The beginnings of telemedicine in The beginnings of telemedicine in Kujawy-Pomerania ProvinceKujawy-Pomerania Province

Grzegorz GrześkGrzegorz Grześk

the Department of Cardiology and Internal Medicine of the Collegium Medicum at the

Nicolaus Copernicus University in Bydgoszcz

Mortality in myocarditis – without pharmacological/invasive reperfusion

Mortality in myocarditis – pharmacological treatment

PCI (angioplasty)

DES

Mortality in myocarditis –interventional treatment

Treatment results of the patients with severe heart attack – what do they depend on?

1. An effective method leading to reperfusion

2.2. The amount of time between the The amount of time between the beginning of pain and reperfusionbeginning of pain and reperfusion

The influence of time between symptoms and intervention on the mortality

0 4 8 12 24

Time [h] between the first symptoms and reperfusion

Red

uctio

n of

mor

talit

y [%

]

0

4

0

6

0

80

1

00

Telemedicine Technical requirements depend on the type

of data which is being send: numbers medical, imaging and health informatics data

images films

on-line transmissions

Telemedicine Text data transmission:

patient’s characteristic interview physical examination lab test results imaging descriptions

Image transmission dermatology psychiatry anatomical pathology surgery gastroenterology

Videoconferences Possible compression of the image Session protocole ITU-T H.323 Transmission bandwidth 128 – 256 kb/s

ISDN or IP

Polycom ViewStation H.323 independent transceiver station

Videoconferences Possible compression of the image Session protocole ITU-T H.323 Transmission bandwidth 128 – 256 kb/s

ISDN lub IP

Polycom ViewStation FX H.323 independent transceiver station

INNOVATIME INNOVATIME PROJECT FOR THE PROJECT FOR THE REGIONREGION

PLANNED STAGES OF THE PLANNED STAGES OF THE NETWORK REALIZATION:NETWORK REALIZATION:

STAGE I STAGE I (2003)(2003) launching the first network launching the first network (3 districts: Bydgoszcz-Toruń-Włocławek)(3 districts: Bydgoszcz-Toruń-Włocławek) STAGE II STAGE II (2004)(2004) launching the network launching the network in five new districtsin five new districts STARE IIISTARE III (2005)(2005) - 13 districts - 13 districts STAGE IVSTAGE IV (2006)(2006) - 19 districts - 19 districts

TUCHOLA

SĘPÓLNOKRAJEŃSKIE

NAKŁO

ŚWIECIE

CHEŁMNO

BRODNICA

RYPIN

LIPNO

GOLUB-DOBRZYŃ

WĄBRZEŻNO

ŹNININOWROCŁAW

MOGILNO

ALEKSANDRÓWKUJAWSKI

RADZIEJÓW

TORUŃ

Treatment results of the patients with severe heart attack – what do they depend on?

1. An effective method leading to reperfusion

2.2. The amount of time between the The amount of time between the beginning of pain and reperfusion beginning of pain and reperfusion

Telemedice in cardiology

Goals: Conducting remote consultations concerning cardiac

surgery and invasive cardiology

Shortening of the the waiting time for the therapy, which depends on suitable, highly-specialised qualification

Conducting trainings and showcase procedures in form of teleconferences

Telekardiologia „Telecardiology” system contains three

modules:

Tele-ECG system Cardiovascular consultation system The system of individual supervision over high-

risk patients

Tele-ECG

The aim is to shorten the time between the diagnosis of Acute Coronary Syndromes and implementing treatment in invasive cardiovascular laboratory on round-the-

clock duty.

Tele-ECG

Tele-ECG

Tele-ECG

Tele-ECG

The first transmission which used the system of telecardiology was done on

December 5, 2003in Kujawy-Pomerania Province, in the Department of Cardiology and Internal Medicine of the Collegium Medicum in

Bydgoszcz.

Tele-ECG Sender:

ECG EHO8 4-channel record: leads I,

II, III, aVL, aVR, aVF and two chosen between V1-V6

Nokia 6310i cellphone (GPRS data transmission)

Receiver: Workstation (Pentium 4, 3

GHz, FSB 800MHz, chipset i875, RAM 1GB, HDD SATA RAID 2x120GB)

Modem GSM Siemens MC35T

First device platform, currently not in use.

Record with limited number of leads No preview Lack of information about the localization of

electrodes – stipulated system of recording

Tele-ECG system’s deficienscies

A change of the systems’ application

The use of GSM network allows the transmission of the records from12-leads ECG LifePack defibrillators included in the ambulance equipment to the centre - the Department of Cardiology and Internal Medicine of the Collegium Medicum in Bydgoszcz.

On the basis of the ECG records, patients are qualified for further procedures: observation conservative treatment invasive diagnostics

District hospital

conservative treatment PCI CABG

Information transmitted to the LIFERNET RS station available for doctors:

Diagnostic 12-leads ECG procedure, ECG graph paper representing the measured parameters (every 30 sec.: ST wave, pulse frequency, Sp02, CO2, BP, event and patient data (sex, age, name, ID – e.g. PESEL number).

You can also transmit: continuous ECG graph paper from one lead (max. back to 45 minutes), the register and the description of the events, containing the ECG progress, sound.

The rescue team is identified with the name and the telephone number.

LIFENET

The procedure for a LIFENET RS user:the Department of Cardiology and Internal Medicine of the Collegium Medicumin Bydgoszcz

• Constant monitoring – the station is used specifically for receiving data from the defibrillator/monitor

• Sound and visual alarm is a signal for receiving data and assesing their correctness• Automatic retransmission to the program – database – CODE-STAT SUITE • Automatic printout of the diagnostic ECG procedure• Calling in the SOAD• Calling the ambulance team to arrange further proceeding• Preparation for the PTCA7. Receiving the patient directly from the ambulance

LIFENET

Tele-ECG After the opening of the centre, which

coordinates Acute Coronary Syndromes treatment, based on LifeNet system, 1731 ECG records have been sent for interpretation between 2005 and 15.05.2007.

Tele-ECG Number of ambulances: 52

Number of transmissions: 2005: 401401 2006: 964964 2007: 386386

TOTAL: 17311731

Tele-ECG Population (GUS 24.06 2004): 2 067 548

Number of transmissions per 100 000 people:

83(period between May 2005 – May 2007)

Tele-EKG Districts with most transmissions per 100 000

people:

Żniński – 369 Tucholski – 362

Time between the beginning of pain and the intervention < 4 hours

42%

44%

46%

48%

50%

52%

54%

K-P PL

53%

46%46%

Teleconsultation in cardiovascular surgery

The aim is to speed up the process of consultation with a cardiac surgeon regarding a patient who already had a coronary angiogram

to qualify the patient for further treatment.

Teleconsultation in cardiovascular surgery

LAN, MAN, WAN

TCP/IP

Teleconsultation – a schematic Teleconsultation – a schematic diagramdiagram

Bydgoszcz

Toruń

Włocławek

Reference lab

Cardiac surgery clinic

serwer

LAN (100-1000 MB/s)MAN, WAN

DICOM 3.0

DICOM 3.0

DICOM 3.0

DICO

M 3

.0DICOM 3.0, AVI

DICOM 3.0, AVI

The system of individual supervision over high-risk patients

The aim of the project:The aim of the project: creating opportunities for electrocardiographic monitoring of patients belonging to risk groups for life-threatening arrhythmias, as well as patients after implantation of stimulating systems or cardioverter-defibrillators.

Monitoring is carried out in the patient’s environment to assess the quantitative and qualitative abnormality of the heart rhythm, then qualify the patient for the proper treatment and to evaluate the treatment’s effectiveness.

The system also allows to evaluate the function of implantable devices and to capture early any possible anomalies of their actions.

PCIPCI Ambulatory careAmbulatory care

pharmacotherapharmacotherapypy

The optimalization of the therapeutic The optimalization of the therapeutic process is applicable for all the process is applicable for all the elements of proceeding.elements of proceeding.

In addition to educational applications,

telemedicine is perfect for wherever the matter of time significantly affects the effectiveness of the

therapy.

telemedicinetelemedicine

Thank you for Thank you for your your

attention!attention!