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1 Copyright © 2007 BF Technologies, Inc. All Rights Reserved. Telemedicine Technology Summit October 30, 2007 UC Davis Medical.

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Presentation on theme: "1 Copyright © 2007 BF Technologies, Inc. All Rights Reserved. Telemedicine Technology Summit October 30, 2007 UC Davis Medical."— Presentation transcript:

1 1 Copyright © 2007 BF Technologies, Inc. All Rights Reserved. Telemedicine Technology Summit October 30, 2007 UC Davis Medical Center

2 © 2007 BF Technologies, Inc. All Rights Reserved. 2 Requirement for fixed communication lines: Requirement for fixed communication lines: For high-speed transmission For high-speed transmission For error-free transport For error-free transport Uses triplex, or triple ISDN lines Uses triplex, or triple ISDN lines System requires fixed stations on both ends: System requires fixed stations on both ends: Fixed video camera sending station Fixed video camera sending station Fixed, expensive base station Fixed, expensive base station → Consulting MD must travel to base station. Typical Video Conferencing Technology ER MD High-quality Video }

3 © 2007 BF Technologies, Inc. All Rights Reserved. 3 ER MD Requirement for fixed communication lines: Requirement for fixed communication lines: For high-speed transmission For high-speed transmission For error-free transport For error-free transport Uses triplex, or triple ISDN lines Uses triplex, or triple ISDN lines System requires fixed stations on both ends: System requires fixed stations on both ends: Fixed video camera sending station Fixed video camera sending station Fixed, expensive base station Fixed, expensive base station → Consulting MD must travel to base station. Typical Video Conferencing Technology High-quality Video }

4 © 2007 BF Technologies, Inc. All Rights Reserved. 4 AccessVideo Site-Independent Technologies Eliminates requirement for fixed lines Eliminates requirement for fixed lines Physician Access ANYTIME, ANYWHERE Physician Access ANYTIME, ANYWHERE Utilizes: Utilizes: Internet Internet Wireless Broadband Wireless Broadband Advanced SMPTE VC1 Video (Broadcast Quality) Advanced SMPTE VC1 Video (Broadcast Quality) Advanced IP Video Error Correction & QoS Technologies provide highest quality video transport Advanced IP Video Error Correction & QoS Technologies provide highest quality video transport AccessVideo Telemedicine Systems Deployed since 2003 AccessVideo Telemedicine Systems Deployed since 2003 MD ER MD Partnering: Partnering: UCSD Cal-(IT)² UCSD Cal-(IT)² Clinical Trials Clinical Trials Qualcomm Qualcomm Early EVDO Alpha Tester Early EVDO Alpha Tester Verizon Wireless Verizon Wireless Broadband Wireless Beta Tester Broadband Wireless Beta Tester

5 © 2007 BF Technologies, Inc. All Rights Reserved. 5 AccessVideo Telemedicine System Deployments by State New York Wisconsin Montana Arizona California Nevada Florida Colorado Minnesota Texas

6 © 2007 BF Technologies, Inc. All Rights Reserved. 6 Key Requirements for Telemedicine Site Independence Site Independence Full HIPAA Compliance (NOT just encryption) Full HIPAA Compliance (NOT just encryption) Precision Video & Audio Precision Video & Audio Smooth, Full 30 fps: NO JITTER Smooth, Full 30 fps: NO JITTER Cannot Guess or Interpolate Lost Frames Cannot Guess or Interpolate Lost Frames Video Quality Indicators Video Quality Indicators Remote Control of Camera Remote Control of Camera Adheres to FDA Requirements: 510K Certification Adheres to FDA Requirements: 510K Certification Integrated PACS Server, DICOM Viewer Integrated PACS Server, DICOM Viewer  Telemedicine is NOT Video Conferencing

7 © 2007 BF Technologies, Inc. All Rights Reserved. 7 Common Misconceptions About Telemedicine Telemedicine is NOT the same as Video Conferencing Telemedicine is NOT the same as Video Conferencing Video Conferencing does not require precise video Video Conferencing does not require precise video Low-Latency not as important in telemedicine Low-Latency not as important in telemedicine Video Conferencing sacrifices video accuracy for lower latency Video Conferencing sacrifices video accuracy for lower latency HIPAA Compliance is NOT ONLY Video Encryption HIPAA Compliance is NOT ONLY Video Encryption Requires Audio Trails Requires Audio Trails Intruder Alerts Intruder Alerts Password Protection: both for access and to protect passwords Password Protection: both for access and to protect passwords FDA Certification MAY BE REQUIRED FDA Certification MAY BE REQUIRED Required when “used to diagnose a patient” Required when “used to diagnose a patient” Physicians may not be near a terminal Physicians may not be near a terminal Site Independence is a REQUIREMENT Site Independence is a REQUIREMENT The Internet was NOT DESIGNED for VIDEO The Internet was NOT DESIGNED for VIDEO Best Effort, NO PRIORITIES for Telemedicine: Packet Loss Best Effort, NO PRIORITIES for Telemedicine: Packet Loss Requires special video transport technology Requires special video transport technology

8 © 2007 BF Technologies, Inc. All Rights Reserved. 8 HIPAA RULES: Summary HIPAA Administrative Simplification Regulation Text, March CFR Parts 160, 162, and 164 § Administrative safeguards § Administrative safeguards (5)(ii)(c) Log-in monitoring (5)(ii)(c) Log-in monitoring (5)(ii)(d) Password management (Password Encryption) (5)(ii)(d) Password management (Password Encryption) § Technical safeguards § Technical safeguards (a) Access Control (a) Access Control Access Authorization (SSL Conditional Access) Access Authorization (SSL Conditional Access) Encryption & Decryption (Video & Audio) Encryption & Decryption (Video & Audio) (b) Audit Controls (b) Audit Controls Report logs Report logs Log-in Monitoring Log-in Monitoring Intruder Alerts Intruder Alerts (c) Integrity (c) Integrity Method to authenticate date Method to authenticate date Insure that data is correct Insure that data is correct (d) Person or Entity Authentication (d) Person or Entity Authentication SSL Conditional Access (128-bit keys) SSL Conditional Access (128-bit keys) Password Protection (Encryption) Password Protection (Encryption) (e) Transmission Security (e) Transmission Security Integrity (Insure data is correct: ClearQoS™) Integrity (Insure data is correct: ClearQoS™) Security (Video, Audio & DICOM Encryption & Decryption) Security (Video, Audio & DICOM Encryption & Decryption)

9 © 2007 BF Technologies, Inc. All Rights Reserved. 9 HIPAA RULES (con’t) HIPAA Administrative Simplification Regulation Text, March 2006 § Administrative safeguards. (a) A covered entity must, in accordance with § : § Administrative safeguards. (a) A covered entity must, in accordance with § : “(5)(ii) Implementation specifications. Implement: (C) Log-in monitoring (Addressable). Procedures for monitoring log-in attempts and reporting discrepancies.” § Technical safeguards. A covered entity must, in accordance with § : § Technical safeguards. A covered entity must, in accordance with § : “ (b) Standard: Audit controls. Implement hardware, software, and/or procedural mechanisms that record and examine activity in information systems that contain or use electronic protected health information.” “ (b) Standard: Audit controls. Implement hardware, software, and/or procedural mechanisms that record and examine activity in information systems that contain or use electronic protected health information.”

10 © 2007 BF Technologies, Inc. All Rights Reserved. 10 Telemedicine Vs. Video Conferencing Must Optimize Lower Priority Telemedicine Video Accuracy: - Full, Constant 30 frames/sec - Full, Constant 30 frames/sec - Minimize Jitter - Minimize Jitter - Minimize transmission loss - Minimize transmission loss - Loss Indicators - Loss Indicators Latency not critical: Audio primarily unidirectional Video Conferencing Low Latency Can Interpolate Video

11 © 2007 BF Technologies, Inc. All Rights Reserved. 11 Quality & Compatibility Technology Tradeoffs Telemedicine System: AccessVideo Telemedicine System: AccessVideo Video quality & accuracy are highest priorities Video quality & accuracy are highest priorities Site independence w/ robust transport is critical Site independence w/ robust transport is critical Windows Media Encoding (SMPTE VC1) instead of H.264 Windows Media Encoding (SMPTE VC1) instead of H.264 Used by broadcasters (NBC) → high quality at low bit rate Used by broadcasters (NBC) → high quality at low bit rate Fixed frame rate, fps, for smooth accurate motion Fixed frame rate, fps, for smooth accurate motion 30 to 40% MORE efficient than Baseline H.264 → Lower Bit rate, Better Video 30 to 40% MORE efficient than Baseline H.264 → Lower Bit rate, Better Video Encryption Protocol → HIPAA Security for Site Independence Encryption Protocol → HIPAA Security for Site Independence Error Correction → Accuracy for Site Independence Error Correction → Accuracy for Site Independence Video Conferencing System Video Conferencing System Low delay & interoperability trumps video quality & accuracy Low delay & interoperability trumps video quality & accuracy Audio quality & low bit rate more important than video Audio quality & low bit rate more important than video H.264 allows variable frame rate for low bit rate → jerky video H.264 allows variable frame rate for low bit rate → jerky video SIP for broader interoperability → no link calibration support SIP for broader interoperability → no link calibration support No error correction → broadens interoperability, reduces delay No error correction → broadens interoperability, reduces delay Error concealment hides loss w/ low delay → corrupts video Error concealment hides loss w/ low delay → corrupts video AccessVideo offers H.264 & SIP as compatibility option AccessVideo offers H.264 & SIP as compatibility option

12 © 2007 BF Technologies, Inc. All Rights Reserved. 12 System Layers & Interoperability Error Correction: FEC vs. ARQ vs. None No General Compatibility or Interoperability Remote Camera Control Not well standardized (many standards) Secure Access Control Not generally interoperable Error CorrectionNot generally interoperable (ARQ, FEC, ProMEG) EncryptionMany standards: AES, DES, RC4, etc. Generally Agreed-upon Standards Video Encoding Format H.264 (MPEG4-AVC Baseline Profile) vs. SMPTE VC1 (High Profile, Broadcast & PC) Connection ProtocolSIP (vs. H.323) Networking LayerInternet (vs. Pt-Pt Links, ISDN, Frame-Relay) Interoperability for Telemedicine (HIPAA & Diagnostic): → Compatibility Requirement Across ALL 7 System Layers Level of Telemedicine Standards

13 © 2007 BF Technologies, Inc. All Rights Reserved. 13 AccessVideo Video Transport Technologies 6 Pending US Video Technology Patents 6 Pending US Video Technology Patents Advanced Video QoS Technologies Advanced Video QoS Technologies High resilience to network losses & congestion High resilience to network losses & congestion Feedback & Feed-forward Error Correction Feedback & Feed-forward Error Correction Eliminates nearly all Internet & Wireless packet loss Eliminates nearly all Internet & Wireless packet loss Provides Best Possible Video Accuracy Provides Best Possible Video Accuracy Automatic & Dynamic Calibration and Adjustments Automatic & Dynamic Calibration and Adjustments Optimizes Video Quality, Resolution, Bitrate Optimizes Video Quality, Resolution, Bitrate Minimizes Delay Minimizes Delay Video Loss Indicator Video Loss Indicator Broadband Wireless Access Technologies Broadband Wireless Access Technologies Promotes Site Independence Promotes Site Independence Link Aggregation Link Aggregation Patent-pending technology binds together multiple low-cost links Patent-pending technology binds together multiple low-cost links Better video resolution at low cost Better video resolution at low cost

14 © 2007 BF Technologies, Inc. All Rights Reserved. 14

15 © 2007 BF Technologies, Inc. All Rights Reserved. 15 Summary Telemedicine Systems have Unique Requirements from Video Conference Systems Telemedicine Systems have Unique Requirements from Video Conference Systems Site Independence Site Independence PACS & DICOM Capability PACS & DICOM Capability HIPAA Compliance HIPAA Compliance FDA Compliance FDA Compliance AccessVideo Telemedicine Systems AccessVideo Telemedicine Systems Designed from ground up for telemedicine Designed from ground up for telemedicine Site Independence Site Independence Smooth, Accurate Diagnostic-quality Video & Audio Smooth, Accurate Diagnostic-quality Video & Audio Telemedicine-specific features (Battery Backup, etc.) Telemedicine-specific features (Battery Backup, etc.) Full HIPAA & FDA Compliance Full HIPAA & FDA Compliance

16 © 2007 BF Technologies, Inc. All Rights Reserved. 16 Extra Slides

17 © 2007 BF Technologies, Inc. All Rights Reserved. 17 STRokE DOC / AccessVideo Related Publications & Clinical Trials Poster Presentation: Meyer BC, Chacon MR, Jensen M, Werner J, Haase G: Prospective Reliability of the STRokE DOC Telemedicine System When assessed by Telemedicine- Naïve Stroke Practitioners. Abstract. Stroke 2007; 38: 496. Meyer BC, Chacon MR, Jensen M, Werner J, Haase G: Prospective Reliability of the STRokE DOC Telemedicine System When assessed by Telemedicine- Naïve Stroke Practitioners. Abstract. Stroke 2007; 38: 496. Meyer BC, Lyden PD, Al-Khoury L, Cheng Y, Fellman R, Beer J, Henthorn T, Zivin JA, Raman R: Prospective Reliability & Validity of the “Stroke Team Remote Evaluation using a Digital Observation Camera (STRokE DOC)” Wireless/ Site Independent Telemedicine Consultation System Using the NIHSS and mNIHSS. Abstract. Stroke 2004; 35: 294. Meyer BC, Lyden PD, Al-Khoury L, Cheng Y, Fellman R, Beer J, Henthorn T, Zivin JA, Raman R: Prospective Reliability & Validity of the “Stroke Team Remote Evaluation using a Digital Observation Camera (STRokE DOC)” Wireless/ Site Independent Telemedicine Consultation System Using the NIHSS and mNIHSS. Abstract. Stroke 2004; 35: 294. Meyer BC, Lyden PD, Rao R, Raman R: Reliability of the Interpretation of Head CT images via a Prototype Wireless Telemedicine System. Abstract. Stroke 2004; 35:261. Meyer BC, Lyden PD, Rao R, Raman R: Reliability of the Interpretation of Head CT images via a Prototype Wireless Telemedicine System. Abstract. Stroke 2004; 35:261. Meyer BC, Lyden PD, Werner JD, Fellman R, Beer J, Rao R, Raman R, Zivin JA: Stroke Team Remote Evaluation using a Digital Observation Camera (STRokE DOC) Telemedicine System: Methods. Abstract. Stroke 2005; 36:494. Meyer BC, Lyden PD, Werner JD, Fellman R, Beer J, Rao R, Raman R, Zivin JA: Stroke Team Remote Evaluation using a Digital Observation Camera (STRokE DOC) Telemedicine System: Methods. Abstract. Stroke 2005; 36:494.Papers: Meyer BC, Lyden PD, Al-Khoury L, Cheng Y, Raman R, Fellman R, Rao R, Zivin JA. “Prospective Reliability of the STRokE DOC Wireless/ Site Independent Telemedicine System. Neurology. 2005;64: Meyer BC, Lyden PD, Al-Khoury L, Cheng Y, Raman R, Fellman R, Rao R, Zivin JA. “Prospective Reliability of the STRokE DOC Wireless/ Site Independent Telemedicine System. Neurology. 2005;64: Meyer BC, Raman R, Rao R, Fellman RD, Beer J, Werner J, Zivin JA, Lyden PD: The “Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC)” Telemedicine Clinical Trial Technique: “Video Clip, Drip and/ or Ship”. In Press. Int Journal Stroke. November Meyer BC, Raman R, Rao R, Fellman RD, Beer J, Werner J, Zivin JA, Lyden PD: The “Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC)” Telemedicine Clinical Trial Technique: “Video Clip, Drip and/ or Ship”. In Press. Int Journal Stroke. November Meyer BC, Raman R, Chacon MR, Jensen M, Werner J: Prospective Reliability of the STRokE DOC Telemedicine System When assessed by Telemedicine- Naïve Stroke Practitioners. Submitted for Publication to Stroke. October Meyer BC, Raman R, Chacon MR, Jensen M, Werner J: Prospective Reliability of the STRokE DOC Telemedicine System When assessed by Telemedicine- Naïve Stroke Practitioners. Submitted for Publication to Stroke. October Scott PA, Starkman S, Choi JY, et al. Provider support systems for acute stroke. National Institute of Neurological Disorders and Stroke, proceedings of a national symposium on improving the chain of recovery for acute stroke in your community. Task Force Reports. NIH Publication No Bethesda, MD: National Institutes of Health Department of Health and Human Services, Office of Communications and Public Liaison; 2003: Available at: Scott PA, Starkman S, Choi JY, et al. Provider support systems for acute stroke. National Institute of Neurological Disorders and Stroke, proceedings of a national symposium on improving the chain of recovery for acute stroke in your community. Task Force Reports. NIH Publication No Bethesda, MD: National Institutes of Health Department of Health and Human Services, Office of Communications and Public Liaison; 2003: Available at:

18 © 2007 BF Technologies, Inc. All Rights Reserved. 18 Federal Regulations Health Insurance Portability and Accountability Act of 1996 (HIPAA) Health Insurance Portability and Accountability Act of 1996 (HIPAA) Specific technical requirements Specific technical requirements Protection of data integrity and security Protection of data integrity and security Food and Drug Administration Regulations (FDA) Food and Drug Administration Regulations (FDA) Medical Devices REQUIRE 510K Certification Medical Devices REQUIRE 510K Certification Medical Device Definition (excerpt): Medical Device Definition (excerpt): "an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is: intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or …” intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or …”

19 © 2007 BF Technologies, Inc. All Rights Reserved. 19 Quality & Compatibility Technology Tradeoffs Video Encoding: Video Encoding: MPEG4-VC1 (Windows Media Encoding) MPEG4-VC1 (Windows Media Encoding) Used by broadcasters (NBC) Used by broadcasters (NBC) MPEG4-AVC (H.264) MPEG4-AVC (H.264) Primarily for video conferencing & security cameras Primarily for video conferencing & security cameras Session Protocol: Session Protocol: ClearQoS™ Auto-adaptive Link Protocol ClearQoS™ Auto-adaptive Link Protocol SIP (Session Initiation Protocol) SIP (Session Initiation Protocol) Error Handling Error Handling ClearQoS™ Error Correction & QoS Features ClearQoS™ Error Correction & QoS Features Error Concealment Error Concealment None None AccessVideo offers H.264/SIP compatibility option AccessVideo offers H.264/SIP compatibility option

20 © 2007 BF Technologies, Inc. All Rights Reserved. 20 Video Encoding MPEG4-VC1 (Windows Media Encoding) MPEG4-VC1 (Windows Media Encoding) Used by professional broadcasters (NBC) Used by professional broadcasters (NBC) Used in DVDs (eg, Terminator in HD) Used in DVDs (eg, Terminator in HD) Standard feature w/ AccessVideo Standard feature w/ AccessVideo MPEG4-AVC (H.264) MPEG4-AVC (H.264) Video conferencing & security cameras Video conferencing & security cameras Used where bitrate is limited Used where bitrate is limited Automatically variable frame-rate Automatically variable frame-rate Used where choppy video is OK Used where choppy video is OK Available as an option for interoperability Available as an option for interoperability

21 © 2007 BF Technologies, Inc. All Rights Reserved. 21 Session Protocols ClearQoS™ Auto-adaptive Link Protocol ClearQoS™ Auto-adaptive Link Protocol Automatic Link Measurement & Calibration Automatic Link Measurement & Calibration Optimizes Session Parameters Optimizes Session Parameters Best video resolution per Internet connection Best video resolution per Internet connection Lowest delay with optimal loss resilience Lowest delay with optimal loss resilience Standard feature w/ AccessVideo Standard feature w/ AccessVideo SIP (Session Initiation Protocol) SIP (Session Initiation Protocol) Industry Standard Industry Standard Available as a compatibility option Available as a compatibility option

22 © 2007 BF Technologies, Inc. All Rights Reserved. 22 Error Handling ClearQoS™ Patent-Pending Technologies ClearQoS™ Patent-Pending Technologies ClearQoS ARQ: dynamic error Correction ClearQoS ARQ: dynamic error Correction ClearQoS FEC: robust forward error correction ClearQoS FEC: robust forward error correction Other ClearQoS features Other ClearQoS features Internet clock synchronization for delay minimization Internet clock synchronization for delay minimization Jitter removal Jitter removal Packet shaping for congestion avoidance Packet shaping for congestion avoidance Dynamic Out-of-Order packet resequencing Dynamic Out-of-Order packet resequencing Standard feature with AccessVideo Standard feature with AccessVideo Error Concealment Error Concealment May be inappropriate for Telemedicine May be inappropriate for Telemedicine Not available with AccessVideo Not available with AccessVideo


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