Transcript SIT EXPO 2004 – E-HEALTH CONFERENCE CASABLANCA - 20 – 21 FEVRIER 2004 TELEMEDECINE EXPERIENCE TUNISIENNE DEVELOPPEMENT ET EXPLOITATION EVALUATION ORGANIZATION PROJETEE EVOLUTION VERS LA TELE SANTE Sit.

SIT EXPO 2004 – E-HEALTH CONFERENCE
CASABLANCA - 20 – 21 FEVRIER 2004
TELEMEDECINE
EXPERIENCE TUNISIENNE
DEVELOPPEMENT ET EXPLOITATION
EVALUATION
ORGANIZATION PROJETEE
EVOLUTION VERS LA TELE SANTE
Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP
DEVELOPPEMENT ET EXPLOITATION
Telemedecine application was identified in 1995 in the Health Telematics Plan Studies – (1996 – 2000) period.
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 :
* 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
EACH USER TERMINAL IS EQUIPPED BY :
Hospital
Video cam
* A Basic PC with high quality screen 19"
Scanner A3
* 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
Scanner A4
Printer
Documents
Video cam
LAN
ISDN
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
Hospital
Scanner A3
Video cam
Scanner A4
Printer
- 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
Documents
Video cam
LAN
ISDN
- 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
THE TELEMEDECINE COMMITEE
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.
Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP
TELEMEDECINE APPLICATION :
The Telemedecine network is constitueted by :
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
Technical Architectue of a Telemedicine
Solution : Exemple : TELERADIOLOGY
Hospital 1
Scanner A3
Video cam
3x 128Kb
ISDN
Scanner A4
Printer
Hospital 2
Router
Documents
Video cam
ISDN – 1x128Kb
RJ 45
LAN
Imagery equipement
Router
Imagery equipements
Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP
LAN
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
- HL7 : Direct Acquisation off Laboratory Results protocol
- H320 – H323 : Videoconferencing protocol to provide voice – Data and Video
- 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
APPLICATIONS REPARTING NEW STRATEGY
TO HAVE PRIORITY
Defined in Health Telematics plan studies for 2001-2005 period.
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
* Farhat Hached Hospital in Sousse
* Fattouma Bourguiba Hospital in Monastir
* Tahar Sfar Hospital in Mahdia
* Habib Bourguiba Hospital in Sfax
2 Regional hospitals situated in Western North:
* Le Kef Regional Hospital
* Jendouba Regional Hospital
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
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
ISDN
ERasme Hospital
Bruxelles
ALGERIA
WESTERN
NORTH
{
Tunis
Jendouba
Le Kef
Sousse
Sfax
WESTERN
SAOTH
{
Gafsa
Tozeur
Zarzis
Gabes
}
Grenoble
EAST SOUTHERN
Purpan Toulouse
Hospital La
Cassagne (Nice)
LYBIA
Latimone Marseille
ST.Rafaelle
Hospital Rome
Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP
Hospital and Medecine
Universities Health Map
Bizerte
2
JENDOUBA
TUNIS
BEJA
1
3 NABEUL
2
ZAGHAOUN
LE KEF
1
ALGERIE
1
SOUSSE
1
KAIRAOUN
MONASTIR
1
KASSERINE
1
MEHDIA
2
TOZEUR
DJERBA
1
1
2 Acadimic hospitals
3 Regional hospital
1 Medecine Faculty
1 Hight School of health
Science And Technologies
GABES
1
ZERZIS
MEDNINE
1
Science And Technologies
SFAX
GAFSA
KEBILI
1 Acadimic hospitals
2 Regional hospitals
1 Medecine Faculty
1 Hight School of health
SIDI BOUZID
1
1
2 Acadimic hospitals
1 Regional hospitals
1 Medecine Faculty
1
SELIANA
1
15 Acadimic hospitals
3 Regional hospitals
1 Medecine Faculty
2 Hight School of health
Science And Technologies
1
3
6
Regional hospitals
BENGERDE
TATAWINEN
1
1
LIBYE
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
Utilisation des divers technologies de communication
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
Les Pré requis Organisationnels
Disponibilité 7x24, nuits, week ends
Résolution des problèmes liés
* 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
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
Utiliser des techniques fiables des compressions d’images
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
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
LA TELESANTE
Internet vs Telemedicine : a Web of solutions…
Content
Distance
Teaching
Medical
Data Base
Wireless
ASP
Network
Platforms
Patient
Discussion
rooms
TeleConsultacy
Health Care
Personalization
Telemedicine
Home
Care
…each with a personalized
solution
Rural
Health Care
Information
Services
Portals
TeleRadiology
Medical
Gaming
Libraries
Doctor to
Patient
Messaging
NOUVELLES OPPORTUNITES POUR LA
TELESANTE DUES AU MOBILE
LARGERDIFFUSION
DIFFUSIONOF
OF
•• LARGER
E-HEALTHAPPLICATIONS
APPLICATIONS
E-HEALTH
FORE-LEARNING,
E-LEARNING,EASIER
EASIER
FOR
CLINICALINFORMATION
INFORMATION
CLINICAL
RECOVERY,ETC,
ETC,
RECOVERY,
PATIENTSTRACKING
TRACKING
•• PATIENTS
(MONITORINGOF
OFVITAL
VITAL
(MONITORING
SIGNS,ANYWHERE,
ANYWHERE,ANYTIME)
ANYTIME)
SIGNS,
PERSONALCARE
CARE IN
INNORMAL
NORMAL
•• PERSONAL
ANDIN
INEMERGENCY
EMERGENCY
AND
SITUATIONS
SITUATIONS
E-HEALTHDEPLOYMENT
DEPLOYMENTIN
IN
•• E-HEALTH
DISASTERAND
ANDEPIDEMIC
EPIDEMIC
DISASTER
SITUATIONS
SITUATIONS
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