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Satellite solutions for Telemedicine

Seminar ETSI/Ministry of Health of Mexico, Tuxtla, 18-19 May 2006

Nathalie RicardTelecommunications DepartmentEuropean Space Agency

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All Member States participate in Space Science mandatory programmes.

• Human space flight and exploration

In addition, members chose the level of participation in optional programmes:

• Microgravity research

• Earth observation

• Telecommunications

• Satellite navigation

• Launcher development

ESA programmes

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• Applications represent the ultimate good for which the End Users are willing to pay

NO APPLICATIONS = NO BUSINESS

• Beside the core activities of R&D and industrialisation of Technology, ESA Telecom is active to promote the development of Satcom based Applications

Why is ESA involved with Applications?

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ESA Telecom Applications projects

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• Hosted in dedicated lines of the ARTES Programme (Advanced Research in Telecommunications Systems)

• Driving idea: provide evidence of benefits and prepare for a commercial deployment

• Over 110 Applications Pilot Projects since 1997 for a total value over 150 MEUR (most of them funded 50% by ESA)

• 60% contracted to SMEs

• 50% contracted to new entrant into ESA Telecom

ESA Telecom Applications Projects

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From Demo Projects to Pilot Service:what makes the difference

contents

demo platform

Exploring Feasibility:Look, it works!

Exploring Sustainability:Get it, it’s worthwhile!

IPR issues

integrationin existing systems

deployment

userscoordination

help desk

trialsevaluation licensing

liability

stability/availability

security

utilisation plan

usabilitypricing

impacts on users’ world

Innovation flag

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Project Concluded in Italic

Telemedicine/

Medical Education• SHARED (I)• EUROMEDNET (I)• MULTIMED (UK)• SECOM (UK)• EMN (CH, D)• SANTTSUR (UK)• IEMN (CDN)• MIST (CDN)• WEBGMS (I)• SM@RT (I)• SKYMED (I)• HPS (UK)• DELTASS (F, D)• TELANY (I, N)• MAYFLOWER (I, N)

• I-DISCARE (F, I, N)• Telecare (CDN)• HIS (D)• NESA (I)• SKYNURSE (I)• TEMOS (D, F)• REACH (CDN)• IGEA-SAT (I)• V-4DL (I)

Community Information

Services• RCST (CDN)• CROCUS (I, NL)• TV Beyond 2000 (F)• Mediaspace (F, SP)• MAMS (IRL)• Space For Science (F)• TESEO (I)• SAT@ONCE (L)• DISaV (I)• SILC (D)• My Home T.TV (NL)• OTV Ch. (UK)• Lift Ch.(IRL)

Satcom Networks

Systems & Services• DESNET (I)• SKYPLEXNET (I)• WEB-SAT (IRL)• SATXPRESS (D)• SWB (IRL)• CollaBOD (CDN)• eWAVE V.S. (D)• Freetimers Int. (UK)• Wired Ocean (UK)• Broadband in the Sky (B)• SDS (B) • ILSE (A)• Fusion St. (IRL)• World-Link (I)• RTI-TVS (L)

Disaster Relief/

Emergency Management

• REMSAT (CDN)• EMERGSAT (F, E)• REMSAT II (CDN, E)• SASS (D) • I-GARMENT (P)• SARFOS (CH)

B2B / B2C• ABARIS (UK)• SUNRISE (UK)• MULTIMAP (UK)• JUPITER (NL)• VERDI (F, CDN, I)• MRSTREAM (UK)• E-SCREEN (I, UK)• D-CINEMA (B)• ESEMAR (I)• IMPSAT (UK)• S@Commerce (I)• TV Snapshot (L)• EDIBS (A)• MeCA (CDN)• Multi-PID (UK)• S@Commerce (I)

Distance Learning

• ESPRESSO (UK)• HERMES (I)• MODUS (I)• TRAPEZE (B, UK)• HAMLET (I)• SchoolSat (B,IRL)• ESMEE (I)• e-Learning DVB (IRL)• SchoolCast (IRL)• eLearning DVB (IRL)

• EODIS (I)• BARRD (UK)• Pacific Skies (NL)• HOST (GR)• BB to Train (UK)• INDIGO (UK)• CampNet (D)

Location Based

Satcom Services

• GWAS (CDN)• WICOR (D)• Mobile WS (NL)• Wireless IbDN (F)• I4S (F)• MoMoSat (D)• PERUSE (IRL)• MUTIS (A) • In Fligth Reporting Tool (IRL)• AeroFleet (D)• BIRDCOM (I)

e-Government

• e-regSAT (I)

• ADMiNiSTRA (I)

• SATMODE (L)• SatServ (N)• BizSmart (GR)• BrandTV (UK)• Sat-n-Surf (L)• LyngBox (S)• 2EDIBS (A)

ESA Telecom Applications Projects

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Telemedicine

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Telemedicine Applications Projects

Project Concluded in Italic

Telemedicine/

Medical Education• SHARED (I)• EUROMEDNET (I)• MULTIMED (UK)• SECOM (UK)• EMN (CH, D)• SANTTSUR (UK)• IEMN (CDN)• MIST (CDN)• WEBGMS (I)• SM@RT (I)• SKYMED (I)• HPS (UK)• DELTASS (F, D)• TELANY (I, N)• MAYFLOWER (I, N)

• I-DISCARE (F, I, N)• Telecare (CDN)• HIS (D)• NESA (I)• SKYNURSE (I)• TEMOS (D, F)• REACH (CDN)• IGEA-SAT (I)• V-4DL (I)

0

1

2

3

Co

ntr

acts

25 Contracts

(20.3% of Applications Projects)

ESA Funding: 20,540 kEUR

(24.9% of total)

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Emergency Consultation

• SECOM (UK)• IEMN (CDN)• MIST (CDN)• DELTASS (F,D)• TELANY (I, N)• I-DISCARE (F, I, N)• NESA (I)

Distributed Environment for Medical Simulation

• MULTIMED (UK)

Teleconsultation andTele-Homecare

• SHARED (I, A)• EUROMEDNET (I)• RCST (CDN)• Telecare (CDN)• TEMOS (D,F)• REACH (CDN)• IGEA SAT (I)

High End

• DELTASS (F,D)

Continuing Medical Education

• EMN (CH, D, F)

• SANTTSUR (UK)

• MAYFLOWER (I,N)

• SM@RT (I)

• SKYMED (I)

• HPS (UK)

• HIS (D)

• SKYNURSE (I, R)

• V-4DL (I)

Clinical Research & Access to Patient Multimedia DBs

• WEBGMS (I])

• HERMES (I)

• TELANY (I, N)

Telemedicine Applications Areas

Project Concluded in Italic

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+ ++Continuing Medical Education

+ ++Access to Multimedia Electronic Health Record

+Clinical Research

+ +++ +Teleconsultation and Home Care

++ +Emergency Consultation

+ ++ +Distributed Environment for Medical Simulation

+ +++High-End

High Capacity + Fast

Deployment for

Temporary Use

Multicasting/ Disseminatio

n of Multimedia Contents

Broadband Access from Underserved

Areas

High Mobility, Communicatio

n in Emergency

and Disaster Situations

Satcom Assets

Telemedicine Areas

Satcom Positioning in Telemedicine

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Key Requirements for Telemedicine Activities sponsored by ESA:

1. Provide evidence of the added value to the end users

2. Coexist with traditional medical practise

3. Elaborate a roadmap on how to integrate into the healthcare

organisation

4. Serve existing paths of communications among healthcare

professionals rather than inventing new ones

5. Have a holistic, end-to-end approach, involving the different actors

(from the patient to the political stakeholder)

6. Maintain a project-bounded, business oriented vision to foster the

self-sustainability of the initiatives

Telemedicine: a Sensible Approach

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Teleconsultation:T@His

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Emergency Telemedicine:NESA

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Teleconsultation:TeleCare

Nurse Terminal

Internet ServiceProvider

Application Serverand Database

Satellite BroadbandProvider

Gateway

Health MonitoringKit

PatientCamera

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Teleconsultation:Reach

Accumulated Travel Time Saved by Psychiatrist and Nurses

-20.0040.0060.0080.00

100.00120.00140.00160.00180.00200.00220.00240.00

260.00280.00300.00320.00340.00360.00380.00

Sep 0

5, 2

005

Sep 1

2, 2

005

Sep 1

9, 2

005

Sep 2

6, 2

005

Oct 03

, 200

5

Oct 10

, 200

5

Oct 17

, 200

5

Oct 24

, 200

5

Oct 31

, 200

5

Nov 0

7, 2

005

Nov 1

4, 2

005

Nov 2

1, 2

005

Nov 2

8, 2

005

Dec 5

, 200

5

Dec 1

2, 2

005

Dec 1

9, 2

005

Dec 2

6, 2

005

Jan

02, 2

006

Jan

09, 2

006

Jan

16, 2

006

Jan

23, 2

006

Jan

30, 2

006

Feb 0

6, 2

006

Feb 1

3, 2

006

Week

Ho

urs

Psychiatrist NursesTotal Linear (Psychiatrist)Linear (Nurses) Linear (Total)

Accumulated Cost Reductions vs Cost of REACH at various price points

( for all patients, since the project began )

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

Sep 1

2, 2

005

Sep 2

6, 2

005

Oct 10

, 200

5

Oct 24

, 200

5

Nov 0

7, 2

005

Nov 2

1, 2

005

Dec 5

, 200

5

Dec 1

9, 2

005

Jan

02, 2

006

Jan

16, 2

006

Jan

30, 2

006

Feb 1

3, 2

006

Week

$s

Saving: Hospital Days Prevented

Saving: Hours of nurses &Psychiatrist Travel ReducedSaving: Total Cost Reduction

REACH @ $500 / month / patient

REACH @ $600 / month / patient

REACH @ $700 / month / patient

REACH @ $800 / month / patient

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100 Sites in A, CH, D, I, F, NL, UK

Continuous Medical Education:EMN.net

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1. Review the current market for Telemedicine

2. Identify the key actors, review the typical service value chains and compare with traditional healthcare

3. Assess the market potential for satcom-based telemedicine

4. Analyse the regulatory framework: current and foreseeable technical, operational and legal frameworks directly affecting Telemedicine in general and via satellite in particular (whenever such distinction is relevant)

Identify domains where satellite communications can bring added-value to telemedicine services

Market and Regulatory study ofTelemedicine via Satellite in ESA Member States

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Lessons learnt

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• There are a lot of Hardware and Software (“systems”) providers and many pilot services but few proper running services and very few service providers able to provide and end-to-end service, in a turn key integrated solution

• State-of-the-Art: mainly tele-radiology, tele-pathology, general medical diagnosis, remote consultations, triage decision-making, and emergency evaluations.

• Activities are mainly limited to the local level, which prevent them to reach the critical mass necessary to turn a pilot activity into an operational and profitable service. The market is thus very fragmented.

• Highest number of running services is in the USA and Canada, rather than in Europe

• Some barriers to widespread diffusion are related to the technology, but most can be attributed to other factors.

Telemedicine in Europe today

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Recurrent problems in ESA Telemedicine projects

Telemedicine projects all face common problems:- Users are forced to find technical solutions on their own with 3 options:

• build in-house expertise before taking decisions • define requirements and “blind trust” suppliers • partner with industry (which drives towards its own solutions)

- Technical and operational issues absorb a lot of resources and disrupt the operations, leading to discover the same barriers again and again- Difficulty of providing generic evidence of viability beyond the specific context of the pilot project

ESA’s initiatives to help:De-risk the access to Satcom solutions with access to a set of facilities and associated services for initiatives not ready for the open market Proxy between the supply side and the demand originated by projects Encourage the use of Open Standards (DVB-RCS)

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Tel

ecom

mun

ica

tion

s P

rovi

der H

ardware &

Softw

are Provide

r

Medical Service Provider

Hospital Departments

GPs &

Specialists

ScientificCenters

Final User

Citizen

Telemedicine Service Provider

Network Integrator

Turn Key Solutions

Telemedicine Value ChainMedical Provider ≠ Telemedicine Provider

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Telemedicine Service Provider:

Coordinate all system integration tasks

Intervene as “one-stop-shop” access point for the customer and the user

Provide round-the-clock technical support, hotline and user training support

Ensure the continuity of the service, quality assurance measures, integrity and confidentiality of data in full compliance with the applicable regulations Organize user feedback and continuous maintenance of the proposed applications

Perform the telemedicine service between two or more physically separated parties. Its main skills are to Integrate Networks and provide

Turnkey Solutions

Role & position of key players

Medical Service Provider Supply professional expertise in the field of medicine

Usually is a healthcare institution specialized in a specific area

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• Disaster Relief Telemedicine

• Rural area Telemedicine

• Home Monitoring

• E-learning and Tele-training

• Maritime/Off-shore/Aviation Telemedicine

The following Application areas are the most promising for telemedicine via satellite:

Market forecast

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Current number of initiatives

European Market

Total Number of initiatives

2

1

2

1

45

23

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0 5 10 15 20 25 30 35 40 45 50

Offshore Telemedicine

Maritime Telemedicine

Aviation Telemedicine

Disaster Relief

E-learning/Teletraining

Rural Telemedicine

Home Monitoring

For all cases telemedicine and telecommunications costs are very small

percentages of the yearly costs of providing medical services(contradicts the preconceived idea that investment in HW, SW and telecom cost is

the main obstacle)

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Home monitoring, rural telemedicine and e-learning/teletraining are led by regional and/or national governments, so funding is partially available• E-learning/teletraining shows greatest promise for wide-scale

market uptake • Home monitoring is currently not the most attractive application in

terms of revenues but is seen by experts as having very strong development prospects, driven by demographics, the increase in preventive medicine and the adoption of cost-containment measures by national health authorities.

• Rural telemedicine uptake is hampered by poor reimbursement status and perceptions of high telecom cost where broadband access is not available

Disaster relief, aviation, maritime and offshore telemedicine are still to be implemented on a wide scale.

European Market

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Key issues for telemedicine via satellite in Europe today

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• Investment is limited to narrow healthcare activities when application to a wider scale could yield a financial and economic return: ability to be expanded on a large scale is key

• Economic and financial case studies become available but do not seem to deal with factors such as patient benefits, health outcomes or health status

• Costs of project management, procurement processes, change management, develop new clinical and working practices, implementation, training etc. are often not taken into account but they are essential resources for the success of telemedicine

• The benefits are not necessarily passed on to those that actually have to invest in the telemedicine service (e.g. cruise telemedicine: passengers benefit while investment comes from the ship owner)

Key issues in Europe today:sustainability

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In Europe the majority of telemedicine initiatives are funded by academic research, government subsidies, EU-level programmes or as part of local government development plans. Industry players across the market perceive that telemedicine is ‘on life-support’ through this public funding, which is a double-edged sword: It is a necessity to allow the benefits of telemedicine to be fully

assessed and evaluated in what is a relative commercial vacuum, but it is not allowing the laws of supply and demand to operate,

postponing the ‘reality check’ that the level of demand for telemedicine remains low and dissimulating the real difficulties associated with implementing self-sustaining business models in this market.

… Nevertheless, major industry players and key opinion leaders interviewed are in majority very optimistic about the future of telemedicine

Key issues in Europe today:public funding vs commercial market

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ESA Telecom website

www.telecom.esa.int

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ESA Telecom Contact Points

Nathalie.Ricard@esa.int

Giovanni.Garofalo@esa.int

Francesco.Feliciani@esa.int

ESA - ESTEC

Telecommunications Department

Directorate of EU and Industrial Programmes