Telemedicine Component

InterCare has included as part of the new technical innovations of ICE™ software: the design, implementation, and evaluation of a telemedicine-based approach for improving access to care and for collecting data on health disparities in diverse populations, using ConferenceXP from Microsoft, integrated with ICE™ electronic health record system developed by InterCare DX, Inc.

ConferenceXP takes advantage of recent advances in high-performance audio, video, and network technologies to seamlessly connect multiple distant participants in a rich immersive environment for distance conferencing, instruction, and collaboration. It also provides an extensible foundation for interactive collaborative environments and serves as a research platform for designing and implementing distance conferencing and learning applications.

The ConferenceXP platform includes the built-in ConferenceXP Client application, ConferenceXP services, and network components.

ConferenceXP Client

The ConferenceXP Client application delivers high-bandwidth, low-latency audio and video conferencing. This application takes advantage of Microsoft DirectShow and Windows Media high-quality audio and video codecs, as well as a custom low-latency networking stack (RTP). RTP is a peer-to-peer network transport that handles stream and message data. The custom RTP stack is specially designed for low-latency conferencing needs.

The ConferenceXP client supports the following:

• Full-screen video at 30 fps, with 250 ms latency
• 1394-FireWire cameras for fast, high-quality video capture
  (256 Kb/sec 320x240, 1024 Kb/sec 640x480)
• Up to five-way conferencing < 2 Mb/sec

The ConferenceXP client provides the following functionality:

• Enumerate venues and their properties.
• Enter a venue and start, view, and stop audio and video streams.
• Record and playback audio and video streams (not yet released).

ConferenceXP Services

ConferenceXP services consists of two main components that provide backend services to the ConferenceXP client:

Venue Service

The ConferenceXP Venue Service provides the services necessary to create and manage collaboration and learning venues, which are virtual spaces where users can participate in synchronous collaborative and learning activities. Venue Server interfaces are exposed as Web services.

Archive Service

The ConferenceXP Archive Service (not yet available) will enable the recording and playback of lectures and conferences. It will use Microsoft SQL Server 2000 as the archival platform for ConferenceXP. The Archive Service will be exposed in two ways:

• As a Web service that provides access to the services of the Recording system and the Playback system.
• As a .NET TCP remoting server to enable direct access for clients during playback to enable fast forward, pause, rewind, and so on.

Network Components

The key element of ConferenceXP is the use of Internet2 multicasting to deliver high-quality and low-latency streaming video.

Real-time Transport Protocol (RTP)

ConferenceXP audio and video streams are transported over an RTP network stack. RTP is a peer-to-peer network transport that handles stream and message data. It is designed for scenarios where latency is more important than guaranteed delivery.

Pipecleaner Network Diagnostics

The Pipecleaner utility provides the ability to monitor, log, and diagnose multicast network problems..

Unicast Bridge

The Unicast Bridge (not yet available) will enable retransmission of multicast signals over unicast. It is primarily designed for use as a backup transport when the multicast network in not working at the end-user site

For the telemedicine component, end users will use wireless tablet PCs connected to exchange messages, going over ICE™ Software Electronic Health Record system and physiological data acquisition program, and collaboratively manipulate the images and data, and perform these tasks using an innovative 3-D interactive paradigm. The first step will be a thorough characterization of the properties and performance requirements of 3-D video or graphics that pose additional challenges to the underlying networks. We believe that a ConferenceXP video data streams running in parallel to the EHR program will allow healthcare providers and paramedics to point out and discuss features of a patients’ clinical presentations and findings in a face-to-face, real-time dialogue.

For the video stream, InterCare DX, Inc., the developer of ICE™ software, have completed the first generation design of the system architecture to support real-time, 3D video transmission over the Internet using the ConferenceXP video data stream running parallel with the ICE™ software. The two key components are : (a) The server-side proxy that adapts the transmission scheme based on monitored network conditions. InterCare DX, considered joint optimization across source/channel coding and congestion control, and (b) The receiver-side video proxy that is responsible for synchronizing audio and video streams and adapting the playout buffer. 2-D and 3-D interactive visualization over a PC .

This is a new telemedicine framework that provides the functionality required for Rural Telemedicine. Equally important, the proposed framework includes the high reliability and performance that is required in order to operate a telemedicine system in the proposed environment. The framework is scalable to multiple sites (each with their own data models and schemas), and enables researchers to incorporate culturally-sensitive surveys.

We hope to achieve up to four remote client connections via each end-user site and attempt to increase this to up to seven clients separately intra-network. Reduction in the videoconferencing quality and instability will be addressed by adjusting parameters.

The framework is highly portable to multiple platforms, and is freely available to other researchers so that they can test and validate the results obtained in any proposed research environment.