Telemedicine and eHealth

Wojciech Glinkowski
Telemedicine and eHealth
in Poland
Polish Telemedicine Society
Advances in eHealth and
Telemedicine International
Conference
1996
Thanks to
Jacek Liszka, Marek Pilch-Kowalczyk, Dariusz Zambrowski, Konrad
Mąkosa, Artur Wojciechowski, Jarosław Żyłkowski, Bogdan Ciszek,
Ireneusz Wojtkowski, Magdalena Sawińska, Mariusz Gil, Łukasz
Preibisz, Katarzyna Dyttus-Cebulok, Szymon Pawlica, Magdalena
Powierża, Monika Wasilewska, Marta Rachoń, Krzysztof Marasek,
Andrzej Staniszewski, Bożena Glinkowska, Artur Przelaskowski, Robert
Sitnik, Tomasz Lekszycki, Michał Słotwiński, Wioletta Włodarska,
Andrzej Górecki
Polish Telemedicine Society
Telehealth/Telemedicine/eHealth
 “medical care delivery and medical information exchange on remote”
“Introduction to Telemedicine”, Wootton (1999)
 Move the information instead of patient or physician
 Telehealth, Telemedicine, Telecare, eHealth
is not:
 A panaceum
 Able to solve all medical problems
 Able to replace medical professionals
Telehealth/Telemedicine/eHealth
„liability makes the thin border
beetween wide eHealth
and telemedicine”
Polish Telemedicine Society
Value of telemedicine
Telemedicine
VALUE of Telemedicine
Integration of IT and clinical medicine
Evidence Based Medicine (EBM)
Applicable in every medical specialty
Telemedicine
Telemedicine
Telemedicine Approach
Interdisciplinary
Team approach ( many specialists – team work
necessary)
physician+ IT specialist + telecom specialist =TM
Specialists take part while solving real clinical
problems
Atributes and Features of Telemedicine
Telemedicine
Telecommunication as fast as possible (economicaly justified)
Move the information, not patient
Shorten way to highest class specialists
•Medical service – served by physician
•Beneficiary - PATIENT
-
Direct or Indirect
•Responsibility and Liability
-
Medical Ethics
Activities in telemedicine and
eHealth
Digital Society – Preparedness to Tele…
Teleeducation – eEducation in Medicine
Telediagnostics – eDiagnostics (remote enhancement of
diagnostic procedures)
Teleconsultations - eConsultations
Telepresence (i.e. in surgery, telementoring, remote enhancement of
invasive procedures)
Telesurgery (incl. robotics)
Telerehabilitation
# Clinical decision support on remote
Polish attitudes toward telemedicine
 Term „telemedicine” brings no association in 42% population (42%)
or makes total misunderstanding (telepathy/ parapsychology – 5%;
TV program – 5%).
 44% respondents aged 15 or above have heard about telemedicine
 24% of population think, that no telemedicine service is available in
Poland, 35% have no idea about telemedicine.
 Most often reason for no interest in telemedicine service use
(independent on service type) is persuasion that direct contact with
physician is necessary, and lack of trust to such service.
Society teleinformatic preparedness
 Almost 90% of population aged 60 and above can not operate the
computer.
 Almost 90% of population aged 60 and above can not use the Internet.
 A little of that population have good will to learn to operate those
devices (4 – 3%).
Society teleinformatic preparedness
 The most promissing devices are phones and mobile phones as devices
for telemedicine.
 42% of respondents would like to use telemedicine service utilizing
phones.
 Almost 60% of population owns Mobile phone, in that group 21% is
aged 60 or older.
Available for physicians
Teleeducation
-internet, Medline, web pages, e-manuals
journals on-line
- e-learning
-Internet
Medline
Videoconferences
Webinars
Teleeducation - example
Anatomy Department
Academic
teachers
Manuals
Radiologic Anatomy
selfeducation
multimedia
ANATOMICAL web page
Preparation toward telemedicine begins here !!!
Anatomy Department Webpage
Teleeducation in anatomy – visitors statistics
www.teleorto.pl
Teleeducation in medicine
Telemedicine
 example– CME - Orthopedics & Traumatology
Videoconferences
TeleOrto – University Regensburg
Teleeducation in medicine
Telemedicine
 Modern techniques – high tech equippment
Demonstrations by experienced surgeon while
teaching required
 Live surgery on-line – useful tool in
teleeducation.
 Usually utilized locally
Rarely via Internet
Our experiences – orthopedic and telemedicine
Webinars – password protected access
Telemedicine
Authorial solutions
Webinars – national and international medical
conferences transmitted via Internet on topics
related to orthopedics and orthopedic trauma.
Connections: One to one, one to many, few to
many
Chat available – online questions
Telemedicine
Conferences & Webinars
Telemedicine
Webinar User side
Telemedicine
Webinar - Conference – Teleasysisted surgery utilizing Computerized Navigation
System – available on site, on PC, and pocket PC
Telediagnostics





TeleECG
Teledermatology
Teleradiology
Telescreening
Etc…
TeleECG support for muskuloskeletal
telerahabilitation project
TELE – EKG,
TeleRR,
„On demand”
while exercising
under telerehab
supervision
Telemedicine
TELEDERMATOLOGY – Authorial tool on the www
/MDA/GPRS/EDGE/WiFi
Telemedicine
TELERADIOLOGY via Internet/GPRS/EDGE/WiFi
Zoom
Teleradiology - intercity regional
diagnostic highway
Instead of Introduction
Exodus of qualified staff
R adiolog is ts in P oland
2600
2500
2400
2300
2200
2100
2000
1900
1800
2004
2005
R adiolog is t
2006
The aim of the presentation
 To present how interregional solutions are
able to meet the problem of specialists
shortage
Warrants of proper radiologic diagnosis
 Qualifiactions based, established hierarchy of
radiologists who diagnose particular case
model applicable in teleradiology
 System monitoring – supervised data and
diagnostic descriptions flow
 Immediate alert reaction
Exam data transfer scheme
Diagnostic center
Diagnostic center
Exam
Diagnosis
description
Exam data transfer
screen capture
Refering for diagnostic exam
Imaging exam description
screen capture
„Highway” speed limits
 2-8 Mbs average data transfer speed
currently
 100 Mbs expected for most peripheric
locations
 15%+ = Teleradiology – 50-80 exams daily
 Images that require second opinion of
another subspecialist
 i.e. cardiac imaging or metabolic bone
diseases (Warsaw)
 Some hospitals transfer data only by night
due to data transfer limits
Teleradiology „highway” along A4 autoroute
other radiology centers potential future „highway” links
Warszawa
Germany
Wrocław
Katowice
Jelenia
Góra
Kraków
Ukraine
Conclusion
 Teleradiology has reached the practical
application level
 Teleradiology seems to be „the cure” for
decreasing number of specialists in the
country
 Teleradiology highway is able to prompt and
improve diagnostic process and patients
management
Medical
recognition
and
advanced
examinations
Treatment optimization – computer telesimulation
biomechanical prediction
Acquired
locally
data
Consulting and
computer
simulations
Preoperative planing on remote service
for distant hospital
Virtual surgery and 3D surgery planning
international study
Lublana, Slovenia – Warsaw, Poland
Osteoporosis Telediagnostics
–
DXR, DXA
PDA phone teleconsultation
TeleConsultations in orthopedics
Wireless data transmission
GPRS
Radiogram digital or
digitalized
Teleconsultation Center
Plus GSM
BSC
SGSN
GGSN
FireWall
Intranet
Internet
BTS
HSCSD/GPRS
Charging Gateway
Consultant
Radiologist
TeleConsultions in Trauma
WIreless data transmission
GPRS
„acute duty”
- PDA phone
-Digital camera
-Digiral X-ray
Teleconsultation
Plus GSM
BSC
SGSN
GGSN
FireWall
Intranet
Center
Internet
BTS
HSCSD/GPRS
Charging Gateway
Consultant
TeleConsultations in Neurotrauma cases
GPRS
-Digital input
Telediagnostic Center
Plus GSM
BSC
SGSN
GGSN
FireWall
Intranet
Internet
BTS
HSCSD/GPRS
Charging Gateway
RIS/PACS, with mms/sms notification
Consultant
Neurosurgeon
Most common teleconsultation
scenario for heterotopic ossification
patients qualified for radiotherapy
Department of Orthopedics
Department of Radiotherap
and Traumatology
Institute Of Oncology
of the Locomotor System
Medical University
The distance - approximately 10 km.
Simple e-mail of anonymized patient‟s
image transfer
X-ray digitalization methods
Preliminary reviewing of digitized x-rays has been shown as useful
for radiotherapeutic treatment planning in the study.
Progressive codec (tele-tool)




Teleconsultations, image transmission
Multiplatform, independent architecture
Progression mode for user selection
Interactive protocol, effective coding
selected ROI
Compression Tele-tool : JPER2000
7
czas kompresji
6
5
4
3
JPER
2
1
0
1
10
20
30
liczba warstw
40
50
A. Przelaskowski
TeleCAD
Subiective quality: 1bpp
ROC Detection : 0.1bpp
CAD: 0.2bpp
TP/(TP+FP+1)
12bpp
mammograms
0.3bpp
0.05b
pp
Medical University in Wrocław
main directions of eHealth and telemedicine
activities
 Telemedicine and eHealth – applications in Primary Health
Care and Family Medicine:
– System of telemedicine services dedicated to Family Medicine
Practitioners (grant KBN, 2000-2002)
– Teleconsultations: Project „Consilium‟ (AM W-w, 2003- )
– BP Tele-monitoring by family medicine practitioners and telecare (own
research AM, 2003- )
– Tele-diabetology (own research AM, 2003- )
 E-learning: Project European MedSkills
(Program UE „Leonardo da Vinci‟, 2004-2007)
 eHealth: Projekt WHO/European eHealth consumer trends
survey
(Program UE „Public Health‟, 2005-2008)
A.Staniszewski
Telescreening of posture and spinal
deformations – measurement System
B
A
C
E
D
A – patient, B – detektor CCD, C – Digital Projector,
D – Stand, E – Computer PC
R.Sitnik
Early results and analysis
417 261 dots (x,y,z) system
Telemedical System Concept
Mobile System 1
(measurement)
Telediagnostic
Center
Internet
GSM
.
.
.
.
.
.
.
-Telescreening – epidemiology
oriented cohort study of posture ansd
spinal deformations
-Age independent
-No – X-ray
-Safe and repeatable measurement
-The first in the world for this purpose
Telerehabilitation
Patients attitudes toward telerehabilitation
 Higher interest noted among younger, active
patients
 Depends on level of education and active work
 Older patients expect some help from third person
to attend telerehabilitation (family member/ nurse)
Telemedicine
web Telerehab – logging page
Telemedicine
Telerehab – telementoring
Telemedicine
Telerehab – telementoring
Via www, mms, videocall, movie transmision – online or „store and froward”
Telecare
Telehomecare
Tele-video-monitoring
Monitoring and diagnostics after hospital
discharge
Telecare
 Lower cost of hospitalization
 Patient oriented and friendly environment
 Better quality of life
 Constant contact patient-physician
Tele-Comfort
Monitoring without diagnozing
Help to older and/or disabled
Telecare solutions
Mobile phone
mHealth
Mobile applications for sports medicine
Endurance tests mobile guide
as mobile phone application
For sports medicine physicians
Unique solution for
middle class sportsmen
I.Wojtkowski
Telemedicine enhanced prehospital
paramedical care utilizing mobile
videoconferencing and GPS navigation
The scheme of data transmission: GPS --> (blackbox) the device on boat --> GPRS
through modem --> server <-- iPlus internet access <-- supervisor’s application (PC).
GPS+GPRS
Serwer
GPS on the boat
Tower box
Tower box
Dispatcher’s Application
IBM Compatible
Server
APN
Server
Radio tower
• Connection via APN (Access Point Name)
• High precision location (GPS)
• Online GPRS data transmission
IBM Compatible
IBM Compatible
Videoconferencing
3G mobile phone
GPS tracking
Difficulties and problems in telemedicine
•Certification
•Diplomas
•Law
•Safety
• Financing
• Liability and responsibility
• Technology (equippment, software, etc.)
• Supporting Institutions
• Medical community Acceptance
•„Passive resistance”
Telemedicine
Conclusions
 Telemedicine is not the futuristic dream
 Selected examples may only approximate
whole effort of telemedicine enthusiasts in
applying it Poland
 It becomes real in medical practice slowly
 Searching for economicaly justified
solutions remain important in telemedicine
research
Structure: Umbrella Organisation
Polish
International
initiatives
Thank you for your kind attention