a cura di scai servizi

MAY 1999

One hundred and six thousand eight hundred and ninety Web sites, unlimited lists of information at our disposal to be freely consulted through the never-ending networks of the Internet. Type “telemedicine” into the space for the key word the search browser “Altavista” (one of the most equipped and trustworthy on the net) provides and the result is as follows - more than a hundred places in the intangible world bearing the name www (World wide web), all dedicated to a medical discipline which was launched in the USA and is in the process of completely revolutionizing for the better the professional behaviour of those who look after our health and our approach to illness, diagnosis and treatment. The sense of interest which telemedicine arouses in the world is embodied in these numbers culled from the web, which in its own way has become the yardstick to gauge the planet's audiences. The future in medicine is digital. The world of informatics, public bodies, research institutes and companies came to realize this a long time ago. Using this premise, CO.ME.T.A. di SCAI Servizi, a company belonging to the SAI Group, took its first steps and gradually made a name for itself in this field. Founded in 1987 with the aim of supplying consultancy and services in the informatics field for affiliated companies, it is a broker in the true sense of the word, yielding informatics solutions by way of services, the supply of hardware, software and systematic consultancy. CO.ME.T.A. stands for Consulto Medico Tele Assistito (Tele Assisted Medical Consultation) and is a telemedicine scheme designed to develop the application of informatics technology in phases of diagnosis and the drawing up of reports. It may be defined as “long distance consultation”, whereby in real time a doctor (assisted) may submit the outcome of instrumental exams and other information gathered to a colleague (expert), who practises in a totally different locality - the aim being to exclude doubts or uncertainties in reference to the diagnosis in hand. To date, the experiments in teleconsultation in real time carried out by SCAI Servizi have touched upon echography during pregnancy, fetusplacenta flow, vascular echodoppler and capillaroscopy. Other imminent fields of application already under observation regard oncological echoflux diagnostics, diagnostic endoscopy, operative endoscopy, intervention radiology, echocardiogram etc. Everything, based on a single techological network, can be obtained by expanding the model conceived by Scai Servizi. Space and time will no longer be an obstacle for doctors and patients alike - in the future the whole health world will be on your doorstep thanks to digital channels. Information concerning case studies will be transmitted in real time from one health centre to another, giving rise to the sharing of experience and competence. This is the direction in which CO.ME.T.A. is heading - entrusting its success to cables and bit speed. CO.ME.T.A.
AIMS AND OBJECTIVES
The ability to elaborate diagnoses and reports by co-operating through multimedia workstations allows us to eliminate the long meanderings of exam documents as they travel from from one expert to another, with the implied waste of time and extenuating movements to and fro of the patient. The reports on instrumental exams obtained through teleconsultation or carried out autonomously are memorized in an electronic file which is completed with all the necessary information on the patient. Using an internal telematic network, it is possible to consult/update the data of a specific patient by accumulating details from all the hospital departments without having to transfer documents on paper. The medical team has, therefore, got at its disposal better potential and flexibility. The memorizing of reports as text, video and audio information coming from the consultation contributes, moreover, to the growth of a knowledge database, which will be made available to linked bodies, the aim being both to utilize examples for teaching purposes and to compare the case in question with other cases that might present analogies.
FUNCTIONAL STRUCTURE OF CO.ME.T.A
The functional structure of CO.ME.T.A. may be broken down as follows:
1. Teleconsultation system
2. Multimedia management system
3. Knowledge base management system
1) Teleconsultation system This is the sector which exploits to the full the wide range telematics infrastructure and the connection with diagnostics equipment (echodoppler, fluxometer etc.) This is how it functions:
It shares in real time the diagnostics information by way of the telematic transmision of dynamic and still images as well as audio? It processes interactivity between the two specialists (assisted and expert) through videoconference, file transfer of any “object”, editor sharing of text and of patient's file, to supply the expert with a complete picture of the situation and of applications of hospital Information System
It processes interaction between diagnostics equipment and the teleconsultation system;
It offers the opportunity to activate teaching sessions or comparisons in real time on cases of particular interest in linkup with university bodies;
The Expert station comprises a personal computer equipped solely with a video conference system - clearly in a more complete vision of the system one envisages a multidiscipline station which all the assisted may be linked to, no matter what their specialization might be. Different specialists may use the station to communicate with each other, considering their particular demands or time schedules;
2) Multimedia management system
This is the integral modular system for multimedia management of the patients' clinical files. Both traditional data and multimedia data are managed in video and audio form. The main functions permit the following:
control of the patient's file from any locality with different levels of access for consultation, updating, etc.;
automatic acquisition of the diagnostics information obtained during the instrumental exam and memorizing of the same in the patient's file;
statistical research on existing data;
interaction with the hospital Information System;
registration of the reports drawn up with dictation systems;
integration of information deriving from teleconsultation; · safety and confidentiality through a system of authorization levels.
3) Knowledge base management system
As a follow up to cases examined in teleconsultation or autonomously a knowledge base is fully developed, the aim of which is to supply a consultation instrument in order to increase know-how in various specializations. The same knowledge base may, moreover, be exploited during seminars, where specific cases are presented, or during courses for ordinary students and/or students on practice.
TECHNOLOGICAL STRUCTURE
The system is characterized by a group of graphic and management functions and is positioned like a wedge designed to manage sequences of images, either moving or still, with or without sound, coming from subordinate specialist systems in the scope of a structural model in which there are one or more integral elements, along with others converging on integration. (see “GRAPHICS I”) The technological structure is based on client/server systems whch make use of the standard hardware and software on the market. It is, moreover, necessary to consider that the evolving tendency of methods of how to treat medical images is moving away from still images with consolidated procedures towards a study, with ever increasing interest, of video sequences reproducing anatometabolic activities. The technical requirements for the transfer of this type of information are embodied in the prerequisite of a network of transmissive techniques guaranteeing results in real time, even during a period of heavy traffic. (see“GRAPHICS II”)
THE STATE OF THE ART
The evolution of Information Technology continually offers new opportunities for experimenting in the field of medicine. Much of this experimenting is limited to a single specialization and in few cases the wide range environment is not exploited. Teleconsultation very rarely happens in real time; normally radiographic, or at any rate still, images are treated. The Internet is beginning to be used to present recordings of the cases on which specialists will afterwards be called upon to supply their opinions. Among the various experiences the most significant are:
TELEMEDICINA IN TOSCANA - Experimenting on MAN di Telediagnosi for emergency and urgency, mutual exchanges between clinical and diagnostics environments;
VETERANS HEALTH ADMIN.(USA) - Federal co-ordination of initiatives in telemedicine;
ISTITUTO CLINICO HUMANITAS (MI) - Multimedia clinical files;
ISTITUTO DI RICERCHE FARMACOLOGICHE “M. NEGRI” - The Internet in cardiology, teleconsultation and teledidactics, catalogues of medical resources,
OXFORD UNIVERSITY (UK) - Experimenting in telepathology;
SCIVAC - Consultation and memorizing of clinical cases by way of the Internet, teleconsultation by use of recordings (veterinary field).
OPPORTUNITIES AND LINKS
If we consider applicability and difficulties in the introduction of teleconsultation, there emerge the questions of the number of aims it may be used for, the degree of working efficiency and the economic side. As to “Organization improvement”, it is simplification itself, since it is no longer necessary to set up costly transport to minimize risk to patients. It is sufficient to reserve and equip a zone in the department or at the service of more than one department. Regarding “Usabilitity” in general and “Didactics” in particular, the widespread use on the market by Pc and Windows based applications bear witness to how easy to employ the system is. Finally, if the “economic viability” factor of the system is to be considered, it is fitting to highlight that if the effectiveness of teleconsultation is easy to imagine but more difficult to measure, it is, however, much easier to determine the economic return if it is considered that to equip a medical-diagnostics zone with teleconsultation entails an investment factor lower than at least one with regard to an echograph or an echodoppler. Using teleconsultation means reducing a phenomenon which traditionally employs ambulances, doctors and nurses for hours to a few minutes of telematic connection.