telemedicine on the grid. cambridge escience centre
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Telemedicine on the Grid
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CeSC Location
CeSC is located in the new Centre for Mathematical Sciences on the West Cambridge site, with office space and conference room for AccessGrid.
Strong links with the Cambridge-Cranfield HPCFPostal address:
www.escience.cam.ac.uk
Cambridge eScience CentreCentre for Mathematical Sciences Wilberforce RoadCambridge CB3 0WA
Cambridge eScience
Cambridge eScience Centre
National Institute for Environmental eScience
Centre for Mathematical Sciences
Cambridge Computational Biology Institute
Cambridge eScienceCeSC Industrial Partners:
IBM, Sun Microsystems
Microsoft Research
Unilever, Siemens Medical Solutions
Macmillan Cancer Relief
BAE Systems, Rolls Royce
Cambridge Computational Biology
Institute• Link Cambridge expertise in medicine, biology,
mathematics and the physical sciences. • World centre that will develop new knowledge and its
application to health, quality of life and wealth creation.
• Research topics: New MPhil Course– basic genetics of bacteria– developmental biology– evolutionary biology– complex cell biology of human disease– systems biology.
• Multidisciplinary approach using advanced informatics techniques:
Seeking Cross-Research Council funding….
Background
• NHS Cancer Plan– Network– MDT Meetings– Specialisation– Data sets
• e-Government• e-Science
“Delivering public services in new and electronic ways to be more convenient, more joined-up, more responsive and more personalised:”
e-government
• building services around citizens’ choices• making Government and its services more
accessible• ensuring social inclusion• using information better
Existing Teleradiology
ISDN Workstation
CT ScannerCT Scanner
DICOM 3.0DICOM 3.0DICOM 3.0DICOM 3.0
Strongly authenticatedStrongly authenticatedconnections:connections:
CHAPCHAPCLICLI
Access listsAccess lists
Strongly authenticatedStrongly authenticatedconnections:connections:
CHAPCHAPCLICLI
Access listsAccess lists
128 kbps 128 kbps
ISDN RouterISDN Router
ISDN RouterISDN Router
Bandwidth limited: doctors travel to case conferences
The West Anglia Cancer Network
The West Anglia Cancer Network
• Cancer Centre– Addenbrooke’s/ Papworth
• Cancer Units– Bedford– Peterborough– West Suffolk– Harlow– Hinchingbrooke– King’s Lynn
RequirementsRequirements
• Multi-site videoconferencing
• Access to pathology & radiology images– Live microscopy– DICOM
• Access to remotely stored patient records through organisational LANs
The NHS Solution The NHS Solution
• Integrate existing commercial VVID system with medical needs– Low entry cost– Simple to operate– Integration with other network services, e.g. DICOM
• Generic solution for clinical collaboration– Advanced collaborative environment for teaching and
research• Initial aim was to roll-out across 8 WACN Hospitals in
year 3.• Key staff: Martin Graves, Radiology, PI/Kate Caldwell
CeSC
Technologies
• Videoconferencing/multimedia• Medical image transfer and archiving
– Digital Communication in Medicine (DICOM)
• Real-time microscopy imaging– PathMeeting (HTTP)
• Data mining– Legacy interfaces/XML
• Dedicated ISDN lines (pending NHSnet upgrade)
Funding
• Macmillan Cancer Relief– £70,000
• Siemens Medical Solutions– £145,000
• eScience funding– £171,974
• NHS Trusts - each has invested in its own dedicated room, now used for MDTs, management, teaching etc. (Typically £40-50,000 per trust).
Telemedicine Project Objectives
• Year 1– Installation of an appropriate voice, video and data
hardware and software demonstrator in a sub-set of WACN hospital sites, using the best available network connectivity.
– Train NHS staff in the effective use of the system.– Produce a detailed specification of NHS needs (data
formats, user interfaces and security requirements).– Prototype the CeSC facilities for medical VVID services
using experience gained from the demonstrator.– Develop additional code, compatible with the Grid Core
Program software kit, to ensure secure VVID services over the Grid.
Telemedicine Project Objectives
• Year 2– Integrate remote visualisation of volumetric medical
image data into the system.– Customise the system with NHS-specific
requirements based upon the demonstrator and the prototype CeSC system into a package suitable for deployment within the entire WACN.
– Integrate demonstrator hardware and software with system
Year 3 Full implementation and evaluation of the NHS
specific system across the eight WACN sites.
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The Reality!The Reality!
Live MDT in progress
Goals met in 18 months
Progress • Telemedicine has been adopted by most
cancer MDTs in Cambridge, and is also used for training, management and general communications by the participating trusts.
• Telemedicine has been rolled out to 5 other Cancer Networks, and a National Programme is under discussion.
• Telemedicine is proposed for use in CancerGrid, for running clinical trials, as part as a broader data management project.
• Collaboration with Australia to exchange expertise.
Lessons from our experience
• Problems are not as expected– NOT security (use encryption, control access to
MDT sessions)– NOT technology (NHS is far behind the cutting edge
of IT - needs simple, reliable, effective tools)– NOT ethics (no example so far of any ethical/patient
problems)
• Some problems are obvious, with easy solutions– Bandwidth on NHSnet was inadequate - implement
private ISDN lines to demonstrate system. Migrate with NHSnet upgrades.
• Peer review system can miss real issues - reviewers taken from bleeding edge advocates, rather than practitioners?
…more lessons…• Problems are sociological and organisational
– NHS personnel are heavily loaded and underfunded– Resistance to shiny new technological fixes– Resistance to imposed external “expertise”– NHS IT has high level of security paranoia
• Need to engage community from outset with sensible/sensitive project leads (Martin Graves/Kate Caldwell)
• Launch with simple, effective solution to real problem
• Build on success to more ambitious solutions, with community push
• Funding agencies create obstacles to incremental rather than revolutionary solutions.
Future work
• Further develop use of the system by extra users• Implement telemedicine for National Radiology
Academies• Set up demonstrator for Paediatric Intensive Care
• Aim to exploit developments of PACS to use more volume visualization data
• Also develop solutions for Telepathology• Leading role in roll-out of solutions across the NHS
Volume Visualisation
Very high quality data now available, not fully exploited
Telepathology
Digital archiving and curation can help with diagnosis, treatment, research and teaching.
Conclusions• Telemedicine has proved itself to be highly
popular with NHS clinicians• Now an everyday part of working practice in East
Anglia• Increasing takeup nationwide
• New opportunities with the NHS IT programme investment….
• …but risk of “management paralysis” when chronic underfunding meets sudden investment…
• …existing NHS projects will need careful nurturing!