INTRAMED: Medical Network in International cooperation of Italy

1. INTRAMED: Medical Network in International cooperation of Italy Prof. F. Sicurello President of @ITIM Italian Association of Telemedicene and Medical Informatics

2. Medicine challenges “Health is far too important a subject to be left in the hands of the medical professionals!!!”(Dr. Halfdam Malher, WHO) • Increase of elderly people • Cronical diseases • Cardiovascular diseases • Cancer • Neuropathologies • Infectious diseases • Genetic causes of diseases • Diseases prevention (epidemiology) • Rehabilitation • Home care assistance • Citizens/patients ask for more information

3. Needs of health assistance and biomedical research • Circulation of knowledge, information and data with the aim of achieving productivity management control and of maintaining high standards of healthcare; • Population ageing with leads to demand for continuous treatment and care improving quality; • Globalization of health, seems as market and demands of ever more qualified health services.

4. Change of Paradigm • Cost containment • Changing demographies • Peripheralization of Health care delivery • Changing disease patterns • Impact of ICT in supporting clinical decisions • More informed and expectant patients • Well-being factor (wellness paradigm ) • Moving information and knowledge • Creation of health network

5. Challenges of healthcare providers (public and/or private) • To improve quality and treatment and care of patient and of life of the citizens. • To reduce costs (expenditure control). • To use advanced diagnostic and therapeutical technologies (CT,MRI, etc.) for a large number of patients/citizens. ICT and Telemedicine can contribute to win this challenges: • Improving level of health maintainance. • Reducing costs.

6. ICT in health care delivery Growing • Globalisation • Health care economics • Patient process • Medical profession • New technologies (mobile videophone, mobile networks) 2000 2005

7. e-Health 3rd industrial pillar for health • Pharmaceutical (7% of HC expenditures) from XIXth century • Medical imaging (3%) from XXth century • e-Health (2% estimated 5% by 2010) from XXIth century

8. Intra/Extranet in medicine • Diffusion of Internet services in healthcare; • Building of web sites and portals in medicine fields; • To share and to access to clinical information (protocols of care, guidelines, etc.); • Teleconsulting and telediagnosis in peripherical health structures and also at home.

9. Telemedicine services: • Teleconsulting (clinicians clinicians) • Telediagnosis (clinicians phisicians) • Telemonitoring (clinical centers patients) • Telesurveillance[i.e. home telecare] (health structure patients) • Tele-emergency(first aid centers health operators ambulances patients)

10. Italian Health System Now entirely decentralized • Health policy & management under government of Regions; • Regional Information System: - for developing health informatics & telemedicine, - and involving:Hospitals, Health Districts and GPs

11. TELEMED Program: • Radiological teleconsulting • Network of eccellence Hospitals (i.e. oncological centers) • Telecardiology • Teletraining Results: • HW/SW prototipes in radiological, cardiological and oncological fields Future: • to pass from experimentation to application activities on telemedicine; • to define DRGs in telemedicine; • to develop training activities for doctors, health operators, etc.

12. Some e-health and Telemedicine applications in Italy

13. Some e-health and Telemedicine applications in Italy

14. Telemedicine in the frame of International Scientific Cooperation of Italy The Italian initiatives want to favourite: • distance consultations, diagnosis and advice for treatment by medical specialists practising in a national regional or international hospital centre for referrals; • opening up new methods of education and training. Rural health-care staff can have regular access to lessons given by specialists in hospitals (e.g. on the management of common and special diseases); • improvement in qualification of national specialists and health technicians, by providing access to international medical databases; • increasing effectiveness and efficiency, for example in reducing waiting times for consultations, and in introducing medical information systems.

15. Bilateral cooperation in Telemedicine and Health Informatics between Italy and: • Egypt • Romania • Hungary • Greece • Croatia • Poland • Slovenia • Bulgaria • Albania • Ukraine • Bolivia • Australia

16. Actors of cooperation: • Research Institutes and hospitals; • Health care administration; • Individual doctors/researchers in biomedicine.

17. Aims of cooperation: • Multi-country training in public health; • Creation of specialized regional databases; • Organization of epidemiological surveillance groups; • Implementation of computerized solutions for telediagnosis; • Coordination of policies in the treatment of major diseases.

18. Some Projects In the frame of Scientific/Technological Cooperation • e-Health project in the frame of VI° F.P. (neuroweb netcard ecc.) • Health cooperating Network for Telemedicine between some Eastern Europe Countries. • Med.Net.med: The Euro Mediterranean Medical Network (Egypt).

19. A European Project: NEUROWEB Partner • National Neurological Institute “Carlo Besta” – Milan (Italy) • National Research Council – Institute of Biomedical Technologies – Milan (Italy) • Università degli Studi di Milano – Bicocca (Italy) • Lombardia Region – General Health Directorate (Italy) • Erasmus MC – University Medical Center - Rotterdam (The Netherlands) • Technological Educational Institution of Athens (Greece) • Medical School of Patras, University (Greece) • National Stroke Centre, National Institute of Psychiatry and Neurology – Budapest (Hungary) • Veszprem University – Veszprem (Hungary) • @ITIM - Italian Association of Telemedicine and Medical Informatics • SIRSENET S.p.a. (Italy) • Microsystems S.r.l. (Italy) • Velti S.a.

20. Aims of the Project Developing of web portal in Neurosciences, making telemedicine services. Web portal features: • knowledge base for patient care in neurology • knowledge base for neurosciences research • knowledge base for information transfer to non specialized audience • management systems for medical imaging database • teleconsulting/telediagnosis in neurology

21. Expected results • A propotype: • dedicated to neurosciences (clinical and research aspects), • tested and validated by neurology experts (doctors and researchers), • configurable, • easy to update, • publicly accessible through Internet, • exportable to different sectors

22. Information and knowledge(Various and increasing) • Clinical Data • Epidemiological indicators • Genomic data • ontological relations • medical literature • standard guidelines • diagnostic and therapeutical protocols. • …..

23. Integration • Within Bio-Medical patient records related to neurological diseases Integration of: • Anamnestic Data (textual) • Objective Data • Lab Data (signals, images, etc.) • Genomic data • Therapeutical data • Epidemiological data Images (i.e. CT) are important investigation of ischemical cerebrovascular ESSENTIAL DATA SET OF CLINICAL DATA BASE

24. Integration • Between Clinical databases of four Neurological Centers • Harmonization of information systems • Interoperability of clinical protocols derived from similar guidelines used • With • Medical Knowledge Bases (rules, classes, etc.) of diseases, epidemiological data, etc.

25. Logical Architecture/1 Web Service Interface (for Navigation and Query on Relations between tests/diagnosis/outcome) VPN Connection • Clinical DB • Images DB • DT Protocols • Ontologies • Epidemiological Registers Internet Connection • SQL (DBMS) • Statistical Packcage • Neural Network SW • Data Miner • Text explorer • Search explorer • .KB MS • Genomic Spider • GL Searcher • Databanks • Literature • Genomics Data • Guidelines • ... • Knoledg Base (Cerebrovascular Diseases, Diabetes, ecc) • Otologies • Epidemiological Data

26. GenomicDB CLINICALDB GenomicDB CLINICALDB Acq.ti GenomicDB CLINICALDB GenomicDB CLINICALDB Knoledg Base Acq.ti DeGeLLIBRARY Knoledg Base MAPPING TOOL Computational Services MEDIATOR GENOMICDATA BANK GENOMICENGINE API GLSEARCHENGINE Intelligent Visualization explorer (Query on KBi, DBJ, COMPk) Protocol & GL appliccation @ITIM - Italian Association of Telemedicine and Medical informatichs

27. T-CARE: AN INTEGRATED SYSTEM TO ASSIST ELDERLY PEOPLE AT HOME • OBJECTIVES: • The aim of this system is to extend the time during which elderly people can live independently in their preferred environment with the support of ICTs.” • T-Care is an innovative integrated system, (TV + Biomedical devices) favouring the independent living of the disable and elderly people, especially those suffering with chronic diseases, ensuring them timely health assistance, alert and education for life styles.

28. Activities and Results • Monitoring clinical parameters • Improving quality of life • Permitting daily independence living • Increasing the performances of the social health system • Minimising social health costs. T-Care system permit a synergic action between the digital TV service and the health monitoring function since the TV can support the elderly with on-line instructions for the use of the biomedical equipment, advise on the circumstances when to use it.

29. Tools of the multifunctional system • Digital TV • STB • Interactive communication channel • Intelligent terminal • Controller of home functions • Visual communicator • Biomedical devices (for support to health care) • Smart Card • Wi-Fi Connection

31. The Euro Mediterranean Medical Network Web based to access clinical database and for teleconsulting/telediagnosis. • Project provides integration among services already available to the local communities or extended to a wider geographical area. • The Portal will provide the access to clinical information and processing in the health services for clinical activity to users (doctor, radiologists, etc.) and the clinical activity of teleconsulting and telediagnosis. • It will also offer the opportunity to integrate and coordinate methods of care and diagnostic/therapeutical protocols.

33. Telemedicine Project: Italy (Palermo) – Egypt (Cairo)

34. PORTAL

35. PORTAL TelePathology Section: patient’s clinical data and pictures slides

36. Interhospital Teleconsulting System, in the frame of the Scientific and Technological Cooperation Protocol between Italy and Romania Hospitals involved: SPECIALITIES

38. ROMANIA HOSPITALS ITALIAN HOSPITALs SERVER FARM DATA REPOSITORY ITALIAN UNIVERSITY SERVICE MANAGER ROMANIA UNIVERSITY SERVICE MANAGER Network

39. HARDWARE • Digital Camera • Video Camera • PC Client for User • PC for Web Server System • Networking

40. SOFTWARE CLINICAL IMAGE INTEGRA • DICOM PLATFORM • Sharing Image • Send data • Video Conference / second opinion

41. International Institute of Tele-Medicine telemedicine EMMIT 2007 EURO-MEDITERRANEAN MEDICAL INFORMATICS and TELEMEDICINE 3rdInternationalConference May 3-5, 2007 Mangalia (Romania) promoted by TOPICS • Internet in healthcare and medical web portals • Distance learning in healthcare • Decision support system in medicine • Statistical software in biomedicine • Bioinformatics and genoma data bank • Neuroinformatics knowledge and brain cognitive processes • Digital signature in health documents • Security, privacy of medical data • Regional and national information Systems • GRID technology in healthcare • Medical record and health cards • Clinical and epidemiological data bases • Multimedia database, imagesand signals processing • Hospital Information Systems and health care networks • Teleconsulting/telediagnosis • Telemonitoring and telehome care • Teleradiology, telecardiology, telepathology, teleophtalmology, telediabetology, etc.

42. International Institute of Tele-Medicine In collaboration with @ITIM (Italian Association of Telemedicine and Medical Informatics) Polo Tecnologico Universitario Desio VILLA TITTONI - TRAVERSI Desio (Milano) Lombardia Region IMMIT: INTERNATIONAL MASTER ON MEDICAL INFORMATICS & TELEMDICINE January 2007 – December 2007 Lessons, labs, e-learning studies and stages (900 hours) 200 hours on site (1 week every 3 months) 180 hours by e-learning 250 hours individual study 250 hours stage in hospitals, universities, ICT companies, etc. 20 hours for examinations