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2. 2 Telemedicine Overview

3. 3 Space Technologies Spin-off The Space Science and Technology eventually released many “terrestrial” applications which were turned into the best benefit of day by day life. Among them are the recent Space emerged communication technologies which allowed the huge essor of Internet as well as other communication techniques as support for more and more tele-applications.

4. 4 Social and Managerial Space Spin-off’s There are many application of space communication, sensing and data processing techniques. The managerial aspects including the issues connected to the benefits of on-line and exact managerial act are those in the field of Remote Sensing: Disaster management and mitigation; Precision agriculture; Weather forecast and warning; etc.

5. 5 Other Important Social Space Spin-off’s The field of social life including health, wellness, and sports, as well as education, took profit of such space technologies as communication, imaging, remote control, etc. Telemedicine; Tele-education; Tele-working; etc.

6. 6 Telemedicine - a complex concept Eventually TELEMEDICINE include any medical act performed at distance, from a telephone medical consult to the remote surgery. Telemedicine is a highly skill interdependent field: medicine, education, imaging, remote control, information and communication technologies, etc. Actually telemedicine means remote diagnostic, clinic and educational medical act lead by means of IT&C.

7. 7 A Multi Site Telemedicine System A Telemedicine system could be perceived as a collection of: medical sites, and communication channels, connected together as an IT network. The network is open in the sense that: virtually any site could be absent, virtually any new site can be connected.

8. 8 The Communication Support The communication support can be mixed into a telemedicine system: broadcast support as Internet over IP communication, satellite broadcasting systems, dedicated transmission channels as satellite leased channel, radio streamers, ISDN, a.s.o.

9. 9 Telemedicine Locations The actors of telemedicine performance could be situated in any imaginable location: standing and/or accessible: medical centers, consulting rooms, schools, sports sites, etc.; mobile and or remote: medical caravans, ships, military mobile units, space stations, etc.

10. 10 Telemedicine Remote medical units Ordinary medical units

11. 11 Telemedicine Locations - The Set-Up The telemedicine location comprises: connection to the communication channel; medical and IT equipment. medium converter physical channel IT support medical equipment communication link telemedicine set-up

12. 12 The Communication Link radio streamer satellite channel telephone, GSM & ISDN Internet barebone medium & standard converter (MODEM) Ethernet to telemedicine set-up The communication channel can be one of the above illustrated or several different channels organized on a back-up basis

13. 13 The Telemedicine Set-Up router Ethernet to communication link servers & databases switch to telemedicine LAN video-conference room & CODEC system surgery clinical investigation reception telemedicine LAN

14. 14 The Telemedicine LAN The telemedicine LAN can be perceived as the site informatic system, connected to several devices: general: cameras, plotters, LCD panels, CRT data projectors, multimedia, etc.; specific: image analyzers and processors, CT, MRI, surgical robots, tactile or holographic interfaces, blood analyzers, etc. In most cases, as for standing accessible sites such as hospitals, universities, a.s.o., the telemedicine LAN actually overlaps the organization's informatic system.

15. 15 Actors in Telemedicine The telemedicine performance implies active and, more or less, passive actors: benefactors: medical personnel, teachers, consultants, occasional medical act performers; beneficiaries: patients, students, remote sites’ personnel.

16. 16 Telemedicine acts - Clinic tele-diagnosis; tele-consulting; tele-radiology; tele-surgery.

17. 17 Telemedicine acts - e-Learning tele-mentoring; tele-instruction; tele-education.

18. 18 Telemedicine acts - VideoConference A synthesis: clinic & educational acts tele-mentoring; tele-instruction; tele-education; surgical act attendance.

19. 19 Telemedicine acts - Health Management remote databases access; remote databases management; medical statistical surveys; general hygienic education; disaster mitigation; better remote, integrated, medical management.

20. 20 Telemedicine in Romania

21. 21 The National Need for Telemedicine Environment: Remote undeveloped, inaccessible zones; Perfectible medical assistance; Needs: Training & education of medical personnel; Integration of clinical databases; International integration and compatibility.

22. 22 Institutional Basis Government Strategy; Romanian Government - NASA agreement; National Programs Funding.

23. 23 Premises Development of IT&C; Development of communication services; Dynamics of Internet and communication services providers; Awareness of the medical community; Political will and support; Public funding support.

24. 24 Some Achievements The development of IT&C and the development of international cooperation allowed some isolate, circumstantial projects, funded on international cooperation or sponsorship basis: Babes Institute; Fundeni - Cardiology Clinic; etc.

25. 25 First Institutional Funded Project In the frame of “AEROSPATIAL” program the project: Telemedicine Demonstrative Pilot with Diagnostic, Clinic and Educational Applications. 3 billions lei public funded; 3.2 billions lei partners co-funded.

26. 26 Telemedicine Pilot Partnership The partnership for the implementation of the Telemedicine Pilot Project are: FUNDENI Clinical Institute as coordinator, Department of General Surgery and Liver Transplantation (DLT), Department of Medical Imaging (DMI); Institute for Space Science as cooperator; InterNET srl private Company as cooperator.

27. 27 Telemedicine Pilot Role The Fundeni Clinic Institute assumes the leadership in concentrating efforts to create the future Telemedicine National System.

28. 28 Pilot Project Goals (1) Demonstrate the competence and infrastruc- tural capabilities to set-up and use a true telemedicine system; Increase the public and governmental awareness for the benefits of telemedicine; Perform specific and public medical education; Demonstrate the health management capabilities of a telemedicine system.

29. 29 Pilot Project Goals (2) Develop national wide partnership; Offer the pillar for the development of a National Telemedicine System; Integrate the occasional efforts into a coherent stream of correlated applications; Perform lobby for the telemedicine concept, system and funding (public and private).

30. 30 Pilot Project Goals (3) Develop international partnership; Offer the possibility of international integration concerning a specific domain; Integrate the medical system, space application system, and private initiative efforts; Perform lobby for international partnership and funding.

31. 31 Mediatization and lobby Organization of a permanent and consistent presence of telemedicine information on Internet; Organization of telemedicine performance on video-conference basis, internal and international; Organization of thematic workshops substantially supported with promotional materials for marketing, advertising, and lobby.

32. 32 Telemedicine Pilot Project Schedule Start of the Project: 2001, October End of the Project:2004, June Expected first functional capabilities:2002, middle Expected extended functional capabilities:2003, middle Expected first international contact:2002, fall

33. 33 The Telemedicine Pilot Structure

34. 34 The Telemedicine Pilot Structure The Pilot is intended to cover, at this stage, the Department of General Surgery and Liver Transplantation (DLT) as well as the Department of Medical Imaging (DMI). The structure of the Pilot follows the standard structure of a telemedicine system, as presented in the tutorial part of this presentation, adapted to the strategic needs of the project. The next slide shows a view of the system related to the intended telemedicine audience.

35. 35 The Fundeni Telemedicine Pilot Links Medical units in Romania Fundeni Medical units abroad Internet barebone

36. 36 The Telemedicine Pilot Environment In the Pilot phase the Fundeni Telemedicine Pilot is connected with standing, accessible medical sites in Romania and abroad. The main communication link is through Internet (over IP); The occasional communication link is radio, through satellite channel or radio streamer. Both kind of links can connect the same sites.

37. 37 The Pilot Permanent Communication Link radio streamer Internet barebone RADIO MODEM Ethernet to telemedicine pilot network At Fundeni location At Polytechnica University Electronics Department At Polytechnica University location Optical fiber

38. 38 The Pilot IT Network router Ethernet to radio modem switch to DLT LAN to DMI LAN Department of General Surgery and Liver Transplantation LAN surgeryvideo-conference room & CODEC system Department of Medical Imaging LAN ABA - DMI server & database B - DLT server & database

39. 39 The Pilot Network Server System The Pilot server system consist of two physical servers: A - The DMI server with functions: resource server; DMI database server. B - The DLT server with functions: router/communication server; Internet application server; DLT database server.

40. 40 The Medical Imaging Clinic LAN The DMI LAN acts as a sub-network of the Pilot IT Network System. It consist of: DMI server; Imaging workstations; Medical Imaging database workstation; Internet workstations.

41. 41 The Hepatic Transplant Clinic LAN The DLT LAN acts as a sub-network of the Pilot IT Network System. It consist of: DLT server; Imaging workstations; Clinic database workstation; Internet workstations.

42. 42 The Video Conference System The video conference system is a very important feature of any telemedicine system including the Fundeni Telemedicine Pilot. Due to insufficient funding, the video conference feature is implemented in the Pilot only as a demonstrative occasional one, funded through sponsorship.

43. 43 Key Structural Features of the Pilot integrating existing equipment; open (any node could be present or not); expandable (accept integrating new nodes); scaleable (accept throughput increase); easy to maintain and service; easy to operate with minimal training.

44. 44 The Telemedicine Pilot Applications

45. 45 Clinic and Diagnostic Applications For the moment, the clinic and diagnostic applications focus on the image and clinic file transfer. Those applications are tight related to the Pilot database application. In the future, as integration and funding will increase there are expected more advanced application as distant consult and surgery.

46. 46 Educational Applications The educational applications range from general medical education for medical and non medical personnel to specific medical advanced e-learning. The main support for these applications are implemented in the general e-learning scenario using Internet Technologies. Advanced educational tools as tele-mentoring and video conferences will be detailed further.

47. 47 Video Conference (1) The video conference as advanced educational tool will be used in the frame of the telemedicine Pilot for: general conference attendance; tele-mentoring; tele consulting; seminars and specific demonstration for students

48. 48 Video Conference (2) The general conference attendance is thought as a mean of mediatization and general medical education for specialists and non specialists. This type of manifestation could be lead from the telemedicine center site, benefiting of rich demonstrational material and broadcasted through mass media.

49. 49 Video Conference (3) The tele-mentoring and tele-consulting by video conference range in the field of advanced medical educational applications. Connecting on-line, video and audio featured, distant medical sites will allow specialists to interact, proceed to remote controlled medical act as surgery, anamneza, etc. The students will have the opportunity to attend such performances.

50. 50 Video Conference (4) The seminars and specific demonstration for students are expected to be the core of the medical educational action through telemedicine, would it be on local, national or international basis.

51. 51 Internet Applications The Pilot will be supported by at least two Internet professional application sites: mediatization, general presentation, general medical information and education site; specialized medical e-learning. The sites will be largely multimedia, flash, search and filtering featured as to be attractive, interactive and highly functional.

52. 52 Medical Databases Application Many previous described applications rely on the medical integrated database of the pilot. The medical integrate database will be conceived by relating the imaging database of the Medical Imaging Clinic with the clinic observational database of the Hepatic Transplant Clinic. The core structure, engines and interactive interfaces of the medical integrated database will allow expandability and scaleability.

53. 53 FUNDENI Telemedicine Pilot Status in June 2002

54. 54 Hardware and Basic Functions Main communication link implementation and testing; Core server configuration implementation and testing; Connection with the existing DMI and DLT LANs; Configuration completion made to DMI and DLT LANs; Implementation of communication, web, e- mail and DICOM servers.

55. 55 Telemedicine Applications Status DICOM compatible data transfer; First functional model of the clinic and diagnostic database system; Works on the Fundeni general patient database integration; First Video-Conference application demonstration in cooperation with Virginia Commonwealth University (VCU) - expected to be done in early July 2002.

56. 56 June 2002 Status Conclusions General activity in advance by the general Project schedule; Some activities rescheduled and advanced due to synergic and functional needs; Stage of implementation allow functional contacts with partners: Floreasca Hospital, first foreseen partner for National Telemedicine System integration.

57. 57 National & International Partnership in Telemedicine

58. 58 Overview of Int’l Partnership in Telemedicine NASA-GOR Agreement 2000; EWSSC – medical training in telemedicine; MITAC-VCU; USUHS; Salinas Valley Memorial Hospital; Stanford University Medical Center.

59. 59 Romanian Partners for the Pilot (1) “Sfantul Ioan” Hospital Bucharest; Unversitary Hospital Bucharest; Military Hospital Bucharest; Floreasca Emergency Hospital; “V. Babes” Hospital Bucharest; “Sfanta Maria” Hospital Bucharest.

60. 60 Romanian Partners for the Pilot (2) “Sfantul Spiridon” Hospital Iasi; Craiova District Hospital; Timisoara District Hospital; Targul Mures District Hospital;

61. 61 Foreign Partners for the Pilot (1) Hospital-to-Hospital; Research Centers; Virtual Collaborative Clinic; already existing European clinical partnerships; partnership to USA medical facilities; new agreements of cooperation.

62. 62 Foreign Partners for the Pilot (2) EWSSC - UMD; MITAC - VCU; USUHS; SVMH; NASA AMES RESEARCH CENTER; STANFORD UNIVERSITY MEDICAL CENTER.

63. 63 The Telemedicine Pilot Project Partners

64. 64 FUNDENI Clinical Institute (1) The FUNDENI Clinical Institute General manager: Prof. Dr. Dan TULBURE 258, Şoseaua Fundeni str. Bucharest, sector 2, Romania phone: +40.1.240.8843 fax: +40.1. 240.8843

65. 65 FUNDENI Clinical Institute (2) The FUNDENI Clinical Institute Hepatic Transplant Clinic Director: Prof. Dr. Irinel POPESCU Medical Imaging Clinic Director: Prof. Dr. Serban GEORGESCU

66. 66 Institute for Space Sciences General manager: Dr. Ing. D. HASEGAN 111, Atomistilor str., Magurele Bucharest, sector 5, Romania phone: +40.1.457.4471 fax: +40.1. 457.4471

67. 67 InterNET srl S. C. InterNET srl General manager: Dr. Ing. Dragos OFRIM 119, Calea Grivitei str. Bucharest, sector 1, Romania phone: +40.1.212.5538 fax: +40.1. 212.5539

68. 68 Project Director & Contact Project Director Prof. Dr. Irinel POPESCU e-mail: fundenip@com.pcnet.ro

69. 69 The Role of Romanian Space Science and Technology System in Telemedicine

70. 70 Space Activity in Romania The ROmanian Space Agency ROSA is the Romanian Governmental structure which coordinates the Romanian Space Program and has a representative role in the cooperation with similar international organizations Recently, ROSA has established protocols of cooperation with The European Space Agency and NASA, continuing a tradition of cooperation begun in the ‘70 within former INTERCOSMOS.

71. 71 ROSA ROSA coordinates the National R&D Program “AEROSPATIAL” ROSA has its own research department and cooperates with research and production units in the field of aero-spatial research and development: aero-spatial and spatial fundamental research; aero-spatial and spatial technological research;

72. 72 Perspectives of Space Activity in Romania Taking into account the internal institutional support and the perspectives of international cooperation, as well as, the Romanian tradition in Space activities which qualify Romania as a “regional spatial power” in South-Eastern Europe, a rational optimism is allowed for the future.

73. 73 Thanks You for your kind attendance and interest!