Using Technology in Urban Areas:
Preparing for the Future
April 26, 1999
Frank Ferrante
Senior Manager
Mitretek Systems, Inc.
Presented to
The Emerging Health Information Infrastructure Conference (HII99)
Improving Health in a Digital World
Sponsored by the Friends of the National Library of Medicine (FNLM)
Washington, D.C.
Agenda
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Technology: Changes and Trends
Digital Healthcare Products
Applications
Current and Future Technologies
Summary
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Technology:
Changes Exponential
Multimedia applications:
Messaging, documents, desktop
conferencing, image storage/retrieval,
TV distribution
ATM/SONET
WDM Networks
100+ Gbps
Data Rates
100+ Gbps
ATM/SONET
Networks
1 Gbps+
IP Switching
FDDI
1 Gbps
100 Mbps
Fast Ethernet
Ethernet
100 Mbps
(IEEE 802.3)
IBM's Token Ring
10 Mbps
16 Mbps
10 Gbps
1 Gbps
100 Mbps
10 Mbps
1 Mbps
100 Kbps
10 Kbps
Dial-Up
300 bps
1 Kbps
100 bps
• ISDN
X.25
Early Modem
56 Kbps
Access
1200 bps
Modem Access
9.6 Kbps
Direct Access
75 bps
10 bps
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
3
Technology:
Internet Trends
 Internet consumer market to reach 43 million in 2000 from 30+
million households in 1998 {INTERNET2 reaching Gbps Rates)
Internet Market in Millions
$5,000
$4,500
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
1995
1996
1997
1998
1999
2000
Source: The Age of Internet: Capitalization on the Data Opportunity,
Information and Interactive Service Report, January 9, 1998
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Technology:
Bandwidth Cost Trends
Legend:
OC - Optical Carrier Rates (155 Mbps
to 4.8 Gbps)
WDM - Wavelength Division Multiplexing
TDM - Time Division Multiplexing
Source: NGN - 1998 Conference Proceedings
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Technology:
Digital Healthcare Products
 Digital Blood Pressure Monitor (Sphygmonometer) - less than 10 Kbits of
data per second (required transmission rates)
 Digital Thermometer - less than 10 Kbits of data (required transmission
rates)
 Digital Audio Stethoscope and integrated electrocardiogram - less than 10
Kbits of data (required transmission rates)
 Ultrasound, Angiograph, - 256 Kbytes (image size)
 Magnetic Resonance Image - 384 Kbytes (image size)
 Scanned X-Ray - 1.8 Mbytes (image size)
 Digital Radiolography - 6 Mbytes (image size)
 Mamogram - 24 Mbytes (image size)
 Compressed and full motion video (e.g., Nasopharyngoscope,
Opthalmoscope, Proctoscope, Episcope, ENT Scope) - 384 Kb/s to 1.544
Mb/s (speed)
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Technology:
Teleradiology Applications - Imaging
8 to 24 bits per
pixel
512 to
4096
pixels
Ima ge T ype
512 to 4096 pixels
Ultra sound
Othe r (Angiogra phy,
Endoscopy, Nucle a r Me d.,
Ca rdiology, Ra diology)
Compute d T omogra phy
Ma gne tic Re sona nce Ima ging
Digitize d (Sca nne d) X-ra y
Digita l Ra diogra phy
Ma mmogra phy
Ima ge Re solution
Spa tia l
Contra st
512x512
x8
Ima ge Size
256 Kbyte s
512x512
x8
256 Kbyte s
512x512
x12
384 Kbyte s
512x512
x12
384 Kbyte s
1024x1250
1024x1024
2048x2048
4096x4096
x12
x8
x12
x12
1.8 Mbyte s
1 Mbyte
6 Mbyte s
24 Mbyte s
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Technology:
Image Transmission Times
Note: Service classes changing faster than ever
29.1 min.
Coaxial Modem Range
Slow-Speed
Services
High-Speed Services
(45 Mb/s - 4.8+ Gb/s)
Medical/Scientific
Visualization
Medium-Speed Services
(384 Kb/s - 45 Mb/s)
Medical Images
15.0 min.
Assumptions:
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32.6 sec.
5.0 sec.
1.1 sec.
2048 x 2048x 12 bit image
No compression
325 ms
21 ms
10.5 ms
28.8 Kb/s
56 Kb/s
1.544 Kb/s
10 Mb/s
45 Mb/s
155 Mb/s
2.4 Gb/s
4.8 Gb/s
(Modem)
(Modem)
(T1)
(Ethernet)
(T3)
(ATM OC-3)
(ATM OC-48)
(ATM OC-96)
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Technology:
ATM Collaborative Computing
Desktop Video
Teleconference
Collaborative
Work Board
{Sample:
discussing
telemedical
application}
Live or stored
video image
transfer
{Sample:
tissue
sample from
patient}
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WDM Technology
 Pre-WDM:
– On a single strand of fiber, a point-to-point backbone link
would carry an OC-48 SONET signal at a single wavelength
 With WDM:
– On a single strand of fiber, a point-to-point backbone link
could carry multiple wavelengths (color bands) each
wavelength capable of carrying an OC-48 SONET signal
– Point-to-point throughput increases by a factor equal to
number of wavelengths accommodated by the WDM
equipment (4-8 in 1995)
– Next development trend in WDM is true optical networking via
optical cross connects where direct switching of optical
signals rather than time slots are performed
• Technology trend towards direct IP over WDM (bypassing
SONET equipment)
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Dense Wave Division Multiplexing
(DWDM) Cost Savings Versus SONET
 Take advantage of DWDM bit-rate independence and lack of
scaling capital expenditure as compared to SONET
Source: NGN - 1998 Conference Proceedings
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Technology:
Smart Cards
 Definition
– Plastic card with embedded silicon chip, 1 to 8 kilobytes of memory,
microprocessor, operating system in ROM (Read Only Memory).
 Capabilities
– Typical 1- 8Kbytes storage memory
– 32kByte chips being developed
– Price range now $2 to $25 per card (8Kb cards @$2)
 Medical Applications
– Military experimenting in triage situations (Dog Tag replacements)
– Insurance firms considering usage to
• reduce cost of accounting for medical
• future storage of patient records (assuming medical records
policy changes takes place)
 Progress
– Slow, with focus on billing/accounting
– Expected to take off in near future if policy on records change
 Future
– Could be useful in remote areas given inexpensive readers available
(current readers cost $300 +)
Reference: 3GI home page -http://www.3GI.com/
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Technology:
Wireless
Future Services
 Digital Voice and Data services
 Fax / Paging (two-way)
 Full High Speed E-mail / internet access
28.8 Kbps to n x 1.5 Mbps
Today’s Services
 Basic voice service
 Fax / Paging (one-way, two-way)
 Limited e-mail and internet access
9.6 Kbps to 14.4 Kbps
H.320
3G Wireless Switch
VLR/HLR/
AUC/EIR
n X DS1 or DS-3
Air Interface:
 3G
 CDMA Based

5 MHz RF Channels Base Station
PSTN
MSC
BSC
IP Gateway
Future
Corporate Intranet
Video
Server
Key:
VLR/
HLR/
AUC/EIR
n
X
DS
1
or
DS
-3
ISP
nX
Base Station
BSC
DS
1o
MSC
(Circuit Switched Cards)
rD
S3
PSTN
AUC
BSC
EIR
HLR
ISP
MSC
PSTN
VLR
Authentication Center
Base Station Controller
Equipment Identification Register
Home Location Register
Internet Service Provider
Mobile Switching Center
Public Switched Telephone Network
Visitor Location Register
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Technology: Other Available Services
Supporting Telemedical Applications
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Digital Subscriber Loop Services
Cable Modems
Frame Relay (predecessor for IP networks)
Wireless services (cellular, satellite, other)
Faster CPUs and memory storage explosion
Future growth of digital record keeping acceptance
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Technology:
Summary
 Technology is changing exponentially
 Internet services in urban areas represent a possible
outreach approach to the public with high bandwidth
offerings and ubiquity of the services
 Cost of bandwidth is dropping rapidly
 Telemedicine requires bandwidth which is now becoming
more affordable and available in urban areas
 Urban areas are ripe for considering new technology
applications as never before (e.g., wireless beyond the
pager and cell phone explosion
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Technology:
Recommendations
 Perform the cost-benefit tradeoff studies now to identify
longer term applications of new technologies in
telemedicine
 Due to the explosive nature of technology changes be
flexible in buying into the new offerings (2 to 3 year
contracts with options to change or get out; lease as much
as possible, don’t own your systems)
 Finally, encourage changes in insurance and legal
restrictions to allow more telemedicine as facts prove their
benefits.
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Contact Information

Frank E. Ferrante
Mitretek Systems, Inc.
Senior Manager, Systems Engineering and Acquisition
Center for Telecommunications and Advanced Technology
7525 Colshire Drive
McLean, VA 22102-7400
Ferrante@Mitretek.org
Tel: (703) 610-2905
fax: (703) 610-2984
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