TELEMEDICINETELEMEDICINE

Background Experience and

Existing Capabilities

“Providing Specialist Care and Medical Knowledge Anytime, Anywhere”

Briefing prepared for the SIMIHO Technical W.G.Rome, November 27th 2002

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• The Telemedicine experience of TELBIOS Company derives from its participation in a number of European and Italian Space Agencies programs since 1995, at the beginning in a Consortium formed by Alenia Spazio (Rome) and the Scientific Park of the San Raffaele Hospital (Milan) and later as an independent Company

• The main International Programs to which TELBIOS participated as “Prime Contractor” were: the Satellite Health Access for Remote Environment Demonstrator (SHARED), the European Medical Net (EUROMEDNET), the TELEMEDICARE and the Medical Sky (SKYMED)

• Aim of the programs :– SHARED: to build the first European Telemedicine Network, in which Satellite

communications were integrated with terrestrial links– EUROMEDNET: to enlarge the above Telemedicine network, including a number of

European and Mediterranean Countries – TELEMEDICARE: to apply to mobile platforms the satellite communication

equipment ,required to enter the EUROMEDNET. – SKYMED:to develop a Continuous Medical Education (CME) system, via satellite and

Internet

TELBIOS Co. Experience

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TELBIOS Co. Experience(Cont.ed 1)• On the completion of such programs and others of minor importance, the

Telemedicine network managed by TELBIOS was able to connect a number of European and North Africa Hospitals and some mobile platforms.

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TELBIOS Company• On 1st January 2001, Alenia Spazio and Scientific Park of S.Raffaele Hospital made

the decision to form TELBIOS Telemedicine Co. • TELBIOS Co. is presently owned by Alenia Spazio (Rome), Hospital S.Raffaele (Milan)

and Value Partners (Rome) according to the shares below indicated

• TELBIOS Company operates in the field of Telemedicine and medical E-Learning with the aim of providing turn-key solutions suitable to meet different customer requirements. Medical E-learning is , in fact, considered a complementary area to Telemedicine.

Value Partners

10%

Science Park Raf

45%

Alenia Spazio45%

Alenia Spazio Science Park Raf Value Partners

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• The American Medical Association defines Telemedicine as “the provision of health-cares consultation and education, using Telecommunication Networks to communicate information”

• Telemedicine is an interdisciplinary discipline. It encompasses Information Technology, Telecommunications and Medical expertise

Telemedicine

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• Telemedicine allows medical services (such as advise on trauma treatment, surgery in emergency, etc.) which require the observation of a patient or part of his body from a distant specialized doctor. To do that Telemedicine uses the videoconference communication technique.

• Telemedicine supports moreover the transfer of medical images (produced in radiology, cardiology, dermatology, dentistry, pathology, etc.) for which is not required an immediate diagnosis from a distant doctor.

• Telemedicine services require images transferred (average 10 MB) be at diagnostic level. Adequate data rates and compression protocols are ,therefore, needed to achieve such a quality of service

Telemedicine Services

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• Telemedicine networks are for simplicity, normally operated at a preset data rate. However:* for receiving a simple advice or for an exchange of opinions between two

doctors (Teleconsultation) a simple connection (telephone , E-mail etc) is sufficient

* for showing a patient or part of his body to a distant doctor (Videoconference), data rates up to 384 Kbps are needed.

* for transmitting medical images (X-rays, ultrasounds,etc), data rates of at least 384 Kbps , associated to selected compression techniques, are normally required to ensure the images transfer at diagnostic level and in a reasonable time.

• Telemedicine services can be performed, however ,in different ways , depending on the pathologies involved, the capability of the network and the data to be transferred

Telemedicine Data Rates

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• Metropolitan Areas Telephone lines allow to address the home market to monitor patient

parameters. That is one of the most popular Telemedicine applications, although of limited performances, notwithstanding the advent in urban areas of the Digital Subscriber Line(DSL) technique.

Telemedicine Networks

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Telemedicine Network(Cont.ed 1)• Out of Area - In regions with scarce terrestrial telecommunications infrastructures and when

Telemedicine applications require the transmission of high volume of traffic, satellite links supplemented by ISDN connections, where available, are needed.

- Internet can be used to support Telemedicine services or used , if available, as complementary network to provide medical services, which are not high data rates demanding.

ISDN

Central HospitalTOC

348 Kbps

Internet ISDN

PeripheralSatellite Terminal 1

Peripheral Satellite Terminal 2

Peripheral Satellite Terminal n

348 Kbps

Banda Ku

TOC = Telemedicine Operation CenterISDN = Integrated Servi rces Digital NetworkKu = Frequency Band of Communication Satellites (11÷14 GHz)

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Telemedicine Networks(Cont.ed 2)• Out of Area Special vehicles equipped with adequate medical instruments and a

satellite terminal are necessary to provide medical support to Army Operations.

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Telemedicine Network(Cont.ed 3)

Van provided with:• medical equipment• satellite terminal

• Out of Area Satellite links are required to provide medical support to mobile platforms

Medical Center

Aircraft

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• Telemedicine can be divided in two basic modes of operations: – Real Time or Videoconference : when a patient is present with the

attending doctor at the remote site with the specialist at the distant Medical Center.

Telemedicine Method of Operations

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Telemedicine Method of Operations (Cont.nd 1)• Store and Forward: when the patient information (X-ray, images etc.) is

transmitted electronically to a distant Specialist, whose response will not be immediate (Normally few hours/days will elapse before receiving the Specialist Report).

Network

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• Telbios uses satellites and/or ISDN landlines to connect doctors at remote hospitals to specialized distant Hospitals or Medical Centers.

• Telbios Telemedicine network is designed to operate according to RealTime/Videoconferencing and Store and Forward mode of operations.

• The network is composed of :– a Telemedicine Operation Center (TOC), which manages the requests for

appointments /connections to carry out Telemedicine services. Such requests are received from peripheral hospitals via Ku band satellite or landlines. The TOC arranges for the connections with the required specialized hospital. (To fulfill the request, the TOC provides satellite bandwidth and power, when a satellite path is needed or operates the landline switching device, when the required hospital can be connected, via terrestrial line).

Telbios Telemedicine

Telemedicine Operation

Centre

ISDN/Internet

Hospital 1

INTERNET/ISDN/SATELLITE

SATELLITE

Hospital n

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Telbios Telemedicine (Cont.ed 1)

- a number of Ku band fixed

satellite terminals and ISDN Line connected to the medical equipment (X-ray,ultrasound, etc.)

- some mobile and transportable satellite terminals, installed on different platforms ,for their use in support of oversea operations and field hospitals.

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• Telbios operates Telemedicine connections under the Eutelsat Ku band satellites( (SESAT (36°E) and Hot Bird 5 (8°W,back up)) coverages, as they meet the requirements of present customers .

• ISDN Lines are supplied by Telecom Italy.• Other satellites and different arrangements could be made, if requested by

new customers.

Telbios Telemedicine (Cont.ed 2)

Sesat (36° E) Hot Bird 5 TM (8° W)

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Distance learning or e-learning

• Distance Learning circuits are considered part of the Telemedicine Network. Distance Learning or e-learning is defined as “the delivery of standardized individual, collective and self-development training to students, paramedics and doctors at the right time and place through the application of multiple means and technologies”.

• Telbios Distance Learning is aimed to provide medical information (generated by university professors, teachers/lecturers and other experts) to doctors, paramedics, nurses ,students spread in a large area

• Telbios performs distance learning :– using WEB pages, to be downloaded by students, separately or in groups.– broadcasting the medical information on a satellite channel,

complemented , when available, by terrestrial return links, used by students to interact with the lecturer, during the didactic event.

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Distance learning or e-learning (Cont.ed 1)• Telbios satellite Distance learning architecture is based on a:

– Service Center ,which normally coexists with the up-link satellite station and the equipment needed for the delivery and management of the medical contents.

– Content Providers (Universities, Hospitals , etc) for the production of the didactic material. Content Providers may be connected through dedicated lines to the Service Center for the direct content uploading.

Service Center

Content Provider

End User

Internet

LAN

End Users-TutorInteraction

Live Content Transfervia ISDN

End User

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End User 1 INTERNET

Network Hub

123456789 *8#

PABX Line

Modem

End User n

Telbios can design other suitable architecture to meet potential customer requirements

- A number of students or end users receiving the data stream (normally 2 Mbps MPEG2-DVB standard) on a T.V. or a P.C. screen in distant rooms , located within the coverage area.

Distance learning or e-learning (Cont.ed 2)

End User 1 INTERNET

Network Hub

123456789*8#

PABX Line

Modem

End User n

Area n

Area 1

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Conclusions

• Telemedicine via satellite is well suited for providing health care delivery to military forces operating in areas under served by terrestrial networks. Telemedicine can complement the medical expertise of doctors supporting such forces and reduce the number of patient evacuations from the area.

• To achieve interoperability amongst different national Telemedicine networks, agreements and protocols should be established and technical standards are to be selected for the videoconference and transfer of medical images.

• To ensure a diagnostic level to the received images, satellite channels capable of carrying large files in reasonable time are necessary.

• Military Forces need a Telemedicine transportable and mobile capability to receive a timely and ubiquitous medical support.