From Ideas To State Of The Art Projects. The German Telemedical Network Nest

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.


Agenda

Introduction NEST Joint Projects StrokeNet Tele Care System (TCS) The new Challenge - Examples


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.


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.


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/


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


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


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”.


NEST Partner


NEST Partner

http://www.onlinelaw.de/index.php

http://www.fu-berlin.de/index.html

http://www.ibb.de/


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)


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


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


Agenda



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


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


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


Agenda



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


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


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


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


Stroke - the bottleneck 'Imaging'

0

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neurologist cCT Stroke Unit

[min

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2003

2004

target

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neurologist cCT Stroke Unit

[min

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target


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


StrokeNet - project technical approach

co-operating hospitals(with of without SU)

ambulance

Telemedical Center

StrokeUnits

mobile arm

stationary arm


Agenda



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


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


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


TCS Modules

1

2

3

4

(1) Main module

(2) Housing (accessories)

(3) Diagnostic module

(4) Therapy module


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 $


TCS Aviation

Prototype available

Tested on long-haul flights

Co-operation with Charité, Deutsche Lufthansa

Next pilot utilization sponsored by the ESA


Maritime Market

Profile: Emergency and Monitoring

Injury (e.g. fracture) Infection/ inflammation Cauterization (e.g. chemical

burn) Internal medicine (e.g.

cardiovascular disease)


TCS Maritime Pilot Utilization

Pre-phase for testing

Prototype available

Tested on Oil and Container Tanker

Testing Trial with Hapag-LloydShipping Company


Agenda



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


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


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


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


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


The bigger picture

all 3 projects have a strong relation to other diseases

diabetes hypertension stroke cardiac insufficiency heart attack


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


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

From Ideas To State Of The Art Projects. The German Telemedical Network Nest

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