SIT EXPO 2004 – E-HEALTH CONFERENCE CASABLANCA - 20 – 21 FEVRIER 2004 TELEMEDECINE EXPERIENCE...

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

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.

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Documents Documents Video camVideo cam

LLANANISDNISDN

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

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LLANANISDNISDN

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


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 :

Technical Architectue of a Telemedicine Technical Architectue of a Telemedicine

Solution : Exemple : TELERADIOLOGYSolution : Exemple : TELERADIOLOGY

ISDNISDN

Imagery equipementsImagery equipements

ISDN – 1x128KbISDN – 1x128Kb

Hospital 2

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RouterRouter

RJ 45RJ 45

Hospital 1

3x 128Kb3x 128Kb




Imagery equipementImagery equipementLLANAN

LANLAN

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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

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 STRATEGYTO HAVE PRIORITY

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 Hospitals : 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

TunisTunis

ISDNISDN

Hospital LaHospital LaCassagne (Nice)Cassagne (Nice)

Purpan Toulouse

{WESTERN

NORTH

{WESTERN

SAOTH }EAST SOUTHERN

Latimone Marseille

SfaxSfax

ERasme Hospital

Bruxelles

ST.Rafaelle

Hospital Rome

Zarzis

Gabes

Jendouba

Le Kef

Gafsa

Tozeur

SousseSousse

Grenoble

ALGERIA

LYBIA


BizerteBizerte

JENDOUBAJENDOUBA BEJABEJANABEULNABEUL

ZAGHAOUNZAGHAOUNLE KEFLE KEF

SELIANASELIANA

KAIRAOUNKAIRAOUN

KASSERINEKASSERINE

SIDI BOUZIDSIDI BOUZID

MEHDIAMEHDIA

GAFSAGAFSA

TOZEURTOZEUR

KEBILIKEBILI

GABESGABESDJERBADJERBA

MEDNINEMEDNINE

TATAWINETATAWINE

Hospital and MedecineUniversities Health Map

15 Acadimic hospitals3 Regional hospitals1 Medecine Faculty2 Hight School of healthScience And Technologies

TUNISTUNIS

SFAXSFAX2 Acadimic hospitals3 Regional hospital1 Medecine Faculty1 Hight School of healthScience And Technologies

BENGERDEBENGERDENN

1

1

1

11

2

1

1

1

1

11

1

1

321

2

1 Acadimic hospitals2 Regional hospitals1 Medecine Faculty1 Hight School of healthScience And Technologies

MONASTIRMONASTIR

1

ZERZISZERZIS1

1

ALG

ERIE

LIBYE

2 Acadimic hospitals1 Regional hospitals1 Medecine Faculty

SOUSSESOUSSE

Regional hospitals36

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.

EVALUATION

Telemedecine applications will :

Encourage the equity through offering same health utilities of all citizens.

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

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

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.

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

Les Pré requis OrganisationnelsDisponibilité 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

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

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

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

EVOLUTION VERS EVOLUTION VERS

LA TELESANTE LA TELESANTE

EVOLUTION VERS EVOLUTION VERS

LA TELESANTE LA TELESANTE

NetworkNetwork PlatformsPlatforms

Health CareHealth CarePersonalizationPersonalization

PortalsPortalsHomeHomeCareCare

Patient Patient Discussion Discussion

roomsrooms

Tele-Tele-ConsultacyConsultacy

WirelessWirelessASPASP

MedicalMedicalData BaseData Base

ContentContent

DistanceDistanceTeachingTeaching

RuralRuralHealth CareHealth Care

InformationInformationServicesServices

Doctor toDoctor toPatientPatient

MessagingMessaging

Tele-Tele-RadiologyRadiology

GamingGaming

Internet vs Telemedicine : a Web of solutions…Internet vs Telemedicine : a Web of solutions…

……eeach with a personalized ach with a personalized solutionsolution

Medical Medical LibrariesLibraries

TelemedicineTelemedicine

NOUVELLES OPPORTUNITES POUR LA

TELESANTE DUES AU MOBILE

• LARGER DIFFUSION OF

E-HEALTH APPLICATIONS

FOR E-LEARNING, EASIERCLINICAL INFORMATIONRECOVERY, ETC,

• PATIENTS TRACKING(MONITORING OF VITALSIGNS, ANYWHERE, ANYTIME)

• PERSONAL CARE IN NORMALAND IN EMERGENCYSITUATIONS

• E-HEALTH DEPLOYMENT INDISASTER AND EPIDEMICSITUATIONS

• LARGER DIFFUSION OF

E-HEALTH APPLICATIONS

FOR E-LEARNING, EASIERCLINICAL INFORMATIONRECOVERY, ETC,

• PATIENTS TRACKING(MONITORING OF VITALSIGNS, ANYWHERE, ANYTIME)

• PERSONAL CARE IN NORMALAND IN EMERGENCYSITUATIONS

• E-HEALTH DEPLOYMENT INDISASTER AND EPIDEMICSITUATIONS

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

SIT EXPO 2004 – E-HEALTH CONFERENCE CASABLANCA - 20 – 21 FEVRIER 2004 TELEMEDECINE EXPERIENCE...

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Transcript of SIT EXPO 2004 – E-HEALTH CONFERENCE CASABLANCA - 20 – 21 FEVRIER 2004 TELEMEDECINE EXPERIENCE...