Design and application of a novel telemedicine system jointly driven by multinetwork integration and remote control: Practical experience from PLAGH, China.

In China, several problems were common in the telemedicine systems, such as the poor network stability and difficult interconnection. A new telemedicine system jointly driven by multinetwork integration and remote control has been designed to address these problems. A multilink aggregation algorithm and an overlay network for telemedicine system (ONTMS) were developed to improve network stability, and a non-intervention remote control method was designed for Internet of Things (IoT) devices/systems. The authors monitored the network parameters, and distributed the questionnaire to participants, for evaluating the telemedicine system and services. Under a detection bandwidth of 8 Mbps, the aggregation parameters of Unicom 4G, Telecom 4G, and China Mobile 4G were optimal, with an uplink bandwidth, delay, and packet loss ratio (PLR) of 7.93 Mbps, 58.80 ms, and 0.06%, respectively. These parameters were significantly superior to those of China Mobile 4G, the best single network ( < 0.001). Through the ONTMS, the mean round-trip transporting delay from Beijing to Sanya was 76 ms, and the PLR was 0 at vast majority of time. A total of 1988 participants, including 1920 patients and 68 doctors, completed the questionnaires. More than 97% of participants felt that the audio and video transmission and remote control were fluent and convenient. 96% of patients rated the telemedicine services with scores of 4 or 5. This system has shown robust network property and excellent interaction ability, and satisfied the needs of patients and doctors.