Experiment on Tele-medicine Applications Using

Broadband Wireless LAN System in Rural Areas

(Asia Pacific Telecommunity / Human Resource Development Program)

 By KDDI Corporation, Waseda University and the Hatinh community

 Abstract

This is report about a project carried out by KDDI Corporation, Waseda University and the Hatinh community.  The project was supported by Asia Pacific Telecommunity (APT) and implemented in Hatinh province of Vietnam.  It was aimed to study the use of broadband wireless LAN for implementation of tele-medicine applications in rural hospitals.  The report describes experiments on X-ray image transmission, video transmission and exchange of electronic medical documents.  The report includes the results of recent survey about the use of new system and the feedback from users.  It also summarizes the lessons learned from the project and calls for discussion about new applications for tele-medicine.

1. Objective of the Project

              The project was carried out in order to show the possibility to create “Digital Opportunities” at the place with difficulties of geographical and economic conditions, and lack of human resources.  It was also aiming at improving capability in healthcare and education system by using Information and Communication Technologies (ICT) in order to narrow the “Digital Divide” in developing countries.  The first purpose of the project was to examine the performance of Wireless LAN and applications of Voice over IP (VoIP) and teleconference system based on IP Technology in the medical field.  The project was carried out in order to acquire the experience and competence in tele-medicine services using IP Technologies.  It was also expected through that project to improve the treatment of patients by using tele-consultation and to obtain better access to medical expertise and knowledge.  Other purpose was the human resource exchange and development.  Through these exchange programs, both Vietnamese and Japanese institutions can get the required knowledge to address the “Digital Divide”.  In the project, the General Hospital and Medical College in Hatinh province were connected with wireless broadband link, which was used for image transmission and tele-consultation.  The project was also the first step of further enhancement of Healthcare system in Hatinh province.

              KDDI has made a proposal in the report “New Technologies for Rural Applications” (ITU-D Focus Group7).  The proposal showed a solution exploiting Wireless LAN and VoIP technology to develop information network accessibility in rural areas.  Since then, few projects, making good use of Wireless LAN technology, have been done while Wireless LAN technology has been making remarkable progress.  The project was an attempt to evaluate the applications of latest Wireless LAN system for Healthcare service in rural areas.

              The role of knowledge sharing is indispensable when we need to develop the new and effective systems.  The case study of the latest Wireless LAN system and its applications were informative and helpful for Vietnamese doctors and engineers.  On the other hand, the study visits to the rural areas and experiment with application of the system were beneficial for Japanese researchers/engineers to understand the real conditions, and possibilities of applying of such applications in the rural areas.  The acquired experience will be also useful for developing new products and making more practical proposals for the Digital Divide solution in the future.

              The project was implemented by:

· KDDI CORPORATION / KDDI R&D Laboratories (Japan)

· Waseda University, Global Information and Telecommunication Studies (Japan)

· Hatinh Province (Vietnam)
Medical Department, General Hospital, Medical College, Posts and Telecommunications

              The project time schedule in chronological order was:

 2. Outline of the Experiment

              The project has 2 foundations to succeed hardware-software component that forms the underlying system and applications that run on top of it.  In general, we deployed the system in 3 sites as seen in figure 1.

 Figure 1 – Site of deployment

2-1. Component of the Experimental System

·           Wireless LAN system:           CFO-SS10A (KDDI R&D Labs.)

·           IP Telephone:                        IP Telephone

·           Video conference system:      Quality Meeting (KDDI R&D Labs.)

                                                           Digital Video Camera

                                                           Projector

·           X-ray transmission:               Scanner

                                                           File transfer software

2-2. Applications

• X-ray Image Transmission

The application was carried out between Hatinh General Hospital (HGH) and Cam Xuyen Hospital (CXH) with distance of 13 km.  The main idea of this application is to digitize the negative X-ray image into digital in CXH and transfer to HGH.  In this case, the doctors in HGH can see the condition of patient in CXH and have some consultation for doctor in CXH.  Despite of long distance between the two hospitals in rural areas, the doctors there can communicate together easily without any meeting.

Figure 2 – X-Ray Image Transmission

• Video Transmission

The application was carried out between HGH and Hatinh Medical College (HMC) with the distance of 500m.  Main purpose of this application is to educate students in HMC directly from HGH.  In this application, video stream is transmitted from Emergency room directly to classroom.  Students there can see what doctors are doing with patient.Figure 3 – Video Transmission

  

• Video Transmission between Vietnam and Japan

There were two additional experiments on video transmission.  The first experiment included sending and receiving video image between HGH and KDDI R&D Lab in Japan using ADSL Internet connection.  The second experiment was a video transmission between HMC and KDDI R&D Labs using both Wireless LAN and ADSL Internet connection.  The main purpose of experiments was to test the performance of video application in different transfer modes.

• Electronic Medical Collaboration System (EMCS).

The EMCS is a Web based Medical Record System with capabilities to communicate with other EMCSs.  The system makes it possible to easily exchange the electronic medical documents as well as other digital data such as video and X-ray image files.  It would be very helpful for educational purposes to develop EMCS for exchanging data between General Hospital and Medical College.  The other possible use of this system is to organize an inter-hospital communication between General Hospital and District Hospitals.  We installed prototype EMCS and carried out experiments with exchanging of medical documents attaching X-ray image files.  The IT teacher of Medical College was trained to install and configure the system.  It is planned that Waseda Team will develop some additional functionality to the system and a “User Guide”.  We also plan to provide source files and technical documentation for EMCS.  The new updated version of EMCS will be sent to Hatinh Province on CD-ROM later.

 3. Experiment evaluation and result

3.1. Result

· Possibilities and effect of each application

-          X-Ray Image Transmission: Almost all the doctors in HGH agreed that this application should be widely carried out in Hatinh province.

-          Video transmission: It is very clear that the Video transmission application was carried out successfully in Hatinh province.  It is opening a new concept for the people in Hatinh province on telemedicine and distant-learning.  Through the success of this experiment, we can conclude that we can construct the medical video conference network within a range of CFO-SS’s transmission characteristic (around 20km) and doctor can hold a consultation or just sending image of patient to other hospitals.

-          The sending and receiving video image between Hatinh and Japan (KDDI R&D Lab): Although that experiment was carried out only one day, it could open a possibility for new type of collaboration between Hatinh and Japan.  For example, using this application, doctors in Hatinh can consult with their colleagues in Japan.

-          EMCS: The last application can open a new way of inter-hospital communication and knowledge sharing in medical field in rural areas.

· Quality of each application

Through the survey in the last visit to Hatinh, we received feedback about the quality of applications.  Most of the users, who answered the questionnaires, used the system for 3 to 5 times (19/32) and evaluated the quality as good.

· Other requirements from local people

Most of the doctors expressed an opinion that the Wireless LAN system, applications for video transmission and exchange of X-ray images should be expanded to other district hospitals.

3.2. Lessons Learnt

              From the results of recent survey and discussions with doctors, we can conclude that Wireless LAN applications, in particular Video transmission and X-ray transmission, can be successfully applied for medical use in rural areas.  However, due to the newness of this technology, it is also important to consider the need for “techno-social integration.”  We believe that by introducing telemedicine technologies to a broad base of health care system participants, the technology can be gradually accepted as a common component of health care in rural areas.

              We found that implementing a multipoint infrastructure would possibly require a designated staff.  Until this technology becomes as ubiquitous and reliable as standard telephone service, there will be a need for troubleshooting and equipment adjustment, maintenance and archiving medical databases in remote sites.  In multiple site circumstance, an organized and systematic approach to scheduling of telemedicine activities would be also required.  One solution here is an implementation of on-line scheduling system, in which the rural sites can electronically request specialty consults.

              Finally, we have learnt that the technical requirements for telemedicine network are relatively new to local ISPs.  In order to establish communication with other provinces and central hospitals in Hanoi, a close cooperation with Hatinh Posts and Telecommunications (P&T) is indispensable.  Such communication can be achieved by using  current network of P&T from Hatinh to Hanoi and other provinces, or combination of P&T technical facilities and CFO-SS 10A Wireless LAN system.

4. Conclusion

Telemedicine for rural areas is being developed day by day in many places around the world.  The applications and methods vary depending on the availability of technologies, experiences and resources.  To enhance and find more suitable applications in this field are the tasks we have to do in the near future.  The design of a technical infrastructure, which is flexible and scalable, is also next challenging task.  Telemedicine is a new way of communicating, and the socio-cultural component cannot be overlooked.  During the process of implementation, the participants achieved a high level of teamwork and established a good interpersonal communications.  Such collaboration helped us to get a better understanding of advantages of Wireless LAN technology, applications for telemedicine, and conditions in rural areas as well.

              We’d also like to express our gratitude to APT, who kindly has been supporting this project.