1. International Telecommunication Union Workshop on Standardization in E-health Geneva, 23-25 May 2003 APT second opinion center Prof. Kiyoshi Kurokawa, M.D.,MACP. Tokai University Institute of Medical Sciences

2. ITU-T 2 23-25 May 2003 Workshop on Standardization in E-health APT Telemedicine Workshop 2002 Jakarta Core members of ATP Telemedicine Workshop 2002

3. ITU-T 3 23-25 May 2003 Workshop on Standardization in E-health Who we are ! ITU ( International Telecommunication Union Tokai University Institute of Medical Sciences is the first Sector Member from health-medical field. Our activities in ITU 1. SG-2 Question 14/2 (Telemedicine & E-Health) Rapporteur: Prof.L. Androchko Int. Univ. In Geneva, Prof. of Tokai Univ. Co-Rapporteur: Prof. I. Nakajima (Tokai Univ.) 2. SG-2 Question 10/2 (Rural communications) Rapporteur: Mr. Y. Kawasumi (Japan Telecom Co. Ltd., Prof. of Tokai Univ.) 3. Telemedicine Expert Training Course 4. The Second Opinion Center (APT & ITU )

4. ITU-T 4 23-25 May 2003 Workshop on Standardization in E-health ITU Telemedicine Expert Training Course Tokai University The Telemedicine Expert Training Course, jointly launched by the ITU/BDT and Tokai University in Japan, offers an excellent opportunity for medical and health care workers from developing countries to understand the current trends and technologies in telemedicine and e-health. It provides the foundation to introduce telemedicine in developing countries. Tokai University Shonan Campus Hiratsuka Kanagawa Japan Tokai University Hospital Isehara Kanagawa Japan http://www.tsj.gr.jp/tsj/tumri/nakajima/index.htm

5. ITU-T 5 23-25 May 2003 Workshop on Standardization in E-health Ambulance communications via Quasi Zenith Satellite

6. ITU-T 6 23-25 May 2003 Workshop on Standardization in E-health Medical knowledge that lends itself to being stored in computer files (digital format); People who are willing to share, apply and use this knowledge; Data processing equipment to record, store and process this data; Telecommunication facilities to transfer (exchange) this data electronically between remote locations. Four essential components make the e-health E-Health components

7. ITU-T 7 23-25 May 2003 Workshop on Standardization in E-health Classification of Telemedicine

8. ITU-T 8 23-25 May 2003 Workshop on Standardization in E-health Ratio of the elderly > 65 y.o.

9. ITU-T 9 23-25 May 2003 Workshop on Standardization in E-health TeleHomecare We have developed an inexpensive ECG data-transmission system to ease the provision of homecare. Connected to an IP-based wireless WAN for operation, this system is capable of automatically detecting arrhythmia in a patient residing at home and automatically sending the ECG data to the homecare service center.

10. ITU-T 23-25 May 2003 Workshop on Standardization in E-health Wireless IP Network for Telehomecare RGW2400/ID antenna Home Power Module VoIP PC IP ECG Ethernet ECG Monitor Clinic RGW2400/ID antenna VoIP PC Ethernet 12 Lead ECG FTTH CATV DSL RGW2400/OD antenna Hospital VoIP PC Router Ethernet Specialist IP-ECG SYSTEM Tele-Homecare Patients are able to be examined at their home by the physician. Second Opinion Physicians can request the consultative opinion from the specialist. Second Opinion Tele-Homecare ECG Transmitter THE INTERNET Tokai University http://www.u-tokai.ac.jp / ROOT Inc. http://www.root-hq.com

11. ITU-T 11 23-25 May 2003 Workshop on Standardization in E-health Block Diagram

12. ITU-T 12 23-25 May 2003 Workshop on Standardization in E-health Arrhythmia detection IP-ECG with DFT 1. SPVC; Supraventricular Premature Contraction 2. VPC; Ventricular Premature Contraction 3. Multifocal VPC 4. Short-run type VPC 5. R on T VPC

13. ITU-T 13 23-25 May 2003 Workshop on Standardization in E-health Outline of the East Bhutan Tele-ECG Project

14. ITU-T 14 23-25 May 2003 Workshop on Standardization in E-health

15. ITU-T 15 23-25 May 2003 Workshop on Standardization in E-health Training to doctors and nurses in Bhutan how to use ECG, cardio echo-graphy, and telemedicine system via Internet.

16. ITU-T 16 23-25 May 2003 Workshop on Standardization in E-health ECG display on Computer

17. ITU-T 17 23-25 May 2003 Workshop on Standardization in E-health APT Second Opinion Center hosted at Tokai Univ. ( expected Indonesia, India near future) 1. Web based consultation 2. Free of consultation charge 3. Open for APT Member State 4. Design of a standard model

18. ITU-T 18 23-25 May 2003 Workshop on Standardization in E-health Realtime comm. or store and forward data comm. for the SOC

19. ITU-T 19 23-25 May 2003 Workshop on Standardization in E-health Problem of Real time communications for the SOC 1) Running cost High costs, difficult to keep self-sustainable operation 2) Scheduling Inconvenience of use for both providers

20. ITU-T 20 23-25 May 2003 Workshop on Standardization in E-health Store and forward data communications 1) Data collection On line, Off line 2) Systems Web based, E-mail style 3) Reporting

21. ITU-T 21 23-25 May 2003 Workshop on Standardization in E-health IP-Telephony One of a solution to reduce running cost

22. ITU-T 22 23-25 May 2003 Workshop on Standardization in E-health Conclusion 1. APT Second Opinion Center(SOC) hosted at Tokai University has been started linking with Internet. 2. A standard model for the SOC is recommended to perform smooth operation to cover all Member States, and shall install another standard SOCs in developing countries to obtain self- sustainable operation.

23. ITU-T 23 23-25 May 2003 Workshop on Standardization in E-health Thank you ! Prof. Kiyoshi Kurokawa, MD, MACP The president of APT Telemedicine Workshop Prof. K. Kurokawa http://www.kiyoshikurokawa.com Telemedicine Society of Japan http://www.tsj/gr/jp E-mail to APT SOC: js2hb@tsj.gr.jp