UNIT II TELEMEDICAL TECHNOLOGY

Principles of Multimedia - Text, Audio, Video, data, Data communications and networks,
PSTN,POTS, ANT, ISDN, Internet, Air/ wireless communications Communication
infrastructure for telemedicine – LAN and WAN technology. Satellite communication,
Mobile communication.

IMPORTANT BIG QUESTIONS

 Explain the principles of multimedia used in text and audio Data.
 Explain in detail about the PSTN
 Explain the features of the telecommunication options and also give an
example of how the various telecommunication technologies can be
integrated into a healthcare network.
 Classify the type of information used for telemedicine. Describe about the
optimum methods used to acquire and transmit them,.
 What is population aging and how can mHealth help in addressing its
challenges? i. What are the main challenges to wider mHealth adoption
associated with technology design and how can designers address these
issues? ii. Outline the steps to create an Android App. Write the coding to
perform a button action.
 Write about the satellite communication in the field of telemedicine
 Describe in detail about ISDN in the field of telemedicine ?
 Explain about the Mobile comminication

Principles of Multimedia - Text, Audio, Video, data,

MULTIMEDIA- TEXT, AUDIO, VIDEO, DATA
 Multimedia involves multiple modalities of text, audio, images, drawings, animation, and
video.
 Examples of how these modalities are put to use:
1. Tele-medicine
2. Video teleconferencing.
3. Distributed lectures for higher education.
4. Co-operative work environments.

Multimedia Telemedcine System(MTS)

 A multimedia telemedicine system (MTS) using Transfer Control Protocol and Internet
Protocol (TCP/IP) over the Internet is developed
 Real-time data, including audio, video and instant message (IM), and non-real-time data,
including vital sign signals, radiological images with DICOM 3.0, file, bio-signal, bio-
data can be exchanged on the system.
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  Discrete (or Time independent) Media:
 E.g., Text, graphics and images, have no real-time demands.
 Termed discrete media.
 Continuous (or Time dependent) media:
 Information becomes available at different time intervals.
 Time intervals can be periodic or a periodic depending on the nature of the media.
 Audio and video are examples of periodic, continuous media.
 Orchestrated Multimedia:
 Capture and/or generation of information done by retrieving stored objects.
 Stored multimedia lecture presentations, on-demand servers, and other multimedia database
applications fall under this category.
 Live Multimedia:
 Information generated from devices such as video camera, microphone or keyboard.
 Multimedia teleconferencing and panel discussion applications fall under this category.
 Participants communicate among themselves by exchanging multimedia information
generated from video camera or microphone.

Multimedia Telemedicine System – Network Architecture

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Discrete Media – Size per Page

Media Size
Text 9.4KB
Graphics 2.8KB
Bitmap Picture 300-900KB
A4 15-247MB

Continuous Media – Bandwidth

Media Bandwidth

Audio digital telephony 64Kb/s

Audio stereo CD quality 1.34Mb/s

Video PAL 176Mb/s

Video HDTV 936Mb/s

Types of Telemedicine Information

 Text and Data
 Audio
 Video
 Frame Rate and Bandwidth

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In a face-to-face consultation, a physician might use some combination of all five senses-sight, sound, touch,
smell and taste-to assess a patient‟s condition.
The first three methods are by far the most common and the sensory data are transmitted directly from the
patient to the observer. In telemedicine, however, the sensory data are first converted into electrical impulses
for transmission to the remote physician. Methods to convert smell and taste stimuli into electrical signals are
still in the experimental stage and. while the sense of touch can be translated successfully into an electrical
equivalent, the reverse process is more difficult and not well understood. Hence. A teleconsultation relies
primarily on the two senses of sight and sound. The information (useful data) derived from these senses can be
divided into four types:
 text and data;
 audio;
 still (single) images;
 video (sequential images).

Table 3 gives telemedicine examples of these types along with their typical file size in kilo- or megabytes
following digitisation. The wide range of electronic files sizes from these sources suggests the need to match
the choice and performance characteristics of the telemedicine equipment to the clinical need. Under- and
over-specification of systems can otherwise lead to disappointment and premature abandonment of a promising
project.

Table 3. Typical examples of telemedicine information

Source Type Typical file size

Patient notes Text < 10KB
Electronic stethoscope Audio 100 KB
Chest X-ray Still image 1 MB
Foetal ultrasound (30 s) Video 10 MB

Text and Data

Electronic documents such as reports, correspondence or medical records containing ASCII or Unicode text
and numerical information can be transmitted directly in digital format. The digitized file can be edited with a
word processor, database or spreadsheet program but this is seldom necessary, or even desirable, since the
transmitted information is invariably „read-only‟.
If a document is only available in paper format then it can be digitized for transmission with either a scanner
(e.g. fax) or a document camera. Unless the text is subjected to optical character recognition it will be in
bitmapped format and cannot be edited. Frequently, textual information is needed before the teleconsultation
takes place or later, as a consequence of the process. In these cases it is more efficient to send the documents
by post or, better still, as attachments to emails .

Audio
The public switched telephone network (PSTN but sometimes known as the plain old telephone system, POTS)
can be used to transmit sound (e.g. speech) and establish a remote diagnosis. However, the quality (ease of
understanding) and bandwidth (capacity to carry information) of analogue telephony are seldom adequate for
medical applications. In contrast, digital signals can be transmitted over networks for large distances without
degradation. Digital signals can also be manipulated to improve system performance.
An analogue sound is digitised by sampling its amplitude at discrete time intervals to recreate the waveform.
The discrete nature of the digitization process introduces quantisation or amplitude round-off errors as the
digital sample value approximates the analogue signal at a given instant. The human ear detects this error as a
hissing noise and to reduce the effect the sample value should have a resolution of at least 1 in 65 536 (216),
giving a 16-bit quantisation error.

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3.2.5 Video
Our perception of video is conditioned by television to the extent that a videoconference between patient or
carer and consultant is regarded as the normal practice of telemedicine. Where video is needed, for example. to
demonstrate a patient‟s mobility after a hip replacement, it is usually sufficient to use a commercial
videoconferencing unit (Section 3.3.2) rather than the much more expensive broadcast television. The output
from such units approaches broadcast quality.
An important consideration for international teleconsultations is the compatibility of the analogue video
signals, and therefore the video equipment, in different countries. There are two widely used formats for
analogue video:

The National Television Standard Committee (NTSC) system adopted in North America and Japan, having
525 lines per picture and a frame rate of 30 pictures per second;
The Phase Alternating Line (PAL) system used throughout Western Europe and Australasia, having 625
lines per picture and a frame rate of 25 pictures per second.
Most modern television receivers and video recorders are able to convert signals from one standard to another.
The Common intermediate Format (CIF) is a format introduced to provide compatibility between NTSC and
PAL and offers a lower resolution of 288 lines per picture at 30 pictures per second.

Frame Rate and Bandwidth

Video frame rates of 25 discrete pictures per second and above fool the human brain into perceiving
continuous and smooth motion. However, when video compression takes place, the display frame rate may fall
due to the time needed to decompress the images. The effective frame rate may drop to 7.5. 10 or 15 frames
per second.
The ultimate solution to this problem is of course to increase the bandwidth at a cost. A no-cost, sometimes
acceptable compromise is to reduce the size of

the display window and hence the number of pixels needed to output a frame.
Naturally, the window size must be large enough to allow a valid teleconsultation to take place.

Introduction to Data Communications:

In Data Communications, data generally are defined as information that is stored in digital
form. Data communications is the process of transferring digital information between
two or more points. Information is defined as the knowledge or intelligence. Data
communications can be summarized as the transmission, reception, and processing of
digital information. For data communications to occur, the communicating devices must be
part of a communication system made up of a combination of hardware (physical equipment)
and software (programs). The effectiveness of a data communications system depends on four
fundamental characteristics: delivery, accuracy, timeliness, and jitter.

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A data communications system has five components:
1. Message: The message is the information (data) to be communicated. Popular forms of
information include text, numbers, pictures, audio, and video.
2. Sender: The sender is the device that sends the data message. It can be a computer,
workstation, telephone handset, video camera, and so on.
3. Receiver: The receiver is the device that receives the message. It can be a computer,
workstation, telephone handset, television, and so on.
4. Transmission medium: The transmission medium is the physical path by which a message
travels from sender to receiver. Some examples of transmission media include twisted-pair
wire, coaxial cable, fiber-optic cable, and radio waves.
5. Protocol: A protocol is a set of rules that govern data communications. It represents an
agreement between the communicating devices.

Data Communication Circuits

The underlying purpose of a digital communications circuit is to provide a transmission path
between locations and to transfer digital information from one station (node, where
computers or other digital equipment are located) to another using electronic circuits. Data
communications circuits utilize electronic communications equipment and facilities to
interconnect digital computer equipment. Communication facilities are physical means of
interconnecting stations and are provided to data communications users through public
telephone networks (PTN), public data networks (PDN), and a multitude of private data
communications systems.
The following figure shows a simple two-station data communications circuit. The
main components are:
Source: - This device generates the data to be transmitted; examples are mainframe
computer, personal computer, workstation etc. The source equipment provides a means for
humans to enter data into system.

Transmitter: - A transmitter transforms and encodes the information in such a way as to

produce electromagnetic signals that can be transmitted across some sort of transmission

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system. For example, a modem takes a digital bit stream from an attached device such as a
personal computer and transforms that bit stream into an analog signal that can be handled
by t he telephone network.
Transmission medium: - The transmission medium carries the encoded signals from the
transmitter to the receiver. Different types of transmission media include free-space radio
transmission (i.e. all forms of wireless transmission) and physical facilities such as metallic
and optical fiber cables.
Receiver: - The receiver accepts the signal from the transmission medium and converts it
into a form that can be handled by the destination device.
Destination: - Takes the incoming data from the receiver and can be any kind of digital
equipment like the source.

Data Communication Circuit Arrangements

A data communications circuit can be described in terms of circuit configuration and
transmission mode.
Circuit Configurations
Data communications networks can be generally categorized as either two point or
multipoint.
A two-point configuration involves only two locations or stations, whereas a
multipoint configuration involves three or more stations.

A two-point circuit involves the transfer of digital information between a mainframe

computer and a personal computer, two mainframe computers or two data communications
networks.

A multi-point network is generally used to interconnect a single mainframe computer (host) to

many personal computers or to interconnect many personal computers and capacity of the
channel is either

Spatially shared: Devices can use the link simultaneously or Timeshare: Users take turns

Transmission Modes
There are three modes of transmission for data communications circuits:

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In simplex mode(SX), the communication is unidirectional, as on a one-way street.
Only one of the two devices on a link can transmit; the other can only receive. Commercial
radio broadcasting is an example. Simplex lines are also called receive-only, transmit-only or
one-way-only lines.

In half-duplex(HDX) mode, each station can both transmit and receive, but not at
the same time. When one device is sending, the other can only receive, and vice versa. The
half-duplex mode is used in cases where there is no need for communication in both
directions at the same time; the entire capacity of the channel can be utilized for each
direction. Citizens band (CB) radio is an example where push to talk (PTT) is to be pressed or
depressed while sending and transmitting.

In full-duplex mode(FDX) (called duplex), both stations can transmit and receive
simultaneously. One common example of full-duplex communication is the telephone
network. The full-duplex mode is used when communication in both directions is required
all the time. The capacity of the channel must be divided between the two directions.

Network Models
Computer networks can be represented with two basic network models: peer-to-peer
client/server and dedicated client/server. The client/server method specifies the way in
which two computers can communicate with software over a network.

Peer-to-peer client/server network: Here, all the computers share their resources, such as
hard drives, printers and so on with all the other computers on the network. Individual
resources like disk drives, CD-ROM drives, and even printers are transformed into shared,
collective resources that are accessible from every PC. Unlike client-server networks, where
network information is stored on a centralized file server PC and made available to tens,
hundreds, or thousands client PCs, the information stored across peer-to-peer networks is

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uniquely decentralized. Because peer-to-peer PCs have their own hard disk drives that are
accessible by all computers, each PC acts as both a client (information requestor) and a
server (information provider). The peer-to-peer network is an appropriate choice when
there are fewer than 10 users on the network, security is not an issue and all the users are
located in the same general area.

The advantages of peer-to-peer over client-server NOSs include:

No need for a network administrator
Network is fast/inexpensive to setup & maintain
Each PC can make backup copies of its data to other PCs for security.
Easiest type of network to build, peer-to-peer is perfect for both home and office use.

Dedicated client/server network: Here, one computer is designated as server and the rest
of the computers are clients. Dedicated Server Architecture can improve the efficiency of
client server systems by using one server for each application that exists within an
organization. The designated servers store all the networks shared files and applications
programs and function only as servers and are not used as a client or workstation. Client
computers can access the servers and have shared files transferred to them over the
transmission medium. In some client/server networks, client computers submit jobs to one
of the servers and once they process the jobs, the results are sent back to the client
computer.

Network Topologies
In computer networking, topology refers to the layout of connected devices, i.e. how the
computers, cables, and other components within a data communications network are
interconnected, both physically and logically. The physical topology describes how the
network is actually laid out, and the logical topology describes how the data actually flow
through the network.

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Network Classifications
One way to categorize the different types of computer netw ork designs is by their scope or
scale. Common examples of area network types are:
LAN - Local Area Network

WLAN - Wireless Local Area Network

WAN - Wide Area Network

MAN - Metropolitan Area Network

SAN - Storage Area Network, System Area Network, Server Area Network, or sometimes Small Area
Network

CAN - Campus Area Network, Controller Area Network, or sometimes Cluster Area Network

PAN - Personal Area Network

DAN - Desk Area Network

Local area network:

• A Local Area Network (LAN) covers a small distance and a small number of computers.
• A LAN often connects the machines in a single room or building

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 • Data transferred in High speed which ranges from 100 Mbps to gigabit for system
development and have a low implementation cost.
• Upper limit: 10 km ; Lower limit: 1 km
• Twisted pair cable or Co-axial cable connects the plug in cards to form a network.

• A work to internet connections would most likely require broadcast network (LAN) with
a connection to the internet (packet switched network).

MERITS
• Cost reductions through sharing of information and databases, resources and network
services.
• Increased information exchange between different departments in an organization, or
between individuals.
• The trend to automate communication and manufacturing process.
DEMERITS
• Special security measures are needed to stop users from using programs and data that
they should not have access to;
• Networks are difficult to set up and need to be maintained by skilled technicians.
• If the file server develops a serious fault, all the users are affected, rather than just
one user in the case of a stand-alone machine.
• There are three topologies of LAN Network
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Metropolitan Area Network (MAN):

A metropolitan area network, or MAN, covers a city. The best-known example of a MAN is the
cable television network available in many cities. This system grew from earlier community
antenna systems used in areas with poor over-the-air television reception. In these early systems,
a large antenna was placed on top of a nearby hill and signal was then piped to the subscribers'
houses. At first, these were locally-designed, ad hoc systems. Then companies began jumping
into the business, getting contracts from city governments to wire up an entire city. The next step
was television programming and even entire channels designed for cable only. Often these
channels were highly specialized, such as all news, all sports, all cooking, all gardening, and so
on. But from their inception until the late 1990s, they were intended for television reception only.
To a first approximation, a MAN might look something like the system shown in Fig. In this
figure both television signals and Internet are fed into the centralized head end for subsequent
distribution to people's homes. Cable television is not the only MAN. Recent developments in
high-speed wireless Internet access resulted in another MAN, which has been standardized as
IEEE 802.16.

WAN: WIDE AREA NETWORK

• A Wide Area Network (WAN) connects two or more LANs, often over long distance.
• A WAN often connects different groups in different countries.
• Range: Beyond 100 km.

ADVANTAGES OF WAN
• Covers a large geographical area so long distance businesses can connect on the one network.
• Shares software and resources with connecting workstations.
• Messages can be sent very quickly to anyone else on the network. These messages can have
pictures, sounds, or data included with them.

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 • Expensive things can be shared by all the computers on the network without having to buy a
different peripheral for each computer.
• Everyone on the network can use the same data.

DISADVANTAGES OF WAN
• Need a good firewall to restrict outsiders from entering and disrupting the network
• Setting up a network can be an expensive, slow and complicated.
• Once set up, maintaining a network is a full-time job which requires network supervisors and
technicians to be employed.
• Security is a real issue when many different people have the ability to use information from
other computers. Protection against hackers and viruses adds more complexity and expense.

Technologies Involved
• Medical Instrumentation
• Sensing Bio-medical Signals,
• Medical Imaging, Measurement of Physical Parameters e.g. Body Temperature, Pressure etc.
• Telecommunication Technology -- Trans-receiver on different communication channels and
network such as, on wired network, wireless medium etc.
• Information Technology -Information representation, storage, retrieval, processing, and
presentation

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 MAN

These types of networks are larger than LANs but smaller than WANs –
and incorporate elements from both types of networks.

These types of networks are larger than LANs but smaller than WANs –
and incorporate elements from both types of networks. MANs span an
entire geographic area (typically a town or city, but sometimes a
campus). Ownership and maintenance is handled by either a single
person or company (a local council, a large company, etc.).

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The smallest and most basic type of network, a PAN is made up of a
wireless modem, a computer or two, phones, printers, tablets, etc., and
revolves around one person in one building. These types of networks are
typically found in small offices or residences, and are managed by one
person or organization from a single device.

SAN

high-speed network that connects shared pools of storage devices to

several servers, these types of networks don‟t rely on a LAN or WAN.
Instead, they move storage resources away from the network and place
them into their own high-performance network. SANs can be accessed
in the same fashion as a drive attached to a server.
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 CAN

Larger than LANs, but smaller than metropolitan area networks (MANs,
explained below), these types of networks are typically seen in
universities, large K-12 school districts or small businesses.

WLAN

Functioning like a LAN, WLANs make use of wireless network

technology, such as Wi-Fi. Typically seen in the same types of

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applications as LANs, these types of networks don‟t require that devices
rely on physical cables to connect to the network.

DAN

Desk Area Network (DAN) is a multimedia workstation based around

an Asynchronous Transfer Mode (ATM) interconnect (as shown in the
above diagram). All communication between peripherals and even
between the CPU and its main memory is achieved by sending ATM
cells through a switch fabric.

• Before multimedia devices were connected to workstation there

was no facility to connect multimedia devices or other peripheral
devices directly to network. But due to this Desk Area Network
(DAN) these devices are now directly connected to network. With
the help of this DAN architecture communication happens between
peripheral devices and Central Processing Unit (CPU), this Desk
Area Network enables sharing of resources over network.
• Benefits of using DAN :
• Provides high performance communication between device to
device or CPU to device.
• Provides reliable data transmission.
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 • Connection oriented transmission mode.
• Offers high level bandwidth as it uses ATM.

Public Switched Telephone Network System

• PSTN stands for Public Switched Telephone Network, or the traditional circuit-switched
telephone network. This is the system that has been in general use since the late 1800s.
• The phones themselves are known by several names, such as PSTN, landlines, Plain Old
Telephone Service (POTS), or fixed-line telephones.
• PSTN phones are widely used and generally still accepted as a standard form of
communication.
• With better compression algorithms it has become possible to transmit video pictures
across the public switched telephone network system.
• Picture quality is of course limited but connectivity is extremely high, allowing
telemedicine to the home .
a videoconferencing system consists of the same basic components:
• Codec, compresses and decompresses still and video images. The codec also manipulates
the audio information and ensures synchronization of voice and image.
• Monitor. to display video images either on a television or monitor
• Camera: usually an auto-focus, auto-iris, single chip device with remote pan/tilt/zoom to
capture information from any part of the consultation room. The camera can be controlled
locally or from the remote site.
• Audio system, which needs surprising sophistication to make it an acceptable
approximation to normal speech.
• User interface to make the system easy to operate for all users. A mouse or some other
push-button control may be more acceptable than a keyboard.

The telephone infrastructure at that time could not support the required transmission rates and
sales were poor

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although the device was a clear 'proof of concept'. AT&T attempted to develop the idea in the
late 1960s and early 1970s, including some telemedicine applications that showed what might be
possible if the technology could be developed further.

The real breakthrough in mass-market terms was made in the early 1990s by Intel with its
ProShare personal videoconferencing product designed to operate over ISDN networks. The
market has since expanded to include
PictureTel , VTEL and CLI, all of which offer a range of products and services to suit individual
requirements.

PSTN stands for Public Switched Telephone Network, or the traditional circuit-switched
telephone network. This is the system that has been in general use since the late 1800s.

The phones themselves are known by several names, such as PSTN, landlines, Plain Old
Telephone Service (POTS), or fixed-line telephones.

PSTN phones are widely used and generally still accepted as a standard form of communication.

PSTN Phone Lines Work

Think of a Public Switched Telephone Network (PSTN) as a combination of telephone networks

used worldwide, including telephone lines, fiber optic cables, switching centers, cellular
networks, as well as satellites and cable systems. These help telephones communicate with each
other.

Put simply, when you dial a phone number your call moves through the network to reach its
destination – and two phones get connected. To fully understand how a POTS actually works,
consider what happens when you dial a number from your own phone.

Step #1 – Your telephone set converts sound waves into electrical signals. These signals are then
transmitted to a terminal via a cable.

Step #2 – The terminal collects the electrical signals and transmits these to the central office
(CO).

Step #3 – The central office routes the calls in the form of electrical signals through fiber optic
cable. The fiber optic conduit then carries these signals in the form of light pulses to their final
destination.

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Step #4 – Your call is routed to a tandem office (a regional hub responsible for transmitting calls
to distant central offices) or a central office (for local calls).

Step #5 – When your call reaches the right office, the signal is converted back to an electrical
signal and is then routed to a terminal.

Step #6 – The terminal routes the call to the appropriate telephone number. Upon receiving the
call, the telephone set converts the electrical signals back to sound waves.

This may sound complicated, but the thing to remember is that it takes a few seconds for your
call to reach its destination. This process is facilitated by using fiber optic cables and a global
network of switching centers.

PSTN – Understanding The Art of Switching

Now, let‟s have a look at each of the four types of switching which take place at different levels.

1. The Local Exchange

A local exchange – which may consist of one or more exchanges – hooks up subscribers to a
PSTN line. Also known as a central office or a switching exchange, a telephone exchange may
have as many as 10,000 lines. All telephones are connected to the local exchange in a specific
area. Interestingly, if you were to dial the number of your supplier located in the building next to
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yours, the call won‟t leave your local exchange and will be routed to the supplier as soon as it
reaches the exchange.

The exchange then identifies the number dialed so it can route the call towards the correct end
destination. This process works as follows:

The first three digits of a phone number represent the exchange (the local switch), while the last
four digits identify the individual subscriber within that exchange.

This means that when you dial a number and it reaches your local exchange, your call is
immediately linked to the subscriber without the need for any further routing.

2. The Tandem Office

Also known as a junction network, a tandem office serves a large geographical area comprising
several local exchanges while managing switches between local exchanges.

Let‟s say you dialed the number of a client who lives in the same city but in another suburb. In
this case your call will be routed to a tandem office from your local exchange, and the tandem
office will route the signal on to the local exchange near your client‟s location.

3. The Toll Office

This is where any national long-distance switching takes place.

A toll office is connected to all the tandem offices. For instance, if you have an office in another
city you‟ll find that, whenever you dial that branch‟s number, your call will be switched through
a toll office.

4. The International Gateway

International gateways manage international call switching, routing domestic calls to the
appropriate countries.

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PBX

Large organizations with 40 or more employees usually go with a Private Branch Exchange
(PBX). A PBX converts your organization into a local exchange where all the phones in your
organization are connected and you get to enjoy a range of services such as call transfer, call
conferencing, auto attendant, voicemail, call hold, and more.

The PBX is connected to your local exchange. It routes external calls to a local exchange while
all internal calls are routed by your PBX.

A PBX is a combination of software and hardware, so it will cost you some serious bucks. It
comes with hubs, switches, phone adapters, routers, and several telephone sets. It is like creating
your own small exchange where your PBX handles switches internally.

Most businesses use PBX phone systems to manage calls because they are easier. However,
installing and managing a PBX is costly. The actual cost may vary depending on the number of
features you prefer to have and the complexity of the PBX. A massive, complex, and feature-rich
PBX will cost your business more than a simple PBX system with just some basic capabilities.

Plain Old Telephone Service

 POTS is an acronym for plain old telephone service, which refers to the standard low
speed, analog telephone service that is still used by most homes and many businesses.
 The term is sometimes used to distinguish that service from the newer
telecommunications services which are digital and have much larger bandwidths. These
include ADSL (asymmetric digital subscriber line), ISDN (integrated services digital
network) and FDDI (fiber distributed data interface).
 POTS is basically an analog voice transmission phone system implemented over copper
twisted pair wires. It is the phone line technology most of us grew up with at home and is
exactly what you think it is: copper wires dangling overhead, carrying your voice from
one place to another.

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 POTS networks were created to facilitate voice communication over copper cables that
traversed countries and continents, and it has been the standard voice-grade telephone
system used by residences and businesses across the world since the 1880‟s. But the
POTS most of us are familiar with is an upgrade over the rudimentary phone system
invented by Alexander Graham Bell.

 The newer services provide some part of their channels for POTS while using most of
their bandwidth for digital data transmission. The newer services also make possible
added features such as call waiting or call forwarding.
 POTS utilizes the lowest 4kHz of bandwidth on twisted pair wiring (i.e., conventional
low-speed copper wiring). Any service sharing a line with POTS (e.g., DSL) must either
use frequencies above POTS or convert POTS to digital signals and interleave them with
other data signals.

 POTS, is a term which describes the voice-grade telephone service that remains the basic
form of residential and small business service connection to the telephone network in
most parts of the world. The system was originally known as the Post Office Telephone
Service or Post Office Telephone System. Today the term Plain Old Telephone Service is
used, after the services were removed from the control of national post offices.
 The pair of wires from the central switch office to a subscriber‟s home was called the
subscriber loop. It was typically powered by 40V(DC) and backed up by a large bank of
batteries in the central office, resulting in continuation of service during most commercial
power outages.
 This 64Kbps service is a bi-directional, or full duplex, voice path with limited frequency
range of 300 to 3400 Hz: in other words, a signal to carry the sound of the human voice
both ways at once. Today, it is also used for internet access via a dial modem, DSL, fax,
credit card terminals, etc.
 Users accessing the Internet with the same twisted pair copper wiring as is used by their
telephone are using a POTS connection. The TCP/IP (transmission control
protocol/Internet protocol) digital data from their computer or LAN (local area network)
is converted to analog format using a modem prior to transmission over the POTS.

28
The POTS setup has remained virtually the same for decades. There have been many upgrades to
usher components of the POTS telephone system into the digital era, but the copper wire
connection has weathered the storm.

As far as the mechanics of a POTS lines go, this phone service works by establishing a dedicated
circuit between Point A and Point B for the duration of a transmission.

Circuit Switching

Back in the old days, circuit switching was the reason you needed an operator‟s assistance when
making calls.

In those days, operators would sit by one giant wooden switchboard, plugging copper wires into
a common patch panel. In the case of connections that required two exchanges, two operators
would go about simultaneously plugging the caller‟s and receiver‟s wires into the same inter-
exchange wire.

This wire was known as a “trunk”.

Long distance calls were unbearably costly because calling long distance was akin to renting the
use of a very long piece of copper wire each time you wanted to make a call.

29
Transistors

The transistor heralded the electronic exchange era, which slowly paved the way for the digital
network. Current phone lines have been upgraded to carry digital signals in the form of
“packets.” Packet-based technology does not dominate the transmission channel by demanding a
continuously open and dedicated circuit, unlike its analog counterpart. Rather, it uses the
underlying network to transmit voice (and data) messages independently through the switches. A
copper line is a bi-directional 64Kbps service capable of carrying human voice both ways at the
same time

Modems

This is a device that was designed to exploit the digital nature of the public switched telephone
network without overhauling your entire phone system. This should come as good news for
small business owners who are not planning to upgrade their analog communications systems
any time soon, especially considering the wealth of options available on the market.

Integrated Services Digital Network (ISDN)

Integrated Services Digital Network (ISDN) ISDN is a dial-up (not dedicated but used on a call-
by call basis) digital connection to the telecommunication carrier. An ISDN line can carry
information at nearly five times the fastest rate achievable using analog modems over POTS
(plain old telephone service).

1980: ISDN Integrated access to all services

Digital end-to-end (Digital subscriber loop)
 One set of interfaces for all services at multiple speeds
 Supports both circuit switching and packet switching
 Out-of-band signaling. Sophisticated network management and maintenance using
Signaling System 7 (SS7)
 Layered protocol architecture

30
ISDN Channels
B: 64 kbps for data or voice
D: 16 or 64 kbps for signaling or packet switched data
H: 384 kbps (H0), 1536 kbps (H11), 1920 kbps (H12)

ISDN Access Interfaces

Basic Rate Interface (BRI): 2B + D = 2 × 64 + 16 = 144 kbps (192 kbps total)

Primary Rate Interface (PRI): For LANs or PBX

23 B + D = 23 × 64 + 64 = 1.536 Mbps » T1
30 B+ D = 30 × 64 + 64 = 1.984 Mbps = 5H0+D = E1- 64 kbps Framing+mgmt

31
Functional Groupings
 Terminal Equipment 1 (TE1): ISDN terminal
 Terminal Equipment 2 (TE2): Non-ISDN terminal, e.g., POT
 Terminal Adapter (TA): Allows non-ISDN devices on ISDN
 Network Termination 1 (NT1): Physical layer device. Separates user premises from phone
company. Owned by user in USA. Owned by PTT in many countries.
 Network Termination 2 (NT2): OSI layers 2-3, e.g., PBX, LAN
 Network Termination 1,2 (NT12): NT1 + NT2

NT1:

 Physical and electrical terminal of ISDN at user

 Isolates the user from the transmission technology of the subscriber loop
 Line maintenance functions such as loop back testing and monitoring
 Bit multiplexes various B and D channels m Supports multi-drop lines
 Telephone, personal computer, and alarm on one NT1

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NT2:
 Digital PBX, LAN, Terminal controller Switching and concentration

ISDN Reference Points

 Rate (R): Between Non-ISDN and Terminal Adapter. Uses X or V series recommendations.
 System (S): Between ISDN equipment and NT2. Separates user equipment from switching
equipment. Terminal (T): Between NT2 and NT1. Separates network from user.
 User (U): U interface not defined by ITU. Defined in North America since NT owned by user.

ISDN Services Six types of services

 Circuit switched calls over a B or H channel
 Semi-permanent connections over a B or H channel
 Packet switched calls over a B or H channel
 Packet switched calls over a D channel
 Frame relay calls over a B or H channel
 Frame relay calls over a D channel

It is a new set of integrated systems that can integrate many different communication services into a
single digital network capability called the Integrated Services Digital Network. ISDN is specially designed
for transmission of digital data and is about twice as fast as conventional telephone lines. It categorized
into two generations:

Narrow-band ISDN, it uses 64 kb/s and has circuit switching orientation.

Broad-band ISDN, it uses very high data rates and has packet-switching orientation. ISDN is a digital
networking that is necessary to Telemedicine applications. Digitalization and integration of services are
the benefits of ISDN.

ISDN provide greater flexibility. The fundamental objectives of ISDN is that it be based on the telephony
network and gives much better audio quality and much faster data transfer. Future versions of ISDN-
Based Telemedicine system will include facilities for on-line interaction between practitioner and
specialist with simultaneous speech.

33
 Internet technology
Internet technology created in 1969 at UCLA by US Department of Defense (4 computers) expanded
to include 50 research sites by 1972 interconnected with other private and public networks during
1970s and 1980s currently a privately run system.

Internet technology World-Wide Web (WWW) –invented by Swiss physicists in 1989 –access
improved through development of browsers (Mosaic, Netscape, Internet Explorer) –usefulness
improved through development of search engines (Yahoo, Infoseek, Alta Vista) –growing in
popularity (53.5 million US adults) .

Taking advantage of technology for medical care medical informatics –computerized patient records
(history, insurance claim processing) –integrated information management systems –expert systems
for advice or warnings –on-line journals and research reports .

Internet Patient Console Referral Hospital

Step 1. Upload Information
step2. Download Information
Step 3. Post Suggestions Telemedicine Server
Step 4. Receive Suggestion Telemedicine over web

34
Health Care and the Internet
• Patients canAccess health care information
Join chat groups
Purchase drugs and other medical items
Consult a health care practitioner online
Informatics describes the development and use of information technology
Assign groups of students the task of finding examples of the Internet services mentioned.

Uses of telehealth the Internet

Patient monitoring (e.g., electrocardiogram, lung capacity)
Patient consultation by videoconference
Transmission of images for diagnosis
Robotic surgery (telesurgery).

• Internet by using a modem and an ordinary telephone network. This method of

communication is quite suitable for telemedicine purposes.
• The Internet based systems can be particularly useful for remote areas where ordinary
telephone lines are still the only available means of communication.
• With the Internet, Virtual Private Network (VPN) can be established between two sites which
can provide a private and secure connection.

Broadband Service
• Broadband is usually referred to as a service that provides for high-speed transfer of data,
voice and video over the Internet.
• Broadband speed required for a particular application depends upon technology, geography
or location

35
and some other parameters.
• broadband service should make available to the users download speeds of at least 1–3 Mbps
during peak hours.
Broadband networks can be accessed through a variety of wired and wireless services

Benefits of Broadband in Telemedicine

• Expansion of healthcare provisions:
• Using broadband-enabled telemedicine technologies, the healthcare services can be
extended to remote and under-served segments of a country. Such a facility can thus result
in provision of quality healthcare services across all demographics and geographical
locations.
• Easier telehome care:
Telehome care services can greatly benefit from the expanding availability and increasing
affordability of the broadband. They can facilitate the establishment of efficient and effective in-
home diagnostic, monitoring, and treatment services.
• Better healthcare administration:
Broadband services can greatly help in streamlining healthcare administration especially in
managing electronic health records, resulting in higher efficiency in back-office operations and
consequently leading to substantial cost savings

Broadband Technologies
• Fixed line broadband technologies depend upon a direct physical connection between the
sites over some kind of terrestrial lines.
• rely for their operation on a cable modem, xDSL (digital subscriber line) broadband or power
line, make use of an existing form of subscriber connection as the medium for
communication.
• smaller antennas are required at higher frequencies which are comparatively easier to
instal. Most of the systems requiring high bandwidth generally operate above 10 GHz
frequency.

DIGITAL SUBSCRIBER LINE (DSL)

• The DSL technology depends upon the use of existing copper telephone wire which is
generally present in most of the places
• the facility that should be located within about 5 km of the switch of the telephone company
• Types of DSL connections, which could be symmetric or asymmetric. These are High bit-rate
• Digital Subscriber Line (HDSL), Single-Line Digital Subscriber Line (SDSL) and Asymmetric
• Digital Subscriber Line (ADSL).

36
 ASYMMETRIC DIGITAL SUBSCRIBER LINE (ADSL)
• This technology can transmit up to 6 Mbps to a subscriber, and as much as 832 Kbps or
more in both directions.
• ADSL has literally transformed the existing public information network which was limited to
voice, text and low resolution graphics to a powerful and efficient system bringing
multimedia, including full motion video, to subscriber’s home.
• This technology has brought movies, television, video catalogs, video-on-demand, corporate
LANs, and the Internet into homes and business premises.
• The working principle of ADSL is very simple. It uses two separate frequency bands for
upstream and downstream communication. With standard ADSL, the band from 25.875–138
kHz is used for upstream communication, while 138–1104 kHz is used for downstream
communication

Wireless Technology
Wireless telemedicine is based on developments in wireless technologies which
have enabled
delivery of healthcare and exchange of medical information and knowledge
anywhere and Anytime
• ease of use, reduced risk of infection, reduced risk of failure, reduced patient
discomfort, enhanced mobility and low cost of care delivery. Wireless

37
 communication thus represents a practical and highly flexible way of
transmitting data in the medical field.
• Wireless connectivity thus would greatly help in developing such products
that can ultimately improve patient care through better tracking and
monitoring of the patients.
• This is possible with the availability of user-friendly, cost-effective and low-
power portable wireless devices whose operating areas can span large
buildings, institution campus and even at home.
• sending reminders to senior citizens and patients undergoing treatment,
monitoring performance of implanted devices and monitoring of fitness data
are other potential areas of applications of wireless technologies.
• The necessary standardization work in the field of medical technology has
been undertaken by the
Institute of Electrical and Electronic Engineers (IEEE). They have already introduced
several standards in the field of wireless technologies. For example, IEEE 802.3
defines the Ethernet specifications which governs most wired computer network
today while IEEE 802.11 defines the WLAN specification which is the base line of the
Wi-Fi standard and IEEE 802.15.4 defines the wireless Personal Area Network (PAN)
standard used in ZigBee.

Regulations for Frequency Bands

• Use of radio frequency bands of the electromagnetic spectrum is regulated
by governments in most countries. This is basically a spectrum management
process, and is known as frequency allocation or spectrum allocation.
• The International Telecommunication Union coordinates the shared global
use of radio spectrum through its radio communication sector (ITU-R).
Several frequency bands use for Industrial, Scientific and Medical (ISM)
applications have been reserved by ITU-R.
• The most popular ISM bands are 433 MHz, 868 MHz, 915 MHz and 2.4 GHz.
These are mostly used in wireless communication devices such as cordless
phones, remote controls for gadgets and Wi-Fi

Challenges of Wireless Technology in Telemedicine

there are several challenges such as low power requirement of wireless devices,
node failure, transmission delay, various types of network communication
infrastructure and data integrity
• Wireless network based devices are mostly wearable and must be battery
operated. Therefore, they are so designed that they consume only minimal

38
 energy which is ensured by using appropriate scheduling algorithms and
power management techniques

five primary parameters form the basic requirements of wireless based medical
devices
• 1. Range: The distance over which the device must operate
• 2. Data: The quantum of data that is required to be exchanged
• 3. Speed: Throughput required to meet clinical requirements
• 4. Frequency: How often the data needs to be transferred
• 5. Power: Whether the device is battery or mains operated
TYPES OF WIRELESS TECHNOLOGIES IN TELEMEDICINE
• New standards such as ZigBee/IEEE 802.15.4, Bluetooth, BLE, and ANT are
widely used in the medical domain along with several other proprietary
technologies operating in the sub-1 GHz or the 2.4 GHz spectrum.
• Wireless technologies can be broadly classified into two categories; Examples
of line-of-sight systems are point-to-point microwave and broadband satellite
technologies.
cellular technologies like Universal Mobile Telecommunication System (UMTS), Wi-
Fi, and WiMAX are non line-of-sight technologies as they do not require line-of-sight
between the transmission hub and receiving equipment

Wi-Fi—Wireless Local Area Network

• Wi-Fi is the name of a popular wireless networking technology.
39
 • It uses radio waves to provide wireless high-speed Internet and network
connectivity
• Wi-Fi is short for “wireless fidelity”.
• IEEE 802.11x standard.
• Current Wi-Fi networks operate in the ISM bands (2.4 GHz, 5 GHz). They give
speed up
to 54 Mbps and allow data, voice as well as video applications. Just like wired LANs,
they
work on the principle of Carrier Sense Multiple Access/Collision Avoidance
(CSMA/CA)
to access the media.
• WLANs not only offer mobility and flexibility, but also results in high
productivity both for caregivers and to the patients

• The access point is connected to another device via Ethernet cord and acts as
an adapter to send/receive the wireless signal from our wireless network.
The primary job of an access point is to broadcast a wireless signal that
computers/devices (mobile clients or MC) can detect and “tune” into
• The technology is being extensively used to provide wireless access to the
Internet and network connectivity for smart phones, laptops, and modern
consumer electronics and similar devices. Wi-Fi connectivity is today widely
available worldwide in public hotspots such as airports, railway stations,
hospitals, university campuses and in millions of homes and factories.
• One of the expanding areas of Wi-Fi technology is in the field of real-time
multimedia, for audio and video streaming applications over a wireless link,
which can offer greater opportunities in the field of mobile telemedicine. The
huge success of Wi-Fi is largely due to the remarkable interoperability of this
technology and to the rising demand of the users for easy and cost effective
Internet access.

• Wired Equivalent Privacy (WEP): It is a security algorithm for IEEE 802.11

wireless networks.
Here, data transmitted over the WLAN is protected by encrypting it.
• Wi-Fi Protected Access (WPA): This protocol provides improved data
encryption based
• on temporal key integrity protocol. This protocol addresses the weaknesses
of WEP by including a per-packet mixing function, a message integrity check,
an extended initialisation vector, and a re-keying mechanism.

40
Worldwide Interoperability for Microwave Access (WiMAX)
• WiMAX as “a standards-based technology enabling the delivery of last mile
wireless broadband access as an alternative to cable and DSL”
• There are two types of WiMAX: Line-Of-Sight (LOS) and Non-Line-Of-Sight
(NLOS) systems. The LOS WiMAX systems are designed to provide point-to-
point connectivity only, while the NLOS WiMAX systems allow point-to-
multipoint applications.
• WiMAX is a family of wireless communications standards based on the IEEE
802.16 standard.

Bluetooth
• Bluetooth is a wireless technology standard for exchanging data over short
distances using radio waves in the ISM band from 2.4–2.485 GHz from fixed
and mobile devices.
• It is ideal for short-range, lowpower, low-cost wireless transmissions
between electronic devices
• Bluetooth was introduced by Ericsson, a telecom company, in 1994, and was
even standardised as IEEE 802.15.1, but the standard is no longer
maintained.
• Bluetooth technology allows direct wireless communication to cellular
phones, laptops and other Bluetooth enabled devices such as sports and
fitness watches, GPS/handhelds, and other personal monitoring devices.
• Bluetooth supports data through put up to 2 MBps and is mostly used in a
point-to-point or in a star network topology.
• Bluetooth operates in the globally unlicensed ISM band in the range of 2.4–
2.4835 GHz, which is a short-range radio frequency band. In classic

41
 Bluetooth, the modulation used is Gaussian Frequency-Shift Keying (GFSK).
However, in later versions, the Adaptive Frequency- Hopping (AFH) Spread
Spectrum technology is used.
• Bluetooth solutions are designed to connect mobile devices in an ad hoc
network called piconet. It is a packet-based protocol with a master-slave
structure. One master may communicate with up to 7 slaves in a piconet;
• There are currently three classes with covering range around 3 m, 30 m, or
300 m. Although it is mostly observed in mobile phones, it is proving useful
for use in small wearable biosensors due to its low power consumption (1
mW for 3 m), simple, and low cost transceiver.

• There has been a constant evolution in Bluetooth technology ever since it

was conceived in 1994. Bluetooth v4.0 is the most recent update, though,
some of the earlier versions are still in use. Bluetooth 4.0 specification has
been divided into three classes: classic, highspeed, and low-energy
(Sparkfun).

42
ZigBee
• ZigBee is a wireless technology developed as an open global networking
standard to address the needs of low-cost and low-power wireless networks.
It is aimed at remote control and sensor applications and for operation in
harsh radio environments and in isolated locations.
• IEEE 802.15.4 specification and operates in the unlicensed radio frequency
bands, including 2.4 GHz, 900 MHz and 868 MHz. The specifications are
maintained and updated by the ZigBee Alliance.
• ZigBee devices are often used in mesh network form to transmit data over
longer distances, passing data through intermediate devices to reach more
distant ones. In the medical field, ZigBee is used to connect unlimited
number of health monitoring devices.
• It operates in the radio bands; 868 MHz in Europe, 915 MHz in the USA and
Australia and 2.4 GHz in most other countries of the world .

• ZigBee based wireless sensors and devices enable the patients to move
around or inside hospitals, or in their homes. The sensors will continue to
monitor and transmit critical health related information to the hospital or the
concerned doctor. This allows the patient to be independent of the
geographical location which offers tremendous benefits and positive impact
on both the patient and the healthcare centre.

43
ANT
• ANT is another ultra-low power, short-range wireless technology designed
for sensor networks and similar applications. The proprietary protocol is
developed and sold by Canadian company Dynastream Innovations Inc
• ANT allows short-range wireless communication in point-to-point or more
complex network topologies. The protocol has proved useful for many
applications, such as collection, automatic transfer and tracking of sensor
data within sports, wellness management and home health monitoring
applications .
• ANT uses the 2.4 GHz ISM band. It works efficiently in embedded systems
that are based on peer-to-peer or star network topology

Ultra-Wide Band (UWB) Technology

• UWB refers to any radio technology having a transmission bandwidth in the
3.1–10.6 GHz band. UWB a preferred choice for short-range wireless
multimedia applications in devices such as wireless monitors, wireless digital
audio and video players and in Wireless Body Area Networks (WBAN).

MOBILE COMMUNICATIONS
• A cellular network or mobile network is a radio communication network
where the last connectivity is provided by one of the wireless technologies.
The network is distributed over land through cells where each cell includes a
fixed location transceiver known as base station.
• Wireless Phone Technology—Cellular Radio
• The main feature of cellular network is the flexibility of continuous
connection provided to the users when they move across the cells. Almost
the entire inhabited land area of the Earth has been covered with cellular
networks provided by major telecommunications companies. This has
enabled connectivity of mobile computing devices to be connected to the
public switched telephone network and Internet for voice and data
communication.
• The transmission in cellular networks runs at a speed that is enough for
telephony and short message services and other computer communication
applications such as email and Internet access. These services offer
convenient method of communicating for medical diagnostic and emergency
purposes. Today, they are employed for sending ECG and other data from
homes and ambulances to hospitals. When used with appropriate software,

44
 a cellular telephone can serve as a workstation to transmit and receive text,
data, images and video, for their use in various telemedicine applications.

Global System for Mobile Communications (GSM)

• GSM is the name of a standardisation group established in 1982 to create a
common European mobile telephone standard that formulated
specifications for a pan-European mobile cellular radio system. The initial
version of GSM transmitted digital media in circuit switched (continuous
transmission) form and later versions of GSM deliver data in packet data
form
• GSM uses three frequency bands namely: 900 MHz, 1800 MHz and 1900
MHz.
• The primary function for GSM system obviously is to use it for speech or
voice purposes.
• This is achieved by digitally encoding the speech and decoding it later using a
vocoder. In addition to the voice services, GSM supports a variety of other
data services. The data services are supported generally with user data rates

45
 up to 9.6 Kbps per channel slot. One service that is used widely and has
become popular is the Short Message Service (SMS).
• The GSM system offers a number of design features. It gives good subjective
speech quality, has a low cost, terminals are handheld instruments, the
system supports international roaming and offers good spectral efficiency.

46
 EVOLUTION OF MOBILE NETWORKS

1G Wireless Systems
 The geographical area divided into cells
 Each with own antenna
 Each with own range of frequencies
 Served by base station - Transmitter, receiver, control unit to carry out actual
radio communications with the device
 Adjacent cells on different frequencies to avoid crosstalk
 Mobile Switching Center Controls all calls attached to this device, Maintains billing
information &Switches calls
 PSTN Public Switched Telephone Network

47
2G Wireless Systems – Characteristics
 Deployed in mid 1990s
 Fully Digital network elements
 TDMA/CDMA for spectrum sharing; Circuit switching
 Operates at 900-1800 MHz frequency band
 3-times increase in overall system capacity.
 supported voice-centric services and limited data-service, like short messages(SMS),
FAX, etc.
 <9.6 kbps data rates

3G Wireless Systems
 Simultanous voice and data transmission
 Faster Internet access -Interactive web sessions
 Video calling
 Multimedia Content - voice, data & video
 Universal global roaming
48
4G Wireless systems
 Highly integrated
 High bandwidth / high-speed wireless
 Highly compatible with wired network infrastructures
 provides mobile ultra-broadband Internet access
 Integration of multi-networks using IP technology
 applications include mobile web access, IP telephony, gaming services, high-definition
mobile TV, video conferencing and 3D television.

Telehealth - Radio-Air Medium model

Telehealth – Layer Functionalities

• Application
– new applications and adaptations
– service location, multimedia
• Transport
– congestion and flow control
– quality of service
• Network
– addressing and routing
– device location, hand-over
• Link
– media access and security
• Physical
– transmission errors and interference

49
 NETWORKS( LAN & WAN)
 A network is two or more computers that are connected so that data and resources can be
shared.
 Most computers are connected to some kind of network.
 Connection can be through a copper wire, fiber optics, microwaves, infrared or satellite.

LAN: LOCAL AREA NETWORK

 A Local Area Network (LAN) covers a small distance and a small number of computers.
 A LAN often connects the machines in a single room or building
 Data transferred in High speed which ranges from 100 Mbps to gigabit for system development
and have a low implementation cost.
 Upper limit: 10 km ; Lower limit: 1 km
 Twisted pair cable or Co-axial cable connects the plug in cards to form a network.

USAGE OF LAN

A work to internet connections would most likely require broadcast network (LAN) with a connection to
the internet (packet switched network).

50
MERITS

• Cost reductions through sharing of information and databases, resources and network
services.

• Increased information exchange between different departments in an organization, or

between individuals.

• The trend to automate communication and manufacturing process.

DEMERITS

Special security measures are needed to stop users from using programs and data that they
should not have access to;
• Networks are difficult to set up and need to be maintained by skilled technicians.
• If the file server develops a serious fault, all the users are affected, rather than just one user
in the case of a stand-alone machine.

 There are three topologies of LAN Network

WAN: WIDE AREA NETWORK

A Wide Area Network (WAN) connects two or more LANs, often over long distance.

A WAN often connects different groups in different countries.

Range: Beyond 100 km.

ADVANTAGES OF WAN

• Covers a large geographical area so long distance businesses can connect on the one network.

• Shares software and resources with connecting workstations.

51
• Messages can be sent very quickly to anyone else on the network. These messages can have
pictures, sounds, or data included with them.

• Expensive things can be shared by all the computers on the network without having to buy a
different peripheral for each computer.

• Everyone on the network can use the same data.

DISADVANTAGES OF WAN

• Need a good firewall to restrict outsiders from entering and disrupting the network

• Setting up a network can be an expensive, slow and complicated.

• Once set up, maintaining a network is a full-time job which requires network supervisors and
technicians to be employed.

• Security is a real issue when many different people have the ability to use information from
other computers. Protection against hackers and viruses adds more complexity and expense.

Technologies Involved
• Medical Instrumentation
Sensing Bio-medical Signals,
Medical Imaging, Measurement of Physical Parameters e.g. Body Temperature, Pressure etc.
• Telecommunication Technology
Trans-receiver on different communication channels and network such as, on wired network,
wireless medium etc.
• Information Technology
Information representation, storage, retrieval, processing, and presentation.

52
 Satellite Communication In Telemedicine

Satellite communication in telemedicine is an application of satellites in medicine that resolves the issue of the
lack of professional healthcare in locations where it cannot be originally accessed . A patient can very well be
diagnosed regardless of long distances using telecommunication equipment that enables the health care specialist,
wherever they may be, to interact with the patient and local healthcare giver, thereby, providing almost accurate
diagnosis and treatment to an individual. Satellite communications transmits digital signals at a very high data rate
with low bit error rate . Satellite communication is the transmission of signals from one earth station to a satellite
in space orbiting in the galaxy which will in turn transmit the signals to another earth station .

The frequency bands are the L-Band, S-Band, C-Band, X-Band, Ka-Band and the Ku-Band [1]. For the purpose of this
research, the brief focus will lie on all with the exception of the S and X-BANDS.

Satellite communication has been adopted to allow telemedicine function globally. Telemedicine requires a high
bandwidth transmission for clear and quality digital signals for proper diagnosis and treatments. Satellite
communication has the ability to transmit at high frequencies and long distances, making it better than any other
communication technology that can be used in telemedicine.

• Satellite technology has been widely used for implementing telemedicine projects to remote
• and isolated areas that otherwise lack a reliable terrestrial communication network facility.
• Some satellites are used for point-to-point telecommunications links, while others are used for mobile
communications, and some for direct broadcast which include relaying telephone calls and television signals.
• They also provide communications connectivity to remote areas of the Earth and mobile vehicles, ships
and aircrafts.
• Satellite connectivity has been mostly used to implement telemedicine projects relating to mobile
situations as in the case of military units or ships in the seas or oceans.
• The signal is transmitted up to the satellite from the Earth on a particular frequency and this
action is termed as uplinking.
• The signal is received by the satellite and retransmitted back to the Earth which is then received at the
destination, the earth station. This is termed as downlinking the which is on another frequency

53
• The satellite carries some electronic circuitry, called a transponder, which performs the functions of a
receiver, frequency changer, and transmitter.
• The building blocks of a transponder are a low noise amplifier, a frequency changer comprising a mixer
and local oscillator, followed by a high power amplifier at the output. In the transponder, the receiver and
the transmitter are located in close proximity.

• It is obvious that all the communication traffic emanating across the globe cannot be carried by one
satellite. The enormous capacity requirements can however be met by making use of several satellites
operating on different bands. In space, they are physically separated from each other. In this way,
different satellites can be distinguished by the beam width of the antenna. They have very narrow beam
width, thus separating the satellites by just a few degrees. Normally, the antennas used are of very high
gain.

• The satellite body is designed to carry a number of transponders, or repeaters. The

number of transponders determines the capacity of a satellite. The INSAT series of satellites
(Launched by India) have typically 12/18 transponders in various frequency bands. The
bandwidth of a transponder is typically 40 MHz.
Satellites can be used in wide area networks, as they provide a highly reliable and high speed
communication link. As such, these properties appear to be highly suitable for telerobotic surgery wherein
the vast amount of data is required to be transmitted, but the inherent long propagation delay in satellite
communication, which could be unacceptable sometimes, limits its use for real-time operations

VERY SMALL APERTURE TERMINAL (VSAT)

• The easiest way to provide a satellite link for a telemedicine network is by using a VSAT. The term VSAT
refers to a small fixed Earth station. VSATs can support any communication requirement relating to
telemedicine such as voice, data, or videoconferencing

• The VSAT technology has revolutionized certain sectors like banking and stock broking by enabling
services that would have been nearly impossible earlier like ATM, screen based stock broking, credit card
authorisation, point-of-sale updates, order entry, claim processing, etc. VSATs have been used by many
players in the field of telemedicine as dedicated networks.

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 • concept of telemedicine implemented by ISRO. The project aims at connecting the district levels hospitals
and health centres with tertiary level and super specialty hospitals for providing expert consultation to
the underserved and needy population of the country.

VSAT based communication system

• Data from the computer/telephone is sent through a decoder to the VSAT antenna
on the building’s roof, from where it is beamed to the satellite. The satellite then beams it to the receiving VSAT
antenna, where it is decoded and received by the computer/telephone.
• Figure

Operation of VSAT in Telemedicine

VSAT comprises of two units; Outdoor and Indoor unit .

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At the outdoor unit, the (Radio Frequency Transceiver) is attached to the feed horn on the frame of the antenna,
where the size of the antenna determines the power of the signal and the received power of the antenna remains
constant given a higher amplitude of the antenna .
The RFT reduces the noise in the signal before passing it to the decoder. The feed horn, which is fixed on the focal
point of the antenna, directs power to and from the transponder to the VSAT antenna. They operate mostly in the
Ku-Band or sometimes, the C-Band with antenna size less than 3.4m in diameter and low power of 1-2 W. The
antenna gain is constant for a fixed area coverage.
At the VSAT indoor unit, the carrier signals are modulated with the user traffic signals by a set of modulators and
then transmitted to the RFT which amplifies and transmits it to the transponder. The received signals are divided
into the original traffic signal and carriers signal by the demodulators at the

Benefits of VSAT in Telemedicine

VSATs provide real time transmission media as required in telemedicine and are portable because of the very small
terminals. The cost of implementation is independent of the distance and volume of data and can provide 99.5-
99.9% availability in relation to the requirements [5]. VSAT option is much better than terrestrial communication in
terms of cost of wiring, availability of the network and installation. It is cheaper and easy to implement in rural
areas.
VSAT is capable of multiplexing video, voice and data on one connection [1].

VSAT is unaffected by natural disasters, geographical barriers and can be located anywhere, even in the middle of
the desert where satellite network is the only option.

VSAT does not provides a customized bandwidth depending on the requirement of the user.

Installation of VSAT takes less than a week and is cheaper in terms of time [1]. It is a scalable network, adding new
sites and reconfiguring existing ones takes only a few days.

The wide coverage and high availability of the network makes telemedicine an efficient way of medical access
which means if there are occurrences when telemedicine cannot be of aid to patients who require immediate
medical attention, it will be 0.1-0.5% of the time.

VSAT technology is also implemented in aircrafts and marine vessels, fulfilling the goals of telemedicine. Whereas,
it is almost impossible for terrestrial cabling to provide telemedicine service on sea and in air .

THE BENEFITS OF SATELLITE COMMUNICATION IN TELEMEDICINE

Satellite communication is the fastest wireless transmission considering the long distances that signals travel from
earth stations to space with little attenuation and can provide instant internet connection and high definition quality
video streaming in even the most remote locations eradicating the problems of unavailability to medical attention .
Patients in rural areas are more likely to seek medical care if they know it is cheap, safe and reliable . It allows for
telemedicine to be possible in local areas in a cost effective manner since the cost to implement satellite equipment
tools are decreasing constantly.

Data transmission rate is very important in telemedicine and can determine the survival of a sick patient especially
in emergency cases, to which satellite communication can provide it with the speed it needs in its functionality. This
saves a lot of time and money if the specialist needed to come and treat the patient personally because of a poor
speed internet access.

The availability of the satellite transmission is about 99.95% making it possible to for patients to receive medical
health care almost every time and any time of the year .
Satellites transmitting in the C-Band are very reliable and cannot be affected by rainfall, snow, or extremely terrible
conditions. Although, the case of mutual interference exists from terrestrial microwave users . There are now
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solutions that converge the Ku-Band and the C-Band frequency bands . With this, telemedicine using the satellite
does not have to be dependent on weather condition.

Aircrafts also have the access to telemedicine via satellite communication. Telephone lines and other means of
communication are not as reliable as the high broadband transmission speed providing video and data services
associated to satellite transmission. It is a much more reliable, faster and safer way of saving lives by giving
instructions to doctors on board to carry out on patients .
Telemedicine on sea is only possible with satellite connectivity by attaching telemedicine devices to satellite feeds
for communication between doctor on ship and the healthcare specialist away . This is a much safer way of travel
since travels on water can take months before arriving the destination. If a crew or passenger were to fall ill during
those months, immediate treatments would be impossible, and the ship might have to make a stop at a closer port for
the patient to get access to healthcare. This is time wasting and can cause the shipping corporations to lose millions
of money in the long run .
Satellite communication is a frequency spectrum efficient method of broadcasting and can cover about 5.2-6.7% of
the total land area in the world with a single range of frequency and 100 W transponder in the BSS (Business
Satellite Services) and FSS (Frequency Satellite Services) band. Implementing a satellite network in telemedicine
with an efficient spectrum which can cover wide areas optimizes the network and saves cost.

Satellite transmissions can provide bandwidth greater than the needs of telemedicine unlike regular telephone lines,
or digital subscriber lines .
Satellite technology e.g. VSAT technology is not only important in the rural areas but, also important on sea and in
air where only the satellite connectivity is possible. Oceans, mountains, deserts are not obstructions in satellite and
transmission.

Mobile Telemedicine Unit

The telecommunication equipment for MTU allows transmitting results of medical examinations to
hospitals and receives corresponding conclusions, recommendations and instructions, plus providing
national medical centers and MTU with videoconference services. The telecommunication equipment
for MTU can be used for training purposes to teach local population about healthy life style, methods of
caring for sick persons, various social and other issues.

The MTU is equipped with a fast deploying ground satellite station (GSS) intended for transfer and
receipt of digital information through the allocated communication networks using channels of the
geostationary satellite. The station provides for delivery of information from any location within the
area serviced by the satellite, to central or intermediary stations-nodes of the communication network.

The wagon is equipped with the following equipment:

• system for fixation of wagon position (turning to horizontal position);
• system for illuminating the wagon;
• system for heating the wagon (heater);
• system for wagon ventilation and air conditioning (air conditioner);
• system for air disinfection in the wagon (UF-radiators);
• system for autonomous energy supply;
• water supply system;
• sanitary arrangements (bio WC, shower);
• system for storing medicines, reagents, preparations and consumables;
• remote working places (collapsible tents, folding tables and chairs).
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The Mobile Telemedicine Unit
Basically the Mobile Telemedicine Unit consist of three blocks i.e. the medical devices that performs
measurement and acquisition of medical data/information including a set of video camera equipment;
the communication block , and a processing data unit.

• Figure 1: Mobile Telemedicine Unit

Medical devices block

Medical devices which are equipped in the unit may vary, according to the urgent medical services that
mostly demanded by the community within the area of interest. Each of medical devices is connected to
a Telemedicine Arbiter that functions as an interface between the equipments and the local PC.
Moreover, the telemedicine arbiter is also applied as a control unit for communication transaction to
local PC and the communication manager.

The Hospital Unit :

As shown in Figure 2, the Hospital Unit consists of a dedicated PC and a Communication Manager. The
PC is used for monitoring signals and data coming from the Telemedicine Unit. Incoming signals are
biosignals measured by medical devices within the Telemedicine Unit. Data may be in a various format,
and the data transaction is controlled by the Communication Manager.

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 Figure 2: Hospital / Doctor Unit

Medical equipment of MTU

The medical equipment of MTU allows conducting examinations necessary for effective
screening of population, including chest X-ray with the lowest possible exposure to x-ray
radiation, biochemical examinations and functional diagnostic.

The medical equipment includes:

• digital low-radiation fluorograph for examination of chest organs in a vertical position of a

patient;
• optical medical microscope for conducting parasitic, bactericidal, cytological and histological
analysis with digital module for input/output and image registration;
• functional diagnostic facilities (digital electrocardiograph);
• set of laboratory equipment for making preparations.
If separately agreed with the Customer, the medical equipment of MTU can be completed with
a wide range of optional medical equipment including remote equipment that has wireless
communication with the MTU.

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Mobile telemedicine station of emergency assistance

This is equipped with registration, data acquisition and imaging devices. There are autonomous tools of
satellite communications, autonomous power supply systems and “life-support system” providing
comfortable working conditions for personal in any climate. The station provides collection and
exchange of ES information and the delivery of the decisions and commands directly to liquidators of ES
consequences.

Small mobile telemedicine unit

This unit is equipped with transportable telemedicine terminal provided with the wireless
communications to the unit. It has autonomous tools of satellite communications and power supply
systems. This unite can be delivered by any transport mean to regional medical centers dedicated for
evacuation of injured. It provides efficient support to medical treatment and collection of data on the
state of patient.

INDIRECT QUESTIONS AND ANSWERS

1. Explain the features of the telecommunication options and also give an example of how the various
telecommunication technologies can be integrated into a healthcare network.

Answer: The 3 basic features of telecommunications

Terminals And Channels

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All telecommunications networks depend on terminals. They‟re the components that allow communications to stop
and start. It may help to think of a terminal as the place where a signal enters and leaves in order to facilitate
communications.

Telecommunications Processors
As you may already be aware, the information that passes through channels requires a lot of processing before it
reaches the end-user. Whether you‟re speaking to someone over the phone or sharing a file from one device to
another, processors need to convert the signals into a usable format.
In a lot of cases, this means moving from analog to digital and then back to analog again. The analog to digital
converter (ADC) receives information in analog and then continuously processes it so that it‟s sent back again as
digital. In the case of audio signals, information needs to be transformed from digital back to analog again before the
person receiving the audio can hear it.

Telecommunications Software
The information that passes through different telecommunications channels needs software to support it too. The
type of software you use will depend on your telecommunications of choice. For example, it‟s expected that there
will be 34 million VoIP users in the United States alone by the end of 2020. All those users need software to
facilitate their experience.

The various telecommunication technologies can be integrated into a healthcare network.

There is a wide variety of technologies and standards that can be used in the delivery of wireless e-healthcare
systems. Mobile electronic healthcare devices are rapidly changing the concept of healthcare delivery globally.
Particularly, cellular/smart phones are playing an important role in service delivery to patients. This consists of
utilizing various standards such as 3G/4G, WiFi, Bluetooth and WiMAX, in order to make patient data accessible in
multiple locations .

Suggest a peer-to-peer model to improve e-health interoperability. In order to facilitate the exchange of patient data
among different systems, interoperability is required. This increases the efficiency of ehealthcare by increasing the
speed of information retrieval, processing and delivery among caregivers. Also, this will increase the accessibility of
information for research purposes.

A metadata management framework for medical multimedia content including X-ray, ECG, MRI and ultrasound
images is also presented, producing identifiers for the medical multimedia content to facilitate efficient query
processing.

3G is a large-scale mobile telecommunication technology, enabling healthcare personnel to load vital patients‟
information anywhere and anytime within the healthcare network.

Wireless local area network is being used very often in many situations today as well as for communications
between medical devices. Wireless local area networks and cellular systems (2.5G, 3G and beyond 3G) integrated
into a flexible and heterogeneous network make m-health services more accessible and reliable for both fixed and
mobile m-health users in a wireless metropolitan area network environment.

Body sensor network describes the application of wearable computing devices. This will enable wireless
communication between several miniaturised body sensor units and a single body central unit worn at the human
body. With the combination of biosensors and wireless networks, medical personnel are able to pervasively monitor
patients‟ health, behaviours, physiological and contextual parameters at all times.

Because a centralised wired infrastructure is not required in ad hoc networks, many medical devices can
communicate with each other by routing traffic from source to destination through multiple hops. Thus, ad hoc
network is an alternative solution for emergency scenarios when either the existing communication system fails or
there are no basic infrastructures in rural remote areas.

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Wireless sensor network technology is considered as one of the most important research areas in computer networks
and e-healthcare application industries. In e-healthcare area, lots of medical applications are developed by working
through wireless sensor networks in order to improve existing healthcare and monitoring services especially for the
elderly and children.

HL7 is widely used for transferring clinical and administrative data between different units of a hospital or clinic.
This standard is utilised by various e-healthcare providers, and it functions on layer 7 in the Open Systems
Interconnection model, the application layer.

The former refers to the interconnected computer networks that span world wide, and the latter refers to the various
heterogeneous objects that are connected to this network. One of the core technologies used in IoT deployments for
healthcare environment is the radio-frequency identification.

IPv6 addressing and network management as part of the challenges faced in designing sensor networks for IoT.

2.. Classify the type of information used for telemedicine. Describe about the optimum methods used to acquire
and transmit them

Answer: i) Classify the type of information used for telemedicine.

The following type of information is generally required to be obtained and transmitted in telemedicine:
• Data: Non-medical patient data such as personal data, admission and discharge information, payments,
insurance status, disease history, status of physiological parameters such as blood pressure, pulse,
respiration rate, temperature.
• Audio: For medical diagnosis, some patient data is primarily acoustic, for example, auscultation of heart
sounds and sounds from respiratory movements.
• Still images: X-ray, CT, MRI images (radiology), skin images (dermatology), images of tissue and cellular
specimens (pathology).
• Video: Video images of the patient, echocardiography and videoconferencing.

Typical examples of telemedicine information

Source Type Typical file size
Patient notes Text < 10KB
Electronic stethoscope Audio 100 KB
Chest X-ray Still image 1 MB
Foetal ultrasound (30 s) Video 10 MB

Data, once captured, processed, and used for the health care of patients, should be expected to come in many forms,
such as text, voice, graphics, still and moving pictures, and colors. Use of processed data for patient care demands
standards that assure the reliablity and integrity of data while sending, receiving, storing, retrieving, and viewing as
well as manipulating it or using it in computational processes.
A concept of operations of a telemedicine system may be helpful for relating how different technologies transform
source data into forms and formats compatible with compression and decompression algorithms and
communications systems, and usable ultimately by health care providers.

In general, an image is a representation of an object, organ, or tissue made visible through physical and
computational processes. Images used in telemedicine applications are frequently reproductions of a clinical image
initially obtained using various modalities such as conventional projection X-rays, computed radiography (CR),
computed tomography (CT), nuclear medicine (NM), magnetic resonance imaging (MRI) or ultrasound (US).

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ii) The optimum methods used to acquire and transmit them

Peripherals
In order to transfer images over a distance, a digital video or still camera is needed for capturing, and for visualisation on a
screen. There are several different industrial standards for such devices depending on the purpose and image quality required by
such a device. The digital camera generally consists of three elements: lens, image sensor, and electronics for the image
processing, encoding, and transmission of the image. Simple camera models have a built-in single sensor to capture images. The
brightness of the image is automatically adjusted by the electronic circuit. Such cameras are often used for remotely controlling a
patient during surgery, for teleconsulting and to transfer images from the operating room to the classroom for students.
Today, the industry uses two types of image sensors for cameras: CCD (charge coupled device) or CMOS (complementary oxide
semiconductor). Both technologies have advantages and disadvantages regarding image quality. Image quality is usually
delivered by a resolution image, which is expressed in pixels. Examples of standard image sizes are: 320x240, 640x480,
720x576, 720x480, 1440x720, and 1920x1080. Some high-end still-camera models can capture at a resolution of 8984x6732
pixels.
Compression reduces the number of bits used to represent each pixel in the image. Codec‟s (compression/ decompression
algorithm) is used for the compression process. Some of the more frequently used video codec‟s today are DV, MPEG1, MPEG2,
MPEG4, DIVIX, and others. The goal of compression is clear: how to reduce the data amount as much as possible in order to
keep the image/sound quality as high as possible.

Telephone lines are one of the media through which we can transmit video signals, but with some limitations. Data transfer is
limited by the so-called bandwidth. The transfer of video via telephone links initially allowed a theoretical bandwidth rate of 56
kbit/s, and 128 kbit/s later for ISDN. Video transmission was limited to low-resolution image. The standard defines the screen
sizes of the Common Intermediate Format (CIF) 352x288, and Quarter CIF (QCIF) to be of 176x144 pixels. Technology allows
for the transferring of high-quality video and audio data over extremely short delay times (latency).

Very small aperture satellite antenna offer one or two way connection links to the internet. In India this service is offered by the
ISRO VAT satellite. This service includes point-to-point (fixed or portable stations), point-to-multipoint (star configuration), and
meshed networks.

The next alternative to fixed lines is to use wireless communication, through cellular networks covering large territories. Mobile
networks have a long way to go before achieving a fixed wired transmission capacity, but they have two advantages mobility, and
availability. The second-generation digital phones were limited to about 14 kbit/s data rate. The third-generation (3G) offers a
theoretical data rate up to 2.4 Mbit/s. In both Europe and the wider world these is great anticipation about the introduction next-
generation networks (NGN), including the important place occupied by the next-generation of mobile networks (NGMN).

The switchover from analogue to digital terrestrial TV will free-up an unprecedented amount of spectrum in the 800 MHz field –
the Digital Dividend. Allocating some of the Digital Dividend spectrum to mobile broadband will allow mobile operators to
provide broadband services to everyone, even in rural areas.

International Mobile Telecommunications (IMT) includes a set of standards for a variety of multimedia mobile networks (EDGE,
UMTS, DECT, WiMAX). Different standards (HSDPA, HSUPA, HSP+, LTE) allowing for transfer speeds up to 50 Mbs. For the
fourth-generation network, ITU requires download transmission speeds of up to 1 Gbit/s.

Transmission of voice and video signals

Video compression

Audio, video, and image signals require a vast amount of data for their representation. There are many reasons why the data must
be compressed, such as large storage requirements, slow storage (playback in real time), and because of the network bandwidth
(bottleneck) .

Compression reduces the number of bits used to represent each pixel in the image. The compression system exploits the
mechanisms of human visual perception to remove redundant information, but still produces a compelling viewing experience. A
video is a sequence of picture frames, usually 24 fps (film industry), 25 pfs (PAL video system) or 30 fps (NTSC video system).
The most used compressing format for stills is JPEG, it is a lossy format based on technique called the discrete cosine transform
(DCT).

Streaming the video over internet

The first task of the internet was delivering only data. The first audio and video applications used the Internet only as media for
file transfer. A computer needed to download the complete file to the disk before it could play them. As soon as the slow analog

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telephone connections were replaced with xDSL, and with higher data transfer speeds, the delivery of multimedia files
(especially video) in real-time over IP became a reality. Streaming technology now allows playing of audio and video files
immediately after being transmitted on the internet, in real-time. The User Database Protocol (UDP) instead of Transmission
Control Protocol (TCP) is used for streaming technologies. The difference between the two protocols is how they check for
errors. Streaming needs a transmission protocol that can ignore data errors.
One of the first applications used the real-time was video-conferencing. Video conferencing codecs started with H.261 followed
by H.263 codecs and the latest advanced video codecs H.264.
The time latency (propagation delay of audio and video signals) is an important factor in video-conferencing, especially in
telemedicine. A webcasting system uses the same real-time protocols, where the latency of some seconds doesn‟t play a role.
Another way to distribute audio and video files over IP is on-demand. The audio and video content is streamed on-demand
whenever a client seeks for the content.

The streaming procedure can be realized in four steps:

Microphone, Video camera: audio and video capture and encoding (compression)
Server: storage and streaming
IP Network: distribution
Computer on site: Media player plays the content

3. What is population aging and how can mHealth help in addressing its challenges? i. What are the main
challenges to wider mHealth adoption associated with technology design and how can designers address these
issues? ii. Outline the steps to create an Android App. Write the coding to perform a button action

Answer: Population aging and mHealth help in addressing its challenges

Population aging—the increase of the share of older individuals in a society due to fertility declines and
rising life expectancy—is an irreversible global trend with far-reaching economic and socio-political
consequences. Population aging will likely lead to declining labor forces, lower fertility, and an increase
in the age dependency ratio, the ratio of working-age to old-age individuals.

Using the mHealth technology alongside medical prescriptions, we can improve physical activity levels,
normalize BMIs and change inactive and sedentary behavior in the elderly population .

The mHealth technology can help change and develop health behaviors (increased consumption of fruits and
vegetables, stress management, reduced consumption of salt and improved quality of diet and sleep) and
improve self-efficacy in elderly individuals with chronic disease (cognitive disorders & Alzheimer’s, heart
disease and susceptibility to metabolic risk & diabetes) through text messages, voice messages, voice calls
and game-based mobile applications.

The mHealth technology can play the role of a reminder, which is a good strategy for adherence to treatment,
improved care for diabetic foot ulcers and in-house clinical measurements .

To present reliable, authentic and practical information relating mHealth services that can lead to improved
health levels and healthy lifestyles, sampling is better done among individuals with similar physical, functional
and psychological conditions, age-groups, cultural characteristics, incomes and places of residence (city, rural,
etc.

The main challenges to wider mHealth adoption associated with technology design and how can designers address
these issues

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The challenge of the traditional approach for digital health Developers

1. Compliance & regulations issues

One of the biggest mHealth app challenges is following compliances.
USA – If you are launching an app for the US region, you will have to comply with the HIPAA and PHI regulations.
In addition to these, you should also concentrate on the CCPA, NIST, and GDPR rules.
Canada – mHealth apps made for the Canadian region have to follow PIPEDA guidelines.
The United Kingdom – The healthcare app developers of the region should follow the guidelines mentioned in
the NSCS website

2. Presence of multiple devices

With a number of new channels and devices entering the healthcare space – Smart TVs, Smartphones, Voice-
powered devices, etc. interoperability continues to be a big problem for the sector. Noting the growth in the number
of active devices that patients and doctors interact with it has become very difficult and yet crucial to ensure
complete security across platforms.
3. Lack of security
There are millions of horror stories around patients‟ data getting hacked or getting misplaced because of un-secure
storage infrastructure.

The coding to perform a button action

Button is a subclass of TextView class and compound button is the subclass of Button class. On a button we can
perform different actions or events like click event, pressed event, touch event etc.
Android buttons are GUI components which are sensible to taps (clicks) by the user. When the user taps/clicks on
button in an Android app, the app can respond to the click/tap.

<Button
android:id="@+id/simpleButton"
android:layout_width="wrap_content"
android:layout_height="wrap_content"
android:text=" Android"/>
Button button = (Button) findViewById(R.id.simpleButton);
button.setText("Learn Android @ AbhiAndroid");//set the text on button

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