# Telemedicine: A Survey of Telecommunication Technologies, Developments, and Challenges
## 7 Communication Standards/Protocols in Telemedicine  
Wireless communication technology plays a significant role in efficient healthcare delivery during medical emergency for patients and health care providers over a distance [38]. Two major connectivity techniques are used in telemedicine, namely, point-to-point and point-to-multipoint [43]. These technologies are used for effective communication between the wireless sensor nodes and the remote health care provider. Wireless Connectivity Protocols in Telemedicine include:  
1. ZigBee/IEEE 802.15.4: the ZigBee protocol is used for interfacing with data processing devices such as personal data assistants (PDA) and PCs that are directly connected to medical devices (point-to-point). Because of its simplicity, low power usage, and ability to cover large numbers of devices per network, ZigBee is projected to succeed in setting a leading standard for home control applications, which forms a vital component of telemedicine applications [60]. In [49], a ZigBee module was used to connect ECG data to a PC through a Universal Asynchronous Receiver-Transmitter (UART) connected to a USB transceiver device. Although the system supports only point-to-point connection, the end terminal can be any PC with a USB port and an operating system equipped with a USB-to-UART driver. 2. Bluetooth/IEEE 802.15.1: Bluetooth is a short-range radio link intended to replace the cables connecting fixed electronic devices. It operates in the unlicensed Industrial Scientific Medicine (ISM) frequency band at 2.4 GHz [82]. A combination of ZigBee and Bluetooth was utilised in [93] to connect four different medical services. The system was interfaced through UART and an analog port, delivering data rates up to 42 kbps. Table 6 shows a comparison between the Bluetooth and Zigbee communication standards. 3. WiMAX/IEEE Broadband Wireless Access (BWA) 802.16: according to [128], WiMAX is a communication protocol based on the IEEE 802.16 standard. Developed to provide long distance broadband wireless data connectivity, it serves as an alternative to cable and DSL because of its high bandwidth and provision of BWA for up to 30 miles for fixed stations and 3-10 miles for mobile stations. With respect to telemedicine applications, [38] shows that WiMAX systems for wireless telemedicine provide high mobile connectivity for multimedia traffic with guaranteed QoS, representing advantages over 3G systems, which are designed for more basic data and voice transmission. A number of major communication challenges are addressed by WiMAX standards, including provision of high bandwidth, QoS support, integrated services, and security. 4. WiFi/WLAN/IEEE 802.11: WiFi/WLAN is a wireless communication protocol based on the IEEE 802.11 standard. In telemedicine applications, WiFi networks usually comprise multiple access points, with medical sensor nodes moving freely among access points [107]. A study by [108] demonstrated a WLAN/IEEE 802.11n standard transmission scheme for wireless telemedicine applications. The WLAN system could transmit measured medical data using digital bits, ECG signals, case histories, and audio/video signals for telemedical purposes. Similarly, medical signal accuracy in WiFi-based telemedicine schemes was presented in [107]. According to the authors, several security threats are associated with WiFi networks due to their use of open an medium to transmit and receive data. Threats which can be detrimental in medical contexts include: denial of service, eavesdropping, and services theft. Another issues is that the WiFi/802.11 protocol is limited to between 30-100 m, which is a disadvantage compared to the WiMAX protocol [128]. 5. User Datagram Protocol (UDP): protocols for media streaming are usually intended for communication between streaming servers and their users, and handle concerns around transport, session control, and network addressing. UDP is a transport protocol that is widely utilized for data streaming in telemedicine contexts [129].