Integrated Telemedicine Networks and Added-Value Services

Transcription

1 Integrated Telemedicine Networks and Added-Value Services Stelios C. Orphanoudakis Institute of Computer Science, FORTH, Heraklion, Crete, Greece Department of Computer Science, University of Crete, Heraklion, Crete, Greece Introduction In recent years, advances in information technology and telecommunications have acted as catalysts for significant developments in the healthcare sector. Many healthcare institutions are currently making extensive use of computer networks, mass storage devices, and sophisticated workstations at which humans and machines interact, assisted by advanced information processing tools and techniques of knowledge engineering, to achieve integration of multimodality multimedia diagnostic data and expert medical knowledge. At an intrahospital level, computer networks provide physical links to other hospital departments and patient wards in order to improve interdepartmental communications and patient monitoring procedures. Telemedicine services build upon and extend this environment to interhospital or hospital to point-of-need communications on a regional, national, or global scale. Therefore, healthcare networks and integrated telemedicine services constitute an extended virtual healthcare institution that encompasses available physical and human resources over a wide region in order to support remote medical procedures and patient management. Telemedicine services are provided over an advanced telecommunications infrastructure and are supported by different information and telecommunications technologies, and related applications. The primary goal of telemedicine is to manage information sources for the purpose of providing different levels of support for remote preventive, diagnostic and therapeutic medical procedures. An implicit goal is to make medical expertise a shared resource, whenever needed and wherever it may be found, in order for telemedicine to also play an important role in home care and continuing medical education. Telemedicine services are currently employed to support various aspects of healthcare delivery, such as: remote (physician-to-physician or physician-to-patient) consultation for diagnostic purposes; remote guidance in the performance of a variety of therapeutic and surgical procedures, thus making expertise available at remote sites (e.g. site of an accident, geographically isolated areas, on board ships and planes, sea-plants, battlefields, hazardous environments, space stations, etc); global access to educational material and statistical information; and remote use of distributed medical information processing facilities. Furthermore, telemedicine also supports continuity of care, making the electronic healthcare record of a patient readily, timely and transparently available wherever and whenever needed. The emerging environment, in which telemedicine services can be provided, has a layered structure. The top layer corresponds to the actual services provided, including telediagnosis, telemonitoring, teleconsultation, telemanagement, and other added-value services. The middle layer consists of all computer applications that provide the necessary communications and a computer-supported cooperative working environment for telemedicine services to be realized. Such applications include electronic mail, multimedia conferencing, synchronous and asynchronous consultation, immersive environments and telepresence, interactive image analysis and visualization of multimedia medical data, tools for querying geographically distributed

2 medical databases, and a variety of other applications that facilitate added-value information services. Web-based collaboration environments are also becoming increasingly important and technologically feasible [1]. The bottom layer corresponds to the hardware and software infrastructure that supports the applications of the middle layer and consists primarily of medical equipment, distributed workstations, the telecommunications network, and tools for the management of network and other resources. The bottom layer together with certain generic applications and middleware services constitute what is commonly known as the Health Information Infrastructure (HII). The next generation of healthcare information systems will consist of a large number of heterogeneous, autonomous, and distributed information systems. Furthermore, knowledgeintensive applications will be used to manage large quantities of multimedia medical data. Hence, as stated in [2], a key challenge facing system researchers and builders is to provide a new organizational framework that can integrate this heterogeneous collection of resources into what appears to be a uniform conglomeration of data and knowledge to increase the availability of previously inaccessible information and to address the demanding information processing requirements of modern medical applications. The requirement for designing and developing the Healthcare Information Infrastructure has also been recognized by other researchers and relevant international organizations [3,4]. In addition to technological reasons for the creation of a HII, it is also driven by the need for: data on outcomes of medical cases that will enable effective choices and compensation of providers, automation of mundane tasks to place the focus on patient needs rather than paperwork, empowerment of citizens to become more actively involved in their own healthcare, flexible remote access to relevant information in order to ensure the continuity of care from the site of an accident to healthcare centers and the home of patients, people with special needs and the elderly, continuous process improvement through integrated and distributed information technology. Existing and emerging technologies provide promising technological solutions to the complex problems involved in all efforts at developing the Healthcare Information Infrastructure. Integration and Interoperability Healthcare is currently regarded as one of the most important application domains in the context of the Global Information Society. The physically distributed resources of the healthcare sector and the diverse requirements of different medical facilities and clinical departments require that specialized autonomous information systems are used to support different needs, while they interact transparently to the user as a federation of autonomous systems. There is a vital need that such information systems go significantly beyond simple computerization and stand-alone support by ensuring that relevant information is delivered at the right place and time, at an institutional and regional level. The development of integrated healthcare information systems must be based on the definition and implementation of an open architecture, where the individual modules: are responsible for autonomous and self-consistent functional areas, interoperate through public and stable interfaces,

3 are configurable, are able to operate in a distributed environment, and can evolve according to the specific requirements and characteristics of the individual organization. Integration is required at various levels [5]: in the exchange of requests and responses among information resources and services (control integration), in order to create a semantically consistent view of the global information space (data integration), through a unified user interface (presentation integration), and in order to automate the use of information resources and services according to predefined administrative or medical process definitions (functional integration). The required integration and interoperability of systems will not be achieved unless a thorough standardization effort takes place. This must be used as a sound basis for developing integrated regional healthcare networks to efficiently support seamless and continuous care. The technology now exists to provide fault-tolerant communications capability to any remote site. Thus, it is possible to integrate existing mobile, satellite and terrestrial voice and data communications networks to provide clinically effective regional and transregional telemedicine services. Towards Networks of Integrated Telemedicine Services Networks of integrated telemedicine services are dependent on networking and the management of information at an institutional level, while they may be operated at a regional or transregional level. At the institutional level, integration mainly aims to achieve the effective and efficient treatment of encounters and episodes in a cost-effective way. Specifically, there is a requirement for tight integration at a system level and the main focus is on managing patient record segments (an episode may consist of a number of encounters). At a regional level, integration mainly aims to support continuity of care for the citizen. In this case, the emphasis is on data integration at a meta-level, for the synthesis of an integrated (virtual) electronic healthcare record on demand. At a transregional level, the main issue is service integration, so that one can achieve quality of healthcare service provision for the population. Services to be provided, based on descriptive and formal definitions of procedures, include human collaboration, system cooperation, information exchange for patient management, population management, continuing education, and information for the citizen. In the provision of clinically effective telemedicine services, an important issue is how to best manage the flow of information. The following specific tasks must be considered: management and organization of information sources information retrieval query formulation and refinement semantic interpretation and visualization of queries and results information sharing and collaboration. The Center for Medical Informatics and Health Telematics Applications of the Institute of Computer Science, FORTH, is currently developing the HII and healthcare services network of Crete, Greece [Fig. 1]. In this effort, the requirements and tasks outlined above are addressed using existing and emerging technologies. The goal is to facilitate the delivery of integrated user-

4 oriented telematic services through the meta-level description of different information sources and the mediation of appropriate agents. The introduction of such services into routine clinical practice is a complex issue, whose successful resolution will require the close cooperation of technology providers and healthcare professionals. Then, all citizens will hopefully also experience the benefits of such technological advances. KRITIKON PELAGOS Chania Rethymnon Dia Heraklion Agios Nikolaos Sitia Gavdos LIVIKON PELAGOS Ierapetra Chrysi Koufonisi Regional Hospitals District Hospitals Primary Health Centers Ambulances, Mobile Screening Units Isolated Sites Community Doctors Figure 1: HYGEIAnet - Regional integrated health telematics network of Crete Current trends in the provision of healthcare services call for integrated user-oriented telematic services, which ensure prompt and secure access to information resources, provided proper authorization is available. To achieve this goal, complex problems and issues related to data heterogeneity, heterogeneity of platform and service requirements, complex protection and authorization policies, and interoperability protocols and standards for information exchange need to be addressed. Therefore, the HII must primarily provide the framework for the effective integration of distributed and heterogeneous components, ensuring overall integrity in terms of functional and information interworking, while advances in network technology should enhance and extend applications, rather than replacing them or making them obsolete. It is commonly accepted that care capacity, available at local level, is greatly enhanced when local practitioners have access to a patient s healthcare record and, as the need arises, when they can be assisted by specialized experts, wherever they may reside. Information and telecommunications technologies can support access to an integrated (virtual) distributed electronic healthcare record, as well as the sharing of medical knowledge and expertise for the benefit of society as a whole. Important objectives in any effort toward establishing global networks of integrated telemedicine services are the following: adoption of a common Healthcare Information Infrastructure for the harmonized development of regional integrated health telematics networks definition of clinically significant health telematic services at a regional level interconnection of cooperating regional healthcare networks for the purpose of creating transregional healthcare networks

5 definition of medical and operational procedures for sharing resources and expertise over transregional healthcare networks, so that patient mobility and improved care practices can be supported effectively agreement on information exchange protocols for the medical domain development of environments for information exchange among regional healthcare networks The operational standards ought to be compliant with CEN TC251 guidelines, such as the PT001 Medical Informatics Vocabulary, the PT002 terminology and coding systems of Medical Procedures, the PT006 Medical Interchange and Related Data Interchange, and the PT008 messages for exchange of Clinical Laboratory Information. In the framework of the healthcare services network of Crete and its HII, currently under development, medical information systems are sources of information which are to be integrated under a common reference architecture. The final goal is to provide integrated user-oriented telematic services and uniform access to networked information sources. These services, in addition to achieving customizable functionality for the user, will also constitute common components of specific clinical information systems. To meet this challenge, a reference architecture has been adopted, on the basis of which an execution architecture is being implemented in order to support the seamless integration of information. Furthermore, existing systems and services are combined into a single, unified information space using digital library technologies [4,6]. Conclusions Health care is an important application domain in the emerging information society. In recent years, we have all been witnesses to the gradual transformation of health informatics into health telematics, a process that continues. For this transformation to be successful, a strategy is needed for the creation of an integrated healthcare information infrastructure, based on the functional and data integration of federated autonomous information systems. Furthermore, in developing such a strategy, one must also consider the need for integrating existing systems into the emerging infrastructure and using it to provide clinically significant added-value services that would justify its cost and ultimately benefit the patient. A fundamental problem for the establishment of a scaleable regional health telematics network is the development of an architecture and tools for the integration of specialized autonomous applications that, together with a shared healthcare record, will support the interoperability of functional units and services within a health care institution, the interconnection of different institutions, and the intelligent management of medical data within such an integrated network [7]. From the technological point of view, the adoption of an open architecture and standards represents the only solution capable of ensuring the achievement of such objectives, allowing the integration of diverse system components through an incremental approach, consistent with evolving requirements. Using such an approach, individual information systems can be independently customized and their operation optimized with respect to the specific requirements of the functional units they serve. Potential benefits of integrated telemedicine services include improved access to medical knowledge and expertise, a reduction in healthcare costs, reduced isolation for both patients and medical personnel, and improved quality of care. The above benefits will become evident after a transition period, during which users of telemedicine services receive proper training and learn to trust them, potential legal issues are resolved, and capital and operational costs are reduced, while service quality is improved with new technological developments.

6 The challenge is to keep up with these developments and to be creative in using the emerging information technology and telecommunications infrastructure to provide clinically significant and cost effective added-value telematic services to the healthcare community. At the same time, one must ensure that the potential benefits to be derived from technological advances also find their way to the scene of an accident and the home of all citizens [8]. References 1. C. Chronaki, D. Katehakis, X. Zabulis, M. Tsiknakis, and S.C. Orphanoudakis. WebOnColl: Medical Collaboration in Regional healthcare Networks, IEEE Trans. on Information Technology in Biomedicine, Vol. 1, No. 4, 1997, pp S.T.C. Wong, and H.K. Huang. A Hospital Integrated Framework for Multimodality Image Base Management. IEEE Trans. On Systems, Man, and Cybernetics, Vol. 26, No. 4, 1996, pp Medical Informatics - Healthcare Information System Architecture, CEN/TC 251, PT1-013, November M. Tsiknakis, C.E. Chronaki, S. Kapidakis, C. Nikolaou, and S.C. Orphanoudakis, "An Integrated Architecture for the Provision of Health Telematic Services based on Digital Library Technologies", International Journal on Digital Libraries, Special Issue on "Digital Libraries in Medicine", Vol. 1, No.3, 1997, pp E. Leisch, S. Sartzetakis, M. Tsiknakis, and S.C. Orphanoudakis, A Framework for the Integration of Distributed Autonomous Healthcare Information Systems, Medical Informatics, Special Issue, Vol. 22, No. 4, pp , G. Wiederhold. Effective information transfer for healthcare, quality versus quantity. In NII 2000 Workshop Notes, Computer Science and Telecommunications Board, National Academy of Sciences, Washington DC, May M. Tsiknakis, D. Katehakis, and S.C. Orphanoudakis. Intelligent Image Management in a Distributed PACS and Telemedicine Environment. IEEE Communications Magazine, Vol. 34, No. 7, 1996, pp S.C. Orphanoudakis, E. Kaldoudi, and M. Tsiknakis. Technological advances in teleradiology. European Journal of Radiology, vol. 22, 1996, pp