are you talking to me?
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Are You Talking to Me?Technical Interoperability of Telemedicine Systems
Agenda
• State of technical interop. in telemedicine• Interop. in videoconferencing/multimedia
collaboration systems• Video Development Initiative (ViDe)• Videoconferencing interoperability
demonstration
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
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
ViDe Interoperability, Middleware and Standards Initiatives
Jill Gemmill, MSEEUniversity of Alabama, Birmingham
Past ViDe Chair
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
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
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