Dr. Robert S.H. Istepanian from the University of Portsmouth in the United Kingdom is a real technical expert in the innovative area of mobile telemedicine systems. At the recent ITIS-ITAB'99 Conference in Amsterdam, he presented the latest developments and future trends in both the design and modelling concepts of wireless communication systems for health care delivery. In the first decade of the 21st century, a new revolution will emerge in the use of digital cellular telephone systems which will completely change the aspect of telemedicine, in order to transform it into a health care service for the mobile patient.
Telemedicine is broadly defined as the use of telecommunication infrastructures to provide medical information and health care delivery at a distant. Mobile telemedicine is a newly emerging area, integrating wireless communications for different telemedical applications. The concept covers a much broader range than just supplying a person with a mobile phone, since it equally involves the use of swiftly moving vehicles, that are equipped with high quality wireless systems, to assist patients in underserved regions or in disaster areas. Various projects today test the potential of distant monitoring by using a wireless link between the hospital physician and the paramedic in the ambulance, while the patient is being transported from his home to the specialized clinic. Teleconsultations are already conducted from rural areas, from riding trains and during air flights.
At present, much of the telemonitoring is still performed through fixed ISDN networks between the referring site and the hospital. In the next phase, this has to be replaced by wireless means. The overall idea consists in adapting the hardware in order to create miniaturized systems for different emergency health care scenarios, like the monitoring of elderly, suffering from diabetes. Another example are people with a pacemaker who, in case of trouble, might want to have direct access to their medical consultant, wherever they are. A lot of research is carried out in the areas of dental care, military health care delivery, and mobile robotic surgery. The installation of wireless links in tele-operations between the master and slave could resolve bandwidth problems.
In the next five years, about fifty million Americans will use cellular phones. The only existing commercial system with a mobile phone is the Nokia 9000, which offers a combination of cellular phone, Internet computer, World Wide Web browser, fax machine, message terminal, and personal organizer. With this device, it is possible to transmit electrocardiograms almost in real time. The second generation of mobile phones evolved from the third generation of analogue systems. Currently, there are four different standard concepts that are the European based GSM or Global System Mobile; the American based TDMA or Time Division Multiple Access; PDC which is the Japanese Personal Digital Cellular; and the United States based Code Division Multiple Access or CDMA. Their mutual incompatibility has prevented the breakthrough of wireless systems beyond the normal use of spoken messages.
By the year 2000, the third generation of mobile systems will be developed in the concept of International Mobile Telecommunications-2000 (IMT-2000), by the International Telecommunication Union (ITU). In the year 2002, this type of systems has to be in practice, to provide high quality wireless multimedia services to a convergent network of fixed systems. To date, the definition of what is precisely meant by multimedia services is still unclear but it includes telemedicine. In the years 2002 to 2007, the second generation systems will gradually and seamlessly be reformed into the fast third generation systems. The latter will integrate new concepts such as B-ISDN and Mobile Broadband System (MBS). After 2007, a datarate of 150 Megabits per second might be accomplished. However, 60% of the mobile operator's income is provided by speech, and only 23% comes from multimedia traffic. Prices for multimedia services won't come down in this constellation so this is the topic for ongoing discussion.
The third generation mobile systems will enable concepts such as mobile tele health systems and clinics on wheels, in order to reduce the costs for health care delivery in isolated regions and to increase the productivity. That is, at least, if the mobile operators are willing to co-operate. To monitor patients in complete mobility, an intelligent telemedical card is built to plug into a GSM system. The current GSM devices, however, show a bandwidth obstacle with their transmission at 9.6 Kilobit per second, which is not adapted to the high mobility speeds in airplanes and in trains, according to Dr. Istepanian. Tests have been performed with transfers of ECG data from optical sensors. This is why a GSM transmitter has to be incorporated in the existing GSM mobile phones.
As long as the third generation systems are not yet installed, the only way to solve the limited bandwidth capacity is to design a new wavelet compression algorithm to compress the data before transmitting them through the mobile channel at high performance. This responds to the concept of TelmedPhone or the programmable mobile phone in which the structure is divided into the mobile communication environment and the medical modality environment, using the method of optical zoning wavelet compression. As a result, it is possible to overcome bandwidth limitations as well as to obtain substantial time savings in the data transmission. In the near future, around the year 2005, we will experience the birth of wearable and humanistic computers, that integrate mobile phones into the general practitioner's computer for the monitoring of patients.