An investigation into the use of 3G mobile communications to provide telehealth services in rural KwaZulu-Natal.
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Date
2015-01-31
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Abstract
BACKGROUND We investigated the use of third generation 3G mobile communications to provide telehealth services in remote health clinics in rural KwaZulu Natal South Africa MATERIALS AND METHODS We specified a minimal set of services as our use case that would be representative of typical activity and to provide a baseline for analysis of network performance Services included database access to manage chronic disease local support and management of patients to reduce unnecessary travel to the hospital emergency care up to 8 h for an ambulance to arrive e mail access to up to date information Web and teleclinics We made site measurements at a representative set of health clinics to determine the type of coverage general packet radio service GPRS 3G its capabilities to support videoconferencing H323 and Skype Microsoft Redmond WA and audio Skype and throughput for transmission control protocol TCP to gain a measure of application performance RESULTS We found that none of the remote health clinics had 3G service The GPRS service provided typical upload speed of 44 kilobits per second Kbps and download speed of 64 Kbps This was not sufficient to support any form of videoconferencing We also observed that GPRS had significant round trip time RTT in some cases in excess of 750 ms and this led to slow start up for TCP applications CONCLUSIONS We found audio was always so broken as to be unusable and further observed that many applications such as Web access would fail under conditions of very high RTT We found some health clinics were so remote that they had no mobile service 3G where available had measured upload speed of 331 Kbps and download speed of 446 Kbps and supported videoconferencing and audio at all sites but we frequently experienced 3G changing to GPRS We conclude that mobile communications currently provide insufficient coverage and capability to provide reliable clinical services and would advocate dedicated wireless services where reliable communication is essential and use of store and forward for mobile applications