CoMed: a real-time collaborative medicine system

Holistic approach to design and implementation of a medical teleconsultation workspace

While there are many state-of-the-art approaches to introducing telemedical services in the area of medical imaging, it is hard to point to studies which would address all relevant aspects in a complete and comprehensive manner. In this paper we describe our approach to design and implementation of a universal platform for imaging medicine which is based on our longstanding experience in this area. We claim it is holistic, because, contrary to most of the available studies it addresses all aspects related to creation and utilization of a medical teleconsultation workspace. We present an extensive analysis of requirements, including possible usage scenarios, user needs, organizational and security issues and infrastructure components. We enumerate and analyze multiple usage scenarios related to medical imaging data in treatment, research and educational applications - with typical teleconsultations treated as just one of many possible options. Certain phases common to all these scenarios have been identified, with the resulting classification distinguishing several modes of operation (local vs. remote, collaborative vs. non-interactive etc.). On this basis we propose a system architecture which addresses all of the identified requirements, applying two key concepts: Service Oriented Architecture (SOA) and Virtual Organizations (VO). The SOA paradigm allows us to decompose the functionality of the system into several distinct building blocks, ensuring flexibility and reliability. The VO paradigm defines the cooperation model for all participating healthcare institutions. Our approach is validated by an ICT platform called TeleDICOM II which implements the proposed architecture. All of its main elements are described in detail and cross-checked against the listed requirements. A case study presents the role and usage of the platform in a specific scenario. Finally, our platform is compared with similar systems described into-date studies and available on the market.

A MEDICAL KNOWLEDGE SERVICE SYSTEM FOR CROSS-ORGANIZATIONAL HEALTHCARE COLLABORATION

Collaboration among healthcare organizations depends on coordination, communication and control among healthcare organizations and effective sharing of medical information and knowledge.

Medical services are knowledge-intensive activities. All information, knowledge, techniques and experience should be integrated, managed and shared using the Internet and information technology. Overall medical service quality and efficiency would be improved markedly if medical professionals and staff at different healthcare organizations could use and share medical knowledge resources. Therefore, a collaborative medical knowledge service would promote medical service quality.

This study presents a novel medical knowledge service system for cross-organizational healthcare collaboration such that all medical professionals and staff at different healthcare organizations could capture, store, manage, integrate and share medical knowledge. This system should improve medical service quality and efficiency, and promote competition in the healthcare industry. Thus, this study (i) proposes a collaborative medical knowledge service model, (ii) designs a collaborative medical knowledge service system framework, (iii) develops this proposed system, and (iv) evaluates the developed system based on user satisfaction.

An integral care telemedicine system for HIV/AIDS patients

OBJECTIVE

In this article we will describe a new approach to improve the quality of care of chronic HIV/AIDS patients, combining the integral care approach with a telemedicine system.

METHODS

Following the integral care approach, we included the patient in a multidisciplinary care team, covering the whole process of care with a telemedicine system that allows the patient to improve his/her self-care and to be remotely followed-up by the healthcare professionals.

RESULTS

This challenge has been met by the creation of the "VIHrtual Hospital" project. Its main goal is the definition, development, clinical routine installation and evaluation of a telemedicine service that complements standard care with a telecare follow-up for treating stable HIV infected patients, in a chronic stage of their disease, and study if that improves the quality of assistance and the expense per patient compared to the conventional control (without telemedicine service) that patients usually have. Although the study is not yet finished, in the discussion the main benefits and drawbacks of this telemedicine system are described.

CONCLUSIONS

The main conclusion of the article is that a new home telecare model for chronic HIV/AIDS patients has been created and has been implemented through the "VIHrtual Hospital" in the Clinic Hospital in Barcelona (Spain). The architecture of this web-based system fulfills the demanding security and integration requirements of the IT department of the hospital. An easy-to-use graphical interface for both patients and professionals has also been developed. The low costs of the system allow us to cover a wide range of patients and promising results are being obtained regarding the use of telemedicine systems for improving the follow-up care of chronic HIV/AIDS patients and for creating a new care model for this disease.

Data Conferencing in Health Care

Data conferencing is a computing technique that helps people to communicate in realtime and to share information with others simultaneously. The T. 120 standard provides a base for: (1) multipoint data sharing; (2) interoperability; (3) reliable data transfer; (4) scalability, transparency and independence; (5) platform independence; (6) application independence. A review of the health-care data-conferencing literature identified 25 articles. Ten articles provided detailed information about data-conferencing applications. Of these, eight focused on application sharing, seven on whiteboards, two on chat and one on screen sharing. Articles published before the year 2000 typically focused on the use of NetMeeting and Intel ProShare with low-bandwidth network connections. After 2000, high-speed Internet connections became more popular and Web-based multimedia data conferencing became feasible. While there are undoubted benefits of data conferencing, more research and evaluation are required before the technique is widely implemented in health care.

Promoting patient safety and enabling evidence-based practice through informatics

OBJECTIVES

The purposes of this article are to highlight the role of informatics in promoting patient safety and enabling evidence-based practice (EBP), 2 significant aspects for assuring healthcare quality; to delineate some challenges for the future; and to provide key recommendations for education, practice, policy, and research.

METHODS

First, we describe the components of an informatics infrastructure for patient safety and evidence-based practice. Second, we address the role of informatics in 4 areas: 1) information access; 2) automated surveillance for real-time error detection and prevention; 3) communication among members of the healthcare team; and 4) standardization of practice patterns. Last, we delineate some future challenges for nursing and for informatics and provide key recommendations for education, practice, policy, and research.

RESULTS

The components of an informatics infrastructure are available and applications that bring together these components to promote patient safety and enable EBP have demonstrated positive or promising results.

CONCLUSIONS

Challenges must be addressed so that an informatics infrastructure and related applications that promote patient safety and enable EBP can be realized.