MEI 2012 Thessaloniki - HELLAS

1. MEI 2012 Thessaloniki - HELLAS

2. Ιδανικό...

3. Πραγματικό...

4. Operational problems in “Intensive Care” Multiple & complex problems Decisions must be taken immediately Integration based on local experience Patients’ history unknown Several inputs from different devices Data stored in different locations Remote retrieval impossible

5. TRENDS IN TOTAL NUMBER OFHOSPITAL VS ICU BEDS ICU BEDS HOSPITAL BEDS

6. Institute of Medicine (IOM): Patient safety is “indistinguishable from the delivery of quality health care” Harteloh PPM(Health Care Analysis. 2003;11(3):259–67) “Quality [is] an optimal balance between possibilities realized and a framework of norms and values.”

7. Why do we need e-Learning / telemedicine in the ICU environment? • Informed decision – EBM practice • Emergency teleconsultationand patient’s triage in remotely located ICU’s • Home care / rehabilitation • Patients’ safety control – regular external audit • Second opinion in difficult cases from remotely located experts • Training in ICM

8. Interactive tele-education session between IsMeTT (Palermo) and UCY (Cyprus)

9. Interactive multipoint tele-consultation during laparoscopy (OP 2000 (Berlin), FMPC (Casablanca), CICE (Clermont-Ferrand)

11. Tele-consultation between OP 2000 (Berlin), ANDS (Algiers) and IsMeTT (Palermo)

12. Κέντρο eICU

14. Cyprus ICU pilot Network Installation sites in Cyprus

15. Satellite terminal at the NGH

17. Project Scenarios (cont.) Medical teletrainingsession

18. Όχι μόνο για παιχνίδια…

19. The kinect sensor

20. Αποκατάσταση με εξοπλισμό ιδεατής πραγματικότητας

21. Ιπποκράτειο ρητό“Ὁ μὲν βίος βραχύς, ἡ δὲ τέχνη μακρή, ὁ δὲκαιρὸςὀξύς, ἡ δὲπεῖρα σφαλερή, ἡ δὲ κρίσις χαλεπή …”Ιπποκράτους αφορισμοί 1.1« … Life is short, [the] art long, opportunity fleeting, experience misleading and judgment difficult.…»Hippocrates, Aphorism 1.1

22. My students are dismayed when I say to them:“Half of what you are taught as medical students will in 10 years have been shown to be wrong. And the trouble is, none of your teachers know which half”Dr Sydney BurwellDean of Harvard Medical School

23. Percentage of current EB knowledge known to physicians after medical school graduation p<0.001 % 35% 15 years years from graduation Shin et al CMEJ 1993

24. ACP Journal Club NEJM, Ann Intern Med JAMA, Arch Intern Med, Circulation, Lancet, Am J Med, BMJ, J Intern Med

25. Technologies needed • Electronic patient record with bio-signals store • Data from home care • Database and statistical analysis of data • Electronic syllabus / curriculum • Repository of educational material (PACT) • Virtual patients bank / simulation • A platform that integrates all

26. Μητρώο σε χαρτί στη ΜΕΘ

27. Δωμάτιο ΜΕΘ με σταθμό εργασίας ΚΠΣ

28. Σταθμός εργασίας ΚΠΣ

31. Παράδειγμα βιοσήματος σε κλινικό δεδομένο Παρακολούθηση του καρδιογραφήματος από συσκευή παρακολούθησης βιοσημάτων

32. Technologies needed • Electronic patient record with bio-signals store • Data from home care • Database and statistical analysis of data • Electronic syllabus / curriculum • Repository of educational material (PACT) • Virtual patients bank / simulation • A platform that integrates all

33. ΠΙΛΟΤΙΚΗ ΥΠΟΔΟΜΗ ΤΗΛΕΪΑΤΡΙΚΗΣΜΕΤΑΦΟΡΑ ΔΕΔΟΜΕΝΩΝ

34. Φορητή συσκευή καταγραφής βιοσημάτων για το έργο Τηλε-Ιπποκράτης

35. Περιβάλλον διάδρασης ιατρού

36. Technologies needed • Electronic patient record with bio-signals store • Data from home care • Database and statistical analysis of data • Electronic syllabus / curriculum • Repository of educational material (PACT) • Virtual patients bank / simulation • A platform that integrates all

37. PROSAFE Consortium GiViTI (Italian Group for the Evaluation of Interventions in Intensive Care Medicine) “Mario Negri” Institute, Italy Nicosia General Hospital, Cyprus Semmelweis University, Hungary Intensive Care Forum NGO, Cyprus Warsaw Medical University, Poland Friedrich-Schiller-Universitat Jena, Germany UCL Center for Intensive Care Medicine & Bloomsbury Institute of Intensive Care Medicine, UnitedKigdom General hospital Novo Mesto, Slovenia

38. server CC Proxy: machine with a specific address that grants a safe internet access using a trusted networking with autentication. If the proxy exist, softwares(like browser) must know its address and autentication credentials client master internet Prosafe tries to guess the system proxy settings. If it is not able to get settings, you will be able to set them. master

40. ICU n. 57 Calibration curve observed mortality expected mortality

41. VLAD: Variable life-adjusted plot patient 2 expected mortality = 46.4% FAILURE: 53.6 outcome = died patient 3 expected mortality = 16.8% SUCCESS: 16.8 outcome = alive patient 4 expected mortality = 95.1% FAILURE: 4.9 outcome = died expected mortality= 6.5% SUCCESS:6.50 patient 1 outcome = alive 0.20 0.10 0 patients 1 2 6 3 4 5 -0.10 -0.20 -0.30 -0.40 -0.50

42. ICU n. 57 if I would have performed as the previous year, how many death would I have observed? 79/291 vs. 92/291 13more deaths (95% CI: 5 – 21)

43. Technologies needed • Electronic patient record with bio-signals store • Data from home care • Database and statistical analysis of data • Electronic syllabus / curriculum • Repository of educational material (PACT) • Virtual patients bank / simulation • A platform that integrates all

44. Competency-Based Training in Intensive CareMedicinein Europe

45. Methodology Phase 1 survey on national methods of training, assessment and accreditation Phase 2 identification of competencies and classification Phase 3 development of guidelines for the assessment of these competencies Phase 4 Identification of training material and link between the competencies and material

48. Technologies needed • Electronic patient record with bio-signals store • Data from home care • Database and statistical analysis of data • Electronic syllabus / curriculum • Repository of educational material (PACT) http://pact.esicm.org • Virtual patients bank / simulation • A platform that integrates all

50. http://teleprometheus.ouc.ac.cy