The main objective is the availability of a common base of multimedia data relevant to any patient in any institution connected to the network. Furthermore a package delivery server has been used to multicast informative video clips and content from a pharmaceutical firm evaluating the system for commercial use. In fact WEBGMS - "Web Global Medical System" aims to immediately promote on the market interactive telecommunications applications based on existing platforms.
Virtual community has been represented in the pilot base by 35 hospitals in Europe collaborating with scientific associations in the field of Marrow Transplant and Haematology. The project duration; was from January 2001 to December 2002.
A telecommunications network and proper software can make the patient data available in remote sites enhancing the co-operation between physicians in the different institutions.
Roche S.p.A. has actively participated in WEBGMS in evaluating the opportunities a pharmaceutical firm can obtain from new technologies. WEBGMS is focused on delivering commercially viable services, such as information about new molecules and medicines, collaboration sessions, etc. Roche as a world leader in pharmaceuticals is very interested in exploring new ways to deliver information and gather feedback from the largest number of customers. The internet via satellite and WEBGMS are valuable opportunities to facilitate this.
The software used in WEBGMS is Kell J-Hospital, the patient record software, and Kell Brujo, the package delivery system.
The figure below outlines our vision of the future health care system data flows. Each participant exchanges data with the intelligent network.
The underlying idea is that the information collected during the patient contacts with health-care structures is of paramount importance for decisions concerning the future treatment of the patient diseases. Each datum must be readily accessible by authorized medical personnel. Medical and paramedical personnel store and retrieve all the relevant data coming from exams, anamnesis, therapy, radiography and any other event relevant to patient contacts with any institute joining the system.
Patient privacy is a primary issue, that is enforced through strict security checks.
The proposed system has relevant economical advantages including:
- It allows several classes of patients to be treated in remote sites, sharing with physician in Centers of Excellence all the data relevant for medical decisions and diagnosis.
- The medical protocols and guidelines for disease treatment can be shared. Medical personnel at remote sites can join Centers of Excellence programs and associations.
- It enhances the autonomy of the remote sites hospital system, increasing efficiency and allowing quality assessment.
Compared to several tele-medicine procedures this has the following advantages:
- The collaborative work is more than a mere tele-conference with data transfer, as the medical data is already validated and stored centrally. This information will be permanently available and is a major asset for patients and institutions.
- The data is stored following well-defined guidelines, reducing the probability of asking for supplemental diagnostic procedures for the patients.
- Off-line consultation is also possible (and is actually one of the main scopes of WEBGMS).
- The data recorded centrally can be used for statistical analysis of similar cases and search for multimedia data of previous patients suffering from pathologies similar to the one of the actual patient.
- Stored data together with the log of the operations on the data are a legal protection for medical practice
- Cryptography and the possibility to retrieve anonymous data enforce patient privacy according to European Union privacy regulations and laws.
This multimedia patient record, the J-Hospital application, is the heart of the project. It is already used in some of the participating hospitals and is validated by several years of everyday use. The key point is that medical data is stored on a central DB, hosted on a server at Telespazio S.p.A. in Rome. Data can be stored immediately before collaborative work, or off-line, for successive independent work by participants involved in the study of that patient.
The application is based on the internet computing model using relational databases to store data. This application, based on a client-server model, runs within an ordinary web browser using the Java virtual machine and significantly reduces the client's PC configuration. This is a fundamental requirement, particularly in an environment like a remote site where the communications and the distance travelled by the personnel from one location to another are not easy. Any update to the system software is simply stored on the server where the patient's data are also stored. The clients connect to the web servers as in the well-known Internet navigation and the pieces of software needed are downloaded automatically together with the HTML pages.
The WEBGMS Project implements satellite telecommunications techniques such as multicasting IP, IP/DVB, etc. which are related to multimedia product distribution, co-operative work, marketing and product support. The bandwidth requirement of medical data transmission is high and rather asymmetric. In fact multimedia data are more often accessed for retrieval than for entry or update.
The project has been divided into the following work packages:
- Content and Application tools: definition & adaptation. The Application Tool is updated, and the Contents that will be handled during the project will be defined.
- Content and Application tools integration: Integration of the Application in the IPerSAT platform, the continuous Content Loading and data management.
- System Platform: architecture definition and network configuration.
- User Environment: methodology and educational support of users to the platform will be carried out.
- Network Implementation: The network will be implemented, every user will receive equipment, procured during WP4, and the satellite receive clients will be installed and configured at the user's premises.
- Pilot Trials Provide WEBGMS services to the Trial Users, in order to test and confirm the validity of the main aspects.
- Evaluation, Information and Promotion: All the Trial output data are monitored.
The WEBGMS system has proved to be successful. Contractors addressed the issues pointed out in the ESA ITT for 25 months, ending January 2003. The delay in the end of the activity is due to some optimistic assumptions in network deployment effort and to the unpredictable business environment for the last two years, that made it difficult to accomplish on-time business related results.
The main outcomes of the project are relative to the three issues pointed-out in the following sections.
A set of 30 centres belonging to GIMEMA and 2 belonging to EBMT have participated. As the clinical protocol data collection would have been conclusive only if all the GIMEMA centres had participated, Kell gave Internet access to its server to about another 40 centres. The data have then been integrated with those collected by the WEBGMS server at Telespazio.
The clinical protocol for thrombocytopenia was carried out between November 2001 and March 2002. The outcomes of the trials are in line with trials performed with conventional systems. Furthermore we have tested a system capable of storing multimedia data together with clinical trials data.
For the future development of the service it is relevant to point out that the system may be fed with all data coming from routine practice (including multimedia); and also that the clinical trial is extracted as a subset of these data. In this scenario, which the participants will pursue in the next period, the satellite communications successfully tested in the first period of WEBGMS can be a key point for system speed and related effectiveness.
This activity is strongly related to the satellite network. The participant who wants to discuss and have opinions about a smear, must load the data acquired from the microscope on the clinical record and schedule a session for teleconsultation.
The main results of WEBGMS are:
- The typical size of an image is half MB (uncompressed) or 100 KB (jpg compressed). The satellite enables analysis of uncompressed images easily. This result is even more relevant for other specializations, like radiology, where the average size of images can be much larger.
- In about half of the cases of use, the images did not need to be accessed in a teleconsultation session. The doctor simply updated the record and another accessed it when (s)he had more time.
- In the other cases the teleconsultations were performed with 2 or 3 participants, which is the best exploitation of satellite technology.
Broadcast of Multimedia Content
This issue is related to future economic sustainability of the initiative. The industrial observing partner supplied to the project team typical multimedia content now largely in use for educational and communications purpose. This content is usually shown by the employees of the company visiting the physicians customers. The average size of the content we got was 50 MB.
Employing the IP/DVB network and the dedicated software, the content was successfully transferred for two events.
In the next few months, considering the changes in the pharmaco market, contractors will focus on commercial activity in promoting use of WEBGMS as a pharmaceutical information vehicle.