Telemedicine Circuits Based On Standards

TELEMEDICINE WORKFLOWS BASED ON STANDARDS

SUCCESS HISTORIES & IMPLEMENTATION PROBLEMS.

STATE OF THE ART AT SPAINToni Contesti [email protected]:toni.contesti.coll

Telefonica Group - ”Global eHealth SUMMIT”

Granada-Spain. 10th & 11th September 2008

Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT”

Introduction.State of the Art of

technology.

Implementation of telemedicine at

Hospitals.

Telemedicine: reality or future.

State of the ART of IT at Hospitals

Implementation of the technology at the hospitals differs a lot from different communities and especially from new hospitals and older Hospitals

Workflow implementations of physicians differs a lot from IT sites to non IT sites.

Independent of the IT implementation, NOWADAYS, all

the physicians and services have the same “TELE” or

sharing information demands


Main vision:

Beyond the PACS.

PACS: The KEY over which to develop most off

the actual Telemedicine Workflows

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Market Prediction

By the end of 2008, 90% of the actual needs of PACS integration, will be implemented in industrialized countries (Patient EHR, Telemedicine, etc).

As minimum value, till the end of 2007, 40% of Primary Care Centers will store non-radiological images in PACS.

MAIN VISION: BEYOND THE PACS: use a PACS to store any

images, videos and data generated at the healthcare

environment.

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PACS just can store DICOM images

PACS Limitations

(but medical technology is multi-provider!)

(but many modalities are supported by non-DICOM!)

The integration of various PACS of different providers is difficult.

(but there is a huge quantity of modalities supported by non-radiological images!)

Nowadays PACS is just extended to radiological image storage (only)

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The Situation Nowadays

How to solve it?

PACS just acts as Radiological Image Repository

We will obtain that

A toolkit and family modules that facilitates the capture, retrieval, Dicom conversion, communication, gateway operations and storage

between source modalities and PACS repositories.

MIO LT, MIO COMM, Server, Broker, Store, Wado, Viewer

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Family Modules

MIO LT™ DICOM converter and PACS integration tool for a single modality. Images to be converted can be opened from a folder, captured using a frame grabber (secondary capture), or imported using DICOM SEND and DICOM PRINT services. PACS integration can be achieved by means of Worklist or through MIO Broker™.

MIO Comm™ Messaging and communication toolkit for systems and modalities integration. Includes patient data integration (HTTP, SOAP, Worklist, parameter passing, manual), communication capabilities (HTTP, TCP/IP), global messaging support (XML, HL7, files), server-based centralized full DICOM services, and image editing module (anonimize, tags superimpose, etc).

MIO Broker™ PACS integration tool with no RIS integration requiered. Allows to send to PACS the images coming from multiple modules MIO LT™ / MIO Comm™, without requiring corresponding agendas into RIS.

MIO Server™: Automatic DICOM converter and silent PACS integration for unlimited modalities in a centralized installation at a corporate level. Allows automatic DICOM conversion of all images generated within the healthcare organization whenever they are stored into a centralized preconfigured folder. Sending to PACS can be performed in a silent way and with no user intervention.

MIO WADO™ Web interface (API) for web access to PACS using DICOM communications. Allows multiPACS / multivendor / multi image Query & Retrieve. Includes full DICOM services for PACS communications and image retrieve.

MIO Store™; Medical imaging storage system for departmental applications. Images to be stored can come from multiple modules MIO LT™ / MIO Comm™.

MIO Viewer™: Image web viewer, to be integrated within third party applications. Includes functions for image comparison, and adjustments for zoom, brightness, contrast, saturation and hue. Fully compatible with MIO Store™ and MIO WADO™.

GE CERTIFIED PRODUCT

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MIO LT AND COM SOLVE EASILY

Patient demographics integration with any EPR or IT system including DICOM WL and CCOW

Automatic generating of accession number at the PACS using MIO BROKER.

Automatic generating of accessionnumber using S12 integration with RIS. Automatching with worklist.

Time efficiency. With 2 mouse clicks the images are at the PACS. Workflow optimization.

Integration with any Medical Device.

DERMATOLOGY AT THE HOSPITAL

OTHORHINOLARINGOLOGY AT THE HOSPITAL

OPHTHALMOLOGY AT THE HOSPITAL

ELECTROCARDIOLOGY AT THE HOSPITAL

ATLAS FLASH VIEWER

http://127.0.0.1:8080/visor/index1.html


Main vision:

Beyond the PACS.

Projects developed with MIO technology

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Medical Imaging Global Repository

C2C Solution• All modalities image/video capture through MIO (TDermatology, Digestology,…)• RIS/PACS y HDIS integration through MIO and standards languages (DICOM, HL7, ODBC, SQL…)• Reports design and implementation to introduce medical information

into images

Summary

ClientSanitas

LocationMadrid(Madrid, Spain)

Project Development2008

Benefits to the Client• Global Management of all generated images at the Clinic• Huge improvements: workflow and patient care• Maximum existent PACS amortization

Objectives• All non radiology images should be

acceded from the same repository

To integrate all non dicom images into

GE PACS

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Imaging Integration – Regional Level

C2C Solution• All modalities image/video capture through MIO (ophtalmology, dermatology, ORL; anatomopathology,…)• HIS / RIS / PACS integration through MIO and standards languages (DICOM, HL7,)• Reports design and implementation to introduce medical information

into images

Summary

ClientIBSAULT, CATSALUT

LocationBaleares Islands, Spain

Barcelona. Spain

Project Development2005-2008

Benefits to the Client• Global Management of all generated images at the Hospital• Huge improvements: workflow and patient care• Quality of health services improvement• Save cost: better profit of infrastructure

Objectives•Digital Clinical Imaging Access (radiological and non-radiological).•Integration Services with EMPI.• Electronic Health Record (EHR) integration with clinical imaging.

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Regional Multi-PACS Project

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Summary

ClientGeneralitat ValencianaConsellería de Sanitat

LocationValencia Community(Spain)

Additional Information22 Health Departments27 Central Hospitals25 Specialized Units900 Primary Care Centers

Project Development2005 - 2008

Benefits to the Client• 900 Primary Care Centers connected with 20 Central Hospitals, sharing Electronic Health Record integrated with clinical imaging and specialists informs.• Huge improvements felt: workflow and patient care (Tele-neurology, Tele-mammography, Tele-dermatology…)• Technologic Costs Reduction above 2 millions € / year

C2C Solution• Image/video capture from any modality, through MIO.• 5 different providers’ PACS integration, through MIO.• Existent applications integration, through Rhapsody and MIO

(HIS LEGACY, RIS, PACS y Master Patient Index).

Objectives• Digital Clinical Imaging Access (radiological and non-radiological).• Electronic Health Record (EHR) integration with clinical imaging.

C2C - the eHealth company – Beyond PACS

MIO converts

Intel MCA

into a

Dicom Device

•Capturing images and send to PACS•Dicom Worklist•HL7 & Dicom embeded

C2C - the eHealth company – Beyond PACS

Mobility Projects

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Medical Imaging Global Repository

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Telemedicine Projects

ONCE the physicians have been working with images and videos

on a PACS a new demand appears: sharing all that information with another

colleagues


MIO Technology

Telemedicine Projects: examples

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Telestroke at BALEARIC ISLANDS:

“TIME IS BRAIN”

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ACUTE CORONARY SYNDROME at BALEARIC ISLANDS: “TIME IS LIFE”

The Architecture

Call Manager

MIO – Call Manager integration

IP Phones

UC

CTDP

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Teledermatology at BALEARIC ISLANDS.

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Teledermatology at BALEARIC ISLANDS: Conclusions study developed

16/12/2005 04/07/2008.

Primary Care Centers: 59,8% (IC95% 50 – 70%) (p <0,0001) Teledermatology 94,7% (IC95% 90 – 99%) (p <0,0001)

MATCHING DIAGNOSES

NO PATIENT GLOBAL VISION

6,6% patients that go to specialist for benign tumors have malignant tumors in other part of the body.

AVERAGE RESOLUTION TIME: 20 h 07 minutes

INTEGRATION WORK BY MIO

TELE CARDIOLOGY

NURSE FROM GP EPR OPENS MIO WITH PATIENT IN CONTEXT

NURSE PERFORMS THE ECG

DATA IS TRANSFERED DIRECTLY TO MIO. ECG MAY BE REVIEWED AT PC SCREEN.

PRINTING TO PAPER IS ALSO POSSIBLE

EMPI INTEGRATION

TRANSMISSION TO MIO COMM

ECG propietary repository

GP EPR Notification

DICOM STORAGE TO PACS

Storage to Helathcare Personal Health Record


NEW CHALLENGES

HEALTH 2.0

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NEW CHALLENGES: NEW USERS

NEW PATIENT PROFILE: I-GENERATION

NEW PHYSICIAN PROFILE: i-GENERATION

NEW HEALTHCARE DEMANDS AND WORKFLOWS

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Healthcare organization

Places to organize medical content, easy access

Clinical Marketing tools

Free telemedicine toolClinician

Images interchange for second opinions, research, learning, etc.

Data source for Clinical Tests (clinical trails) monitoring based on images

Telementoring, teleproctoring, clinical comitees

Real time interchange functionality (like a messenger) for real time clinical service … and free

University use, big images events, …Patient

Open images consultation for diagnosis, before a surgery

Diagnosis development and monitoring of group of patients with clinical participation

Global repository of clinical data (my Health)

NEW CHALLENGES

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IS TECHNOLOGY READY?

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WEB 2.0 and HEALTH 2.0

Web 2.0 in Healthcare = Health 2.0

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SOME EXAMPLES

http://medting.com


MEDTING

http://medting.com

What is Medting?

• MEDTING is an internet website for the exchange of clinical cases, medical images and videos.

• Physicians, researchers and educators can use MEDTING for clinical peer review, research, teaching, second opinion and decision support purposes.

• MEDTING can be used as an asynchronous service, offline, but also doctors may want to create online meetings sessions through the MEDTING Virtual Meeting functionality.

• MEDTING is free and is exclusively for clinicians. • Medting can organize clinical cases from within an organization and can store

physicians’ medical images. It is also ideal for second opinions, telemedicine, teaching purposes and for decision support.

• MEDTING allows working with public and private content. Doctor may want to share a clinical case privately with other colleagues and can be also done with MEDTING. We strongly believe that by sharing the content in a public way we are building a helpful repository for other doctors to review samples and provide better care.

What is Medting for? For Public Health, Clinical collaboration and Research purposes

World wide research platform for all medical images specialties

eLearning, Telemedicine purposes, CME.

Image interchange, diagnosis images classification, diagnosis plat.

Anonymous Telemedicine Tool

A service for Medical Meetings, second opinion

Virtual Clinical Session Tool

A repository for a medical center to classified their content and give access to their professionals

Founders

CABRER GONZÁLEZ, MIGUELFounder & President

Computer Science degree.R&D grant for evaluation of Telemedicine (Stanford Medical University Center, Emory University (Atlanta).Former CIO of Son Llatzer Hospital, first Digital Hospital in Europe.eHealth Coordinator of Balearic Islands Health Service.Member of the HIMSS Europe Governing Council.Member of IMIA (International Medical Informatics Association) Web 2.0 taskforce workgroup.Digital Hospital, EHR – RHIO Initiatives, Integration Competence Centres, Medical Tourism and Health 2.0.

CONTESTI COLL, ANTONIOFounder & Technical Innovation Manager

Telecommunications Science degree.IT Coordinator of Catalonian Red CrossIntegration specialist at Son Llatzer Hospital Image integration specialist and Telemedicine Coordinator at Balearic Islands Health Service.

Director of Innovation of C2C.

Member of IHE-SPAIN.

Professor of Telemedicine at the UOC (Catalonian Open University)

Main areas of interest and specialisation of Toni Contesti are: Digital Hospital, EHR, DICOM, HL7, INTEGRATION, WEB 2.0.

Images worldwide interchange repository for clinical research and collaboration purpose

Health 2.0

One vision

Connecting Images in a clinical context

Medting.com 59

MedtingThe Power of Collective Wisdom

Clinical Cases

Medting.com 60

Atlas

Medting.com 61

Multilanguage• Keywords (tags) are based on SNOMED CT terminology• Automatic translation of the keywords

• SNOMED provides a battery of more than one million clinical terms in several languages.

• The more SNOMED terms you use as keywords, the better your content will be indexed.

Medting.com 62

Pubmed integration

Medting.com 63

Repository and Tool

• Private and Public cases:– Public cases can be reviewed from any internet user since it’s published into the

platform. – Private content (cases, images or videos) can be also posted and uploaded to

MEDTING. Those cases will not be shown on the MEDTING website and only invited users will be permitted to review those cases. This functionality is useful for Telemedicine and second opinion services.

• Any user can be invited by the author to review a private case:

Medting.com 64

Social components (Web 2.0)

• Powerful video management: transcoding and broadcast

• Multiple images viewers• Connectors: Mash-up• Social component: Vote, comment and

share

Medting.com 65

Atlas viewer

Medting.com 66

• Atlas flash viewer• Upload images to Medting

and show them from another website

• Disease atlas, specialties, organs, etc.

Medting a reference site for medical media

Medting.com 67

• Users don’t easily share their clinical content

• A win-win relationship has to be established

• Emphasizing the potentials of Medting is necessary

Clinical Marketing, promoting physician’s website

Free Telemedicine Tool

Connectors: linking Medting content from an external

website

Medting Connectors: mash-up

Medting.com 68

Medbloggers, medical magazines, forums, intranets can benefit from Connectors and show content from Medting in external websites


ON LINE DEMO

Who can be interested?

• Education and training organizations• Virtual Clinical Sessions (online / offline)• Clinical marketing tool• Telemedicine / Second opinion• Independent doctors: have your medical blog • Medical workgroups or researcher• Media Syndication

Medting.com 70

Medting for independent doctors

• Medting is a no cost service• Premium users also free• Medting is a service that can be used to post

information privately or public• Private information:

– Case: sharing a case privately only between invited users– Store images on a private repository

• Public Case or Resource: will remain public for other users searching on Medting

Medting.com 71

Enterprise Partners

• Health care organization, hospitals, medical centers can become Enterprise Partner

• Extra functionalities of Enterprise Partner– White Label: use Medting functionalities with the

Enterprise-only content– Online Virtual Clinical Session (collaborative tools)– Direct Medical modality connection (MIO)

• Enterprise Partner is a fee based service. Fee may depend on volume and size

Medting.com 72

A Multimedia European Platform for Endoscopic Surgery Knowledge Exchange (A preliminary proposal for the 7th Framework Programme of

the EC)

Second Opinion Expert Board Online CME Programs

Objective: “To develop a multimedia, Web-based European second opinion expert board with associated CME programs specialized in Endoscopic Surgery .”

Medting Technology

• Endoscopic Surgery network of excellence

• Collaborative clinical case discussion for decision-making support

• Focused on rare/complex cases of high academic value

• Online visualization of surgical interventions

• Interactive, multimedia Web-based CME programs

• High quality standards supported by a European network of excellence

• Integrated clinical information exchange (images and videos)

• Multilingual, international coverage

• Web 2.0 community-based approach

• Powerful and secure exchange of large volumes of images and videos

• Quick information search via SNOMED CT

• Low-cost, flexible integration into existing Web sites

Base platform for other projects


MEDTING

PLATFORM TO DO ANY TELEMEDICINE PROJECT

EASILY

In the first 3 months … 3 Enterprise Projects

HEALTH SCIENCES LEARNING TROUHG THE MEDTING

First Step: Upload case/images•Web 2.0 –based task for the professor

Second Step: Student view the cases•Keywords, descriptions, images and videos•Student search for related cases

Third Step: Work in class• ANALYSIS OF: COMMENTS : KEY WORDS, POSSIBLE TREATMENTS, IMAGES.•Professor proposes activities about the topics and questions about the material on the web and students:

Peer review, working groupsDiscussion boardsMake pictures/videos of possible treatment procedures

Fourth Step: STUDENTS UPLOAD COMMENTS/IMAGES after work in class/at home

Fifth Step: Reading and correction

SixthStep: Reviewing all comments and implementations


Benefits according to students

•Working with real cases provided in the web: bridge between academic and clinical environment•Viewing all type of images•Developing deep understanding of the topic being studied•Maintaining knowledge based on cases and reports•Using professional online databases .

Inconvenience according to students

•Too much time to:•read and analyze cases•analyze Images•upload cases and images•Get good marks!!•No feeling of learning


Benefits according to professors

•Students: •work with the material (CASES/IMAGES) provided in the web 2.0 to learn real problem solving•Improve decision making and critical thinking•Improve teamwork and communication•Applications in all specialties

Inconvenience according to professors

•Changing role of the professor•Time spent•Lack of real practice documentation/cases/images shared on webs•Preparing/searching cases/images related to the topic


CONCLUSIONS

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7 TECHNOLOGIES THATH COULD CHANGE HEALTHCARE

The first and the second are related with data and image

interchange between hospitals. The technology that I’ve

explained today.

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FUTURE WITH ILUSION

A lot of new ideas to develop:Synchronous Telemedicine platform on Skype, Health

Tourism platform, Medas ….

Virtual Health Record Platform for Medical Tourism Purposes

Health Destination Project

MEDAS ASP EPR

Is your Hospital achieving

optimum profit

from its PACS?

Does your hospital need to integrate non-Radiological Images into its PACS?

Does your Hospital know how to maximize profit, from the investment in

Imaging Technology already in place?

Is your hospital able to incorporate

Images into your Patients

Electronic Health Record?

Has your Cardiological Department asked for

ECGs storage into your PACS?

Should your hospital centralize in just one single repository ALL Medical Imaging?

Does your hospital participate in some Telemedicine Project

that requires

Medical Imaging sharing?

Thanks for your attention!C2C the eHealth company

Director of InnovationToni Contestí

Bussiness Development ManagerÓscar López

Integration Project Engineers& Developers

Victor BasPaco Bevia

Matías BonetJuan Brines

Roberto CastellorJosé Colomer

Antonio de PedroVanesa del Casar

Enrique de la VegaAntonio Hernández

Pedro HurtadoDaniel López

Toni MasJoan OliverBerta PérezXavier PonsSilvia Ramis

Sebastián RoncoliVicente RossellóAgustín Sabater

Sergio Sanz

Office ManagerBelén Martín

Ireland Office ManagerHernán Alberti

International Sales ManagerRita Almada

Clinical ConsultantMiguel Cabrer (IRC)

Jordi Pozo

C2C Consultoría TSIS SLRepública Dominicana, 3 bajos local 1

07014 Palma de MallorcaBaleares (Spain)

Office: (+34) 971.919.124Fax: (+34) 971.918.423

[email protected]

ThanksFeel free to ask me any doubt or come with me to the next Summit: the Everest, where Telemedicine is a need.

Skype: toni.contesti.coll [email protected] +34607840967

Telemedicine Circuits Based On Standards

Health & Medicine

Transcript of Telemedicine Circuits Based On Standards