1、 Reference number ISO/TR 16056-2:2004(E) ISO 2004TECHNICAL REPORT ISO/TR 16056-2 First edition 2004-07-01 Health informatics Interoperability of telehealth systems and networks Part 2: Real-time systems Informatique de sant Interoprabilit des systmes et des rseaux de tlsant Partie 2: Systmes en temp
2、s rel ISO/TR 16056-2:2004(E) PDF disclaimer This PDF file may contain embedded typefaces. In accordance with Adobes licensing policy, this file may be printed or viewed but shall not be edited unless the typefaces which are embedded are licensed to and installed on the computer performing the editin
3、g. In downloading this file, parties accept therein the responsibility of not infringing Adobes licensing policy. The ISO Central Secretariat accepts no liability in this area. Adobe is a trademark of Adobe Systems Incorporated. Details of the software products used to create this PDF file can be fo
4、und in the General Info relative to the file; the PDF-creation parameters were optimized for printing. Every care has been taken to ensure that the file is suitable for use by ISO member bodies. In the unlikely event that a problem relating to it is found, please inform the Central Secretariat at th
5、e address given below. ISO 2004 All rights reserved. Unless otherwise specified, no part of this publication may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying and microfilm, without permission in writing from either ISO at the address below o
6、r ISOs member body in the country of the requester. ISO copyright office Case postale 56 CH-1211 Geneva 20 Tel. + 41 22 749 01 11 Fax + 41 22 749 09 47 E-mail copyrightiso.org Web www.iso.org Published in Switzerland ii ISO 2004 All rights reservedISO TR 16056-2:2004(E) ISO 2004 All rights reserved
7、iiiContents Page Foreword . v Introduction vi 1 Scope 1 2 Normative References 1 3 Terms and definitions 2 4 Abbreviations . 12 5 Multimedia Conferencing Standards 13 5.1 General . 13 5.2 H.320 recommendations . 16 5.3 H.321 and H.310 Recommendations 17 5.4 H.323 Recommendations 19 5.4.1 H.323 Termi
8、nals 19 5.4.2 Gateways. 21 5.4.3 Gatekeeper 21 5.4.4 Multipoint control unit 21 5.5 H.324 Recommendations 22 5.6 T.120 Recommendations 23 5.6.1 T120 Overview. 23 5.6.2 T.120 Layer composition 23 5.6.3 T.120 Interoperability24 6 Telehealth applications 24 6.1 General . 24 6.2 Telelearning . 25 6.3 Te
9、leconsultation 26 7 Interoperability issues . 28 7.1 General . 28 7.2 Standard-related sources of interoperability issues. 28 7.2.1 Loose adaptation of previous protocols. 29 7.2.2 Loosely defined encoding and decoding methods 29 7.2.3 Inconsistent definition of mandatory/optional requirements 29 7.
10、2.4 Gaps in the recommendations. 29 7.2.5 No specifications for data encoding in the H.320/H.323 Recommendations . 30 7.2.6 Evolving T.120 Recommendations 30 7.2.7 Loosely defined specifications for an MCU 30 7.2.8 Evolving/undefined specifications for Gateways and Gatekeepers . 30 7.2.9 Loosely def
11、ined bandwidth management. 31 7.2.10 Poor standardization of media conferencing . 31 7.3 Product-related Sources of Interoperability Issues 31 7.3.1 Time delay between the standards (ever-evolving) and products 31 7.3.2 Implementation of a different subset of the standards 32 7.3.3 Proprietary solut
12、ions 32 7.4 Implementation-related sources of interoperability issues 32 7.4.1 Undefined specifications for Gatekeeper Communication 32 7.4.2 Gateway to Gatekeeper Communication. 32 7.4.3 A decentralized multipoint conference . 33 8 Interoperability requirements 33 8.1 General . 33 8.2 Call Setup. 3
13、4 8.3 Acquisition, processing, and transmission of multimedia data 35 8.4 Controlling near- and far-end devices .36 ISO TR 16056-2:2004(E) iv ISO 2004 All rights reserved8.5 Call termination 36 9 Interoperability in heterogeneous telehealth networks . 36 9.1 General . 36 9.2 Interoperability of H.32
14、0 systems over frame relay network 36 9.3 Interoperability of h.3xx-compliant systems over heterogeneous networks 37 9.3.1 Gatekeeper functions 38 9.3.2 MCU functions. 39 9.3.3 Design requirements Telehealth solutions 40 10 Framework for interoperable architectures 41 10.1 General . 41 10.2 Teleheal
15、th component boundaries.41 10.2.1 User interface 41 10.2.2 Medical Devices 42 10.2.3 Data manager 42 10.2.4 Processing Manager . 42 10.2.5 Communications Manager . 43 10.2.6 Resource Manager 43 10.2.7 Integration Manager 43 Bibliography 45 List of Figures Figure 1 - The H.320 Terminal 16 Figure 2 -
16、A multipoint configuration 17 Figure 3 - The H.321 Terminal 18 Figure 4 - The H.323 Terminal 20 Figure 5 - The H.324 Terminal 22 Figure 6 - The T.120 Recommendations. 23 Figure 7 - Parties contributing to telehealth interoperability. 28 Figure 8 - Interoperability dimensions for real-time telehealth
17、 services . 34 Figure 9 - H.320 video services incorporated into existing data and voice networks over frame relay 37 Figure 10 - Connectivity in a heterogeneous system and network environment 38 List of Tables Table 1 - Summary of the multimedia conferencing standards 15 Table 2 - Summary of the H.
18、320 Recommendations. 17 Table 3 - The H.323 and T.120 protocol stack 20 Table 4 - Summary of the H.323 Recommendations. 21 Table 5 - Summary of functionality of a telelearning system . 25 Table 6 - Summary of functionality of a teleconsultation system . 26 ISO TR 16056-2:2004(E) ISO 2004 All rights
19、reserved vForeword ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO member bodies). The work of preparing International Standards is normally carried out through ISO technical committees. Each member body interested in a subject for
20、 which a technical committee has been established has the right to be represented on that committee. International organizations, governmental and non-governmental, in liaison with ISO, also take part in the work. ISO collaborates closely with the International Electrotechnical Commission (IEC) on a
21、ll matters of electrotechnical standardization. International Standards are drafted in accordance with the rules given in the ISO/IEC Directives, Part 2. The main task of technical committees is to prepare International Standards. Draft International Standards adopted by the technical committees are
22、 circulated to the member bodies for voting. Publication as an International Standard requires approval by at least 75 % of the member bodies casting a vote. In exceptional circumstances, when a technical committee has collected data of a different kind from that which is normally published as an In
23、ternational Standard (“state of the art”, for example), it may decide by a simple majority vote of its participating members to publish a Technical Report. A Technical Report is entirely informative in nature and does not have to be reviewed until the data it provides are considered to be no longer
24、valid or useful. Attention is drawn to the possibility that some of the elements of this document may be the subject of patent rights. ISO shall not be held responsible for identifying any or all such patent rights. ISO/TR 16056-2 was prepared by Technical Committee ISO/TC 215, Health informatics. I
25、SO/TR 16056 consists of the following parts, under the general title Health informatics Interoperability of telehealth systems and networks: Part 1: Introduction and definitions Part 2: Real-time systems ISO TR 16056-2:2004(E) vi ISO 2004 All rights reservedIntroduction Delivery of health care servi
26、ces by means of telehealth is advancing rapidly. Telehealth enables providing these services with the use of information and telecommunications technologies. This includes a broad spectrum of capabilities including acquisition, storage, presentation, and management of patient information (represente
27、d in different digital forms such as video, audio, or data), and communication of this information between care facilities with the use of communications links. Telehealth interactions may be carried out in three ways: real-time, store-and-forward or with the use media streaming methods. While real-
28、time interactions imply that all parties directly participate in the telehealth session, store-and-forward interactions involve sending, reviewing, and returning an opinion over a period of time. Streaming is a method of delivery real-time or stored data such as audio, video, documents, still images
29、, or other data type across networks with a reasonable amount of Quality of Services (QoS). With streaming, a receiving system can start displaying (or playing) the data before the entire content arrives. Real-time telehealth sessions usually involve synchronous data transmission while store-and-for
30、ward can usually be regarded as asynchronous. Streaming uses time-synchronized streams of continuous media during transmission. However, data presentation uses buffering, if the receiving system receives data more quickly than required. If the data is not received quickly enough, the presentation of
31、 the data is interrupted. Interoperability of telehealth systems and networks is critical in ensuring the telehealth technology serves well the care recipients and providers and meets their expectations. While this requirement is essential to the long-term sustainability of telehealth, interoperabil
32、ity is difficult to achieve. There are many reasons that make telehealth interoperability difficult, however, the following three need urgent addressing: (1) too broad definition of telehealth, (2) lack of standards specifically designed for telehealth, and (3) collaboration between the information
33、technology and telecommunications industries. There are multiple definitions of telehealth. The services provided by telehealth cover a broad spectrum of activities ranging from videoconferencing through exchange of health information to providing care services in emergency and complex clinical case
34、s. From a technology perspective, the scope of these services is too broad and this makes it difficult to develop telehealth standards and products. There is no official telehealth standard. The telehealth industry uses high-level health care guidelines and technical standards developed for various
35、technology sectors including multimedia conferencing, information technology, data communications, and security. These guidelines and standards focus on functional and operational requirements and do not address interoperability. To further complicate the problem, all of these standards as well as t
36、he telehealth needs and practices are rapidly changing. Telehealth, more than any other recent development, bridges the boundaries between telecommunications and information technologies. The business goals and attitudes of these two industries are different. Telecommunications industry has a histor
37、y of regulation, standardization, and control of the customer premises equipment. Interoperability and reliability have been the key factors to growth. The information technology industry (the desktop computing industry in particular) has achieved success through encouraging innovation, diversity, a
38、nd tremendous cost-efficiency not always paying attention to interoperability aspects of the technology. The marriage of these two cultures and the integration of their respective technologies proved to be challenging. To address the needs for interoperable telehealth systems and networks, telehealt
39、h services must be clearly defined in terms of their scope and interrelationships with other health-related services, a set of telehealth-specific standards must be developed, and subsequently implemented by the respective industries. This two-part ISO Technical Report addresses interoperability iss
40、ues in telehealth systems and networks. This document has been structured as follows: Part 1: Introduction and definitions. Covers an introduction to telehealth and includes the definitions of telehealth, interoperability, and related terms. Part 2: Real-time systems. Defines the scope of the techni
41、cal standards related to real-time applications, (including video, audio, and data conferencing), identifies gaps and overlaps in the standards, defines requirements for interoperable telehealth systems and networks, and identifies building blocks for interoperable telehealth solutions. ISO TR 16056
42、-2:2004(E) ISO 2004 All rights reserved viiThis Technical Report is to be complemented by two other documents that will cover interoperability of store-and- forward and media streaming telehealth applications. The target users of these documents are care providers and health care organizations, tele
43、health equipment vendors and implementers of telehealth solutions, professional organizations, and governments. ISO TR 16056-2:2004(E) ISO 2004 All rights reserved 1Health informatics Interoperab ility of telehealth systems and networks Part 2: Real-time systems 1 SCOPE This Technical Report entitle
44、d Interoperability of telehealth systems and networks Part 2: Real-time systems builds on the introduction to telehealth described in ISO/IEC TR 16056-1 Health informatics - Interoperability of telehealth systems and networks - Part 1: Introduction and definitions and focuses on the technical standa
45、rds related to real-time applications, (including video, audio, and data conferencing) and interoperability aspects of telehealth systems and networks. Specifically, this document addresses four main areas: i) Standards for real-time telehealth systems. This Technical Report describes the technical
46、standards related to real-time telehealth applications, including audio, video, and data conferencing capabilities. It also identifies gaps, overlaps and inconsistencies in the standards, and provides some guidance about how they need to evolve. ii) Interoperability issues in telehealth applications
47、. This Technical Report examines interoperability aspects of real-time multimedia conferencing standards and telehealth products, and identifies areas of concerns from the interoperability perspective that need to be resolved. iii) Requirements for interoperable telehealth systems and networks. This
48、 Technical Report defines interoperability requirements at different levels of interaction between telehealth systems and provides some guidelines on how interoperability can be achieved. iv) Framework for interoperable architectures. This Technical Report identifies interoperable building blocks fo
49、r telehealth solutions and interactions between these building blocks, and explores the possibility of standardization of these building blocks. The scope of the Technical Report does not include conformity and interoperability tests or functional specifications for telehealth systems and networks. 2 NORMATIVE REFERENCES This Technical Report incorporates by dated or undated reference, provisions from other publications. These normative references are cited in the appropriate places in the text, and the publications are li
