2005
Anthony Codrington-Virtue*,**, Paul Wittlestone**, John Kelly**, Thierry Chaussalet*
*Health and Social Care Modelling Group, Centre for Health Informatics, Cavendish School of Computer Science, University of Westminster, London, UK
**RKW Healthcare Strategists London, UK
Abstract:
Discrete event simulation can be a valuable tool in modelling health care systems. This paper describes an interactive framework to both enter data and display patient pathways and activity using a discrete event simulation package in a hospital accident and emergency (A&E) department setting. The interactive framework allowed data such as patient pathways, arrival times, service times and resource information to be entered into a discrete event simulation package (Simul8) via Excel in a user-friendly way. Simul8 was also configured to visually show patient flow and activity on a plan of the A&E. The patient flow and activity information included patient icons flowing along pathways, processes undertaken in work areas and queue activity. One major benefit of visually showing patient flow and activity is that modellers and decision makers can rapidly gain a dynamic insight into the performance of the overall system and see those changes over the model run cycle. Another key benefit of the interactive framework is the ability to quickly and easily change model parameters to trail, test and compare different scenarios. The models could then be analysed by modellers and decision makers to “develop basic understanding, find and compare decisions and policies”.
14 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: Hospitals, Simulation
Maria Zolfo*, Lut Lynen*, Kurt Brauchli**, Martin Oberholzer**
*Institute for Tropical Medicine, Antwerp, Belgium
**University of Basel, Switzerland
Abstract:
Worldwide there are more than 40 million HIV infected people, and 90% of them are living in settings with limited resources. In many countries, and particularly in Africa, HIV/AIDS has become the most important health problem. Besides continuous efforts for prevention, the introduction of antiretroviral therapy (ART) has become a humanitarian and economic necessity and possibility. Recent price reductions for antiretroviral drugs make this intervention possible.
Facing the necessity to assist physicians in low resource settings to treat patients with newly introduced ART and to offer good standard of care for Opportunistic Infections (OIs), the Institute of Tropical Medicine, Antwerp (ITMA) set up a computer aided training program for healthcare providers working is these settings. Expert advice from HIV/AIDS specialists about ART and management of OIs has been offered to colleagues working in different resource limited settings. The telemedicine advice has been organized initially through an e-mail network but later, in response to the need of continuous medical education on HIV and ART, through a discussion forum on a telemedicine web site (http://telemedicine.itg.be). More than 300 cases and questions have been assessed from April 2003 (date of first telemedicine referral) till today, with evaluation of direct impact on patients care, individual patient management, and resolution of more general problems as organization of health services for AIDS care. Only a quarter of cases/questions is available on the telemedicine discussion forum web site, which resulted in 345 interactions between colleagues with more than 12 000 accesses on the web. Several similar activities have showed with their experience and longer existence a good functionality in supporting transfer of medical information between colleagues for remote diagnostic, teaching, and consultations:
One telemedicine project that has a long experience with low resource settings is the iPath telemedicine project at the University of Basel (http://telepath.patho.unibas.ch). This platform was initiated in 2001 and is now used by more than 1000 doctors on all continents for consultations, case discussions and educational applications. By the end of 2004, over 1900 consultations from developing countries had been submitted and diagnosed by experts from around the world (on average 70 cases per month). These consultations came from approximately 80 users in 20 developing countries. While iPath is not exclusively targeted at low resource settings – most users are from Western Europe – the software for the iPath project has been continuously adapted to needs of users from developing countries. As a result, the basic functions for discussing cases on iPath are available not only with an Internet browser, but also over an email interface, which allows users with a slow connection to utilise telemedicine as well. Besides, the iPath software is open source and freely available ( http://ipath.sourceforge.net ). Several telemedicine projects are using iPath (e.g. South Africa, Nepal).
Workshop description and methodology: what is the workshop about and how the workshop will be conducted?.
The workshop will focus on practical information about how to use telecommunications to improve health care for HIV/AIDS patients in remote areas.
The workshop will be divided in 3 parts:
- Presentation of successful experiences with telemedicine systems in developing countries: ITMA telemedicine and discussion forum functionality; iPath, open source telemedicine server with integrated web- and email-interface: experiences from long term telemedicine application in developing countries – problems and solutions.
- Basic technical requirements with a focus on off-the-shelf equipment such as ordinary PC computers, email or internet connections and low cost digital cameras.
- Analysis of appropriate resources and expertise needed in different countries and for different types of telemedicine.
- Comparison of different low cost technologies available at the moment on the market for telemedicine projects – looking at technical requirements and communication strategies.
- Use of telemedicine as method of education and training for medical and paramedical staff (distance teaching and medical literature delivery).
Objective: what will be achieved in the workshop?
After the workshop completion, participants will have a clear knowledge of:
- different telecommunication systems that can be used in telemedicine
- necessary equipment to set up a telemedicine network
- how to access education and training through the Internet
- cost effectiveness of telemedicine
- future perspectives: collaboration among network operator; exchange of data between systems; real-time exchange of knowledge, information and expertise
Target audiences
This workshop is mainly targeted at people who want make use of telemedicine in low resource settings. In addition, it should be interesting for organisations who want to create and utilise their own telemedicine networks and/or link up with existing telemedicine networks.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: HIV, Telemedicine
K Brauchli*, D O’Mahony**, L Banach*** and M Oberholzer*
*Department of Pathology, University Hospital Basel, Switzerland
**Family Practitioner, Port St Johns, South Africa
***Telemedicine Unit, University of Transkei, South Africa
Abstract:
In many developing countries there is an acute shortage of medical specialists. The specialists and services that are available are usually concentrated in cities and health workers in rural health care, who serve most of the population, are isolated from specialist support. Besides, the few remaining specialist are often isolated from colleagues. With the recent development in information and communication technologies, new option for telemedicine and generally for sharing knowledge at a distance are becoming increasingly accessible to health workers also in developing countries. Since 2001 the Department of Pathology in Basel, Switzerland is operating an Internet based telemedicine platform to assist health workers in developing countries. Over 1800 consultation have been performed since. This paper will give an introduction to iPath – the telemedicine platform developed for this project – and analyse two case studies: a teledermatology project from South Africa and a telepathology project from Solomon Islands.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: Dermatology, Information Technology, Internet, Telemedicine
D. Kopec, R. Eckhardt, S. Tamang, D. Reinharth
Brooklyn College; Albert Einstein Coll. of Medicine, USA
Abstract:
The United Nations Security Council reports HIV/AIDS as the fastest growing threat to human development. In addition, the World Health Organization (WHO) reports that nearly 5 million persons (4.3 million adults and 700,000 children) are newly infected with HIV each year; more than 95% of them found in developing countries. Since STDs as a group are a personal problem which few people feel comfortable discussing, we believe that hand-held PDAs can provide an opportunity the learning about this disease while insuring anonymity. This device will employ the newest technologies including Bluetooth wireless technology, which can transmit and receive data via a short-range radio link using a globally available frequency band (2.4 GHz ISM band), enabling rapid and accurate synchronous and asynchronous data communication. The first generation of Bluetooth permits exchange of data up to a rate of 1 Mbps per second, even in areas with much electromagnetic disturbance. This emerging technology will facilitate HIV/AIDS outreach around the globe.
Recent advances in learning have taken a particularly cognitive perspective and these findings have implications for education in general as well as for the development of intelligent tutoring systems in particular. In the past, effective SmartTutors have been developed for AIDS education to disseminate the critical knowledge relevant to this epidemic (Kopec, Brody, Wood and Shi, 1992). But since 1993, with proliferation of the World Wide Web, the Internet has created a plethora of new opportunities for the delivery of electronic distance learning systems. A new, comprehensive, web-based learning system called SmartTutor has been developed, at Brooklyn College of The City University of New York (CCIT, 2004). This technology provides a user-friendly, self-paced, easy to modify, software environment intended to serve the user’s learning needs and is based on a generic SmartTutor methodology organized around the use of concept mapping. Early assessment of SmartTutor has shown that it is well received by students and helps significantly in their learning processes. It is readily adaptable to the presentation of academic and more general subject matter such as the latest available information on HIV/AIDS. Our new HIV/AIDS SmartTutor will incorporate this SmartTutor paradigm. The paradigm, developed over a number of years since the introduction of SmartBooks in 1992, entails:
- Consultation between subject matter and domain specialists and experts, educationists, psychologists, computer scientists and the potential end-users.
- Development of the prototype concept maps with a number or iterative refinements and improvements.
- 3Design of the specific SmartTutor interface, with concept maps, specific link buttons and system features (glossary, history, help function, self assessment, references, etc.).
- Coding for a web-enabled platform (e.g. Javascript, XML, Perl, Java, Flash).
- Testing and evaluation of the systems effectiveness.
Our new SmartTutor would provide worldwide access to medical professionals as well as the general public to learn about HIV/AIDS. This new device could also provide a survey tool to facilitate HIV risk assessment. Demonstrations of the SmartTutor learning system will be presented and the continued development of the applications will be discussed.
World Health Organization [online] WHO HIV/AIDS Programme, [cited 2005-3-1]. Available from Internet: http://www.who.int/hiv/en/
D. Kopec, M. Brody, C. Shi, and C. Wood. “Towards an Intelligent Tutoring System with Application to Sexually Transmitted Diseases” in Artificial Intelligence and Intelligent Tutoring Systems: Knowledge-based systems for learning and teaching, Ellis Horwood Publishers, Chichester, England, May, 1992, pp. 129-51.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: HIV, Wireless
Cesar Caceres*, Enrique J. Gomez*, Felipe Garcia**, Paloma Chausa*, Jorge Guzman*, Francisco del Pozo*, Jose Maria Gatell**
*Bioengineering and Telemedicine Unit. Universidad Politecnica de Madrid, Spain
**Infectious Diseases Unit. Clinic Hospital, Barcelona, Spain
Abstract:
VIHrtual Hospital is a telemedicine web system for improving home integral care of chronic HIV patients through the Internet. Using the videoconference, chat or messaging tools included in the system, patients can visit their healthcare providers (physician, psychologist, nurse, psychiatrist, pharmacist, and social worker), having these access to the Electronic Patient Record. The system also provides a telepharmacy service that controls treatment adherence and side effects, sending the medication to the patient’s home by courier. A virtual community has been created, facilitating communication between patients and improving the collaboration between professionals, creating a care plan for each patient. As a complement, there is a virtual library where users can find validated HIV/AIDS information helping to enhance prevention. This system has been developed using low cost technologies in order to extend the number of patients involved in its trial. Thus, VIHrtual Hospital is now on trial in the Hospital Clinic (Barcelona, Spain) involving a hundred patients and twenty healthcare professionals during two years.
Although we are still waiting for the final results of the trial, we can already say that the use of telemedicine systems developed ad hoc for a chronic disease, like HIV/AIDS, improve the quality of care of the patients and their care team. The system described is a good example of the possibilities that technologies are offering to create new chronic patient care models based on telemedicine.
4 June 2005 | No Comments »
Categories: 2005, Conferences | EHR: EHR | Tags: HIV, Internet, Telemedicine, Web
G. Graschew*, T.A. Roelofs*, S. Rakowsky*, P.M. Schlag*, S. Kaiser**, S. Albayrak**
*SRU OP 2000, Robert-Roessle-Klinik and Max-Delbrueck-Center, Charité – University Medicine Berlin, Germany
graschew@mdc-berlin.de
**DAI-Labor, Agent Technologies in Business Applications and Telecommunication, Technical University Berlin, Germany
Abstract:
eHealth and Telemedicine aim at equal access to medical expertise irrespective of the geographical location of the person in need. New developments in Information and Communication Technologies (ICT) have enabled the transmission of medical images in sufficiently high quality that allows for a reliable diagnosis to be determined by the expert at the receiving site. At the same time, however, these innovative developments in ICT over the last decade bear the risk of creating and amplifying a digital divide in the world.
In recent years, different institutions have launched several Euro-Mediterranean eHealth and telemedicine projects which aimed to encourage the Euro-Mediterranean cooperation between the European member states and the Mediterranean Countries. All these projects have demonstrated how the digital divide is only a part of a more complex problem, the need for integration.
In the framework of the EMISPHER project (Euro-Mediterranean Internet-Satellite Platform for Health, medical Education and Research, EUMEDIS Pilot Project 110, see www.emispher.org, 9/2002-12/2004, co-funded by the EC under the EUMEDIS Programme) a dedicated internet-satellite platform for Telemedicine in the Euro-Mediterranean area was deployed and put in operation. The network currently consists of 10 sites in Morocco, Algeria, Tunisia, Egypt, Turkey, Italy, Greece, Cyprus, France and Germany, and hosts key applications in the field of medical eLearning (courses for under-graduates, graduates, young medical professionals, etc., in real-time and asynchronous modes), real-time Telemedicine (second opinion, demonstration and spread of new techniques, Telementoring, etc.) and eHealth (medical assistance for tourists and expatriates). The EMISPHER network serves as a basis for the development and deployment of a Virtual Hospital for the Euro-Mediterranean region.
Virtual Euro-Mediterranean Hospital (VEMH) aims to facilitate and accelerate the interconnection and interoperability of the various services being developed (by different organisations at different sites) through real integration. This integration must take into account the social, human and cultural dimensions; that strive towards common approaches but open and respectful of cultural differences: multi-lateral cooperation instead of aid.
VEMH will provide a heterogeneous integrated platform consisting of a satellite link and a terrestrial link for the application of various medical services, such as medical e-learning, real-time telemedicine and medical assistance. Fellowship programmes for the training of young medical doctors will be implemented and allow to gain experience in multidisciplinary and multicultural environment.
The methodologies for the VEMH are medical-needs-driven instead of technology-driven. They provide new management tools for virtual medical communities and allow management of clinical outcomes for improved implementation of evidence-based medicine. By the integration of different telemedical solutions in one platform many different medical services shall be supported. Data security and patient’s privacy will be assured by use of a unique coding algorithm and assignment of a patient ID code. Each service will be evaluated according to a cost-benefit and a cost-effectiveness analysis.
VEMH will foster cross-Mediterranean cooperation between the leading medical centres of the participating countries by establishing a permanent medical and scientific link. Through the deployment and operation of an integrated interactive communication platform (satellite link, terrestrial, wireless, etc.), VEMH will provide for medical professionals in the whole Euro-Mediterranean area access to the required quality of medical service depending on the individual needs of each of the partner. The services such as E-learning, the applications in real-time telemedicine and the improved medical assistance contribute to an improved level of healthcare in the whole Euro-Mediterranean region and build the basis for the introduction of Evidence-Based Medicine.
For a successful integration of the various services, the development and implementation of special GRID technologies dedicated to Telemedical applications is required. Existing Grid Engines provide basic computing power needed by today’s medical analysis tasks but lack other capabilities needed for communication and knowledge sharing services envisioned. When it comes to heterogeneous systems to be shared by different institutions especially the high level system management areas are still unsupported. Therefore a Metagrid Engine is needed that provides a superset of functionalities across different Grid Engines and manages strong privacy, AAA requirements and QoS constraints at this comprehensive level.
Relying on this architecture the envisioned services can be created. For these tasks appropriate engineering methodologies have to be developed as the concerned application goals differ from classic design environments. Due to the high level of abstraction needed for making the applications independent from the underlying Grid Engines the developers have to be supplied with accordant procedure models and supported by a corresponding range of development tools. The services to be created need flexible and multi-modal access in order to be available to the different users met in the medical environment.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Country: Europe | Tags: e-Health, Information Technology, Interoperability, Mediterranean, Telemedicine, Virtual Hospital
Bettina Zippel-Schultz, Carsten Schultz, Prof. Hans Georg Gemünden
Berlin University of Technology, Institute of Technology and Innovation Management, Germany
Abstract:
Due to globalization of health care, cross-border competition and limited financial resources, hospitals have to face an increasing economic pressure. International virtual networks of health care providers offer the opportunity to survive and to be successful in that new environment. This innovative network is based on a powerful technological infrastructure. However, economical aspects like the adjustment to different political systems and the implementation of new operational and management processes of health care are crucial.
During an extensive research project concerning business models of telemedical services, we carried out three empirical studies to analyze: “Acceptance of Integrated Health Care in Germany”, “IT cooperation of Hospitals” and “Acceptance of a Telemedical Platform / Service”. Based on our findings we developed a framework for successful virtual structures. Within this context we identified the acceptance and the perceived value of every participant as highly important for the success of the virtual hospital and the diffusion of innovative therapies. Consequently we searched for drivers that are positively affecting the acceptance and the value of the network. Our findings identified three main aspects: characteristics of the individual partner, characteristics of the network structure and those attributes dealing with the relationship between the partners.
In order to ensure the positive effects of those network characteristics and to define processes between the partners we have to establish a professional network management (”e-department”) for the whole virtual hospital. Additionally there has to be a self management within every single hospital. Those two managements enable the network to provide an effective and efficient health care and push the implementation of the evidence based medicine.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: Mediterranean, Networks, Telemedicine, Virtual Hospital
M. Poulymenopoulou
Department of Informatics, University of Piraeus, Piraeus 185 34, Greece
Abstract:
The concept of a virtual Euro-Mediterranean hospital (VEMH) is to merge geographically dispersed hospitals of Euro-Mediterranean countries into a network of healthcare delivery in an attempt to provide ease of access to care for their citizens and to provide shared care and continuity of care at regional, national and international level. A virtual hospital can be seen as a collection of geographically dispersed healthcare units whose healthcare processes can be inter-connected and supported by information and communication technology. Although a virtual hospital has no physical boundaries, information access and exchange boundaries are considered to separate those who participate in the virtual hospital structure from those who are not.
In a virtual hospital structure, the ability to readily access and exchange medical information is essential in improving the quality of the healthcare provided, supporting the continuity of healthcare and the shared care while reducing practice variability and patient care costs. A web-based electronic patient record (EPR) system can be developed to provide access to integrated patient information irrespective of the location where it has been stored. On an authorized user request, patient information can be retrieved from various sites, transformed into common format, structure and semantics, collated and presented to the requesting user. On these grounds, it is suggested the development and implementation of a web-based electronic patient record (EPR) system for the VEMH in order to provide:
- Authorized access to integrated patient information at the point of care, when and where needed
- Timely patient information exchange among the participants in healthcare delivery processes
To this end, the needs for integrated patient information of the participating healthcare organizations should be addressed and interoperability among heterogeneous healthcare systems should be supported using widely acceptable standards at both structural and semantic level. The web-based EPR system suggested is based on a horizontal, process-oriented view of healthcare delivery and aims at supporting cross-organizational healthcare processes executed within the boundaries of health districts, within the boundaries of countries and among the healthcare organizations participating in the VEMH. The EPR system architecture is based on a document-oriented approach (XML documents) according to which documents are considered as the basic information objects and document exchange as the basic inter-organizational interface. In addition, web services are designed in the framework of the architecture to implement the information retrieval and exchange activities of the cross-organizational healthcare processes and an EPR system security policy is also specified and incorporated into the system architecture. Finally, the existing investments on information systems made by the participating healthcare organizations are preserved and the EPR system is incorporated into these systems.
4 June 2005 | No Comments »
Categories: 2005, Conferences | EHR: EHR | Tags: Health Information Exchange, Mediterranean, Virtual Hospital
Laurence Cecchetti
Sonema S.A.M, Italy
Abstract:
The Virtual Euro-Mediterranean Hospital is directly connected with political issues. A way to evaluate the politically sustainable aspects in integrating the VEMH is to analyse the health issues of the targeted Mediterranean countries.
First at all, after describing the traditional health systems established in most western countries (”Bismarck” versus “Beveridge” schemes), the presentation shows the limits of these methods facing the new problems of Healthcare. (Globalisation, Europeanization, lack of healthcare in isolated or rural areas, need for modernizing the systems).
Then, Telemedicine is presented as an alternative solution to face these new political issues, knowing that obstacles (cost, risk management, cultural differences) still exist.
Moreover, the various specificities of the Mediterranean countries (Algeria, Morocco, Tunisia, Egypt, Turkey) must be integrated to analyse such a project:
- A low Healthcare budget as a percentage of the GDP (WHO, 2004),
- A low medical expenditure per capita (WHO, 2001),
- Some common issues:
- Coexistence of “primitive and contagious diseases” with “modern diseases”,
- Preponderance of the Public sector,
- Unbalanced care access in rural areas and for poor people,
- Dependence on imports of medical goods.
However, the Euro-Mediterranean countries are setting up health reforms such as:
- A five years Plan in Morocco (Creation of the AMO – Mandatory Health Insurance),
- A renewal of Hospital infrastructures in Algeria,
- A six years’ Program to reform the healthcare system in Egypt,
- A development Plan to promote healthcare exports in Tunisia.
Finally, as a complement to these efforts, some political scenarios could be sustainable for the VEMH. Only the one including new technologies (Telemedicine) was retained because it is able:
- To cope with the common issues in Euro-Mediterranean regions (Tuberculosis, AIDS, Cardio-vascular disease),
- To solve the restructuring needs for Euro-Mediterranean health systems (equal care access and needs for the new infrastructures),
- To face the inequalities between social groups of population.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: Mediterranean, Rural, Telemedicine, Virtual Hospital
Stanescu Liana, Dumitru Dan Burdescu
University of Craiova, Faculty of Automation, Computers and Electronics, Romania
Abstract:
The Romanian Government uses nowadays the DRG classification system as a base to finance 185 hospitals, and it plans to extend this number in the following years.
The DRG is a system which permits to classify the patients based on the diagnosis, the procedures and other information (the complexity of each case) and to link this type of patients that each hospital treats to the expenses needed (DRG, 2005).
The necessary data for the patient classification on the basis of the diagnosis and the procedures in DRG categories are: age, sex, hospitalization period, principal diagnosis, secondary diagnosis, procedures, health condition when leaving hospital, the birth weight (in the new-born child case). These data define the DRG classification system.
Nowadays, to gather the information for the patients it is used the DRGNational v4.0 application that is delivered through the district agencies (DRG, 2005). This application must be installed on every computer used for gathering data about the patients. The electronically registration for a patient, one for the whole period the patient stays in hospital, is in concordance with the new clinical observation form introduced by the Romanian Health and Family Ministry. Once collected, the data are added to a database which has to be send monthly to the DRG department from the National Health Institute for Research and Development, Bucharest. The application DRGNational v4.0 is delivered on a CD as a Runtime application implemented in Microsoft Access 2000, that collects information about the patients at the department level, encrypt them and after that send them to the DRG National Bureau using the e-mail.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Country: Romania | Tags: Hospitals
I. Klapan*, A. Pavelin**, R. Stevanovic***
*Ministry of Health Republic of Croatia, Croatian Telemed Society, telMED@mef.hr
**T-Com, Service Department, Business Services and Solutions, Zagreb, Croatia
***Croatian National Institute of Public Health
Abstract:
ACTIVITIES:
- installation of TeleMED equipment in small, as well as expert MCs (medical centers)
- professional TeleMED Center has to be founded/inside VPN, based on the highest professional standards, rational, efficient, high ethical (such as i.e. Croatian Center for Telemedicine),
- all “partners” are offered the possibility of contact with physicians from their settings, as needed, thus directly and significantly improving the Croatian TeleMED offer,
- real time aplication/variuos TeleMED activities; information provided at once, better decisions.
MAIN GOAL AND OBJECTIVE:
- promotes regional cooperation,
- assists in pre-planning for present/future TelMED (telemedicine) coalitions; service to remote locations,
- contribute to NATO, and operate with NATO forces,
- become respectable partner with other partners,
- “to improve dialogue with local partners in issues and scenarios related to military emergency medicine, developing of modern teleheath of the 21st century, emergency planning”
BENEFITS:
- “telepresence” of the worldvide well known authorities in any MC of the Adriatic region/south-east Europe,
- emergency planning,
- intervention and momentary consultation / throughout 24 hrs in remote MCs,
- protection, successful emergency response,
- application of the latest technologies are closely followed and implemented in the health/telehealth care of both domicile population and foreign guests,
- supervision of TeleMED activities will be performed nationally,
- international agreements of the supervision should be developed and the possible need for international registration of doctors practicing TeleMED internationally shall be evaluated/developed.
TECHNICAL DETAILS:
- Videoconference equipment: high-quality communication over ISDN and IP networks is enabled and facilitated with diverse implemented interfaces and supported audio-video standards, alongside the broad spectra of auxiliary equipment. The system can be easily upgraded in the future,
- The system is an ITU-T H.320 and H.323 compliant for communication over ISDN and IP networks. The XGA (1024×768), SVGA (800×600) and VGA (640×480) video resolutions can be displayed on a system monitor. It is possible to attach additional displays, video cameras, a document camera, an additional PC, video recorder, microphone and speakers. The IP Ethernet 10/100 and 4 ISDN BRI network interfaces support efficient communication over any existing LAN and WAN technology,
- Implemented IP protocol stack supports transparent integration of the installed videoconference equipment into the unique intranet environment of any MC. Relying on IP technology allows for integration with VoIP system and standard systems for centralized management, administration and billing. In the WAN segment, a transparent transition from ISDN to the next generation networks based on IP and MPLS technologies is inherent. Embeding the TeleMED system in an IP/MPLS VPN environment is estimated as the optimal intranet solution at the national level and is seen as an evolutionary step,
- a connection to other telecommunication systems such as PSTN, the Internet or other intranets will be realized through the gateways. Appropriate safety mechanisms (firewall, AAA, NAT/PAT) will be used. The possibility of using the Internet as a system infrastructure should not be rejected. However, QoS and security issues remain restricting factors,
- In addition to specific application servers a set of standard servers (WWW, mail, DNS) should be installed. Public WWW server is a priority task to be realized as early as phase A of the project. In subsequent phases, the cost-effectiveness of a dedicated video server should be considered in order to archive high quality medical images and video clips. This will form a sophisticated and efficient database of medical records that could prove highly useful. The possibility of using this video server for educative purposes of both medical students and professionals should be seriously considered.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: Croatia, Standards, Telemedicine, Video
Steffen Märkle
FG Computer Graphics & Computer Assisted Medicine, Technical University Berlin, Germany
Abstract:
All digital medical data of a patient can be combined in an Electronic Health Record (EHR). A health care portal provides the integrated access to all data of this EHR. In this paper we present a three-dimensional virtual reality environment, the “Sanagate – virtual hospital”, which provides an intuitive user interface for such a system. In addition to the textual and image data, spatial representations of anatomical information can be examined. For communication, conferencing tools are included.
4 June 2005 | No Comments »
Categories: 2005, Conferences | EHR: EHR | Tags: Communication, Portal
Arno Rootsaert*, Huub Schuurmans**, Bernhard R. Katzy***
*VAIPS Wireless Solutions & Wireless Leiden, NL
**committee member Wireless Leiden Foundation, NL
***Leiden University School of Management and CeTIM, Center for Technology and Innovation Management, NL
Abstract:
WIFI technology is commonly used for wireless office networks and also for hotspots (wireless access points which provide connections to the Internet), i.e. for indoors and single point usage. In contrast, the Wireless Leiden Foundation has been enhancing WIFI technology for building a fully independent network of cooperating (federated) nodes, covering the City of Leyden and surrounding villages.
The network is fast, inexpensive, and extremely well suited for local communication and community Internet access. It is one of the largest outdoor WiFi-networks in the world with over fifty network nodes, most of them linked to at least two other nodes, and covers the whole region Rijnland (about 200.000 people). It has easy and free access, both for making a connection, for delivering information and services over the network and for experimenting with new applications.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: Internet, Wireless
Brandon Spencer
Nova South Eastern University, Australia
Abstract:
It is widely recognized that the sense of smell plays an important role in the field of medicine. The sense of smell not only assists the physician in the diagnosis of certain disorders, but it also plays a surgical role as well. Historically, learning this skill was contingent upon some level of clinical exposure to medically related odors. The advent of computerized scent production devices could change this. This article proposes a surgical simulation model that incorporates olfactory technologies into existing haptic, surgical simulators. If incorporated into virtual educational settings such as these, computerized scent production devices could be used not only as a novel way to enhance the virtual experience, but also as a way for medical students to begin to recognize the important role that the sense of smell plays during surgery.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: smell
Claudia Pagliari(1), PhD; David Sloan(2), MSc; Peter Gregor(2), PhD; Frank Sullivan(3), PhD; Don Detmer(4), MD; James P Kahan(5), PhD; Wija Oortwijn(5), PhD; Steve MacGillivray(3), MSc
(1) Division of Clinical and Community Health Sciences (General Practice Section), University of Edinburgh, Edinburgh, United Kingdom
(2) Division of Applied Computing, University of Dundee, Dundee, United Kingdom
(3) Tayside Centre for Health Informatics, University of Dundee, Dundee, United Kingdom
(4) Department of Health Evaluation Sciences, University of Virginia, Charlottesville VA, USA
(5) RAND Europe, Leiden, The Netherlands
Abstract:
Background: Lack of consensus on the meaning of eHealth has led to uncertainty among academics, policymakers, providers and consumers. This project was commissioned in light of the rising profile of eHealth on the international policy agenda and the emerging UK National Programme for Information Technology (now called Connecting for Health) and related developments in the UK National Health Service.
Objectives: To map the emergence and scope of eHealth as a topic and to identify its place within the wider health informatics field, as part of a larger review of research and expert analysis pertaining to current evidence, best practice and future trends.
Methods: Multiple databases of scientific abstracts were explored in a nonsystematic fashion to assess the presence of eHealth or conceptually related terms within their taxonomies, to identify journals in which articles explicitly referring to eHealth are contained and the topics covered, and to identify published definitions of the concept. The databases were Medline (PubMed), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Science Citation Index (SCI), the Social Science Citation Index (SSCI), the Cochrane Database (including Dare, Central, NHS Economic Evaluation Database [NHS EED], Health Technology Assessment [HTA] database, NHS EED bibliographic) and ISTP (now known as ISI proceedings).We used the search query, “Ehealth OR ehealth OR e*health”. The timeframe searched was 1997-2003, although some analyses contain data emerging subsequent to this period. This was supplemented by iterative searches of Web-based sources, such as commercial and policy reports, research commissioning programmes and electronic news pages. Definitions extracted from both searches were thematically analyzed and compared in order to assess conceptual heterogeneity.
Results: The term eHealth only came into use in the year 2000, but has since become widely prevalent. The scope of the topic was not immediately discernable from that of the wider health informatics field, for which over 320000 publications are listed in Medline alone, and it is not explicitly represented within the existing Medical Subject Headings (MeSH) taxonomy. Applying eHealth as narrative search term to multiple databases yielded 387 relevant articles, distributed across 154 different journals, most commonly related to information technology and telemedicine, but extending to such areas as law. Most eHealth articles are represented on Medline. Definitions of eHealth vary with respect to the functions, stakeholders, contexts and theoretical issues targeted. Most encompass a broad range of medical informatics applications either specified (eg, decision support, consumer health information) or presented in more general terms (eg, to manage, arrange or deliver health care). However the majority emphasize the communicative functions of eHealth and specify the use of networked digital technologies, primarily the Internet, thus differentiating eHealth from the field of medical informatics. While some definitions explicitly target health professionals or patients, most encompass applications for all stakeholder groups. The nature of the scientific and broader literature pertaining to eHealth closely reflects these conceptualizations.Conclusions: We surmise that the field – as it stands today – may be characterized by the global definitions suggested by Eysenbach and Eng.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Country: UK | Tags: e-Health
M. McKeon Stosuy, B.R.M. Manning
European Federation for Medical Informatics: Working Group on Planning and Modelling in Healthcare
Abstract:
Substantial demographic changes in the number of elderly in the developed world are forcing a radical re-evaluation of how to deliver care more effectively. “Joined up” multi-disciplinary, multi-agency extended care co-ordination and support service centres are beginning to set the pace towards the establishment of “Virtual Service Utilities”. The dual keys to this are the optimizing of end-to-end service process chains and real-time access to comprehensive records and relevant knowledge systems.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: Virtual
S Sanyal
Central Hospital, South Eastern Railway, India.
Email:sanishita@vsnl.net
Abstract:
This paper attempts to detail the evolution of a system synergy for more than 3 decades where the health services researchers; clinicians and others have been investigating the use of advanced information and communications technologies (ICT) to improve Indian health care. At the core of all these efforts lies a successful system synergy or a marriage between medicine and ICT and combination of innovative and mainstream technologies. The system is being developed in the context of the medical standards and practices in India, addressing issues, challenges and problems specific to Indian health care scenario where its 1 billion populations are predominantly rural and distributed in distant geographical locations. The health and medical facilities presently available in the non-urban parts of the country is inadequate and there are wide disparities in terms of health care infrastructure, facility, manpower and funds between rural and urban communities, and between different states and even districts within states. This calls for innovative methods of utilization of science and technology for the benefit of our society and ICT and medicine assumes a greater significance to revolutionise the health care system in India.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Country: India | Tags: Information Technology
Ranko Stevanovic*, Ivan Pristas*, Ana Ivicevic Uhernik*, Arsen Stanic**
*Croatian Institute of Public Health, Croatia
**Orthopaedical Clinic in Lovran, Croatia
Abstract:
Croatian Primary Health Care Information System pilot project, conducted between 2001 and 2003, aimed to develop and deploy a health information system based on the latest technologies which would improve the quality of primary health care and rationalise the consumption. 60 primary health care teams (physician and nurse) were equipped with PCs and connected via central server to the main national health insurer, state treasury and public health institute. Developed information system enabled rapid retrieval of documents, replacement of manual data input and a real-time insight into needed information as well as prompt interventions within the system. The project also introduced electronic smart cards for physicians and nurses, so that at each medical check-up the information system verified both the ensuree’s and the physician’s or nurse’s status and rights. Based on the experiences from the pilot project, plan has been made for comprehensive health information system at national level which would connect primary health care teams, hospitals, laboratories, dentistries, health insurance companies, state treasury, public health institutes and electronic health records database. Its major goals are more rapid diagnostics, accuracy in prescribing therapy, standardisation of the good practice as well as better utilisation of capacities, shorter waiting times and shorter stays in hospitals, which would lead to improvement in overall health care quality and better control over the health care consumption. Estimated 5-year investment for installing such system would be 125 million EUR. However, information system could save substantially more and yield a return of investment in only two years. As information system for primary health care should be a strategic component of every health care reform and development plan, we can recommend our model, based on the results of the pilot project, to other transitional countries.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: Croatia
Delia Carmen Mihalache*, Andrei Achimas-Cadariu*, Richard Mihalache**
*Medical Informatics and Biostatistics Dept., University of Medicine and Pharmacy “Iuliu Hatiegan”, Cluj-Napoca, Romania
**Faculty of Pharmacy, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
Abstract:
AIM: The aim of the project is to create the databases in pharmacies, which will include all the medications and treatment schedules for the patients with chronicle disease.
MATHERIAL AND METHOD: In every pharmacy, each patient will have his own electronic file, where the pharmacists have to mention all the medication delivered. For a good supervision of the patients, these people will be distributed to the specific pharmacy, where they will purchase all the drugs, including the over-the-counter. We will supervise only the chronicle disease (e.g. cardiovascular diseases, asthma, hepatitis, epilepsy, Parkinson disease, ulcer, diabetes etc), because in this cases are huge risks for medical interactions between treatment for acute disease and chronicle disease, who can be omitted by the specialists, pharmacists and patients. Using this system the pharmacists can informed all the time the patients how to incorporate the medication into your daily lifestyle, how to manage side effects, when to seek medical help and how to keep track of important information for the doctor and pharmacist.
Doctors can send prescriptions via Internet or wirelessly to the pharmacy (pharmacy receives it as a fax). Alternately, it can be printed via an infrared printer and given directly to the patient. This system removes the possibility of illegible prescriptions and patient tampering, increases efficiency and optimizes the time of physicians and pharmacists. In the same way, the pharmacists will send the information to the doctors.
RESULTS: The databases can provide detailed data about the prevalence and incidence of diseases, distribution of risk and preventive factors, interaction of the drugs, adverse events and patterns of drug utilization.
DISCUSSION: Information obtained in pharmacies will be send to the general practitioners and specialists for:
- Identify the possible drug interaction of the chronicle diseases therapy with treatment for acute disease;
- Identify the other possible reaction which could appear during the therapy;
- Avoid the self medication, which could harm results of the therapy instituted by the specialists;
- Avoid the overdose and under dose because the patient unawareness;
CONCLUSION: The last decade has seen a surge in the use of computerized health care data to provide better health service for the patients and information for pharmacoepidemiology and pharmacovigilace. Results of this study may be compared with clinical trial data and the limited published data from observational studies. In general practice it is know that unlabelled drug related adverse events are more frequently reported compared to labeled events.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: Chronic Care, Internet, pharmacist, Wireless
Tamang S., Kopec D., Shagas G., Levy K.
Brooklyn College; Albert Einstein Coll. of Medicine, USA
Abstract:
Chronic and terminally ill patients are disproportionately affected by medical errors. In addition, the elderly suffer more preventable adverse events than younger patients. Targeting system wide “error-reducing” reforms for vulnerable populations can significantly reduce the incidence and prevalence of human error in medical practice. Recent developments in medical informatics, particularly the application of artificial intelligence (AI) techniques such as data mining, neural networks, and case-based reasoning (CBR), presents tremendous opportunities for mitigating error in disease diagnosis and patient management. Additionally, the ubiquity of the Internet creates the possibility of an almost ideal network for the dissemination of medical information. We explore the capacity and limitations of web-based palliative information systems (IS). These can be used to transform the delivery of care, streamline processes and improve the efficiency and validate the correctness of treatments. As a result, medical error(s) that occur when patients with severe, chronic illnesses and/or the frail elderly are treated, can be reduced.
The palliative care model grew out of the need for pain relief and comfort measures for patients diagnosed with cancer. Applied definitions of palliative care extend commonly used conventions, but there is no widely accepted definition. This research will discuss the development life cycle of the CONFER management information systems (MIS), currently used by a community-based palliative care program in Brooklyn, New York, and the CAREN CBR. CONFER is based on the idea of ‘eCare’, a process based application for care management. CONFER uses XML (extensible mark-up language), a W3C-endorced standard mark-up to define systems data. The CAREN system is a CBR prototype designed for palliative care patients in the cancer trajectory, which was developed by the first author in her research. CBR is a technique, which tries to exploit the similarities of two situations and match decision-making to the best-known precedent cases. The system uses the opensource CASPIAN shell developed by the University of Aberystwyth, Wales and is available by anonymous FTP. Our preliminary results suggest that these systems can be used to improve the quality of care and disseminate expert level ‘know how’ to palliative care clinicians.
4 June 2005 | No Comments »
Categories: 2005, Conferences | Tags: Chronic Care, Data Mining, Internet, Medical Errors
