October 1999

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Towards the Millennium of Cybermedicine

Read VMW's coverage of MedNet'99: an anthology of the most fascinating telemedicine presentations held at the Fourth World Congress on the Internet and Medicine

Special issue with an update on results from European R&D projects, 1999 !

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.
Forum discussions freshly available as of 01-08-99!

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Remote hot CHILI radiology images processing at the Deutsches Krebsforschungszentrum
At the MedNet'99 meeting, Dr. Engelmann illustrated the potential of the CHILI application in borderless teleradiology, as it has been developed at the Deutsches Krebsforschungszentrum (DKFZ). CHILI was born out of the MEDICUS project that was aimed at creating a general purpose radiology workstation equipped with teleconferencing features. Currently, the software architecture consists of twenty components, making the system suitable for different configurations. CHILI has a plug-in concept for the integration of existing programmes and disposes of a very secure protocol. In this way, the programme corresponds with nowadays' tendency to design general purpose systems for various application scenarios.

Theory and practice of Store-and-Forward Telemedicine over the Internet in a nutshell
VMWC partner Dr. Vincenzo Della Mea from the University of Udine in Italy, led a workshop on Store-and-Forward Telemedicine through the Internet during MedNet'99. Seven speakers highlighted the technical and legal issues, and the sometimes surprisingly creative solutions this type of remote application holds in store for the user. Experiences from the field in Germany and Italy but also in developing countries, situated in Africa and South-America, as well as the particular definition and implication of remote for a country like Australia, were presented to the audience by Christian Elsner, Claudio Eccher, Klaus Woerle, Jack Woodall, and Joe Hovel. Giorgios Kontaxakis described the impact of the TeleInViVo project in the Azores, Kazakhstan and Uganda.

Remote pathology diagnosis enhanced through high-resolution digital photomicrography and Internet e-mail
In the MedNet telemedicine session chaired by Dr. Greg Mogel, Dr. Della Mea introduced high-resolution digital photomicrography and Internet e-mail as two efficient tools for telepathology consultations. Still histologic images are sent through an asynchronous channel for remote expert diagnosis. After preliminary image sampling, performed by a qualified pathologist, the diagnostic accuracy highly increases. The technology is very suitable for biopsies and transplantation pathology. Various tests have been executed between sites in Udine and Los Angeles with signed and encrypted messages to enhance patient privacy and security. In no less than 93,5% of the cases, the remote diagnosis offered by expert pathologists was correct.

For dynamic In Vitro Diagnostic Net "change is the only constant thing in life"
In the morning telemedicine session of the second international MedNet'99 conference day, VMWC partner Dr. Martina Dressel gave a lively overview of In Vitro Diagnostic Net, a Virtual Community and marketplace of laboratory medicine on the Internet. In the Spring of 1998, IVD-Net started as a virtual thematic and interactive meeting point for the exchange of lab-related medical information on the Web. At present, universities, research institutes, companies, doctor's offices, labs, and other interested parties from over 30 countries enjoy free membership and consult the marketing services, delivered by IVD-Net and paid for by the participating suppliers. Dr. Dressel was kind enough to present IVD-Net to the VMW readers' public.

Writing and editing for the Web becomes a piece of cake with the "Virtual Magazine Publisher"
The last presentation at MedNet'99 came from VMWC co-ordinator Drs. Ad Emmen with the detailed description of the "Virtual Magazine Publisher" (VMP) software system. The VMP tool addresses the needs of authors and editors publishing on the Web, and is very suitable for the managing of magazines, newsletters, journals, member profile pages and project description pages. Currently, the software is already applied to run the Virtual Medical Worlds Community on the Internet. The system can be used for almost any kind of publication and accessed from anywhere in the world. Its revolutionary aspect is that the content is separated from the lay-out and that its structure is captured in an SGML definition. A new design will use XML to implement the article structure.

First things first in research and funding of IT, the Internet and medical informatics
At the MedNet'99 Conference, Dr. Ted Shortliffe, who is Professor for Medical Informatics at Stanford University, offered the audience a brief overview of the current status in the Internet research and its implications for the future of health care. The political agenda for research funding in the coming years has to include both basic informatics research as an enabler of long-term goals and support for traditional biomedical research. At present, we are facing an underinvestment in long-term fundamental research which industry is unable to sustain. It is of vital importance that the government continues to support the education and proportion of the IT workforce, and the high risk, innovative ideas. The governmental agencies are pressed by the growth of IT needs and urgently require funding for basic research and development actions in IT.

Teledermatology in Australia or a different sense of remoteness
Senior lecturer Joe Hovel from the Australian Monash University in Bendigo, Victoria, has a particular experience with the remote aspects in life. As a child, he was raised in Cologne, Germany, but ran away from home as far as he could to end up in Australia. Today, he is completing a Master of Health Science degree with a thesis on Teledermatology via the Internet, a research project which started in 1995. At MedNet'99, Mr. Hovel tried to offer the audience in the Sunday afternoon session as well as the participants to the workshop on Store-and-Forward Telemedicine via the Internet, an idea of what "remote" really means in a country like Australia where the 5000 km span from coast to coast exactly bridges the distance between the European capitals Madrid and Moscow.

New Health Care Center Standards expand accreditation scope to centres with limited opening hours
Recognizing the important role of health call centres, the United States leading standard-setting body for managed care organizations just broadened its standards to include all health call centres. The American Accreditation HealthCare Commission, referred to as the URAC, has just released the second generation of its accreditation standards for health call centres. These organizations respond to requests from health plan members for guidance about their health care. The revised standards, which are titled "Health Call Center Standards, version 2.0", accommodate the full range of telephone health information programmes. They are broader in scope than the prior version, titled 24-Hour Telephone Triage and Health Information Standards, which applied only to call centres that provided around-the-clock coverage.

Internet Supercourse new paradigm in 21st century global health odyssey towards tele-preventive medicine
What on earth do John Kennedy and Rocky have to do with Internet quality training courses for disease prevention? At MedNet'99, Dr. Ron LaPorte, Professor for Epidemiology at the University of Pittsburgh, School of Public Health, held a supercourse on information dominance to rule out as far as possible the morbidity risks on a global scale. The Global Health Network unites experts in health and telecommunications to improve the health of populations by gathering information on epidemiology. Since accurate knowledge enhances power, Dr. LaPorte has developed the concept of supercourses which consists in the manufacturing, sharing, distribution, and personalised adoption of passionate lectures via the Internet by local teachers. Passion in education and training may form the key to various scenarios for the prevention of disease.

Key challenges of building strong Internet partnerships between health care providers and consumers
The ways in which we structurise health information are crucial to the question of how we are to cope with overload. At McMaster University in Canada, Dr. Alejandro Jadad is Co-Director of the Cochrane Collaboration and Professor for Clinical Epidemiology and Biostatistics. As the first MedNet key-note speaker, he pictured the major challenges faced by patients as well as clinicians, using the Internet as a source of information in order to forge solid partnerships and optimize the level of health care. How can we reach for the ideal scenario of gaining access to the best available technology and information in a supportive environment with the most adequate user skills?

The value of accurate neural networks for future medical decision making
In the Department of Experimental Medicine in Galway, Ireland, the effectiveness of neural networks for medical diagnosis is being tested. A diagnostic system for jaundice related disease detection has to be as accurate when it comes to medical decision making as the physician in the emergency room. At MedNet'99, Mr. Ben Kanagaratnam explained how neural networks learn to solve new problems in very much the same way as humans use their past experience to solve current issues. If properly prepared and used, neural networks can be of great practical use in the diagnostic practice.

Berlin hospital generates kidney patient records through available Web technology
In the Department of Nephrology at the Charité Campus Mitte in Berlin, Germany, an Internet-based electronic medical record has been implemented for patients who underwent a kidney transplantation. Dr. Lutz Fritsche presented the system to the MedNet'99 audience in the clinical information track, which was chaired by Dr. Vincenzo Della Mea. It looks as if the haemodialysis service in Berlin has been provided with a solution that is simple, fast, up-to-date, comprehensive, reliable, accessible, affordable, and safe.

Modcomp's ViewMax solution delivers electronic records through the clinical intranet
Modular Computer Systems GmbH based in Cologne, is a systems integrator specializing in large-scale server applications in conjunction with high-availability solutions. The company, referred to as Modcomp, has been founded in 1970. In the first clinical information session at MedNet'99, Mr. Martin Berger presented the electronic records system which Modcomp has installed at Heatherwood & Wexham Park Hospitals NHS Trust in the United Kingdom. The ViewMax software offers physicians a simple, yet intuitive user interface with multiple screen navigation thus minimising the need to retrain the hospital staff. As far as security is concerned, Modcomp has taken what is available in the market with regard to encryption codes.

Small incisions, big results with Intuitive Surgical's da Vinci system
The da Vinci Surgical System, developed by Intuitive Surgical, the California-based world leader in computer-enhanced surgical systems, has proven its excellent performance in two European hospitals during the past summer. At San Matteo Hospital in Pavia, Italy, a fully endoscopic, closed-chest cardiac surgical procedure was successfully performed in July. In the Department of Thoracic and Cardiovascular Surgery at the Johann-Wolfgang von Goethe University Hospital in Frankfurt, Germany, the world's very first closed-chest Atrial-Septal Defect (ASD) closure took place on August 24th 1999.

Joslin Diabetes Center to integrate clinical trial of new Diasensor 2000 into telemedicine programme
Clinical investigators at the Joslin Diabetes Center in Boston, Massachusetts, plan to co-ordinate and conduct a clinical trial to satisfy the requirements for the premarket approval (PMA) submission to the United States Food and Drug Administration (FDA) for the Biocontrol Technology Company's Diasensor 2000 Noninvasive Glucose Monitor. The trial will be conducted in accordance with a contract encompassing a protocol written by the Joslin Diabetes Center.

French Atomic Energy Commission CEA orders Fujitsu VPP5000 supercomputer
The French Atomic Energy Commission, (Commissariat a l'Energie Atomique, CEA) has ordered a Fujitsu VPP5000 supercomputer with a peak performance of 144 Gflop/s. The machine will be delivered to CEA's civil research centre in Grenoble in November 1999 and will replace the current Fujitsu VPP300E system. CEA will use the VPP5000 for a variety of research activities, such as the development of applications in the areas of energy, industry, research, health care, and environmental protection.

TimTem on Tilos enjoys no bed of roses, no pleasure cruise...
The Italian team of "Tilos Medicine & Tele-medicine" (TimTem) project workers is having a difficult time, going through some tough experiences. After so many months of hard work, a general feeling of discouragement seems to dominate the recent TimTem reports of the project Head, Professor Enrico Cavina. VMW Magazine insists at citing his own poetic but sorrowful words in an attempt to shake up the minds and political consciousness of all those people involved in similar endeavours. "A very fragile small boat in the midst of a calm sea of intentions but with no seamen and no rudder at all. The engine and the basic structure are ready but there is no will of either making them work continuously and of managing them." TimTem, the sad story of a telemedicine model and infrastructure totally in place for remote islands and rural areas but lacking the human drive to make proper use of it.

JAVA-based PMOD software enables real time image fusion and kinetic modelling
In the MedNet Monday morning telemedicine session chaired by Dr. Michael Walz, the conference audience enjoyed two presentations on the PMOD modelling and image processing environment. Dr. Cyrill Burger from the Universitätsspital in Zürich, Switzerland, illustrated the use of the JAVA-based software as an excellent tool for real time image fusion on open Magnetic Resonance systems. His project colleague, Mr. Piotr Rudnicki from the Warsaw University of Technology in Poland, highlighted its qualities for kinetic modelling as applied in positron emission tomography (PET). Both speakers consider it as their mission to spread the implementation of PMOD in theoretical research as well as in clinical practice.

L&H's acquisition of CAMS' assets ushers in birth of voice-enabled electronic patient record
Lernout & Hauspie has acquired the assets of Computer Aided Medical Systems Limited (CAMS), a United Kingdom based company which developed the ReadEngine and whose founder created the Read Code Terminology which serves as the coding standard for medical records in the UK. The acquisition significantly expands L&H's market presence in Europe by giving it immediate access to a potential customer base of 1.4 million UK health care workers and diversifies L&H's medical reporting solutions family. L&H plans to combine its speech recognition technology and Natural Language Technology (NLT) with the ReadEngine to voice-enable and further automate the medical coding process.

Have you ever surfed to the United Kingdom National Database of Telemedicine?
In October 1998, a National Database of Telemedicine (NDTM) was launched for the United Kingdom at the University of Portsmouth, with large funding assistance of the British government. An agreement was signed to maintain this Web-based service up to May 2001. Already since 1996, there have been plans in England to measure the telecare activity in detail. At the MedNet'99 Conference, during the Monday afternoon telemedicine session, Dr. Jim Briggs illustrated how the NDTM has been of great use in monitoring the effect of marketing and publicity for the telemedicine related activities of companies and institutions. By means of the "extreme tracking" technique, it is possible to accurately measure the readership of the NDTM Web site.

Volume shipments of Cray SV1
SGI has begun volume shipping of its Cray SV1 supercomputers, the first in the company’s line of scalable vector systems. By the end of this month, SGI expects to complete most shipments against this initial order backlog of 68 Cray SV1 systems totaling more than 1,400 Cray SV1 processors. Among initial customers for the Cray SV1 are the U.S. Department of Energy’s National Energy Research Scientific Computing Center (NERSC) and the US National Cancer Institute.

Finalization of Fonix acquisition gives L&H resources to offer enterprise wide health care reporting solutions
Lernout & Hauspie (L&H) has completed its acquisition of the Fonix Healthcare Solutions Group, formerly Articulate Systems. The acquisition helps L&H expand its medical market presence by giving it a comprehensive suite of speech solutions for the health care market. By combining Fonix Healthcare Solutions Group's offerings with its existing departmental-oriented medical dictation products, L&H is well positioned to seize leadership in the speech-enabled health care-reporting arena.

MRI technology combined with contrast agent optimizes diagnosis of cardiovascular disease
Siemens Medical Systems Inc., EPIX Medical Inc. and Mallinckrodt Inc. have decided to collaborate with regard to the development of contrast-based cardiovascular magnetic resonance imaging (MRI) technologies which might improve diagnosis of clogged arteries and associated cardiovascular diseases. The collaboration will combine AngioMARK (MS-325)-enhanced MRI with advanced imaging and 3D computerized visualization technologies. This combination is intended to enable non-invasive, cost-effective methods of diagnosing atherosclerosis, characterized by narrowing or blockage of arteries, and associated cardiovascular diseases.

MUSE Technologies issues plans for acquisition of Virtual Presence Limited
MUSE Technologies Inc., being a developer of advanced perceptual computing software products, has entered into a letter of intent to acquire Virtual Presence Limited, headquartered in London, United Kingdom. The transaction is expected to close prior to December 31, 1999, at which time Virtual Presence will operate as a wholly owned subsidiary of MUSE Technologies. Virtual Presence is one of the board members of the Virtual Medical Worlds Community.

Profit forecast for PolyDoc wrapped up in mystery
Richard Maddocks is managing director of PolyDoc, the quoted Anglo-Dutch knowledge management software firm. In 1998, the company reported a 981,000 (1.4 mln euro) loss on sales of 891,000, after a 1.527 mln loss in 1997 on sales of 241,000. The company gives no profit forecast beyond saying it expects to expand its initial customer base to volume sales at the end of this year.

Note from the VMW editorial team:
This interview has appeared earlier, on July 29th 1999 in Issue 199 of Euro Info Tech, the fortnightly newsletter on European Union policy in telecommunications, information technology and consumer electronics. VMW wishes to kindly thank the Euro Info Tech Editorial Staff and the author, Mr. Nigel Tutt, for granting permission to publish the interview.

Virtual Explorer Environment makes learning complex concepts fun
A research group at the University of California in San Diego (UCSD) announced that the Virtual Explorer science-based virtual reality adventure is now available at no cost to schools, museums and researchers. This interactive simulation of a voyage through the human immune system makes it fun to learn about the highly complex mechanisms that help fight disease.

E-commerce and bank transfers no longer considered save
A group of researchers led by Herman te Riele from the Centre of Mathematics and Computing Science (CWI) in Amsterdam, has cracked a 512-bit RSA number. These types of numbers are in day-to-day use by for instance banks to transfer money. It is the first time that such a number from the real "RSA challenge list" has been factored. This could have profound implications on electronic banking and e-commerce. There are larger numbers, like 1024-bit RSA, but these slow down transfer. Also, the USA government does not allow this type of technology to be exported. The Te Riele group used a cluster of 300 workstations distributed over a number of institutes which calculated in total 35 years on the problem. This means that you need only a few million euro to install a system that can crack 512-bit RSA numbers routinely and give access to, for instance, financial, medical and commercial data.

Cybermedicine and telemedicine shake hands in Heidelberg at MedNet'99
The Fourth World Congress on the Internet and Medicine, briefly referred to as the MedNet'99 Conference, for the first time has left the United Kingdom to be held in Germany from September 19th to 21st. The major event covered the whole spectrum of cybermedicine for health care consumers and telemedicine for health care providers, distributed over three international tracks. Education and training; Internet publishing and commercial portals; and a wide variety of telemedicine and clinical applications were introduced by expert speakers from the five continents.

Web community gives self-confidence to children struggling with bedwetting
The MedNet'99 session, chaired by Dr. Greg Mogel, started with a supporting solution for an embarrassing problem. Dr. Robert Pretlow from eHealth International commented on the existence of a Web site for children who fight against nocturnal enuresis or bedwetting. This ailment may seem difficult and unsatisfying to treat but the Internet can play a fantastic role in facilitating paediatric care for this kind of handicap. The global enuresis Web site teaches children how to motivate and even cure themselves by creating a community atmosphere among people who are sharing the same problem.

World wide web demo shows a patient's heart chamber in Virtual Reality
In the good tradition of its name, Next Dimension Imaging displays a heart chamber on the Web using virtual reality techniques. The scene is composed of objects hosted on computer systems in different continents in order to demonstrate world wide distributed scenes. The demonstration shows both, a new visualization method applied to medical imaging and the latest option of the product 3D LV-View. This product can generate highly compressed virtual reality objects of heart chambers and masses for immediate availability on the World Wide Web.