Fundeni Telemedicine Pilot V'1

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The AEROSPACE Programme
Telemedicine Pilot Project
I. C. Fundeni, I.S.S., InterNet srl
June 2002
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Presentation AGENDA

• Telemedicine Overview
• Telemedicine in Romania
• FUNDENI Telemedicine Pilot Project
• The Telemedicine Pilot Structure
• The Telemedicine Pilot Applications
• The Telemedicine Pilot Status - June 2002
• National International Partnership
• The Telemedicine Pilot Partners.

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• Telemedicine
• Overview

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Space Technologies Spin-off
The Space Science and Technology eventually
released many terrestrial applications which
were turned into the best benefit of day by day
life. Among them are the recent Space emerged
communication technologies which allowed the huge
essor of Internet as well as other communication
techniques as support for more and more
tele-applications.
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Social and Managerial Space Spin-offs

• There are many application of space
  communication, sensing and data processing
  techniques. The managerial aspects including the
  issues connected to the benefits of on-line and
  exact managerial act are those in the field of
  Remote Sensing
• Disaster management and mitigation
• Precision agriculture
• Weather forecast and warning
• etc.

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Other Important Social Space Spin-offs

• The field of social life including health,
  wellness, and sports, as well as education, took
  profit of such space technologies as
  communication, imaging, remote control, etc.
• Telemedicine
• Tele-education
• Tele-working
• etc.

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Telemedicine - a complex concept
Eventually TELEMEDICINE include any medical act
performed at distance, from a telephone medical
consult to the remote surgery. Telemedicine is a
highly skill interdependent field medicine,
education, imaging, remote control, information
and communication technologies, etc. Actually
telemedicine means remote diagnostic, clinic and
educational medical act lead by means of ITC.
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A Multi Site Telemedicine System

• A Telemedicine system could be perceived as a
  collection of
• medical sites, and
• communication channels,
• connected together as an IT network.
• The network is open in the sense that
• virtually any site could be absent,
• virtually any new site can be connected.

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The Communication Support

• The communication support can be mixed into a
  telemedicine system
• broadcast support as
• Internet over IP communication,
• satellite broadcasting systems,
• dedicated transmission channels as
• satellite leased channel,
• radio streamers,
• ISDN,
• a.s.o.

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Telemedicine Locations

• The actors of telemedicine performance could be
  situated in any imaginable location
• standing and/or accessible medical centers,
  consulting rooms, schools, sports sites, etc.
• mobile and or remote medical caravans, ships,
  military mobile units, space stations, etc.

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Telemedicine
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Telemedicine Locations - The Set-Up

• The telemedicine location comprises
• connection to the communication channel
• medical and IT equipment.

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The Communication Link
The communication channel can be one of the above
illustrated or several different channels
organized on a back-up basis
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The Telemedicine Set-Up
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The Telemedicine LAN

• The telemedicine LAN can be perceived as the site
  informatic system, connected to several devices
• general cameras, plotters, LCD panels, CRT data
  projectors, multimedia, etc.
• specific image analyzers and processors, CT,
  MRI, surgical robots, tactile or holographic
  interfaces, blood analyzers, etc.
• In most cases, as for standing accessible sites
  such as hospitals, universities, a.s.o., the
  telemedicine LAN actually overlaps the
  organization's informatic system.

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Actors in Telemedicine

• The telemedicine performance implies active and,
  more or less, passive actors
• benefactors medical personnel, teachers,
  consultants, occasional medical act performers
• beneficiaries patients, students, remote sites
  personnel.

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Telemedicine acts - Clinic

• tele-diagnosis
• tele-consulting
• tele-radiology
• tele-surgery.

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Telemedicine acts - e-Learning

• tele-mentoring
• tele-instruction
• tele-education.

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Telemedicine acts - VideoConference

• A synthesis clinic educational acts
• tele-mentoring
• tele-instruction
• tele-education
• surgical act attendance.

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Telemedicine acts - Health Management

• remote databases access
• remote databases management
• medical statistical surveys
• general hygienic education
• disaster mitigation
• better remote, integrated, medical management.

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• Telemedicine
• in Romania

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The National Need for Telemedicine

• Environment
• Remote undeveloped, inaccessible zones
• Perfectible medical assistance
• Needs
• Training education of medical personnel
• Integration of clinical databases
• International integration and compatibility.

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Institutional Basis

• Government Strategy
• Romanian Government - NASA agreement
• National Programs Funding.

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Premises
Development of ITC Development of communication
services Dynamics of Internet and communication
services providers Awareness of the medical
community Political will and support Public
funding support.
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Some Achievements

• The development of ITC and the development of
  international cooperation allowed some isolate,
  circumstantial projects, funded on international
  cooperation or sponsorship basis
• Babes Institute
• Fundeni - Cardiology Clinic
• etc.

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• FUNDENI Telemedicine
• Pilot Project

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First Institutional Funded Project

• In the frame of AEROSPATIAL program the
  project
• Telemedicine Demonstrative Pilot with Diagnostic,
  Clinic and Educational Applications.
• 3 billions lei public funded
• 3.2 billions lei partners co-funded.

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Telemedicine Pilot Partnership

• The partnership for the implementation of the
  Telemedicine Pilot Project are
• FUNDENI Clinical Institute as coordinator,
• Department of General Surgery and Liver
  Transplantation (DLT),
• Department of Medical Imaging (DMI)
• Institute for Space Science as cooperator
• InterNET srl private Company as cooperator.

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Telemedicine Pilot Role
The Fundeni Clinic Institute assumes the
leadership in concentrating efforts to create the
future Telemedicine National System.
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Pilot Project Goals (1)

• Demonstrate the competence and infrastruc-tural
  capabilities to set-up and use a true
  telemedicine system
• Increase the public and governmental awareness
  for the benefits of telemedicine
• Perform specific and public medical education
• Demonstrate the health management capabilities
  of a telemedicine system.

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Pilot Project Goals (2)

• Develop national wide partnership
• Offer the pillar for the development of a
  National Telemedicine System
• Integrate the occasional efforts into a coherent
  stream of correlated applications
• Perform lobby for the telemedicine concept,
  system and funding (public and private).

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Pilot Project Goals (3)

• Develop international partnership
• Offer the possibility of international
  integration concerning a specific domain
• Integrate the medical system, space application
  system, and private initiative efforts
• Perform lobby for international partnership and
  funding.

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Mediatization and lobby

• Organization of a permanent and consistent
  presence of telemedicine information on Internet
• Organization of telemedicine performance on
  video-conference basis, internal and
  international
• Organization of thematic workshops substantially
  supported with promotional materials for
  marketing, advertising, and lobby.

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Telemedicine Pilot Project Schedule
Start of the Project 2001, October End of the
Project 2004, June Expected first
functional capabilities 2002, middle Expected
extended functional capabilities 2003,
middle Expected first international contact 2
002, fall
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• The Telemedicine Pilot
• Structure

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The Telemedicine Pilot Structure
The Pilot is intended to cover, at this stage,
the Department of General Surgery and Liver
Transplantation (DLT) as well as the Department
of Medical Imaging (DMI). The structure of the
Pilot follows the standard structure of a
telemedicine system, as presented in the tutorial
part of this presentation, adapted to the
strategic needs of the project. The next slide
shows a view of the system related to the
intended telemedicine audience.
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The Fundeni Telemedicine Pilot Links
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The Telemedicine Pilot Environment

• In the Pilot phase the Fundeni Telemedicine Pilot
  is connected with standing, accessible medical
  sites in Romania and abroad.
• The main communication link is through Internet
  (over IP)
• The occasional communication link is radio,
  through satellite channel or radio streamer.
• Both kind of links can connect the same sites.

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The Pilot Permanent Communication Link
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The Pilot IT Network
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The Pilot Network Server System

• The Pilot server system consist of two physical
  servers
• A - The DMI server with functions
• resource server
• DMI database server.
• B - The DLT server with functions
• router/communication server
• Internet application server
• DLT database server.

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The Medical Imaging Clinic LAN

• The DMI LAN acts as a sub-network of the Pilot IT
  Network System. It consist of
• DMI server
• Imaging workstations
• Medical Imaging database workstation
• Internet workstations.

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The Hepatic Transplant Clinic LAN

• The DLT LAN acts as a sub-network of the Pilot IT
  Network System. It consist of
• DLT server
• Imaging workstations
• Clinic database workstation
• Internet workstations.

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The Video Conference System
The video conference system is a very important
feature of any telemedicine system including the
Fundeni Telemedicine Pilot. Due to insufficient
funding, the video conference feature is
implemented in the Pilot only as a demonstrative
occasional one, funded through sponsorship.
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Key Structural Features of the Pilot

• integrating existing equipment
• open (any node could be present or not)
• expandable (accept integrating new nodes)
• scaleable (accept throughput increase)
• easy to maintain and service
• easy to operate with minimal training.

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• The Telemedicine Pilot
• Applications

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Clinic and Diagnostic Applications
For the moment, the clinic and diagnostic
applications focus on the image and clinic file
transfer. Those applications are tight related to
the Pilot database application. In the future, as
integration and funding will increase there are
expected more advanced application as distant
consult and surgery.
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Educational Applications
The educational applications range from general
medical education for medical and non medical
personnel to specific medical advanced
e-learning. The main support for these
applications are implemented in the general
e-learning scenario using Internet
Technologies. Advanced educational tools as
tele-mentoring and video conferences will be
detailed further.
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Video Conference (1)

• The video conference as advanced educational tool
  will be used in the frame of the telemedicine
  Pilot for
• general conference attendance
• tele-mentoring
• tele consulting
• seminars and specific demonstration for students

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Video Conference (2)
The general conference attendance is thought as a
mean of mediatization and general medical
education for specialists and non
specialists. This type of manifestation could be
lead from the telemedicine center site,
benefiting of rich demonstrational material and
broadcasted through mass media.
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Video Conference (3)
The tele-mentoring and tele-consulting by video
conference range in the field of advanced medical
educational applications. Connecting on-line,
video and audio featured, distant medical sites
will allow specialists to interact, proceed to
remote controlled medical act as surgery,
anamneza, etc. The students will have the
opportunity to attend such performances.
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Video Conference (4)
The seminars and specific demonstration for
students are expected to be the core of the
medical educational action through telemedicine,
would it be on local, national or international
basis.
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Internet Applications

• The Pilot will be supported by at least two
  Internet professional application sites
• mediatization, general presentation, general
  medical information and education site
• specialized medical e-learning.
• The sites will be largely multimedia, flash,
  search and filtering featured as to be
  attractive, interactive and highly functional.

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Medical Databases Application
Many previous described applications rely on the
medical integrated database of the pilot. The
medical integrate database will be conceived by
relating the imaging database of the Medical
Imaging Clinic with the clinic observational
database of the Hepatic Transplant Clinic. The
core structure, engines and interactive
interfaces of the medical integrated database
will allow expandability and scaleability.
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• The Telemedicine
• Pilot Status - June 2002

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Hardware and Basic Functions

• Main communication link implementation and
  testing
• Core server configuration implementation and
  testing Connection with the existing DMI and DLT
  LANs
• Configuration completion made to DMI and DLT
  LANs
• Implementation of communication, web, e-mail and
  DICOM servers.

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Telemedicine Applications Status

• DICOM compatible data transfer
• First functional model of the clinic and
  diagnostic database system
• Works on the Fundeni general patient database
  integration
• First Video-Conference application demonstration
  in cooperation with Virginia Commonwealth
  University (VCU) - expected to be done in early
  July 2002.

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June 2002 Status Conclusions

• General activity in advance by the general
  Project schedule
• Some activities rescheduled and advanced due to
  sinergic and functional needs
• Stage of omplementation allow functional
  contacts with partners
• Floreasca Hospital, first foreseen partner for
  National Telemedicine System integration.

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• National International Partnership in
  Telemedicine

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Overview of Intl Partnership in Telemedicine

• NASA-GOR Agreement 2000
• EWSSC medical training in telemedicine
• MITAC-VCU
• USUHS
• Salinas Valley Memorial Hospital
• Stanford University Medical Center.

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Romanian Partners for the Pilot (1)

• Sfantul Ioan Hospital Bucharest
• Unversitary Hospital Bucharest
• Military Hospital Bucharest
• Floreasca Emergency Hospital
• V. Babes Hospital Bucharest
• Sfanta Maria Hospital Bucharest.

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Romanian Partners for the Pilot (2)

• Sfantul Spiridon Hospital Iasi
• Craiova District Hospital
• Timisoara District Hospital
• Targul Mures District Hospital

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Foreign Partners for the Pilot (1)

• Hospital-to-Hospital
• Research Centers
• Virtual Collaborative Clinic
• already existing European clinical partnerships
• partnership to USA medical facilities
• new agreements of cooperation.

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Foreign Partners for the Pilot (2)

• EWSSC - UMD
• MITAC - VCU
• USUHS
• SVMH
• NASA AMES RESEARCH CENTER
• STANFORD UNIVERSITY MEDICAL CENTER.

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• The Telemedicine Pilot Project Partners

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FUNDENI Clinical Institute (1)
The FUNDENI Clinical Institute General
manager Prof. Dr. Dan TULBURE 258, Soseaua
Fundeni str. Bucharest, sector 2, Romania phone
40.1.240.8843 fax [phone]
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FUNDENI Clinical Institute (2)
The FUNDENI Clinical Institute Department of
General Surgery Liver Transplantation Director
Prof. Dr. Irinel POPESCU Department of Medical
Imaging Director Prof. Dr. Serban GEORGESCU
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Institute for Space Sciences
Institute for Space Sciences General
manager Dr. Ing. D. HASEGAN 111, Atomistilor
str., Magurele Bucharest, sector 5,
Romania phone [phone] fax [phone]
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InterNET srl
S. C. InterNET srl General manager Dr. Ing.
Dragos OFRIM 119, Calea Grivitei
str. Bucharest, sector 1, Romania phone
40.1.212.5538 fax [phone]

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Project Director Contact
Project Director Prof. Dr. Irinel
POPESCU e-mail fundenip_at_com.pcnet.ro
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• Thanks You for your kind attendance and interest!