Pediatric Informatics: Computer Applications in Child Health (Health ...

282 C. Sable et al.
Table 20.3 Telemedicine bandwidth options
Bandwidth Cost Availability
POTS Plain Old
Telephone Systems
14.4 Kbps Low Universal
ISDN Integrated service 128 Kbps
Low Wide
Digital Network
(three lines
commonly
bonded)
T1 Terrestrial 1 1.54 Mbps Low to
Moderate
Wide
SDSL/ADSL Synchronous/ Variable (128 Kbps Low Variable Increasing
Asynchronous Digital
Subscriber Lines
to 1 Mbps)
ATM Asynchronous
Transfer Mode
Very high High Variable
Satellite Very high High Variable
Internet Variable Low Universal Software/
bandwidth/
security limitations
Wireless Low Unknown Limited/increasing
and/or interaction that can be perceived and used by a user for clinical purposes).
The former may be improved by reducing noise or repeating the signal along the
transmission path, and the latter may be improved through better rendering tools
(higher amplitude, resolution, and contrast).
Many options for connectivity are available, including low and high speed
telephone lines, cable, digital subscriber lines (DSL) and wireless (Table 20.3).
The rate of data transmission (bandwidth) affects the time required for a “store
and forward” file to be sent (hours on a phone connective vs seconds for a highspeed
connection. Bandwidth clearly impacts the quality of live videoconferencing
because of the required interactivity. Bandwidths of 384 Kbps and higher provide
acceptable frame rates (20–30/s) for live videoconferencing, while Internet-based
connections may require slightly higher bandwidth for the same quality. Routers
that allow transmission of data to multiple destinations simultaneously are available
and can bridge alternative types of connections between a sender and receiver.
There are myriad vendors and choices for each component. Some technical
expertise is required from in-house engineers or telemedicine consultants to ensure
the computers, inputs, and telephone lines work together properly. This requires
coordination between computer hardware and software manufacturers, local and
long distance telephone companies, and input device vendors.
20.3 Telemedicine Personnel and Organization
Personnel support for installation, use and maintenance is essential, including
a telemedicine coordinator who understands telemedicine technology, connectivity
options, and how medical practices and hospital administrations work.