Performance evaluation of WebRTC-based online consultation platform

Information technologies give patients the opportunity to communicate with medical professionals remotely.Telemedicine uses these technologies to provide advanced healthcare and medical services. We present a medical onlineconsultation application based on Web Real-Time Communications (WebRTC) technology enabling chat, audio, andvideo calls. Communication architecture and protocols of the application are explained in detail. Additionally, theuser interface of the application is shown via performed calls. The application is tested and evaluated on differentnetwork connections (3G, 4G, local, and DSL) and different browsers and mobile operating systems (Android, Chrome,Firefox, Internet Explorer, iOS, Opera, Safari). During calls, communication quality parameters such as round-triptime (RTT) and packet loss, obtained via the WebRTC application programming interface, are analyzed. 3G, 4G, andlocal connections show low packet losses (1%) in Android, Chrome, iOS, Opera, andSafari for DSL connection, but RTT values are low (

PDF

___

[1] De La Torre-Díez I, López-Coronado M, Vaca C, Aguado JS, de Castro C. Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review. Telemedicine Journal and E-health 2015; 21 (2): 81-85.
[2] Lindberg B, Nilsson C, Zotterman D, Söderberg S, Skär L. Using information and communication technology in home care for communication between patients, family members, and healthcare professionals: a systematic review. International Journal of Telemedicine and Applications 2013; 2013 (1): 461829.
[3] Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemedicine Journal and E-health 2009; 15 (3): 231-240.
[4] Sheikh A, Sood HS, Bates DW. Leveraging health information technology to achieve the “triple aim” of healthcare reform. Journal of the American Medical Informatics Association 2015; 22 (4): 849-856.
[5] Cueto-Manzano AM, Gallardo-Rincón H, Martínez-Ramírez HR, Cortés-Sanabria L, Rojas-Campos E et al. A pilot study of a mobile phone application to improve lifestyle and adherence of patients with kidney disease. Journal of Telemedicine and Telecare 2015; 21 (2): 119-120.
[6] Caffery LJ, Smith AC. Investigating the quality of video consultations performed using fourth generation (4G) mobile telecommunications. Journal of Telemedicine and Telecare 2015; 21 (6): 348-354.
[7] Azevedo J, Pereira RL, Chainho P. An API proposal for integrating sensor data into web apps and WebRTC. In: 1st Workshop on All-Web Real-Time Systems; Seoul, South Korea; 2015. pp. 1-5.
[8] Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. International Journal of Medical Informatics 2010; 79 (11): 736-771.
[9] Sood S, Mbarika V, Jugoo S, Dookhy R, Doarn CR et al. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings. Telemedicine Journal and E-health 2007; 13 (5): 573-590.
[10] Puel A, Von Wangenheim A, Meurer MI, De Macedo DD. BUCOMAX: Collaborative multimedia platform for real time manipulation and visualization of bucomaxillofacial diagnostic images. In: IEEE 27th International Symposium on Computer-Based Medical Systems; New York, NY, USA; 2014. pp. 392-395.
[11] Kumar S. Introduction to telepathology. In: Kumar S, Dunn BE (editors). Telepathology. 1st ed. Heidelberg, Germany: Springer, 2009. pp. 1-4.
[12] Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Affairs (Millwood) 2014; 33 (2): 228-234.
[13] Latifi R, Weinstein R, Porter J, Ziemba M, Judkins D et al. Telemedicine and telepresence for trauma and emergency care management. Scandinavian Journal of Surgery 2007; 96 (4): 281-289.
[14] Istepanian RS, Petrosian AA. Optimal zonal wavelet-based ECG data compression for a mobile telecardiology system. IEEE Transactions on Information Technology in Biomedicine 2000; 4 (3): 200-211.
[15] Whited JD. Teledermatology research review. International Journal of Dermatology 2006; 45 (3): 220-229.
[16] Massin P, Chabouis A, Erginay A, Viens-Bitker C, Lecleire-Collet A et al. OPHDIAT©: A telemedical network screening system for diabetic retinopathy in the Île-de-France. Diabetes and Metabolism 2008; 34 (3): 227-234.
[17] Rees CS, Haythornthwaite S. Telepsychology and videoconferencing: issues, opportunities and guidelines for psychologists. Australian Psychologist 2004; 39 (3): 212-219.
[18] Marescaux J, Leroy J, Rubino F, Smith M, Vix M et al. Transcontinental robot-assisted remote telesurgery: feasibility and potential applications. Annuals of Surgery 2002; 235 (4): 487-492.
[19] Eron L. Telemedicine: the future of outpatient therapy? Clinical Infectious Diseases 2010; 51 (2): 224-230.
[20] Farnan JM, Sulmasy LS, Worster BK, Chaudhry HJ, Rhyne JA et al. Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards. Annals of Internal Medicine 2013; 158 (8): 620-627.
[21] Finkelstein SM, Speedie SM, Potthoff S. Home telehealth improves clinical outcomes at lower cost for home healthcare. Telemedicine Journal and E-Health 2006; 12 (2): 128-136.
[22] The IWG ASIA Task Force on Telemedicine. Roadmap for Telemedicine, Key Considerations and Recommendations. Innovation Working Group, 2013.
[23] Liu WL, Zhang K, Locatis C, Ackerman M. Internet-based videoconferencing coder/decoders and tools for telemedicine. Telemedicine Journal and E-Health 2011; 17 (5): 358-362.
[24] Johnston AB, Burnett DC. WebRTC: APIs and RTCWEB protocols of the HTML5 real-time web. St. Louis, MO, USA: Digital Codex LLC, 2012.
[25] Jesup R, Loreto S, Tuexen M. WebRTC Data Channels. IETF, 2015.
[26] Antón D, Kurillo G, Goñi A, Illarramendi A, Bajcsy R. Real-time communication for Kinect-based telerehabilitation. Future Generation Computer Systems 2017; 75: 72-81.
[27] Bharath R, Vaish P, Rajalakshmi P. Implementation of diagnostically driven compression algorithms via WebRTC for IoT enabled tele-sonography. In: IEEE EMBS Conference on Biomedical Engineering and Sciences; Kuala Lumpur, Malaysia; 2016. pp. 204-209.
[28] El Jaouhari S, Bouabdallah A, Bonnin JM, Lemlouma T. Toward a smart health-care architecture using WebRTC and WoT. In: World Conference on Information Systems and Technologies; Porto Santo Island, Portugal; 2017. pp. 531-540.
[29] Gillis J, Calyam P, Bartels A, Popescu M, Barnes S et al. Panacea’s glass: Mobile cloud framework for communication in mass casualty disaster triage. In: 3rd IEEE International Conference on Mobile Cloud Computing, Services and Engineering; San Francisco, CA, USA; 2015. pp. 128-134.
[30] Jang-Jaccard J, Nepal S, Celler B, Yan B. WebRTC-based video conferencing service for telehealth. Computing 2016; 98 (1-2): 169-193.
[31] Hong J, Kong HJ, Yoon HJ. Web-based telepresence exercise program for community-dwelling elderly women with a high risk of falling: randomized controlled trial. JMIR mHealth and uHealth 2018; 6(5): e132.
[32] Anton D, Kurillo G, Yang AY, Bajcsy R. Augmented telemedicine platform for real-time remote medical consultation. In: International Conference on Multimedia Modeling; Reykjavik, Iceland; 2017. pp. 77-89.
[33] Loreto S, Romano SP. Real-Time Communication with WebRTC: Peer-to-Peer in the Browser. Sebastopol, CA, USA: O’Reilly Media Inc., 2014.
[34] Schulzrinne H, Casner S, Frederick R, Jacobson V. RTP: A transport protocol for real-time applications. Internet Engineering Task Force, RFC, 2003.
[35] Holmer S, Shemer M, Paniconi M. Handling packet loss in WebRTC. In: IEEE International Conference on Image Processing; Melbourne, Australia; 2013. pp. 1860-1864.
[36] Kumaravel K. Comparative study of 3G and 4G in mobile technology. International Journal of Computer Science Issues 2011; 8 (5): 256-263.
[37] Mok RK, Chan EW, Chang RK. Measuring the quality of experience of HTTP video streaming. In: 12th IFIP/IEEE International Symposium on Integrated Network Management and Workshops; Dublin, Ireland; 2011. pp. 485-492.
[38] Nafaa A, Taleb T, Murphy L. Forward error correction strategies for media streaming over wireless networks. IEEE Communications Magazine 2008; 46 (1): 72-79.
[39] Tehrani M, Murat U, Halim Y. Device-to-device communication in 5G cellular networks: challenges, solutions, and future directions. IEEE Communications Magazine 2014; 52 (5): 86-92.