Telemedicine Circuits Based On Standards

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Telemedicine Circuits Based On Standards

  1. 1. 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
  2. 2. 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.
  3. 3. 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
  4. 4. 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
  5. 5. 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.
  6. 6. 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)
  7. 7. z The Situation Nowadays How to solve it? <ul><li>PACS just acts as Radiological Image Repository </li></ul>We will obtain that
  8. 8. 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
  9. 10. z Family Modules <ul><li>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™. </li></ul><ul><li>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). </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>MIO Store™; Medical imaging storage system for departmental applications. Images to be stored can come from multiple modules MIO LT™ / MIO Comm™. </li></ul><ul><li>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™. </li></ul>
  10. 13. GE CERTIFIED PRODUCT
  11. 14. 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.
  12. 16. DERMATOLOGY AT THE HOSPITAL
  13. 17. OTHORHINOLARINGOLOGY AT THE HOSPITAL
  14. 18. OPHTHALMOLOGY AT THE HOSPITAL
  15. 19. ELECTROCARDIOLOGY AT THE HOSPITAL
  16. 22.
  17. 23.
  18. 24.
  19. 25. ATLAS FLASH VIEWER
  20. 26. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” Main vision: Beyond the PACS. Projects developed with MIO technology
  21. 27. z Medical Imaging Global Repository
  22. 28. <ul><li>C 2 C Solution </li></ul><ul><li>All modalities image/video capture through MIO (TDermatology, Digestology,…) </li></ul><ul><li>RIS/PACS y HDIS integration through MIO and standards languages (DICOM, HL7, ODBC, SQL…) </li></ul><ul><li>Reports design and implementation to introduce medical information </li></ul><ul><li>into images </li></ul>Summary Client Sanitas Location Madrid (Madrid, Spain) Project Development 2008 <ul><li>Benefits to the Client </li></ul><ul><li>Global Management of all generated images at the Clinic </li></ul><ul><li>Huge improvements: workflow and patient care </li></ul><ul><li>Maximum existent PACS amortization </li></ul><ul><li>Objectives </li></ul><ul><li>All non radiology images should be </li></ul><ul><li>acceded from the same repository </li></ul><ul><li>To integrate all non dicom images into </li></ul><ul><li>GE PACS </li></ul>
  23. 29. z Imaging Integration – Regional Level
  24. 30. <ul><li>C 2 C Solution </li></ul><ul><li>All modalities image/video capture through MIO (ophtalmology, dermatology, ORL; anatomopathology,…) </li></ul><ul><li>HIS / RIS / PACS integration through MIO and standards languages (DICOM, HL7,) </li></ul><ul><li>Reports design and implementation to introduce medical information </li></ul><ul><li>into images </li></ul>Summary Client IBSAULT, CATSALUT Location Baleares Islands, Spain Barcelona. Spain Project Development 2005-2008 <ul><li>Benefits to the Client </li></ul><ul><li>Global Management of all generated images at the Hospital </li></ul><ul><li>Huge improvements: workflow and patient care </li></ul><ul><li>Quality of health services improvement </li></ul><ul><li>Save cost: better profit of infrastructure </li></ul><ul><li>Objectives </li></ul><ul><li>Digital Clinical Imaging Access (radiological and non-radiological). </li></ul><ul><li>Integration Services with EMPI. </li></ul><ul><li>Electronic Health Record (EHR) integration with clinical imaging. </li></ul>
  25. 31. z Regional Multi-PACS Project
  26. 32. 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 <ul><li>Benefits to the Client </li></ul><ul><li>900 Primary Care Centers connected with 20 Central Hospitals, sharing Electronic Health Record integrated with clinical imaging and specialists informs. </li></ul><ul><li>Huge improvements felt: workflow and patient care (Tele-neurology, Tele-mammography, Tele-dermatology…) </li></ul><ul><li>Technologic Costs Reduction above 2 millions € / year </li></ul><ul><li>C 2 C Solution </li></ul><ul><li>Image/video capture from any modality, through MIO. </li></ul><ul><li>5 different providers’ PACS integration, through MIO. </li></ul><ul><li>Existent applications integration, through Rhapsody and MIO </li></ul><ul><li>(HIS LEGACY, RIS, PACS y Master Patient Index). </li></ul><ul><li>Objectives </li></ul><ul><li>Digital Clinical Imaging Access (radiological and non-radiological). </li></ul><ul><li>Electronic Health Record (EHR) integration with clinical imaging. </li></ul>C2C - the eHealth company – Beyond PACS
  27. 33. <ul><li>MIO converts </li></ul><ul><li>Intel MCA </li></ul><ul><li>into a </li></ul><ul><li>Dicom Device </li></ul><ul><li>Capturing images and send to PACS </li></ul><ul><li>Dicom Worklist </li></ul><ul><li>HL7 & Dicom embeded </li></ul>C2C - the eHealth company – Beyond PACS Mobility Projects
  28. 34. z Medical Imaging Global Repository
  29. 35. z 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
  30. 36. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” MIO Technology Telemedicine Projects: examples
  31. 37. z Telestroke at BALEARIC ISLANDS: “ TIME IS BRAIN”
  32. 38. z ACUTE CORONARY SYNDROME at BALEARIC ISLANDS: “TIME IS LIFE”
  33. 39. The Architecture Call Manager MIO – Call Manager integration IP Phones UC CTDP
  34. 40. z Teledermatology at BALEARIC ISLANDS.
  35. 41. 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
  36. 42. <ul><li>INTEGRATION WORK BY MIO </li></ul>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
  37. 43. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” NEW CHALLENGES HEALTH 2.0
  38. 44. z NEW CHALLENGES: NEW USERS NEW PATIENT PROFILE: I-GENERATION NEW PHYSICIAN PROFILE: i-GENERATION NEW HEALTHCARE DEMANDS AND WORKFLOWS
  39. 45. z <ul><li>Healthcare organization </li></ul><ul><ul><li>Places to organize medical content, easy access </li></ul></ul><ul><ul><li>Clinical Marketing tools </li></ul></ul><ul><ul><li>Free telemedicine tool </li></ul></ul><ul><li>Clinician </li></ul><ul><ul><ul><li>Images interchange for second opinions, research, learning, etc. </li></ul></ul></ul><ul><ul><ul><li>Data source for Clinical Tests (clinical trails) monitoring based on images </li></ul></ul></ul><ul><ul><ul><li>Telementoring, teleproctoring, clinical comitees </li></ul></ul></ul><ul><ul><ul><li>Real time interchange functionality (like a messenger) for real time clinical service … and free </li></ul></ul></ul><ul><ul><ul><li>University use, big images events, … </li></ul></ul></ul><ul><li>Patient </li></ul><ul><ul><ul><li>Open images consultation for diagnosis, before a surgery </li></ul></ul></ul><ul><ul><ul><li>Diagnosis development and monitoring of group of patients with clinical participation </li></ul></ul></ul><ul><ul><ul><li>Global repository of clinical data (my Health) </li></ul></ul></ul>NEW CHALLENGES
  40. 46. z IS TECHNOLOGY READY?
  41. 47. z WEB 2.0 and HEALTH 2.0
  42. 48. Web 2.0 in Healthcare = Health 2.0
  43. 49. z SOME EXAMPLES
  44. 50. z SOME EXAMPLES
  45. 51. z SOME EXAMPLES
  46. 52. z SOME EXAMPLES
  47. 53. http://medting.com
  48. 54. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” MEDTING http://medting.com
  49. 55. What is Medting? <ul><li>MEDTING is an internet website for the exchange of clinical cases, medical images and videos. </li></ul><ul><li>Physicians, researchers and educators can use MEDTING for clinical peer review, research, teaching, second opinion and decision support purposes. </li></ul><ul><li>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. </li></ul><ul><li>MEDTING is free and is exclusively for clinicians . </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>
  50. 56. What is Medting for? <ul><li>For Public Health, Clinical collaboration and Research purposes </li></ul><ul><li>World wide research platform for all medical images specialties </li></ul><ul><li>eLearning, Telemedicine purposes, CME. </li></ul><ul><li>Image interchange, diagnosis images classification, diagnosis plat. </li></ul><ul><li>Anonymous Telemedicine Tool </li></ul><ul><li>A service for Medical Meetings, second opinion </li></ul><ul><li>Virtual Clinical Session Tool </li></ul><ul><li>A repository for a medical center to classified their content and give access to their professionals </li></ul>
  51. 57. 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.
  52. 58. Images worldwide interchange repository for clinical research and collaboration purpose Health 2.0 One vision Connecting Images in a clinical context
  53. 59. Medting The Power of Collective Wisdom Medting.com
  54. 60. Clinical Cases Medting.com
  55. 61. Atlas Medting.com
  56. 62. Multilanguage <ul><li>Keywords (tags) are based on SNOMED CT terminology </li></ul><ul><li>Automatic translation of the keywords   </li></ul><ul><li>SNOMED provides a battery of more than one million clinical terms in several languages. </li></ul><ul><li>The more SNOMED terms you use as keywords, the better your content will be indexed. </li></ul>Medting.com
  57. 63. Pubmed integration Medting.com
  58. 64. Repository and Tool <ul><li>Private and Public cases: </li></ul><ul><ul><li>Public cases can be reviewed from any internet user since it’s published into the platform.   </li></ul></ul><ul><ul><li>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. </li></ul></ul><ul><li>Any user can be invited by the author to review a private case: </li></ul>Medting.com
  59. 65. Social components (Web 2.0) <ul><li>Powerful video management: transcoding and broadcast </li></ul><ul><li>Multiple images viewers </li></ul><ul><li>Connectors: Mash-up </li></ul><ul><li>Social component: Vote, comment and share </li></ul>Medting.com
  60. 66. Atlas viewer <ul><li>Atlas flash viewer </li></ul><ul><li>Upload images to Medting and show them from another website </li></ul><ul><li>Disease atlas, specialties, organs, etc. </li></ul>Medting.com
  61. 67. Medting a reference site for medical media <ul><li>Users don’t easily share their clinical content </li></ul><ul><li>A win-win relationship has to be established </li></ul><ul><li>Emphasizing the potentials of Medting is necessary </li></ul>Medting.com Clinical Marketing, promoting physician’s website Free Telemedicine Tool Connectors: linking Medting content from an external website
  62. 68. Medting Connectors: mash-up <ul><li>Medbloggers, medical magazines, forums, intranets can benefit from Connectors and show content from Medting in external websites </li></ul>Medting.com
  63. 69. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” ON LINE DEMO
  64. 70. Who can be interested? <ul><li>Education and training organizations </li></ul><ul><li>Virtual Clinical Sessions (online / offline) </li></ul><ul><li>Clinical marketing tool </li></ul><ul><li>Telemedicine / Second opinion </li></ul><ul><li>Independent doctors: have your medical blog </li></ul><ul><li>Medical workgroups or researcher </li></ul><ul><li>Media Syndication </li></ul>Medting.com
  65. 71. Medting for independent doctors <ul><li>Medting is a no cost service </li></ul><ul><li>Premium users also free </li></ul><ul><li>Medting is a service that can be used to post information privately or public </li></ul><ul><li>Private information: </li></ul><ul><ul><li>Case: sharing a case privately only between invited users </li></ul></ul><ul><ul><li>Store images on a private repository </li></ul></ul><ul><li>Public Case or Resource: will remain public for other users searching on Medting </li></ul>Medting.com
  66. 72. Enterprise Partners <ul><li>Health care organization, hospitals, medical centers can become Enterprise Partner </li></ul><ul><li>Extra functionalities of Enterprise Partner </li></ul><ul><ul><li>White Label: use Medting functionalities with the Enterprise-only content </li></ul></ul><ul><ul><li>Online Virtual Clinical Session (collaborative tools) </li></ul></ul><ul><ul><li>Direct Medical modality connection (MIO) </li></ul></ul><ul><li>Enterprise Partner is a fee based service. Fee may depend on volume and size </li></ul>Medting.com
  67. 73. 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 <ul><li>Endoscopic Surgery network of excellence </li></ul><ul><li>Collaborative clinical case discussion for decision-making support </li></ul><ul><li>Focused on rare/complex cases of high academic value </li></ul><ul><li>Online visualization of surgical interventions </li></ul><ul><li>Interactive, multimedia Web-based CME programs </li></ul><ul><li>High quality standards supported by a European network of excellence </li></ul><ul><li>Integrated clinical information exchange (images and videos) </li></ul><ul><li>Multilingual, international coverage </li></ul><ul><li>Web 2.0 community-based approach </li></ul><ul><li>Powerful and secure exchange of large volumes of images and videos </li></ul><ul><li>Quick information search via SNOMED CT </li></ul><ul><li>Low-cost, flexible integration into existing Web sites </li></ul>Base platform for other projects
  68. 74. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” MEDTING PLATFORM TO DO ANY TELEMEDICINE PROJECT EASILY
  69. 75. In the first 3 months … 3 Enterprise Projects
  70. 76. HEALTH SCIENCES LEARNING TROUHG THE MEDTING <ul><li>First Step: Upload case/images </li></ul><ul><ul><li>Web 2.0 –based task for the professor </li></ul></ul><ul><li>Second Step: Student view the cases </li></ul><ul><ul><li>Keywords, descriptions, images and videos </li></ul></ul><ul><ul><li>Student search for related cases </li></ul></ul><ul><li>Third Step: Work in class </li></ul><ul><ul><li>ANALYSIS OF: COMMENTS : KEY WORDS, POSSIBLE TREATMENTS, IMAGES. </li></ul></ul><ul><ul><li>Professor proposes activities about the topics and questions about the material on the web and students: </li></ul></ul><ul><li>Peer review, working groups </li></ul><ul><li>Discussion boards </li></ul><ul><li>Make pictures/videos of possible treatment procedures </li></ul><ul><li>Fourth Step: STUDENTS UPLOAD COMMENTS/IMAGES after work in class/at home </li></ul><ul><li>Fifth Step: Reading and correction </li></ul><ul><li>SixthStep: Reviewing all comments and implementations </li></ul>
  71. 77. HEALTH SCIENCES LEARNING TROUHG THE MEDTING <ul><li>Benefits according to students </li></ul><ul><ul><li>Working with real cases provided in the web: bridge between academic and clinical environment </li></ul></ul><ul><ul><li>Viewing all type of images </li></ul></ul><ul><ul><li>Developing deep understanding of the topic being studied </li></ul></ul><ul><ul><li>Maintaining knowledge based on cases and reports </li></ul></ul><ul><ul><li>Using professional online databases . </li></ul></ul><ul><li>Inconvenience according to students </li></ul><ul><ul><li>Too much time to: </li></ul></ul><ul><ul><li>read and analyze cases </li></ul></ul><ul><ul><li>analyze Images </li></ul></ul><ul><ul><li>upload cases and images </li></ul></ul><ul><ul><li>Get good marks!! </li></ul></ul><ul><ul><li>No feeling of learning </li></ul></ul>
  72. 78. HEALTH SCIENCES LEARNING TROUHG THE MEDTING <ul><li>Benefits according to professors </li></ul><ul><ul><li>Students: </li></ul></ul><ul><ul><li>work with the material (CASES/IMAGES) provided in the web 2.0 to learn real problem solving </li></ul></ul><ul><ul><li>Improve decision making and critical thinking </li></ul></ul><ul><ul><li>Improve teamwork and communication </li></ul></ul><ul><ul><li>Applications in all specialties </li></ul></ul><ul><li>Inconvenience according to professors </li></ul><ul><ul><li>Changing role of the professor </li></ul></ul><ul><ul><li>Time spent </li></ul></ul><ul><ul><li>Lack of real practice documentation/cases/images shared on webs </li></ul></ul><ul><ul><li>Preparing/searching cases/images related to the topic </li></ul></ul>
  73. 79. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” CONCLUSIONS
  74. 80. z 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.
  75. 81. z FUTURE WITH ILUSION A lot of new ideas to develop: Synchronous Telemedicine platform on Skype , Health Tourism platform, Medas ….
  76. 82. Virtual Health Record Platform for Medical Tourism Purposes Health Destination Project
  77. 83. MEDAS ASP EPR
  78. 84. Is your Hospital achieving optimum profit from its PACS?
  79. 85. Does your hospital need to integrate non-Radiological Images into its PACS ?
  80. 86. Does your Hospital know how to maximize profit , from the investment in Imaging Technology already in place ?
  81. 87. Is your hospital able to incorporate Images into your Patients Electronic Health Record?
  82. 88. Has your Cardiological Department asked for ECGs storage into your PACS ?
  83. 89. Should your hospital centralize in just one single repository ALL Medical Imaging ?
  84. 90. Does your hospital participate in some Telemedicine Project that requires Medical Imaging sharing ?
  85. 91. 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

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