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A Telecommunication Network Architecture for Telemedicine in Bangladesh and Its Applicability M. Sanaullah Chowdhury, Md. Humaun Kabir, Kazi Ashrafuzzaman, Kyung-Sup Kwak

A Telecommunication Network Architecture for Telemedicine in Bangladesh and Its Applicability M. Sanaullah Chowdhury, Md. Humaun Kabir, Kazi Ashrafuzzaman, Kyung-Sup Kwak Graduate School of IT and Telecommunications, Inha University, South Korea [email protected], [email protected], [email protected] , [email protected] doi: 10.4156/jdcta.vol3.issue3.19 important role in the training of the medical professionals and clinical research through video broadcasting and teleconferencing. Telemedicine integrates diagnostic technologies, medical information management resources and telecommunications into a unified and clinically useful system [1]. Bangladesh is one of the most densely populated countries in the world. About 140 million people living within 144,000 sq. km of land. About 80% of the total population of the country lives in rural areas. With inadequate number of physicians and urban centric mentality of available physicians, telemedicine is the crying demand of the country. Following statistics will give an overview of the healthcare facilities in the country. There are only 663 Government hospitals in district head-quarters and sub district areas and total number of beds available in both public and private hospitals and clinics are 43,293 which leave 3,063 persons per hospital bed. Similarly the resultant of population per physician is 4147. Analyzing the above statistics anyone will realize the inadequate healthcare infrastructure in this highly populated country. In this scenario, telemedicine is very useful way to disseminate health facility to the rural Bangladesh utilizing its limited resources. Telemedicine activities emerged at Bangladesh in mid 1999. The productivity and usability of telemedicine data depends on the availability of high bandwidth. Last few years, information and communication infrastructures in Bangladesh have experienced huge development. Bangladesh government has given immense importance to ICT sector for development for economic growth. In April 2007, Bangladesh got connected to the submarine cable network as a member of the SEA-ME-WE-4 consortium [2]. Several private telecommunications operators along with public one have established their network all over the country. They are expanding their operation to the most rural areas of the country. Internet facility is almost available in every district of Bangladesh. If government and private organization take proper steps, then a patient in remote places will able to consult the doctors over internet.

Abstract Telemedicine refers to the use of information and communication technology to assist with medical information and services by the transmission of images, voice and other data over large distances. Although a number of institutions have tried to introduce telemedicine in Bangladesh since 1999, none of them have been commercially successful. The reasons include technical limitations, lack of a legal framework, and inability to meet the needs of the community at a low cost. Therefore, we propose a telemedicine network architecture using existing fiber optic backbone of Bangladesh. Its applicability is shown with a database system to communicate between doctors and patient. The proposed system is more rigorous and speedy. It has less installation charge. Besides, an overview of telemedicine in Bangladesh perspective has also been presented. The services and benefits from the proposed architecture have been discussed. The architecture can also be connected with Wireless Body Area Networks (WBANs).

Keywords Telemedicine, Fiber Optic Link, Database Systems, Satellite, Wireless Body Area Networks

1. Introduction Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Telemedicine is a new era in the field of modern medical management. Communicating with a medical doctor, particularly an expert is a difficult task for a patient who stays at a distance. Telemedicine is an upcoming technology which is intended to minimize the gap between medical professionals and patients. This system not only allows communication of patients with the doctors, but plays a very important role in the diagnosis, management, and follow-up of patient across continents. Telemedicine is also playing an

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International Journal of Digital Content Technology and its Applications Volume 3, Number 3, September 2009

telephone lines, ISDN, fractional to full T-1’s, ATM, the Internet, intranets, and satellites. Telemedicine is utilized by health providers in a growing number of medical specialties, including dermatology, oncology, radiology, surgery, cardiology, psychiatry etc and health care provider [6].

We have proposed telemedicine network architecture for Bangladesh in this paper. Its applicability using database is also described. The organization of this paper is outlined as follows. After a brief introduction, we have presented the overview of telemedicine followed by a description of a simple telemedicine system at section 3. The perspective of telemedicine in Bangladesh is stated at section 4. A telemedicine network architecture is proposed in next section. Section 6 describes the database system for the proposed architecture. Section 7 describes the services of telemedicine by the proposed system. Some benefits of the proposed telemedicine system is described at section 8. And finally, we have concluded our paper in section 9.

2.1 International Initiatives Telemedicine is becoming an important tool for delivery of health care to distant places, where medical resources are scarce or even absent. The developed countries like USA, UK, Australia and other European countries have already made telemedicine their most precious tool for development of applications of medical sciences for today and for future. Some countries are working for appropriate tele-robotic surgery, which indicates their willingness to use telemedicine as their next generation of medical scientific development. The successful application of robotic telepathology system in many countries is yet another proof of success in the field of telemedicine. Following initiatives in different parts of the world gives a fair view of what is happening around us: Trans-Continental: North American Telemedicine Network, Telematics Applications Program, Europath, Australasian Telemedicine Network. National: Canadian Tele-health Program, China, Singapore, Malaysia, Thailand, Vietnam, India, and many other countries. Associations: American Telemedicine Association (ATA), Bangladesh Telemedicine Association (BTA), United Kingdom Telemedicine Association, International Society for Telemedicine, Canadian Society of Telehealth, Japanese Telemedicine Society, etc.

2. Overview of Telemedicine The American Telemedicine Association (ATA) has defined telemedicine as follows: “Telemedicine is the use of medical information exchanged from one site to another via electric telecommunications for the health and education of the patient or healthcare provider and for the purpose of improving patient care”. A simple telemedicine is shown at Figure 1. The integration of multi-sciences into the telemedicine system allows building of a health network between medical facilities of different locations of a city or a country or even a region to exchange health information, which includes but not limited to radiological images, laboratory data, and clinical findings along with sound recognition. Transfer of medical information through the telecommunication channels require high bandwidth electronic telecommunication platform. Rapid development of compression technology is allowing us to do the job using existing normal telephone lines Worldwide, people living in rural and remote areas have very limited access to quality medical care when necessary, because specialist physicians are more likely to be located in areas of concentrated population [3]. Due to innovations in computing and telecommunications technology, many elements of medical practice can be accomplished when the patient and health care provider are geographically separated [4]. This distance could be as small as town to town, state to state or even from a country to another. Broadly defined, telemedicine is the transfer of electronic medical data (i.e. high resolution images, sounds, live video and patient records) from one location to another [5]. This transfer of medical data may utilize a variety of telecommunications technology including, but not limited to: ordinary

2.2 Components and Methods of Telemedicine The major components of Telemedicine are: Telemedicine Workstation, Telemedicine Peripherals, Telecommunication Network Architecture, Software Architecture, Human Intervention The three major methods of telemedicine are: Store and Forward, Teleconferencing and Videoconferencing So far, store and forward method, where a patient file including patient’s medical history, diagnostic images, medical scans (X-Ray, CT, US, etc), diagnostics reports and clinical findings along with other relevant demographic information are stored using any suitable telemedicine software. This file is a multimedia record called Electronic Medical Record

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Satellite

Urban or Suburban Home

District Hospital

Special Hospital Satellite dish

Satellite dish

Video Conferencing

Cardiology

Computer Computer

Video Conferencing

Pathology

Panel of Doctors Satellite dish Ambulance

Figure 1: A Simple Telemedicine System (EMR) is then transmitted to a medical expert or better medical facility for diagnosis and treatment advices. Store and forward overcomes the barrier of coordinating different physicians schedule for consultation. Any consultant can go the patient file and view detail of the condition to provide his or her expert opinion at his or her convenience. This is not effective in case where emergency medical intervention is required. Teleconferencing was always a part of teleconsultation between colleagues for appropriate management of patients from early days of the last century after invention of the telephone system. Still doctors are very used to this mode of telconsultation among themselves. Videoconferencing is the most appropriate mechanism to have teleconsultation but it needs expensive set of equipment and along with high bandwidth requirement, which is the most expensive item to buy in Bangladesh.

Although, being citizens of the poorest country we are paying the highest cost for telecommunication channels (bandwidth) in the world, sometime even higher than the USA, UK and India for sure. However, mobile phone coverage all over Bangladesh and recent introduction of fiber optic cable has made a huge impact in Information and Communication Technology in the country.

2.3 Tools of the Trade Many tools used in telemedicine system development and applications are chosen from simple and regular tools that we are used to practice in our professional life. It is simply the integration of telecommunication technologies that made the difference in using intelligent brain of computers and human interface in medicine. The major tools are : Telephone , Television, Videotape, CD-ROM, Videoconference , Multimedia files , Computer, Internet , Fax, E-mail

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Telemedicine was being practiced in limited fashion long before evolution of information technology, but due to rapid global development of information technology telemedicine took its final shape. The technology is being developed in a very aggressive way in different countries of the world. Few ideas, existing technology based applications are making major changes in medical science, which are listed below: Voice, video and data transmission Compression, Codecs, etc. DVV over IP Telephone, cellular, internet, LAN, WAN, etc. Videoconferencing Health portal

communication between any tertiary-to-tertiary care hospital, we would need a type of infrastructure as: video conferencing equipment with software, a minimum of 384 kbps leased line connectivity, X-ray scanner, digital camera, flatbed print scanner, digital ECG recorder, ultrasound machine with digital output, digital microscope, and two Pentium IV PCs. The money needed to deploy this kind of solution is around Tk. 20-30 lakh (30-44 Thousands US $) per site, with a recurring cost of Tk. 3-4 lakh (4-6 thousands US $) per annum. By contrast, a store-and-forward system is extremely cost-effective. A central server can store all the information about cases to be referred to the concerned specialist. The expenditure to deploy this kind of solution is around Tk. 2-3 lakh (3-4 thousands US $) per site, which is ten times less than the interactive model. Moreover, all the sites in the network can share the cost of the central server.

2.5 Future Applications of Telemedicine in Bangladesh

4. Telemedicine in Bangladesh Perspective

2.4 Role of Information Technology in Telemedicine

The concept of telemedicine and e-health is almost unique in Bangladesh, though it has been in use for more than 25 years for human civilization. This emerging field can increase efficiency in health care; thereby decreasing costs, enhancing quality care, empowerment of consumers and patients; provide continuing medical education for health professionals and health education for consumers, bridging the urban-rural health facilities. Bangladesh, as a developing country, has a huge population (above 140 million) with inequitable distribution of resources. Approximately 70% of its population lives in rural areas whereas 75% of qualified consultants practice in urban centers. Due to non availability of health facilities in remote areas, a large health service seeking people may need to travel for their appropriate health care in a few specialized health centers mostly situated in capital city or big cities. The use of Information and Communication Technology (ICT) in the health sector is very limited in Bangladesh, though its use will make a significant contribution to the improvement of health sector and change the present scenario. To meet these challenges, a group of responsible physicians, IT specialist and eminent persons have come together and formed a common platform named Bangladesh Society for Telemedicine & eHealth (BSTeH). The BSTeH exists

Among many applications, few important and strategic applications of telemedicine technology will change the perception of the technology and make significant contribution in to our communities, irrespective of geographic barriers. Major applications of telemedicine in Bangladesh are: Rural Telehealth care programs Home health care services E-health Mobile medical services International health care services Continuing medical education Patient education Post-Disaster medical Management

3. A Simple Telemedicine System Let us elaborate a simple type of a telemedicine system, its prerequisites, requirements, deploying, cost as well as usage. Prerequisites for developing a system in any backward area are electricity, telephone line, Internet or fax facilities and other necessary things. A doctor, nurse and an attendant are also required [7]. A block diagram of a very basic telemedicine system shown in Figure 2 can do with a data acquisition unit, PC, telephone and scanner, it needs to be scaled up as needs increase. A store-and-forward telemedicine tools (to capture patient data or images) basic product with a normal Pentium PC, a web cam, and an Internet dialup connection would provide the same results as a fancy real-time application. But for

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Text Edit

Transmitter at Remote Site BioSignal Acquisition

Signal Conditioning

PC

Scanner Receiver at Big City Signal Conditioning

PC

Printer

Consultant/ Physician

Figure 2: A Block Diagram of a Simple Telemedicine System

consultation with their colleagues in different countries but a more formal approach was taken only after 1999 [8].

to facilitate the dissemination of knowledge and experience in Telemedicine and eHealth and to provide access to recognized experts in the field. Recently, in Bangladesh, a network connecting different regions has been formed by the highly reputed local organizations, like Grameen phone Limited, Anovatech Ltd, Moon Hospital, Concept Hospital, Sitakund X-ray and Pathology and Chevron Clinical Laboratory. This telemedicine network is being used for medical consultation using video conference, store and forwarding data, report interpretation, health counseling etc, which improved the patient health care system. In near future the remote areas of Bangladesh will be connected to this network and provide the telemedicine services to the poor people.

1999: Center for Rehabilitation of Paralyzed in Savar established telemedicine link with the Royal Navy Hospital, Haslar, UK using a digital camera and satellite telephone July 1999: TRCL started feasibility study and infrastructure development to establish national and international telemedicine services. Mid - 2000: Grameen Communications took rural tele-health initiatives using wireless technology. January 25, 2001: TRCL demonstrated telemedicine system in the US Trade Show 2001 in Dhaka using Icare software and normal Internet connection & started test-run of the system between US and Bangladeshi physicians. April 2001: The Bangladesh Telemedicine Association (BTA) is formed but the lack in the government sector without which the technology will remain out of reach for the majority of poor people of the country. 2003: Sustainable Development Network Program (SDNP) Bangladesh began in January 2003. The e-HL project built two network segments (8Km; and 6Km) using point-to-point radio with bi-directional bandwidth of 2 Mbps. Currently, SDNP has four regional nodes in different parts of Bangladesh (Cox’s Bazar, Dinajpur and Satkhira), including Mymensingh. These nodes are connected to satellite through VSAT (SCPC/MCPC) technology. Their sessions provide consultancy and diagnostic support to the physician at the remote end, through medical experts at the SDNP

4.1 Timeline of Telemedicine in Bangladesh In a developing country such as Bangladesh, advanced medical service is growing with medical resources and expertise even with the presence of budgetary constraints, inadequate infrastructure, poor coordination of development projects, absence of referral system and medical records. Patients can’t receive the appropriate services of needed in case of emergencies in remote areas. The overall situation compels the patients to seek advanced diagnostic and treatment services in neighbouring countries often leading exhaustion their family resources. This leads to drainage of a huge amount of foreign currency from the national reserve every year. Many Bangladeshi physicians and surgeons were practicing informal tele-

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established from SDNP node in Mymensingh (120 km away from Dhaka) to a Community Based Medical College and Hospital (CBMCH), about 6 km away from Mymensingh node, creating a length of 134 km (including existing 120 km of SDNP backbone) of radio link with 4 hops in between. There are 4 other regional nodes of SDNP Bangladesh present at 4 different parts of Bangladesh, i.e. Cox's Bazar, Dinajpur and Satkhira as shown in Figure 3. These nodes are directly connected to the satellite through own VSAT and thus connected to the head office as well as to the rest of the world through Internet. Using this most suitable infrastructure SDNP Bangladesh has already taken initial steps towards implementing telemedicine service. SDNP Tele-Health system is using its own internet backbone. It is using FTDMA Satellite Connections in its four regional nodes and Radio linked (wireless) connections in three other sub-nodes. More wireless networks are in the pipeline and they will be implemented very soon. The system can be accessed from any Desktop terminals with most commonly used web browsers and active internet connection.

head office. Since August 2005, 72 patients have been treated [9]. 2003: Bangladesh University of Engineering & Technology (BUET) and Comfort Nursing Home had started a Telemedicine project with the financial collaboration from European Union (EU) via Email. Recently the project is not functional. May 2004: Bangladesh. DNS diagnoses Centre, Gulshan-1 and Comfort Diagnoses &Nursing Home’s started a Telemedicine centre. The project was discontinued because of lack of financial viability, patient disinterest and poor market promotion 2005: In August 16, 2005 Grameen Telecom (GTC) in cooperation with the Diabetic Association of Bangladesh (DAB) launched telemedicine services, giving patients at Faridpur General Hospital access to specialist doctors of their choice in Dhaka. DAB’s BIRDEM Hospital Dhaka, was connected via a video conferencing link to DAB’s Faridpur General Hospital. Consultations now take place over video conference where patient and doctor see each other on television screen. The cost per consultation for a new patient was 600 Taka, with repeat patients getting some discount [10]. 2006: Mevenova Pvt. Hospital started an email and internet base Telemedicine service joint with some renounced India based Hospitals 2006 November: Telemedicine Reference centre Ltd. And Grameen phone has started a unique telemedicine Service “HealthLine Dial 789” A GSM infrastructure based call centre for Grameen phone 10 million subscribers. Providing different types of medical information facility, emergency service (SMS based LAB report, ambulance) and real time medical consultation over mobile phone [11]. The e-Health & Learning Project, through its Medical Portal and videoconference seminars, is bringing the relatively new concept of Telemedicine in Bangladesh and is also modifying them according to current status and needs.

4.2 Telemedicine Infrastructure of SDNP, Bangladesh Sustainable Development Networking Programme (SDNP) of Bangladesh funded by United Nations Development Programme (UNDP) started its journey of Telemedicine back in January, 2003. According to [12], the project has built two network segments using point-to-point radio link with a bi-directional bandwidth of 2 Mbps. The first setup of the segment was in Dhaka and it connected the SDNP node at BIDS with the Comfort Nursing Home, covering an air distance of about 8 km. The second one was

Figure 3: Regional Nodes of SDNP Bangladesh [12]

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District Node 5

District Node 4

Main Center, at Dhaka

District Node 64

District Node 3

Fiber Optic Link

District Node 1

District Node 2

Internet Based Link Subdistrict Node 1

Subdistrict Node N Internet Based Link

Health Center System 1

Health Center System N

Health Center System 1

Health Center System N

*Each of the District Nodes 2, 3, 4,.. ,N has same entity as shown in District Node 1

Figure 4: A Proposed Telemedicine Network Architecture for Bangladesh Now, the problem is how to make a communication backbone for this set up. We propose to use the existing high speed fiber optic backbone of BTTB (Bangladesh Telegraph and Telegraph Board) that covers all districts of Bangladesh. These 64 district nodes will be connected to the main center at Dhaka, the capital city of Bangladesh. The district nodes will be connected to sub district nodes through internet. In same way, the health center will communicate with its corresponding sub district nodes with internet. The proposed system will be more rigorous and speedy than the existing SDNP network architecture as it uses fiber optic instead of satellite. Moreover, it has less installation and maintenance cost.

5. Proposed Telemedicine Network Architecture for Bangladesh At present, SDNP using satellite connections in its four regional nodes and radio linked (wireless) connection in other sub nodes. This is not effective as Bangladesh has fiber optic backbone. Therefore, considering the communication background of Bangladesh we propose a telemedicine network architecture in this section. The objective of the proposed model is to build up a connection between remote health centers and to use existing fiber optic backbone of Bangladesh. The network architecture is shown in Figure 4. Bangladesh is administratively divided into 64 districts. Each district consists of several sub districts (Upojila).Usually each sub district has one government small hospital. The rural or remote people of Bangladesh access these hospitals for their medical treatments. We consider these hospitals as primary health centers.

6. Database System for the Proposed Telemedicine Architecture Telemedicine is all about communication between patients and doctors. Hence, a database system has to be developed and to be maintained to store the profiles of these two members. The patients complain and the

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Central Telemedicine Database Server

Patient in Video Conference

Internet

Telemedicine Device Operator

Local Server for Database

Physician at Remote Center 



Telemedicine device related tests are carried out and recorded in Database

  Data Entry & Health Card Verification

  



Visit records, case history made and stored in Database. Telemedicine reports attached if required. Prescription is stored in Database Video Conferencing is arranged if needed

Patient Information are entered and recorded at the Database. Identity cards issued. Records are entered against particular visit.

Figure 5: Databases for the Proposed Telemedicine Model The registration will be undertaken and the operator will process a visit entry for the patient’s current visit. With the visit slip issued from operator, the patient will visit the physician at that rural health centre. The visit slip will contain detail about patients present complain and medical records. There will be a questionnaire through which patients complains are entered in database against particular visit number. At the data entry and health card verification stage the patient information are recorded at the database. Based on the current complain, the local medical officer at remote health center will decide whether a second opinion from a specialist doctor is required or not. The advised prescription along with complains, available medical records should be entered in the database. If a second opinion is required, expert doctors will be informed about it through a mail or any other messaging service. Specialist doctors will be facilitated with internet connectivity and after investigating a case (Patients

complete treatment process needed to be preserved in the system. Major modules of the system are described below and are shown in Figure 5. Patient registration is the means by which all patients are entered in to the health centre system. Patients can be registered to the system once at their first visit. The exact electronic record can be found by using various selection criteria later on. When the patient comes to visit the rural health centre for the first time he/she has to provide some specific information. Based on the information, an identification card will be generated. This card would contain a unique number and this will be the identification for all subsequent visits. Patients complain, prescription and other medical records will be preserved in the Health Care database against this number. When a patient will come to a health centre for telemedicine treatment, he will be registered first by a data entry operator from sub-district node.

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medical records, personal record and complains) specialist doctors put their expert opinion in central database. After having a look at the available records and data if the expert physician still feels a need of video conferencing with the patient, sub district nodes will arrange it using existing infrastructure. These opinions and prescriptions are accessible to sub-district operator from web.

1. Telemedicine program development for medical facilities. 2. Rural-Telehealth program development for government, NGOs, and private organizations. 3. Defence and correctional facility telemedicine program development. 4. Post-Disaster medical management program. 5. Medical education, training and distant education program development. 6. Local and International health care facility management.

7. Services of Telemedicine by the Proposed System

7.3 System Solution

Our proposed system can offer international medical services.

Telemedicine System Solution may include:  Project Report that includes needs assessments, Technical and Financial feasibility, etc.  Procurement of low-cost Telemedicine and Telecommunication equipments.  Installation.

7.1 Patient Care The patient care services may be offered as follows: Complete Disease Management: from diagnosis to treatment plan from the system. Electronic Medical Board: Patients suffering from complex disease processes have the opportunity to seek advanced treatment plan from multiple worldclass physicians from Dhaka, Chittagong and other cities. Follow-up or Continuation of Treatment: Patients, who received treatment in a remote city may avail the opportunity to get their follow-up care from our proposed telemedicine health care centre. Second Opinion: to confirm diagnosis of patients’ disease from famous doctors and hospitals. Teleradiology: accurate interpretation of all kinds of radiological images, e.g. CT, MRI, Angiography, Mammography, etc. Telepathology: All kinds of pathological tests can be digitally converted using static and robotic microscopy for diagnostic second opinion of cancer and other complex diseases. Free International Referral: patients may be offered free national referral services to the partners’ medical facilities. Personalized and Corporate Services: Personalized healthcare services for family or company executives.

 

Human Resources development and training. Maintenance Services.

8. Benefits of the Proposed Telemedicine System The proposed multipurpose system has many benefits typical in developing countries like Bangladesh where the rural areas are not facilitated up to the mark. The city hospitals are not capable to accommodate the huge influx of people coming from rural areas for tertiary even mostly for primary care. It is because the lack of resources, lack of management, unavailability of technology and due to lack of trained people as well. The concept of telemedicine system and its potentials could serve well for such developing countries, particularly for Bangladesh. Looking to the current scenario of Bangladesh as eighty percent of the population lives in rural areas where road and transport facilities are limited. It is no exaggeration when one hears of patients being carried on bull cart for one to two days to reach the nearest district or town hospital for an alignment which could have easily been cured in the patient’s home place provided information and medical advice was available. The limitation of provisions for medical services in rural Bangladesh is many fold, in particular lack of transport access and financial constraints due to lack of resources for infrastructure, shortage of doctors and their lack of motivation to work in rural areas. However, despite limited resources to most parts of the country,

7.2 Medical System Integration The proposed architecture may provide system integration in medical facilities around the world in collaboration with international partners. It may offer research and evidence based industry experience to medical facilities in following categories:

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telecommunications facilities are relatively well developed. National and international telephone links are available in most parts of the country Internet can be accessed from over most of villages of Bangladesh. Hence for Bangladesh telecommunications can provide a solution to meet health information need and provide a solution to health problems in rural areas through telemedicine. The concept could enable medical expertise to be accessed by local medical practitioners from district and central hospitals using telecommunications as well as opening the possibility to allow access to universal health information. The implementation of the such type of systems at initial stage may not be able to provide quality assurances for the rural mass but it could provide solutions to emergency medical assistance, long distance consultation, distance medical education and supervision over space and time for basic yet fatal, common and preventable diseases such as tuberculosis, waterborne diseases and HIV and community awareness.

aggregated, and processed using a variety of wearable sensor nodes. WBAN transmits the summary of patient’s medical data to the surrounding sensor network which further transmits the data to the hospital system or the doctor using Internet or cellular network. If the patient is outside, where there is no sensor network is deployed, then WBAN interacts with the hospital system using the patient’s PDA or cellular device. The telemedicine network architecture can be connected with WBAN with internet of cellular network. Further research can explore more WBAN applications with telemedicine especially in remote health monitoring and emergency health services.

10. Conclusion In this paper, we have proposed a telemedicine network architecture using existing fiber optic backbone of Bangladesh. The proposed model is more rigorous, speedy and cost effective. Its applicability is shown with a database system to communicate between doctors and patient. We also have presented an overview of telemedicine in Bangladesh perspective. The services and benefits from the proposed architecture also have been shown. We strongly feel that the Bangladesh government should patronize the telemedicine. The future of telemedicine in Bangladesh is truly vast.

9. WBAN with the Proposed Telemedicine Network Architecture Wireless Body Area Networks (WBANs) are expected to improve remote health monitoring substantially by allowing inexpensive, non-invasive, and continuous remote health monitoring with realtime updates of personal medical records. In future, WBAN will play a major role in this sector. Lowpower integrated circuits and low-cost and lightweight sensor nodes can be used in WBANs as they are capable of sensing, processing, and communicating vital signs.

WBAN with Patient/ Doctor

PDA or Cellular Device

Internet or Cellular Network

11. Acknowledgment This research was supported by the MKE(The Ministry of Knowledge Economy), Korea, under the ITRC(Information Technology Research Center) support program supervised by the IITA(Institute for Information Technology Advancement) (IITA-2009C1090-0902-0019)

12. References

Proposed Telemedicine Network Architecture

[1] Report of the Technical Working Group on Telemedicine Standardization May, 2003 Technical working group for Telemedicine Standardization Department of Information Technology (DIT), Ministry of Communications and Information Technology (MCIT) [2] Nessa Ahasanun, Ameen M. A., Ullah Sana, Kwak Sup Kwak; “Applicability of Telemedicine in Bangladesh: Current Status and Future Prospects”; Proceedings of the 2008 Third International Conference on Convergence and Hybrid Information Technology, South Korea. [3] Maheu, M., Whitten, P., & Allen, A. eHealth, Telemedicine & Telehealth: A comprehensive guide, New York 2004.

Remote/Outdoor/House

Figure 6: WBAN with the Proposed Telemedicine Network Architecture

Our proposed telemedicine network architecture can accommodate WBAN as shown in Figure 6. Inside WBAN, vital signs of the patient are collected,

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[4] E.A. Franken et al., "Telemedicine and Teleradiology: A Tale of Two Cultures," Telemedicine Journal, vol. 1, No. 1, spring 1995, p. 7 [5] Antezana, F., Telehealth and Telemedicine will Henceforth be part of the Strategy for Health for All. Internet, 1997; http://www.who.ch// [6] Impact of telecommunications in health-care and other social Services, “TELECOMMUNICATION DEVELOPMENT BUREAU ITU-D STUDY GROUPS Document 2/155(Rev.2)-E7’’ September 1997 [7] Memon D Tayab, Chowdhry B.S, Memon S Mohammad, “The Potential of Telemedicine System: An Approach Towards a Mobile Doctor”, National Conference on Emerging Technologies 2004, Pakistan, 2004 [8] Sikder M. Zakir, Introduction of Telemedicine in Bangladesh and role of IT infrastructure in Medicine, Bangladesh Vol.1 1999 [9] Murelli Elena et al, e-Health & Learning: the Bangladesh experience 1, The University of Birmingham, UK [10] Grameen Telecom (GTC) Official web site www.grameentelecom.bd .com [11] Telemedicine Reference Centre Ltd. Official URL: //www.trclcare.com [12] Sustainable Development Networking Programme (SDNP) http://www.sdnpbd.org/

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