Novel telemedicine

TeleMedIS™TeleMedIS™A Novel Mobile-Health A Novel Mobile-Health

System in SwedenSystem in Sweden Presentation by: R&D Engineer, Sven Jonsson

Biomedical Engineering Department, Karolinska University Hospital

Project co-financed by:

http://www.vinnova.se/main.aspx

TTeC 2006, Tromsö, Sven Jonsson, Karolinska

AgendaAgenda

TeleMedISTM Project

TeleMedISTM Main Sub-systems

The Users

Trials Program

Potential Benefits

Conclusion

Reflection from the past


TeleMedISTeleMedISTMTM Project Project

Telehealth Telehealth Monitoring Monitoring

Wristwatch (TMW) Wristwatch (TMW) TeleMed HC TeleMed HC

Platform (TP) Platform (TP) Wireless Network Wireless Network

(WN) (WN)

Telehealth Telehealth Monitoring Monitoring

Wristwatch (TMW) Wristwatch (TMW) TeleMed HC TeleMed HC

Platform (TP) Platform (TP) Wireless Network Wireless Network

(WN) (WN)

Tadiran LifeCare(Israel) TeliaSonera

(Sweden) Karolinska(Sweden)

“Wireless, anytime, anywhere, real-time monitoring of patient’s vital signs”


Telehealth Monitoring WristwatchTelehealth Monitoring WristwatchThe Device:

• Wrist-wearable, mobile and personal • Single unit• Very easy to carry and simple to use

Vital Signs:

• Multi-parameter monitoring: pulse rate, blood oxygen saturation level (SpO2), and 1-lead ECG

• Automatic measurements• On demand measurements (local and remotely)• Personalized for each user

Communications:• Cellular communication• Two-way voice & data communications• Real time messaging• Emergency alarm pushbutton


TeleMed Home-Care PlatformTeleMed Home-Care PlatformSeamless connection of the hospital to patients

(in and out of the hospital)

Integrate and coordinate patient’s medical data from various resources

Enhanced level of information in real-time for patients & caregivers

Common infrastructure for telemedicine applications

Rapid Development of future applications

Easier management, and greater extensibility


TeleMedISTeleMedISTMTM – System Layout – System LayoutRemote Center

GPRS

Internet

SMS

InternetZone

ExtranetZone

Firewall Firewall

IntranetZone

Gateway

FTPServer

SMSTransmitter

FilesOrganizer

FirewallLAN

CellularTerminal

LAN

TP

TPApplication

LAN

TMW


TeleMedISTeleMedISTMTM Users UsersPopulations:

• In-hospital patients • Post-hospital patients (at home) • People at risk groups (living in the community) • Elderly people

Diseases:

• Congestive Heart Failure (CHF)• Arythmia• Respiratory diseases• COPD follow-up


Engineering Trials ProgramEngineering Trials Program

Usability tests

Communication tests

Reliability tests

Security and safety tests

Interoperability tests


Engineering Trials ResultsEngineering Trials ResultsUsability tests

• Handling TMW through application

• Assigning TMW to patients

• Managing updates to TMW work very well towards end-users

• Error handling in TMW and detection by TP and technical staff was smooth as well.

Note: usability of TeleMedIS System will be conducted also during Clinical trials


Engineering Trials ResultsEngineering Trials Results

Communication tests• Sending data from 250 simulated TMWs• Processing time took only 28 seconds for FTP Server

Procesing time only 74 seconds for Ensemble.

Conclusion:• Clinical and technical staff at Karolinska will be able to look

at patient information of 250 patients after 2 minutes from the time when TMW sends patient information to Karolinska.


Engineering Trials ResultsEngineering Trials ResultsReliability tests

• 1000 Simulated users =>909 simulated patients = OK (Test case:6:01, Reliability, security and saftey test)

• If TMW won’t have GPRS connection:Save measurements for up to 48 hours = memory full.

• Red: Number of users logged in, Green : Incoming traffic (byte/s)• Blue: Outgoing traffic (byte/s), Black: Total traffic (byte/s)



Security and Saftey tests• Implemented state-of-the-art security solutions from TMW

to TeleMedIS Gateway. • All messages are sent through encrypted channels. • And in addition, no names and personal identification

numbers are sent through those channels. • Therefore, even if intruder gets down to the information

sent from TMW, he/she won’t pinpoint the actual patient.• Once the message is decrypted at TeleMedIS Gateway, it

is sent to the TP in plain text. This is a normal practice in Karolinska, where the network is already secured. This is part of Sjunet security service.



Interoperability tests• TeleMedIS System comprises of:

• TMW• Gateway• TP• Clinical and TMW Manager Applications.

Tests have been performed to identify interoperability issues, and any deviations from current standards.

Conclusion:At its current state, TeleMedIS System is interoperable.


Engineering Trials ResultsEngineering Trials ResultsBack draw

• TMW Manager and Clinical applications that are hosted in TP were developed in early phases of the project and therefore lacked user-friendliness towards clinical staff.

• Small interoperability issues between Gateway, and TP, which was mostly due to software updates between partners. => Once latest releases were integrated => OK

• Some issues between TP and Clinical and TMW Manager Applications, due to incompatible Java Interface at TP. => This has been solved by implementing new Java Interface at TP.


Resume Enineering TrialsResume Enineering Trials

The results were positive and necessary towards further improvement of TeleMedIS System.

System can be used at its current stage, without further upgrade of hardware and software.

Conclusion:

Therefore, the system is ready to be rolled out for Clinical Trials.


Clinical Trial ObjectivesClinical Trial Objectives

INSIDE TRIAL:

Compare the measured values with conventional equipment

Testing of the TeleMedIS system in real life situations

To control the usability of the TMW and the TP


Clinical Trial ObjectivesClinical Trial Objectives

OUTSIDE TRIAL:

Testing of the TeleMedIS system in real life situations

To control the usability of the TMW and the TP


Patient characteristicsPatient characteristics

Male or female patient suffering from severe COPD

Subjects must be enough healthy to be able to handle the TMW

Subjects must have a prescribed oxygen treatment at home

Subjects must sign the written informed consent


Trial procedure Inside HospitalTrial procedure Inside Hospital

Approximately 24 hours

Compare to conventional equipment

Perform Pulse rate, ECG and SpO2 measurements once an hour

Information will be sent to the TP at least once a day (Automatically, TP request or patient selection)


Trial procedure, Outside Trial procedure, Outside HospitalHospital

One week

Perform Pulse rate, ECG and SpO2 measurements once an hour

Information will be sent to the TP at least once a day (Automatically, TP request or patient selection)


Clinical TrialClinical Trialss Program (1) Program (1)

Evaluation of Information Quality Success:

• Accuracy

• Presentation

• Flexibility

Evaluation of System Use Success:

• Usefulness

• Easy of learning

• Convenience

• User support


Clinical TrialClinical Trialss Program ( Program (22))

Evaluation of User Satisfaction Success:

• Patients

• Healthcare professionals (HCP)

Evaluation of Service Impacts Success:

• Service quality for patients, relatives and HCP

• Monitoring accuracy


Sweden – Potential BenefitsSweden – Potential BenefitsGovernment/Public:

• Economical:• Possible cost reduction in healthcare systems• Enabling process oriented healthcare services• Assisting nurses and medical staff

• May be integrated with future systems, like: Sjunet (the Swedish national health information network)

Patients:

• Better healthcare – long arm of the hospital• Increasing patient’s involvement

Physicians:

Effective information for efficient medical treatmentMore efficient medication management


CConclusiononclusionBased on the trial outcomes and the expected results of the clinical trials we recognized the potential benefits for patients, physicians, administrators and other stakeholders using the TeleMedIS system as follows:

• On-line contact with medical center

• More efficient medical treatment

• Better post hospital treatment and recuperation

• Cost savings to providers and users by reduction the numbers of visits at the clinic

• Enhanced, timely information for physicians & patients

• Eliminate the need to travel to clinic forunnecessary visits

• Enhanced lifestyle and peace in mind


Result of Result of TTTeC 2003TeC 2003Based on face to face meetings between Tadiran and Karolinska at the Tromsö Telemedicine Conference 2003, the outcome resulted with a international project in the area of telemedicine, in the project TeleMedIS:

• Banquet atForskningsparken in Breivika =>

• 15-17 Sept 2003

• 380 people 32 nations

• Network building

• Face to face meeting

• TeleMedIS project


QuestionsQuestions

Contact:

Sven Jonsson [email protected]

Phone:08-585 807 55

www.karolinska.se/mta

mailto:[email protected]



http://www.karolinska.se/mtae

http://www.karolinska.se/mtae

Technology

Novel telemedicine