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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Since the launch of Telemedicine Technologies (Wiley, 2010), the technologies surrounding telemedicine have changed immeasurably, particularly with the emerging trends of Internet-of-Things (IoT), digital/e-Health, and wearable, smart and assistive technologies. This second edition overhauls and expands on the original text to reflect the technical advances of the last decade. It covers applications from traditional healthcare services to remote patient monitoring and recovery, to alternative medicine and general health assessment for maintaining optimal health. This welcome update brings together a broad range of topics demonstrating how information and wireless technologies can be used in healthcare.
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Veröffentlichungsjahr: 2020
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Table of Contents
Cover
Foreword
Preface
Acknowledgments
About the Book
Book Overview
1 Introduction
1.1 Information Technology and Healthcare Professionals
1.2 Providing Healthcare to Patients
1.3 Healthcare Informatics Developments
1.4 Different Definitions of Telemedicine
1.5 The Growth of E‐health to M‐health
1.6 The Connected World Between Human and Devices
References
2 Communication Networks and Services
2.1 The Basics of Wireless Communications
2.2 Types of Wireless Networks
2.3 M‐health and Telemedicine Applications
2.4 The Outdoor Operating Environment
2.5 RFID in Telemedicine
References
3 Information and Communications Technology in Health Monitoring
3.1 Body Area Networks
3.2 Emergency Rescue
3.3 Remote Recovery
3.4 Smart Hospital
3.5 General Health Assessments
3.6 Multisensory Stimulation for Aging Care
References
4 Data Analytics and Medical Information Processing
4.1 Noninvasive Health Data Collection
4.2 Biosignal Transmission and Processing
4.3 Patient Records and Data Mining Applications
4.4 Knowledge Management for Clinical Applications
4.5 Artificial Intelligence (AI) in Digital Health
References
5 Wireless Telemedicine System Deployment
5.1 Planning and Deployment Considerations
5.2 Scalability to Support Future Growth
5.3 Integration with Existing IT Infrastructure
5.4 Evaluating an IT Service and Solution Provider
5.5 Quality Assurance
5.6 IoT and Cloud Integration
References
6 Safeguarding Medical Data and Privacy
6.1 Information Security Overview
6.2 Cryptography
6.3 Safeguarding Patient Medical History
6.4 Anonymous Data Collection and Processing
6.5 Biometric Security and Identification
6.6 Conclusion
References
7 Information Technology in Alternative Medicine
7.1 Technology for Natural Healing and Preventive Care
7.2 Interactive Gaming for Healthcare
7.3 Consumer Electronics in Healthcare
7.4 Telehealth in General Healthcare and Fitness
References
8 Digital Health for Community Care
8.1 Telecare
8.2 Safeguarding Senior Citizens and the Aging Population
8.3 Telemedicine in Physiotherapy
8.4 Healthcare Access for Rural Areas
8.5 Healthcare Technology and the Environment
References
9 Wearable Healthcare
9.1 From Mobile to Wearable
9.2 Medical Devices Versus Consumer Electronics Gadgets
9.3 Connectivity
9.4 Enhancing Caring Efficiency
9.5 Wearable Physiotherapy
References
10 Smart and Assistive Technologies
10.1 Affordability in Assistive Technologies
10.2 Smart Home Integration
10.3 Digital Health in Improving Treatment
10.4 Prognostics in Telemedicine
10.5 Clothing Technology in Telehealth
References
11 Future Trends in Healthcare Technology
11.1 Haptic Sensing for Practitioners
11.2 Business Intelligence in Healthcare Prevention
11.3 Cross‐border Care: A Case Study of Syndromic Surveillance
11.4 5G‐based Wireless Telemedicine
11.5 The Future of Telemedicine and Information Technology for Everyone: From Newborn to Becoming a Medical Professional all the Way Through to Retirement
References
Index
End User License Agreement
List of Tables
Chapter 2
Table 2.1 Properties of some common wireless communication systems.
Chapter 3
Table 3.1 Data throughout requirements for some telemedicine applications.
Chapter 4
Table 4.1 The two main blood glucose units used worldwide.
Chapter 7
Table 7.1 Product specifications of a massage chair.
Chapter 9
Table 9.1 Measurement from a controlled experiment.
List of Illustrations
Chapter 1
Figure 1.1 A simple telemedicine system.
Figure 1.2 Sensors attached to the back of a patient using wires that severe...
Figure 1.3 Some examples of digital health applications supported by telemed...
Figure 1.4 Subsets of telemedicine connecting patients to medical profession...
Figure 1.5 Simple network connection from the patient's body to the outside ...
Figure 1.6 Simplified structure of a typical data packet that contains the a...
Chapter 2
Figure 2.1 Block diagram of a basic communication system that consists of th...
Figure 2.2 Communication system under the influence of noise.
Figure 2.3 Guided versus unguided transmission medium, which describes wheth...
Figure 2.4 Within a twisted pair cable, a pair of wires are literally twiste...
Figure 2.5 A simple fiber optic communication system.
Figure 2.6 Network infrastructure linking the hospital to many entitles, bot...
Figure 2.7
System‐on‐chip
(
SoC
) implementation for mobile health...
Figure 2.8 A small oxygen saturation meter that utilizes a pair of light sou...
Figure 2.9 Propagating wireless signal degrades, owing to different phenomen...
Figure 2.10 Effect of rain attenuation at different rainfall rates. The sign...
Figure 2.11 A horizontally polarized signal undergoes more severe attenuatio...
Figure 2.12 Multipath fading caused by different components of the same sign...
Figure 2.13 An RFID tag.
Chapter 3
Figure 3.1
Body area network
(
BAN
) connecting a range of devices/systems wit...
Figure 3.2 A simple emergency rescue system where multiple vehicles on the s...
Figure 3.3 Taking a closer look at the ambulance shown in Figure 3.2, there ...
Figure 3.4 Wireless devices serving a paramedic on the scene.
Figure 3.5 Emergency rescue network block diagram. A radio hub (which can be...
Figure 3.6 A well‐equipped paramedic capable of carrying out a rescue missio...
Figure 3.7 Block diagram of a typical hospital network.
Figure 3.8 Case study: radiology information system.
Figure 3.9 Telerobotic surgery.
Figure 3.10 The 3D space is represented by “six dimensions,” effectively the...
Figure 3.11 RFID readers installed in a hospital maternity ward to ensure th...
Figure 3.12 Schematic of the shoe‐integrated gait sensors.
Figure 3.13 A gy network that simultaneously providing health and safety tra...
Figure 3.14 The water's surface causes reflection and refraction, which make...
Figure 3.15 A multipurpose sensory stimulator for senior citizens.
Chapter 4
Figure 4.1 Block diagram of a medical information system.
Figure 4.2 Normal variation of body temperature throughout the day.
Figure 4.3 Circadian rhythm of heartbeat.
Figure 4.4 Heart rate sensors mounted on the hand grips.
Figure 4.5 Assistive device with environmental sensing and communication cap...
Figure 4.6 Blood pressure meter that can automatically send the measurement ...
Figure 4.7 Telemedicine under water.
Figure 4.8 Partial pressure of oxygen in arterial blood (PaO
2
) measurement....
Figure 4.9 Infrared energy absorption by hemoglobin versus wavelength.
Figure 4.10 Pulse oximeter oxygen saturation (SpO
2
) measurement.
Figure 4.11 Block diagram for collecting patients' information.
Figure 4.12 Image processing. The fundamental idea of medical imaging is to ...
Figure 4.13 MRI scanner where the patient enters the scanner that allows a d...
Figure 4.14 MRI scanned image of a healthy human brain.
Figure 4.15 X‐ray radiography.
Figure 4.16 Photon scattering.
Figure 4.17 Ultrasound image of a healthy beating heart.
Figure 4.18 Ultrasound image of a healthy fetus.
Figure 4.19 When an X‐ray beam strikes the tissue.
Figure 4.20 Radiograph of a tumor in the lung.
Figure 4.21 MRI scanned image: (a) without data compression; (b) moderate co...
Figure 4.22 Electrical activities: (a) electrocardiogram (ECG); (b) electroe...
Figure 4.23 The information retrieval process.
Figure 4.24 Clinical knowledge system.
Figure 4.25 System linking a physician to the outside world.
Figure 4.26 Inside the clinic.
Figure 4.27 Knowledge management for electronic patient records.
Figure 4.28 Patient monitor.
Figure 4.29 Photoplethysmogram (PPG) measurement through counting the light ...
Figure 4.30 Extraction of feature frequencies using SSR.
Figure 4.31 Recurrent neural network (RNN) that processes PPG and ACC signal...
Figure 4.32 Laboratory utilizes AR for clinical training that operates on a ...
Chapter 5
Figure 5.1 A simple peer‐to‐peer (P2P) network. This is the most basic form ...
Figure 5.2 The seven‐layer Open Systems Interconnection (OSI) model.
Figure 5.3 An ad hoc network that consists of individual devices communicati...
Figure 5.4 Constellation diagram that shows a signal modulated by any digita...
Figure 5.5 Coverage enhancement through augmentation.
Figure 5.6 Cellular coverage.
Figure 5.7 Frequency reuse with alternate polarization.
Figure 5.8 Subchannels separated by a guard band. This effectively provides ...
Figure 5.9 Time division multiplexing where the channel is divided into time...
Figure 5.10 Frequency division multiplexing where the channel is divided int...
Figure 5.11 Switching between time slots.
Figure 5.12 Filtering for different sub‐bands.
Figure 5.13 “Ideal” filter with sharp cutoff.
Figure 5.14 Conventional outdoor TV antenna, used over several decades from ...
Figure 5.15 Antennas of circular polarization.
Figure 5.16 Sectorization from one cell into four and eight sectors.
Figure 5.17 Asthma self‐monitoring system.
Figure 5.18 Database sharing in a hospital.
Figure 5.19 A sample medical liability waiver form.
Figure 5.20 A telemedicine IoT ecosystem.
Figure 5.21 Real‐time location tracking.
Figure 5.22 Tracking sensors' network grid.
Figure 5.23 Model representing the different healthcare dimensions of IoT in...
Chapter 6
Figure 6.1 A simple safe‐keeping plan.
Figure 6.2 Backup tapes that were used for many decades until around the ear...
Figure 6.3 Top view of the inside of an NAS that contains a control circuitr...
Figure 6.4 Backup with a mirror site.
Figure 6.5 Uninterrupted power supply with an external battery that supplies...
Figure 6.6 Cryptography.
Figure 6.7 Certificate‐based authentication.
Figure 6.8 Private key encryption.
Figure 6.9 Public key encryption.
Figure 6.10 Key encryption process.
Figure 6.11 Digital signature.
Figure 6.12 Screenshot of the various NHS online service providers.
Figure 6.13 Healthcare service infrastructure.
Figure 6.14 Process for infectious disease spread pattern analysis.
Figure 6.15 Blood sample of a swine flu patient.
Figure 6.16 Healthcare service organizational structure.
Figure 6.17 Screen shot of a population pyramid.
Figure 6.18 Fingerprint impression.
Figure 6.19 Scanned image of a portion of a finger under different alignment...
Figure 6.20 Another scanned portion of the same finger.
Figure 6.21 An industrial grade fingerprint scanner with dirt and surface sc...
Figure 6.22 Palmprint scanning.
Figure 6.23 Image of the retina.
Figure 6.24 Retina scanner with a built‐in low‐energy infrared light source....
Figure 6.25 Contact lens does not affect the performance of retina scanning....
Figure 6.26 Sound spectrogram of a voiceprint.
Figure 6.27 Framework for user identification over a telemedicine network.
Chapter 7
Figure 7.1 2D acupoint chart.
Figure 7.2 Reference points with reference to
anterior superior iliac spine
...
Figure 7.3 Body profile.
Figure 7.4 Three human pictures not easily recognized by computational algor...
Figure 7.5 Telemedicine for offshore relief support.
Figure 7.6 Virtual skiing videogame.
Figure 7.7 eSport gaming system for physical exercise.
Figure 7.8 Field strength versus distance.
Figure 7.9 Fundamental components of a pedometer.
Figure 7.10 Workout summary.
Figure 7.11 Simulated cycling path profile.
Chapter 8
Figure 8.1 Collection of telehealth devices covering everything from simple ...
Figure 8.2 Pharmacy kiosk.
Figure 8.4 A telehealth network that serves different request sites.
Figure 8.3 Generalized telecare network.
Figure 8.5 Screenshot of statistics on aging.
Figure 8.6 Aging population projection of G8 nations.
Figure 8.7 Telehealth for older patient care.
Figure 8.8 Assistive home setup for living alone, comprehensive services ens...
Figure 8.9 Body area network biosensors.
Figure 8.10 Assistive care smartphone.
Figure 8.11 Pandemic outbreak locality map.
Figure 8.12 Video motion sensing network.
Figure 8.13 Motion tracking camera.
Figure 8.14 Lens focal length versus coverage angle.
Figure 8.15 Installation of accelerometers on a dummy.
Figure 8.16 An accelerometer senses 3D movement.
Figure 8.17 Skin impedance measurement.
Figure 8.18 Wireless insulin pump.
Figure 8.19 Telecare network.
Figure 8.20 An ancient telemedicine system.
Figure 8.21 Radiation sources.
Figure 8.22 X‐ray dosage.
Chapter 9
Figure 9.1 Telemedicine in a smart city framework.
Figure 9.2 Experimental setup for noninvasive glucose monitor prototyping; r...
Figure 9.3 An MIMO antenna (left) performs better than a microstrip antenna ...
Figure 9.4 Test subject with wearable sensors, markers, and
electromyographi
...
Figure 9.5 A simple baby monitoring system.
Figure 9.6 A smartphone app that assists general health tracking.
Figure 9.7 Product Classification Database for determining the device class....
Figure 9.8 Smart shoe for start pain management.
Figure 9.9 Helmet with integrated sensors for both health monitoring and saf...
Figure 9.10 Wearable sensing network placed along the spine for gait and pos...
Figure 9.11 Relationship between human and machines.
Figure 9.12 Wearable electrical muscle stimulation for stroke recovery.
Chapter 10
Figure 10.1 AI‐generated diet for cholesterol control.
Figure 10.2 Hair dyes for medication binding: mixing to yield a natural tran...
Figure 10.3 Color analyzer for tone matching and clinical trial reporting.
Figure 10.4 Support for varicose veins relief through dynamic inflation of a...
Figure 10.5 Dual function smart pill for health data acquisition and drug de...
Figure 10.6 Prognostics framework.
Figure 10.7 Network failure model.
Figure 10.8 Network breakdown with re‐routing.
Figure 10.9 Performance degradation to initiate self‐calibration prior to an...
Figure 10.10 Automatic winding movement mechanism.
Figure 10.11 Glucose measuring wristband.
Figure 10.12 Noninvasive optical glucose measurement.
Chapter 11
Figure 11.1 Haptic glove.
Figure 11.2 Remote health monitoring CPS within a patient's smart home envir...
Figure 11.3 Remote patient monitoring CPS.
Figure 11.4 Respiratory syndrome data.
Figure 11.5 Telemedicine network in syndromic surveillance.
Figure 11.6 Wireless baby monitor.
Guide
Cover
Table of Contents
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Telemedicine Technologies
Information Technologies in Medicine and Digital Health
Bernard Fong
Providence University, Taichung City, Taiwan
A.C.M. Fong
Western Michigan University, USA
C.K. Li
Alpha Positive Clinic, Hong Kong
Second Edition
This edition first published 2020© 2020 John Wiley & Sons Ltd
Edition HistoryJohn Wiley & Sons, Ltd (1e, 2010)
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Bernard Fong, A.C.M. Fong and C.K. Li to be identified as the authors of this work has been asserted in accordance with law.
Registered OfficesJohn Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USAJohn Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
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Library of Congress Cataloging‐in‐Publication Data
Names: Fong, Bernard, author. | Fong, A. C. M., author. | Li, C. K. (Chi Kwong), 1952‐ author.Title: Telemedicine technologies : information technologies in medicine and digital health / Bernard Fong, A.C.M. Fong, C.K. Li.Description: Second edition. | Hoboken : Wiley, 2020. | Includes bibliographical references and index.Identifiers: LCCN 2020004340 (print) | LCCN 2020004341 (ebook) | ISBN 9781119575740 (hardback) | ISBN 9781119575757 (adobe pdf) | ISBN 9781119575771 (epub)Subjects: MESH: Telemedicine–methods | Telemedicine–instrumentation | Medical Informatics Applications | Wearable Electronic DevicesClassification: LCC R858.A1 (print) | LCC R858.A1 (ebook) | NLM W 83.1 | DDC 610.285–dc23LC record available at https://lccn.loc.gov/2020004340LC ebook record available at https://lccn.loc.gov/2020004341
Cover Design: WileyCover Images: Smart city and wireless © tcharts/Shutterstock, Telemedicine concept © Agenturfotografin/Shutterstock
Foreword
Technology has come a long way since the publication of this book's first edition in 2011, such that capabilities of telemedicine systems have grown tremendously due to advances in information and communication technologies.
A wide range of healthcare services cannot be extended beyond hospitals and clinics without reliable telecommunication networks. Over the past few decades, advances in digital health and information technology have brought healthcare services to patients everywhere in a convenient and reliable manner. For example, a surgeon can now carry out a surgical operation away from the operating theater, while medical students can practice their surgical skills repeatedly without the risk of causing any harm to actual patients through augmented reality (AR) and virtual reality (VR), and a physiotherapist can monitor the progress of postsurgical rehabilitation anytime, anywhere. Technologies not only assist with medical practitioners and patients receiving treatment, perfectly healthy people can also benefit from a wide range of general health monitoring solutions that ensure optimal health can be maintained and any anomaly can be identified at the earliest opportunity through preventive care.
This second edition contains new information that offers readers a diverse range of possibilities through an introduction to telemedicine and its related technologies. Written by three experts in the areas of telemedicine, multimedia, and knowledge management, the book comprehensively covers many aspects of telemedicine applications that benefit both medical professionals and patients. It provides readers with fundamental knowledge in data communications without extensive mathematics, followed by a number of applicable areas, each with case studies in different areas of medical practice.
Nirwan AnsariDistinguished ProfessorNew Jersey Institute of Technology
Preface
Telemedicine is the broad description of providing medical and healthcare services by means of telecommunications. Information and communications technology (ICT) in areas covering control, multimedia, pattern recognition, knowledge management, image, and signal processing has enabled a wide range of digital health and medical applications to be supported.
The combined effect of worldwide population growth and an aging population in most developed nations has given rise to a soaring demand on public health systems. The impact on national health systems in many countries has been further fueled by changes in lifestyle and environmental pollution. All these factors are stretching health systems to their limits, particularly under the constraints of limited healthcare resources. This is evident from the trend of chronic disease and obesity‐related complications affecting younger people in recent years. The economic prosperity now enjoyed by many is a direct result of hard work by the previous generation and excessive consumption of natural resources, which may bring a range of problems for future generations. In response to all this, we should aim to take good care of the senior citizens who have devoted decades of work to today's prosperity. By the same token, we are working hard to enhance medical technologies to improve our health, and to provide a sustainable healthcare system for the next generation. Telemedicine forms the fundamental backbone in fulfilling our responsibilities for providing a diverse range of healthcare solutions to people of all ages.
There is an emergent interest among government authorities, healthcare service providers, academia, medical professionals, equipment manufacturers, and supplier industries to optimize the efficiency of providing a wide range of medical services in terms of both cost and time. The effective utilization of telemedicine and related technologies will be able to assist with, but is not limited to:
Support more types of services.
Bring services to more people in more regions.
Make healthcare more affordable to the poor and older people.
Optimize health for all ages.
On‐scene treatment for mobile medical professionals.
Provide preventive care in addition to emergency treatment.
Remote rehabilitation monitoring.
Chronic disease relief and care.
Ascertain service reliability and reduce human error.
Safeguard patients' personal information and medical history.
To address the growing trend of telemedicine deployment in both urban and rural areas throughout the world, this book discusses different technologies and applications surrounding telemedicine and the challenges its implementation faces. This book also looks at how various signs of a human body are captured and subsequently processed so that they can be used for providing treatment and health monitoring. As conventional medical science tends to seek remedies according to symptoms, we explore how technologies in alternative medicine can go back to basics to address the root cause of many ailments by optimizing health in general.
Acknowledgments
First and foremost, the authors wish to thank all their readers for taking the time to learn more about telemedicine technologies. The authors are confident that this book will help readers to develop their expertise in further enhancing medical and healthcare technologies to benefit more people in the community. The main objective of telemedicine technologies has always been to extend medical services to more areas for more people so that people can live healthier for longer irrespective of where they are.
Over the years, the authors have seen numerous cases where people are unable to access healthcare either because they cannot afford it or because the service cannot be extended to their areas due to a number of reasons. The continuing advances of telemedicine technologies that break the geographical barrier of providing quality healthcare prompted us to write a book to share our insights together with the underlying technologies that can potentially benefit millions, if not billions, of people. Much of what we have learned over the years comes as a direct result of taking care of our retired parents as well as our delightful children, all of whom, in their unique ways, inspired us and, subconsciously, contributed a tremendous amount to the content of this book on promoting enhancement of telemedicine technologies to help people of all ages.
We also wish to thank the editorial team at John Wiley with their profusion of patience and talent, whose excellent work has led to a significant improvement on the presentation of this book.
Every effort has been made to trace rights holders. However, in case any have been inadvertently overlooked, the authors would be pleased to make the necessary arrangements at the very earliest opportunity.
About the Book
This book looks at the underlying information technologies providing telemedicine services. The text covers applications from traditional healthcare services to remote patient monitoring and recovery to alternative medicine and general health assessment for maintaining optimal health. It is primarily intended for readers ranging from medical professionals to final year undergraduate and first year graduate students in biomedical engineering or related disciplines. One of the book's main objectives is to help medical practitioners acquire fundamental knowledge in the technology behind the systems that help them with their work, and to serve as a reference for people who design and implement telemedicine systems. The text also provides detailed coverage of how technological advancements in high‐speed wireless networking for the secure transmission of medical information may benefit both healthcare professionals and patients.
Book Overview
Chapter 1 is an introductory chapter that provides a general picture of what telemedicine entails and the importance of providing quality healthcare in various areas of medical practice with the aid of telemedicine technologies. The underlying concepts in various areas are summarized, and most of these will be elaborated on in more depth throughout the book. The technologies associated with individual applications would depend on their availability and specific regulatory limitations imposed by the respective authorities of a given country. Readers should be able to get a good understanding of how medical and information technology (IT) professionals are linked closely together through technological advancements. It is about how they help each other work better – and more importantly, how the general public improves the way they enjoy better health and medical services as a result of technology.
Chapter 2 provides technical coverage on what telecommunication technology is all about, and how it can be applied to better healthcare. Although this chapter primarily provides technical knowledge to readers, we do not go deeply into the engineering and mathematical aspects as the main scope of this book concerns technologies related to medical and healthcare applications. However, adequate knowledge will be provided to make use of underlying communications technology for healthcare. The chapter discusses what solutions are currently available and how to select the type of network most suitable for a given telemedicine application. Examples are given to demonstrate how each technology is applied. We also look at the harsh outdoor environment, where wireless communication systems are affected by various factors. The fundamental limitations of technology are dealt with, so what is and is not possible with technology is also discussed.
Chapter 3 looks at how life saving can be accomplished with technology developed for emergency rescue. It also looks at wireless communication systems used in remote patient monitoring. This is a particularly important application for servicing rural areas and older people. Such technology is also suitable for rehabilitation so that patients can recover at home with the assurance that they are being properly looked after even after they are discharged from the hospital. Various topics on body area networks (BANs) are also considered. These include different types of wearable monitoring devices, body sensors, data communication between devices, and practical difficulties faced.
Chapter 4 discusses the information theory behind the successful representation of various types of medical information with binary bits. It starts by looking at different ways of collecting data from patients; different applications require very different types of capturing devices. For example, measuring a person's heart rate and electrocardiograph (ECG) would require very different instruments. It also looks at what precautions are necessary for medical data transmission and storage, and covers the increasingly important area of artificial intelligence (AI) in various aspects of healthcare from medical training to preventive care.
Chapter 5 considers system deployment issues with examples of wireless telemedicine system development. It deals with a number of possible options and the importance of ensuring quality and reliability, something particularly important in critical life‐saving missions. The concept of connectivity through the Internet of things (IoT) and cloud health management is also discussed.
Chapter 6 introduces the concept of information security and how to implement secure telemedicine systems for different applications. Patient privacy must be respected and any information collected needs to be safeguarded throughout the entire process from collection to analysis and subsequent storage. There have been reported cases of medical personnel losing removable storage devices, like USBs (universal serial buses) and memory cards, containing patient information. These irresponsible acts can be easily restrained by providing secure remote access to hospital staff. Any data collected for statistical analysis must ensure individual persons cannot be identified so that all such information remains anonymous. Since certain data needs to be shared between medical institutions and government agencies, a mechanism for maintaining data accuracy as well as anonymity is always crucially important. The chapter concludes with a look at the evolution of technologies related to biometric identification.
Chapter 7 introduces alternative medicine and may not be too relevant to certain medical professionals, although it is increasingly accepted as an effective way to treat prolonged illnesses such as colds and asthma. This chapter therefore aspires to give readers some background information on what alternative medicine entails and how information technology can be applied to serve the community better through practicing alternative medicine, often in conjunction with mainstream approaches. It also looks at an example of using biomedical databases for herbal medicine and acupressure aimed at treating patients who may require long‐term treatment. The discussion then proceeds to using technology to optimize health, like progress monitoring in gyms or using an smartphone app when going on a short morning jog. Consumer healthcare products such as foot spas and massage chairs are becoming increasingly popular throughout the world. These products offer many novel features, including integration with existing audiovisual systems and other home appliances.
Chapter 8 addresses the issues of providing electronic healthcare from a user's point of view. This is considered important because as population aging becomes a more serious problem in most developed countries the demand for these services is expected to grow tremendously over the next few decades. Through the utilization of technology we will pay fewer visits to clinics and hospitals, and we will be better looked after. People living in rural areas will find this particularly helpful since not all remote small towns have medical facilities readily available at all times. Telecare becomes an important telemedicine application for providing easy access to healthcare for those with special needs. Although technology may not always reduce the risk of accidents occurring, we do have mechanisms for keeping an eye on people who need to be cared for so that necessary actions can be taken without delay should a mishap occur. In addition to providing special care for older people and those with special needs, we also look at how technology can help people recover from sports injuries. Some exercises may facilitate speedy recovery yet improper movement can worsen the affected area. So, technology that monitors the rehabilitation progress can therefore be very helpful for those struggling to recover from injuries.
Chapter 9 takes an in‐depth look at spinoffs from the ever‐growing list of wearable devices brought to us through the administration of devices, circuits, and systems that in turn provide numerous opportunities for digital health applications. The concept of consumer healthcare and medical devices is discussed in providing round‐the‐clock care anywhere in an affordable and efficient manner. The emerging topic of using transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS) for rehabilitation is also introduced.
Chapter 10 presents an overview of smart and assistive technologies based on a telemedicine framework. It considers examples of deployment from a patient's point of view that include smart home healthcare and smart clothing. It also looks at improving treatment with an example on optimizing medication delivery through media such as hair treatment and smart pills.
The book concludes with Chapter 11 and a brief summary of the possibilities in telemedicine for the foreseeable future. The chapter explores cases like learning support for medical and nursing students as technology makes training healthcare professionals easier and more efficient. We also explore other emerging technologies for telemedicine advancements, such as haptic sensing by conducting various tasks through touch, and what future telemedicine and digital health technology have to offer, how the transition from 4G to 5G mobile communication technology changes the way patient‐centered health services develop, and finally the benefits telemedicine brings to people of all ages.
1Introduction
1.1 Information Technology and Healthcare Professionals
The history of modern telemedicine goes back to the traditional telephone about a century ago. Medical advice was given by physicians over the telephone. The term “telemedicine” is very simply a description of supporting medical services through the use of telecommunications. The prefix tele comes from the Greek for “distant.” So, “telemedicine” literally means providing medical services over distance. Telecommunications used in medical applications can be categorized as sending medical information between a pair of transmitter and receiver. The “medical information” can be as simple as a doctor providing consultation from sophisticated data captured from a human body. “The Radio Doctor,” which first appeared in the Radio News magazine (c.1924), is perhaps the earliest documented case of utilizing telecommunication technology for medical application. Although information technology (IT) has been used in healthcare since then, it was the first scientific literature formally addressing the application of technology in medicine that appeared. (Moore et al. 1975).
IT advances over the past decades mean a wider range of healthcare services can be supported. Indeed, the types of services that can be supported are so vast that any book which makes an attempt to provide comprehensive coverage of all areas will most likely contain thousands of pages over several volumes. This book aims to provide in‐depth coverage of how wireless communications and related technologies are used in medical services. We will also look at the challenges and limitations of current technology associated with healthcare information systems.
We begin by taking a look at how simple wireless communication networks function and what a telemedicine system consists of. We look at a number of examples that describe how a primitive system supports healthcare services. Over the course of the book, more sophisticated systems will be described in more detail.
This chapter aims give readers an overview on how IT is widely used in assisting healthcare without going into any technical depth. To begin our discussion, we revisit the term “information technology,” something often associated with computer science. Essentially, it is extensively interpreted as a blend of computing and telecommunications. This leads to the acronym ICT, which stands for information and communications technology, also known as “infocomm” for short. All these are merely descriptions of the use of technology to securely and reliably transmit information between two or more entities. IT is widely used in many areas that influence our daily life, for example banking, transportation, manufacturing, etc. This list is seemingly endless. When we see information technologies support so many things that we use on a daily basis, it will not be difficult to understand how widely it can be used in supporting healthcare and medical applications.
The IT industry has never quite recovered from the “dot‐com bubble” bursting in 2000, which saw the industry lose much of its value for several years. And the IT sector was similarly hit by the financial crisis of 2008/09, triggered by the collapse of the subprime mortgage market. Put simply, although IT systems are widely used in many aspects of daily life, the industry remains tied to the global economic market, and so will always be affected by any changes to it. In contrast, health and medical services are two of the few domains that are in consistent high demand, simply because illness is not market led: it is experienced by everyone on the planet to a lesser or greater degree. For this simple reason, healthcare naturally becomes an essential part of daily life that will continue to be in high demand for many years to come.
Having realized the prime importance of healthcare, we go further into how IT is applied to healthcare and medical services. Long before the evolution of IT, herbal medicine practitioners millennia ago were already using the most primitive form of information exchange mechanism, namely communication system, to convey messages on medical services. Wang et al. (1999) documented a case where Shen Nong made use of information exchange for the treatment of respiratory syndrome as far back as 2735 BCE. This may not be the first case but it is certain that medicine and communications have been linked together for over 4000 years. As IT became more sophisticated over time, a more diverse range of medical services could be supported. To name a few, IT in medicine involves drug prescription, spread of pandemic modeling, patient monitoring, remote operation, medical database, and so on. This is by no means an exhaustive list and we cover these as well as many others throughout the book.
Obviously, healthcare professionals can make use of IT advancements in different areas. Advantages brought by IT include improvement in reliability, efficiency, precision, ease of information retrieval, accomplishing tasks remotely, and better organization. Healthcare therefore becomes more readily accessible and more efficient. We will look at how technology benefits healthcare professionals, with the assumption that readers have very little prior IT knowledge and know virtually nothing about the underlying technologies.
1.2 Providing Healthcare to Patients
In addition to facilitating medical practitioners perform their tasks, providing healthcare services to patients is also an important issue to address as they are the end users who must feel comfortable to receive the treatment given. Providing a technically feasible solution is not the only obstacle to deal with. Other important issues, including patients' acceptance and accessibility, must also be addressed. We strive to look at providing healthcare solutions to patients using IT from the perspectives of both providers and patients. End users, particularly children and older people, may not be too keen on accepting technology as a tool for healing. Convincing patients of the benefits of IT for healthcare may involve liability, security, and privacy issues. For example, in the case of monitoring or tracking a patient recovering at home, the patient must be assured that personal information is securely kept and no such information accessed in any way without consent.
With the number of senior citizens increasing steadily over the past decade, there has been a growth in demand for healthy aging care (Colby and Ortman 2014). Assistive care provides numerous opportunities for supporting independent living through smart home integration (Bonaccorsi et al. 2015). A comprehensive range of customized solutions for the care of older people has been made possible through advances in IT and digital health.
Before leaving the topic on providing care to older people, it is worth briefly noting the advantages brought to this group of users by telemedicine technology. As population aging is becoming more significant concern in many countries, it can widely be expected that more care and monitoring will be needed. A significant increase in the application of wireless communications in care for older people has been seen over the past few years as related technologies have matured. The cost of service becomes more affordable and portable devices become smaller and more user‐friendly. As pervasive computing technology advances, more comprehensive and automated services will become available to the aging population in the years to come (Stanford 2002). The design of interconnected devices and sensors on the patients' side must ensure non‐obtrusiveness and can be comfortably worn. Also, users' movement will not be restricted and reliability will not be affected irrespective of wearing condition. User‐friendliness is another important design factor, as absolute minimal training should be necessary, especially for children and older people. These should be genuine plug‐and‐play devices. In this sense, the healthcare system in the patient's home can be installed by a technician during initial deployment. Thereafter, almost everything should be fully automatic, except for unavoidable scheduled maintenance such as battery replacement and calibration.
Let's elaborate more on a patient's point of view as an end user. The primary objective of telemedicine is to provide medical services remotely. Among numerous advantages brought to patients by telemedicine, an obvious convenience is reducing the need for clinical visits. Through the utilization of IT, a patient can rest at home while receiving full medical attention. Reviewing the level of medical support provided over the past two to three decades, it can be seen that IT has certainly provided tremendous benefits to the general public as a whole. The advancement of faster computers and more efficient bandwidth usage has allowed more types of services to be extended to more users. For example, a few decades ago a simple request for medical advice could be obtained by finding a fixed line telephone and dialing in to the clinic where a physician was stationed. With the availability of mobile voice over Internet protocol (VoIP) technology, one can now simply pick up a mobile phone and place a video‐enabled call to a physician; the physician does not necessarily have to be situated inside the clinic in order to provide advice. This is just one among numerous examples where IT advancements have made healthcare more readily available. More such examples are presented throughout the book.
While the benefits to patients are obvious, there is a wide range of challenges that different parties face in order to serve patients. These concern people from developers, practitioners, and healthcare management and authorities. The following highlights challenges that different people face, starting from the initial planning stage to the final rollout and continuing maintenance.
From the IT perspective, the fundamental question is feasibility. The primary consideration is whether current technology is capable of doing something. After this comes practicality and cost effectiveness. We begin by considering an example where schoolchildren are to enroll into a program that ensures their school bags are ergonomically prepared so that there will be no issue with back pain. The advantage to participating children is very obvious because the program should ensure that they will not suffer from any back pain. However, how viable is the entire program? We need to understand more about the technology involved in order to answer this seemingly simple question.
In this case study, we have the following parties involved: engineers developing the monitoring system, clinical staff analyzing the captured data, funding bodies providing necessary resources, children participating in the study, and finally participants' parents giving consent to their children's involvement. Below, we look at the case with respect to benefits and concerns from each party's standpoint.
Figure 1.1 A simple telemedicine system.
1.2.1 Technical Perspectives
Biomedical engineers need to develop a system based on requirements specified by clinical staff, such as that illustrated in Figure 1.1, with the necessary sensors and data communication network. This simple system has a number of sensors forming a sensor network for capturing different types of information about a patient. It is linked to the system for analysis by a workstation and storage in an electronic patient record (EPR), and is monitored by the necessary system and network administration tools. In this discussion, we shall not go into the technical details while giving an insight into what is involved. Engineers analyze this by evaluating technical feasibility and practicality. Digging deeper into the technical challenges, one obvious issue to address is how to ensure whatever captured data is meaningful. There are several factors that influence the validity of data, most notably from what the sensors have picked up followed by what has been transmitted and subsequently received. In this respect, the sensors must be securely attached at the relevant points of the participant's body, and each sensor must be sensitive enough to pick up any subtle tilting of the body while not being too sensitive that it picks up any vibration from other sources. Having dealt with these problems, next we must ask whether the sensors are suitable for the specific application – the size may be too large for attaching onto a child, for example – and whether it will cause any discomfort. Are readings affected by any physical obstacles that may be separating the children from the backpack, such as clothing? How is captured data sent out for processing and analysis? Will sensors interfere with each other if placed too close together? These are just some of the questions related to sensors that need to be dealt with.
We shall proceed by assuming that the sensors are well designed and the problems listed above have been overcome. So, we are technically able to capture a set of valid data that tell us something about a child's behavior when carrying a backpack. We now look briefly at how telemedicine is utilized in a biosensor network; we will come back to this with more details in Section 3.5. In the previous paragraph we raise a question about how the captured data is sent out. Essentially, we have two choices: using wireless communications or connecting the sensors with wires. How they compare will depend on the system itself as there is no clear advantage with either option. This is one major topic that we cover throughout this book.
Briefly summarizing the discussion here, we have seen how many questions need to be addressed in relation to the deployment of such supposedly simple health monitoring systems. So, although the system may appear simple enough to patients, its design and implementation may not be as straightforward, and there are many limitations.
1.2.2 Healthcare Providers
Healthcare professionals should understand that technology is available for making their routine work easier and safer. Many may still prefer traditional methods, just like many people still prefer jotting down notes using pen and paper. Others may find technologies helpful when using a personal digital assistant (PDA) or tablet computer for the same purpose. There are, of course, many advantages with a tablet, although users may need to familiarize themselves with its user interface. Another concern to some is the risk of losing its stored data due to breakdown, or unauthorized access of data if backed up on a cloud server. We can see that people who are used to conventional ways of carrying out a task may need to be convinced of the associated benefits technologies bring, in order to impel them into learning to utilize these technologies. So, as a practitioner, a simple‐to‐use interface would be a fundamental design requirement. User experience (UX) developers should involve professionals throughout the design process. The entire process should be as automated as possible while maintaining a very high level of reliability. Different applications may have very different demands. For example, telesurgery requires ultra‐high precision for control and crystal clear imaging details with no time delay, whereas teleconsultation may have much less stringent requirements.
Although technical advancements have made, and will continue to make, current technologies more efficient and fault‐free, and hence do and will enable numerous tasks to be accomplished quicker and more reliably, the incentive to use them may not be compelling unless practitioners actually know how to use them. Getting used to something new, especially for critical tasks, can be a major challenge. A uniform change to new technology for all applications would be vitally important for a swift switch to make good use of the new technology.
1.2.3 End Users
The end users of the system are the patients. The term “patient” refers to someone who receives medical treatment or a medical service, which includes routine check‐ups. We should clarify at this point that by definition a person described as a patient may not necessarily be unwell. A perfectly healthy person can be referred to as a patient in this regard. Here, in our case study we have a group of patients who participate in the study of schoolbags on children. They help with the study by having a set of sensors attached to their back while carrying a schoolbag of varying weights. An illustration on how the sensors are attached to the back of a patient is shown in Figure 1.2. We discuss the case study from a patient's point of view by first looking at Figure 1.2. As shown, a number of sensors are attached to the back; each sensor is connected to a data capturing device by a wire. Movement is somewhat affected by the wires so we can readily see the advantages of using wireless sensors as far as the patient is concerned. So, why not wireless? This example exhibits three major technical challenges that make wires extremely difficult to eliminate. First, sensors attached to a child's back must be very small. Powering the sensors can be an issue as installing an internal battery may be a problem. Also, wave propagation issues effectively rule out its use between the body and the bag, as absorption would be a very significant issue. Finally, measurement accuracy given the physical separation of individual sensors and the amount of movement would make a wireless solution impractical. For all these reasons, patients have to bear with the wires surrounding them while participating in the experiment.
Figure 1.2 Sensors attached to the back of a patient using wires that severely restrict the patient's movement.
1.2.4 Authorities
Funding agencies and authorities are most concerned about cost effectiveness. Long‐term benefits to the community must be clear. In this particular case study, obtaining funding may be difficult despite all the benefits stated in the above subsections. This is primarily due to the projected time length of realizing the benefits; this will only be seen when a clear statistical trend of reduction in back pain is attained. The political details are far beyond the scope of the book so we will not discuss anything in detail here. As a general rule, those looking to acquire funding for projects on applying technology to healthcare services, by and large, need to prove that the benefits will be immediately realized. And this explains why there is generally a lack of financial support for healthcare solutions using innovative technology.
1.3 Healthcare Informatics Developments
In this section, we look briefly at how healthcare and bioinformatics have evolved over the past decades. Medical science has undergone consistent advancements for thousands of years and IT is certainly a much newer topic that has only really commenced from the first computer by Konrad Zuse (1936). Soon after the birth of computers, information storage devices were born. Health informatics is made possible only when computers are connected together to form a network, hence computer networking. The whole idea of health informatics kicked off after World War II as technology became more readily accessible. These networks provided a framework to link hospitals together in the cyberworld. More recently, computational intelligence has made a wide range of services available. In fact, by combining with multimedia and technological advancements, healthcare has been enhanced greatly. As illustrated in Figure 1.3, a diverse range of medical and healthcare services can be supported by technology.
Figure 1.3 Some examples of digital health applications supported by telemedicine.
So, the eight decades since The Radio Doctor appeared have seen the blend of technology with medicine in just about all areas of practice. We have very briefly covered how health informatics has evolved from the first computer; we shall pay more attention to more recent developments that are directly related to possible future developments. The first challenge that many people will talk about are probably security and privacy issues. There are cases of patient information being leaked because of a wide range of reasons from breach of security to simply loss of storage devices. A significant part of health informatics involves ensuring the security of data keeping. This includes protection from theft or altering of information and policies in ensuring that data will not be misused by parties authorized to access patient records. A thorough discussion on security and privacy is presented in Chapter 6. In addition to assurance for safeguarding medical data and privacy, there are many other issues to address since health informatics entails a very wide range of topics in linking people, resources, and devices together, and many of these have developed independently over time. The first documented case of modern healthcare informatics deployment in the United States was around the 1950s in a dental project pioneered by Robert Ledley for the National Bureau of Standards (now the National Institute of Standards and Technology) (Ledley and Wilson 1965). More medical information systems were developed over the next few years across the USA and most projects were advanced independently of each other. It was therefore practically impossible to develop standards for health informatics systems. The International Medical Informatics Association (IMIA) was formed in 1967 with the main objective to coordinate the development of health informatics and related technological advancements. Soon after its formation came the programming language MUMPS (Massachusetts General Hospital Utility Multi‐Programming System) for building healthcare applications which is still used today in electronic health record systems. There was soon a need for different variants of the programming languages to run on different computer platforms and a standard was inaugurated in 1974. It is now developed as “Caché” for medical application development on different computer platforms. It is worth noting that, although Caché is still currently used today, many present electronic health record systems are developed using relational databases.
The traffic flow in terms of passengers and cargo internationally has seen substantial growth. partly because of the synergistic effect between the lower cost of air travel with an influx of budget airlines and global e‐commerce (Bigne et al. 2018). This has facilitated the flow of emerging pathogenic microbes across countries (To et al. 2015). The increasing international travel of passengers and animal products can rapidly import emerging or re‐emerging infections into a region and export them to other parts of the world. The huge population and density of metropolitan cities, in particular, provide an ideal incubator for brewing and spreading new infectious agents and antimicrobial resistance. Thus this growing issue of infectious diseases and control of emerging and re‐emerging microbes should be controlled and monitored through the development of international health informatics strategies.
So, a quick look at the development of healthcare informatics reveals that a vast collection of topics in IT are involved. It deals with all aspects of technologies related to preventive caring, consultation, treatment, rehabilitation, and monitoring. From this point onwards, we shall concentrate our discussion on communications and networking technologies for healthcare. Related technologies will also be covered from time to time as appropriate.
1.4 Different Definitions of Telemedicine
Telemedicine, the combination of ICT, multimedia, and computer networking technologies to deliver and support a wide range of medicine applications and services, has several widely accepted definitions. The definition given in wiki is: “Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred through the phone or the Internet and sometimes other networks for the purpose of consulting, and sometimes remote medical procedures or examinations.” This definition is simply a brief recapitulation of what is described in Section 1.5 below. Other definitions exist. For example, the Telemedicine Information Exchange (Brown 2005) gives its own definition as the “the use of electronic signals to transfer medical data from one site to another via the Internet, telephones, personal computers, satellites, or videoconferencing equipment in order to improve access to health care”; and (Reid 1996) defines telemedicine as “the use of advanced telecommunications technologies to exchange health information and provide health care services across geographic, time, social, and cultural barriers.”
Variations of definitions do not stop here. The Telemedicine Report to Congress (Kantor and Irving 1997 gives “telemedicine can mean access to health care where little had been available before. In emergency cases, this access can mean the difference between life and death. In particular, in those cases where fast medical response time and specialty care are needed, telemedicine availability can be critical. For example, a specialist at a North Carolina University Hospital was able to diagnose a rural patient's hairline spinal fracture at a distance, using telemedicine video imaging. The patient's life was saved because treatment was done on‐site without physically transporting the patient to the specialist who was located a great distance away.”
Among these various definitions, there are several points in common, including that they were all given in the mid‐1990s and are closely related to providing different kinds of medical services over distance by utilizing some form of telecommunication technology.
We mention what telemedicine is at the beginning of the book. Very briefly, it is about the use of telecommunications and networking technologies for the transmission of information related to medical and healthcare application. In modern telecommunications, information can be transmitted across many types of networks in many forms. By definition, telemedicine can be as simple as two doctors talking about a patient over the telephone or as complex as a sophisticated global hospital enterprise network that supports real‐time remote surgical operations with surgeons situated in different parts of the world controlling an operation that takes place in one hospital simultaneously. To elaborate on the vast coverage of telemedicine, Figure 1.4
