MEI 2012 Thessaloniki - HELLAS

Ιδανικό...

Πραγματικό...

Operational problems in “Intensive Care”

Decisions must be taken immediately

Multiple & complex problems

Data stored in different locations

Several inputs from different

devices

Patients’ history

unknown

Integration based on local

experience

Remote retrieval

impossible

TRENDS IN TOTAL NUMBER OF

HOSPITAL VS ICU BEDS

ICU BEDS HOSPITAL BEDS

Institute of Medicine (IOM):Patient safety is “indistinguishable from the delivery of quality health care”

Harteloh PPM (Health Care Analysis. 2003;11(3):259–67)“Quality [is] an optimal balance between possibilities realized and a framework of norms and values.”

Why do we need e-Learning / telemedicine in the ICU environment?

• Informed decision – EBM practice• Emergency teleconsultation and patient’s

triage in remotely located ICU’s• Home care / rehabilitation• Patients’ safety control – regular external audit• Second opinion in difficult cases from remotely

located experts• Training in ICM

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

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

Ferrand)

Tele-consultation between OP 2000 (Berlin),

ANDS (Algiers) and IsMeTT (Palermo)

Κέντρο eICU

Cyprus ICU pilot Network Installation sites in Cyprus

Nicosia New General Hospital

Evangelismos Private clinic Paphos

Larnaca General Hospital

Satellite terminal at the NGH

Project Scenarios (cont.) Medical teletraining session

Όχι μόνο για παιχνίδια…

The kinect sensor

Αποκατάσταση με εξοπλισμό ιδεατής πραγματικότητας

Ιπποκράτειο ρητό

“Ὁ μὲν βίος βραχύς, ἡ δὲ τέχνη μακρή, ὁ δὲ καιρὸς ὀξύς, ἡ δὲ πεῖρα σφαλερή, ἡ δὲ κρίσις

χαλεπή …”Ιπποκράτους αφορισμοί 1.1

« … Life is short, [the] art long, opportunity fleeting, experience misleading and judgment

difficult. …»

Hippocrates, Aphorism 1.1

My students are dismayed when I say to them:

“Half of what you are taught as medical students will in 10 years have been shown to

be wrong. And the trouble is, none of your teachers know which half”

Dr Sydney BurwellDean of Harvard Medical School

Percentage of current EB knowledge known to physicians after medical school graduation

p<0.001

Shin et al CMEJ 1993

%

years from graduation 15 years

35%

ACP Journal ClubJournals No No of

issues No of

articles Issues per 1

article core* 9 272 139 2

others 17 188 39 5

the rest 21 199 0 00

NEJM, Ann Intern Med JAMA, Arch Intern Med, Circulation, Lancet, Am J Med, BMJ, J Intern Med

Technologies needed

• Electronic patient record with bio-signals store

• Data from home care• Database and statistical analysis of data• Electronic syllabus / curriculum• Repository of educational material (PACT)• Virtual patients bank / simulation • A platform that integrates all

Μητρώο σε χαρτί στη ΜΕΘ

Δωμάτιο ΜΕΘ με σταθμό εργασίας ΚΠΣ

Σταθμός εργασίας ΚΠΣ

Παράδειγμα βιοσήματος σε κλινικό δεδομένο

Παρακολούθηση του καρδιογραφήματος από συσκευή παρακολούθησης βιοσημάτων

Technologies needed

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

ΠΙΛΟΤΙΚΗ ΥΠΟΔΟΜΗ ΤΗΛΕΪΑΤΡΙΚΗΣΜΕΤΑΦΟΡΑ ΔΕΔΟΜΕΝΩΝ

Φορητή συσκευή καταγραφής βιοσημάτων για το έργο Τηλε-Ιπποκράτης

Περιβάλλον διάδρασης ιατρού

Technologies needed

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

Γενικό Νοσοκομείο Λευκωσίας

ΜονάδαΕντατικήςΘεραπείας

Γενικό Νοσοκομείο Ηρακλείου

ΜονάδαΕντατικήςΘεραπείας

PROSAFE CONSORTIUMGiViTI (Italian Group for the Evaluation of Interventions in Intensive Care Medicine)“Mario Negri” Institute,Italy

Semmelweis University,Hungary

Warsaw Medical University,Poland

General hospital Novo Mesto,Slovenia

Nicosia General Hospital,Cyprus

Intensive Care Forum NGO,Cyprus

Friedrich-Schiller-Universitat Jena,Germany

UCL Center for Intensive Care Medicine & Bloomsbury Institute of Intensive Care Medicine,United Kigdom

inte

rnet

Proxy: machine with a specific address that grants a safe internet access using a trusted networking with autentication.

master

client

serverCC

If the proxy exist, softwares(like browser) must know its address and autentication credentials

Prosafe tries to guess the system proxy settings.

If it is not able to get settings, you will be able to set them.

master

ICU n. 57Calibration curve

expected mortality

obse

rved

mor

talit

y

VLAD: Variable life-adjusted plot

patient 1expected mortality= 6.5%

outcome = aliveSUCCESS:

6.50patient 2 expected mortality = 46.4%

outcome = diedFAILURE:

53.6 patient 3 expected mortality = 16.8%

outcome = aliveSUCCESS:

16.8 patient 4 expected mortality = 95.1%

outcome = diedFAILURE:

4.9

0-0.10-0.20-0.30-0.40-0.50

0.10

0.20

1 2 3 4 patients5 6

ICU n. 57

79/291 vs.

92/291

13 more deaths (95% CI: 5 – 21)

if I would have performed as the previous year, how many death would I have

observed?

Technologies needed

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

Γενικό Νοσοκομείο Λευκωσίας

ΜονάδαΕντατικήςΘεραπείας

Γενικό Νοσοκομείο Ηρακλείου

ΜονάδαΕντατικήςΘεραπείας

Competency-Based Training in Intensive Care Medicine in

Europe

MethodologyPhase 1 survey on national methods of training,

assessment and accreditationPhase 2 identification of competencies and classificationPhase 3 development of guidelines for the assessment of

these competenciesPhase 4 Identification of training material and link

between the competencies and material

Technologies needed

• Electronic patient record with bio-signals store• Data from home care• Database and statistical analysis of data• Electronic syllabus / curriculum• Repository of educational material (PACT)

http://pact.esicm.org• Virtual patients bank / simulation • A platform that integrates all

http://teleprometheus.ouc.ac.cy

ΕπαγγελματίεςΥγείας

Ασθενείς / Συγγενείς Ασθενών

Εκπαιδευτές

The materialization of an innovative project who will address the educational needs of health care practitioners with enrichment of their work environment with learning elements

Κύριοι στόχοι έργου

The adaptation of the platform to the needs of patients and their families from the hospital to the home based care

&

Πανεπιστημιακό Γενικό Νοσοκομείο

Ηρακλείου

Γενικό Νοσοκομείο Λευκωσίας

• Depict and translate clinical needs to educational processes

• Select and organize educational material

• Adapt and integrate the proposed solution to the ICU environment

Process analysis

KNOWLEDGE DIFFUSION

e

Infrastructure requirements outlineTele-education rooms– Interactive boards– Teleconference systems– Simulation tools

Physical and virtual “points of training” in the work place and in their every day life

Lessons / Training program managementEducational material managementTeleconferences management

Tele-education platform

“ … Where is the Life we have lost in living?

Where is the wisdom we have lost in knowledge?

Where is the knowledge we have lost in information? …”

T.S. Eliot’s The Rock (1934)