telemedicine project analysis
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TELEMEDICINETELEMEDICINE
DIGITAL MULTIMEDIADIGITAL MULTIMEDIA
ARCHIVINGARCHIVING
andandELECTRONIC PATIENTELECTRONIC PATIENT
RECORDRECORD
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TELEMEDICINETELEMEDICINE
Application of telecommunicationApplication of telecommunication
technology to the practice of medicinetechnology to the practice of medicine
Commonly used to define interactiveCommonly used to define interactive
medical multimediamedical multimedia
Better manage patients by having moreBetter manage patients by having more
complete informationcomplete information
Dynamic imaging with full motionDynamic imaging with full motionvideo/audiovideo/audio
( interactive = real( interactive = real--time )time )
( store and forward = video E( store and forward = video E--mail )mail )
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HISTORY
Initial developments in late 1950s:Initial developments in late 1950s:
Dr. Cecil Wittson in Omaha, NebraskaDr. Cecil Wittson in Omaha, Nebraskadeveloped an extensive telepsychiatrydeveloped an extensive telepsychiatry
programprogram
Dr. Albert Jutras in Montreal, QuebecDr. Albert Jutras in Montreal, Quebec
developed an interdeveloped an inter--facility teleradiologyfacility teleradiologyprogramprogram
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HISTORY
Subsequent programs in NorthSubsequent programs in North
America established with federalAmerica established with federalgrants and most utilized satellitegrants and most utilized satellite
uplinksuplinks
By the late 1970s, none could sustainBy the late 1970s, none could sustain
themselvesthemselves
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HISTORY
Reawakening of interest in the lateReawakening of interest in the late
1980s:1980s: decreased cost of landdecreased cost of land--basedbased
telecommunicationstelecommunications
CODECsCODECs
improved inexpensive computersimproved inexpensive computers
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HISTORY
19891989 -- 3 interactive3 interactive--video telemedicinevideo telemedicine
programsprograms19931993 -- 10 interactive10 interactive--video programvideo program
19941994 -- 20 programs20 programs
19951995 -- almost 40 programs in variousalmost 40 programs in variousstages of discussion/implementationstages of discussion/implementation
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EUROPEAN COMMUNITY
PROJECTS
AIMAIM / /EuriPACSEuriPACS
SMZOSMZO -- 400400 --bed geriatric hospital, 1000bed geriatric hospital, 1000--bed acute care hospital, geriatric center, andbed acute care hospital, geriatric center, and
a nursing collegea nursing college
COVIRACOVIRA -- integration of CT, MRI/MRA,integration of CT, MRI/MRA,
DSA, PET, and other modalitiesDSA, PET, and other modalitiesFESTFEST -- telemedicine integrationtelemedicine integration
frameworkframework
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EUROPEAN COMMUNITY
PROJECTS
GEHRGEHR -- define requirements for a standarddefine requirements for a standard
health record architecturehealth record architecture
MILORDMILORD-- integrated departmentalintegrated departmental
environment using objectenvironment using object--oriented model tooriented model to
implement a true multimedia environmentimplement a true multimedia environment
SAMMIESAMMIE-- software for an integratedsoftware for an integratedmedical workstationmedical workstation
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EUROPEAN COMMUNITY
PROJECTS
SEISMEDSEISMED -- guidance on security matters nguidance on security matters n
CEC DGXIII/F publication (ITSSEC)CEC DGXIII/F publication (ITSSEC)
DIOGENEIIDIOGENEII-- distributed HIS integrateddistributed HIS integrated
with PACS and RISwith PACS and RIS
RACE/TELEMEDRACE/TELEMED -- working groupworking group
IMPHONEIMPHONE-- investigation of hospitalinvestigation of hospitalcommunication needs and functionalitycommunication needs and functionality
needs in workstationneeds in workstation
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PROJECTSWITHIN THE
UNITED STATESTEXAS TELEMEDICAL PROJECTTEXAS TELEMEDICAL PROJECT
MAYO CLI
NI
CMAYO CLI
NI
CKANSAS / OKLAHOMA / IOWAKANSAS / OKLAHOMA / IOWA
MCGMCG
MilitaryMilitary
Over 20 interactive video project inOver 20 interactive video project in
telemedicinetelemedicine
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MAJORPROBLEMS FACINGMAJORPROBLEMS FACING
TELEMEDICINETELEMEDICINE
1) Mistrust and miscommunication1) Mistrust and miscommunication
2) Lack of consistent reliable managerial2) Lack of consistent reliable managerial
planplan
3) Lack of standards3) Lack of standards
4) Legal / confidentially issues4) Legal / confidentially issues
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MAJORPROBLEMS FACING
TELEMEDICINE (cont.)
5) Reliance on vendor claims
6) Poorly selected or overpriced
equipment
7) Continued reliance on federaland state grants
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MAJOROPPORTUNITIESWITH
TELEMEDICINEClinical Consultations to provide access toClinical Consultations to provide access to
cost effective Health Carecost effective Health Care
Medical Education in a real timeMedical Education in a real time
environmentenvironment
AdministrationAdministration
Financial with ability to drive down costsFinancial with ability to drive down costs
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TELEMEDICINETELEMEDICINE
DIGITAL ARCHIVINGDIGITAL ARCHIVING
ELECTRONIC PATIENTELECTRONIC PATIENT
RECORDRECORD
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ECH
TCHC
icesTCHC utreachClinics
Hospitals Serviced
Savannah
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Primary Impetus is to improve patient carePrimary Impetus is to improve patient care
Early intervention = early diagnosis =Early intervention = early diagnosis =shorter hospital stayshorter hospital stay
Improve utilization of resources:Improve utilization of resources:
Physician / technicianPhysician / technician
always accessible studies within thealways accessible studies within thesystem which by definition aresystem which by definition are
diagnostic qualitydiagnostic quality
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Initial thrust to transmit
ECHOCARDIOGRAMS in a real-time
interactive environment
Open platform / scaleable
DICOM / HL-7 compatible
Digital solution (becomes a link in a totalelectronic patient record)
Off-the-shelf solution
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Cost savings
Neonatal transport savings466 Neonatal transports via Angel
25% Approximate Cardiology referrals
$2,500 Average cost / transport
$292,000 Savings in Transport costs (ideal)$150-200kIncreased revenue to referral
hospital
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Cost savings
Physician Time
140 Average number of Remote
echocardiograms / month 1995
70 Echocardiograms which could be
performed with a telemedicine
application
2.33 Average number of
telemedicine episodes / day
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Cost savings (cont.)
4.0 Hours of underutilized physician
time / day
150k Average Cardiologist salary
30% Benefits for physician
$ 95 Value / hour physician time
$ 380 Savings / day physician time
$138,700 Cost savings / year in physician
time
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COMMUNICATIONCOMMUNICATION
HOSPITAL NETWORK DESIGNHOSPITAL NETWORK DESIGN EthernetEthernet 10 Mbits / sec10 Mbits / sec
FDDIFDDI 100 Mbits / sec100 Mbits / sec
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COMMUNICATIONCOMMUNICATION
TELECOMMUNICATIONTELECOMMUNICATION FIBEROPTIC CABLEFIBEROPTIC CABLE
TT--3 / T3 / T--11
ATM / SONETATM / SONET
ISDNISDN
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COMMUNICATIONCOMMUNICATION
TELECOMMUNICATIONTELECOMMUNICATION 64 K / 56 K64 K / 56 K
Twisted pairsTwisted pairs
CellularCellular Satellite ( SWAN )Satellite ( SWAN )
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WORKSTATION DESIGNWORKSTATION DESIGN
Essential part ofEssential part ofIMACS/PACSIMACS/PACS User friendlyUser friendly
Well developed management toolsWell developed management tools
High performance with sustainedHigh performance with sustainedthroughthrough--put and speedput and speed
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STORAGE MEDIASTORAGE MEDIA
Magnetic DiskMagnetic DiskJukeboxJukebox
Capacities in excess of 28 TbytesCapacities in excess of 28 Tbytes
Magnetic TapeMagnetic Tape
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STORAGE MEDIASTORAGE MEDIA
Optical DiskOptical Disk WORMWORM
MOMO
Optical TapeOptical Tape CDCD--ROMROM
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STORAGE AND
COMMUNICATIONSTANDARDS
1983 ACR1983 ACR--NEMA Digital Imaging And NEMA DigitalImaging And
Communications Standards CommitteeCommunications Standards Committee 1985 Standard 1.01985 Standard 1.0
1988 Standard 2.01988 Standard 2.0
1993 DICOM 3.0 ( ANSI )1993 DICOM 3.0 ( ANSI )
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SPECIFIC ISSUESTO
CARDIOLOGY
File formatFile format
Demographic dataDemographic data Administrative informationAdministrative information
Video imageVideo image
concurrent calibration information forconcurrent calibration information for
measurementmeasurement
raw dataraw data
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SPECIFIC ISSUESTO
CARDIOLOGY
Identify the endusersIdentify the endusers
general hospital communitygeneral hospital community rapid access to data via networkrapid access to data via network
easy integration with all areas/easy integration with all areas/
modalitiesmodalities
Clinical echocardiographerClinical echocardiographer
rapid access to current and all priorrapid access to current and all prior
studiesstudies
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STANDARDIZATION
Size of screen to archiveSize of screen to archive
512 x 512512 x 512 256 x 256256 x 256
further windowing to best utilizefurther windowing to best utilize
archive mediaarchive media
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STANDARDIZATION
CompressionCompression
manageable levels of compressionmanageable levels of compression Gold Standard is videotapeGold Standard is videotape
ratio 24:1ratio 24:1
a lack of clinically validated studiesa lack of clinically validated studies
existexist JPEG, MPEG, Wavelets, and othersJPEG, MPEG, Wavelets, and others
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TECHNOLOGY CAVEATSTECHNOLOGY CAVEATS
Adaptability to changeAdaptability to change
Open architectureOpen architectureScaleabilityScaleability
Ease of operationEase of operation
Minimal maintenance requirementsMinimal maintenance requirementsTechnologicalTechnological
compatibility/upgradeabilitycompatibility/upgradeability
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ApplicationsApplications-- matching technologymatching technology
with specific demands of specialtywith specific demands of specialty
(consumer driven)(consumer driven)ResearchResearch-- specifically in areas ofspecifically in areas of
standardizationstandardization
Standardsofcare/outcome analysisStandardsofcare/outcome analysis--evaluation of added value toevaluation of added value to
communitycommunity
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ReimbursementReimbursement
ImplementationImplementationConfidentialityConfidentiality-- software/hardwaresoftware/hardware
protocolsprotocols
Value/EconomicsValue/Economics-- identify as a valueidentify as a valueadded serviceadded service
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Educational valueEducational value- on-going
educational value/CME/interactiveeducational value/CME/interactive
surgical teachingsurgical teaching
CommunicationcostsCommunicationcosts-- flexibility offlexibility of
technology/new technologiestechnology/new technologies
Motivation for providers/patientsMotivation for providers/patients
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MEDICAL EDUCATIONMEDICAL EDUCATION
RESEARCHRESEARCH
VIRTUAL HOSPITALVIRTUAL HOSPITAL
VIRTUAL RESEARCH CONSORTIUMVIRTUAL RESEARCH CONSORTIUM
CLINICAL TRIALSCLINICAL TRIALSMAGNETMAGNET
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