International Journal of Emerging Technology and Advanced Engineering Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 10, October 2012)

Wireless Applications of Telemedicine Network for public Health in Bangladesh Md.Tarek-Uz-Zaman1, Delower Hossain2, Md. Bodiuzzaman3, Md. Mehedi Jowbaied Jaman Anu4, Dr. A.K.M Fazlul Haque5 1,2,3,4,5

Department of Electronics & Telecommunication Engineering, Daffodil International University, Dhaka, Bangladesh This application is very efficient since patient records, stored electronically, can be made available through the Internet. Pathological reports, images and video transmitted as part of a computerized file and also it will be stored electronically so, the need for physical storage can be eliminated. Records can be accessed any time anywhere and also in real time. This will greatly enhance the chances of correct diagnosis of a particular illness and possible suggest courses of treatment. Health information of the patient, collected in digitized form, can be easily transmitted without requiring his / her physical presence for the examination. The support of video conferencing through the Internet allows a health care professional to observe and interact with the patient who is not in the same physical location. Patient records, lab results and images from detailed examinations can be stored in computer file format, making them easier to search and transfer to distant locations when needed. Most of the works focused the application of telecommunication technology to health care and necessity of telemedicine in Bangladesh. The major areas of our project are tele-consultation, tele-monitoring, tele-diagnosis, tele-support, tele-treatment, tele-education and tele training. We attempts to narrow the gap underlying urban and rural counterparts, in term of quality health care.

Abstract— In this project, a new method has been proposed to decrease the centralization of Bangladeshi’s public health care service by using the developments of telemedicine and the wireless networks implementations. This model presents a medical data access system that can be used to exchange medical data between medical centers and a remote patient, which ensures the specialty care in small towns, rural locations or in a moving vehicle. The main purpose is to enhance health care delivery to a remote patient in real time through the Internet. To exchange patients pathological reports, audio and video from any different geographical locations a domain and hosting entitled ‘www.telehealthcarebd.com’ has been developed. In this project, signal quality for audio and video has also been analysis in moving vehicle facing different speed and obstacle. Keywords— Telemedicine, Live Streaming, CINR, RSSI

I. INTRODUCTION Telemedicine is the advancements of telecommunication technology for the provision of clinical care at a distance. Wireless telemedicine is a new and evolving area in telemedical and telecare systems. Healthcare personnel require real time access to accurate patient data, including clinical histories, treatments, medication, tests, laboratory results and insurance information. With large-scale wireless networks and mobile computing solutions, such as cellular 3G, Wi-Fi mesh and WiMAX, healthcare personal can tap into vital information anywhere and at any time within the healthcare networks. Doctors can get the health status of their patients, if patients away from the central hospital. Telemedicine technology supports the transfer of pathological and imaging reports of patients across the telemedicine networks, so specialists can provide consultation from any different geographically locations.

II. BACKGROUND The first test of telemedicine in Norway for example, took place in 1922, when the Sahlgrenska Medical center started to give medical guidance to ill and damaged mariners via stations. Physicians offering tips on analysis or treatment of conditions through paper content or through stations and TV programming has also been used. But today telemedicine is not recognized in this simple type.

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International Journal of Emerging Technology and Advanced Engineering Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 10, October 2012) It does now mean a more entertaining and more innovative in the use of new interaction technological innovation. The Nationwide Aeronautics and Area Management (NASA) performed a significant aspect in the beginning development of telemedicine. NASA’s effort in telemedicine started in the beginning Sixties when people started traveling wide. Researcher at NASA confirmed successful that health professionals in the world could observe the physical operate of an astronaut. Other beginning telemedicine tests were based on the use of television. A patient-physician telemedicine system was established in 1957, as aspect of a tele-psychiatry and medical knowledge program in Omaha holder, Nebraska. From its start, progression of telemedicine was produced by the need to provide medical analysis for sufferers in distant places, who cannot travel. Its main concentrate was regional range. Lately, cost discount rates and difficulty of visiting have become more key elements of its progression. Telemedicine does not seem to have a lengthy registered historical past in Ethiopia. The Ethiopian Telephony Companies (ETC) acknowledged telemedicine as one of its solutions only in May 1997, and structured a Department within its rankings to deal with this assistance. However the Staff of Remedies (FoM), at the Addis Ababa School, had attempted to make attention about telemedicine and its advantages using catalogues. To synchronize telemedicine relevant initiatives in the nation, there was a need to type a nationwide panel consisting of associates from worried govt organizations. In Feb 1998, associates from ETC, FoM and Secretary of state for Wellness (MoH) founded a National Telemedicine Managing Committee (NTCC) [4].

Fig 3.1.a: Proposed architecture of telemedicine system.

3.2 Video Streaming In this project, live video streaming method has been used for video transmission (real time patient’s condition). It has been done by Web domain & hosting, Web design and Video streaming software. A platform (www.telehealthcarebd.com) has been designed with the help of HTML via Dreamweaver for transmitting the condition of patients by live video streaming through Internet. Now patient’s information (pathological reports, voice and images) can be uploaded in our website and also it is possible to transmit in real time. Hence doctor(s) can get the reports in any time or in real time when he / she want or need from anywhere.

III. SIMULATIONS AND RESULTS 3.1 Proposed Architecture In a mobile station or moving vehicle audio, video signals, and physiological signals such as ECG and blood pressure are obtained from the patient. These signals are transmitted to a fixed station via internet. In the fixed station, the signals received and presented to a medical doctor, or processed in an automatic monitoring system. Instructions from the doctor are then transmitted back to the mobile station through the internet link. Fixed station has its own domain and hosting which provides the facilities of audio, video and patient pathological reports transmission.

3.3 Ustream For video streaming, software has been used powered by Ustream. It is a website which consists of a network of diverse channels providing a platform for life casting and live video streaming of events online. Ustream allows users to broadcast from the Web site once logged in or from a mobile device using Ustream's mobile broadcasting application. Users can watch streams live on the Web site and on the Ustream iPhone and Android applications. The Web site allows users to interact, such as vote in polls, rate, chat, and so on.

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International Journal of Emerging Technology and Advanced Engineering Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 10, October 2012) 3.4 Analysis 3.4.1 Patient Status

3.4.2 Video streaming analysis at indoor

Fig 3.4.1.a: Snap shot of pathological report. Fig 3.4.2.a: Snap shot of video streaming at home.

Pathological reports can be uploaded in the predefined patient profile of our website and also doctors can provide their suggestion at the same time. A screen shot shown in the Fig 3.4.1.b

For the purpose of analysis, (Fig 3.4.2.a) snap shot of the video streaming has been taken at home environment to observe the condition of video signal. In this case the value of Carrier to Interface + Noise ratio (CINR) has been observed 32 dB. The standard value of CINR for 1Mbps wireless internet is 15+ (dB) and it is best around 40 dB. The value of CINR less than 15 dB is not enough to transmit video signal as well as any other internet service. The value of receive signal strength indicator has been observed -47 dBm. Standard value of receive signal strength is-65 dBm. 3.4.3 Video streaming analysis in moving vehicle

Fig 3.4.1.b: Snap shot of ECG signal in Matlab.

For ECG signal it is possible to transmit in real time through our website. We have been generated this ECG signal in offline using Matlab. From transmitting end this signal can be broadcast in two forms. One is store and forward where pre-recorded signal is uploaded in our server via the website and when required it can be download. Another form is in real time where ECG signal is broadcast from transmitting end and doctor observes at the same time in receiving end without storing this signal depicts in the Fig 3.5.1.b

Fig 3.4.3.a Snap shot of video streaming in a moving vehicle

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International Journal of Emerging Technology and Advanced Engineering Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 10, October 2012) The snap shot of the video streaming (shown in fig 3.4.3.a) has been taken from moving vehicle to observe the condition of video signal. It has been done to understand what will be the condition of receive video data of a patient carried by an ambulance from remote area. In this case the value of Carrier to Interface + Noise ratio (CINR) has been observed 28 dB. The standard value of CINR for 1Mps wireless internet is 15+ (dB) and it is best around 40 dB. The value of CINR less than 15 dB is not enough to transmit video signal as well as any other internet service. The value of receive signal strength indicator has been observed -55 dBm. Standard value of receive signal strength is -65 dBm.

3.4.5 Video streaming analysis in a moving vehicle under the flyover.

3.4.4 Video streaming analysis in open area

Fig 3.4.5.a Snap shot of video streaming in a moving vehicle under the flyover.

The snap shot of the video streaming (shown in fig 3.4.5.a) has been taken from moving vehicle to observe the condition of video signal. It has been done to understand what will be the condition of receive video data of a patient carried by an ambulance from remote area under the flyover. In this case the value of Carrier to Interface + Noise ratio (CINR) has been observed 21 dB. The standard value of CINR for 1Mps wireless internet is 15+ (dB) and it is best around 40 dB. The value of CINR less than 15 dB is not enough to transmit video signal as well as any other internet service. The value of receive signal strength indicator has been observed -48 dBm. Standard value of receive signal strength is -65 dBm.

Fig 3.4.4.a Snap shot of video streaming at in open space.

3.4.6 Analysis value of video streaming at different position

The snap shot of the video streaming (shown in Fig 3.4.4.a) has been taken from an open area where wireless modem get maximum signal from BTS. In this case the value of Carrier to Interface + Noise ratio (CINR) has been observed 40 dB. The standard value of CINR for 1Mps wireless internet is 15+ (dB) and it is best around 40 dB. The value of CINR less than 15 dB is not enough to transmit video signal as well as any other internet service. The value of receive signal strength indicator has been observed -40 dBm. Standard value of receive signal strength is -65 dBm.

Fig 3.4.6.a: Analysis value of video streaming at different position

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International Journal of Emerging Technology and Advanced Engineering Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 10, October 2012) 3.4.7 Standard value of Receive Signal Strength Indicator

3.4.9 Standard value of Receive Signal Strength Indicator

Fig 3.4.9.a: Standard value of Receive Signal Strength Indicator in Excel.

In above graph the curve represent a reference value of RSSI of Wi-max modem (Banglalion wi-max internet). Where X axis is distance from the BS (Base Station) in kilometer whereas Y axis is RSSI in dBm. A formula has been used for calculating RSSI, RSSI = R=-62.5-(26.5*log10(r)) Where r is distance from the base station. If the transmitting end goes away from the base station then the internet connection would be disconnected. Because of Banglalion wi-max base station can support maximum 1.6 kilometer coverage area.

Fig 3.4.7.a: Standard value of Receive Signal Strength Indicator in Matlab.

This figure is created to represent the Receive Signal Strength Indicator reference value with help of the following equation by using Matlab. RSSI= -62.5-(26.5*log10(r)) Where, r = distance from base station 3.4.8 Scatter value of Receive Signal Strength Indicator

3.4.10 Scatter value of Receive Signal Strength in Excel

Fig 3.4.10.a: Scatter value of Receive Signal Strength in Excel.

Fig 3.4.8.a: Scatter value of Receive Signal Strength Indicator in Matlab.

This figure is the scatter representation of experimental data from different critical place with unknown distance from base station. The value of RSSI is not same in different place, so it is difficult to hold the internet connection and it can be disconnected any moment.

This figure is created to represent the Receive Signal Strength Indicator reference value with help of the following equation by using experimental data.

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International Journal of Emerging Technology and Advanced Engineering Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 10, October 2012) 3.4.11 Values of CINR in different position

This is the tracing visualization of CINR in Dhaka to find the variation of CINR value.In the open space better CINR has been found but in the higher populated area the CINR becomes small (in the ground position). 3.4.13 Visualization of RSSI Dhaka Bangladesh

Fig 3.4.11.a: Values of Carrier Interference + Noise Ratio in different position.

CINR is the quality measurement of the signal in dB. The higher value of CINR needed for betterment of bandwidth to steaming or file uploading purpose in the internet. This figure is representing the value of CINR in different places (mainly in street). The highest value is 40 dB found on the obstacle free area in stable condition. The beginning of moving state contains higher value of CINR but after few seconds it falling down (state 5, 6 & 7). In the flyover the value of CINR is not so good but it can hold the connection to the internet. But under the flyover or besides the taller building or structure on the street CINR becomes very poor and having a risk of disconnection. 3.4.12 Visualization of CINR Dhaka Bangladesh

Fig 3.4.13.a: Visualization of Receive Signal Strength Indicator in Dhaka.

This is also a visualizing figure which contains the tracking value of RSSI. Different color represents the quality of RSSI [6]. In this project work, all the analytical values have been taken considering the Banglalion 1Mbps Wimax modem. Finally experimental values reveal that quality of the receive signal through internet (video, audio, image and pathological reports) depends on the modem signal quality which will be best within the range of + 15 to + 40 dB (Signal to Noise Ratio) and Receive Signal Strength Indicator approximately -65. For better result of audiovideo transmission 2.5 Mbps or higher bandwidth is required. Without this requirement it cannot possible for live video streaming for treatment in moving state.

Fig 3.4.12.a: Visualization of Carrier Interference + Noise Ratio in Dhaka.

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International Journal of Emerging Technology and Advanced Engineering Website: www.ijetae.com (ISSN 2250-2459, Volume 2, Issue 10, October 2012) IV. CONCLUSION

REFERENCES [1 ] Mohammad Shafiqul Islam and Mohammad Woli Ullah, “People’s Participation in Health Services: A Study of Bangladesh’s Rural Health Complex”, Bangladesh development research working paper series 7, June 2009, Page(s):1-6. [2 ] Telemedicine healing touch through space, “Enabling Specialty Health Care to the Rural and Remote Population of India”, Indian space research organization, publications and public relations unit, ISRO Headquarters, Bangalore-560094, Page(s): 3-5. [3 ] Rudeep Piya, “Scope and Challenges of Telemedicine in NEPAL: A Look Towards Future”, a case study at OM HOSPITAL and RESEARCH CENTRE KATHMANDU, NEPAL, Page(s): 10-12. [4 ] Fidreyohannes Lemma, “Desigh of architecture and Implementation Issues for a Terrestrial Telemedicine Network in ETHIOPIA”, Department of Computer Science, Addis Ababa University, Page: 8. [5 ] H S Ng, M L Sim, C M Tan and C C Wong, “Wireless Technologies for Telemedicine”, BT Technology Journal, Vol 24 No2, April 2006, Page(s): 133-134. [6 ] http://www.gpsvisualizer.com/

Health service is most important factor for human wellbeing. So telemedicine in health service is very significant to reduce centralization problem. Heath services based on primary health services have been expanding gradually in Bangladesh to improve the health status of the people, especially in rural areas where more than 85 percent of people are living and are underserved and underprivileged groups. The study focused for providing better health care service to a wider remote population. In this work, we have presented the architecture of telemedicine system for remote patient either real time or stored and forwarded using Internet. An attempt has been made to employ a method than can be implemented for transmitting pathological reports, images, voice and video from any geographical location in real time and also it is possible to store in the website’s server. The main benefits of this method are very much cheaper and easier. In future, it is possible to transmit video without any delay and could be observed from receiving end without any buffering.

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