Telemed J E Health - An investigation into the use of 3G mobile communications to provide telehealth services in rural KwaZulu-Natal.

Tópicos

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Resumo

CKGROUND: We investigated the use of third-generation (3G) mobile communications to provide telehealth services in remote health clinics in rural KwaZulu-Natal, South Africa.MATERIALS AND METHODS: We specified a minimal set of services as our use case that would be representative of typical activity and to provide a baseline for analysis of network performance. Services included database access to manage chronic disease, local support and management of patients (to reduce unnecessary travel to the hospital), emergency care (up to 8h for an ambulance to arrive), e-mail, access to up-to-date information (Web), and teleclinics. We made site measurements at a representative set of health clinics to determine the type of coverage (general packet radio service [GPRS]/3G), its capabilities to support videoconferencing (H323 and Skype? [Microsoft, Redmond, WA]) and audio (Skype), and throughput for transmission control protocol (TCP) to gain a measure of application performance.RESULTS: We found that none of the remote health clinics had 3G service. The GPRS service provided typical upload speed of 44 kilobits per second (Kbps) and download speed of 64Kbps. This was not sufficient to support any form of videoconferencing. We also observed that GPRS had significant round trip time (RTT), in some cases in excess of 750ms, and this led to slow start-up for TCP applications.CONCLUSIONS: We found audio was always so broken as to be unusable and further observed that many applications such as Web access would fail under conditions of very high RTT. We found some health clinics were so remote that they had no mobile service. 3G, where available, had measured upload speed of 331Kbps and download speed of 446Kbps and supported videoconferencing and audio at all sites, but we frequently experienced 3G changing to GPRS. We conclude that mobile communications currently provide insufficient coverage and capability to provide reliable clinical services and would advocate dedicated wireless services where reliable communication is essential and use of store and forward for mobile applications.

Resumo Limpo

ckground investig use thirdgener g mobil communic provid telehealth servic remot health clinic rural kwazulunat south africamateri method specifi minim set servic use case repres typic activ provid baselin analysi network perform servic includ databas access manag chronic diseas local support manag patient reduc unnecessari travel hospit emerg care h ambul arriv email access uptod inform web teleclin made site measur repres set health clinic determin type coverag general packet radio servic gprsg capabl support videoconferenc h skype microsoft redmond wa audio skype throughput transmiss control protocol tcp gain measur applic performanceresult found none remot health clinic g servic gprs servic provid typic upload speed kilobit per second kbps download speed kbps suffici support form videoconferenc also observ gprs signific round trip time rtt case excess ms led slow startup tcp applicationsconclus found audio alway broken unus observ mani applic web access fail condit high rtt found health clinic remot mobil servic g avail measur upload speed kbps download speed kbps support videoconferenc audio site frequent experienc g chang gprs conclud mobil communic current provid insuffici coverag capabl provid reliabl clinic servic advoc dedic wireless servic reliabl communic essenti use store forward mobil applic

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