May 1999

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The secret behind surgery simulation and VR treatment planning

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NEW - special issue with an update on results from European R&D projects, 1999 ! - NEW

Each year hundreds of European R&D projects produce important results. In this special issue, co-published by the magazines Primeur and VMW, we give an update from a number of projects in the HPCN and medical sectors that were supported within the Esprit or Telematics programmes from the European Commission.

Please, check in at the telemedicine project below:

TeleInViVo, the building of an economically viable telemedical workstation for 3D ultrasound

This special issue is published in conjunction with the ITIS-ITAB 99 event in Amsterdam.

The next issue is planned in November during IST 1999 in Helsinki.
When you want your project results in this issue, please contact the editors of Primeur magazine or Virtual Medical Worlds magazine.

ITIS99logof Visit the Web site of the second International Conference on the Telemedical Information Society.
Combined ITIS'99-ITAB'99 Conference, April 12-13 1999, Amsterdam.
The full coverage is now available!

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ITIS-ITAB'99 breathes fresh spirit of community and collaboration
Two days filled with presentations, discussions, many questions asked and few answers given, forum talks, announcements made, and piles of information exchanged... All this has left the truly motivated ITIS-ITAB'99 Conference participants with a rich feeling of satisfaction but also with the sound knowledge that there remains still a lot of work that needs to be done. Co-chair, Dr. Swamy Laxminarayan noted that all the issues that have been tackled with relation to Information Technology applications in biomedicine and telemedicine services, are in the process of development. The second co-chair, Dr. Andy Marsh fused the different themes, which emerged during the discussions, into an energetic acrostichon. Privacy, Legal issues, Evaluation, Applications, Standards, Environments, Security, Telecommunications use, Accessibility, Resources, Technology are all items which are being dealt with, so PLEASE START !

Special issue with an update on results from European R&D projects
Primeur Magazine and VMW Magzine have copublished a second Special Issue in Europen R&D projects. This issue is published in conjunction with the ITIS/ITAB 99 event at HPCN Europe in Amsterdam. A selection of the articles is presented.

What influences physicians to adopt medical innovations, such as telemedicine?
As the opening speaker at the ITIS-ITAB'99 Conference, that took place in Amsterdam last April, figured Dr. Mary Moore, Dean of Library and Information Resources at the State University of Arkansas. Research studies show that the adoption of medical innovations in general and telemedicine in particular is influenced by a complex set of factors, involving socio-economic, demographic, psychological and communication related characteristics. Dr. Moore based her findings on scientific investigations, made by Everett Rogers with relation to the diffusion of innovations in general. These results applied to her own research on the early adoption of telemedicine, back in 1989, in the Texas Tech MEDNET project. Dr. Moore also presented the results of two other studies, analysing the attitude of paediatricians and anaesthesiologists towards innovative changes in their medical practice.

From digital dawn to the Next Generation Internet in biomedical Information Technology
Since 1996, Dr. Swamy Laxminarayan is the Editor-in-Chief of the IEEE Transactions on Information Technology in Biomedicine (T-ITB). This scientific journal, launched under the sponsorship of the IEEE Engineering in Medicine and Biology Society (EMBS), addresses and highlights state-of-the-art application and infrastructure topics in medicine, biology and health care. At the recent ITIS-ITAB'99 Conference, Dr. Laxminarayan, in the role of Conference Co-Chair, presented an overview of the Information Technology (IT) Road Map as today's health care society rapidly moves from the basic Internet evolution to the initiatives of the Next Generation Internet (NGI), and from entity-centred technologies to a human-centric paradigm. The audience received an exploratory impression of the future convergence between IT and medicine.

Which strategies are we to deploy for the 21st century Global Health Network challenge?
One of the most successful speakers from the USA at this year's ITIS-ITAB Conference, was Dr. Luis Kun. For 14 years, Dr. Kun worked with IBM. After this, he was appointed Director of Medical Systems Technology and Strategic Planning at Cedars-Sinai Medical Center in Los Angeles. In the last three years, he operated as Senior Information Technology Advisor at the Agency for Health Care Policy and Research (AHPCR) in Rockville, Maryland. In this capacity, the speaker represented AHPCR in two committees, the first one being the High Performance Computing and Communications (HPCC) Group, while the second one was the Joint Working Group on Telemedicine (JWGT). At JWGT, he acted as chairman of the subcommission on Security, Privacy and Confidentiality, and also as co-author of the Telemedicine Report to the Congress. Dr. Kun shared his vast experience in matters like genetics, homecare, telehealth, counter-bioterrorism, and security and privacy of data with the attentive ITIS-ITAB audience.

The newly emerging concept of next generation wireless and mobile telemedicine systems
Dr. Robert S.H. Istepanian from the University of Portsmouth in the United Kingdom is a real technical expert in the innovative area of mobile telemedicine systems. At the recent ITIS-ITAB'99 Conference in Amsterdam, he presented the latest developments and future trends in both the design and modelling concepts of wireless communication systems for health care delivery. In the first decade of the 21st century, a new revolution will emerge in the use of digital cellular telephone systems which will completely change the aspect of telemedicine, in order to transform it into a health care service for the mobile patient.

Cardiac emergencies at sea tackled with portable ForeRunner defibrillators
Princess Cruises, one of the three largest cruise lines in the entire industry, has equipped its whole existing fleet of ten ships with more than 65 automatic external defibrillators (AEDs). The lightweight portable devices are developed and distributed via Hewlett-Packard's Seattle-based subsidiary Heartstream. The ForeRunner defibrillators allow shipboard medical staff to provide the required qualitative care in the event a passenger gets a sudden cardiac arrest while being at sea.

Euromed at the turn of an exciting process of re-birthing
In December 1998, the three-year Euromed project, funded by the European Commission, was completed. The initiative however is planned to widely cross the border of the next millennium and continue to build out the framework, that ambitiously has started to grow. ITIS-ITAB'99 co-chair and inspirer of the Euromed project, Dr. Andy Marsh, illustrated the concept and fundamental aspects of the International Telemedical Information Society in a video film. Ladies and gentlemen, may we ask your kind attention please, for "Euromed Project - the movie".

Artificial intelligence teaches nurses how to make the right decision in diagnosis
Nursing Informatics and Computer Aided Education (NICE) forms a three-year project, funded by the European Commission under the Phare Tempus programme. In the final NICE year, the main objectives have been achieved. They consist in the creation of a new short cycle degree courses in Nursing Informatics, and the design of computer managed instruction (CMI) tools for nurses. One of these tools is based on the concept of decision trees and automatic learning, in order to enhance the learning process in nursing education. Before the ITIS-ITAB'99 audience, Professor Peter Kokol from the University of Maribor in Slovenia, explained the exact functioning of decision trees and their usefulness in learning how to make correct diagnoses.

The integration of DICOM medical images into Euromed's Virtual Medical Worlds
The recent ITIS-ITAB'99 Conference formed an excellent occasion to highlight the concept of the Virtual Medical Worlds as developed in the Euromed project. Dr. Tuomo Kauranne presented the Euromed results from a technical point of view. At the University of Joensuu, the Finnish partners have built a prototype environment with the patient as the focal point. Using Web technology, it is possible to perform remote medical analysis on images stored in a Digital Imaging and Communications in Medicine (DICOM) image database. The DICOM gateway allows the physician to access DICOM images from the Virtual Medical Worlds interface via a simple WWW browser by logging on with a password.

Web technologies to enable remote brain tissue classification and visualization
The Department of Mathematics at the University of Joensuu has been involved in a programme on medical image processing as an extension to the Euromed project. Mr. Olavi Kelle specified some particular issues with relation to remote brain image segmentation during the last ITIS-ITAB event. The brain is a complex structure and there is a great medical need to assign the various brain tissues to different classes of white matter and grey matter, in order to predict pathologies, such as tumours and necrosis. The method of segmentation used by the Finnish team is based upon the Markov Random Field (MRF) modelling or maximum a posteriori (MAP) probability. Typical for the application is that the result of the segmentation can be visualized as a Virtual Reality Modelling Language (VRML) world.

Creation of a Web-enabled prediction model for tumour growth in vitro using meta-computing
Dr. Andy Marsh, co-chair of ITIS-ITAB'99, introduced a cancer in vitro experiment to the conference participants. The application allows the use of visualizations on the Web and involves meta-computing techniques. A research team, under the lead of Dr. Georgios Stamatakos, attached to the Department of Electrical and Computer Engineering at NTUA, the National Technical University of Athens, applied a Monte Carlo type of simulation to predict the proliferation of cancer cells. The research team examined how this process leads to the origin and growth of a tumour. Dr. Marsh, who was involved in the experiment, explicitly stressed the major interest of prediction models that are generated with Web and High Performance Computing (HPC) technologies, for the future of medical research.

HPC technology to minimize modelling time of 3-dimensional cardiac structures
In western societies, cardiovascular diseases are responsible for at least 50% of the mortality rate. Seen in this perspective, the 3D modelling of cardiac structures based on 2D X-ray angiographic sequences has a strong clinical relevance. At ITIS-ITAB'99, Mr. Nikos Papazis presented a technical overview of the Esprit funded 3D HeartView project. The partners have built an advanced prototype, able to generate 3D heart models with minimal user interaction. The system makes no assumptions on the geometric properties of the model and uses no a priori information. The 3D model is produced in a few seconds since the modelling process has been parallelized on a CCi-3D, delivered by Parsytec. The system enables direct visualization as well as fully automatic measurement of the blood volume in the heart chamber interior. The prototype has proved its medical added value in various clinical cases.

Web based service for automated interpretation facilitates diagnosis of cardiac images
One Swedish and two Danish hospitals designed and validated a Web based tool for the automated interpretation of diagnostic heart images, based on image processing techniques, artificial neural networks, and vast medical databases. Dr. Lars Edenbrandt from Lund University introduced this AIDI-Heart project to the ITIS-ITAB'99 audience. The physician can use the computer-based service as a decision support assistant in cases where a more experienced medical expert is not available or as a professional means to obtain a second opinion for his own diagnosis. The user-friendly as well as accurate alternative for personal advice among medical colleagues, has the great advantage of being accessible 24 hours per day and 365 days per year.

Success of "hospital without walls" depends on systematic methodology
Professor Ewart Carson from the City University of London sheds a light on telemedicine from the perspective of built-in evaluation criteria. At ITIS-ITAB'99, he illustrated his viewpoints on telemedical methodology with the Fourth Framework project HOMER-D, a homecare haemodialysis service for patients with end-stage renal failure. HOMER-D was set up by the Greek Ergo company in order to develop, apply and validate innovative telemedical monitoring services to support isolated patients who perform haemodialysis treatment at home or at satellite centres outside the hospital. Through use of state-of-the-art multimedia and networking technologies, the functionality of an existing dialysis machine is enhanced, and monitoring and supervision services are implemented between the hospital-based control station and the patient's site. Remote advice and decision support should provide the patient with more confidence.

Advanced medical decision support system applied for early breast cancer detection
At the University of Calabria in Italy, the medical decision making process has been computerized. Physicians at the Cosenza General Hospital currently are using the diagnostic decision support system to help them with the timely identification of breast cancer in patients through the application of a well-defined set of classification data. Dr. Mimmo Conforti presented the system before the ITIS-ITAB'99 audience. As a mathematician, he explained the architecture from this particular point of view, emphasizing the powerful efficiency and effectiveness of Mathematical Programming approaches as the basic tools for the design of the CAMD or Computer Aided Medical Diagnosis system.

Polydoc unites with academic hospitals to build system for medical protocols in Pro-Gram
Three major teaching hospitals in The Netherlands have set up a joint venture with Polydoc, a British-Dutch software provider, specialized in knowledge management. The Pro-Gram consortium aims to develop a system based on language technology, to unequivocally record some 15.000 medical protocols and directives. If the plan succeeds, Pro-Gram is bound to realize a turnover amounting to tens of millions of guilders within three years. In due time, the four partners hope to design a universal system for knowledge management and document control, to be applied in all Dutch hospitals, and at medical facilities, situated in Flanders, Surinam and the Dutch Antilles, as stated by the Automatisering Gids.

HealthLine Internet Corner to provide integrated information to telemedicine networks
Within the Atkosoft company, ITIS-ITAB'99 speaker, Mr. Yiannis Samiotakis, is responsible for the two-year HealthLine project, funded by the European Union. The aim is to create an easily accessible Internet Corner for health care professionals where they are able to find all kinds of information and training material for telemedical applications. The network will equally disseminate results from other European health projects and supply useful links from existing telemedical software, and information provision services. Four different sites are being built in Greece, Ireland, Italy and Sweden to support a similar set of services and to mutually exchange information. For on-line training, HealthLine relies on the know-how of existing projects, such as Nightingale and IT-Eductra. In turn, NIVEMES and RISE, two currently operative telemedicine networks, are strongly related to HealthLine in terms of software support.

The embedding of telemedical services in a method of continuous evaluation
One of the important issues, tackled during the recent ITIS-ITAB Conference in Amsterdam, constituted the evaluation of telemedical services. Dr. Gudrun Zahlmann from the German national research centre for Health and Environment (GSF Medis), highlighted the current approach in this area and presented to the audience an illustrative case study of a teleconsultation network in ophthalmology. The implementation of a telemedical application requires a continuous evaluation strategy which is divided into four phases. The clinical trial method used for assessment of therapeutic effectiveness as well as diagnostic accuracy forms an excellent starting point for telemedical evaluation. Gradually, the focus has to shift from the system's technological capabilities to its medical performance and cost-effectiveness.

TeleInViVo, the building of an economically viable telemedical workstation for 3D ultrasound
In Europe but especially in other parts of the world, including the third world, the costs for health care delivery to each individual in every imaginable situation have risen to an astronomical level. The need for affordable diagnostic systems which can be used in difficult-to-reach as well as underserved regions has become urgent. In response to this demand, nine partners decided to launch TeleInViVo, a two-year project, funded by the European Commission under the Telematics Technologies Programme. The aim is to develop a transportable, integrated telemedicine workstation, utilising 3D ultrasound, connected with a lightweight, portable ultrasound system for use in rural, isolated, or crisis situation areas. The workstation includes both computing and telecommunication capabilities, and is able to support a variety of applications ranging from gynaecology and urology, over endocrinology, surgery, orthopaedics to cardiology and abdominal scans.

President of the International Forum Gastein announces Second European Health Forum Gastein
Last year, the European Health Forum Gastein (EHFG) convened for the first time as a health policy conference, crossing the boundaries of the European Union and societal sectors. International leading figures of health care gathered to discuss the creation of the European health system of the 21st century. The verdicts of the participants and mentors confirmed the organizers in their intention to have the EHFG convene annually with the purpose of bringing people together and promoting a dialogue. Just as the first European Health Forum Gastein, the follow-up event will also look for "ways to create a better future for health in Europe". A new aspect in the second EHFG, which will take place from October 6th to 9th, 1999 in Bad Hofgastein, Austria, shall be the examination of the wide range of challenges related to Health & Social Security.

Large-scale use of satellite communication too expensive for Médecins sans Frontières
In 1971, the French humanitarian organization, Médecins sans Frontières, was established. At present, there are head-offices in five European countries. Each year, the organization sends out a number of 1500 people, half of which are physicians. The aid programmes run in some 80 different countries all over the world. They specifically focus on the most elementary medical care for indigent populations in isolated and often war-raved regions which are almost inaccessible. In these circumstances, the access to reliable communication tools is of vital importance. In terms of confidentiality, communication by satellite meets all the required standards. Satellite applications for large-scale use however constitute a luxury which an organization, such as Médecins sans Frontières, simply cannot afford.

A warm invitation to next year's ITAB-ITIS 2000 Conference in Washington DC, USA
In 1997, the Information Technology Applications in Biomedicine (ITAB) initiative was launched by the IEEE Engineering in Medicine and Biology Society (EMBS). The EMB Society is an internationally renowned organization which consists of 37 societies and some 10.000 members. The initial ITAB meeting in 1997 formed the technical precursor of the current yearly conferences. In 1998, the EMB Society decided to partner with the organization committee of the International Telemedical Information Society (ITIS) conferences in order to combine the two events. Since the meetings alternatively take place in Europe and the United States, next year's 2000 ITAB-ITIS Conference will be held in Washington DC, as stated by co-chair Dr. Swamy Laxminarayan.

Emergence of the Virtual Medical Worlds Community on the European telemedicine and IT scene
The Virtual Medical Worlds Community constitutes a new and dynamic concept. VMWC holds the potential of soon becoming a part of the standard vocabulary of everyone involved with telemedicine and Information Technology. During the recent ITIS-ITAB'99 Conference, the VMWC topic was introduced by Drs. Ad Emmen from Genias Benelux, who has been the major promoter of this initiative. A clear answer was offered to questions on what VMWC exactly represents, why there is an urgent need for this kind of community, how the pre-set objectives will be encountered, which type of activities currently are undertaken, and what the future plans hold in store.

US reimbursement level for telemedicine services in 1997 doesn't exceed $4.2 million
According to the latest details, as provided by Feedback Research Services, the estimated maximum reimbursement level for existing services from United States telemedicine programmes in 1997 amounted to a sheer $4.2 million. This is due to the fact that the medical community as well as third-party payers are not yet familiar with the new legal procedures to apply for telemedicine related reimbursement.

United Kingdom pharmacists communicate electronically with colleagues, wholesalers and industry
The dynamic Health Information Services Division of National Data Corporation has launched an innovative networking solution, which will be available to all retail pharmacies in the United Kingdom. The NDC Network Manager enables retail pharmacies to electronically communicate with other pharmacy locations and industry groups, receive current drug tariff and industry information, and obtain software updates over a private network. This solution also allows wholesalers to provide current pricing information to their customers. The initial roll-out will be to selected sites.

Business aspects of Trusted Third Party services in Europe
The concept of trusted services forms a key issue for any kind of electronic service, developing at a large scale. At ITIS-ITAB'99, Mr. Robbert Fisher, consultant at Price/Waterhouse/Coopers in Luxembourg, highlighted the current business perspectives of the European trusted services market. In tele health care as in other kinds of services delivered via open networks, security plays a dominant role. The Business Environment Study of Trusted Services (BESTS) indicates that trusted services are essential for Europe's growth into the information society, and that therefore it should have native competence in trusted services. How can it be explained that Europe seems to be lagging behind North America?

IntraCom to receive International Patent Protection of EchoLive telemedicine products
The US Food and Drug Administration for the first time has awarded clearance for a teleradiology system which is able to transmit medical images live and in real time over the Internet. The EchoLive system is developed by IntraCom Corporation, a Silicon Valley, California based company, that since early 1996 has been specializing in the design of Internet software solutions for the medical industry.

Immersive WorkWall meets industrial standards for interactive and stereoscopic visual presentation
As one of the major providers of interactive visualization solutions for engineers, industrial designers, medical experts, or scientific researchers, Fakespace never seems to take any breath. Their latest achievement in the area of interactive stereoscopic viewing and hands-on manipulation of large-scale computer-generated visualizations, simulations and prototypes, is the Immersive WorkWall. This newest addition to the virtual WorkSpace product line consists of a flat-screen, rear-projection display system, scaling to 8 by 24 feet, and offers high-resolution imagery with great dimensional accuracy.

Cerner urges hospitals to test their software systems for Y2K readiness
The thorough testing of all software systems constitutes a crucial part of hospital and health system Y2K preparedness, according to Cerner Corporation. This company is a major supplier of clinical and management information and knowledge systems to over 1000 health care organizations worldwide. Hospital systems which are not currently engaged in the last 90 days of planning for the famous millennium bug incur the risk to ultimately lack the adequate protection for patients and caregivers in case of a critical system failure on January 1st, 2000. Cerner's Health Network Architecture (HNA) Classic and Millennium solutions have successfully passed the severe testing in order to confirm their readiness for the Year 2000.

Remote communications for telemedicine and disaster operations around the world
Throughout the world, telemedicine programmes are hampered by the inability to adequately deliver communications in those places where it is needed most. There have been tremendous inroads and inventions of devices which have the capacity to deliver precise patient data very efficiently. Many of these systems and peripherals however do not reach the rural and remote areas, simply because there is inadequate infrastructure to deliver the broad communications capability required. Vortex Technologies Inc. has been able to purchase 35 mobile telecommunications systems, including wide-band C and Ku satellite systems, which have the capacity to connect remote medical operations back to a point virtually anywhere on the globe.