<<January 21, 2000>>

Salah H. Mandil, Ph.D.
Director-Advisor on Informatics
World Health Organization
20, Avenue Appia
CH-1211 Geneva 27
+41-22-791-2426 (direct)
Fax: +41-22-791-4702

Dear Salah:

(1) It was my great pleasure to have attended your International
Consultation Conference on TeleHealth and TeleMedicine at your WHO from
January 12th to 14th, with your generous invitation.

(2) After the conference, I visited the United Nations Industrial
Development Organization (UNIDO) and the Office of Outer Space Affairs
at the U.N. in Vienna on January 17th and 18th. I arrived back in New York
in late afternoon of 19th.

(3) ATTACHMENT I below is my reply to your questionnaire. As you
requested, I tried to be succinct. I hope this will be satisfactory to you.

Thank you again for your invitation!!

Best, Tak

Reply to questionnaire


(a) TeleMedicine activities can be subdivided into the following
categories in the order of their frequent usages;

1. TeleLearning,

2. Consultation,

3. Diagnosis.

Subsequently TeleMedicine and TeleLearning are closely tied
together for healthcare providers and end users,

(b) Economical view:

Since practice of TeleMedicine alone nor TeleLearning alone will
not be economically viable, both have to go side-by-side for
sharing of expensive telecommunication media.


(a) Telecommunications media;

Depending on the situation, the use of the following
telecommunications media should be closely examined for all the
categories mentioned above,

1. Analog terrestrial/satellite audio broadcasting,

2. Plain Old Telephone Services (POTS),

3. Narrow band Internet,

4. Broad band Internet -- albeit expensive,

5. ISDN,

6. Wireless (microwave and spread spectrum),

7. Analog video satellite,

8. Digital HDTV satellite -- albeit expensive,

9. Optical/coaxial fiber -- albeit expensive,

10. Broadband (up to 34 Mbps) wireless Internet units for
laptops, and other devices for TeleLearning -- in the near
future of 5 to 10 years.

(b) Methodologies,

1. Email/listserve via narrow band Internet,

2. Computer mediated conferencing system (CMCS) via narrow band Internet,

3. CMCS with audio and video conferencing system via broadband Internet,

4. World Wide Web (WWW) with CMCS,

5. Videoconferencing via narrow band Internet (and later via broadband Internet),

6. Videoconferencing via ISDN (usually up to 384 Kbps) and
later preferably via broadband Internet with conjunction of
utilizing WWW simultaneously,

7. Use of 3D animation, VRML, application programs, and simulation models.


(a) Technological aspects:

1. Vital need of global broadband Internet,

as looking into the future of 5 to 10 years hence, and as
the most cost effective approach,

a. Use of global broadband digital satellite Internet to
cross oceans, continents, and national boundaries,

b. Use of broadband microwave networks for medium (25 to 100 mile) range,

c. Use of spread spectrum broad band (up to 10 Mbps)
Internet for closing last mile to end users.

Start this configuration with non-profit, non-governmental
organizations to form global private virtual network (PVN)
in order to circumvent cumbersome local telecom regulations
and the right-of-way licensing which is often accompanied
with unethical dealings,

2. Financing of this global broadband virtual private Internet
network should be done with Official Development Assistant
(ODA) funds of G7 countries in initial phase, and then to
have subsidies by commercial firms' involvements in later
stage which will handle the large financial burden of the
broadband Internet backbone system.

(b) Methodological aspects;

1. Form partnership between providers and end users --
including the consideration of forming a community
development in the end users' localities for cost sharing,

2. Have face-to-face meeting between providers and end users as
often as possible to foster trust among them so that they
can utilize email and other Internet features while they are
apart from each other,

(c) Institutional aspects;

1. Form local and/or regional consortiums/coalitions so that
they can share their common telecommunication media,
information and knowledge,

2. Looking into the future of 10 to 25 years hence,
globalization is inevitable. Subsequently, those
consortiums/coalitions need to be interconnected around the world.
* Takeshi Utsumi, Ph.D., P.E., Chairman, GLOSAS/USA *
* (GLObal Systems Analysis and Simulation Association in the U.S.A.) *
* Laureate of Lord Perry Award for Excellence in Distance Education *
* Founder of CAADE *
* (Consortium for Affordable and Accessible Distance Education) *
* President Emeritus and V.P. for Technology and Coordination of *
* Global University System (GUS) *
* 43-23 Colden Street, Flushing, NY 11355-3998, U.S.A. *
* Tel: 718-939-0928; Fax: 718-939-0656 (day time only--prefer email) *
* Email: utsumi@columbia.edu; Tax Exempt ID: 11-2999676 *
* http://www.friends-partners.org/GLOSAS/ *

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