Using Technology in Urban Areas: Preparing for the Future

April 26, 1999

Frank FerranteSenior Manager

Mitretek Systems, Inc.

Presented to

The Emerging Health Information Infrastructure Conference (HII99)

Improving Health in a Digital World

Sponsored by the Friends of the National Library of Medicine (FNLM)

Washington, D.C.

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Agenda

Technology: Changes and Trends Digital Healthcare Products Applications Current and Future Technologies Summary

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Technology: Changes Exponential

Multimedia applications:Messaging, documents, desktop conferencing, image storage/retrieval,TV distribution

• ISDN

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

75 bps

300 bps

1200 bps

Data Rates

IBM's Token Ring16 Mbps

Ethernet(IEEE 802.3)

10 Mbps

Direct Access

Dial-Up

Early Modem Access

100 Mbps

10 bps

100 bps

1 Kbps

10 Kbps

100 Kbps

1 Mbps

10 Mbps

1 Gbps

10 Gbps

ATM/SONET Networks1 Gbps+

9.6 KbpsModem Access

IP Switching1 Gbps

Fast Ethernet100 Mbps

FDDI100 Mbps

X.2556 Kbps

ATM/SONET WDM Networks

100+ Gbps

100+ Gbps

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Technology:Internet Trends

Internet consumer market to reach 43 million in 2000 from 30+ million households in 1998 {INTERNET2 reaching Gbps Rates)

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000

Inte

rnet

Mar

ket

in M

illio

ns

1995 1996 1997 1998 1999 2000Source: The Age of Internet: Capitalization on the Data Opportunity, Information and Interactive Service Report, January 9, 1998

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Technology:Bandwidth Cost Trends

Source: NGN - 1998 Conference Proceedings

Legend: OC - Optical Carrier Rates (155 Mbps to 4.8 Gbps) WDM - Wavelength Division Multiplexing TDM - Time Division Multiplexing

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Technology: Digital Healthcare Products Digital Blood Pressure Monitor (Sphygmonometer) - less than 10 Kbits of

data per second (required transmission rates)

Digital Thermometer - less than 10 Kbits of data (required transmission rates)

Digital Audio Stethoscope and integrated electrocardiogram - less than 10 Kbits of data (required transmission rates)

Ultrasound, Angiograph, - 256 Kbytes (image size)

Magnetic Resonance Image - 384 Kbytes (image size)

Scanned X-Ray - 1.8 Mbytes (image size)

Digital Radiolography - 6 Mbytes (image size)

Mamogram - 24 Mbytes (image size)

Compressed and full motion video (e.g., Nasopharyngoscope, Opthalmoscope, Proctoscope, Episcope, ENT Scope) - 384 Kb/s to 1.544 Mb/s (speed)

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Technology:Teleradiology Applications - Imaging

8 to 24 bits per pixel

512 to 4096 pixels

512 to 4096 pixels

Image Type Image Resolution Image SizeSpatial Contrast

Ultrasound 512x512 x8 256 KbytesOther (Angiography, Endoscopy, Nuclear Med., Cardiology, Radiology)

512x512 x8 256 Kbytes

Computed Tomography 512x512 x12 384 Kbytes

Magnetic Resonance Imaging512x512 x12 384 Kbytes

Digitized (Scanned) X-ray 1024x1250 x12 1.8 MbytesDigital Radiography 1024x1024 x8 1 Mbyte

2048x2048 x12 6 Mbytes

Mammography 4096x4096 x12 24 Mbytes

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Technology:Image Transmission Times

Slow-Speed Services

Medium-Speed Services

(384 Kb/s - 45 Mb/s)

Medical Images

High-Speed Services

(45 Mb/s - 4.8+ Gb/s)

Medical/Scientific

Visualization

29.1 min.

15.0 min.

1.1 sec. 325 ms

28.8 Kb/s(Modem)

56 Kb/s(Modem)

10 Mb/s(Ethernet)

45 Mb/s(T3)

155 Mb/s(ATM OC-3)

1.544 Kb/s(T1)

2048 x 2048x 12 bit image No compression

Assumptions:

Coaxial Modem Range

10.5 ms

4.8 Gb/s(ATM OC-96)

32.6 sec. 5.0 sec. 21 ms

2.4 Gb/s(ATM OC-48)

Note: Service classes changing faster than ever

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Technology:ATM Collaborative Computing

Live or stored video image transfer

Desktop VideoTeleconference

Collaborative Work Board

{Sample: discussing telemedical application}

{Sample: tissue sample from patient}

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WDM Technology Pre-WDM:

– On a single strand of fiber, a point-to-point backbone link would carry an OC-48 SONET signal at a single wavelength

With WDM:– On a single strand of fiber, a point-to-point backbone link

could carry multiple wavelengths (color bands) each wavelength capable of carrying an OC-48 SONET signal

– Point-to-point throughput increases by a factor equal to number of wavelengths accommodated by the WDM equipment (4-8 in 1995)

– Next development trend in WDM is true optical networking via optical cross connects where direct switching of optical signals rather than time slots are performed• Technology trend towards direct IP over WDM (bypassing

SONET equipment)

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Dense Wave Division Multiplexing (DWDM) Cost Savings Versus SONET Take advantage of DWDM bit-rate independence and lack of

scaling capital expenditure as compared to SONET

Source: NGN - 1998 Conference Proceedings

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Technology:Smart Cards Definition

– Plastic card with embedded silicon chip, 1 to 8 kilobytes of memory, microprocessor, operating system in ROM (Read Only Memory).

Capabilities– Typical 1- 8Kbytes storage memory– 32kByte chips being developed– Price range now $2 to $25 per card (8Kb cards @$2)

Medical Applications– Military experimenting in triage situations (Dog Tag replacements)– Insurance firms considering usage to

• reduce cost of accounting for medical• future storage of patient records (assuming medical records policy

changes takes place) Progress

– Slow, with focus on billing/accounting– Expected to take off in near future if policy on records change

Future– Could be useful in remote areas given inexpensive readers available

(current readers cost $300 +)

Reference: 3GI home page -http://www.3GI.com/

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Technology:Wireless

Today’s Services Basic voice service Fax / Paging (one-way, two-way) Limited e-mail and internet access

9.6 Kbps to 14.4 Kbps

Base StationBSC

VLR/HLR/

AUC/E IR

M SC(Circuit Sw itched Cards)

ISP

PST N

AUC Authentication CenterBSC Base Station ControllerEIR Equipment Identification RegisterHLR Home Location RegisterISP Internet Service ProviderMSC Mobile Switching CenterPSTN Public Switched Telephone NetworkVLR Visitor Location Register

Key:

Base Station

H.320

BSC

VLR/HLR/AUC/EIR

MSC

IP Network

PSTNn X DS1 or DS-3

IP Gateway

Corporate Intranet

VideoServer

3G Wireless Switch

Air Interface: 3G CDMA Based 5 MHz RF Channels

Future

Future Services Digital Voice and Data services Fax / Paging (two-way) Full High Speed E-mail / internet access

28.8 Kbps to n x 1.5 Mbps

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Technology: Other Available Services Supporting Telemedical Applications

Digital Subscriber Loop Services Cable Modems Frame Relay (predecessor for IP networks) Wireless services (cellular, satellite, other) Faster CPUs and memory storage explosion Future growth of digital record keeping acceptance

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Technology: Summary Technology is changing exponentially Internet services in urban areas represent a possible

outreach approach to the public with high bandwidth offerings and ubiquity of the services

Cost of bandwidth is dropping rapidly Telemedicine requires bandwidth which is now becoming

more affordable and available in urban areas Urban areas are ripe for considering new technology

applications as never before (e.g., wireless beyond the pager and cell phone explosion

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Technology:Recommendations

Perform the cost-benefit tradeoff studies now to identify longer term applications of new technologies in telemedicine

Due to the explosive nature of technology changes be flexible in buying into the new offerings (2 to 3 year contracts with options to change or get out; lease as much as possible, don’t own your systems)

Finally, encourage changes in insurance and legal restrictions to allow more telemedicine as facts prove their benefits.

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Contact Information

Frank E. Ferrante

Mitretek Systems, Inc.

Senior Manager, Systems Engineering and Acquisition

Center for Telecommunications and Advanced Technology

7525 Colshire Drive

McLean, VA 22102-7400

Ferrante@Mitretek.org Tel: (703) 610-2905 fax: (703) 610-2984