CHAPTER 7. THE MULTI-TECHNOLOGY SOLUTION

A successful telemedicine program requires the melding of a number of different technologies into a seamless telemedicine system. In planning your telemedicine system, it is essential to have a completely integrated, fully operational solution set. Often, a single system integrator is selected to install the system and assure its functionality. If you select a single integrator, you may want to develop a functional and technical specification summary to guide product selection, and request "connection" diagrams and application notes related to each application to assure consideration of all issues effecting system operations.

The following briefly describes major areas of technology integration that may be appropriate for review and assessment as part of the planning process. If you need any assistance or support in any of these technology areas, please feel free to enter AMD's DESIGN CENTER or Contact Us. AMD can provide answers or supply references for information in each technology discipline.

Medical Devices. Ultimately, Medical Devices are the interface between the caregiver and the patient, designed to collect information (whether data, images or sound) and then transmit that information to interested parties, or store that information for use at a later date. Your selection of medical devices should be driven first by the intended medical applications and, thereafter, by a series of operational and technological considerations including:

• Compatibility with operating platform - devices selected must function with the desired operating platform, whether it is a PC (desktop or laptop), or client server or video.

• Integration - if you wish to use multiple devices with a single application software, or multiple devices on a single PC platform, then those devices and related software must be compatible with each other and interface with the selected operating platform and operating software.

• Power Supply - Most devices require access to a power supply to function. The power supply must be appropriate for the intended use. For example, in laptop based mobile applications, devices powered by the laptop using a firewire connection may be preferable if the choice eliminates the need for a battery supply for each device. This will reduce the size and weight of the devices used in mobile applications. Conversely, however, if the laptop is used in mobile applications without ready access to an AC power supply, then the battery life of the laptop must be known with planned redundancies for loss of power to avoid data loss.

• Telecommunications Compatibility - The devices must be compatible with the desired transmission method (e.g. "live" or "store and forward") and the available telecommunications platforms. For example, if the program desires to transmit "live" IP sound, then analog sound must be converted to a digital format, interfaced with a PC and software application for transmission. Similar procedures must be followed on the receiving end to decode the sound.

  No matter what medical application is desired, it is advisable to create a brief written functional specification for each intended application to assure that no miscommunication occurs in the selection of devices.

Network Computing. Network computing relates to the computing devices which drive functionality, permit the storage of data (whether temporary or permanent, and local or on a central server), and facilitate the transfer of the desired data from the medical device to the available communications platform for distribution to other professionals or for storage. It often involves matters such as the selection of computing hardware (including all required video cards, audio cards, the method of connecting devices to the computing platform, etc.), the definition of the network for purposes of distribution of information (e.g. local area network, wide area network, etc.) and the data storage requirements for the network (e.g. pc or server based). In addition, the hardware specifications for the network must satisfy the specifications recommended by the device manufacturer to assure appropriate data capture, transmission and storage.

Video-conferencing. Parties desiring "live" transmission of video select video-conferencing equipment to display images and to transmit sound and data on a real time basis. Fortunately, newer generation video-conferencing systems operate on a standards basis and connection of users of different video-conferencing systems can be readily achieved. Even with standards based systems, however, there are limited situations in which devices will not easily interface with video-conferencing systems. AMD is pleased to consult with your video-conferencing vendor to review system requirements and achieve a smooth installation.

Software Requirements. Generally, development of an integrated telemedicine system involves a number of software issues.

• Applications Software - Telemedicine programs often use business or clinical applications software to manage program operations. This software often associates data with a particular patient, and then manages transmission of data to various parties.

• Device interfaces - Frequently, devices are designed using proprietary software or systems which do not readily interface to applications software. Device interfaces may be required to assure the flow of information.

• Interface to database/other applications - Quite often, the telemedicine system sponsor would like the program applications to interface with the sponsor's database systems or with other specific applications (e.g. financial reporting, billing, physician scheduling). Because the goal is to mainstream telemedicine, operating software must interface to other software systems customarily used in the operation of health care providers.

  New standards have been promulgated under the U.S. Health Insurance Portability and Accountability Act ("HIPAA") relating to electronic data interchange and security. It is advisable to review software for HIPAA compliance.

Telecommunications Options. The telecommunications options at the Originating Site often dictate the transmission method (live vs. store and forward). Generally, transmission of live images, data or sound, or the transmission of extremely large data files, requires high bandwidth telecommunication options such as T1 or T3 lines, ISDN lines or DSL service.

Consideration must also be given to two way data transfer and transfer in synchronous or asynchronous modes. Understanding of available telecommunications options may dramatically affect the selection of devices.

Selecting Technology Partners. When selecting your technology partners, AMD recommends that you consider the following selection criteria:

• Does the vendor offer the complete solution within their area of technology expertise?

• How long has the vendor been serving the telemedicine market and what is their experience (number of installations and customers)?

• Does the vendor offer installation, technical and training support, and warranty service?

• How familiar is the vendor with the other technology disciplines necessary for a complete solution?

• How committed is the vendor to continuing to serve the telemedicine industry?

• Is the proposed vendor willing to provide references and contact information?

Ideally, you want to develop a long-standing relationship for technology support, and to implement a system with the comfort that vendors will stand behind their products and support the system for many years to come.

In conclusion, the development of a successful telemedicine program requires careful attention to the Multi-Technology Solution. Consider the expertise you need to address the complexity of the solution and document the intended functionality of the system before you engage in product selection. Choose your vendors with their commitment to telemedicine in mind.

If you need any assistance regarding technology matters affecting your program, please visit AMD's Design Center or Contact Us.