1. Telemedicine on the Grid

2. Cambridge eScience Centre

3. CeSC Location CeSC is located in the new Centre for Mathematical Sciences on the West Cambridge site, with office space and conference room for AccessGrid. Strong links with the Cambridge-Cranfield HPCF Postal address: www.escience.cam.ac.uk Cambridge eScience Centre Centre for Mathematical Sciences Wilberforce Road Cambridge CB3 0WA

4. Cambridge eScience Cambridge eScience Centre National Institute for Environmental eScience Centre for Mathematical Sciences Cambridge Computational Biology Institute

5. Cambridge eScience CeSC Industrial Partners: IBM, Sun Microsystems Microsoft Research Unilever, Siemens Medical Solutions Macmillan Cancer Relief BAE Systems, Rolls Royce

6. Cambridge Computational Biology Institute Link Cambridge expertise in medicine, biology, mathematics and the physical sciences. World centre that will develop new knowledge and its application to health, quality of life and wealth creation. Research topics: New MPhil Course –basic genetics of bacteria –developmental biology –evolutionary biology –complex cell biology of human disease –systems biology. Multidisciplinary approach using advanced informatics techniques: Seeking Cross-Research Council funding….

7. Background NHS Cancer Plan –Network –MDT Meetings –Specialisation –Data sets e-Government e-Science

8. “Delivering public services in new and electronic ways to be more convenient, more joined-up, more responsive and more personalised:” e-government building services around citizens’ choices making Government and its services more accessible ensuring social inclusion using information better

9. Building the Information Core - Implementing the NHS Plan

10. Existing Teleradiology ISDN Workstation CT Scanner DICOM 3.0 Strongly authenticated connections:CHAPCLI Access lists 128 kbps ISDN Router Bandwidth limited: doctors travel to case conferences

11. The West Anglia Cancer Network Cancer Centre –Addenbrooke’s/ Papworth Cancer Units –Bedford –Peterborough –West Suffolk –Harlow –Hinchingbrooke –King’s Lynn

12. Requirements Multi-site videoconferencing Access to pathology & radiology images –Live microscopy –DICOM Access to remotely stored patient records through organisational LANs

13. The NHS Solution Integrate existing commercial VVID system with medical needs –Low entry cost –Simple to operate –Integration with other network services, e.g. DICOM Generic solution for clinical collaboration –Advanced collaborative environment for teaching and research Initial aim was to roll-out across 8 WACN Hospitals in year 3. Key staff: Martin Graves, Radiology, PI/Kate Caldwell CeSC

14. Technologies Videoconferencing/multimedia Medical image transfer and archiving –Digital Communication in Medicine (DICOM) Real-time microscopy imaging –PathMeeting (HTTP) Data mining –Legacy interfaces/XML Dedicated ISDN lines (pending NHSnet upgrade)

15. Funding Macmillan Cancer Relief –£70,000 Siemens Medical Solutions –£145,000 eScience funding –£171,974 NHS Trusts - each has invested in its own dedicated room, now used for MDTs, management, teaching etc. (Typically £40-50,000 per trust).

16. Telemedicine Project Objectives Year 1 –Installation of an appropriate voice, video and data hardware and software demonstrator in a sub-set of WACN hospital sites, using the best available network connectivity. –Train NHS staff in the effective use of the system. –Produce a detailed specification of NHS needs (data formats, user interfaces and security requirements). –Prototype the CeSC facilities for medical VVID services using experience gained from the demonstrator. –Develop additional code, compatible with the Grid Core Program software kit, to ensure secure VVID services over the Grid.

17. Telemedicine Project Objectives Year 2 –Integrate remote visualisation of volumetric medical image data into the system. –Customise the system with NHS-specific requirements based upon the demonstrator and the prototype CeSC system into a package suitable for deployment within the entire WACN. –Integrate demonstrator hardware and software with system  Year 3  Full implementation and evaluation of the NHS specific system across the eight WACN sites.

18. The Reality! Live MDT in progress Goals met in 18 months

19. Progress Telemedicine has been adopted by most cancer MDTs in Cambridge, and is also used for training, management and general communications by the participating trusts. Telemedicine has been rolled out to 5 other Cancer Networks, and a National Programme is under discussion. Telemedicine is proposed for use in CancerGrid, for running clinical trials, as part as a broader data management project. Collaboration with Australia to exchange expertise.

20. Lessons from our experience Problems are not as expected –NOT security (use encryption, control access to MDT sessions) –NOT technology (NHS is far behind the cutting edge of IT - needs simple, reliable, effective tools) –NOT ethics (no example so far of any ethical/patient problems) Some problems are obvious, with easy solutions –Bandwidth on NHSnet was inadequate - implement private ISDN lines to demonstrate system. Migrate with NHSnet upgrades. Peer review system can miss real issues - reviewers taken from bleeding edge advocates, rather than practitioners?

21. …more lessons… Problems are sociological and organisational –NHS personnel are heavily loaded and underfunded –Resistance to shiny new technological fixes –Resistance to imposed external “expertise” –NHS IT has high level of security paranoia Need to engage community from outset with sensible/sensitive project leads (Martin Graves/Kate Caldwell) Launch with simple, effective solution to real problem Build on success to more ambitious solutions, with community push Funding agencies create obstacles to incremental rather than revolutionary solutions.

22. Future work Further develop use of the system by extra users Implement telemedicine for National Radiology Academies Set up demonstrator for Paediatric Intensive Care Aim to exploit developments of PACS to use more volume visualization data Also develop solutions for Telepathology Leading role in roll-out of solutions across the NHS

23. Volume Visualisation Very high quality data now available, not fully exploited

24. Telepathology Digital archiving and curation can help with diagnosis, treatment, research and teaching.

25. Conclusions Telemedicine has proved itself to be highly popular with NHS clinicians Now an everyday part of working practice in East Anglia Increasing takeup nationwide New opportunities with the NHS IT programme investment…. …but risk of “management paralysis” when chronic underfunding meets sudden investment… …existing NHS projects will need careful nurturing!