Journal of the International Telemedicine Academy, Vol. 1, No. 1, pp. 34-57
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3rd International Conference on Telemedicine and Multimedia Communication - REPORT
The conference took place in Kajetany, POLAND, 21-22 October 2005.
Abstracts of all papers are presented below.
Vocational rehabilitation applications of telemedia and the telerehabilitation laboratory
Rehabilitation Counseling Program, and Vice-Chair Department of Rehabilitation Science and Technology, University of Pittsburgh, USA
McCue M.
We presented last year the concept of multiple telerehabilitation applications for vocational rehabilitation. This work has developed from pilot work conducted through the University of Pittsburgh's Department of Rehabilitation Science and Technology and now has culminated in the realization of our Telerehabilitation Laboratory. Examples of the telemedia resources employed include use of Internet technology for remote job coaching, wireless PDAs for cognitive rehabilitation with individuals with cognitive disabilities, and technology for using video/robotics for remote behavioral assessment and intervention. This telecasted session itself will serve as a real-time demonstration of the laboratory conference room. Experiences to-date and further implications for vocational rehabilitation using telerehabilitation also will be discussed.
Update on biomedical information transcoding--telemedicine via mobile devices
Parmanto B.
Department of Health Information Management, University of Pittsburgh, USA
We reported last year on the development of a transcoder gateway that transforms web pages on the fly. The transcoder adapts the pages to the limitation of the user's device, especially the small screen of PDAs and smart phones. We also developed novel template-matching algorithms to detect the structure of a webpage and to match the structure with a known template in the template library. Transformation rules then are applied to the template to make reading full-text documents in small screen devices more usable. The current report gives further details of our project focused on transcoding full-text biomedical information resources (such as biomedical journals) and an update on results of this effort to support mobile healthcare professionals via portable data devices.
An internet-based intervention: cognitive-behavioral intervention for fibromyalgia
Holm M. B.1, Breland H.2, Rogers J. C.3
1 Post Professional Education, University of Pittsburgh, USA
2 Graduate Student Researcher, University of Pittsburgh, USA
3 Department of Occupational Therapy, University of Pittsburgh, USA
Fibromyalgia is among the most common diffuse pain syndromes, affecting about 1 of every 10 rheumatology patients. Such patients experience widespread chronic pain and fatigue that negatively influences their activity participation (i.e. causes disability) and their overall quality of life. The purpose of the 3-year study reported is to use a cognitive-behavioral intervention to facilitate adoption of a wellness lifestyle in people with fibromyalgia. Specifically, we are testing the efficacy of an Internet-based health promotion computer program (online, Balance Center) used in conjunction with a wearable sensor (SenseWearTM) for developing a wellness lifestyle and improving the quality of life of adults with fibromyalgia. A controlled clinical trial, the Experimental (Balance Center + SenseWearTM) Intervention group is compared to a Usual Care control group. The experimental arm of the Internet-based intervention will be described, and use of the wearable sensor in the intervention also will be explained.
Sharing of rehabilitation and scientific knowledge between poland, the united states and the world
LaPorte R. E.
Disease Monitoring and Telecommunications, World Health Organization Collaborating Centre
Department of Epidemiology, University of Pittsburgh, USA
Global life expectancy has increased 30 years over the past four decades. Experts attribute 28 of the 30-year increase to prevention. Most such prevention entails information sharing. Therefore, harnessing the information revolution could have a powerful effect on world health. Our team created the Supercourse, a simple, yet highly effective web-based system to improve the global sharing of rehabilitation and scientific information. We designed an open source system with 6 levels of quality control. We extracted 2303 outstanding PowerPointŽ lectures in rehabilitation and prevention and shared them with scientists across the world. The Supercourse now represents a network of over 30,000 faculty members from 151 countries. We describe this program which now enjoys worldwide interest with over 70 million web-based hits each year.
Telemedicine in the operating theater: applications to minimally invasive surgery of the cranial base
Snyderman C.1, Kassam A.2
1 Department of Otolaryngology, University of Pittsburgh, USA
2 Minimally Invasive Neurosurgical Center Dept of Neurosurgery, University of Pittsburgh, USA
Modern advances in both the areas of medical diagnostic imaging and multimedia computer science now permit an extraordinary marriage of information and resulting video-media presentation to help guide the surgeon in endoscopic skull base surgery. The entire ventral skull base can now be accessed endoscopically with the avoidance of morbidity of open approaches. This requires greater precision in the identification of anatomical landmarks. Two-dimensionsial videoendoscopic images are integrated in video with data and real-time signals from a sophisticated positioning system (intraoperative navigational device) to supplement endoscopic surgical maneuvers with precise location. Such image guidance systems not only facilitate extraordinarily delicate and risky surgeries, but naturally facilitate teaching, improve communication between surgeons, and provide robust images on large viewing screens in the operating room or amphitheater. The media involved are naturally conducive to distance learning applications, as well. The technical aspects of the Minimally Invasive Neurosurgical Center operating room at the University of Pittsburgh Medical Center and their potential applications in the training of surgeons are summarized in this presentation.
Pilot study on students perception of interactive videoconferencing in community based education
P. Yogeswaran, L Banach, Mthatha, South Africa
MBCHB IV programme includes Family Medicine block of six weeks, of which four weeks of CBE at peripheral hospitals far from the main campus. Interactive videoconferencing may be an effective way to conduct teaching and learning sessions for medical students on district hospitals remote rotation far away from the main campus. PURPOSE: To study undergraduate medical student perception of interactive tutorials conducted from the main campus through videoconferencing. METHODS: A descriptive study was done to assess the perception of the students who took part in the interactive tutorials using video conferencing as a technical tool. An open ended questionnaire with few quantitative questions was completed by the students at the end of the block . RESULTS: Evaluation forms for 5 lectures were received from 20 remote attendees. 95% (n=20) students scored 3 and more on Likert scale ( 35% - score 3, 20% - score 4, 40% - score 5). 95% students wanted to have video conference as an additional method to their normal classes. CONCLUSIONS: Videoconferencing is a useful tool for teaching and learning, to complement the face to face teaching in community based education programmes, when students are placed far from the central campus.
Semantic web based image and report retrieval as basis for a scientific work place in the OENSC
Schrader T., Niepage S., Leuthold T.
Institut für Pathologie, Universitätsmedizin Berlin, Charité, Germany
Background: OENSC (Open European Nephrology Science Center) is a project to store and manage clinical and scientific data about kidney diseases. The goal of this project is the creation of a so called scientific workplace using a metadata repository of all cases with kidney diseases in the university hospital Charité and validated scientific information in the field of nephrology. This Charité hospital is the home of four major centers of Nephrology. The scientific workplace is a tool to coordinate and organise clinical studies and the cooperation with the external scientists.
Material and Methods: The basis of OENSC is a metadata repository for clinical data, scientific information and scientific literature. The front end is the so called scientific nephrology workplace (SNW). The software model is based on web services, which allows a highly flexible software solution concerning different operating systems, programming languages and specific requirements of the partners.
The Ontology which reflects the knowledge domain Nephrology is the backbone of the system. Pathology reports will be linked to virtual slides using a so called "diagnostic path". A semantic web based retrieval system for image and text retrieval can be adapted into specific tools of the scientific workplace.
Results: The semantic web based retrieval system is a user friendly tool which supports the requests graphically as well as text based. The user can operate with the concepts of the knowledge domain and walk visually through the relations between the concepts. The precision and recall of this system is lower than a complete text retrieval concerning the current limitations of the linguistic analysis.
Conclusion: With the current system we cover one specific knowledge domain. Future development will be the extension of the domain to operational and organisational knowledge.
The OENSC-Project is founded by the Deutsche Forschungsgemeinschaft.
Perceptual masking and dithering to ease communication with audiology patients
A. Czyzewski (Gdańsk & Warsaw, Poland)
Perceptual properties of human hearing have already been investigated in the field of noise reduction, but the author's proposal is different. According to this concept, noise suppression can be obtained in two ways: first, by uplifting the masking threshold above the level of these components that are assumed to convey mostly the noise energy; second, by reducing the power of the later components to the level just below the masking threshold.
In this way the noise starts to be perceived no longer, because it gets masked by these signal components which convey most of the useful signal energy. The concept is also applicable to noise reduction in hearing aids and cochlear implants. The paper presents fundamentals of masking modelling and the ways of masking models can be enhanced in order to produce more applications in the domain of audiology.
Another problem concerning hearing impaired people is the narrow dynamic range of hearing sensitivity. In such conditions the spatial filtration of sound is necessary in order to discriminate sounds coming from the preferred direction. A neural network-controlled spectral filtration algorithm was conceived and implemented in order to decrease the effects of masking useful components by interfering sounds coming from lateral directions.
To treat Tinnitus, therapists recommend behind-the-ear generators (maskers). They look like regular hearing aids. The purpose of using maskers is not to provide an extra gain on the signal which is the task of hearing aids, but to generate noise. The idea is to continuously excite the ear. Meanwhile, dithering is a process that adds broadband noise to a acoustic signal. As is widely recognised in audio technology adding noise would make a signal sound better. The introduction of noise lessens the audibility of the spontaneous noise generated due to threshold quantising of the signal. As it is demonstrated in the paper, understanding the existing links between dithering technique and Tinnitus masking may lead to some vital improvements in the Tinnitus therapy.
All three topics mentioned above will be discussed in the paper and illustrated with experimental results and audio excerpts.
Development trends in wireless broadband communications
Nowicki K., Woźniak J.
Faculty of Electronics, Telecommunications and Informatics, Gdansk University of Technology, Poland
We have been witnessing enormous and still increasing interest in wireless communications. Apart from cellular mobile systems, connecting billions of people, different broadband wireless systems, allowing fast multimedia transfers, are deployed. The main standardization bodies, including IEEE, ETSI, ITU or IETF, as well as leading networking manufacturers are involved in elaboration of new products. Wireless technologies become, not only alternatives for wire-based systems, but can effectively substitute such systems in many specific environments.
The paper presents the current status and development trends, observed in wireless communications. Special interest is directed towards MAN and LAN wireless solutions - their new standards, hot topics and open questions.
The most popular IEEE 802.11 - WiFi - and Bluetooth - LAN or Home/Office networks - used in local environments as well as new IEEE 802.16 -WiMAX and UMTS solutions - candidates for core, wireless broadband networks are discussed. In particular, a survey of current works on IEEE 802.11 standard extensions, including:
Inter Access Point Protocol - IAPP (Inter Access Point Protocol) - for smooth handover between access points,
Dynamic Frequency Selection (DFS) and Transmit Power Control (TPC) - for collision elimination with medical and military equipment and systems,
WiFi Multimedia - for multimedia service differentiation (especially for VoIP and video applications support)
WiFi Cellular Convergence - for proper operation of multifunctional devices and seamless handoff between WLAN and cellular telephony systems is also presented.
Additionally, newly developed IEEE 802.20, 21 and 22 proposals are presented. Finally, a certain overview of solutions like Bluetooth, ZigBee, UWB (Ultra Wide Band) and NFC (Near Field Communications), dedicated to home and personal area networks together with sensor networks is also given.
Variety of wireless systems, acting on the same area and utilizing the same frequency channels, causes serious operational problems. For this reason important coexistence and/or interoperability issues for heterogeneous environments, concerning mobility support, handover procedures and security aspects are also addressed.
Towards an automated virtual slide screening: theoretical considerations and practical experiences of an automated tissue-based virtual diagnosis to be implemented in the internet.
Kayser K.1, Radziszowski D.2, Bzdy P.2, Sommer R.3, Kayser G.4
1 UICC-TPCC, Charite, University of Berlin, Berlin, Germany
2 AGH-UST Krakow, Krakow, Poland
3 Cairo Consult, Mannheim, Germany
4 Institute of Pathology, University Freiburg, Freiburg, Germany
Aims: To develop and implement an automated virtual slide screening system that distinguishes normal histological findings and several tissue - based crude (texture - based) diagnoses.
Theoretical considerations: Virtual slide technology has to handle and transfer images of GB Bytes in size. The performance of tissue based diagnosis can be separated into a) a sampling procedure to allocate the slide area containing the most significant diagnostic information, and b) the evaluation of the diagnosis obtained from the information present in the selected area. Nyquest's theorem, that is broadly applied in acoustics, can also serve for quality assurance in image information analysis, especially to preset the accuracy of sampling. Texture - based diagnosis can be performed with recursive formulas that do not require a detailed segmentation procedure. The obtained results will then be transferred into a "self-learning" discrimination system, that adjusts itself to changes of image parameters such as brightness, shading, or contrast.
Methods: Non-overlapping compartments of the original virtual slide (image) will be chosen at random and according to Nyquest's theorem (predefined error-rate). The compartments will be standardized by local filter operations, and are subject for texture analysis. The texture analysis is performed on the basis of a recursive formula that computes the median gray value and the local noise distribution. The computations will be performed at different magnifications that are adjusted to the most frequently used objectives (*2, * 4.5, *10, *20, *40). The obtained data are statistically analyzed in a hierarchical sequence, and in relation to the clinical significance of the diagnosis.
Results: The system has been tested with a total of 400 lung cancer cases, that include the diagnoses groups: (1) normal lung - cancer; within cancer: (2) small cell lung cancer - non small cell lung cancer; within non small cell lung cancer: (3) squamous cell carcinoma - adeno carcinoma - large cell carcinoma. The system can classify all diagnoses of the cohorts (1) and (2) correctly in 100%, those of cohort (3) in more than 95%. The percentage of the selected area can be limited to only 10% of the original image without any increased error rate.
Conclusions: The developed system is a fast and reliable procedure to fulfil all requirements for an automated "pre-screening" of virtual slides in lung pathology.
From mobility in telepathology to mobility in telemedicine
Seiwerth S., Jurkovic J., Mazul N., Dzbur A.
Institute of Pathology Medical Faculty and VAMSTECH Zagreb, Croatia
A couple of years ago the idea of a mobile Telepathology unit for frozen section diagnosis was launched. The project did not receive broad support so we decided to start with a pilot project including mobile telemedicine, but not telepathology. The project was launched in one of the most picturesque and wild regions of Croatia, Lika. This region includes few cities, a much dispersed population and scarce medical facilities. Gracac, a city located at the foot of Velebit mountain, at two major highways connecting the inland with the coast and 65 km from the nearest hospital was chosen for the pilot project starting just before the summer season.
Two levels of teleconsultation needs were identified: 1) communication of the terrain nurse/technician with the medical crew located at the medical facility in Gracac (the area covered by only one nurse/technician per shift is about 200 sq km of wood and mountains) and 2) consultations of the medical crew either from the location in Gracac or from a field intervention with the referral hospital.
The telemedicine unit includes a digital camera, a CCD TV color camera, a ECG scanner and a laptop computer and can be run using standard telephone lines or a handy.
The telemedicine software used must be stable, simple and versatile. The ISSA-server based system option alerting the consultant by SMS that a consultation case is in his mailbox at the server ads additional time effectiveness. In cases were internet access is not possible the whiteboard-based telemedicine system Pharos is implemented.
One of the most important drawbacks for teleconsultation is the availability of the consultant, most of them being highly occupied professionals. In a server-based teleconsultation system, combined with mobile communication equipment seems to be an interesting choice. Combining these tools the consultant can be reached anytime, anywhere.
Digital radiology - is it everything so perfect
Petkovic G.
Radiological Department Nykobing Falster County Hospital, Denmark
Subject: One of the medical branches that is most affected by recent technical progress is radiology. Teleradiology, digitalization of the different radiological techniques, "virtual" radiology based on the multislice CT technology - this is just the beginning of the big brake-troughs long list.. Increased productivity and more diagnostic accuracy are the major goals of this rapid process. But in this race, there are some difficulties we have to face - new working environment, bigger and different knowledge needs, enormous amount of the information etc. These problems need to be recognized and defined, so we can deal with them.
Materials and Methods: Author analyses long term experience with different aspects of digital radiology: teleradiology, MSCT technology, digitalization of the radiological images RIS and PACS. Analysis is focused on the implementation of new technologies, proper application, changing of classical radiological and clinical routine, data overflow and radiologist-machine-patient interactions.
Results: Few major problems are identified: new working requirements are very demanding, especially to the radiologists. New sophisticated diagnostic techniques are based on the time-consuming post processing of the images, so doctors are getting part of the technologists job. Patients flow is increasing which brings us absurd that new technology require more radiologists. Voice-recognition systems give additional burden to the radiologist that has to deal with part of the secretary job too.
Implementation of the new radiological technologies need to be combined with the serious education of the clinicians. Indications and clinical interpretations of the radiological reports have to be regularly checked. Digital x-ray pictures can be confusing for the clinicians - they can vary in the format and relative size of the filming objects.
Teleradiology sometimes is connected with the lack of clinical information, also with the impossibility of the additional radiological procedures. Technology can become barrier in the patient - radiologist communication.
Conclusion: Digitalization of the radiology, like in all other medical branches, gave us many benefits, but some problems also. Needs for broader medical and technical education are increasing. Redefinition of radiological - clinical relations permanently goes on. Dramatically changed working environment has need for a new working standards. Patient - doctor communication can be affected by new organization of the radiological work.
Telepathology in developing countries in south east asia: results, limits, future phnom penh project
Stauch G.1, Oberholzer M.2, Kuakpaetoon Th.3, Schattka S.4
1 Institute of Pathology, Aurich, Germany
2 Department of Pathology, University Basel, Switzerland
3 Department of Pathology, Rajavithi Hospital Bangkok, Thailand
4 Westerstede, Department of Urology, Ammerland-Klink, Westerstede, Germany
Introduction:
The medical quality in developing countries is limited by shortage of experts in all fields. Only 6 Pathologists are providing the morphological service for 13 million inhabitants in Cambodia. Telemedicine may be a chance for clinician and pathologists to get second opinions and to participate in training programs.
Historical background:
In 1996 a Thai German Working Group was settled in Bangkok in 2000 DIAGAID and iPath were established as a platform for Telemedicine. In 2002 a Telehistologylab was established at the National Referral Hospital in Honiara/Salomon Islands and a second lab at Sihanouk Hospital Center of Hope in Phnom Penh Cambodia and a third at the Department of Pathology Medical Faculty of Laos, Vientiane Laos.
Results:
Since 2002 there is a constant increase of specimen workload from SHCH from 50 in 2003 to 600 per year in 2004. We expect an increase to 1.000 in 2007. We expect an decrease of Telepathology requests from 100% to 60% of all cases, because of the growing experience of local participants.
At presence SHCH sent already 900 cases which were commented by experts world-wide. Analysing the first 40 cases each year 2003 to 2005 we found a shift from Telehistology to Tele-FNA cytology from 89% to 53%.
There is steady number of images from 2003 to 2005 however an increase of image quality (score 0 - 2) from 1,27 - 1,88 there is also a steady diagnostic concordance between sender and experts ranging from 63,5 to 84% depending on the subject of request.
We also found a high diagnostic security of the experts maximal 10% of requests were refund concerning Lymphnode and bone marrow histology.
Discussion:
- Limits of Telepathology may be on the side of the sender.
- Slidequality, which can be optimised by continuos training of technicians.
- Sampling errors, which can be reduced by non experts in sending more images or in better selecting diagnostic hot spots by more experienced non experts. Growth of diagnostic knowledge will extend diagnostic independence to all fields of histology and cytology.
- Image quality can be increased using new generation of digital cameras.
- Also experts are obliged to provide short turn around time using simple and user-friendly systems. An other way is to establish a virtual institute.
- Reduction of communication problems by using the identical terminology and using diagnostic guidelines on each side.
Perspectives:
Analysing the need of pathological services and techniques in developing countries in South East Asia.
We found 3 issues:
- Individual diagnostic and therapy monitoring by Telepathology and Telecytology .
- Education of medical students by teaching and postgraduate training by teleconferencing.
- The validation of Tumour- and Disease-registration which is necessary for planing medical care in future.
This 3 issues could be managed by a simple device and organisation provided by iPath (http://telepath.patho.unibas.ch) looking at the first experience of the 3 years.
Summary:
Telemedicine seems to be and optimal tool in routine diagnostic and academies in developing countries which are suffering on shortage of experts. Teleteaching can create the needed capacity in all fields of medicine in future.
There should be simple and low cost solutions for Telemedicine, adapted to the economic situation in theses countries.
Workshops should be organised in future to bring non experts and experts together in personal contact to break through psychological barriers.
Telemedicine may be one tool to create a global Community.
Investigation of reflection spectra model based processing of dermatology images
Marozas M.1, Beliauskien A.2, Jurkonis R.1
1 Biomedical Engineering Institute, Kaunas University of Technology, Lithuania
2 Clinic of Skin and Venereal Diseases, Kaunas University of Medicine, Lithuania
This pilot study is intended to investigate possibilities of skin and nevus imaging using digital still image camera. The main objective is to develop method of dermatology images interpretation, which enables the looking on the skin lesions and nevus from the optical background of skin coloration. Kubelka-Munk calculation method for light transport and reflection from multi-layered complex media is applied in modeling of light reflection spectra from skin. Calculation of model shows that red, green, blue and infrared colors lighting is satisfactory to access distribution of comparative estimates of the following skin parameters: volume fraction of melanin in epidermal layer, volume fraction of hemoglobin in dermal layer, presence of dermal melanin and thickness of papillary layer. Performance of image processing method on fourteen samples of images of common melanocytic nevi, dysplastic melanocytic nevi, Spitz nevus, thrombotic hemangioma and surrounding healthy skin were made.
Results: In normal epidermis mean volume fraction of melanin was lower, but its variation was higher than in pigmented lesions. Mean volume fraction of hemoglobin and its variation were lower in papillary dermis of pigmented lesions than in the normal skin. In papillary layer of normal skin volume fraction of melanin and its variation were lower than in pigmented lesions.
Conclusions: Explored model based skin imaging show that digital still image camera with special lighting adapter assures comparative quantitative content interpretation of inspected skin area, while regular dermatoscopy cannot explain the image formation process depending on structure and composition of endogenous pigments (melanin and hemoglobin). Further reliability evaluation of this method including comparison with histological data is necessary.
Teleradiology and telepathology for the second opinion of lung cancer diagnosis. Our experiences in daily medical practice.
Pacho R.1, Słodkowska J.2, Bestry I.2, Siemiatkowska K.3, Małek G.2, Cieslinski K.3, Roszkowski-Sliz K.2
1 Medical University of Warsaw; Warsaw.
2 National Tuberculosis and Lung Diseases Research Institute [NTB&LDRI], Warsaw
3 Bydgoskie Centre of Pulmonology [BCP], Bydgoszcz.
Teleradiology [TR] an telepathology [TP] are widely used image transmission services in lung cancer diagnostics. The experienced radiologists and pathologists work mainly at appropriate specialised medical centres. The NTB&LDRI is the referral centre for the diagnostic consultations and treatment of lung cancer. The morphological diversity of lung cancer is a challenge for radiologists and pathologists.
The studies were performed to: *analyse the needs and workflow of the conventional radiology and pathology service in the pulmonary centre regarding lung cancer, *to develop a distant lung cancer teleconsultations in radiology and pathology.
25 lung tumours of the routine radiology service of BCP entered the study. The transmitted images of the scanned chest radiograms and computer tomography [CT] (flat bed scanner, Luminiscan 50/75, USA) were evaluated according to 5 radiological characteristics. The results were compared with the conventional film inspection.
19 lung tumours of the routine histopathology BCP service were consulted using the direct TP method. The new generation of telemicroscopy system (Coolscope, Nikon, Japan) was implemented. The results were verified with a tissue-based diagnosis.
Very high confidence for the scanned transmitted images was observed; the accessory findings were more often seen on direct films. The histological collection of cases comprised less frequent/rare types of tumours (carcinomatous and sarcomatous). The telediagnoses and the conventional microscopy diagnoses showed very high accordance.
Our preliminary results indicate the feasibility of the used TR and TP methods in a distant communication between hospitals for getting the second opinion in lung cancer evaluation.
New techniques assisting cochlear implants fitting
W. Walkowiak (Warsaw, Poland)
This study evaluates a method for a measurement of the longitudinal spread of electrically evoked neural excitation in the cochlea, using the Neural Response Telemetry (NRT) system available with Nucleus 24 cochlear implant system. Measurement of Spread of Excitation (SoE) function provides a potential method of assessment of cochlear implant users' benefit. To provide maximum benefit for the cochlear implant users the speech processor should be fitted to the patients' need. One objective method that could deliver important information for fitting is Neural Response Telemetry (NRT). It is possible to determine Spread of Excitation - the longitudinal spread of electrically evoked neural excitation in the cochlea, based on NRT results. The parameters of the Spread of Excitation in the individual patient may help to explain the patients' performance. The method and obtained results will presented in the paper.
Databases for "I Can Hear" system
Szwoch G.
Gdansk University of Technology and Excellence Center "Proksim", POland
The multimedia system 'I Can Hear' is the first hearing screening test system in Poland that operates using the Internet. Apart from the scripts and static web pages that do the actual testing, a database system had to be designed for storing test results and producing reports. This system performs tasks such as collecting data entered by the user in the survey, collecting test results, searching data according to various queries, statistical analysis, authorisation of access to data at various levels.
The whole database system is built using open-source components:
PostgreSQL database engine, Apache web server and perl interpreter for CGI scripts. Access to data stored in the database is possible with the internet browser interface and scripts. The results of data analysis obtained using the system described here may be useful for prevention of hearing impairments, especially in children.
Webhis-ipcardio: an open source cardiological patient record based on web technologies
Vian P.1, Cervesato E.2, Della Mea V.3
1 University of Udine and Associazione per la Ricerca in Cardiologia, Pordenone, Italy
2 Cardiology Unit, Pordenone City Hospital, and Associazione per la Ricerca in Cardiologia, Pordenone, Italy
3 Medical Informatics and Telemedicine Lab, Dept. of Maths and Computer Science, University of Udine, Italy
Electronic patient records are recognized as tools for reducing errors in clinical processes and thus enhancing the quality of care. This is even more true in medical disciplines where urgent treatments and chronic diseases are both the norm, like cardiology. In the former, fast availability of patient data helps in correctly managing the patient; in the latter, long patient histories need to be maintained during the time, possibly giving access to many healthcare professionals in different places. In order to introduce a cardiological inpatient management system into the City Hospital of Pordenone, Italy, the Association for Research in Cardiology recently started collaboration with the Medical Informatics and Telemedicine Lab at the University of Udine. The aim of the collaboration was to develop an open source cardiological patient record based on web technologies. The requisites of the system were analysed by interviewing cardiologists and nurses at the Cardiology Unit of the Hospital; from this preliminary phase, a set of desired features was identified, including: admission and dimission management; clinical diary (with cardiologist and nurse areas); graphical rendering of patient parameters; and connection to existing systems (outpatient system, and regional demographics server). The requested functionalities were then implemented into a complete system based on PHP, a relational database (Interbase or Firebird), and the Apache Web server. Pages were coded into XHTML and CSS languages, while Javascript has been optimized for Internet Explorer. The system has been preliminary validated by the personnel of the Cardiology Unit, and it is now being released as open source at the address http://mitel.dimi.uniud.it/ipcardio/ . Further developments include translation in other languages, and adoption of a database abstract layer, in order to avoid dependence from a specific database.
Using ambient intelligence technologies to achieve health monitoring and emergency management at home
De Natale F. G. B.1, Mayora O.2, Conci N.1, Prisciandaro L.2
1 University of Trento, Italy
2 Create-Net, Polo Tecnologico, Italy
In this paper, we describe an advanced ambient intelligence (AmI) technology able to provide healthcare-at-home services and to automatically detect and manage emergency situations. The target of such system is to enable a person with reduced self-sufficiency (from an elderly, to a person with medium-severity diseases) to conduct a normal life at home, without requiring the physical presence of an assistant or the transfer to a rest-home. An application of this technology has been recently demonstrated through a prototype within the T-Rex testbed of the international research centre Create-Net, in northern Italy.
The system is based on an indoor AmI infrastructure, exploiting a number of wireless and wired sensors, to monitor the environment and detect possible anomalies. In particular, the system is able to constantly monitor the presence, position and behaviour of home inhabitants and objects in a dynamically changing environment. This is achieved by a joint operation of video cameras and RF tags, through a robust target tracking tool. Environmental data can be easily enriched by adding additional wireless sensors to measure status parameters (e.g., heat, humidity, presence of gases, lighting, intrusions, etc.) typical of domotic/surveillance systems, or personal parameters (blood pressure, pulsation rate, oxygen saturation, and other biomedical data).
The sensorial infrastructure is connected to a local processing unit, which has the task of continuously analysing the data in search of possible anomalous patterns. An anomalous pattern may be connected to a specific pathology (e.g., a heart attack), or more generally to an unusual situation possibly connected to a danger (e.g., a person laying on the floor for a while may be due to a fall down or a faint. In the case of a potential emergency, the system is able to interact with the home inhabitant through a very intuitive and interactive interface (voice control or tv set), in order to better understand the situation and reduce the possibility of false alarms. Whenever the event is confirmed, the local unit can automatically create an interactive multi-modal multimedia link with an emergency centre, where a remote operator can get information about the patient, select and analyze a set of historical data (for instance, a record of the video tracks and biomedical data that generated the alarm), video-communicate with the person, acquire live information. According to the collected data, the operator can organize the relevant rescue operations, and ask the support of the most suitable medical services.
The full paper will propose an in-depth overview of the proposed architecture and its main components, together with examples of its operation and functioning.
Hierarchical approximation of compound concepts from data and domain knowledge
Skowron A.
Institute of Mathematics, Warsaw University, Poland
Solving many classification and prediction problems requires approximation of compound concepts. Searching methods for approximation of such concepts directly from data are not feasible because of the huge size of searching spaces for relevant features. We propose a method for hierarchical approximation of such concepts. The method is based on the rough set approach. We assume soft constraints defined by domain ontology are given. The approximation of the target compound concept is constructed using approximations of concepts and dependencies from ontology. The results of experiments on different data sets are reported.
Rule-based emotion classification by acoustic features
Grimm M., Kroschel K.
Institut für Nachrichtentechnik (INT),Universitaet Karlsruhe (TH), Kaiserstr, Germany
Abstract
In this paper we present our current results in emotion classification based on features extracted from the speech signal. Recognising a patient's emotional state by means of observation and intelligent signal processing might improve the medical treatment in diagnosis, therapy, and rehabilitation.
Our emotion recognition system uses the pitch and energy contour of the speech signal as a basis for extracting features describing the emotional state of the speaker. Additional features are related to speaking rate and spectral characteristics. A Principal Component Analysis (PCA) is applied to remove the correlation between the features.
The classifier uses training data acquired from speakers expressing authentic emotions as guests in TV talk-shows. All utterances are labelled according to a 3-dimensional emotion space representation by several human evaluators. We apply a rule-based fuzzy inference system which gives us an estimation of the emotional state expressed in each utterance. The rules are derived from the correlation between the acoustic features and the emotional con- tent attested by the evaluators. In comparison to human evaluation consent, the recognition results show to be a promising basis for emotion recognition.
As an outlook, we propose to extend our system towards additional observation methods, thus requiring interdisciplinary co-operation. These modalities might include video signal
(facial expression), heart beat rate, blood pressure, skin resistance and breathing rate. From all of these signals, features might be extracted as a representation of the emotional state. The fusion of all modalities might further improve the classification results.
The necessary juridical framework of telemedicine : the French model
Louis Lareng - CHU of TOULOUSE (FRANCE)
abstract not available
Internet-based "telescience"
Buravkov S.
Faculty of fundamental medicine, Moscow State University, Russian Federation
At the present time wide spreading and very fast developing Internet telecommunication technology in medicine especially remarkable in Russian Federation creates conditions for distributed scientific work. The situation in scientific field is resembled to remote telemedicine consultations in clinical practice. The highest qualified scientific specialists are still located in large cities including high-tech equipment. At the same time experimental basis (especially in fields like geographic and ecological pathology) are remained in remote areas. In the last several years the system of expeditions was applied for gathering the experimental material. Unfortunately now it became time and money consuming. New digital microscopes including electron ones provide new possibilities for remote and shared work for many scientists.
Experiments on investigation of alcohol influence on rats were performed as per se as on background of mixed application of protein and vitamin-B deficiency. Erythrocytes of peripheral blood were investigated by light and scanning electron microscopy.
Just immediately after fixation with aldehyde + osmium tetroxide and dehydration the samples were sent by ordinary post to Moscow from Archangelsk for further processing and examinations by both light and scanning electron microscopes, which were controlled from both sides through Internet. Results also have been discussed via e-mail or on line via voice phone. Light microscopy revealed deformations and allowed to qualitatively estimate the presence of echinocytes and stomatocytes. More detailed observations of the same preparation have been made by scanning electron microscope.
One of recent tendency in clinical and scientific equipment is the development and growth of number apparatus with networking abilities. Therefore the approach used in our investigation seems to be very perspective not only for Russia but also for international scientific cooperation.
An integrated telemedicine platform for the assessment of affective physiological states
Ganiatsas G.1, Katsis Ch.D.2, Fotiadis D.I.1
1 Unit of Medical Technology and Intelligent Information Systems, Dept. of Computer Science, University of Ioannina, Greece
2 Dept. of Medical Physics, Medical School, University of Ioannina, Greece
AUBADE is an integrated platform built for the affective assessment of individuals. The system performs evaluation of the emotional state by classifying vectors of features extracted from: facial Electromyogram, Respiration, Electrodermal Activity and Electrocardiogram. The AUBADE system consists of: (a) a multisensorial mask along with a wearable signal acquisition module, (b) a feature extraction and intelligent emotion recognition module, (c) a 3D facial model module which is used for the projection of the obtained data through user specific 3D face meshes; whereas the end-user will be able to view the facial expression of the subject in near-real time, (d) a wireless communication module and (e) the AUBADE databases where the acquired signals along with the subject's animation videos are saved. AUBADE develops new and efficient methods for processing multisensorial signals based on sensor management and data fusion techniques. The Intelligent Emotion Recognition module, through its classification sub-module, combines data from the user's health record along with the features extracted from the various sensors and with the aid of various intelligent classification techniques detects the psychological state of the user. Furthermore, AUBADE implements a near real-time 3-D facial representation module, which animates the face of the specific user with respect to his/her muscle movements. The system is designed to be applied to human subjects operating under extreme stress conditions, such as car racing drivers, aircraft pilots and also to patients suffering from neurological and psychological disorders. The system pilot application are being tested and evaluated on Maserati's car racing drivers.
Health on-line in Poland - the national e-health implementation plan. Towards obtaining pan-european interoperability
W. Skawiński (Warsaw, Poland)
Abstract not available
Practical biomedical image processing using imagej: a tutorial
Vincenzo Della Mea
Medical Informatics and Telemedicine Lab, Dept. of Maths and Computer Science, University of Udine, Italy
Many biomedical research and practice fields involve the use of images, now often digitized and manageable through a computer. AMong the aims of computer based management of images, one of the most interesting and crucial is image processing and analysis. However, biomedical images are rather peculiar, as they carry diagnostic information that should be conserved and often understood in processing them; this in turn means that is mandatory to understand image processing concepts and possibilities.The aim of the present tutorial is to give an overview on digital image representation and processing, followed by a practical session . In the first part, we'll deal with bitmap and vectorial images, compression issues, and the image processing and analysis basic steps (acquisition, transformation, reduction, interpretation). In the second part, examples will be given using the free software ImageJ (http://rsb.info.nih.gov/ij/), with the aim of suggesting practical applications but also issues to be considered. Candidate attendants for this tutorial are medical professionals with image processing interests, as well as technical people with some more informatics education, but without practical knowledge on image processing.
Demand for telemedicine services in Poland
Rudowski R., Karlińska M.
Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Poland
Health safety is ranked at the top of social values. Efficient and commonly available medical care with the use of modern technologies is capable to extend human life, improve its comfort, and to preserve citizens from premature death. The local hospitals play an important role in the health care system. The quality of their services can be significantly improved by the application of telemedicine which ensures communication among health care institutions with the different levels of medical technologies and different referential level. We plan to design the website, discussing telemedicine problems, on a server of Medical University of Warsaw. The questionnaire in electronic form addressed to the managers of the local hospitals will be placed on this website. The link to this page with the request for filling questionnaire will be sent to all local hospitals in Poland. E-mail addresses will be taken from ZOZMAIL (E-mail System of Health Care Institutions), which was created at the Center of Information Systems in Health Care. We would like to collect data on telecommunication infrastructure, digital diagnostic equipment, range of consultations conducted in a traditional way (courier mail, physician service trips) and first of all we would like to determine the demand for the of teleconsultations as well as postgraduate education in e-learning form. Analysis of obtained data with the use of MapInfo program (Geographic Information System) as well as SAS (Statistical Analysis System) should allow estimating the demand for telemedicine services in Poland on local levels. We think that the new forms of organizational solutions in health care incorporating recent achievements of ICT require urgent and widespread implementation in this country. This work should prove this thesis.
A simple method of telepathology in frozen section service. Results of the westerstede - aurich project
S. Schattka1, G. Stauch2
1 Department of Urology, Ammerland-Klinik, Westerstede, Germany
2. Institute of Pathology, Aurich, Germany
Introduction:
Frozen section service is mandatory in urologic oncosurgery. The histological assurance of tumourfile margins in prostate ectomies seems to have an important influence on the disease free and over all survival of the cancer. Hospitals without pathologic department have logistic problems and delay in performing prostatie surgery. Telepathology is a suitable solution for those hospitals.
The urologic department in Westerstede is performing 130-150 total prostate ectomies per year and the next pathological department is in 40 km distance to the hospital. In 1994 the authors started with frozen section service in breast surgery. In 2000 the service was offered to the newly established department for urology. In a short training period we tested the diagnostic accuracy of Telepathology in diagnosing the slides directly at the microscope and at distance on the videoscreen. The department of Urology Westerstede is preparing 130-150 total prostate ectomies per year. Investigating 7 to 9 specimen of the resection margins at each case.
Method:
The authors are using a simple device: CCD camera mounted on a BH2 Olympus microscope. The images are digitalized and send in a store and forward mode to the pathologist via 2 channel ISDN line (128 kb/sec.). The images are read by the pathologist on a Eizo Flex Scan 68. Videoscreen and the results are reported by phone directly to the surgeon.
Nearly 2500 FS were done in 600 prostate ectomies in the last 5 years. The diagnostic accuracy was about 96% equally to accuracy of conventional frozen section. The primary rate of 5% refused video diagnosis was reduced to 1% due to the training effect and the higher diagnostic security of the pathologists.
Results:
Summarizing on 5 years experience, we found:
- Low risk of sampling errors, even technicians selecting the diagnostic fields. There is a great benefit of continuous training of technicians in morphology.
- Superior importance of slide quality to technical device eg. Camera or Microscope.
- Simple questions (yes/no) and good clinical informations prior surgery.
- Adequate turnaround time of 20 minutes, which can be integrated properly in the workflow of surgical procedures.
Conclusion:
Telapathology can be a tool in frozen section. Service under good conditions, simple questions and a good cooperation between clinician and pathologists.
Musculoskeletal telerehabilitation via mobile phone
Glinkowski W.1,2, Górecki A.1
1 Chair and Departament of Orthopedics and Traumatology of the Locomotor System, Center of Excellence "TeleOrto", Medical University of Warsaw, Poland
2 Departament of Anatomy, Center of Biostructure Research, Medical University of Warsaw, Poland
Continuous Passive Motion (CPM) is a postoperative treatment method that is designed to aid recovery after joint surgery. CPM are prescribed by orthopaedic surgeons following total knee replacement, anterior cruciate ligament reconstruction, tendon repair, open reduction and internal fixation (stabilization) of intra-articular fractures, rotator cuff repair, articular cartilage microfracture, articular cartilage transplantation, meniscal repair and many other surgical procedures.
There are CPM devices for the hip, knee, ankle, shoulder, elbow, wrist, and hand. During early period of rehabilitation after knee, ankle, elbow, shoulder surgery the settings of the range of motion on device require adjustment accordingly to individual rehabilitation progress and pain.
Material and method:
Seven patients were monitored with mobile phones after knee and ankle arthroscopic and open surgery. Patients used few types of mobile phones (Nokia, Siemens, Sony-Ericsson, Qtec) by local GSM operators.
Arthroscopic or open surgeries were performed as "one day surgery" or normal hospital stay. Patients were discharged from hospital with instructions for handling the device, home care and mobile phone follow up. Patients rented CPM devices from secondary care medical companies. The minimal range of motion was set at discharge. Further changes of ROM setting were done by a patient within up to 14 days post-op. Patients have sent MMS, images or movie files directly form his/her mobile phone and received further instructions for safe CPM setting. Files containing images and movies of patients home rehab program were transferred as MMS, from patients were sent as Results Images from patients were sent as MMS (3), JPEG (3), or movie file (1).
Instructions were sent as SMS of e-mail in most cases. Quality of the pictures received was good enough to evaluate ROM achieved by patients. Progress of rehabilitation did not differ from conventional followed up patients.
Conclusions
Simple implementation of mobile phone telerehabilitation monitoring eliminates unnecessary patient's transport to the outpatient clinic. The number of early follow up consultations decreases but patient's comfort rises up.
Teleconsultations before radiotherapy and surgery for patients with heterotopic ossification after total hip replacement
Glinkowski W.1,2 , Dyttus-Cebulok K.3, Górecki A.1
1 Chair and Department of Orthopedics and Traumatology of Locomotor System, Center of Excellence "TeleOrto", Medical University, Warsaw, Poland
2 Department of Anatomy, Center of Biostructure Research, Medical University, Warsaw, Poland
3 Maria Skłodowska-Curie Memorial Cancer Center And Institute Of Oncology, Warsaw, Poland
The teleconsultation was developed for patients who are isolated in countries where climatic or geographical conditions render transport difficult or costly. In Poland the teleconsultations are relatively rarely used. The advances in modern radiotherapy throughout the last decade are based not only on development in technology but also on cooperation between medical centers. Considering Pakos and Ioannidis identification of radiotherapy as more effective than nonsteroidal antiinflammatory medication for the prevention of heterotopic ossification after major hip surgery, we decided to introduce the procedure with telemedicine enhancement.
The aim of the study was to enhance patients "flow" in cooperation between Radiotherapy Department and Department of Orthopedics and Traumatology of Locomotor System from two different institutions for patients suffering heterotopic ossification after total hip arthroplasty and to decrease "patient's mileage" between medical centers. Preliminary reviewing of digitized x-rays has been shown as useful for radiotherapeutic treatment planning. Six patients were qualified for surgical excision of heterotopic ossification with following low dose radiotherapy as prophylaxis of further ossification by simple asynchronous telemedical approach.
Medical images (x-rays) were transferred to radiotherapy department for radiotherapy planning without personal patient evaluation by radiotherapist. Radiotherapeutic prophylactic procedure was performed within 48 hours of surgery (excision of heterotopic ossification). Each patient experienced only one radiotherapist consultation less than the typical patent what raised patient's satisfaction rate. Short term (avg. 6-months) follow-up of surgically treated patients with Brooker grade 3 and 4 ossifications shows no case of relapse of symptoms. Good preliminary results with rise of patient's satisfaction after simple telemedical enhancement support effort for further investigations and patient flow mechanisms from specialist to specialist.
Cellular phone as a tool for sports medicine and sports physiology screening
Wojtkowski I.1, Glinkowski W.2,3
1 MATRIX.PL SA
2 Chair and Departament of Orthopedics and Traumatology of the Locomotor System, Center of Excellence "TeleOrto", Medical University of Warsaw, Poland
3 Departament of Anatomy, Center of Biostructure Resaerch, Medical University of Warsaw, Poland
Physiological endurance evaluation plays an important role in Sports Medicine. Aerobic endurance testing methods are equally useful for sportsmen, coaches, physiologists and sports medicine specialists. Exercise prescription does not differ for older and younger persons and conditioning exercises can reduce biological age by 10 to 20 years. The testing methods may also be used for persons in all ages. Both aerobic power and muscle strength leads to improvement of musculoskeletal health. The United Nations, the World Health Organization, and 37 countries including the United States have proclaimed 2000-2010 as the Bone and Joint Decade to promote the importance of a healthy musculoskeletal structure for a lifetime. Exercise is also the key to maintaining the quality of life, and the number of years of life expectancy extension. Now doctors can encourage their patients to start using resistance training along with their aerobic training as an integral part of their heart-disease prevention and/or treatment program. The major form of aerobic exercise should be walking, running, cycling, swimming, or cross-country skiing. Walking and running are most often recommended because they do not require special training or skills. Cellular phones become more and more suitable devices in most developed countries. They are able to fulfill many tasks serving not only as communicators but also as personal digital assistants. PulseTester is the first application for mobile phones which is able to support simple, cardiovascular endurance testing without any additional equipment. Program was designed in Java MIDP technology and can be run on any Java enabled handset.
PulseTester supports most popular physiological tests, including:
Ruffier's, Harward's and Cooper's tests. The calculation of results appears automatically at the end of each test. Individual maximal Heart Rate as well as VO2Max may be estimated. Four HR training zones calculations were established for easy viewing. Storage of saved test results is an option for further analysis. Application user can set a beeping metronome option for keeping steady rate of exercise.
In clinical settings of sports medicine PulseTester was tested and evaluated as very useful and applicable for low to medium and recreational level of sports training.
Tools for remote decision support in the telecardiological system electronic patient record and patient database
Sierdziński J., Rudowski R., Karpiński G., Grabowski M.
Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Poland
The diseases of cardiovascular system are the main cause of mortality in Poland (ca. 50%). That is why they are treated as a serious civilisation problem. One of the most frequent diagnoses of ischaemic heart disease is the acute coronary syndromes (ACS) which contain all three clinical types of events (heart attack, unstable coronary heart disease, some cases of cardiac death). The project of telecardiological system was proposed to support the interventional cardiology in Mazowsze District. The system aggregates systemized ACS patient data from the medical centres. It is expected to improve the co-operation among regional and reference medical centres. The first task of the system is to help to undertake remote decision about patients' transportation to the reference centres for interventional treatment. The other task of this system is to shorten the time from the onset of symptoms to the start of treatment, which should reduce mortality. The design of 2 main elements of the system Electronic Patient Record model and relational patients data base was the aim of this work. Several tools for creating EPR and EPR archive were used such as: XML, PHP, Java Script and MySQL. The electronic patient record has been created for 100 patients from SP CSK AM Hospital (reference center) and for a few patients from the regional centres remotely. This confirmed system operation and verified applied solutions. The telematics use is possible to support cardiological health care.
The review of the e-health initiatives in respiratory medicine developed by referential university centre
Duplaga M.
Kraków, Poland
The use of teleinformatic solutions is associated with substantial potential for improvement of care in respiratory medicine. The paper brings insight into e-health related initiatives in the domain of respiratory medicine navigated from the level of University Department of Medicine. These initiatives are examplified by three types of applications covering teleconsultation scenarios, chronic care in obturative disorders and the issue of postgraduate education in invasive procedures. The case of teleconsultations was focused on the bringing of second opinion option to peripheral pulmonary wards located in the Malopolska voivodship and was implemented within the activities of Krakow Centre of Telemedicine. The next field is delivery of chronic care to patients with bronchial asthma. Within the project supported by Ministries of Health and Ministry of Research and Informatics, the system enabling the registration of patients with severe ashtma was developed. The system enables also keeping long-term medical record of the patient, sharing the acces to patients medical record among health professionals and telemonitoring of disease severity. The application of Medical Digital Server Video is developed in the cooperation between Jagiellonian University Medical Colllege and Department of Telecommunication of UMM Science and Technology University in Krakow. The main idea behind these initiatives is streaming of educaiton videos recorded during interventional pulmonology procedures to potential end-user representing diversified community of physicians and other health professional in the course of training in pulmonology.
The european survey on e-health consumer trends - an international pilot project
Bujnowska-Fedak M., Staniszewski A., Steciwko A.
Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
Background: There is an increasing focus on the use of the Internet for health purposes, but properly designed studies investigating this issue are still few. In the USA, about 40% of the Internet users use it for health purposes. In the EU, 23% of people use the Internet to get information about health. In Poland, according to the national poll agencies, about 23% of population are Internet users; however, there is still no information how many of them use the Internet for health purposes.
Aim: The aim of the project is to investigate European health consumers' use of, their attitudes to, and their needs with regards to information and communication technology for health purposes.
Methodology: This objective will be achieved by conducting two biennial surveys (in 2005 and 2007) in seven European countries: Norway (project coordinator), Denmark, Germany, Greece, Latvia, Poland, and Portugal to ensure a broad European coverage and to compare different regions. The informants (1000 people, aged 15-80) will be representative samples of the participating countries' population. Both surveys will be conducted by national opinion poll agencies using telephone interviews. The study will use a cross-sectional comparison design. Data will be analyzed with descriptive statistics, correlations and comparisons. Trends' analysis will be conducted from the second survey.
Expected outcomes: Since the Internet is one of the most important sources for health information for consumers and patients, and its use for health purposes will probably increase during the study-period, this study will provide an useful input to public health and infrastructure policies, health care providers, researchers and commercial parties across Europe.
Telemedicine in africa and asia - desired or impossible?
Łęcka I.
Institute of Developing Countries Faculty of Geography and Regional Studies, Warsaw, Poland
The paper presents the state of the development of telemedicine in developing countries in Asia and Africa. The introduction contains advantages of the application of telemedicine with emphasis on the most expected ones in weaker developing countries. The main part of the paper presents the geographical conditioning in the application of the teleinformatic solutions in health care in Asia and Africa. Also the current state of the development of telemedicine in selected countries in the continents as well as of the obstacles in the spreading of its application.
In 2005 out of almost 6.5 milliard of the world population, around 5.3 milliard live in less developed countries. Health condition of the inhabitants of individual countries of the world and actual economic conditions determine the future use of telemedicine. In countries with wealthier, better educated and longer-living population (where the risk of chronic social diseases is greater) the use of telemedicine for health protection and improvement of health condition will be easier to accept. Such countries can also easier afford the introduction of the adequate technical equipment and the employment of qualified medical personnel for the servicing of the equipment and software. Poorer countries, whose inhabitants still fight diseases resulting from malnutrition and lack of hygiene, and where technical equipment of the existing health centres is inadequate, are in the most pressing need of telemedical services. Their introduction in such countries is however very difficult for financial and technical reasons. International aid creates a certain hope in such situations; it must be however continual, since computer equipment and software require constant maintenance, and have to be upgraded every few years - in particular if they have to be compatible with those used in cooperating medical clinics, domestic or foreign.
Hearing impaired speech rehabilitation application using animated avatar with non-verbal communication
Szczuko P., Kostek B.
Gdańsk University of Technology, Multimedia Systems Department, Gdansk, Poland
The aim of this study is to construct a computer application that will assist speech therapists in their work with hearing impaired children. The main stress in this research is on the creation of animated characters that will serve as an enforcement of learning skills. A child task is to repeat phonemes and syllables contained in lesson units pre-prepared by speech therapist. An animated character (avatar) performs different motions according to the answers given by a child. Depending on the answer avatar's acting expresses wide range of reactions while at the same time introducing reward aspect. The animation system consists of a database with basic motion sequences. Animation is directed with scripts including list of sequences from the database, time stamps for synchronization, and statements to display. It can also be integrated with speech recognition and text-to-speech systems. In the paper assumptions of such a system are described with the emphasis on the application for hearing impaired speech rehabilitation process having a motivational aspect. Present results and future work are also given.
Virtual hearing aid a multimedia tool for hearing training
Suchomski P.
Gdańsk University of Technology, Multimedia Systems Department, Gdansk, Poland
Most hearing impaired people are not aware about all possibilities of hearing impairment compensation. The multimedia technology allows to develop a smart software which can be helpful during the hearing aid fitting process. The designed virtual hearing aid software can be used as an approximate simulator of a real hearing device. The virtual aid can be fitted according to the desired hearing aid dynamics characteristics. The software allows to present benefits of using a well fitted hearing aid. It is also useful as a computer based training tool for the hearing impairment compensation characteristics adaptation process. Details of the virtual hearing aid implementation as well as of the elaborated fitting process and the hearing training procedure will be also presented in this paper.
Mobile digital assistant as a tool for telemedical support in radiology, orthopedic trauma and neurotraumatology
Glinkowski W.1,2, Wojciechowski A.3 , Ciszek B.3, Gil M.4
1 Chair and Department of Orthopedics and Traumatology of Locomotor System, Center of Excellence "TeleOrto" Medical University, Warsaw, Poland
2 Department of Anatomy, Center of Biostructure Research, Medical University, Warsaw
3 Department of Radiology, Medical University, Warsaw, Poland
4 Department of Integrated Teleinformatic Projects, Polkomtel S.A., Poland
There has been an increasing interest in the use of wireless handheld technologies, such as the personal digital assistant (PDA) in hospitals, worldwide. The commercial development and expansion of mobile phone networks has led to the creation of devices combining mobile phones and personal digital assistants. Recent reports suggest these devices may become necessary devices for physician's as the stethoscope. MDA's are superior to pager system in facilitating inter-professional communication in a hospital clinical team. A most important reason for this interest is the possibility that MDA's may support safer decision making and improved efficiency of healthcare delivery. Wireless networks and increased use of handheld devices have contributed to the development of mobile access to the Internet. MDA's having capabilities to connect to the Internet are useful for personal information management and various medical applications.
Material and Method:
Members of the team were equipped with Qtec 2020 MDA with web-browsing facilities, connected to a Plus GSM network. The purpose of this study was to utilize a mobile phone for transferring medical images to a specialist at a remote site in radiology, orthopedic trauma and neurotrauma emergency setting.
Images of patients' examinations and signs, symptoms were collected and transmitted for further evaluation by consultant radiologist, orthopedic surgeon and neurosurgeon. Cases of head, spinal and extremity trauma were subjects of evaluation. Direct digital or digitized images of X-ray, USG, CT and MRI images were transmitted via wireless network. Internet utilizing mobile personal assistants (MDA) with digital camera on both ends were used for teleconsultation. Memory cards were used for images storage and exchange between digital camera and MDA. Images originally obtained in DICOM format or converted were also sent and received. JPEG files can be compressed to reduce transmission time but it may influence on deterioration of image quality. To evaluate the quality of images received at the remote site, images were compressed at various compression ratios and transmitted to a MDA. The analysis revealed that the final image "readability" are its original size, quality and compression ratio dependent. Received and remotely evaluated for immediate "second opinion" images have had sufficient quality and resolution for reliable teleconsultation.
Conclusion:
A newer, more technologically advanced device, a combined personal digital assistant and mobile phone device may improve communication between doctors. Particularly, they support junior surgeons and radiologists with supervising consultant using telecommunication data transfer. Further, a large-scale clinical trial of the use of MDA's in facilitating inter-professional communication in a hospital setting is required. Original size and compression of images need to be optimized for clinical application. We find usefulness of MDA devices for teleconsultations in radiology, orthopedic trauma and neurotraumatology.
Expert system for risk stratification of patients with acute coronary syndromes
Grabowski M.,1,2, Rudowski R.1
1 Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Poland
2 1st Department of Cardiology, Medical University of Warsaw, Poland
Purpose: The aim of the study was to develop and evaluate expert system (ES) for risk stratification and therapeutic decision making in acute coronary syndromes.
Material and methods: Knowledge base contains rules according to the current guidelines. ES consists of: a) risk voting system which votes on risk on the basis of points counted according to 4 risk scores (SIMPLE, TIMI STEMI, GRACE, ZWOLLE) and on B-type natriuretic peptide levels (BNP); b) module suggesting the type of reperfusion therapy (invasive vs. fibrynolisis); c) module which chooses pharmacotherapy. The system was evaluated on medical data of 149 patients.
Results: Classification error for risk scores and BNP were: for SIMPLE - 8,05%; TIMI STEMI - 4,70%; GRACE - 6,71%; ZWOLLE - 6,04%; BNP - 11,41%. Developed majority voting system had the lowest classification error - 4,03%. Changes in cut-off number of votes on high risk resulted in sensitivity (from 50% to 90%) and specificity (from 93% to 100%) changes. Full agreement was seen between physician-expert and ES in decision for the need of reperfusion therapy; good agreement in decision for the type of reperfusion therapy (kappa=0,65), good for angiotensin converting enzyme inhibitors (kappa=0,69), beta-adrenolitics (kappa=0,705), nitroglycerin (kappa=0,69), furosemide (kappa=0,72), very good agreement for aspirin (kappa=0,889) and full (kappa =1) for heparin.
Conclusions:
1) developed voting system significantly decreased classification error to risk groups,
2) good and very good agreement was observed between ES and physician-expert.
Secure wireless networks in medical appliances
Woźniak J., Gierłowski K., Gierszewski T., Nowicki K.
Faculty of Electronics, Telecommunications and Informatics Gdansk University of Technology, Poland
Currently, we have been experiencing a dynamic growth in popularity of wireless networks. Wireless devices are getting affordable for individual customers, and many hardware manufacturers incorporate wireless network functionality in their products, like: notebooks, palmtops, smart phones, printers, GPS receivers, security or photo cameras. This list can be extended almost infinitely, because there are not many technical devices which cannot benefit from wireless connectivity.
With high cost the expensiveness barrier out of the way, we should expect explosive growth of wireless networking devices, and that is actually the case in personal and SOHO (small office, home office) use. In case of larger enterprises the use of wireless networks is still limited. The cause for this is lack of sufficiently matured and tested security and management mechanisms in currently available wireless network technologies.
Because of that, many of currently running wireless installations were intended for open use (meaning any user with compatible network hardware can connect). In this case there is no need for complicated security mechanisms and therefore management is also simplified.
If the network should be one with restricted access, we have at our disposal a number of mechanisms incorporated in standard hardware. Unfortunately, as said before, common network security mechanisms are considered insecure and additional management and security mechanisms should be employed to ensure protected access for a closed user group.
In our case, where we want to employ wireless networks in medical appliances, we are interested in both highly reliable and secure installation. I our presentation, we analyze a few scenarios of wireless network employment in medical environment. In most of these cases we want to provide advanced functionality in all aspects of network reliability and security:
- Data integrity - our data should be delivered without loss or change to it's destination. Malicious users should not be able to alter it or impair functionality of our network.
- Data confidentiality - unauthorized users should not be able to decipher transmitted data,
- Identity - identity of senders and receivers of information should be confirmed,
- Access control - unauthorized users should not be able to use our network resources,
- Access and network state monitoring - administrators should ensure network's proper working condition by monitoring performance and security related events.
We shall gather requirements which these scenarios put up before us, and compare them with abilities of currently available network technologies, to see if standard mechanisms provided by them will satisfy our needs.
As these, mentioned above, mechanisms often prove inadequate to the task and even flawed, we shall illustrate their weaknesses and provide examples how they could be exploited. If standard mechanisms are insufficient to provide security for our network, we need to look for alternatives - the next section of our presentation we dedicate to alternative methods of providing security and management services in secured wireless networks.
This order of presentation will allow us to display potential uses of wireless technologies in supporting tasks related to secure information acquisition, storage, management and access, which can prove very useful in medical appliances. Potential applications of currently available technologies will be shown, as well as their weaknesses and methods to remedy them. Technologies currently entering the market or being in stage of final development will also be presented.
"Multimedia communication" as a very important tool for ISO 13485 quality control in medicine and for medical devices.
L. Moser, Wuerzburg, Germany
My view will be mainly from the eyes of Audiology but the principles will be valid for all faculties. Quality control is not finished with a single task, quality control is a never ending task. Carl Friedrich Gauss, the mathematician from Göttingen is one of the masters of QC with his normal distribution. Quality is a continuous process of observation, data logging and control. In ISO this is called audit. This can be done with less physical travel to do the audit and with "live" inspection by multimedia communication. My paper will present examples for very old procedures like pure tone audiometry and very modern ones like newborn screening or complex digital hearing aids.
Progressive and interactive modes of image transmission: optimized wavelet-based image representation
Przelaskowski A., Hałasa P., Rives D.
Institute of Radioelectronics, Warsaw University of Technology, Poland
Enhancement of image data transmission for telediagnosis and PACS/RIS applications. We look for scalable image data representation to increase diagnostic quality of progressively encoded, transmitted and reconstructed image exams in relation to amount of processed bits.
Energy packing in the areas of diagnostically important image features and extraction of pathology symptoms was sought.
We studied and designed the following compression modes and conditions to make image representation more user friendly:
a) possibility of interactive influence on the parameters of transmitted data stream;
b) region of interest (ROI) progression;
c) diagnostic quality progression;
d) useful interface.
Materials
We used images of different modality, especially huge mammograms and radiograms. Mammograms were collected from 3 Warsaw medical centers.
Other reference mammograms were taken from DDSM. Radiograms were collected from Internet sources. More medical test images were taken from JPEG and JPEG2000 test data files. Over 100 images were considered.
Network infrastructure of Warsaw University of Technology was used in the experiments.
Methods
First of all JPEG2000-based image encoder (accepted by DICOM) was optimized but other multi-scale decompositions and data stream forming techniques were considered. We studied a possibility of wavelet decomposition enhancement (kernels and subband distribution) and modified rate-distortion optimization by improvement of a procedure of data stream creation and forming. We performed our experiments in collaboration with radiologists.
/- JPEG2000 medical standard/
An important reason for this DICOM acceptance was that it allows transmission of images with improving resolution and quality, which will be extremely useful in teleradiology and in some PACS network environments. The adoption of JPEG2000 as a standard by the ISO and its inclusion into DICOM is a validation of the newer technology and the logical result of the desire for a more advanced yet standardized method of compression and transmission of medical images.
/ - Acceleration of coding: faster rate control/
Standard quality and precise rate control procedure was accelerated by proposed algorithm of information selection with passes sorting (ISPS).
Time consuming iterative procedure was replaced by R-D sorting of successive data block.
/ - Optimization of coding: selection of decomposition and progression/
Useful interface with clearly defined options of coding process was realized. Experimental selection of coding parameters allowed establishing JPEG2000 presets for mammograms, radiograms, CT, MR and US exams. The following parameters were optimized: wavelet base, multiscale decomposition, progression mode.
/ - Acceleration of transmission: Progressive Interactive Internet Codec (PIIC)/
Essential codec feature is progressive image data stream decoding and reconstruction in interactive process. High performance of 'image source device' - 'image diagnosis station' connection was assured.
Results
High efficiency of progressive and interactive transmission was realized. Significantly increased quality of images in comparison to JPEG2000 (part I) and JPEG coders was noticed. PSNR and subjective rating was used as the image quality measures. Moreover, accelerated compression process was achieved and different progression modes were verified (interactively ROI-oriented, layers, resolution and precincts-oriented).
Conclusions
JPEG2000 standard describes effective tools for progressive image data transmission in digital medical imaging applications: PACS-RIS, telediagnosis, CADs. However, optimization of data transformation, selection and stream forming procedures can significantly improve standard implementations available nowadays in the market. Diagnostic quality enhancement and accelerating coding process of applied compression tools can actually improve image-oriented real-time diagnostic systems.
Education in biomedical engineering
Nowakowski A.
Department of Biomedical Engineering Gdansk University of Technology, Gdansk, Poland
The aim of this presentation is to show the present situation in education of biomedical engineering in Poland in broader historic context and taking into account the global situation, but especially initiatives in Europe.
Education in biomedical engineering in Poland has a long lasting tradition, as for the first time the MSc course started in 1946 in Warsaw University of Technology, in parallel to a similar initiative taken at the same year in London. Today, almost 20 sites in several Polish universities are strongly involved in different aspects of biomedical engineering education at BSc, MSc and PhD levels. Just recently, minima of the newly accepted educational direction called - Biomedical Engineering - have been accepted and approved by The Central Accreditation Commission. At the beginning 6 technical universities are involved in preparation of specific for each site programmes. The general schemas of BSc and MSc programmes are discussed. The activity of the Biomedical Engineering Department TUG (http://www.eti.pg.gda.pl/katedry/kib) is presented.
Initiatives performed in several Polish universities are pushing forward development of distance learning tools, devoted for normal BSc or MSc study courses as well as for extramural or distant learning courses. The initiatives taken in Gdansk University of Technology are especially discussed. Most important educational service is the Medtech (http://medtech.eti.pg.gda.pl), comprising of around 2000 pages accompanying by tests, allowing control of student knowledge. This service is highly appreciated by many universities using it as a basic Internet textbook for medical engineering education. At present several new vocational courses are under development in the project "KNOW- Kształcenie na odległość wspierające rozwój kwalifikacji zawodowych". The features of the courses and experience gained are concluding the presentation.
Internet-based knowledge in medical practice. Should doctors be under obligation to search information in each case?
Kasztelowicz P.
Departament of Pulmonary Diseases. Ludwik Rydygier Hospital, Torun, Poland
Internet Based Knowledge in medical practice can be defined as using information achieved from Internet (including websites, electronic journals, articles from electronic version of standard medical newspapers downloaded from network, consultation performed by Net or in form of discussion on medical list or discussion board) provided to help or verify knowledge to treat any (specific) patient. This idea differs from using internet as standard sources to achieve educational information, which is not specifically joined with any patient under doctor's care.
I see this as a way to search the best possibilities of diagnosis and therapy for currently managed patient from entry diagnosis till decision making. Conception to search information suitable for any, currently managed patient has been originated from known difficult cases, which was solved by help of large consultation and help found during discussion and searching information on net. A hypothesis can be discussed, using Internet Based Knowledge to solve more difficult cases can successfully improve patient management by finding best method to treat as well as specialised centre, which can offer a best care. I will attempt in this article to discuss all problem associated with including Internet Based Knowledge to "every day" practice. This will include technological, sociological, organisational, legal and educational problems, but solving it can assure ability to improve patient care by using information enhanced in net "in real time".
Speech recognition system providing assistance to people with hearing impairments
Dalka P., Kostek B.
Gdańsk University of Technology, Multimedia Systems Department, Gdansk, Poland
This work presents research results in the domain of speech recognition providing assistance to hearing impaired people. The system engineered uses both visual and acoustic data for speech recognition in order to facilitate speech training of patients with serious hearing impairments. The Active Shape Model method is utilized for extracting visual speech features from the shape and movement of lips. The acoustic feature extraction process involves mel-cepstral analysis. These two modalities of speech form feature vectors used in the classification process. An artificial neural network is employed as a classifier allowing recognition of speech utterances. Additional experiments with the degraded acoustic information are carried out in order to test the system robustness against various distortions affecting the signal.
Array technology for efficient communication
Diemer de Vries
Laboratory of Acoustical Imaging and Sound Control Delft University of Technology, The Netherlands
Wave Field Synthesis (WFS) is a concept introduced in the 1980s by Guus Berkhout, then leader of the Delft Acoustics Group. Using closely spaced arrays of loudspeakers, it enables to image a sound source at a fixed point in space, such that all listeners in the audience area perceive the source at its correct position - and not only in a restricted 'sweet spot' as is the case for the usual reproduction formats. This also holds for moving sources. Among many other applications, the concept can effectively be used in teleconferencing between larger groups of participants: even when people walk around it is clear at the other side who is speaking. When, instead of arrays of traditional loudspeakers, MAPs - Multi-Actuator flat Panel loudspeakers - are used which can simultaneously be used for video projection, a full multimedia integration can be achieved. This approach can well be applied to medical telecommunication and education.
As the reciprocal of WFS, the concept of array-based Wave Field Analysis (WFA) was introduced. Recording the sound field of a source with a closely spaced array of microphones takes the spatial correlation between the individual responses into account and enables beam-forming, such that the recording can be focused in a certain direction or at a certain point. A medical application could be to focus, from a non-disturbing distance, a microphone array on the mouth of an operating surgeon, such that his commands to his assistants are clearly understandable, without frustrating the medical process with the presence of nearby electro-acoustic equipment.
First results of a TP project based on internet for second opinion in developing countries in south east asia
Stauch G.1, Kunze K.D.2, Haener C.3, Vathana Ch.3, Bounthom S.4, Oberholzer M.5, Haroske G.2, Oberli H.6, Atisook K.7
- Department of Pathology, Aurich
- Department of Pathology Klinikum Neustadt, Dresden
- Sihanouk Hospital Center of Hope, Phnom Penh
- Department of Pathology Medical Faculty, Vientiane
- Department of Pathology Kantonspital, Basel
- Referral National Hospital, Honiara
- Department of Pathology Siriraj Hospital, Bangkok
Introduction:
Second opinion is necessary in routine pathology in respect to diagnostic of complex and rare cases, which needs expert consultation as well as in routine cases to evaluate diagnostic quality.
In industrialised countries there is sufficient number of pathologists and experts in all fields of morphology. Blocks or slides can besent very easily to any pathologist in Europe within 24 hours and the diagnostic turnaround time can be reduced to this time.
However in emerging and developing countries there is a shortage of pathologist manpower and a difficult access to expert rounds. In these countriesTelepathology (TP) seems to be a tool for second opinion.
Table I. Economy and Medical Quality in Countries of South East Asia
| Country | HDI |
Infant morta- -lity |
Life expec- -tancy |
Population | Pathologist |
| % | a | n(million) | n | ||
| Thailand | 66 | 25 | 69.6 | 62.4 | 150 |
| Vietnam | 110 | 45 | 67.2 | 78.7 | unknown |
| Myanmar | 118 | 90 | 55.8 | 47.7 | unknown |
| Cambodia | 121 | 85 | 56.5 | 13.1 | 2 |
| Laos | 31 | 95 | 52.5 | 5.4 | 1(+1) |
| Germany | 12 | 3.6 | 74.6 | 88 | 1500 |
HDI Human Development Index is ranking 162 countries based on different indicators
Rank 49 - 125 represents emerging countries, 126 - 162 developing countries. Infant mortality and life expectancy are indicators of quality of medical care
History:
- I-Path, a group of pathologists of University of Basel established a telepathology station and a small lab in Referral National Hospital Honiara, Salomon Islands in 2001 and covered also the request for second opinion from Department of Pathology University Dhaka, Bangla Desh from the beginning of 2002.
- DIAGAID a Thai - German group of pathologists established in 2002 a telepathology station and a small histo - lab at Sihanouk Hospital Center of Hope (SHCH) in Phnom
Penh, Cambodia and a donated in January 2003 a TP station to the Department of Pathology of the Medical Faculty in Vientiane, Laos.
There is an identical basic scenario in Honaria and Phnom Penh: new labs were established and the peripheral senders have only low experience in histopathology. In Vientiane a fairly trained pathologist is selecting the cases, whereas the Dhaka pathologist is an experienced expert in neuropathology.
Until September 2003 more than 700 requests were sent from the 4 peripheral partners.
Results:
Table II. Number of second opinion requests
| 04/2001 | 06/2002 | 12/2002 | 06/2003 | 09/2003 | |
| Honiara | 15 | 20 | 80 | 164 | 359 |
| Dhaka | 30 | 20 | 114 | 222 | |
| Phnom Penh | 20 | 133 | 233 | ||
| Vientiane | 23 | 45 | |||
| 15 | 50 | 120 | 434 | 759 |
We analysed the PNH project as an example for TP project in developing countries.In December 2001 the decision was made to establish a Histolab and TP station at SHCH in PNH. The sponsored material technical equipment was sent within 3 month to PNH, a histolab was settled and technicians were trained within 2 weeks. The diagnostic service started in July 2003. A total amount for establishing the lab and training the technicians were calculated with Ź 14000.
Telepathology consultation started in October 2002 and the request covered all diagnostic fields. The first 45 cases were re-evaluated.There was a prevalence for slight breast and serosal lesions.
Table III. Quality of PNH SO first 45 cases
| n | CD % | RD % | |
| Breast | 10 | 70 | 20 |
| serosal membranes* | 10 | 90 | 10 |
| thyroid gland | 8 | 75 | 12 |
| GI tract | 9 | 89 | 11 |
| LN | 8 | 50 | 12 |
| 74,8 | 13 |
* Cytology
CD certain diagnosis
RD referred diagnosis
11 images in average per case were submitted to the experts. The second opinion was given by the expert within 24h, in cases of requesting additional images the average turn around time were extended to 72h. A certain TP diagnosis was given by the expert in 74,8% ranging from 50% in lymphnodes up to 90% in cytological specimen of serosal effusions. In 13% a diagnosis was refused due to the complexity of diagnostic problems. The image quality depending on poor quality of slides and the lack of immunohistochemistry.
Analysing the first 25 primary refused diagnoses the experts asked in 96% for better staining, in 60% for additional image mostly in higher magnifications to get more detailed information, and in only 1 case for immunohistochemistry.
Analysing the results of the beginning of the project we found the essentials for telepathology:
- Confidence of experts in the field selection done by non experts, based on personal structure of the laboratory providing good slide quality and a basic panel of staining procedures.
- Organisation structure, which makes it possible to reduce diagnostic turnaround time to a minimum.
- Competence of non-experts in selecting diagnostic spots and of experts who are familiar with reading the images.
Essentials in Telepathology
| Competence |
Technicans Non Expert Expert |
| Structure |
Laboratory Organisation |
| Confidence | Contact |
Ranking the factors influencing the quality of TP diagnostic we evaluate the major importance of slide quality to the quality of technical equipment. Analysing different systems for image capturing was found the use of 1chip cameras for more comfortable for non-experts even when the investigation costs are higher compared with those of digital cameras.
Future:
On the basis of established projects there should be an extension of local function to teleradiology and teledermatology as well as teleteaching providing exact image. The existing project should be a nucleus to national projects especially in telecytology and should be linked to other existing networks world wide.
Conclusion:
Summarising the aims of DIAGAID and I-Path telepathology is the first step in diagnostic need from foreign aid to self aid in developing countries.
Ealth on-line in poland - the national e-health implementation plan. Towards obtaining pan-European interoperability
Skawinski W.
National Centre for Health Information System. Warsaw, Poland.
Developments in information and communication technologies will have a profound impact on health in the coming decades. The development of telemedicine should be driven by the health needs of people, in accordance with their functional and operational capabilities, assuring eqiutable access to information for all. The lack of products complying with standards is one of the main reasons for the sub-optimal use of Information and Communication Technologies (ICTs) for health. The eEurope 2005 Action Plan proposes policy measures to bring about modern on-line health servicies. The CEN/ISSS e-Health Standarization Focus Group has provided recommendations for establishing an interoperability platform for e-Health to facilitate co-operation between Member States.
Based on the directive of the Council of Ministers on the public statistics, the National Centre for Health Information System prepares annual statistics concerning the public health sector. The recent data have revealed that the distribution of the modern medical equipment ( CT, MR, ECHO, EEG, Digital Radiography)is not even in Poland. The National Centre for Health Information System acting as a mandatory of the Health Ministry has elaborated "The e-Health strategy for Poland in 2004-2006 years" and "The strategy of the development of health care in Poland in 2007-2013 years". Both strategies have been accepted by the Council of Ministers. Next the Operational programme "Health 2007-2013" was preapared and accepted by the head of the Health Ministry in September 2005.
The immediate focus of these documents is on the tackling innovation in information technologies for health. This is of the highes importance to accomplish the European policy for the prevention of informatic exclusion. An action plan for a European e-health area was accepted by the European Economic and Social Committee and the Committee of the Regions in 2004. By end 2006, Member States, in collaboration with the European Commission, should identify and outline interoperability standards for health data messages and electronic health records, taking into account best practices and relevant standardisation efforts.
According to EC recomendations, the establishing of an international multilingual terminology is to support the cross-border mobility of patiens and facilitate their access to medical services. Starting new and developing existing telemedicine projects Polish stakeholders should take into account future needs of international health market.
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