SOURCE: Andriyan B. Suksmono, Institute of Technology Bandung

Transcription

1 INTERNATIONAL TELECOMMUNICATION UNION TELECOMMUNICATION DEVELOPMENT BUREAU ITU-D STUDY GROUPS Document RGQ14-1/2/026-E 20 June 2004 English only RAPPORTEUR'S GROUP MEETING ON QUESTION 14-1/2 - HIRATSUKA, JAPAN, JUNE 2004 Question 14-1/2: Application of telecommunications in health care STUDY GROUP 2 SOURCE: Andriyan B. Suksmono, Institute of Technology Bandung TITLE: Overview of Telemedicine Activities in Indonesia: Progress and Constraints Contact point: Andriyan B. Suksmono Institute of Technology Bandung

2 Overview of Telemedicine Activities in Indonesia: Progress and Constraints Andriyan B. Suksmono, U. Sastrokusumo, Tati L.R. Mengko, J. Tjandra Pramudito, and Susi Oktowaty Abstract-- This paper presents an overview of the telemedicine activities in Indonesia. Historical development, especially in ITB Bandung, is briefly discussed. Present and future trends of telemedicine, focusing on current trend in wireless communication technology for rural area, and the constraints are described. I. INTRODUCTION Indonesia is an archipelago, a country of thousand islands with about 220 million population. Scarcity of medical experts which are unevenly distributed, mainly only in the main cities in Java and Bali; such as Jakarta, Bandung, Surabaya and Denpasar; and also the wide-span and the nature of the country that consists of many islands is the main constraint in raising social health care of the people. Therefore, telemedicine is arguably the most suitable tool to solve health problem in the country. This paper describes some of works on telemedicine in Indonesia. Because most of the activities are not well disseminated to publics, rarity of scientific meetings in this field and because telemedicine itself is a quite new technology for the country, this presentation covers only a part of it. Nevertheless, it hopefully able to spots the past, current and future development of telemedicine in Indonesia. II. TELEMEDICINE IN INDONESIA: PAST AND PRESENT ACTIVITIES The first computer and satellite based telemedicine experiment in Indonesia was conducted in , along side with other academic interaction in the SHARE (Satellite for Health and Rural Education) project sponsored by INTELSAT to commemorate her 20 th anniversary. The Faculty of Medicine Diponegoro University (Semarang, Central Java) and the World Health Organization (WHO) conducted a teleconference on Tropical Diseases with medical societies in Canada, the USA and Europe. The information exchanged was in a text mode. The results were evaluated in terms of technical performance and user s subjective evaluation. In the early nineties we conducted a low cost Still Picture Transmission by Narrowband Technique for educational and medical services and continued by series of image processing experiments in a laboratory scale, which need more field test toward operational application. A new regional cooperation called PARTNERS (Pan Asia-Pacific Region Telecommunication Network for Experiments and Research by Satellite) sponsored by the MPT of Japan and managed by

3 ARIB was introduced to conduct experiments on ETS-V L-Band transmission and its application. The 64 Kbps stream was utilized for slow scan video lectures among our PARTNERS members ( ). The finding was that this kind of application can be used appropriately for educational as well as for medical communications. Tokai University s School of Medicine was one of the most prominent member and partner for ITB. In the year 1997, a satellite based telemedicine experiment was conducted between three institutions: Faculty of Medicine and Faculty of Engineering of the UNJANI in Bandung as the center/control station, while the Central Hospital of Mataram (Lombok, about 500 km east of Bali) and the Harapan Kita Hospital in Jakarta as the clients. The demonstration was on maternal care using a full television three party conferences dedicated for the development of remote/outreach in the Eastern Territory of Indonesia. Another joint Post-PARTNERS telemedicine experiment was the wireless based telemedicine system (Fig.1) connecting two Schools of Medicine in Bandung, Hasan Sadikin Hospital (RSHS) and UNJANI, by 2.4 GHz Wireless LAN, through JCSAT 3 satellite link between ITB and former CRL in Tokyo, further connected by ISDN to Ohkura National Hospital in Hibiya, Tokyo. Meanwhile, research on image coding and information retrieval and exchange has been conducted since In 1999, a research paper on a neuro-vq X-ray image coding system was presented in IEEE-ISPACS [2]. The system (Fig.2) is further developed and designed for telediagnosis purposes [3] and implemented in a web-based system that is reported recently in APT Workshop India, 2004 [4]. At present, we are working on a new image C-S coding based on wavelet. Some of the new results on a lossy wavelet-coding for biomedical image have been reported in [5], and a new CS-wavelet coding is now under development. Another activity on telemedicine is the one that is conducted in the Biomedical Laboratory (now, the Graduate School of Biomedical Engineering) ITB. Focusing on telemedicine for Primary Community Health Center (Puskesmas) in the country, the research team developed an internet-based telemedicine. Applications being served are including: tele-consultation, simple tele-diagnostic, tele-coordination, tele-education and medicine database. This activity is supported by a grant from PanAsia Foundation. Some of initial results have been reported in the first APT Telemedicine workshop [6, 7].

4 Fig. 1 Early 2.4 GHz Wireles LAN-based Telemedicine connecting ITB, UNJANI, Hasan Sadikin Hospital (Indonesia) and CRL, Ohkura Hospital (Tokyo). In the Faculty of Medicine, Padjajaran University, a group of researchers developed telebiomicroscopy [8]. In the system, a biomicroscopic image of eye disease is transmitted through a wireless communication channel. It is concluded that the diagnosis of eye disease can be conducted remotely by a telemedicine system. Another research group conducted experiments on hemodynamic status of critically ill patients data [9] which is then transmitted via communication line. The haemodynamic deals with cardiovascular performance in supplying oxygen to peripheral tissue to maintain metabolism. It was reported that the experiment results is promising. Beside of the universities, some telemedicine activities are also conducted. In PT Telkom (National Telecommunication Company, Indonesia) R&D Center, a group of researchers created a web-based medical information system for public community [10]. The system integrates a medical information database and information delivery system using Wireless Access Protocol (WAP). The current ongoing research is being supported by a grant from APT. Second notable activity is that of what initiated by MediFa. Their system utilizes a videophone connecting a primary care clinics and a referral hospital. The feature being introduced are tele-consultation and tele-education [11]. Recently, this system is extended by using most recent technology available in local market: the video streaming, SMS (Short Messaging System), and WAP to be used by family doctors [12].

5 III. THE FUTURE OF TELEMEDICINE IN INDONESIA The above-mentioned activities surely are not a complete list. It is noted that telemedicine has begun to attract also interests of telecommunications society [13] and policy makers [14] too. Trends in communication technology will also influence greatly to telemedicine. In the country, internet and wireless communication is growing vastly. The wireless LAN technology on 2.4 GHz, is now very popular and it is affordable for the community. Focusing on rural areas, special attention should be made on this technology. Telemedicine systems based on this technology have a great opportunity to be developed for the country. The development of telemedicine in many countries, in some respect, depends on the availability of the equipments in the market, the existing telecommunication infrastructures and the enthusiasm of the users. The current trend among medical doctors/ paramedics is the use of the MMS (Multimedia Messaging System) by mobile phone (for example: streaming 3GPP with image capture resolutions of pixels; video capture of H.263 inside 3GP file format/ MPEG.4, supported by Java MIDP 1.0 technology to send MMS or to a compatible phone or PC. Data transfer up to 43.2 Kbps in a high speed circuit switched data networks, or up to 40.2 Kbps in GPRS networks) as a communication tool for the first aid in an emergency situation. However, they are quite aware that it must be upgraded or refined to meet the minimum requirement of the medical imaging services. At present, there is a collaboration project supported by a grant from APT, between PT Telkom (R&D center), Pertamina Jakarta Hospital, Telecom College STT Telkom Bandung, MediFa, the CRL-Japan and the UEC-Japan. The objectives of this project is to develop an integrated medical contact center for enhancing public health services in Indonesia using combination of most recent technology available in the market. The system will be accessible through hand phone with WAP (Wireless Application Protocol) capability, SMS (Short Messaging System), also over fixed phone and fax machine, which then will be answered via IVR (Interactive Voice Response system) or human operator, and it is also accessible through the internet. This integrated medical contact center provides easy access for people to medical database. Parties involved in telemedicine in the country: government/regulator, research centers /universities, industries / telecommunications operators, NGO and the users, should works hand in hand to develop this technology for the sake of community s health (Fig.3). At present, not only the cooperation among player is not well established, but between parties in the same sectors-research centers for example, is not well coordinated.

6 Fig.2. Block Diagram of VQ-Based Client Server Image Coding for Telediagnosis IV. ISSUES Last but not least, there are some remaining issues to be addressed in conducting telemedicine activities, among others are: Who pays? Most of the patients who need help belong to the poor, located at distant area where the communication infrastructures are poor too, unless we use satellite communication system which is still expensive. The interface equipments for the telemedicine are scarce either. All need big funding. Diagnosis at a distant. There are problems to provide the equipments for a proper and responsible diagnostics at a distant. Another problem is the cultural environment or background which refused other than the more traditional way. Legal issues: who is responsible for the remote patient? This issue needs firm acts, whether state regulation, accreditation or liability which involved agencies/ or professionals. Medical Laws: who has the duty to whom? How far are medical practices without direct examination considered against ethics? Privacy and confidentiality of the patients which must be protected in this radio and digital environment. Still another issue might be, because of the fast development in technology and peoples dynamics, we may anticipate the possibility of structural change in healthcare delivery. As a total, we need to know the acceptance of all sides which are involved in this system.

7 ACKNOWLEDGEMENTS The authors would like to acknowledge Prof. I Nakajima and the Telecommunications and Microwave Laboratory, EE Department ITB, for their continuous supports on our telemedicine activities. RESEARCH CTRS/ UNIVERSITIES: REGULATOR/ GOVERNMENT: -Min. of Health -Min. of Comm. & Info -Faculty of Info- Comm. Technology -Fac. of Medicine -Industrial R &D Ctr -MediFa TELEMEDICINE ACTIVITIES INDUSTRIES: -Electronic/ Telecomm. Industries/Operators -Medical eqpmt.industries -Pharmacetiucal Ind. N.G.O: USERS: -MASTEL (Telematics Society of Indonesia) - Indonesia Soc. Of Telemedicine, -etc. -Hospitals -Community Health Care (PUSKESMAS) -Drugstore -Physicians Fig.3 Parties involved in telemedicine activities