A virtual private network has been implemented for the benefit of physicians working in a Boston-area hospital, after an extensive trial which was conducted during the past summer. The virtual private network (VPN) technology enables neurosurgeons to view large radiological images from a PC in their home office over an existing high-speed broadband cable modem service with use of commercial medical imaging software. Regular visits to the hospital in order to review trauma cases will be substantially restricted in the future thanks to the new application, secured both by encryption and authentication features at an affordable price. This low-cost telemedicine solution is likely to provide the patient with faster and more adequate help.
Last summer, it was decided to organize the VPN trial in order to assess the practicability of the method. Doctors in the Boston area selected a medical imaging application which offered appropriate tools to examine the patient images for diagnostic outcomes, and provided additional means for annotation, storage and retrieval. The software included digital standards for medical imaging with use of Web protocols, such as XML and Microsoft COM object standard, for distribution via the Internet. High-speed Internet access was delivered to the participating doctors via a cable modem service over a soundly secured virtual private network, given the confidentiality of the patient data. The overall ease of use pleased the physicians enormously.
The Boston solution might raise telemedicine to a new level of acceptance. The VPN service delivers the medical images to practising physicians rather than to radiologists. As a result, on-call neurosurgeons are able to save a lot of time by reducing their frequent trips to the hospital, just in order to view patient images. The doctor now can consult the data remotely and decide whether another specialist should be called in, or whether it is necessary to pay a visit to the health care facility after all. In all cases, the patient is sure to receive the best care possible because of the faster home-based diagnosis. Without any help from a cable operator, the physician can access and share confidential medical patient files from the home office.
In general, VPN technology means a breakthrough for telemedicine related applications because of the large bandwidth and high speed which can be offered at a very reasonable price. Subscribers to the video services only pay between $34.95 and $39.95 per month. The other customers are charged monthly from $39.95 to $49.95 in different parts of the country. The use of Integrated Services Digital Network (ISDN) or Asynchronous Transfer Mode (ATM) largely exceeds these rates. Whereas ATM is able to supply a very fast transmission speed, the maximum ISDN performance is still limited to 128 kilobit per second. In turn, most of the cable modems provide bandwidth rates in the T1 data range, with access speeds of 1.544 megabits per second up to Ethernet-like speeds of 10 Mbps.
Considering that the patient records often surpass the range of one gigabyte, affordable remote access at present is only possible through cable systems. This leaves us with the delicate issue of guaranteed security, since users of cable modems operate in a shared Local Area Network (LAN) environment. In the case of sensitive and confidential patient information, this is far from sufficient. Therefore, specific VPN security features, including encryption and authentication, have been applied to the cable modem solution in order to combine the advantage of economical bandwidth with the highest possible degree of security. As a result, telemedicine works fine in the Boston area to the benefit of both patient and doctor.