1. Developing a Practical Wearable Telemedicine System for Emergency and Mobile Medicine Martin Dudziak, PhD Tamara Koval, MD Medical College of Virginia and Silicon Dominion Computing, Inc. November 22, 1998

2. 2 Presentation Outline Mobile Telemedicine –Issues and Motivations Requirements and Demands Mobile Wearable PCs TransPAC and MediLink Methods for Testing and Evaluation

3. 3 Issues and Motivations for Mobile Telemedicine Increased mobility of general population Decreased centralization of health services Expansion of electronic medical records Increased use of imaging and video Need for more remote/home health care Increased role of assistant-level staff

4. 4 Effective Mobile Medical Communications : Requirements Convenient Common Standards Interoperability Upgradeable Customizable Interchangeable Secure

5. 5 Mobile Wearable PCs for Patient Data Access and Acquisition Evolution in Computing Platforms Maturation in Telecommunications Advances in Data Compression Availability and Readiness of Data Advances in Security, Power, and Storage

6. 6 Three Examples

7. 7 Pros and Cons of the Wearable PC Full PC features, compatibility Lightweight, convenient to carry Speech, pen, keyboard, mouse inputs Internet-capable; large memory, storage capacity Expensive Dangling wires and parts Hardware and speech quirks Not user-friendly for general population

8. 8 Current and Projected Medical Enterprise Data Systems Practical speech, smart card, video, intranet functionality Adaptable Ergonomic Wearable PC TransPAC with MediLink TransPAC Alternative Integrated Approach

9. 9 A Systems Engineering Approach to Telemedicine Mobile network emphasizing seamless communication for data and voice Medical process and flow continuity: Enhance, do NOT disrupt Adapting to institutional data management and “IT” structures, not demanding alternatives Requirements  Specifications  Design  RAP / RAD  Implementation

10. 10 Modular and wearable PC (Windows95/98) High-end graphics and video features and extensibility (128MB+, 200MHz+, 2 GB+) Speaker-independent and speaker-custom speech recognition Wireless Internet modem Direct link with image and database servers Smart card for access and transaction registry TransPAC Mobile Computing Platform

11. 11 Beltpack or Bodypack Carrying Unit CRT or LCD Display Base System Unit Extension Pack Microphone Headphones Cell Phone Wireless Modem Battery Pack AC Power Adapter Kbd / Mouse RS232 Data Acquisition Device(s) Parallel Data Acquisition Device(s) PCMCIA Data Acq Device(s) CD/DVD/Tape Unit

12. 12 Testing/Engineering/Maintenance System Databases (typical scenario: ModelServer Discovery with connectivity to Oracle databases) Field Office/ Lab PC (Base Station) Card Reader Active Session Card 1 2 Task dataset loaded onto Active Session Card in Base Station PC Wearable PC with CardReader built-in or as plug-in (PCMCIA interface) Active Session Card 3 In-field data collection process; data processed on PC and stored on Active Session Card 4 Work completed and Active Session Card time-stamped and ready for upload through BASE station 5 Voice input Internet access Camera or video (MAGVISION) Keyboard/ mouse/pen input GPS Active Session Card 6 Active Session Card returned to Base Station PC for upload TransPAC Function and Data Flow

13. 13 TransPAC Internal Data Model

14. 14 Patient-oriented application session and auto- managed files and folders Freeform Writing Pad with graphic and video options (cut-and-paste and links) Patient-oriented distributed database access protocol BodyMap graphic interface for patient records Standard internet browser functions Multimedia data acquisition & imaging functions MediLink Key Features

15. 15 MediLink Application

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17. 17 newsession folder new_session.htm header file jgsmythe-243-67-9631 folder jgsmythe-243-67- 9631.htm header file Enter new patient basic data jgsmythe-243-67-9631 folder jgsmythe-243-67- 9631.htm header file Download from server, enter notes, drawings, capture video, EKG, other data Store on server, session card, hard drive SESSION DATA FLOW

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19. 19 On-Board Interactive Assistance Speech-to-Text-to-Database Customized speaker-independent vocabularies for command, control, entry Patient record pointers eliminate searching, keystrokes, commands Image comparison and differentiation tool for real-time image analysis

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21. 21 Wireless Intranets

22. 22 Wavelet-Based Image Compression Fetal faceUltrasound 72K 50:1, 7K 125:1, 2K Huntington’s MRI+SPECT overlay 44K 100:1, 7K 200:1, 4K

23. 23 Adaptive Pattern Recognition - Like Humans Do It

24. 24 Another Example - Cutting Through the Noise

25. 25 Acknowledgements Slava Vaseken, Silicon Dominion –TransPAC Design Team Interactive Solutions, Inc. Bentley Systems, Inc.