Assignment on IP Telephony

ETE-605

Design & Implementation of a Wireless IP Telephony Solution for Telemedicine Service

Submitted by

Rehana Zakia Id:063411056

Section-ETE-605[2]

North South University

Electronics & Telecommunication Engineering Department

SI no TOPIC Page no 1 Introduction 1 2 1.1 IP Telephony Architecture

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3 1.2 Telemedicine & Tele-health 2 4 1.3 Components of a telemedicine system 3 5 1.4 Telemedicine service in Bangladesh 4

6 1.5 Benefits of Telemedicine 4 7 1.6 Benefits to the Patient

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8 1.7 Benefits to Practitioners

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9 1.8 Telemedicine Services

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10 1.9 Telemedicine and Bangladesh 6 11 2. History of Telemedicine

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12 3. Implementation & the design of a Wireless IP Telephony System for Telemedicine service

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13 3.1 Wireless IP Telemedicine System 9 14 3.2 System design of a independent wireless IP

for Wide Area Network: 11

15 3.3 The wireless IP Telephony system

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16 3.4 The RTB2400 wireless router

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17 3.5 IP Telephony gateway 13

18 3.6 Results and Discussion 14

19 3.7 Technical features

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20 3.8 Clinical benefits 15

21 3.9 Cost analysis 15 22 4. Issue of Broadband health services over

wireless networks

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23 5. Conclusions

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24 References 17

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1. Introduction: International Internet Telephony has been evolving since its introduction in 1996. In 1996, the typical player was someone like Delta Three, who used the Internet as a backbone network, used agreements with local ISPs to “graymarket” terminate traffic in a country, such as Columbia or Israel, and then used a VocalTec type gateway to interconnect the local call with an E&M or R2 type signaling. Today, four years later, there is a clear segmentation of models. At one extreme is the extension of the Delta Three approach still being provided by Delta Three as well as Ibasis and ITXC. Internet Protocol or IP was originally designed in support of U.S military and higher education data networks and was migrated into general business usage in 1990s. In most cases, IP is used in conjunction with other protocols, such as the Transmission Control Protocol (TCP). The term TCP/IP actually refers to a suite of protocols, which in most cases are incorporated into the host’s operating system. Here we implement and design a Wireless IP Telephony solution for Telemedicne Service. The movement of telemedicine to wireless and Internet Protocol(IP) based applications is imminent in the next few years. This migration from desktop platforms to wireless and mobile configurations will have a significant impact on future healthcare delivery systems and their globalization. Wireless and IP based telecommunications networks will significantly enhance the current methodologies of telemedicine and telecare systems that are not possible with conventional telephony.

Here we propose and describe the design of a prototype wireless IP telephony system for telemedicine. It enables integrated voice and data transmission in a wireless and mobile environment. The preliminary results show that it is possible to provide stable IP connectivity for highly flexible medical services that are not possible with conventional telephony. Here we present and analyze some of the technical problems and economic aspects associated with the implementation of wireless IP telemedicine system.

The beginning of the new millennium is a time to look back from where we have come and to dream of where we wish to go. For those in health care, the scientific triumph of the past such as the eradication of polio and small pox, point to a future, when closing the health gap between the “haves and have nots” through out the world including Bangladesh is possible. Imagine a world, where no matter who we are and where we are. We get the health care we need, when we need it. Technologies such as interactive video conferencing, the internet, store and forward imaging, streaming media, satellite and other wireless communication networks already exist and can deliver health services and education over vast distances.

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1.1 IP Telephony Architecture:

Figure1: The components of an IP Telephony architecture

Figure1 shows the components of an IP Telephony architecture and the manner in

which it inter-operates with the PSTN system. A key entity in the architecture is the IP Telephony Gateway (ITG) which provides interoperability between PC based IP Telephony users and PSTN endpoints. An ITG operates at the application level, with connectivity to the PSTN on one side and the Internet on the other. To connect to a PSTN endpoint, an IP host first connects to an ITG, which terminates the IP portion of the call and initiates a PSTN call to the PSTN endpoint by allocating one of its many circuits (voice ports) to the call. To perform the function as an application level proxy each ITG is capable of initiating and terminating IP Telephony signaling protocols, such as H.323 and/or the Session Initiation Protocol (SIP) and the Signaling System7 (SS7) protocol. 1.2 Telemedicine & Tele-health: Telemedicine is the practice of medical care using audio, visual and data communications; this includes medical care delivery, consultation, diagnosis, treatment, education and the transfer of medical data.

Tele-health is an expansion of the functionality of telemedicine. Unlike telemedicine (which focuses on the curative aspect) it also encompasses preventive, promotion and curative aspects. Originally used to describe administrative or educational functions related to telemedicine; today the emphasis is on practicing tele-health and not telemedicine12. This paper focuses primarily on e-health as an emerging trend and new paradigm for providing better, more efficient and effective healthcare services. The following section describes why e-health is an emerging topic, followed by analysis on limitations and challenges posed by telemedicine and tele-health initiatives. Telemedicine is the investigation, monitoring and management of patients and the education of patients and medical staff, which allow easy access to expert advice and patient information, no matter where the patient or relevant information is located.

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For more than 30 years, clinicians, health service providers, researchers and others have been investigating the use of advanced telecommunication and information technologies to improve health care. At the intersection of many of these efforts lies telemedicine a combination of innovative and mainstream technologies. Telemedicine is the use of electronic information and communication technologies to provide and support health care when distance separates the participants. It is the use of information in conjunction with communication systems to provide healthcare support remotely. 1.3 Components of a telemedicine system:

Three main components of a telemedicine system: 1. The Telemedicine Service Taker (Patients) 2. The Telemedicine Service Provider (Doctors inside/ outside country) 3. The Telemedicine Network

Medical Medical Data Data Transfer Transfer

Second Opinion

Fig: Schematic Diagram of a Telemedicine System

Telemedicine Service taker

Remote Pateints

Telemedicine Service Provider

Doctors

Hospitals

Telemedicine Network

Other Telemedicine Networks of the World

Distance Separates Treatment provider and who need it

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1.4 Telemedicine service in Bangladesh: The potential number of telemedicine service takers in Bangladesh is considering not only the number of patients who go outside for major surgical operation but also by recognizing the high number of patients going outside for initial or follow-up cjheck. There are two existing telemedicine service provider in Bangladesh. First one is Bangladesh Telemedicine Services (BTS) a subsidiary of Comfort Hospital located in Green Road. The second one is Delta Telemedicine Limited (DTL) of Delta Network service (DNS) groups an IT business company. 1.5 Benefits of Telemedicine:

The people who responsible for health care planning may wish to take telemedicine into account within the framework of the national health policy and that planners should consider at least four aspects of health care where telemedicine could play a role. The benefits of telemedicine are given below:

1.5.1 Administrative: Telemedicine could help in the administrative tasks involved in implementing national health policies.

1.5.2 Reinforcing national health structures: Telemedicine could help improve linkages between rural district hospitals and the main national hospitals using telecommunications.

1.5.3 Education: Telemedicine services could help provide training and education to health-care professionals in rural areas.

1.5.4 Quality and efficiency of health-care services: The importance of establishing a national telemedicine policy and/or strategy in the context of a national “health for all” policy could identify health-care priorities and could include consideration about how telecommunications facilities for telemedicine can be funded.

1.6 Benefits to the Patient: ??Fewer patients need to be referred to urban hospitals which saves time and money

spent on travel and which reduces the stress when family members are separated. ??Rapid access to tertiary center health resources. ??Remain close to home where family and friends can provide support. ??Avoids costly and traumatic patient transfer when possible. ??Receiving facility can coordinate preparation and transfer of patient

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1.7 Benefits to Practitioners: ??Access to real-time specialty consultations. ??Assists with maintaining primary provider skills during consultation. ??Improves access to continuing education opportunities without absence from

practice. ??Enables professional networking and collegial support. ??Health care professionals can keep up to date through access to the latest

information. 1.8 Telemedicine Services: There are many application of telemedicine well recognized in many developed and developing countries. Major telemedicine services are as follows: ??Patient Care ??Professional Medical Education ??Clinical Research ??Public Health ??Patient Education ??Virtual Medical Conferencing

1.8.1 Patient Care: The Primary initiative behind the development of this technology was to provide patient care. It remains to be the main focus, although newer applications now share the mainstream utility. The list of beneficiaries is unending; those in the rural areas, those trapped in disasters, those limited physically, or due to physiological reasons, or any other factors, are all to avail of this new technology. 1.8.2 Professional Medical Education: This ranges from group teaching of qualified clinicians at continued education programs, to individual monitoring and instruction at distant education programs. Also included in the same spectrum is the on-line information and education resources. The clinicians interested in exploring new cases can at the same time have access to the patient and sources of E.B.M (Evidence Based Medicine). The consultant, as he sees a new case (and wishes to probe the diagnostic criteria, treatment, investigative rules or other issues of clinical management) can take support from these sources of E.B.M while the patient is being observed and the diagnosis made the system can be fed with the needed information. By the time the patient is observed, data can be collected for evidence base of medicine and proved to the physician as and when he wishes to search it.

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1.8.3 Clinical Research: Medical cases and patient data can be aggregated from multiple sites. It will broaden the scope and horizon of research, as collection of cases will no more be limited to local clinics only but extended to remote sites (cities, countries, continents). Also, the research can be conducted much more easily and inexpensively, by co-ordinating efforts at various research sites. 1.8.4 Public Health: Its scope in terms of epidemiology and public health policy is a possible application with shared data resources ( and data banks). The organizations which agree to participate in sharing their data can play a vital role in this respect. Another dimension of the same application is offering the data and knowledge through various channels. The availability of data sets and health indicators by World Health Organization (WHO), on the internet sites is one example. 1.8.5 Patient Education: This is a field of application already explored at a not so professional but wider scale on the internet. There are numerous web-sites on the internet offering health care tips to users. At present some of them are on cost and others are free services. People can be brought to discuss medical issues that they do not wish to, or hesitate to, discuss even with their regular practitioners. Such have been successful more in the developing countries with strong cultural taboos. General public is invited on an unmoderated mailing list to discuss matters regarding health and offered to pose their queries to the professionals on the list. It was observed that not only did they discuss specific health matters concerns but also general issues like family planning, breast feeding, AIDS (Acquired Immune Deficiency Syndrome) and Hepatitis B infection etc. 1.8.6 Virtual Medical Conferencing: This application is more of academic interest than a direct patient utilization. It is a method of conducting conferences in virtual reality. The participants, the conductors or the attendants, nobody shares one roof. Everybody is using his/her own work place, and his/her respective workstation. They are connected together so that each one is in direct contact with the other. Even the question answer sessions can be conducted conventionally. The major saving is that of the cost of attendance, the cost of arrangement and the effort. Such is a possible substitute to academic conferences and seminars with participants of distant education. 1.9 Telemedicine and Bangladesh: Bangladesh, being a developing country is medically under served in many aspects including but not limited to medical resources, expertise, budgetary constraints,

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inadequate infrastructure, poor coordination of development projects, absence of referral system and medical records. Patient have to go through same investigations repeatedly and there is no approved mechanism for management of patients in remote areas in Bangladesh. Over all situation compels patients to seek advanced diagnostics and treatment services in neighboring countries often leading to sell their earthly possessions to go through such involuntary practices, not to mention draining of a huge amount of foreign currency from the national reserve. With the nations health care system undergoing profound changes and experiencing relentless financial pressures, telemedicine can be investigated in Bangladesh for its utility in urban as well as rural settings. To the extent that telemedicine offers a mechanism for centralizing specialists and supporting primary care clinicians, managed care plans in Bangladesh may find certain applications efficient and attractive in the cities and suburbs where their patients are concentrated. 2. History of Telemedicine: It is very surprising that telemedicine started back in the year 1959. The early telemedicine was proved to be technically feasible but the cost was beyond the means of integration in to the health care delivery mechanism. In 1990s due to sustainability and affordability of telecommunication and computer technologies, telemedicine become the choice of effective health care delivery to distant medically under served communities, like the remote rural areas of Bangladesh. In 1959, the first successfully accomplished documented use of visual telecommunication for health care by Nebraska University College Medicine. In 1959, Cecil Whittson established the functional telemedicine program. This program focused on psychiatric patients care and medical education. For patient care, telemedicine was used for group therapy. The system was also used to instruct the medical students by connecting clients and classroom. Telemedicine Reference Center Ltd. (TRCL), Dhaka Bangladesh. In 2000, after 41 years of first functional telemedicine program in USA, TRCL of Dhaka, Bangladesh documented successful teleconsultation for a lung cancer patient with the same University of Nebraska, College of Medicine (University of Nebraska Medical Center). Many Bangladeshi physicians and surgeons were practicing informal teleconsultation with their colleges in different countries. But a more formal approach was taken only since 1999. Approaches include: ??1999:

At the end of 1999 the CRP in Savar established telemedicine link with the Royal Navy Hospital, Haslar, UK using a digital camera and satellite telephone.

??July 1999:

TRCL started feasibility study and infrastructure development to establish national and international telemedicine services.

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??OCT 1999: TRCL got registered as a limited liability company in Bangladesh.

??Mid 2000:

Grameen Communications took rural telehealth initiatives. ??January25, 2001:

TRCL demonstrated telemedicine system in the US Trade Show 2001 in Dhaka using lcare software and normal Internet connection & started test run of the system between US and Bangladeshi physicians.

Telemedicine is becoming an important tool for delivery of health care to distant

places, where medical resources are scarce or even absent. The developed countries like US, UK, Canada, Australia and other European countries have already made telemedicine their most precious tool for development of application for medical sciences for today and for future. Some countries are working for appropriate robotic surgery, which indicates their willingness to use telemedicine as their next generation of medical scientific development. The successful application of robotic telepathology system in many countries is yet another proof of success in the field of telemedicine. Following initiatives in different parts of the world gives fair view of what is happening around us: ??Trans Continental: North American Telemedicine Network, Telemetics Application Program, Europath,

Australian telemedicine network. ??National: Canadian telehealth Program, China, Singapore, Malaysia, Thailand, Vietnam, India

and many other countries. ??Associations: American Telemedicine association, United Kingdom Telemedicine Association,

International Society for Telemedicine, Canadian Society for Telehealth, Japanese Telemedicine Society, etc.

Above-mentioned telemedicine initiatives and association are a result of active integration of the system in different countries of the world. Recently, our neighbors, India and Nepal have taken in to serious consideration of integrating telemedicine technologies. India is usually pioneers new technology development in this region and in telemedicine there is no exception. The Center for Development of Advanced Computing under the ministry of information Technology of India has released telemedicine application software for nationwide application of the technology, which is called Mercury. Indian government is giving maximum priority to this technology in order to distribute health care effectively to distant communities.

However, Telemedicine is no more in its infancy. It has got its momentum even in

our neighboring countries. It proved its effectiveness in many other countries, where

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health care services delivery to distant and backward communities were distant dreams. We have a vast community of more than 130 million people with very minimum medical resources. The available medical resources need to be distributed among other parts of the country, where even very poor road communication is further complicated by huge numbers of rivers and canals. Distribution of medical care is a great challenge in a country like Bangladesh. Most medical experts principally work in the major cities leaving the distant communities in a hopeless situation. People often become frustrated and travel to foreign countries in search for better diagnosis and treatment of diseases. The enormous migration of patients from one place to another causes great suffering and pain to the families with sick people thus causing negative impact in the national economy.

3. Design & Implementation of a Wireless IP Telephony System for Telemedicine service:

The movement of telemedicine to wireless and Internet Protocol (IP) based applications is imminent in the next few years. This migration from desktop platforms to wireless and mobile configurations will have a significant impact on future healthcare delivery systems and their globalization. Wireless and IP-based telecommunications networks will significantly enhance the current methodologies of telemedicine and telecare systems that are not possible with conventional telephony. Here we showed and describe the design of a prototype wireless IP elephony system for telemedicine. It enables integrated voice and data transmission in a wireless and mobile environment. The preliminary results show that it is possible to provide stable IP connectivity for highly flexible medical services that are not possible with conventional telephony. It will present and analyze some of the technical problems and economic aspects associated with the implementation of wireless IP telemedicine system. Recommendations on future research directions will also be discussed. Key words are wireless IP, telemedicine, IP telephony, Voice over IP, wireless broadband multimedia communications

The recent advances in telemedicine applications are propelled by two converging trends: advances in enabling Internet and telecommunications technologies and the increasing demand for access to high-quality medical care irrespective of location or geographical mobility. 3.1 Wireless IP Telemedicine System:

Wireless telemedicine is a new and evolving research area that exploits recent

advances in wireless telecommunications networks. Conventional telemedicine systems using public switched telephone network (PSTN) are already available for a doctor to deliver medical diagnosis and education remotely. Wireless and mobile systems provide further flexibility, wider coverage and new applications for telemedicine. For these reasons, the next step in the evolution of telemedicine will be wireless telemedicine systems, and the advantages in wireless and mobile telecommunications technologies will enable swift and better healthcare delivery, regardless any geographical barriers, and time

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and mobility constraints . In the last couple of years, IP telephony has seen a tremendous surge in interest. Known as voice over IP (VoIP), it promises to deliver real-time, two-way, synchronous voice and data traffic over packet-switched IP-based networks. Supporting telephony services over IP network is considered a promising trend in the telecommunications business. It has been increasingly used as alternatives to the traditional circuitswitched networks for carrying voice traffic . IP-based networks represent the future trends towards convergence of the public switched telephone network (PSTN), mobile network, fixed wireless and the Internet in the communication industry. With the second-generation mobile networks shifting to IP platforms as the deployment of 3G systems, IP appears to have emerged as the unifying platform for all forms of communications. Because IP technology uses network capacity more efficiently, it has the potential to provide reduced cost, greater flexibility, better manageability and enhanced services.

The IP telephony technology can be extended to create limitless possibilities for

the transmission of voice alone, or in combination with any other digitizable information. These features are essential for telemedicine to deliver integrated multimedia medical information to the underserved population or any other people in need. IP telephony has reached a certain level of maturity in the technology area as well as in the market place. There already exist several protocols that aid in delivering the promise of IP telephony.

However, until recently, wireless and mobility issues have not been investigated

in detail within the scope of IP telephony, and the main focus has been on fixed IP telephony systems. In light of the current convergence trend of wireless communications and IP-based technology, we have proposed and tested a wireless access IP telephony solution for telemedicine applications. The solution combines a wireless router manufactured by Root, Inc. with an IP telephony system from OSI Plus Co., producing a scalable communications solution for healthcare institutions. In the following sections, we try to discuss and analyze the challenges and opportunities brought about by wireless IP telephony for the future healthcare delivery systems.

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3.2 System design of a independent wireless IP for Wide Area Network:

The most important advantage of wireless IP telephony system for telemedicine is given below:

1. The integrated transmission of voice traffic, 2. Patients’ images and demographic data.

An independent wireless IP wide area network (WAN) has been proposed and tested for telemedicine applications.

Fig. 1 Wireless IP telephony WAN for telemedicine Figure 1 illustrates an outline of the wireless IP telephony system for

telemedicine. 3.3 The wireless IP Telephony system:

The wireless IP telephony system is based on the integration of two advanced products:

1. The RTB2400 wireless router and 2. The IP Phone 323 software.

The RTB2400 is manufactured by Root, Inc., a Tokyo-based R&D firm founded

in 1993. IP Phone 323 is a software product of OSI Plus Corporation, a KDD subsidiary. The RTB2400 and IP Phone 323 have already been used in many applications independently. IP Phone 323 has been put into operation by several IP telephony carriers in the world, including KDD. The RTB2400 has been used to establish several wireless networks in Japan, including a wireless Intranet connecting medical facilities at the Itabashi Health Care Center in Tokyo.

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3.4 The RTB2400 wireless router:

Fig.2 RTB2400 wireless router manufactured by Root Inc.

The RTB2400 wireless router, which functions as a receive/transmit terminal as well as a repeater, provides circular coverage with a radius of 3km (5km using a unidirectional antenna) when configured in compliance with Japanese regulations on frequency use and maximum transmission power. If higher power is allowed the wireless reach can be much longer. The transmission speed of the RTB2400 router can reach 2Mbit/s with a TCP/IP platform. The entire IP-based wireless WAN covers an area with a radius of 15 km. The network topology adopts a flat connectivity between the scattering nodes.

In contrast to the general-purpose wireless LAN which adopts a hierarchical connectivity, the topology of the wireless IP WAN for telemedicine allows several path options between the nodes to transmit voice and data traffic. This approach offers greater resiliency, more flexible node locations, and better traffic distribution than the ordinary wireless network topology. The network capacity has been exploited with improved efficiency. Since the wireless WAN is IP-based, it can be easily interconnected via a gateway with any public and dedicated networks, including intranets, Internet, PSTN, ISDN, and/or even a satellite link. Local, long-distance and international telephone/video conferencing can be carried out through the gateway connected to the public telephone networks or the Internet.

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Fig.(3) Network topology of the wireless LAN

The wireless IP telephony system consists of multiple Client Stations managed and monitored by computers located at a Center Station. At the Client Station, the wireless router equipment consists of an antenna, a main unit, a junction unit, and interconnection cables. 3.5 IP Telephony gateway:

An IP telephony gateway is connected to the router equipment using a 10Base-T

interface. The gateway contains two ports, each of which can be connected to a standard telephone set or a lap-top computer. The main Center Station houses a management server for the IP telephony network and an SNMP server to monitor the wireless router network. The IP telephony management server has the capacity to serve a large number of unit systems. Local Center Stations can be established at appropriate client sites.

The minimum configuration requires to establish a network consists of two Client

Stations and a Center Station. In terms of equipment, a minimal network requires at least three wireless routers and three IP telephony gateways, supporting between three and five telephone lines (including one at the Center Station). IP Phone 323 is installed on a personal computer (PC) server. The software can respond flexibly to the needs of the network functions. Multimedia computers can be set up at each node to serve as the communication platform to integrate the voice and data traffic and transmit them through the wireless IP telemedicine system. If only voice communication is desired, a typical telephone set is enough. The equipment used at each site occupies limited space and can be loaded on an ambulance. The ambulance is then turned into a mobile Client Station. The system configuration is simple, expandable, and do not require too much capital investment.

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3.6 Results and Discussion: From the above discussion we can consider the following issue: ??The wireless IP telephony system investigated provides voice communication as

its basic service. Analog voice signals are converted into digital data, compressed, segmented into packets, added an IP address, and then distributed over the wireless IP network. ??On the receiving station, the compressed digital data are extracted and converted

back into analog signals meaningful to humans. Since the network system is based on IP telephony technology, normal PCs and other electronic devices that use TCP/IP can easily be operated on the current network. Internet telephony software can integrate the voice and data traffic over the computers. ??Multimedia communication services including data, video, audio and image

transmission are provided through this wireless IP network. These multimedia functions can be used to enable medical consultation, health information services, distance education, and e-commerce. ??The wireless IP telephony system has been tested in the field study. The Client

Stations on the network were monitored at the Center Station. The parameters of the wireless routers could be reset from the Center Station as well. If a gateway experienced problems, the Center Station was signaled. In general, the connectivity and voice quality were fine in the trial.

3.7 Technical features: Some key aspects of the wireless IP telemedicine system are discussed below:

(1) The data transmission speed can reach 2Mbit/s with a TCP/IP platform. Such transfer rate is adequate for interactive multimedia communication.

(2) Since digital data is free from signal decay depending on transmission distance, the voice quality for long distance telecommunications is better than that of analog calls. (2) Certain level of voice delay is generated by data compression and extraction. (3) Multimedia data (such as images and video) and Fax can be integrated and

transmitted along with the voice traffic.

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(4) IP-based wireless connections are more easily established which allow users to talk to multiple parties simultaneously. The network size and functions can be expanded with flexibility.

(5) The network is easy to operate and maintain, and resilient against disasters and network outages.

3.8 Clinical benefits:

The clinical benefits of such a wireless IP telemedicine systems lay in the following aspects:

(1) Prompt response to critical medical scenarios regardless of any barriers, (2) Flexible and swift access to expert opinions and advice to the point of care and without delay and optimize the management of medical resources; (2) Interactive medical consultation and communication links of medical images

and video data in complete mobility and in global coverage and connectivity when through a gateway,

(4) Increased empowerment and management of medical expertise, especially in rural and underserved areas using the above technologies, (5) Swift and better medical care delivery in emergencies and management of medical data in catastrophes or natural disaster circumstances where conventional communication links could be unavailable.

3.9 Cost analysis:

Under the assumption of a total of 200 lines in the network, the initial investment for a wireless IP telephony system costs US$ 2,644 per line. This figure is higher than the reported cost of various rural communication systems ranges from US$500 to US$750 per line. However, these lower per-line costs are generally based on full utilization of large capacity networks. If a relative small network is proposed, for example 30 client terminals as in the case of telemedicine, the wireless IP telephony system is considered to be competitive. As for communication cost, it has been generally accepted that IP telephony brings about cost saving for long-distance and international communication. Example: We assume that, Ca: Call charges for user A Cb: Call charges for user B Ia: Payment to Internet Service Provider (ISP) from user A Ib: Payment to ISP from user B P: Public telephone network charge for the call between A and B

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If Ca, Ia, Cb, Ib, and P are variables, the function for comparing the charges

between IP telephony and the conventional telephone calls is as follows: g{(Ca+Ia)+(Cb+Ib), P}. If the costs for communications line and ISP are fixed per month at the price schedule effective as of March 2001 (Ca=4,050 yen, Ia=1,950 yen, Cb=$19.95, Ib=$49.95, $1=120 yen), IP-based phone calls between Tokyo and San Francisco are cheaper than the conventional international telephone calls (6-yen/6-sec during the daytime, through KDDI or NTT) once the call time exceeds 240 minutes (4 hours) per month.

This example suggests that IP telephony has the potential to generate cost-saving

on telecommunication, especially for long-distance or international communication. Since the wireless IP telephony system can be easily connected to any public and private networks, this feature will facilitate the deployment of telemedicine over a long-distance or in a global scenario, particularly for those international telemedicine programs in developing countries. 4. Issue of Broadband health services over wireless networks:

With the advent of 3G wireless system and the new IP version- 6 (IPV6), the next few years we will see the emergence of next generation wireless and Internet telemedicine networks that will provide broadband health services over wireless networks. Issue are given below:

(1) The mobility issues of the current wireless IP telephony system; (2) The integration of 3G, IPV6 and signal processing technologies for selected telemedicine applications: (3) The interconnectivity issues with various public and private networks, as well as with the bio-medical data collecting devices. (4) The performance and reliability issues and economic analysis of the wireless IP telephony system in different healthcare scenarios.

5. Conclusions: As demand for improved health care is getting prioritized an effective and planned framework is needed to provide quality health care using telemedicine by centralizing the limited and valuable medical resources distributed in any geographic location with any demographic profile in developing countries like Bangladesh.

The current evolution of the next generation of Internet and mobile

communication technologies will have a crucial impact on the movement of telemedicine to the Internet platform and migration of the technology from the conventional desktop configuration to the wireless and mobile area. In this assignment, we have proposed and tested a prototype wireless IP telephony system used for telemedicine applications. It demonstrates that the healthcare and medical community could benefit from the latest advance in telecommunication and information technologies which should be very much

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necessary for our society. By implementing this type of Wireless IP telephony system for telemedicine service we can provide better health service for people.

References: [1] Laxminarayan, S. and Istepanian, R.H., "Unwired e-Med: The next generation of wireless and internet telemedicine systems [Editorial] ", IEEE Transactions on Information Technology in Biomedicine, 4 (3): 189-193, Sep 2000. [2] Davidson, J. and Peters J., Voice over IP fundamentals, Cisco Press, Indianapolis, 2000. [3] Lusweti P., "The IP opportunity", ITU News, No.2: 6-7, Mar 2001. [4] Kaiyama, A., "Internet and mobile communications" (in Japanese), Journal of the Japan Society for Simulation Technology, 20 (1): 30-33, Mar 2001. [5] Sengodan, S. and Bansal, R., "Standardization efforts in IP telephony", Proc. SPIE: Multimedia Systems and Applications II, Vol. 3845: 77-86, 1999. [6] Sengodan, S., Koodli, R. and Rajahalme, J., "Wireless and mobility issues in IP telephony'', Proc. SPIE: Multimedia Systems and Applications II, Vol. 3845: 68- 76, 1999. [7] Schiller, J., Mobile Communications, Addison-Wesley, Harlow, England, 2000. [8] Qiang, G., Liu, Z.J., Ishihara, S. and Mizuno, T., "Enhanced mobile Internet Protocol based on IPV6 addressing scheme for third generation wireless network", IEICE Trans. Commun., Vol. E84-B: 885-891, Apr 2001.