FORM -2

THE PATENTS ACT, 1970
(39 of 1970)
&

THE PATENTS RULES, 2003
COMPLETE
Specification

(See Section 10; rule 13)
REMOTE MEDICAL DIAGNOSIS AND CONSULTATION
TATA CONSULTANCY SERVICES LTD.,
an Indian Company of Nirmal Building, 9th floor, Nariman Point, Mumbai 400 021, Maharashtra, India
THE FOLLOWING SPECIFICATION PARTICULARLY DESCRIBES THE INVENTION AND THE MANNER IN WHICH IT IS TO BE PERFORMED

5 NOV 2008

Field of the Invention
This invention relates to the field of remote medical diagnosis and consultation.
Background of Invention
There are many areas in the world, remote or otherwise, where people do not
have access to expert and specialist medical professional. There people may have access to general physician or other health professional who can cater to many of their medical requirements. But there are instances where the locally available medical professional cannot successfully treat and cure some of their ailments and in those cases expert or specialist doctors' advice is required. Due to the remote location of these places, scarcity of specialist expert doctors and combination of various factors it is not possible to bring in specialist doctors to remote places to treat uncommon medical conditions..
In these situation telemedicine equipment can be used whereby a specialist and expert doctor can provide medical consultation to a patient or a doctor at a remote location. Specialist doctors can use the telemedicine facility to remotely communicate with a patient, remotely see and hear relevant pathological, clinical and physiological and pathological data and static or moving image of some parts of the patient, and provide a prescription and advice. To enable this successfully, the relevant physiological and pathological data and image from different sensors including a camera and medical instruments like ECG, USG, Vi-Scope needs to be transferred from the patient's local facility to a remotely located specialist.

Good quality physiological and pathological, as disclosed in paent application PCT/IN2009/000281, which includes physiological data and signals usually involving vast amount of electronic data that needs to be transferred. However, in many remote locations the available network bandwidth is limited. So this poses a challenge to the transfer of the necessary physiological and pathological data and image with desired quality to the specialist doctor in timely manner,
Moreover as the necessary equipment to sense physiological and pathological data and image are at the patient end, the remote specialist does not have direct control over the equipment at the patient end. The remotely located specialist has to rely upon the local health professional for controlling the equipment. If the local health professional cannot understand or act on the specialist's request for position or orientation or any other specific requirement of patient-end equipment, it causes a problem. It will invariably waste the scarce and valuable time of the specialist, and introduce delay in the treatment process.
To overcome these problems the current invention proposes a method and apparatus for a telemedicine system where majority of the data will be sent in lossy transmission and, or lower resolution and some critical data identified by the remotely located specialist will be transmitted in lossless manner and, or at a higher resolution to make best use of the network bandwidth constraint and the remote specialist can control some of the relevant modes of operations of the sensor equipment like the camera or other medical instruments which capture patient's physiological and pathological and other related information and image.

The invention envisages a method and apparatus for prioritizing information that needs to be sent from patient-end to remote specialist based on the requirement and input from the remotely located specialist and prioritized information is sent with better quality compared to other information transfer to specialist.
In the current generation of telemedicine devices, the transferred data and its characteristics are dictated by the prevailing configuration at the patient-end. The remote specialist has to either accept this or request a human being on the other end to change it. There may be situations where the local personnel cannot properly understand and or carry out the requested change. The remote specialist may have to make repeated requests to get the device to desired position or get the desired data.
Summary of Invention
In particular, this invention envisages a method and apparatus for allowing a
remote specialist to control many aspects like position, orient, etc of the patient-end equipment remotely by sending suitable instruction(s) to the telemedicine system at patient-end.
In particular, this invention envisages a method and apparatus for allowing the remote specialist to control many aspects of transmission and data to be transferred from patient-end to remote specialist.
In accordance with this invention a system is envisaged where patient-end equipment are logically connected to a telemedicine system also situated at the

patient-end and the said telemedicine system has the capability of establishing communication links with remote specialist using public internet or any internet protocol based network and further capability of transmitting and receiving voice, data and multimedia content over the established communication link.
According to this invention, there is provided an apparatus for remote medical consultation between at least one remote location comprising a set of diagnostic apparatus and at least one remotely located medical practitioner, said apparatus comprising:
- remotely located diagnostic apparatus adapted to read medical diagnostic
parameters from a patient located near said remotely located diagnostic
apparatus;
- dual mode communication channel including a lossy communication channel
mode and a lossless communication channel mode;
~ prioritizing means adapted to prioritize said read medical diagnosis parameter in relation to usage of mode of communication channel;
- assigning means adapted to assign a read diagnostic parameter to a communication channel mode from said communication channel modes;
- transmitting means adapted to transmit said read diagnostic parameters through a communication channel assigned by said assigning means;
- receiving means adapted to receive said read diagnostic parameters through a communication channel assigned by said assigning means; and
- aggregating means adapted to aggregate read diagnostic parameters received through various communication channels.
According to this invention there is provided a method and apparatus for efficiently transferring human physiological and pathological data and image to

remote medical specialist by use of a novel telemedicine system which
comprises:
A telemedicine device which can be logically connected to suitable sensor equipment like camera and or medical instruments for gathering sensed and captured physiological and pathological and related data from the said equipment;
and a means of receiving input which are ordinarily manually entered; and a means of establishing communication link with remote specialist access terminal over the public internet or LAN or any internet protocol based network;
and a means of transferring human physiological and pathological and related data and image to remote access terminal over the said established connection where data can 6e prioritized and different data of different priority is sent with different quality with the purpose of optimizing available bandwidth.
In particular this invention will be useful to any system which needs to transfer vast amount of data in a network bandwidth-constraint environment to a remote location, where it is acceptable to optimally adapt the quality of data transmission according to priority of data.
Typically, said diagnostic parameter include human physiological and pathological data selected from a list of data consisting of ECG, USG, EEG, EMG, ViScope data, pathological test data, image data and the like.
The telemedicine system in accordance with this; invention allows a remotely located person to directly control several aspects like position, orientation and

the like of many of the equipment remotely by issuing necessary commands to the telemedicine device.
The telemedicine system in accordance with this invention allows a remotely located person to directly control several aspects of transmission and data to be transferred from patient-end remotely by issuing necessary commands to the telemedicine device.
Typically, said first communication channel is a public internet connection or any Internet Protocol based network either wirelessly or through wired connection.
Typically, said second communication channel is a dedicated internet connection with a robust protocol for ensuring data sanctity.
Typically, second communication channel is an Internet or IP based network which will provide for more error prevention and detection through enhanced coding overhead and the content carried by it will be of higher resolution and higher quality.
Typically, said apparatus includes an operating mode selection mechanism adapted to select an operating mode selected from a range of operating modes consisting of complete live session, partial live session, and any combination thereof.
Typically, said complete live session includes means to transfer said read diagnostic parameter in real time or near real time to a receiving means monitored by a medical practitioner.

Typically, said partial live session includes means to upload said read diagnostic parameter in advance to a receiving means before being read by a medical practitioner.
Typically, said apparatus includes instruction means adapted to read instructions as relayed by a medical practitioner in order to prioritize said read diagnostic parameter in accordance with said medical practitioner's instruction.
Typically, said apparatus includes instruction means adapted to read instructions as relayed by a medical practitioner in order to assign a communication channel mode to said read diagnostic parameter in accordance with said medical practitioner's instruction.
More particularly, the telemedicine system in accordance with this invention employs different kind of communication and information exchange inclusive of but not limited to video conference, voice call, transfer of sensed and captured human physiological and pathological data, manually entered text data, static or moving image and other type of content.
Brief Description of the Accompanying Drawings:
Figure 1 of the accompanying drawings shows a block diagram of the typical
organization of the components of the telemedicine system
Figure 2 is a block diagram showing another typical organization of the components of the telemedicine system in accordance with this invention which contain a server to facilitate many other services; and

Figure 3 shows a typical flowchart of patient end equipment being operated remotely by remotely lcoated medical specialist.
Detailed Description of the Invention:
This invention relates to a novel telemedicine system which among other situations can be used in a locally available healthcare facility and extend the reach and quality of locally available treatments by facilitating to bring in expertise of medical experts and specialist from different locations.
A typical use-case of the solution contained in the invention is elaborated through the preferred embodiments of the use case around the technology.
People go to their local and or preferred medical clinic or healthcare facility for treatment as usual. There the medical team provides treatment and advice to patients for the cases for which required expertise is available locally. However there may be situations where the expertise or the local medical staff is not sufficient and it is required to consult a medical expert who has the necessary know-how of the symptoms or illness. Faced with this kind of situation, people traditionally had to go and visit the medical specialist where he or she is available. To alleviate this problem, and to bring in remote medical specialist's advice telemedicine system can be utilized where specialist from different locations can treat and advise a patient remotely.
To facilitate prompt and good-quality remote medical consultation, occasionally a vast amount of human physiological and pathological data like ECG, USG,

and ViScope etc and suitable image of patient needs to be transferred electronically to the remote specialist. However with the limited amount of network bandwidth available in most part of the network or the public internet, this poses a big challenge to promptness, quality and in some cases the very feasibility itself of the remote medical consultation through the currently available telemedicine systems over the public internet. Either the system has to incur the high cost of a dedicated connection or use of the telemedicine system becomes problematic.
Figure 1 displays a preferred embodiment of the logical organization of the involved components which establish the basic premise for the current invention. Medical measurement equipment like ECG, USG or ViScope are attached to a patient and one or more cameras are focused appropriately. These medical measurement equipment are logically connected to the telemedicine device either wirelessly or through wired connection. The telemedicine device is connected to the public internet or any Internet Protocol based network either wirelessly or through wired connection to one or many remote access terminals of remote doctors.
Figure 2 essentially displays the Figure 1 with the additional component of Server being incorporated mainly for background uploading of necessary physiological and pathological data , images and audio video stream and their subsequent use later on.
The remote consultation can be either complete live session or partial live session or any other combinations of them. In the complete live session, there is real-time or near-real-time transfer of necessary data and images between

patient-end and remote specialist and the remote specialist doctors provide consultation through live sessions to all patients selected at patient-end facility. In the partial live sessions the physiological and pathological and related data for patients are uploaded in advance to an intermediate server as depicted in Figure 2. A subset of the patients whose record have been uploaded are selected by remote specialists or some other mechanism based on criticality and other attributes of treatment requirement. During the subsequent live consultation session the selected subset of patients are treated by remote specialist doctors.
Detailed description of one particular use case of a typical remote medical consultation session is provided in the following section as a way of elaboration.
A patient visits a health camp/ health care unit. Attendant records patient's health parameters like temperature, blood pressure & pulse rate. Attendant connects to the remote end (remote doctor's laptop) from the telemedicine console and initiates a video conferencing session. Doctor at remote end accepts the video conferencing session. Local attendant opens web based application on the telemedicine console and keys in the patient temperature, blood pressure & pulse rate parameters at local end. ECG, USG & ViScope devices used by attendant to record patient data. ECG & ViScope data are sent to the remote end on a live basis. USG data is stored in the medical repository for deferred access from the remote end. Camera connected to the console records patient video and transmits to the remote end. Doctor sees the patient image on laptop/ desktop along with a control terminal for controlling the remote devices viz. ECG, USG & ViScope & the USB camera. Remote doctor chooses the device from which data is required and correspondingly gets the same and he or she

can also control many aspects of the patient-end device remotely. Doctor also can control the camera at remote end for customized image viewing
The attached medical measurement equipment measure some human physiological and pathological data signal and transfer it to the telemedicine device. The camera captures images of certain parts of the patient and transfer them to the telemedicine device. The telemedicine device compresses and encodes the captured physiological and pathological data stream and images taking into account the nature of the data stream, available network bandwidth and minimum quality requirement. The device then transmit the compressed and encoded data to the remote access terminal of remote specialist doctor using streaming mechanism and protocol most suitable for streaming. If the physiological, pathological and image data stream contains both audio and video component, suitable encoding scheme is applied for each component. Moreover the telemedicine device is responsible for ensuring that the audio and video components are properly synchronized when they arrive at the recipients. It also perform adaptive quality control during transmission of data by adaptively adjusting the quality of data to be transmitted based on the available bandwidth, reliability and other relevant characteristics of the available network connection.
In typical scenario majority of human physiological and pathological or other type of data is sent in lossy transmission or in a relatively lower resolution with the optimum quality that is possible under the constraint of available bandwidth and link quality. The remote specialist usually provides his advice based on the received data those have been transmitted in the said manner. However the specialist may need to do detail analysis for certain portion or subset of data,

and for that he needs the data for those sections in better quality which can involve lossless transmission or higher resolution or both. The remote specialist selects the desired portion and asks for a better quality of data for it by issuing necessary command through his terminal. The telemedicine device receive and interpret this request, it identifies the said selected section and send the data for the selected portion in lossless transmission or higher resolution or a combination of both. In the bandwidth limited situations, it may not be feasible to transfer this high quality of data instantaneously to the remote recipient. This high quality of data can be streamed to the remote recipient with a minor but still workable delay or alternately it can be uploaded to the server as mentioned in Figure 2 and the remote specialist doctor can view it form there at his convenient time or it can be utilized during remote consultation at a later time or a later date or both.
This innovative combination and mechanism of regular quality of data and high quality of data provide both breadth and depth of necessary human physiological and pathological information, images or any relevant data for optimum analysis by remote specialist under the constraint of limitation of available bandwidth.
The system in accordance with this invention overcomes the problems in the prior art; therefore the present invention envisages a scheme whereby the remote specialist can remotely control most of the attributes of the patient-end sensor devices including camera and medical instruments like their position, orientation, resolution of data etc. In the flowchart in Figure 3 a typical series of steps are depicted to accomplish this mechanism. In Figure 3 the term equipment or its syntactic or inferable variations are used to mean sensor

devices in the patient-end including camera and medical instruments like ECG, USG, Viscope and the like.
The flowchart provides a preferred embodiment of the mechanism of remotely controlling medical equipment attached to the patient and the telemedicine device. The display interface presented to the remote specialist has the necessary tools or interaction fields for remotely controlling the said equipment. When the remote specialist wants to remotely control any equipment through the telemedicine device, a modeled view of the equipment is presented to him along with the related data. The specialist makes the desired changes in the modeled view in his terminal. These change requests are captured, and transmitted to the remote telemedicine device. The telemedicine device parses these requests and instructs the target equipment to carry out the requested changes by using some exposed interface which are available for this purpose.
More over, the present invention also envisages schemes whereby the specialist can control many aspects of the remotely located transmission and data to be transferred including captured video size, captured video frame rate.
Although the invention has been described in terms of particular embodiments and applications, one of ordinary skill in the art, in light of this teaching, can generate additional embodiments and modifications without departing from the spirit of or exceeding the scope of the chained invention. Accordingly, it is to be understood that the drawings and descriptions herein are offered by way of example to facilitate comprehension of the invention and should not be construed to limit the scope thereof.

We Claim:
1. An apparatus for remote medical consultation, medical telemetry control and
communication between at least one remote location comprising a set of
diagnostic apparatus and at least one remotely located medical practitioner,
said apparatus comprising:
- remotely located diagnostic apparatus adapted to read medical diagnostic parameters from a patient located near said remotely located diagnostic apparatus;
- dual mode communication mechanism including a lossy communication channel mode and a lossless communication channel mode;

- prioritizing means adapted to prioritize said read medical diagnosis parameter in relation to usage of mode of the data;
- assigning means adapted to assign a read diagnostic parameter to a communication channel mode from said communication channel modes;
- transmitting means adapted to transmit said read diagnostic parameters through a communication channel assigned by said assigning means;
- receiving means adapted to receive said read diagnostic parameters through a communication channel assigned by said assigning means; and
- aggregating means adapted to aggregate read diagnostic parameters received through various communication channels.
2. An apparatus as claimed in claim 1 wherein, said diagnostic parameter
includes human physiological and pathological data selected from a list of
data consisting of ECG, USG, EEG, EMG, ViScope data, pathological test
data, image data and the like.

3. An apparatus as claimed in claim 1 wherein, said first communication channel is a public internet connection or any Internet Protocol based network either wirelessly or through wired connection.
4. An apparatus as claimed in claim 1 wherein, said second communication channel is a dedicated internet connection with a robust protocol for ensuring data sanctity.
5. An apparatus as claimed in claim 1 wherein, said apparatus includes an operating mode selection mechanism adapted to select an operating mode selected from a range of operating modes consisting of complete live session, partial live session, and any combination thereof.
6. An apparatus as claimed in claim 5 wherein, said complete live session includes means to transfer said read diagnostic parameter in real time or near real time to a receiving means monitored by a medical practitioner.
7. An apparatus as claimed in claim 5 wherein, said partial live session includes means to upload said read diagnostic parameter in advance to a receiving means before being read by a medical practitioner.
8. An apparatus as claimed in claim 1 wherein, said apparatus includes instruction means adapted to read instructions as relayed by a medical practitioner in order to prioritize said read diagnostic parameter in accordance with said medical practitioner's instruction.

9. An apparatus as claimed in claim 8 wherein, said apparatus in instruction means adapted to read instructions as relayed by a m practitioner in order to assign a communication channel mode to sai< diagnostic parameter in accordance with said medical practiti instruction.
Dated this 5th day of November, 2009.