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Are You Talking to Me? Technical Interoperability of Telemedicine Systems

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Page 1: Are You Talking to Me?

Are You Talking to Me?Technical Interoperability of Telemedicine Systems

Page 2: Are You Talking to Me?

Agenda

• State of technical interop. in telemedicine• Interop. in videoconferencing/multimedia

collaboration systems• Video Development Initiative (ViDe)• Videoconferencing interoperability

demonstration

Page 3: Are You Talking to Me?

State of Interoperability in Telemedicine

• Best interoperability in videoconferencing, but some development still needed in:– Authentication– Transcoding between H.32x and SIP– Camera and other device (peripheral) control

• Limited interoperability in medical devices– Fair from device to EHR– Poor for telemetry/telemonitoring

• Is there a role for Open Source models?– Clear societal benefit– Does not preclude profit– 70-80% health IT costs in support/maintenance, but

companies compete on the other 20-30%– Motto: simple, clean interfaces

Page 4: Are You Talking to Me?

Videoconferencing Interoperability

Capability/Feature Applicable Standard(s) Stds Dev’t Org. (SDO)

Videoconference quality

H.323, including:H.261, H.263, and/or H.264 video compressionG.711, G.722 audio compression

ITU

Multipoint H.225/RAS, H.245 ITU

Security/Encryption Adv. Encryption Std. (AES); H.235 NIST, IETF, ITU

Dual Media Stream H.239 ITU

Application Sharing Function of various software packages (used to be ITU T.120)

?

Remote Camera Control

Often serial interface, some protocol extensions in H.323

?

Directory Services H.350 ViDe, ITU (H.3XX-based), IETF (SIP-based)

Peripheral Input/Output (I/O)

Broadcast videoVid. Cnx (RCA, BNC, S-VHS) VGA, DVI monitor inputRS-232FireWire (IEEE 1394)Universal Serial Bus

NTSCVESA

EIA IEEEUSB IF

Page 5: Are You Talking to Me?

ViDe Interoperability, Middleware and Standards Initiatives

Jill Gemmill, MSEEUniversity of Alabama, Birmingham

Past ViDe Chair

Page 6: Are You Talking to Me?

Interoperability Demo

• Purpose: demonstrate multi-vendor interoperability in real-world telemedicine usage scenarios, in order to: – introduce existing interoperability standards,

capabilities, and terminology– show interoperability between commercially-

available systems– illustrate issues associated with interoperability– serve as a basis/model for additional, more

comprehensive interoperability demonstrations at future ATA meetings

Page 7: Are You Talking to Me?

Generic Telemedicine Use Cases

• Teleconsultation– patient accompanied by a presenter who a at a clinical site

outfitted with peripherals & collaborates with a MD or other consultant at a center of medical expertise

• Multispecialty health care collaboration– subspecialists at multiple locations collaborating on single case

or groups of cases, e.g. tumor board

• Distance learning– lecturer or instructor who delivers presentation materials to

multiple locations for courses, grand rounds, or continuing education, may need to support student/participant Q&A

• Patient interview/follow-up/compliance/education– direct communication with a patient and/or care giver in situ

(e.g. home care) for following up on problems related to a known diagnosis, ascertaining compliance with treatment plans, and/or patient education

• Meetings/Administrative

Page 8: Are You Talking to Me?

Scenario-driven Interop Demo

Clinical/Operational Scenario Tumor Board Pediatric Cardiology

Application Multi-specialty Health Care Teleconsultation

Videoconference Quality Diagnostic/High Diagnostic/High

Multipoint Yes No

Security/Encryption Yes Yes

Dual Media Stream Yes Yes

Application Sharing Yes No

Remote Camera Control (PZT) No No

Directory Services Yes No

Peripheral I/O Microscope, PC (EMR) Stethoscope, Echo