telemedicine circuits based on standards
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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
Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT”
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
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ATLAS FLASH VIEWER
Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT”
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
Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT”
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
Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT”
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
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SOME EXAMPLES
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SOME EXAMPLES
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SOME EXAMPLES
http://medting.com
Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT”
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
Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT”
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
Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT”
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
HEALTH SCIENCES LEARNING TROUHG THE MEDTING
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
HEALTH SCIENCES LEARNING TROUHG THE MEDTING
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
Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT”
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
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