VEMH – Virtual Euro-Mediterranean Hospital For Global Healthcare

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.

Acceptance as Prerequisite for Success: Recommendations for the Virtual Euro-Mediterranean Hospital (VEMH)

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.

Role of Electronic Patient Records in Global Health Care of the VEMH

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.

Political Evaluation and Sustainability of VEMH

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.