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Telehealth
Technology
The
primary Telehealth network in West Virginia is an ISDN (Integrated
Services Digital Network) video network. However, the CAMC
Center for Telehealth has added, with a project grant funded
by the USDA, Telehealth sites using ATM (Asynchronous Transfer
Mode) protocols on T-1 (1.54 Megabytes) high speed telecommunications
lines. Along with ATM and ISDN, CAMC Center for
Telehealth has also begun to deploy IP (Internet Protocol)
connected video.
ISDN
(H.320) is a "dial-up" technology that was introduced more
than 15 years ago and has been used for data and video for
more that 10 years.
It is a very stable technology and has been used
across the world for Telehealth applications.
The biggest advantage of ISDN is that it is very
widely available and a well understood technology.
It does require dedicated telecommunications circuits
and operational costs are usage based technology.
ATM
(H.321) is an "always on" technology.
It is a broadband backbone delivery protocol designed
with the Video application in mind. ATM offers "Quality of Service" architecture
that allows efficient bandwidth sharing with various applications.
ATM allows sharing of the bandwidth with other IP
applications such as Teleradiology, Internet Access.
It requires a specially provisioned T-1 telecommunication
circuit to the local site much like ISDN does.
IP
(H.323) is also an "always on" technology.
IP networks have been in use since the start of the
Internet. The technology has been in use more than
20 years and is undergoing constant upgrading. With the development of Broadband connections
and the advent of "Switched Ethernet" technology, the deployment
of Voice and Video over IP (VoIP) has now come to fruition. IP offers many of the advantages of ATM
technology, that is sharing of IP based applications with
a full time voice and video.
Because it is a "connectionless protocol" the "Internet"
can be used to connect organizations that do not have direct
(hard wired) links with each other. By using VPN (Virtual Private Network)
technology and data encryption, all patient data and teleconsultations
can traverse the "Public" Internet without revealing this
information. In addition, various telecommunication
delivery infrastructures can be used.
Standard Frame Relay, Point to Point T-1, DSL (Digital
Subscriber Line), and Cable Modem circuits can be used to
carry IP video.
The
CAMC Center for Telehealth has also added an ATM/ISDN/IP
Gateway to allow the use of all three network infrastructures.
This Gateway allows connection between ISDN (H.320), ATM
(H.321), and IP (H.323) sites.
The "transcoding" done within the Gateway allows
complete Telehealth coverage across the various network
technologies used by the many different organizations participating
in Telehealth activities in West Virginia.
CAMC
Center for Telehealth has also participated in a research
project to improve the health of (CHF) Congestive Heart
Failure patients using telecommunications. CHF patients status is monitored in their
home. These
devices use paging satellite technology to automatically
transmit information to CAMC. This information is reviewed daily allowing
precise control of the patients health status.
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