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SIT EXPO 2004 – E-HEALTH CONFERENCE CASABLANCA - 20 – 21 FEVRIER 2004 TELEMEDECINE EXPERIENCE TUNISIENNE Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED.

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Présentation au sujet: "SIT EXPO 2004 – E-HEALTH CONFERENCE CASABLANCA - 20 – 21 FEVRIER 2004 TELEMEDECINE EXPERIENCE TUNISIENNE Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED."— Transcription de la présentation:

1 SIT EXPO 2004 – E-HEALTH CONFERENCE CASABLANCA - 20 – 21 FEVRIER 2004 TELEMEDECINE EXPERIENCE TUNISIENNE Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP DEVELOPPEMENT ET EXPLOITATION EVALUATION ORGANIZATION PROJETEE EVOLUTION VERS LA TELE SANTE

2 DEVELOPPEMENT ET EXPLOITATION The first application was implemented in 1996 by Tunisian and French physicians working in children academic hospital of Tunis and in LaTimone hospital of Marseille France : EACH USER TERMINAL IS EQUIPPED BY : * A Basic PC with high quality screen 19" * A Network interconnexion TCP/IP Mode, using ISDN Network 128 Kb/s * Standard MS Office Tools * Internet Browser * Software Medical Document Management (Sigmacom) * Document Scanner * X Ray image scanner * Exchange Medical Data Package : X Ray images, Medical documents and Informations about Patient * Remote Assistance : Telediagnosis, Teleconsulting, Teleassistance * develop research cooperation * Exchange some training Case -Supports Telemedecine application was identified in 1995 in the Health Telematics Plan Studies – (1996 – 2000) period. Printer Video cam Hospital Scanner A3 Scanner A4 Documents Video cam LAN ISDN

3 The second application was implemented in 1996 by physicians working in the anticancerous institute of Tunis and Lacassagne Anticancerous Hospital of Nice France * It completes the first experience by telepathology application and Videoconferencing application * Exchange complete medical data package : scans, X-RAY image, PATOLOGY ANATHOLOGY image, diagnosis, reports. * Real time monitoring of appliances (Microscope) * Medical document acces during the conference * Training and support informations EACH USER TERMINAL IS EQUIPPED BY : - Basic PC (Pentium) - High Quality Scren 19" - Standard MS Office Tools - Network inter connexion on TCP/IP Mode : * ISDN connxion 128 Kb/s speed for telemedicine applications (Transfer,monotoring) * ISDN connexion 384kb/s speed for Videoconferencing - Internet Browser - Conferencing equipment (Tv Monitor - Mobile camera, fixed camera, microphone, loudspeakers….) - Conferencing software on H320 standard. - Real time acquisition/monitoring Interfaces. - Software medical document management (Mediolis). - Image standard conversion DICOM3/JPEG - medical Peripherals (Scanners And Micoscope Medical Devices) – Telemedecine station Printer Video cam Hospital Scanner A3 Scanner A4 Documents Video cam LAN ISDN

4 The Development Of Information Society over the world, The definition of a solid national policy on information technology in Tunisia The important telecomunication investment progress in Tunisia The Vertiginous growth of telecomunication technologies and multimedia systems The availability of computers capabilities. The positive telemedecine experience evaluation and sudden awarness of it benefits. Suggested to the Health Ministry to define Telemedicine policy : * For defining strategy and keeping of the plan achievement a national committee of telemedicine was constitued by minister decision on 15 May MEMBERS ARE : * General Director of Health - Public health Ministry * Representative member of Science Research and Technology secretary of state. * Representative member of Informatics and Internet secretary of state. * Representative member of Public telecommunication Operator : Tunisia Telecom Working partner is the health ministry informatics centre. THE TELEMEDECINE COMMITEE Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP

5 3 FRENCH SITES : Acces mic hospital - Latimone Marseille - Lacassagne Nice - CHU Grenoble 4 SPECIALISED HEALTH CENTRES IN TUNISIA : - Children Hospital - Tunis - Cancerous Institute - Tunis - National Neurology Institute - National Orthopedic Institute 3 GENERAL ACADEMIC HOSPITALS - Rabta Hospital - Charles Nicolle Hospital - La Marsa Hospital 3 REGIONAL HOSPITALS : - Le Kef Hospital – Western North - Gafsa Hospital – Western Saouth - Gabes Hospital – Eastern Saouth THE APPLICATION ARE : TELERADIOLOGY – TELEPATHOLOGIE AND VIDEOCONFERENCING The Telemedecine network is constitueted by : TELEMEDECINE APPLICATION :

6 Technical Architectue of a Telemedicine Solution : Exemple : TELERADIOLOGY ISDN Imagery equipements ISDN – 1x128Kb Hospital 2 Printer Video cam Router RJ 45 Hospital 1 3x 128Kb Scanner A3 Scanner A4 Documents Video cam Imagery equipement LAN LAN Router Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP

7 TECHNICAL CONSIDERATIONS Adoption of commun standards : a must for cost effective exchange of any information : - Facilitate ther capturing, sase communication and structured management - TCP/ IP Network Protocol - DICOM 3 : Direct aquisition of image equipement protocol - H320 – H323 : Videoconferencing protocol to provide voice – Data and Video - HL7 : Direct Acquisation off Laboratory Results protocol - NTSC, PAL, SVGA : format Video - G711 – G722.1 Standared Audio - T120 : Remote sharing application protocol - JPEG – MPEG : Imaging Format Protocol - HTML : Document Format Protocol This to satisfy : Compatibility and Interoperability between diffirent systemS Adoption of image data and uniformed security technique - User : Profile and Institution - Content : Primarely informations and knowledge - Usage : Management and governance - Technological applicants : Computing, Networking and Telecomunication

8 Consist to go on national healthnet over which would cooperate on sharing patient records. 4 Academic specialized hospitals : * Tunis Children Hospital * Tunis Anticancerous Institute * Tunis Orthopedic Institute * Tunis Neurological Institute 8 General Academic hospitals: * Charles Nicole Hospital in Tunis * La Rabta Hospital in Tunis * Aziza Othmana Hospital in Tunis * Mongi Slim Hospital in Tunis * Fattouma Bourguiba Hospital in Monastir * Tahar Sfar Hospital in Mahdia * Habib Bourguiba Hospital in Sfax Defined in Health Telematics plan studies for period. * Farhat Hached Hospital in Sousse APPLICATIONS REPARTING NEW STRATEGY TO HAVE PRIORITY

9 2 Regional hospitals situated in Western South : * Gafsa Regional Hospital * Tozeur Regional Hospital 2 Regional hospitals situated in Eastern South : * Zarzis Regional Hospital * Gabes Regional Hospital 2 Regional hospitals situated in Western North: * Le Kef Regional Hospital * Jendouba Regional Hospital cooperation with European institute * 4 French Academic Hospitals : Marseille – Nice – Grenoble - Toulouse * 1 Belgium Hospital: ERasme Hospital * 1 Italian Hospital : ST.Rafaelle Hospital Rome All these organizations are equipped by * Teleradiology solution * Telephatlogy solution * Videoconferencing solution

10 Tunis ISDN Hospital La Cassagne (Nice) Purpan Toulouse { WESTERN NORTH { WESTERN SAOTH } EAST SOUTHERN Latimone Marseille Sfax ERasme Hospital Bruxelles ST.Rafaelle Hospital Rome Zarzis Gabes Jendouba Le Kef Gafsa Tozeur Sousse Grenoble ALGERIA LYBIA Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP

11 Bizerte JENDOUBABEJA NABEUL ZAGHAOUN LE KEF SELIANA KAIRAOUN KASSERINE SIDI BOUZID MEHDIA GAFSA TOZEUR KEBILI GABES DJERBA MEDNINE TATAWINE Hospital and Medecine Universities Health Map 15 Acadimic hospitals 3 Regional hospitals 1 Medecine Faculty 2 Hight School of health Science And Technologies TUNIS SFAX 2 Acadimic hospitals 3 Regional hospital 1 Medecine Faculty 1 Hight School of health Science And Technologies BENGERDE N Acadimic hospitals 2 Regional hospitals 1 Medecine Faculty 1 Hight School of health Science And TechnologiesMONASTIR 1ZERZIS1 1 ALGERIE LIBYE 2 Acadimic hospitals 1 Regional hospitals 1 Medecine FacultySOUSSE Regional hospitals 3636

12 OBJECTIVES : Extend professional services and uses of equipment to remote and rural areas Raise the level of diagnosis services Contribute to the equity of access by all the population to quality care services Avoid unprofitable evacuation of sick patients to academic hospital from regional hospital Increase the productivity of the daily work of health professionals or specialists Provide powerful collaboration tool for simultaneously staff work when the case concern a critical situation or a critical policy matter Improve the support on diagnosis and proposed treatment (Neurology emergencies - Orthopedic emergencies…). Provide interactive Video conferencing capabilities and teleradiological reading sending data and Images Plan the telestaff and keep practitioners and specialists in touch with the last developments. Enhance researches and medical scientific publications accompanied by Image and patient documents. Develop a large health information system. Spread the medical education to any member of network scattered over academic, regional hospitals or local care centres.

13 EVALUATION Telemedecine applications will : Encourage the equity through offering same health utilities of all citizens. Encourage physicians, specialts and young practitioners to work in the long way region in the regional and local hospitals. Ensure a sustained training and experience for all medical sector. Avoid the unprofitable patient transport and unless examination (X-RAY, pathology, loboratory analysis) Enhance the medical research and the participation in international research programs Permit to develop training to have access to universal knowlege bases Au vu des objectifs arrêt é s Partage des connaissances entre praticiens

14 Meilleur utilisation des é quipements m é dicaux lourds par : Le Parrainage des HR par les CHU Les T é l é -staffs Le T é l é enseignement Il a é t é constat é pour les sites é quip é s 13 Sites de T é l é -radiologie et 2 Sites de T é l é -pathologie : Un Faible volume de donn é es transf é r é es Une Faible communication entre services hospitaliers l organisation n est pas au point l aspect juridique n est pas trait é Les co û ts des communications sont é lev é s

15 Les applications de T é l é -m é dicine ne sont pas cibl é es : le t é l é -diagnostic dans les cas d urgence le t é l é -enseignement la t é l é -consultation pour avoir une seconde opinion Le t é l é staff Le plan de charge pr é visionnel nexiste pas Organisation projet é e : Pour palier au manque de sp é cialistes à l int é rieur du pays et dans les zones rurales et pour d é velopper le travail en équipe et la recherche. Cr é er un Centre National de Telemedecine au Service des Praticiens é loign é s, dot é s de stations compl è tes et d un r é seau de communication performant : Pour traiter et donner un avis de Senior dans le cas des urgences graves ( accident é s de la route, accident é s du travail, attaques cardiovasculaires et autres ….) Pour tenir des telestaffs auquels prendront part les medecins exercant dans les zones é loign é es.Ces T é l é staffs concernerait la medcine de pointe et des cas difficiles ou atypique.

16 Pour assurer un service r é gulier de t é l é enseignement. En temps r é el En temps diff é r é Pour g é rer un service de Biblioth è que Virtuelle M é dicale Pour assurer La veille Technologie dans le domaine de la m é decine de pointe Les Pr é requis Technologiques Communication ais é e de Bout en Bout en large bande Echange d information multim é dia Internet - Fax - T é l é phone ISDN - Fibre optique – Satellite - ADSL Support Technique (Installation – Maintenance – S é curit é ) Choix des é quipements ( é tat de l art) Fiabilit é des techniques de Compression Utilisation des divers technologies de communication

17 Les Pr é requis Organisationnels Disponibilit é 7x24, nuits, week ends * aux Gardes * à la Facturation * à la Transmission des Comptes Rendus * à l é valuation et à l é laboration des Statistiques d Activit é Responsabilit é Civile * Certification et Confirmation des m é decins * Authentification des Comptes Rendus R é glementation des honoraires – (vacataires ou heures suppl é mentaires) Par acte de base Contrat annuel R é solution des probl è mes li é s

18 Arrêter la m é thode d estimation des co û t en tenant compte de : Des Investissements en é quipements au niveau du Centre de T é l é m é decine et du Centre demandeur Co û t de la maintenance Co û t des communications Co û t de la logistique administrative Evaluation de l activit é Volume des cas Types des cas Nombre d image par cas Temps moyen n é cessaire par cas Satisfaction des usagers Qualit é des images (excellente, bonne, moyenne) Exactitude des diagnostics

19 Fiabilit é des techniques de transmission et de r é ception des images Taille des images : 1 image de m é decine nucl é aire : bytes = 16 Ko 1 image Mammographie : bytes = 16 Mo Arrêter une technique et une politique d archivage : Au niveau : * du transmetteur (exp é diteur) * du Receveur * des Deux Archivage total ou s é lectif des images Pendant combien du temps * Sous l aspect m é dical * sous l aspect l é gal Utiliser des techniques fiables des compressions d images

20 Type d archivage : On line (acc è s rapide) Sur disque : RAID Co û t de l archivage é lev é Off line (acc è s lent) Bandes – CDS – disque amovibles Co û t de l archivage faible

21 EVOLUTION VERS LA TELESANTE

22 Network Platforms Platforms Health Care Personalization Portals HomeCare PatientDiscussionrooms Tele-Consultacy Wireless ASP Medical Data Base Content DistanceTeaching Rural Health Care Information Services Doctor to PatientMessaging Tele-Radiology Gaming Internet vs Telemedicine : a Web of solutions… …each with a personalized solution MedicalLibraries Telemedicine

23 NOUVELLES OPPORTUNITES POUR LA TELESANTE DUES AU MOBILE LARGER DIFFUSION OF E-HEALTH APPLICATIONS FOR E-LEARNING, EASIER CLINICAL INFORMATION RECOVERY, ETC, PATIENTS TRACKING (MONITORING OF VITAL SIGNS, ANYWHERE, ANYTIME) PERSONAL CARE IN NORMAL AND IN EMERGENCY SITUATIONS E-HEALTH DEPLOYMENT IN DISASTER AND EPIDEMIC SITUATIONS LARGER DIFFUSION OF E-HEALTH APPLICATIONS FOR E-LEARNING, EASIER CLINICAL INFORMATION RECOVERY, ETC, PATIENTS TRACKING (MONITORING OF VITAL SIGNS, ANYWHERE, ANYTIME) PERSONAL CARE IN NORMAL AND IN EMERGENCY SITUATIONS E-HEALTH DEPLOYMENT IN DISASTER AND EPIDEMIC SITUATIONS

24 CONCLUSION The telemedecine is a great future technology Regarding on the personnel disponibilities, the organisations capacities,the budget ressources and quality of international health cooporations 3 Key words : * Canalizing * Guiding * Optimizing The trends of the new telecommunication technologies gives us : * More services abilities * More security * More quality in life The benefits for developping countries are largely proved by improving health care services, medical researches and reducing costs

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