SIT EXPO 2004 – E-HEALTH CONFERENCE
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SIT EXPO 2004 – E-HEALTH CONFERENCE

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  • 1. SIT EXPO 2004 – E-HEALTH CONFERENCE CASABLANCA - 20 – 21 FEVRIER 2004 TELEMEDECINE EXPERIENCE TUNISIENNE Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP DEVELOPPEMENT ET EXPLOITATION EVALUATION ORGANIZATION PROJETEE EVOLUTION VERS LA TELE SANTE
  • 2. DEVELOPPEMENT ET EXPLOITATION The first application was implemented in 1996 by Tunisian and French physicians working in children academic hospital of Tunis and in LaTimone hospital of Marseille France : EACH USER TERMINAL IS EQUIPPED BY : * A Basic PC with high quality screen 19" * A Network interconnexion TCP/IP Mode, using ISDN Network 128 Kb/s * Standard MS Office Tools * Internet Browser * Software Medical Document Management (Sigmacom) * Document Scanner * X Ray image scanner * Exchange Medical Data Package : X Ray images, Medical documents and Informations about Patient * Remote Assistance : Telediagnosis, Teleconsulting, Teleassistance * develop research cooperation * Exchange some training Case -Supports Telemedecine application was identified in 1995 in the Health Telematics Plan Studies – (1996 – 2000) period. Printer Hospital Scanner A3 Scanner A4 Documents Video cam L AN Video cam ISDN
  • 3. The second application was implemented in 1996 by physicians working in the anticancerous institute of Tunis and Lacassagne Anticancerous Hospital of Nice France * It completes the first experience by telepathology application and Videoconferencing application * Exchange complete medical data package : scans, X-RAY image , PATOLOGY ANATHOLOGY image, diagnosis, reports. * Real time monitoring of appliances (Microscope) * Medical document acces during the conference * Training and support informations
    • EACH USER TERMINAL IS EQUIPPED BY :
    • - Basic PC (Pentium)
    • - High Quality Scren 19"
    • - Standard MS Office Tools
    • - Network inter connexion on TCP/IP Mode :
    • * ISDN connxion 128 Kb/s speed for telemedicine applications (Transfer,monotoring)
    • * ISDN connexion 384kb/s speed for Videoconferencing
    • Internet Browser
    • - Conferencing equipment (Tv Monitor - Mobile camera, fixed camera, microphone, loudspeakers….)
    • - Conferencing software on H320 standard.
    • - Real time acquisition/monitoring Interfaces.
    • - Software medical document management (Mediolis).
    • - Image standard conversion DICOM3/JPEG - medical Peripherals (Scanners And Micoscope Medical Devices) – Telemedecine station
    Printer Hospital Documents Video cam L AN Video cam Scanner A3 Scanner A4 ISDN
  • 4. The Development Of Information Society over the world, The definition of a solid national policy on information technology in Tunisia The important telecomunication investment progress in Tunisia The Vertiginous growth of telecomunication technologies and multimedia systems The availability of computers capabilities. The positive telemedecine experience evaluation and sudden awarness of it benefits. Suggested to the Health Ministry to define Telemedicine policy : * For defining strategy and keeping of the plan achievement a national committee of telemedicine was constitued by minister decision on 15 May 1996. MEMBERS ARE : * General Director of Health - Public health Ministry * Representative member of Science Research and Technology secretary of state. * Representative member of Informatics and Internet secretary of state. * Representative member of Public telecommunication Operator : Tunisia Telecom Working partner is the health ministry informatics centre. THE TELEMEDECINE COMMITEE Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP
  • 5. 3 FRENCH SITES : Acces mic hospital - Latimone Marseille - Lacassagne Nice - CHU Grenoble 4 SPECIALISED HEALTH CENTRES IN TUNISIA : - Children Hospital - Tunis -  Cancerous Institute - Tunis -  National Neurology Institute -  National Orthopedic Institute 3 GENERAL ACADEMIC HOSPITALS -  Rabta Hospital -  Charles Nicolle Hospital -   La Marsa Hospital 3 REGIONAL HOSPITALS : -  Le Kef Hospital – Western North -  Gafsa Hospital – Western Saouth -  Gabes Hospital – Eastern Saouth THE APPLICATION ARE : TELERADIOLOGY – TELEPATHOLOGIE AND VIDEOCONFERENCING The Telemedecine network is constitueted by : TELEMEDECINE APPLICATION :
  • 6. Technical Architectue of a Telemedicine Solution : Exemple : TELERADIOLOGY Imagery equipements ISDN – 1x128Kb Hospital 2 Printer Router RJ 45 Hospital 1 3x 128Kb Scanner A3 Documents Video cam Imagery equipement L AN LAN Router Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP ISDN Video cam Scanner A4
  • 7. TECHNICAL CONSIDERATIONS Adoption of commun standards : a must for cost effective exchange of any information : - Facilitate ther capturing , sase communication and structured management - TCP/ IP Network Protocol - DICOM 3 : Direct aquisition of image equipement protocol - H320 – H323 : Videoconferencing protocol to provide voice – Data and Video - HL7 : Direct Acquisation off Laboratory Results protocol - NTSC, PAL , SVGA : format Video - G711 – G722.1 Standared Audio - T120 : Remote sharing application protocol - JPEG – MPEG : Imaging Format Protocol - HTML : Document Format Protocol This to satisfy : Compatibility and Interoperability between diffirent systemS Adoption of image data and uniformed security technique - User : Profile and Institution - Content : Primarely informations and knowledge - Usage : Management and governance - Technological applicants : Computing, Networking and Telecomunication
  • 8. Consist to go on national healthnet over which would cooperate on sharing patient records. 4 Academic specialized hospitals : * Tunis Children Hospital * Tunis Anticancerous Institute * Tunis Orthopedic Institute * Tunis Neurological Institute 8 General Academic hospitals: * Charles Nicole Hospital in Tunis * La Rabta Hospital in Tunis * Aziza Othmana Hospital in Tunis * Mongi Slim Hospital in Tunis * Fattouma Bourguiba Hospital in Monastir * Tahar Sfar Hospital in Mahdia * Habib Bourguiba Hospital in Sfax Defined in Health Telematics plan studies for 2001-2005 period. * Farhat Hached Hospital in Sousse APPLICATIONS REPARTING NEW STRATEGY TO HAVE PRIORITY
  • 9. 2 Regional hospitals situated in Western South : * Gafsa Regional Hospital * Tozeur Regional Hospital 2 Regional hospitals situated in Eastern South : * Zarzis Regional Hospital * Gabes Regional Hospital 2 Regional hospitals situated in Western North: * Le Kef Regional Hospital * Jendouba Regional Hospital cooperation with European institute * 4 French Academic Hospital s : Marseille – Nice – Grenoble - Toulouse * 1 Belgium Hospital: ERasme Hospital * 1 Italian Hospital : ST.Rafaelle Hospital Rome All these organizations are equipped by *   Teleradiology solution *   Telephatlogy solution *   Videoconferencing solution
  • 10. Tunis ISDN Hospital La Cassagne (Nice) Purpan Toulouse { WESTERN NORTH { WESTERN SAOTH } EAST SOUTHERN Latimone Marseille Sfax
        • ERasme Hospital
        • Bruxelles
    ST.Rafaelle Hospital Rome Zarzis Gabes Jendouba Le Kef Gafsa Tozeur Sousse Grenoble ALGERIA LYBIA Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP
  • 11. Bizerte JENDOUBA BEJA NABEUL ZAGHAOUN LE KEF SELIANA KAIRAOUN KASSERINE SIDI BOUZID MEHDIA GAFSA TOZEUR KEBILI GABES DJERBA MEDNINE TATAWINE Hospital and Medecine Universities Health Map 15 Acadimic hospitals 3 Regional hospitals 1 Medecine Faculty 2 Hight School of health Science And Technologies TUNIS SFAX 2 Acadimic hospitals 3 Regional hospital 1 Medecine Faculty 1 Hight School of health Science And Technologies BENGERDEN 1 Acadimic hospitals 2 Regional hospitals 1 Medecine Faculty 1 Hight School of health Science And Technologies ZERZIS ALGERIE LIBYE 2 Acadimic hospitals 1 Regional hospitals 1 Medecine Faculty Regional hospitals 1 1 1 1 1 2 1 1 1 1 1 1 1 1 3 2 1 2 MONASTIR 1 1 1 SOUSSE 36
  • 12. OBJECTIVES : Extend professional services and uses of equipment to remote and rural areas Raise the level of diagnosis services Contribute to the equity of access by all the population to quality care services Avoid unprofitable evacuation of sick patients to academic hospital from regional hospital Increase the productivity of the daily work of health professionals or specialists Provide powerful collaboration tool for simultaneously staff work when the case concern a critical situation or a critical policy matter Improve the support on diagnosis and proposed treatment (Neurology emergencies - Orthopedic emergencies…). Provide interactive Video conferencing capabilities and teleradiological reading sending data and Images Plan the telestaff and keep practitioners and specialists in touch with the last developments. Enhance researches and medical scientific publications accompanied by Image and patient documents. Develop a large health information system. Spread the medical education to any member of network scattered over academic, regional hospitals or local care centres.
  • 13. EVALUATION  Telemedecine applications will : Encourage physicians, specialts and young practitioners to work in the long way region in the regional and local hospitals. Ensure a sustained training and experience for all medical sector. Avoid the unprofitable patient transport and unless examination (X-RAY, pathology, loboratory analysis) Enhance the medical research and the participation in international research programs Permit to develop training to have access to universal knowlege bases Au vu des objectifs arrêtés Partage des connaissances entre praticiens Encourage the equity through offering same health utilities of all citizens.
  • 14. Meilleur utilisation des équipements médicaux lourds par : Le Parrainage des HR par les CHU Les Télé-staffs Le Téléenseignement Il a été constaté pour les sites équipés 13 Sites de Télé-radiologie et 2 Sites de Télé-pathologie : Un Faible volume de données transférées Une Faible communication entre services hospitaliers l’organisation n’est pas au point l’aspect juridique n’est pas traité Les coûts des communications sont élevés
  • 15. Les applications de Télé-médicine ne sont pas ciblées : le télé-diagnostic dans les cas d’urgence le télé-enseignement la télé-consultation pour avoir une seconde opinion   Le téléstaff Le plan de charge prévisionnel n’existe pas Organisation projetée : Pour palier au manque de spécialistes à l’intérieur du pays et dans les zones rurales et pour développer le travail en équipe et la recherche. Créer un Centre National de Telemedecine au Service des Praticiens éloignés, dotés de stations complètes et d’un réseau de communication performant : Pour traiter et donner un avis de Senior dans le cas des urgences graves ( accidentés de la route, accidentés du travail, attaques cardiovasculaires et autres….) Pour tenir des telestaffs auquels prendront part les medecins exercant dans les zones éloignées.Ces Téléstaffs concernerait la medcine de pointe et des cas difficiles ou atypique.
  • 16. Pour assurer un service régulier de téléenseignement. En temps réel En temps différé Pour gérer un service de Bibliothèque Virtuelle Médicale Pour assurer La veille Technologie dans le domaine de la médecine de pointe Les Pré requis Technologiques Communication aisée de Bout en Bout en large bande Echange d’information multimédia Internet - Fax - Téléphone ISDN - Fibre optique – Satellite - ADSL Support Technique (Installation – Maintenance – Sécurité ) Choix des équipements (état de l’art) Fiabilité des techniques de Compression Utilisation des divers technologies de communication
  • 17. Les Pré requis Organisationnels Disponibilité 7x24, nuits, week ends * aux Gardes * à la Facturation * à la Transmission des Comptes Rendus * à l’évaluation et à l’élaboration des Statistiques d’Activité Responsabilité Civile * Certification et Confirmation des médecins * Authentification des Comptes Rendus Réglementation des honoraires –(vacataires ou heures supplémentaires) Par acte de base Contrat annuel Résolution des problèmes liés
  • 18. Arrêter la méthode d’estimation des coût en tenant compte de  : Des Investissements en équipements au niveau du Centre de Télémédecine et du Centre demandeur Coût de la maintenance Coût des communications Coût de la logistique administrative Evaluation de l’activité Volume des cas Types des cas Nombre d’image par cas Temps moyen nécessaire par cas Satisfaction des usagers Qualité des images (excellente, bonne, moyenne) Exactitude des diagnostics
  • 19. Fiabilité des techniques de transmission et de réception des images Taille des images : 1 image de médecine nucléaire : 64.000 bytes = 16 Ko 1 image Mammographie : 16 000.000 bytes = 16 Mo Arrêter une technique et une politique d’archivage : Au niveau : * du transmetteur (expéditeur) * du Receveur * des Deux Archivage total ou sélectif des images Pendant combien du temps * Sous l ‘aspect médical * sous l’aspect légal Utiliser des techniques fiables des compressions d’images
  • 20. Type d’archivage : On line (accès rapide) Sur disque : RAID Coût de l’archivage élevé Off line (accès lent) Bandes – CDS – disque amovibles Coût de l’archivage faible
  • 21. EVOLUTION VERS LA TELESANTE
  • 22. Network Platforms Health Care Personalization Portals Home Care Patient Discussion rooms Tele- Consultacy Wireless ASP Medical Data Base Content Distance Teaching Rural Health Care Information Services Doctor to Patient Messaging Tele- Radiology Gaming Internet vs Telemedicine : a Web of solutions… … e ach with a personalized solution Medical Libraries Telemedicine
  • 23. NOUVELLES OPPORTUNITES POUR LA TELESANTE DUES AU MOBILE • LARGER DIFFUSION OF E-HEALTH APPLICATIONS FOR E-LEARNING, EASIER CLINICAL INFORMATION RECOVERY, ETC, • PATIENTS TRACKING (MONITORING OF VITAL SIGNS, ANYWHERE, ANYTIME) • PERSONAL CARE IN NORMAL AND IN EMERGENCY SITUATIONS • E-HEALTH DEPLOYMENT IN DISASTER AND EPIDEMIC SITUATIONS • LARGER DIFFUSION OF E-HEALTH APPLICATIONS FOR E-LEARNING, EASIER CLINICAL INFORMATION RECOVERY, ETC, • PATIENTS TRACKING (MONITORING OF VITAL SIGNS, ANYWHERE, ANYTIME) • PERSONAL CARE IN NORMAL AND IN EMERGENCY SITUATIONS • E-HEALTH DEPLOYMENT IN DISASTER AND EPIDEMIC SITUATIONS
  • 24. CONCLUSION The telemedecine is a great future technology Regarding on the personnel disponibilities, the organisations capacities ,the budget ressources and quality of international health cooporations 3 Key words : * Canalizing * Guiding * Optimizing The trends of the new telecommunication technologies gives us : * More services abilities * More security * More quality in life The benefits for developping countries are largely proved by improving health care services, medical researches and reducing costs
  • 25. Thank you for your attention