from ideas to state of the art projects. the german telemedical network nest
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III Meeting on eHealth and Telemedicine
FROM IDEAS TO STATE OF THE ART PROJECTS. THE GERMAN
TELEMEDICAL NETWORK NEST
June 17th 2009Santander
Mr. Ywes Israel, M.A.
III Meeting on eHealth and Telemedicine
Agenda
Introduction NEST Joint Projects StrokeNet Tele Care System (TCS) The new Challenge - Examples
III Meeting on eHealth and Telemedicine
Networks in Germany
In Germany many company-networks with different focuses (as for example on security issues or medical applications) exist.
Also the German Government supports enterprises in forming networks. While some networks develop innovative products/ services or international co-operations others fall apart very quickly.
Purpose of this presentation is to show promising factors, based on the example of NEST.
III Meeting on eHealth and Telemedicine
Network for integrated Systems in Telemedicine
Why in Berlin-Brandenburg?
widely acknowledged research and science community High concentration of hospitals, clinics, and medical
research and care facilities the region is recognized as a centre of innovation in
health care International health projects and patients
NEST pools the available resources in the field of telemedicine and taps the full potential.
III Meeting on eHealth and Telemedicine
Health City Berlin
67 Hospitals 17.700 Physicians 3.700 Dentists 180.000 people working in the
health industry 50.000 employees in science
and research 22 pharmaceutical businesses 150 Medical-engineering
enterprises 160 Biotechnology firms 70 Independent Research
institutions 4 Universities 7 technical colleges
Fields of Specialization
German Heart Center Berlin First Laser Hospital First completely digitalized
Hospital First Clinic for minimal
invasive surgery Institute for Proton-therapy First Neuro-imaging Center http://
www.gesundheitsstadt-berlin.de/
III Meeting on eHealth and Telemedicine
Telemedicine in Berlin
Berlin offers a huge range of hospitals, research institutions as well as companies in the health care sector
One of them: NEST- Network for integrated Systems in Telemedicine
NEST involves more than 20 participants from all healthcare-domains, i.e. hospital operators and service providers, universities and research institutions, small and medium sized companies with special focus on IT solutions for the healthcare sector
Driven by hospital and medical needs
III Meeting on eHealth and Telemedicine
Network for integrated Systems in Telemedicine
founded in 2005, supported by Federal Government NEST involves more than 28 participants from all
healthcare-domains, i.e. hospital operators and service providers, universities and
research institutions, small and medium sized companies with focus
on IT solutions for healthcare and on medical technology from Germany
Common objective: improving healthcare through telemedicine, by developing new treatment paths, products and services
III Meeting on eHealth and Telemedicine
NEST bundles competencies in
Virtual microscopy, Telemonitoring, object tracking, blood pressure measuring tools, patient records, anonymisation and pseudonymisation, middleware, modular clinical paths, support for clinical trials, efficient documentation procedures,
research on knowledge based systems, semantic web, functional telemedical standards
Healthcare service for international patients NEST aims to support the network partners in developing
and marketing products, systems and methods in the area of “eHealth / telemedicine”.
III Meeting on eHealth and Telemedicine
NEST Partner
III Meeting on eHealth and Telemedicine
NEST Partner
III Meeting on eHealth and Telemedicine
Management by TimeKontor AG
TimeKontor is working as a business enabler.
established between politics, economy and science activities focused on areas, where ICT play a key role, expertise in IT security, eHealth, and Serious Games within the network management TimeKontor supports in
Identification of business opportunities Initiating and accompanying innovative projects and
cooperation and its financing Knowledge transfer (organization of international
workshops and conferences)
III Meeting on eHealth and Telemedicine
NEST at international Events
Arab Health 2006 Zdravoochranenije 2006 Arab Health 2007 II International Moscow Conference on
Information and Telemedical Technologies in Healthcare 2007
Zdravoochranenije 2007 Arab Health 2008 Hospimedica India 2008 RomMEDICA 2008 2-nd International Conference on
Telemedicine: Myths and Reality Partnering Day in Tel Aviv and
Jerusalem 2008
III Meeting on eHealth and Telemedicine
International Cooperation
Cooperation with international partners
Cooperation with APAN – Japanese telemedicine association (September 2007)
Scientific Exchange between the Medical State University in Moscow and the ALS Ambulance in Berlin on Amyotrophic Lateral Sclerosis (April 2008)
Cooperation with Ukrainian Telemedical Association
Cooperation with Aserbaidschan & Kazakhstan
III Meeting on eHealth and Telemedicine
Agenda
Introduction NEST Joint Projects StrokeNet Tele Care System (TCS) The new Challenge - Examples
III Meeting on eHealth and Telemedicine
NEST- network
Driven by hospitals and their medical needs
Focus of NEST: enabling partners to tackle new joint projects developing and marketing innovative products and
convenience solutions
Topics within the network: Interfaces (TM7) Symptom related projects (ALS-Manager) Disease related projects (StrokeNet)
TimeKontor- network management eHealth and security
III Meeting on eHealth and Telemedicine
Joint Projects
TM7- Development of a standard for telemedicine
which combines the ease of existing standards (Dicom, HL7) with the excellence, precision and functionality of proprietary solutions from its partners
TM7 will be used for transmission of (picture, sound) data, communication of devices as well as for tele- controlling of medical equipment
III Meeting on eHealth and Telemedicine
Joint Projects (1)
ALS Manager
Development and establishment of an internet platform for patients with ALS (Amyotrophic Lateral Scleroses) and their caregivers
for more efficient clinical studies and a qualitative
improvement of patient provision
III Meeting on eHealth and Telemedicine
Agenda
Introduction NEST Joint Projects StrokeNet Tele Care System (TCS) The new Challenge - Examples
III Meeting on eHealth and Telemedicine
Joint Projects (2)
StrokeNet
Development of a telemedicine system for Ambulances transmitting monitoring and vitality functions, picture and
sound between mobile intensive care units and a specialised stroke unit
use expertise of stroke specialists for the immediate treatment
Patients and their caregivers benefit from reduced assistance requirements and shorter rehabilitation periods
III Meeting on eHealth and Telemedicine
StrokeNet - in brief
telemedical system in ambulances, stroke
units and cooperating hospitals for stroke-
treatment
2-year R&D-project: nov. 05 bis oct. 07
area of application: Berlin
Aim: Use of mobile communication
infrastructure to improve the preparation of
stroke-treatment
III Meeting on eHealth and Telemedicine
Stroke - the problems
patient at an inappropriate hospital no bed available no Stroke Unit no thrombolytic therapy no interventioanl therapy no neurosurgical department
frequent hospital transfers
time-delays pre-/ intrahospital many departments have to be informed and
involved
III Meeting on eHealth and Telemedicine
Stroke - the NINDS* recommendations
(1) Neurological consultation 10 min
(2) ECG, temperature, blood glucose, blood pressure
20 min
(3) CCT 25 min
(4) CT-interpretation 45 min
(5) time taken to arrive at Stroke Unit 60 min (-> 80% success rate)
Time is Brain Reducing Time-to-needle
* The National Institute on Neurological Disorders and Stroke
III Meeting on eHealth and Telemedicine
Stroke - the bottleneck 'Imaging'
0
10
20
30
40
50
60
70
80
neurologist cCT Stroke Unit
[min
]
2003
2004
target
0
10
20
30
40
50
60
70
80
neurologist cCT Stroke Unit
[min
]
2003
2004
target
III Meeting on eHealth and Telemedicine
StrokeNet - project
(1) emergency call
(2) Patient comes to the next appropriate hospital
(3) Medical stuff/ patient has early support by a (stroke –experienced) neurologist
(4) StrokeUnit neurologist ...• is informed about the patient in advance
(time, syndrome)• can schedule further treatment (info to: ward, radiologie)• support treatment within ambulance
III Meeting on eHealth and Telemedicine
StrokeNet - project technical approach
co-operating hospitals(with of without SU)
ambulance
Telemedical Center
StrokeUnits
mobile arm
stationary arm
III Meeting on eHealth and Telemedicine
Agenda
Introduction NEST Joint Projects StrokeNet Tele Care System (TCS) The new Challenge - Examples
III Meeting on eHealth and Telemedicine
Joint Developments
Tele Care System:
Medical care aboard an aircraft via satellite or Pico cell, transmitting vital parameters of the passenger to an expert on ground
combined with videoconferencing between the flight attendant and the expert,
thereby enabling the flight attendant to perform diagnostic and therapeutic measures
III Meeting on eHealth and Telemedicine
In Case of Emergency
No doctor at patient side
Helper without emergency experience
Medical solutions only by “telephone”, no vital data
No much time to make a right diagnosis
High potential of secondary damages
Wrong decision can cause deaths (and cost)
Interruption of the journey
III Meeting on eHealth and Telemedicine
TCS of GHC
12-lead ECKG, SPO2, Blood pressure integrated
Temperature, blood glucose extern
Defibrillator (1-lead-ECG) integrated
Videoconferencing, Chatting
Audio-visual, textual and graphical instructions
Medical Help
III Meeting on eHealth and Telemedicine
TCS Modules
1
2
3
4
(1) Main module
(2) Housing (accessories)
(3) Diagnostic module
(4) Therapy module
III Meeting on eHealth and Telemedicine
Aviation Market
Number of passenger is growing
200,000 life-threatening emergencies/year
About 12 deaths at one airline/year
Main cause: cardiovascular problems
Cost of diversion: several 100,000 $
III Meeting on eHealth and Telemedicine
TCS Aviation
Prototype available
Tested on long-haul flights
Co-operation with Charité, Deutsche Lufthansa
Next pilot utilization sponsored by the ESA
III Meeting on eHealth and Telemedicine
Maritime Market
Profile: Emergency and Monitoring
Injury (e.g. fracture) Infection/ inflammation Cauterization (e.g. chemical
burn) Internal medicine (e.g.
cardiovascular disease)
III Meeting on eHealth and Telemedicine
TCS Maritime Pilot Utilization
Pre-phase for testing
Prototype available
Tested on Oil and Container Tanker
Testing Trial with Hapag-LloydShipping Company
III Meeting on eHealth and Telemedicine
Agenda
Introduction NEST Joint Projects StrokeNet Tele Care System (TCS) The new Challenge - Examples
III Meeting on eHealth and Telemedicine
The new Challenge
demographic change more and more people getting older and older more time for (aged-based) leisure activities longer need for (special) medical care
target ambient assisted living keeping autonomy support at home and on the way social services
III Meeting on eHealth and Telemedicine
The approach
how can telemedicine support those needs? move the data, not the patient / physician Home Care monitoring of patients offering a feeling of security combing telemedicine and local based services
examples for projects in realization
Home Care
Home Monitoring
Home Care Devices
III Meeting on eHealth and Telemedicine
Example 1: pain - treatment
implantation of a spinal-catheter
connection of a mobile device via Bluetooth
instant monitoring of analgesic dosage
additional information about state of health and mood of the patient
using lbs: in case of emergency, an ambulance can be send to the patient wherever he is
III Meeting on eHealth and Telemedicine
Example 2: decubitus-prevention
Bedsore (decubitus) affecting ~ 800.000 patients/ p.a.
only in Germany, causing costs ~ 2 Bill. Euro/ p.a.
developing a sensor-mat, which measures and monitors the self-mobility of bedridden patients
target: gaining information on "perfusion-stimulating" movement to prevent decubitus
additional "intelligence" for wound-management by integrating a camera
III Meeting on eHealth and Telemedicine
Example 3: peritoneal dialysis
90.000 patients in with PD, haemodialysis (HD) or kidney-transplantation
focus: aPD at night main targets:
HD>PD to be changed telemedical interface:
• getting additional vital parameter like weight, blood pressure
• additional A/V-connection social aspects of PD
III Meeting on eHealth and Telemedicine
The bigger picture
all 3 projects have a strong relation to other diseases
diabetes hypertension stroke cardiac insufficiency heart attack
III Meeting on eHealth and Telemedicine
Find innovative partners, interested in close cooperation and knowledge transfer
Find a management institution, that is neutral and experienced in management of networks
Identify problems in healthcare, that could be solved trough telemedicine
Involve the users in the process: i.e. physicians and patients
Look out for partners in other countries and try to initiate joint projects with them (participate in conferences, fairs, partnering events)
Success factors
III Meeting on eHealth and Telemedicine
Thank You very much for Your attention!
Ywes Israel, M.A.
COO
TimeKontor AG T: +49 30 390087-0
NEST Network for integrated Systems in Telemedicine F: +49 30 390087-25
Schönhauser Allee 10 – 11 E: [email protected]
10119 Berlin, www.timekontor.de
Germany www.nest-telemedizin.de