- 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.
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