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...making Linux just a little more fun! | Linux to Save the Health of the World By Janine M Lodato

Abstract:In Order to deliver a workable and affordable telemed system we need to break away from all conventions:

- replace telephone-line based connectivity with data over power-line technology; this is readily available all over the world and at a lower cost.
- replace the Windows environment with Linux due to its lower cost and higher reliability, simplicity
- replace the keyboard- and and mouse-based human-to-machine interface with voice recognition.

This will be done by a group of dedicated and courageous teams outlined below, but they do need one more consortium member: a Linux implementation team. This article is written with the aim to find such Linux team.

## I. Statement of Purpose

TelMedForte is a project formed as a consortium of:

- a large MasterASP-BSP (=Application Services Provider / Business Services Provider)
- experienced entrepreneurs and professionals located in the Silicon Valley of California
- a VAR for Siemens medical group
- a VAR for Siemens data-over-power-line division
- a small high tech comapany offering medical e-record systems

The goal of TelMedForte is to become the leader in the design, integration and implementation of advanced telemedicine solutions enabled by power line and wireless broadband technologies, and through leveraging existing wireline facilities.

The financial support for all the various telemedicine implementations efforts in the rural communities will be based on USDA Loan/Grant made available to rural communities under the USDA large solicitation: Distance Learning and Telemedicine Loan and Grant Program.

In each community the above consortium teams up with the local medical facilities to jointly offer the community-wide collaborative telemed system and distance-learning system.

TelMedForte will also provide integrated solutions for the medical facilities of each community by integrating telemedicine applications and the facilities management applications of MasterASP-BSP. This will bring significant additional revenues to MasterASP-BSP.

## II. Background and Market

For TelMedForte, telemedicine is the examination, diagnosis and treatment of health-care consumers by health care service providers when direct, face-to-face interaction is inconvenient, costly, inefficient or ineffective for the consumer or purchaser of healthcare services. Also included is telemonitoring of medical devices. Broadband deployment and adoption has proceeded at a blinding rate over the past few years. However, there is market of at least 30 million health care consumers in the U.S. alone without broadband access. Several key factors make TelMedForte's offering the right technology at the right time:

- Gartner forecasts the number of power line broadband lines in service worldwide will be 200,000 by end-2003 and will hit the 1 million mark by 2006 with equipment revenues exceeding $200M.
- Cost of bandwidth continues to decrease. The cost to go by each home using power line broadband communications is significantly less than Cable or DSL. There are a number of medium-voltage power-line broadband trials that have been successful and the technology is available today. Also, the regulatory environment is favorable. TelMedForte provides a 5-10x improvement in performance, at substantially lower costs, over available power line carrier (PLC) solutions in the market.
- Payer issues have been resolved using the MedStage e.Health web-based telemedicine solution from Siemens Medical Health Services Corporation.
- Videoconferencing equipment and applications have become affordable, and standardized. Use of videoconferencing for home health care has demonstrated that provider resources can be managed more efficiently while also improving quality of care.
- Sharing of medical images has been made easier through the use of Siemens syngo® technology
- Technology is available for telemonitoring using Siemens Hot Key wireless modules
- Additional applications will also be included such as electronic medical records (Sensitron), e-visit (Rao) etc

## III. TelMedForte Solutions

TelMedForte will create integrated solutions including multimedia communications to regional and teaching hospitals, enhanced communications with medical devices (including Siemens "syngo" enabled and Hot Key), delivery of broadband to the homes of patients using 216 Mbps medium-voltage networks (over the existing power grid) and HomePlug standard in-home power line modems, provision of telemedicine software solutions (MedStage), in-home devices to support the provision of telemedicine, plus in-home and mobile telemonitoring of medical devices using Hot Key or other wireless modules.

## IV. TelMedForte Technology

The TelMedForte system includes components to distribute a high capacity connection over the medium-voltage grid to multiple end-user gateways located at or near neighborhood transformers. Consumer premises are linked into the network with either low-voltage HomePlug, Bluetooth or 802.11x modems or a combination of them.

This power line-wireless combination is useful as a ubiquitous network for in-home and mobile medical device monitoring (e.g., using Hot Key GPS with the appropriate wireless modules).

Alternative power line broadband technologies are also starting to appear in the market. These are all based on traditional balanced-line approaches and operate in the 2-40MHz frequency ranges. These solutions are inherently limited in performance in terms of network capacity and susceptibility to noise interference, compared to the TelMedForte system.

## V. Competition

Siemens is already in the telemedicine market with MedStage®, but they are not going after the Rural communities which will be the major market for TelMedForte. In fact TelMedForte will be a VAR for Siemens. Existing Cable and DSL access technologies are only infrastructures not as much competition to the TelMedForte solution. In fact they can be a supplier of MAN services to TelMedForte in each community. TelMedForte with HomePlug and wireless solutions beats both in terms of performance - higher bandwidth, symmetric operation, low-latency - and cost - 2-5x lower cost in terms of installed infrastructure.

## VI. Strategic Relationships

As a VAR of Siemens solutions, TelMedForte will integrate solutions from a number of different Siemens divisions including MedStage from Med, Hot Key and wireless module technology from ICM, and low-voltage Powerline modems from Efficient Networks (a Siemens company). Broadband access is an enabler to video and image based telemedicine applications. In order to effectively market telemedicine in rural communities, TelMedForte will leverage government and other grant funding and loan programs for equipment and broadband deployment. TelMedForte will also provide integrated solutions for the medical facilities of each community by integrating telemedicine applications and the facilities management applications of MasterASP-BSP. TelMedForte will add additional value to the System Integrator (SI) and VAR value chains by leveraging the expertise of its management team in product marketing and support. These elements converge to create a powerful mixture of enabling technologies, expertise and implementation of new products and services. An example of the new generation of services and the strategic VAR relationships capable of adapting and developing new services at Layers 6-7 into vertical markets include TelMedForte forming localized consortia with:

- Local health care providers
- Regional and teaching hospitals
- Application Service Providers currently servicing the local health care providers
- Local power companies; and,
- Internet Service Providers (ISPs) to provide seamless end-to-end telemedicine solutions. Siemens Global Services will also be a VAR of TelMedForte's packaged telemedicine solutions.

Although market estimates vary widely, one estimate of the global demand for telehealth services is $1.125 trillion. TelMedForte will support these offerings with a comprehensive set of business case information and tools to help its customers develop winning strategies for their broadband telemedicine service offerings.

Copyright © 2003, Janine M Lodato. Copying license http://www.linuxgazette.com/copying.html
Published in Issue 92 of Linux Gazette, July 2003

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