23.5 Issues to be Resolved

Because telemedicine involves crucial information exchange over communication networks, security has always been a prominent concern. Security measures should be provided at the network and access levels, and a separate, private network often is required. As seen in the examples presented, data transmitted across a telemedicine system can be huge files such as high-resolution images, or time-critical information, including video streams and real-time physiological signals. A major bottleneck in using wireless Internet for applications like these is the low data transfer rate, because bandwidth provided by wireless communication is still generally lower than that provided by wired communication. This problem can even defeat the purpose of using telemedicine if the situation is not evaluated carefully before system implementation. One solution is to compress the data before transmission. Various lossy and lossless compression algorithms specifically for telemedicine already have been developed. In cases with lossy compression, the decompressed data should contain enough information in order to be qualified for proper clinical diagnosis. All these challenges become even more complicated as new wireless and medical technologies continue to emerge.

Inevitably, we are lead to the point where standards for medical information exchange are needed to ensure reliability, interoperability, and widespread use of telemedicine. Medical equipment industries and health care organizations have attempted to develop different standards, such as Digital Imaging and Communications (DICOM) and Health Level Seven (HL7), over the past few decades. ^[62] Despite all these efforts, there is still a need for a set of standards that are globally accepted. The IEEE 1073, currently still under construction, is a set of standards for medical equipment communication. Among these, transport standards for wireless communication also are investigated. The third generation of cellular communication is on its way. Data rate will be significantly higher, and 3G devices will have multimedia capability. This will undoubtedly bring telemedicine into a new era. The major challenge here is merging it with the existing telemedicine systems and at the same time conforming to the standards.

^[62]Blair, J.S., Overview of Standards Related to the Emerging Health Care Information Infrastructure, in The Biomedical Engineering Handbook, 2nd ed., Bronzino, J.D., Ed., CRC Press, Boca Raton, FL, 2000.