Start: 0.00.00 End: 0.00.48 Hello everybody, My name is Kurt Boman, and I am Professor of Medicine at Umeå University Hospital in Sweden. I am a specialist in cardiology and internal medicine, and am also a consultant at the department of internal medicine, Skellefteå County Hospital in Sweden. I am also the project leader of this special European Union project, and that project is named HeartNet.
Start: 0.00.48 End: 0.01.15 Today, I am going to tell you about our special project that has been done within the HeartNet project, and that is the development of a remote controlled robot to perform echochardiography on distance.
Start: 0.01.22 End: 0.02.48 The HeartNet project started in 2001 and from that on we have been doing a lot of work with the development of this robotic arm as you can see on the picture, and this has been a cooperative project with many other manufacturers, and on the slide you can see a second European project, named CARDISTA, which has been started in 2005, and that is going on to implement the robot system in primary health care centers. And we have also the university of Luleå together with us and they have been a very good help with us, and the Skeria development in Skellefteå, that is my hometown, and we have also been in cooperation with Alkit Communications from Luleå and Mobile Robotics, which is a company situated in Skellefteå. These are the main contributors of the system that have developed this project and the robotic arm.
Start: 0.02.54 End: 0.04.02 To perform echochardiography on distance we need telemedicine, and for this purpose we have used what we call the second generation telemedicine, and that is to give us support in demanding distance investigations. We need that to achieve a high communication quality, and this has been achieved through a module based communication environment. In that we use the broadband potentials and utilize the standard desktop computers and by this we also can access patient information directly in the telemedicine situation. And we can combine synchronous and asynchronous information. And this has been done to support regional development, and by that we mean that we can move knowledge to the patient and that we can export top expertise services to other regions.
Start: 0.04.08 End: 0.05.12 And now I will start to give you some background to why we are doing this in northern Sweden. In northern Sweden we have long distances between hospitals and primary health care centers, and by that we are faced with expensive transports to achieve the quality of health and to give them a good medication and other services within the healthcare. And we have limited access to cardiac expertise, and like many other western countries we have many elderly people and they are growing elderly and elderly and they will need more and more healthcare, and they will also need nursing and rehabilitation. We also face new kinds of hospitals, they will become smaller but more specialized towards acute treatment.
Start: 0.05.19 End: 0.06.02 We also know that there is an increased preventive and knowledge-based health care nowadays, and we can meet many more physically and mentally active people in high age and not only among the patients themselves but also among patients and their relatives. And we know that there is an increased usage of Information Technology within the health care itself. And finally, more treatment and rehabilitation of patients will take place at the patients own houses.
Start: 0.06.06 End: 0.06.49 We started HeartNet for one special disorder, namely Congestive Heart Failure, and the background for this was that Congestive Heart Failure is the only cardiovascular condition in which both the prevalence and the incidence continue to rise. And Congestive Heart Failure is the leading cause of hospitalisation amongst people older than 65 years of age. And we also know in Sweden that the annual inpatient and outpatient expenditure on Congestive Heart Failure is very high, and it has been estimated in Sweden to 2.6 billion crowns.
Start: 0.06.57 End: 0.08.17 So, for these patients with Congestive Heart Failure we have set up some clinical goals to achieve for these patients, and we want to give them a correct diagnosis. We know from many papers that the diagnose for heart failure is wrong in about half of the cases, so there is a great need to improve the diagnostic situation for these patients. Congestive Heart Failure is a malignant disorder and that is why it is important to have a correct diagnosis from the beginning, and also to give them an optimal treatment which is not the situation today. We also want to give them a managed care and that includes, of course, an optimal treatment, but not only that, but also the follow-up of selected patients, namely those who are most severely ill. By proper and an optimal medication we can improve prognosis for patients and maybe we can do this with a lower cost by using the new Information Technology.
Start: 0.08.24 End: 0.09.17 When we started the HeartNet project, we proposed some projects to take place from 2001 until 2005. And the first was to create a system for improved communication between primary health care centers and specialists, and we also wanted to develop diagnostic algorithms for heart failure, focusing on echochardiography on distance. And we also wanted to create a system to improve quality in the health care managing process. And by that we mean to improve the therapy by optimizing heart failure treatment. Included to that, the aim was also to make new products and new services for patients with heart failure.
Start: 0.09.23 End: 0.11.27 When the HeartNet project started in 2001 we decided to develop a cooperation with some primary health care centers, and that was done together with my hospital and the clinic in which I am working. And the first year was followed by this cooperative interest and effort and we finally came up with work with two primary health care centers. And in 2002 we started with a portable echomachine and some consultation at the primary health care center. And in this year, 2002, my sonographer and myself, we visited the primary health care center. And from 2003, we continued with echocardiography with a portable echomachine and that was done by the sonographer, who travelled to the primary health care center, and after the echochardiographic examination was done, there was a consultation through telemedicine as a videoconference. In 2004, we had come to the decision to develop this remote-controlled echomachine and we performed remote-controlled echocardiography and consultation using broadband and Internet. And from this year, 2005, we are in the phase of starting clinical tests in daily care at rural health care centers.
Start: 0.11.32 End: 0.12.56 On this slide, I want to show you a schematic view of how we are working. You can see that we use broadband and that we have interactivity online and on the picture on the left you can see a picture from our laboratory room where we have the patient with the robotic system and that is supposed to be at the primary health care center, and this will be more in detail presented in another session. And to the right you can see the specialist side with the sonographer operating with a joystick, which will also be be presented much more in detail later on. So, what we can do with this system is to have an interactivity online, not only for echochardiography, but also take advantage of synchronous and asynchronous communication, so we can use other tools, like sound and direct communication between the health care center and the specialist center.
Start: 0.13.05 End: 0.13.45 This is a picture of a mobile, remote controlled, sonographer support, that holds the transducer during the ultrasound examination of a patient. And this is the first prototype which we have been using in the examination of patients at the primary health care center, and we hope that this will be followed by other prototypes and will be developed further on. And in the next slide I will also go through the components and some technical specifications for the Medirob system
Start: 0.13.54 End: 0.15.07 This is the Medirob system much more in details, and you can see how the Medirob holds the transducer, and in the middle of this picture you can see the transducer that is placed in the transducer holder of the Medirob. And you can also see to the left a more sophisticated echo machine and what we are doing is that the kinds of echomachine will be independent of the Medirob, so we want to use our Medirob to any echomachine and also to any IT platform also, but that has to be developed much more in detail. And up to the right you can see a view of the empty transducer holder. So this is, in summary, the Medirob system.
Start: 0.15.10 End: 0.16.55 With the Medirob system and video consultation we have set up some goals to be achieved with the primary health care centers. And of course we want to shorten the time to a correct diagnosis of heart failure. And we hope that this will save money for the health care system, this has to be improved in the future, but we think we can achieve that. And from the patient point of view, we want to ease the agony and suffering for patients with heart failure. And we want to obtain technical clarification on what type of IT platform that is going to be sufficient for this situation, and we want to start to diagnose 30 patients in daily care using a standard level communication technology, and that is the H 323 platform and that can provide us with 5 to 10 Megabits for performing the echocardiographic examination and consultation with the primary health care doctors. And we also want to test this system and diagnose 30 patients in daily care using high level communication technology, that is called the Confero system, that will give us 20 to 40 Megabit to be available in the examination situation.
Start: 0.17.00 End: 0.18.59 And this is a map of the test that we have performed during the last two years, and we have done this, not with patients, but with healthy subjects and from a laboratory milieu and this has been done in the county of Västerbotten between Umeå and Skellefteå in 2004. And between Norsjö, that is the primary health care center that we are cooperating with, and another primariy health care center is Arvidsjaur that we are going to perform tests in 2006. In November 2004, we had a demonstration of this system at the Swedish Medical Association’s annual meeting in Gothenburg, and the distance from Skellefteå to Gothenburg is about 150 Swedish miles, and that means 1500 kilometers. And in May this year, we made our first international test and that was between Tromsö, which is situated in Norway, and this was done during the European Union Summit for the health care ministers and that test was very well done and succeeded in a very good way, so we can say that we can use it both nationally and also internationally with a very good quality.
Start: 0.19.04 End: 0.21.05 I will now give you some aspects of the clinical possible application of a remote-controlled echocardiographic system, and this was primarily done for a clinical purpose and that is to perfrom telemedical consultations in remote areas like we have in Sweden, and of course in other countries. And during this developing procedure we discovered that this remote-controlled echocardiography also might be very well suitable for sonographers as it might help them with the ergonomical problems of the neck and shoulders. This has not been tested so much to this day, but we think it might be a good tool to relieve this constrain on the neck and shoulders. There might be also another possible application and that is for special areas, like in dangerous areas, such as war and emergency situations where you don’t want to have people, but it could be replaced by a robotic system. And there are some other dangerous areas like in chemical and bacteriological poisoned areas or radation poisoned areas where you want to have a robotic system rather than people, so the application has widened for using this remote-controlled echocardiography but we have to prove it, and we want to test it, and we want to start to test this in a clinical situation.
Start: 0.21.09 End: 0.21.58 So, ladies and gentlemen, I want to finish with showing this picture and say that we are ready to go, and that means that we are ready to start our clinical trials in real life, and that means that we are placing a robotic system at a primary health care center and we will try to use it in ordinary clinical practice, and if we succeed in the local area like that we have in Skellefteå and the neighbouring primary health care centers, we hope that we can extend this to not only national but maybe also to an international arena. Thank you very much. [CUT TO MONA OLOFSSONS SLIDES]
2a - Kurt Boman.ppt
Remote Controlled Robot to Perform Echocardiography on Distance Luleå 21th September, 2005 K Boman, Professor of Medicine HeartNet, Skellefteå Umeå university, Sweden Umeå Skellefteå
Remote Controlled Robot to Perform Echocardiography on Distance Luleå 21th September, 2005 K Boman, Professor of Medicine HeartNet, Skellefteå Umeå university, Sweden Umeå Skellefteå
HeartNet, Cardista (EU-projects) Luleå University of Technology Skeria, Skellefteå Alkit Communications, Luleå Mobile Robotics, Skellefteå Partners in the Project: Artic circle Luleå EU project since 2001 Umeå Skellefteå
Remote controlled echocardiography ”Second Generation” Telemedicine <ul><li>Support demanding distance investigations </li></ul><ul><li>Achieve high communication quality </li></ul><ul><li>Create a module based communication environment, </li></ul><ul><li>Utilize the broadband potentials </li></ul><ul><li>Utilize standard desktop computers </li></ul><ul><li>Access patient information directly in the telemedicine situation </li></ul><ul><li>Combine synchronous and asynchronous communication </li></ul><ul><li>Support regional development: </li></ul><ul><ul><li>- move knowledge to the patient </li></ul></ul><ul><ul><li>- “export” top expertise services to other regions </li></ul></ul>
The general background in Northern Sweden: <ul><li>Long distances. </li></ul><ul><li>Expensive transports. </li></ul><ul><li>Limited access to cardiac expertise </li></ul><ul><li>More elderly people will need health care, </li></ul><ul><li>nursing and rehabilitation. </li></ul><ul><li>New kinds of hospitals, smaller but more </li></ul><ul><li>specialized towards acute treatment. </li></ul>
The general background in Northern Sweden: <ul><li>Increased preventive and knowledge-based </li></ul><ul><li>health care. </li></ul><ul><li>More physically and mentally active people in </li></ul><ul><li>high age will be found among patients and their </li></ul><ul><li>relatives. </li></ul><ul><li>An increased usage of IT within health care itself. </li></ul><ul><li>More treatment and rehabilitation of patients at </li></ul><ul><li>their homes. </li></ul>
Congestive Heart failure (CHF) Background: <ul><li>CHF is the only cardiovascular condition in which </li></ul><ul><li>both the prevalence and the incidence continue to rise 1 </li></ul><ul><li>CHF is the leading cause of hospitalisation amongst </li></ul><ul><li>the >65 year age group 3 </li></ul><ul><li>Annual inpatient and outpatient expenditure on </li></ul><ul><li>CHF in Sweden has been estimated at SEK 2.6 billion 2 </li></ul>1Yamani & Massie (1993); 2Rydén-Bergsten et al (1999); 3Graves & Bilium (1996);
• Correct diagnosis. • Early diagnosis • Optimal treatment • Managed care • Follow-up of selected patients. • Improved prognosis • Lower cost Clinical goals for patients in rural areas.
Proposed projects from 2001-2005 <ul><li>System for improved communication between primary health care centers and specialist. </li></ul><ul><li>Develop diagnostic algorithms for heart failure, focusing on echocardiography on distance. </li></ul><ul><li>A system to improve quality in health care managing process. </li></ul><ul><li>Improved therapy by optimizing heart failure treatment </li></ul><ul><li>New products and services </li></ul>
Project developement <ul><li>2001: Clinical and scientific cooperation with primary health care. </li></ul><ul><li>2002: Echocardiography with portable echomachine and consultation at the primary </li></ul><ul><li>health care center. </li></ul><ul><li>2003: Echocardiography with portable echomachine and consultation through </li></ul><ul><li>telemedicine as a videoconference. </li></ul><ul><li>2004: Remoted-controlled echocardiography and consultation using broadband </li></ul><ul><li>and Internet </li></ul><ul><li>2005: Clinical tests in daily care at rural health care centers </li></ul>
Echocardiography on distance Interactivity on-line Patient side Specialist side
<ul><li>A Mobile, Remote Controlled, Sonographer Support, that holds the transducer during the ultrasound examination of a patient. </li></ul>Components and technical specifications for Medirob
Medirob holds the transducer Ultrasonix Ultrasound scanning system from any vendor on the market. The transducer* is placed in the transducer holder on the Medirob. View of empty transducer holder. *A transducer is an electronic device that converts energy from one form to another. It is a small, hand-held device attached to the scanner by a cord. The sonographer presses the transducer firmly against the patients skin to obtain images.
The Goals: <ul><li>Shortening time to diagnosis </li></ul><ul><li>Saving money for Health Care System </li></ul><ul><li>Easing agony and suffering for patients </li></ul><ul><li>Obtain technical clarification </li></ul><ul><li>Diagnose 30 patients in daily care using standard level communication technology (H 323 platform 5-10 Mbit) </li></ul><ul><li>Diagnose 30 patients in daily care using high level communication technology (Confero system 20-40 Mbit) </li></ul>A Clinical Test in Northern Sweden
Skellefteå Gothenburg Nov 2004 Umeå Sept 2004 Norsjö 2005 Arvidsjaur 2006 Tromsö May 2005 Performed and planned tests
Possible applications of remote-controlled echocardiography : - Clinical: - Telemedical consultations in remote areas - Ergonomy for sonographers - Special areas - dangerous areas: war and emergency situations, - chemical and bacterilogical poisoned areas, - radiation poisoned areas