Politeknik Negeri Bandung

communication links, and automatically transmit patient’s biosignal to Base Unit • Comprises of medical devices, digital camera, telemedicine arbiter,...

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PENGEMBANGAN SISTEM TELEMEDIKA BERGERAK & APLIKASINYA Dr. Ediana Sutjiredjeki Politeknik Negeri Bandung

disampaikan pada 4th Biomedical Engineering Forum Teknik Elektro - Universitas Ahmad Dahlan Yogyakarta 10 April 2010

Masalah Pelayanan Kesehatan • Disparitas status kesehatan antar wilayah • Rendahnya kualitas pemerataan dan keterjangkauan akses pelayanan kesehatan • Keterbatasan tenaga kesehatan dan distribusi yang tidak merata (Supari, 2006) (Purwadianto, 2008).

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Telemedicine • “The use of advanced telecommunication and information technologies to exchange health information and provide health care services across geographic, time, social and cultural barriers” • It includes both, the clinical (diagnosis, treatment and medical records) and academic medicine (research, education and training)

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Mobile Telemedicine System Drivers • rapid advances in wireless, and network technologies • advances in communication and medical technologies • The pervasiveness, cost effectiveness and availability of mobile phones (GSM and 3G networks) • Availability and cost effectiveness of satellite communications

E-Health (WHO, 2005) • Penggunaan teknologi informasi dan komunikasi dengan biaya efektif dan aman dalam mendukung bidang kesehatan dan bidang-bidang lain yang berhubungan dengan kesehatan, termasuk layanan perawatan kesehatan, pengawasan kesehatan, bahanbahan kesehatan, dan pendidikan

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Kelebihan Telemedicine • Increase the accessibility of and to professional caregivers • Increase the quality and continuity of care to patients • Increase the focus on preventive medicine through early intervention • Reduce the overall cost of healthcare • For education and training • For providing services to remote areas in case of natural calamities, disasters and military and space operations. • Remote monitoring

Telemedicine Categories • • • • • • • • • • •

Telehome Home Health Care Telepsychiatry Teleradiology General Telemedicine Telecardiology Telemedicine Consulting Teledermatology Emergency Telemedicine Telepathology Teledentistry Telesurgery

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Konsep Sistem Telemedika Bergerak

Telemedika Pada Peta e-Health

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Aplikasi Sistem Telemedika Bergerak

Masalah Pengembangan STB

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Kota dan Kabupaten Sukabumi

Pengukuran kuat sinyal di daerah Sukabumi (2005/2006 -75 ~ -40

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-85 ~ -75

-90 ~ -85

-100 ~ -90

-110 ~ -100

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7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

Lokasi

Provider 1

Provider 2

Provider 3

Provider 4

Provider 5

Provider 6

Radio VHF

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Ketersediaan link komunikasi 3 provider (Oktober, 2008)

Tampilan Pengukuran Kuat Sinyal

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Kriteria Evaluasi Teknologi • Bandwidth : Transmission rate in kbps • Latency Real time and Delayed • Availability : the percentage of the time the network or particular link is operational • Security : availability, confidentiality, and integrity • Ubiquity : influenced by network’s geographic scope and by rules regulating participation

Arsitektur STB dengan Multi Communication Links Mobile Telemedicine Unit

Base Unit

Sanbungan Langsung

IP Based

Radio

Telemedicine Arbiter

Manajer Komunikasi

Pengolah Informasi Medis

Internet IP IP Based

IP Based

Radio

IP Based

GSM GSM

IP Based

CDMA

Manajer Komunikasi

IP Based

Sambungan Internet

IP Based

IP Based Internet IP IP Based

CDMA IP Based

PSTN PSTN SD

PRO

Pr of essi onal Wor kst ati on 6000

EKG

Tekanan Darah

Kamera

FHR Notebook

Printer

Komputer Server

Printer

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Tahapan Pengembangan STB • • • • • • •

Fungsi STB Spesifikasi Pengembangan skenario aplikasi System requirements Pengolah informasi kedokteran Manajer komunikasi Mobile telemedicine unit / Portable telemedicine unit • Base unit • Integrasi STB

Aliran Informasi STB

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Perancangan dan Realisasi • Interface card for each connected medical devices • Integration the interface cards to medical information concentrator • S/W for data acquisition • User interface software • S/W for base unit include PIR • Software for data communication • S/W application • Realization portable telemedicine unit

Instrumentasi

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Mobile Telemedicine Unit • Responsible for collecting medical information, and display critical signals, e.g. ECG, BP, FHR • Must be able to write and to record data • Support data transaction via variety of communication links, and automatically transmit patient’s biosignal to Base Unit • Comprises of medical devices, digital camera, telemedicine arbiter, and a processing unit that can be PC or laptop.

Diagram Blok Mobile Telemedicine Unit

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Parameter Perancangan • • • • • •

Kompleksitas Unjuk kerja sistem Pemenuhan fungsional Keandalan sistem Portabilitas dan tahan benturan mekanik Ekonomis

Realisasi Mobile Telemedicine Unit • Mudah dibawa dan cukup ringan, • Mempunyai sumber daya tersendiri yang dapat beroperasi lebih dari 60 menit untuk membawa pasien pada keadaan darurat, • Dilengkapi dengan user friendly interface, • Dapat mengumpulkan dan menampilkan biosinyal pasien yang diperlukan, seperti sinyal EKG, BP, SpO2, temperatur, dan FHR baik langsung maupun tidak langsung, • Dapat merekam informasi dan data pasien, • Serta mendukung berbagai teknologi komunikasi.

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Mobile Telemedicine Unit dan EKG

Portable Telemedicine Unit

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Base Unit / Doctor Unit • Located at a hospital or Community Health Centre (CHC). In this case, it is placed at RSUD R. Syamsudin S.H. • Equipped with a PC to display incoming signals from the telemedicine unit, and communication manager as a transceiver • Implement continuous scanning to monitor incoming information and response to them as soon as possible • Integrated with PIR (Patient Information Record)

Komputer Server di Base Unit

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Perangkat Lunak STB • Model client-server, the Telemedicine unit is the client, and the Base unit is the server • Acquire of patient related information • Store and display data of the patient • Maintain and control connection between the Telemedicine unit and the Base unit over several communication means • Schedule doctor appointments • Capture image/other data from the output of medical equipments • Support PIR (Patients Information Record)

Arsitektur Perangkat Lunak STB

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Use Case Diagram Telekonsultasi

Jaringan Sistem Telemedika Bergerak

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Uji Coba • Uji coba fungsional • Uji coba transmisi data • Uji coba skenario aplikasi

Contoh Hasil Uji Coba [1/3]

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Pengujian Telekonsultasi di Puskesmas

Permohonan Telekonsultasi

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Pengukuran Sinyal EKG

Contoh Tampilan Perekaman Biosinyal

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Contoh File Biosinyal Lengkap

Tampilan Permohonan Telekonsultasi di Base Unit

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Pengujian Transmisi Data di Ambulan

Contoh Hasil Uji Coba Transmisi Data Type of Signals

Data Size (byte)

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BP

2322

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FHR

6144

173

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PIR

96256

309

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Still image

23252

88

No.

Maximum Transmission Time (second)

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Contoh Hasil Uji Coba Transmisi Data

Pengecekan Transmisi Data

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Interface Setting

Lokasi Base Unit

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Jaringan STB

Penutup • Teknologi • Infrastruktur (Perencanaan & pengembangan) • Peraturan telekommunikasi • Sistem pembiayaan • Licensing and credentialing • Legal aspek (malpraktek) • Kerahasiaan • SDM

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