported a 22 percent reduction in emergency department visits among children with telemedicine access over a seven-year period [11]. V. APPROACHES TO INCREASE AND IMPROVE THE USE OF TELEMEDICINE IN RURAL AREAS While telemedicine technologies can be deployed across different geographic areas and care settings, they are particularly well-suited to rural areas, where distances, low patient density and low provider density contribute to challenges in accessing and providing care. Here we discuss six strategies to make fuller use of this potential. 1. Expand broadband connectivity to enable growth of telemedicine adoption. To successfully engage in telemedicine, physicians must have the necessary infrastructure access to broadband, video- conferencing technology and telemetry-enabled medical- devices. 2. Encourage physicians to incorporate telemedicine into their practice. Many physicians remain uncomfortable with telemedicine [22]. The technology requires a shift in the practice of medicine. While telemedicine has the potential to benefit physicians and their patients, education and support are needed to ease the transition for many providers. As with electronic health record adoption, the adoption of telemedicine will also require structural changes in many practices: staff composition, work schedules and record
  • 4. Int. J. Advanced Networking and Applications Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290 2303 keeping are all likely to evolve in practices that use telemedicine extensively [23]. Health plans, employers and public purchasers of care can all encourage providers in their networks to use telemedicine by educating them about its ability to serve patients better by combining telemedicine encounters with face-to-face care. Demonstrations of the technology and its capabilities tailored to physicians in small practices may also help. To encourage specialists in urban areas to participate in telemedicine referrals, similar approaches should be deployed. 3. Use telemedicine to build primary care capacity in rural areas. Telemedicine builds capacity in rural areas by making it easier for primary care physicians to connect with and monitor their patients; allowing nurse practitioners and physician assistants to practice in more areas while still being advised by physicians; and increasing the availability of specialists. Rural areas without ease of access to specialists use telemedicine to provide care without the need for transporting patients from small hospitals or physician offices to urban centers. Through video conferencing, physicians located in urban hubs can visit with, treat and prescribe medications for patients in distant rural locations. New telemedicine systems can capture radiology images and eliminate the need for local film processing and reading. Telemedicine makes mobile care units more functional and versatile. Health plans and employers can collaborate with providers to deploy telemedicine in ways that enhance primary care needs in local areas. Ensuring that there are clinical partners to connect to is crucial to the success of this technology in expanding primary care capacity. 4. Increase access choices for rural beneficiaries. Employers and other purchasers can provide greater choices for rural residents in how they communicate with health care professionals by making available telemedicine applications, such as video consultations, online care and patient kiosks. Telemedicine broadens the scope of care and types of provider networks available to rural residents and makes it more convenient to access services. Telephonic and web- based primary care referral programs can be used to direct patients to appropriate care. 5. Raise patient comfort levels with telemedicine technology and encourage its use in rural care models. Patients who are not accustomed to technology may resist using telemedicine devices. However, given the general advancement in society’s overall comfort with technology over the past decade, combined with the convenience of gaining access to services remotely, we may in the future see more patients select this mode of care delivery. Providers can encourage patients to use telemedicine tools, such as remote monitoring, as part of their care. These tools are especially helpful to rural residents with chronic illness who need to track this information to stay healthy, and can lead to greater engagement by patients in the management of their own health. 6. Improve care coordination and patient safety in rural areas. Providers should consider adopting telemedicine to aide in efforts to improve patient safety and care coordination. Telemedicine can improve health system efficiency by connecting professionals to each other and to pertinent data (medical records, data from remote monitoring systems, and images). It can also enable greater follow-up with patients post-surgery. Remote patient monitoring in ICUs can improve patient safety and reduce the need for patient transfers. Data transfers from ambulances to hospitals can improve the speed and effectiveness of emergency care. The federal government should encourage adoption of telemedicine in new payment reform models, such as the patient-centered medical home and accountable care organizations [11]. VI. PRINCIPLE APPLICATIONS OF TELEMEDICINE USED IN TELEHEALTH MEDICAL CENTERS A. Telecardiology Figure 3.Telecardiology-how it works [12,13] ECG or electrocardiograph can be transmitted using telephone and wireless. Teletransmission of ECG using indigenous methods. One of the oldest known telecardiology system .This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline.This system was also used to monitor patients with pacemakers in remote areas. The central control unit at the ICU was able to correctly interpret arrhythmia. This technique helped medical aid reach in remote areas.
  • 5. Int. J. Advanced Networking and Applications Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290 2304 B. Teleradiology Teleradiology is the ability to send radiographic images (x- rays) from one location to another. For this process to be implemented, three essential components are required, an image sending station, a transmission network, and a receiving / image review station. The most typical implementation is two computers connected via Internet. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer so that images can be printed for convenience. Figure 4.Teleradiology [14] The teleradiology process begins at the image sending station. The radiographic image and a modem or other connection are required for this first step. The image is scanned and then sent via the network connection to the receiving computer. VII. MEDICAL DEVICES USED IN HEALTHCARE CENTERS A. LifeGuard :NASA developed the wireless LifeGuard system [15], a lightweight, portable device that enables physicians to monitor the health and safety of explorers in remote locations. The system allows real-time monitoring of vital parameters such as heart rate, blood pressure, electrocardiogram (EKG), breathing rate, and temperature. The LifeGuard’s button sensors stick to the skin to take EKG and breathing rate. The system’s sensors connect to the LifeGuard by wires. LifeGuard’s data logger has a transmitter that radios collected data by satellite to a base station computer. This is a good example of a system that could be used in telemedicine. Figure 5. Digital Otoscope [16] B. Digital Otoscope With Digital Otoscope, you can conduct a full range of ear, nose and throat examinations that provide the remote physician with clear, live and still images of the ear canal and tympanic membrane. This features an insufflation port for a pneumatic otoscopy exam. C. Digital stethoscope A digital stethoscope can be used to assist physicians in analyzing cardiac signals in real time during auscultation to reduce the risks of not detecting certain conditions. digital stethoscope used to serve as a platform for potential computer aided diagnosis (CAD) applications for the detection of cardiac murmurs. The system uses a custom-built sensor to capture heart sounds at 8 kHz and converts them to electrical signals to be processed by an ATmega644 microcontroller. The captured signals are outputted via pulse-width modulation to a standard 3.5 mm audio socket for real-time auscultation. In addition, the stethoscope uses a 1MB external Flash memory chip to record and playback audio waveforms. For the user interface, the system includes a 4-line 20- character wide LCD display and a 16-button keypad. Real- time and recorded data can also be visualized using a MATLAB interface that runs on a separate PC and connects to the stethoscope system via the USART interface on the microcontroller. The MATLAB interface also uses the transmitted data to calculate and display the patient’s average heart rate in beats per minute. Figure 6. Digital Stethoscope System [17] D. Tele-Echo System A new "Tele-Echo System" for real-time telediagnosis using medical ultrasound (US) image sequences on a public digital network has been implemented and evaluated. The Tele-Echo System compresses and transmits US image sequences in real-time using a network bandwidth up to 1.5 Mbps. This system compresses US image sequences with Motion Picture Experts Group (MPEG) compression algorithm and transmits with Internet protocol (IP) and user datagram protocol (UDP). Experiments were conducted on the Tele-Echo System for US image sequences of the heart. The transmitted US image sequences contained 9% root-mean-square-error (RMSE) and a 30-dB peak signal-to-noise ratio (PSNR) when the size of images was 352 X 240 pixels, and the speed was about 27 frames per second. The experiments confirmed the clinical
  • 6. Int. J. Advanced Networking and Applications Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290 2305 effectiveness of the Tele-Echo System for remote diagnosis. The transmission of US image sequences was conducted in a few seconds, and some contained noise. The "Tele-Echo System" enables real-time ultrasound image sequences on the network. Figure 7. Tele-Echo system [18] VIII. PROPOSED IMPLEMENTATION OF REMOTE HEALTH MONITORING CENTER FOR WEB TELEMEDICINE SYSTEM Figure8 indicates that the telemedicine process through Medical center is implemented through 4 main stages as follow: First: Registration Medical center Representative can register in Ain Medical portal by entering his/her information (name, address, e-mail, user name and password and specialty), the center's information (center's name, address, image, specialty and Commercial Registration No.), and doctors' information who work in the center (names, graduation year, e-mails, specialties and Trade union figure). The site sends confirmation e-mail to confirm the registration then the site will include this medical center to his database then center will appear to all users in search. Second: Doctor Addition The medical center can search for doctor by (name, specialty, graduation year, experience, ……..) Then can see doctor's profile then he can book an interval of time and if the doctor confirms that, the site will send confirmation message to the medical center. Third: Booking an appointment The medical center can search for doctor by (name, specialty, graduation year, experience,……..) Then can see doctor's profile and see available timeslots and if these suitable to the patient ,he will insert patient's information and book a timeslot and if the doctor confirm that ,the site will send confirmation message to the medical center and doctor including the video conference link as shown in the screenshot in figure (9). Figure 8.Proposed Implementation of Remote Health Monitoring center for Telemedicine system Figure.9 Video Web-conference between doctor and patient Fourth: Make visit First the medical center will review today's reservations and if it's the 2nd time for patient and he has required examinations or digital data so he will insert them and send them to the doctor then open the link of video conference and when the reservation ends the site will send a file contains the status of this patient, the required examinations, X-rays and drugs. IX. REQUIREMENTS IN MEDICAL CENTERS Tele-consultation room Patient engagement facilities (bed, scopes, etc.)
  • 7. Int. J. Advanced Networking and Applications Volume: 6 Issue: 3 Pages: 2300-2307 (2014) ISSN : 0975-0290 2306 Selective medical and medico-IT equipments, preferably IT compatible, with interface to Telemedicine and/or other software / hardware Computer hardware / software platform (PC, switch, etc.) and IT electronics equipments Mobile vans are a part of telemedicine service Desktop PC platform with Laser Print IP Video Conferencing Kit Tele medicine software Digital ECG A3 Film Scanner Digital Microscope & Camera Glucometer &Haemogram analyzer Non-invasive Pulse & Blood Pressure unit Connectivity device & Router Figure.10 Requirements in Medical Centers Looking to the past experience for success of telemedicine: Video conferencing Accompanied by data and image transfer (live) Common software usage at both ends, thus globalization of a single database software Role of trained technical personnel is equally important and necessary at the patient end. Successful remuneration system to attract private practitioners Distant Site: The Centers for Medicare and Medicaid Services (CMS) define the distant site as the telehealth site where the provider/specialist is seeing the patient at a distance or consulting with a patient’s provider. Others common names for this term include – hub site, specialty site, provider/physician site and referral site. Figure (11-a). Digital Camera (still images): A digital camera is typically used to take still images of a patient. General uses for this type of camera include dermatology and wound care. This camera produces images that can be downloaded to a PC and sent to a provider/consultant over a network. Document Camera: A camera that can display written or typed information (e.g., lab results), photographs, graphics (e.g., EKG strips) and in some cases X-Rays. Figure (11-b). Figure.11 (a) Digital Camera (b) Document Camera (c) Patient Exam Camera [19-21] Patient Exam Camera (video): This is the camera typically used to examine the general condition of the patient. Types of cameras include those that may be embedded with set-top videoconferencing units, handheld video cameras, gooseneck cameras, camcorders, etc. The camera may be analog or digital depending upon the connection to the videoconferencing unit. Figure (11-c). X. CONCLUSION The Proposed Implementation of Remote Healthcare Monitoring center for Telemedicine system through www.AinMedical.com web-Portal is achieved and running. The equipped system with new technology is used to provide wide range of services in Telemedical center which facilitates the provision of medical aids from a distance. It is an effective solution for providing specialty healthcare in the form of improved access and reduced cost to the rural patients and the reduced professional isolation of the rural doctors. Telemedical centers can enable ordinary doctors to perform extra-ordinary tasks. While some forms of telemedicine, such as store and forward applications for imaging reads, are commonly in use, other uses of the technology are still in developing. Among rural hospitals, about one-fourth participated in tele-cardiology and video teleconferencing for consultations and about 10 percent used tele-emergency services. Steady growth is occurring with e-ICU hubs and their use is increasing in small critical care hospitals. FUTURE WORK Other telemedicine technologies hold promise for the future, although their full realization may be some way off , These include: • Telehealth services. This approach to telemedicine uses cloud computing — servers hosted on the Internet — to allow providers to connect with systems from different
  • 8. Int. J. Advanced Networking and Applicatio Volume: 6 Issue: 3 Pages: 2300-2307 (20 organizations and share health data generate remotely. It can, for example, link remote he electronic health records and services such centers. This approach removes the burden of in telemedicine infrastructure and distribut multiple parties. • Robotics. Telemedicine robots allow do virtually to a patient’s bedside. Robots are a be used in remote surgery, although most ro still carried out by on-site surgeons. • Clinical kiosks. These care sites may becom medical care directly to patients and help in areas with limited broadband connectivit realized, clinical kiosks should be capable of readings and allowing individuals to upload the eventual aim of providing a full diagnosti recommendations for treatment without the personnel. REFERENCES [1] U.S. Department of Health and Huma Services Administration Bureau of Heal (2000). The Pharmacist Workforce: A Supply and Demand for Pharmacists. [2] Sarasohn-Kahn J (2011). The Connected P the Vital Signs of Remote Health Monito Health Care Foundation. [3] American Telemedicine Association (20 and Health Care Provider Shorta telemedicine Association Position Stateme [4] Edwards J, et al (2009). Hype Cycle fo Gartner Industry Research. Publication G0 [5] Bergmo TS (2010). Economic Telemedicine – Still Room for Im TelemedTelecare 16.5 (2010): 2 10.1258/jtt.2010.009008. [6] American Telemedicine Association (20 and Health Care Provider Shorta telemedicine Association Position Stateme [7] Young LB, et al (2011). Impact of Teleme Care Unit Coverage on Patient Outcome Review and Meta-analysis, Arch Intern M 506. oi:10.1001/archinternmed.2011.61. [8] Agency for Health Research and Q Telemedicine for the Medicare Popu AHRQ Publication No. 06-E007. [9] U.S. Veterans Administration (2010). Administration Brochure Series, Rural He [10]Berenson RA, Grossman JM and Novem Does Telemonitoring of Patients – the e ons 14) ISSN : 0975-0290 ed from patients ealth monitoring, as 24-hour call f having to invest tes costs among octors to travel also beginning to obotic surgery is me a tool to bring ncrease access in ty. When fully taking biometric vital signs with ic evaluation and e use of on-site an Services and lth Professionals A Study of the Patient: Charting oring, California 007). Telehealth ages. American ent. or Telemedicine, 00169011. Evaluation in mprovement, J 229-31. DOI: 007). Telehealth ages. American ent. edicine Intensive es: A Systematic Med 171.6: 498- Quality (2006). ulation: Update. U.S. Veterans ealth, 2010. mber EA (2009). eICU – Improve Intensive Care? Health Affairs, 10.1377/hlthaff.28.5.w937. [11]McConnochie KM, et al (20 Patterns Change with Use of 123.6: e989 – e995. DOI: 10.15 [12]http://www.news-medical.net/h Telecardiology.aspx [13]http://jrs.sagepub.com/content/1 tml [14]http://www.news-medical.net/h Teleradiology.aspx [15]http://kiosbukugema.blogspot.c way-into-telemedicine.html [16]http://www.amdtelemedicine.co equipment/clinical configuratio BasedTelemedicine.html [17]http://people.ece.cornell.edu/lan rojects/s2012/myw9_gdd9/myw [18]http://online.liebertpub.com/doi 00311860 [19]http://www.flagstaffmedicalcen medicine/Telemedicine101/tme [20]http://www.maximed.pro/en/ [21]http://www.amdtelemedicine.co equipment/clinical-configuratio case.html [22]Chen P (2010). Are Doctors New York Times, January 7, 20 [23]Edwards J, et al (2009). Hype Gartner Industry Research. Pub Authors Biography Hafez Fouad, A degree in Electro engineering in 1 his M.Sc. and Shams Universit Ph.D. is ded Optimization of CMOS RF Pow Communication systems. The M. and Optimization of Silicon RF Communication Systems. He wor Electronics Research Institute (E Research since 1994, Cairo, Eg interests are Telemedicine Sy network for Telemedicine and Bioelectronics, Bioinformatics an 2307 , 28.5: w937 – w947. DOI: 009). Acute Illness Care f Telemedicine, Pediatrics 542/peds.2008-2698). health/What-is- 103/11/442/F1.expansion.h health/What-is- com/2011/06/gps-found-its- om/telemedicine- ons/ TelemedEDforSchool- nd/courses/ece4760/FinalP w9_gdd9/ i/abs/10.1089%2F1078302 nter.com/OurServices/Tele edterms om/telemedicine- ons/amd-3000-dispatch- Ready for Virtual Visits? 010. e Cycle for Telemedicine, lication G00169011. uthor, he received his BSc. onics and communications 993, EGYPT and received Ph.D. degrees from Ain ty in 2001 and 2008. His dicated to Performance wer Amplifiers for Mobile .Sc. is dedicated to Design F Front-ends For Mobile rks as Ass Professor at the RI), Ministry of Scientific gypt. His current research ystems, wireless sensors d Industrial Applications, d their applications.