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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)
z The Situation Nowadays How to solve it? ,[object Object],We will obtain that
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
 
z Family Modules ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
GE CERTIFIED PRODUCT
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.
 
DERMATOLOGY AT THE HOSPITAL
OTHORHINOLARINGOLOGY AT THE HOSPITAL
OPHTHALMOLOGY AT THE HOSPITAL
ELECTROCARDIOLOGY AT THE HOSPITAL
 
 
ATLAS FLASH VIEWER
Telemedicine Circuits  based on standards. Success Histories. Telefonica Group  - ”Global  eHealth  SUMMIT” Main vision:  Beyond the PACS. Projects developed with MIO technology
z Medical Imaging Global Repository
[object Object],[object Object],[object Object],[object Object],[object Object],Summary Client Sanitas Location Madrid (Madrid, Spain) Project Development 2008 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
z Imaging Integration – Regional Level
[object Object],[object Object],[object Object],[object Object],[object Object],Summary Client IBSAULT, CATSALUT Location Baleares Islands, Spain Barcelona. Spain Project Development 2005-2008 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
z Regional Multi-PACS Project
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 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],C2C - the eHealth company – Beyond PACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],C2C - the eHealth company – Beyond PACS Mobility Projects
z Medical Imaging Global Repository
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
Telemedicine Circuits  based on standards. Success Histories. Telefonica Group  - ”Global  eHealth  SUMMIT” MIO Technology  Telemedicine Projects: examples
z Telestroke at BALEARIC ISLANDS:  “ TIME IS BRAIN”
z ACUTE CORONARY SYNDROME at BALEARIC ISLANDS:  “TIME IS LIFE”
The Architecture Call Manager MIO – Call Manager integration IP Phones UC CTDP
z Teledermatology at BALEARIC ISLANDS.
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
[object Object],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
z ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEW CHALLENGES
z IS TECHNOLOGY READY?
z WEB 2.0 and HEALTH 2.0
Web 2.0 in Healthcare = Health 2.0
z SOME EXAMPLES
z SOME EXAMPLES
z SOME EXAMPLES
z SOME EXAMPLES
http://medting.com
Telemedicine Circuits  based on standards. Success Histories. Telefonica Group  - ”Global  eHealth  SUMMIT” MEDTING http://medting.com
What is Medting? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is Medting for? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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
Clinical Cases Medting.com
Atlas Medting.com
Multilanguage ,[object Object],[object Object],[object Object],[object Object],Medting.com
Pubmed integration Medting.com
Repository and Tool ,[object Object],[object Object],[object Object],[object Object],Medting.com
Social components (Web 2.0) ,[object Object],[object Object],[object Object],[object Object],Medting.com
Atlas viewer ,[object Object],[object Object],[object Object],Medting.com
Medting a reference site for medical media ,[object Object],[object Object],[object Object],Medting.com Clinical Marketing, promoting physician’s website Free Telemedicine Tool Connectors: linking Medting content from an external website
Medting Connectors: mash-up ,[object Object],Medting.com
Telemedicine Circuits  based on standards. Success Histories. Telefonica Group  - ”Global  eHealth  SUMMIT” ON LINE DEMO
Who can be interested? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Medting.com
Medting for independent  doctors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Medting.com
Enterprise Partners ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Medting.com
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 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],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
In the first 3 months …  3 Enterprise Projects
HEALTH SCIENCES LEARNING TROUHG THE MEDTING ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HEALTH SCIENCES LEARNING TROUHG THE MEDTING ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HEALTH SCIENCES LEARNING TROUHG THE MEDTING ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Telemedicine Circuits  based on standards. Success Histories. Telefonica Group  - ”Global  eHealth  SUMMIT” CONCLUSIONS
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.
z FUTURE WITH ILUSION A lot of new ideas to develop: Synchronous  Telemedicine platform on Skype , Health Tourism platform, Medas ….
Virtual Health Record Platform for Medical Tourism Purposes Health Destination Project
MEDAS ASP EPR
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

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Telemedicine Circuits Based On Standards

  • 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. 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. 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. 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. 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. 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.
  • 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.
  • 11.  
  • 12.  
  • 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.
  • 15.  
  • 16. DERMATOLOGY AT THE HOSPITAL
  • 20.  
  • 21.  
  • 22.
  • 23.
  • 24.
  • 26. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” Main vision: Beyond the PACS. Projects developed with MIO technology
  • 27. z Medical Imaging Global Repository
  • 28.
  • 29. z Imaging Integration – Regional Level
  • 30.
  • 32.
  • 33.
  • 34. z Medical Imaging Global Repository
  • 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
  • 36. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” MIO Technology Telemedicine Projects: examples
  • 37. z Telestroke at BALEARIC ISLANDS: “ TIME IS BRAIN”
  • 38. z ACUTE CORONARY SYNDROME at BALEARIC ISLANDS: “TIME IS LIFE”
  • 39. The Architecture Call Manager MIO – Call Manager integration IP Phones UC CTDP
  • 40. z Teledermatology at BALEARIC ISLANDS.
  • 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
  • 42.
  • 43. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” NEW CHALLENGES HEALTH 2.0
  • 44. z NEW CHALLENGES: NEW USERS NEW PATIENT PROFILE: I-GENERATION NEW PHYSICIAN PROFILE: i-GENERATION NEW HEALTHCARE DEMANDS AND WORKFLOWS
  • 45.
  • 46. z IS TECHNOLOGY READY?
  • 47. z WEB 2.0 and HEALTH 2.0
  • 48. Web 2.0 in Healthcare = Health 2.0
  • 54. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” MEDTING http://medting.com
  • 55.
  • 56.
  • 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.
  • 58. Images worldwide interchange repository for clinical research and collaboration purpose Health 2.0 One vision Connecting Images in a clinical context
  • 59. Medting The Power of Collective Wisdom Medting.com
  • 62.
  • 64.
  • 65.
  • 66.
  • 67.
  • 68.
  • 69. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” ON LINE DEMO
  • 70.
  • 71.
  • 72.
  • 73.
  • 74. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” MEDTING PLATFORM TO DO ANY TELEMEDICINE PROJECT EASILY
  • 75. In the first 3 months … 3 Enterprise Projects
  • 76.
  • 77.
  • 78.
  • 79. Telemedicine Circuits based on standards. Success Histories. Telefonica Group - ”Global eHealth SUMMIT” CONCLUSIONS
  • 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.
  • 81. z FUTURE WITH ILUSION A lot of new ideas to develop: Synchronous Telemedicine platform on Skype , Health Tourism platform, Medas ….
  • 82. Virtual Health Record Platform for Medical Tourism Purposes Health Destination Project
  • 84. Is your Hospital achieving optimum profit from its PACS?
  • 85. Does your hospital need to integrate non-Radiological Images into its PACS ?
  • 86. Does your Hospital know how to maximize profit , from the investment in Imaging Technology already in place ?
  • 87. Is your hospital able to incorporate Images into your Patients Electronic Health Record?
  • 88. Has your Cardiological Department asked for ECGs storage into your PACS ?
  • 89. Should your hospital centralize in just one single repository ALL Medical Imaging ?
  • 90. Does your hospital participate in some Telemedicine Project that requires Medical Imaging sharing ?
  • 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

Notas del editor

  1. 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.