How to achieve the full potential of telemedicine

Telemedicine — which is defined for this article as the use of videoconference capabilities to bring together clinicians and patients, regardless of geography — provides a powerful solution to help healthcare organizations contain costs and deliver quality care. Mobile computing workstations play a key role in the success of telehealth programs by enabling clinicians to bring the technology to a patient at the point of care while connecting him or her to a clinician at a different location.

Building a telehealth workstation with enhanced mobility and a reliable design that supports the specific applications clinicians need remains a major challenge. Explored in depth below, these issues include: power system options, energy efficiency of videoconferencing components, wireless LAN connectivity, form factor, image quality and monitor size.

Power system options
For mobile systems, power is a major consideration. From a system design approach, it is critical that the on-board power is compatible with the different components on the workstation to provide the clinician with sufficient “unplugged” run time at the point of care.

Current battery chemistries for mobile applications include sealed lead acid (SLA), nickel metal hydride (NiMH) and lithium nanophosphate (LiNano). Each has different capabilities and cost. The SLA battery, for example, has a low initial cost but low energy density, which means a heavy power supply is necessary to provide the required mobile power. Performance of SLA also degrades rapidly over its 300-cycle life. By contrast, the NiMH battery has a moderate initial cost, almost twice the energy density of SLA, and has a consistent performance over 90 percent of its 1,000-cycle life. The LiNano battery has a moderate initial cost, more than three times the energy density of SLA, and provides a consistent performance over more than 3,000 cycles.

When designing videoconference hardware codecs, most vendors are designing for room or desktop systems without consideration for mobility or power consumption.

Understanding the characteristics of these batteries can be used to accomplish different goals. The needs for each mobile telehealth workstation must be carefully evaluated in order to select the right battery chemistry for its purpose.

Energy efficiency of videoconferencing components
When designing videoconference hardware codecs, most vendors are designing for room or desktop systems without consideration for mobility or power consumption. Codecs designed for mobility should be designed from the ground up, with power efficiency at the forefront of design rather than viewed as an afterthought. Just as laptops are designed for mobility and power efficiency, videoconferencing components should be designed for mobile applications. Input power to the codec, for example, should be DC voltage and not AC. If a codec has AC power input, the mobile workstation would require an AC inverter. This adds an extra power conversion step, costing between 5 and 15 percent in power efficiency. Designing the codec for wide-input DC voltage adds to the efficiency of the device and eliminates a DC-to-DC converter for regulated DC voltage. These are relatively feasible adjustments when considered and incorporated at the design phase.

Wireless LAN connectivity
In order to achieve true mobility at the point of care, a mobile telehealth system should be wireless. Although currently available hardware codecs offer only wired network connectivity, a wireless client bridge can be utilized until wireless LAN becomes part of the basic design of a mobile codec. Enterprise-class wireless LAN security and roaming capability are key considerations when choosing a client bridge. In addition, ensuring that a mobile telehealth workstation is compatible for wireless in some fashion is vital to enabling proper care.

Image quality/monitor size
Unlike room or desktop systems that require large monitors to enhance the image quality and teleconference experience, mobile telehealth systems do not necessarily require large, high-end monitors. Appropriate video conferencing gear for the mobile telehealth workstation — notwithstanding available bandwidth — is the key to delivering a desired quality image at the consulting clinician side. This is where a high-quality image may be desired or even necessary. For the mobile computing workstation, a 22-inch monitor is more than adequate for delivering the image quality required at the patient side, without breaking the mobile power budget.

Form factor
When considering a telehealth solution, size, footprint and weight of the workstation are just as important for delivering enhanced, efficient patient care as the aforementioned factors. Because space is often limited within patient rooms, a small-form-factor telehealth workstation makes it easy for clinicians to work around or maneuver the workstation. In fact, when all of the above criteria are taken into consideration, the result is a small, maneuverable workstation that delivers quality, efficient telehealth at the point of care.

Summary
From a system design approach, a mobile telehealth workstation should have the right battery chemistry, efficient teleconference equipment, wireless connectivity, proper size monitor and small form factor. Above all, the workstation should be intuitive to use and reliable. Only then will clinicians be able to devote their full attention to the most important task at hand: taking care of the patient.

Through a system design approach, healthcare organizations can achieve the full potential of telemedicine by improving patient outcomes while containing costs and increasing overall
clinician efficiency.                       

The article represents views of the author and not necessarily those of InterMetro Industries (Metro)

Fouad Abu-Akel is director of global applications development, Metro.
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