V.M. Levanov, O.V. Perevedentsev, O.I. Orlov

With the integration of telemedicine (TM) technology in the health care system, a number of issues related to the optimal use of expensive hardware and software systems arise, including use of mobile telemedicine systems (MTMK). Multifunctional MTMK are an effective means to increase efficiency and accessibility of high quality medical care to eliminate health consequences of disaster and provide emergency medical assistance to victims of accidents and other emergency situations. The most important parameter of the effectiveness of MTMK in such situations is to reduce waiting time before a medical assistance is provided to the victim. In order to reduce the duration of TM-consultations with virtually no change to the volume of transmitted information, the authors propose to change the rules of TM-consultation through a series of processes executed simultaneously. First of all, it is possible to register a number of physiological parameters such as blood pressure and temperature at the same time. Secondly, the duration of TM-consultation can be reduced if registration of patient's health parameters, transmission of data blocks to expert and an expert analysis of the data are executed simultaneously. In this case medical data should be accumulated on the side of the TM complex expert and transmission of next data block should begin immediately after completion of its registration. A remote expert can start analysis of each incoming data block before the registration of last data block has been finished by subscriber. The highest possible saving of time spent on the preparation, transmission and analysis of medical data can exceed 60%. To estimate time reduction in duration of TM-consultations in urgent and emergency situations under proposed modification of regulations, the actual functioning MTMK has been exposed to simulation. The results of simulation have shown that the use of the modified regulations for TM-consultation provides reduction in duration of TM-consultation at 21,5 ± 0,3% in case if the satellite channel speed is in range from 128 kbit/s to 512 kbit/s, that means13,6 ± 0,3 min in absolute values. Provisioning of MTMK based on VSAT satellite communication system takes rather long time. As a result, the total time between the moment when MTMK has arrived to the affected person and the moment when recommendations from consulting doctor have been obtained can exceed 100 minutes. However, if you do not only use the satellite communication system such as VSAT, but you also duplicate it with wireless data transmission system based on satellite communication systems such as Thuraya or cellular communication system, you can start work on preparation and transmission of data for TM-consultation almost immediately. There is a possibility to perform diagnostics of the affected person using autonomously working laptops and diagnostic devices, to transmit data to the remote consultant via cellular or satellite phone, and concurrently perform actions for provisioning of the other MTMK systems. The proposed hybrid telecommunications infrastructure combines the use of low-speed wireless data transmission systems with a high level of readiness for the transfer of medical data to consultant and broadband VSAT satellite communication system for video consultations. As a result, with use of a modified regulation of TM-consultation and hybrid telecommunications infrastructure, the total time needed for MTMK to arrive to the place where medical assistance is required can be reduced by more than 36.8 %. The described above ways to optimize duration of TM-consultation can be used not only to improve MTMK effectiveness, but also for a wide class of TM-means to provide remote assistance in urgent and emergency situations.