Thanks to Telefonica to invite me to this event. Let’s begin. We have seen this morning at the presentations a lot of examples how technologies are ready to perform any telemedine workflow. We’have seen examples from Cisco that looks like extracted from a star wars movie with the Healtpresence Platform, examples from Intel with the MCA units that helps to avoid the use of paper at any service of the healthcare environment, examples like the knowledge platforms based on the use of interenet, and virtual patient from IAVANTE, and finally the also amazing use of computer vision and interactive health technology from Gesturetek to promote rehabilitation, learning, sensory simulation and so on. The problem from my point of view is that there are a great difference between the state of the art of the technology and the implementation of them at the healthcare environment in Spain. In this session I’ll try to explain my experience with real cases of the implementation of it telemedicine workflows in Spain and the problems and mile stones that we sure will have in front at any healthcare service from any community. You will see how difficult is to start any project in a healthcare environment due to security, use of standards, patient identification problems and integration between application problems. I’m Integration engineer at the Regional Government at the Balearic Island and also Director of innovation and also integration engineer from a company called C2C and I’m a technical guy with a technical profile. I’ll explain my expertise in the different Telemedicine workflows I’ve implemented at Balearic Islands, Different communities of Spain and also different companies and healthcare services at different countries all over the world. This sessions will be a practical session and all the examples you will see will be working on real. On the second part of the session I’ll show how technology is ready to do much more, like the examples that we’ve shown this morning at the presentations and I’ll show how to use web 2.0 and other technologies to do real telemedicine workflows that are demanded nowadays by physicians and healtcare services private companies and how to work together with the problems of integration and use of standards demandes by healthcare communities. I wish you enjoy and of course feel free to stop me to ask me any doubt or to stop if you don’t understand my english. I aopologise not to talk better it.
TELEMEDICINE WORKFLOWS BASED ON STANDARDS SUCCESS HISTORIES & IMPLEMENTATION PROBLEMS. STATE OF THE ART AT SPAIN Toni Contesti Coll [email_address] skype: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
z 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.
z 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)
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
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™.
z 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.
z Summary Client Generalitat Valenciana Consellería de Sanitat Location Valencia Community (Spain) Additional Information 22 Health Departments 27 Central Hospitals 25 Specialized Units 900 Primary Care Centers Project Development 2005 - 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
C 2 C 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).
Digital Clinical Imaging Access (radiological and non-radiological).
Electronic Health Record (EHR) integration with clinical imaging.
z Teledermatology at BALEARIC ISLANDS: Conclusions study developed 16/12/2005 04/07/2008. Primary Care Centers: 59,8% (IC 95% 50 – 70%) (p <0,0001) Teledermatology 94,7% (IC 95% 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
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
z NEW CHALLENGES: NEW USERS NEW PATIENT PROFILE: I-GENERATION NEW PHYSICIAN PROFILE: i-GENERATION NEW HEALTHCARE DEMANDS AND WORKFLOWS
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.
A repository for a medical center to classified their content and give access to their professionals
Founders CABRER GONZ Á LEZ, MIGUEL Founder & 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, ANTONIO Founder & Technical Innovation Manager Telecommunications Science degree. IT Coordinator of Catalonian Red Cross Integration 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 The Power of Collective Wisdom Medting.com
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:
Enterprise Partner is a fee based service. Fee may depend on volume and size
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
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 Innovation Toni Contestí Bussiness Development Manager Óscar López Integration Project Engineers & Developers Victor Bas Paco Bevia Matías Bonet Juan Brines Roberto Castellor José Colomer Antonio de Pedro Vanesa del Casar Enrique de la Vega Antonio Hernández Pedro Hurtado Daniel López Toni Mas Joan Oliver Berta Pérez Xavier Pons Silvia Ramis Sebastián Roncoli Vicente Rosselló Agustín Sabater Sergio Sanz Office Manager Belén Martín Ireland Office Manager Hernán Alberti International Sales Manager Rita Almada Clinical Consultant Miguel Cabrer (IRC) Jordi Pozo C2C Consultoría TSIS SL República Dominicana, 3 bajos local 1 07014 Palma de Mallorca Baleares (Spain) Office: (+34) 971.919.124 Fax: (+34) 971.918.423 [email_address] www.c2ctsis.com Thanks Feel 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_address] +34607840967