July 1998

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Newly available from 01-07-98: coverage of the three forum discussions held at ITIS'98!

Virtual reality therapy releases fear of flying
The sheer sight of an aircraft can leave some people in a cold sweat hands and even make them sick. Flying phobia usually is treated by means of gradual exposure to the feared experience. At the California School of Professional Psychology (CSPP), Brenda Wiederhold is the director of a new Centre for Advanced Multimedia Psychotherapy, where she uses integrated models of training to treat psychophysiological and psychological disorders. She recently has developed a programme combining real-time physiological monitoring with virtual reality graded exposure therapy to turn frightened people into confident and relaxed flight travellers in only eight sessions.

Internet2 looks promising for human anatomy study
Last April the faster speeds of data travel over Internet2 was demonstrated at the National Internet2 Members Conference in Washington D.C. Together with the National Library of Medicine (NLM), the University of Yale has set up a study of human anatomy. This project was chosen as one of the showcase applications to put Internet2 through its paces with regard to its promising high-speed exchange capacities of three-dimensional medical images. The National Science Foundation (NSF) has been funding Internet2 to fill the need for an advanced research network.

Can telemedicine make money ?
The concept of telemedicine is fairly young. Yet, in the United States, health care providers are now concerned about the profitability aspect of telemedical implementation. First they wanted to prove whether is was possible to deliver remote health care through networking facilities, in which they have succeeded. Now, they are busy trying to collect hard figures to show that telemedicine optimises the quality of care, while reducing costs at the same time. Unfortunately, this is no evidence of intrinsic profitability, because the programme itself might turn a loss. Some experts plead for the introduction of a special standard by which telemedical programmes are judged profitable as long as they serve the specific objectives of the entire health care organization. Others stick to a strict business approach, claiming the programme should make money in its own right.

American nurses play major role in telehealth guidelines
Since 1996, the American Nurses Association (ANA) has been actively involved in the development of guidelines for telemedical practices. Professional nurses are omnipresent in the field of telehomecare in the United States, where distant, isolated, underserved rural areas are typical factors to be taken into account for the delivery of qualitative health care. The organization has declared multistate licensure for registered nurses as a key item to be dealt with in 1998. As a result, it is scheduled as one of the main topics at the ANA Biennal Convention, which takes place in San Diego at the end of June.

Help tools transform video systems into full-fledged telemedicine gear
Video systems have the potential to pay large services with regard to high quality image provision in teleconsultations between physicians and specialists or between physicians and patients. However, a few important conditions need to be fulfilled in order to benefit to the full extent of both the material and intellectual resources which telemedicine has to offer with regard to accurate diagnosis. Electronic interaction or store-and-forward traffic between two sites implies competent operators and excellent voice and image quality. Currently, there exists a range of specialized components which can be inserted between the video source and the transmission medium to enhance the transfer quality of anatomical data, radiology scans, ultrasound, infrared images, pathology specimens, ECG traces, and so on.

NASA and Yale partner to commercialise telemedicine
In July 1997, the University of Yale and NASA started a partnership for the development and testing of next generation technologies in the telemedicine domain. Their latest project involves the health condition follow up of four mountain climbers, who reached Mount Everest's summit last May. Through NASA's Advanced Communications Technology Satellite (ACTS), a telecommunications bridge has been installed between Mount Everest and the participating research institutions. The expedition formed an excellent opportunity to try out some innovative health care devices, based on space science technology. Mountain climbers are exposed to huge medical challenges similar to astronauts in a space shuttle.

A VRML Based 3D Visualization and Sonification Environment
At the ITIS'98 Conference, Emil Jovanov, professor at the Institute "Mihajlo Pupin", University of Belgrade, presented a demo version of a 3D EEG visualization and sonification environment. Professor Jovanov and his research team developed a telemedical software package based on VRML and Java technologies, in the overall framework of the Euromed project. This work introduces different views on the same EEG record using Virtual Medical Devices (VMD). This concept takes advantage of recent investigations in the field of Virtual Reality User Interfaces (VRUI).

MedExplorer is a big hit for search fans
Consumers and health professionals looking for medical Web sites in order to discover more information on a specific topic or problem, can rely on a useful and solid guide to help them find their way through the labyrinth of available health care items on the Internet. MedExplorer is a free medical and health related search engine with no membership or registration requirements. In its short existence, MedExplorer already has achieved a rate of approximately 12.000 hits per day.

Maimonides Medical Centre shows way to hospital of the future
Hospitals all over the world are focused on two burning issues in this decade of health care reorganization: improvement of patient treatment results and overall cost reduction. Since 1995, the Maimonides Medical Centre in Brooklyn, New York, is working together with Unisys on an integrated health care delivery solution, referred to as the Maimonides Access Clinical System or MACS. This clinical support services system has been nominated as one of six finalists in the Medicine category of the 1998 Computerworld Smithsonian Awards, which every year honour the most remarkable information technology initiatives for the general improvement of society.

Remote child heart checkups compare well with the real thing
At the East Carolina University (ECU), a double-blind study has been organized during one year to test the effectiveness of teleconsultation in the evaluation of paediatric heart patients. The research project has been set up to convince cardiologists that modern videoconferencing tools are just as reliable as live patient consultation to obtain a correct diagnosis. They can even save costs by helping the physician decide to suppress the production of superfluous echocardiograms. Although the study showed an almost 100% accuracy for remote diagnoses, the ECU researchers insist that it is not proven that telemedicine offers the same quality of service as face-to-face examination. Due to insufficient transmission speeds, acoustic and image data are inferior to the real-time echo and stethoscope outcomes.

Long Dutch hospital waiting lists to appear on the web
The length of hospital waiting lists for treatment and rehabilitation has become a severe problem in the Netherlands. The Dutch Federation of Patients and Consumers Organizations (NP/CF) wants to address the issue by using the Internet as a dissemination tool for waiting list surveys of all major Dutch hospitals. By the end of 1998, the NP/CF staff plans to start up a Web site with detailed information on waiting terms for each medical specialization. According to the Automatisering Gids , the public will have general access to this site in order to compare waiting times between the different hospitals.

High value of telemedicine for renal therapy
At Georgetown University Medical Centre (GUMC), a three-year project is studying the impact of telemedicine services on the condition of renal dialysis patients. The National Library of Medicine has offered a grant of $2.8 million to the Project Phoenix, that started off in October 1996 and will end in March 1999. The ultimate purpose is to prove that chronic illnesses are ideally manageable through electronic interactive communication between physicians and patients. The quality of care is being intensified to everyone's satisfaction and the costs for permanent treatment are being lowered. In addition, accessibility and security within Phoenix are superior to the paper-based system.

NOVICE provides hospitals with high performance visualisation
On the 1st January 1998, a number of European hospital, academic and industrial partners started to work on a new three-year project, referred to as NOVICE, or Network Oriented Visualisation in a Clinical Environment. The overall costs amounting to 3.1 Mecu, are partly funded by the European Commission under the ESPRIT programme. The purpose of this joint effort involves the development of extensible Web-based visualisation tools for medical applications, which are suited to a High Performance Computing (HPC) environment. The final results will include a Demonstrator and Service Centre at the University of Manchester Visualisation Centre (MVC), a parallel library of 3D image processing functions, and a teleradiology tool, accessible via the Web.

Ovarian cancer treatment discussed over satellite connection
At the Eurocancer Congres in Paris, which took place from June 3rd to 5th, a direct connection via satellite TV was established between Antwerp University Hospital and the University of Pisa in order to allow oncology experts from all over Europe to exchange data on cancer research and treatment. Professor Jan Vermorken chaired a forum, discussing a new medicine which is successfully being administered to treat ovarian cancer.

Health care organizations start using Internet to measure outcomes
One of the recurrent creeds in the postmodern consumersociety is "getting the best product or service at the lowest price". Citizens and patients, who heavily pay for their health care, are increasingly forcing the hospitals to show that the service they are offering, results in higher quality at a lower cost. In the United States, health care organizations more and more are launching outcomes research projects in order to discover alternative ways to optimise their efficiency. For this purpose, some of them use Internet-based benchmarking software, allowing them to regularly retrieve relevant outcomes data from similar institutions or databases, to compare these figures with their own and search for methods to improve them.

Home telemedicine help, through Internet TV
The Health Affairs Division of the American Department of Defence (DoD) is co-sponsoring a disease management project for the delivery of personalized, high-quality home health care. The Strategic Monitored Services (SMS) Company has been involved in the initiative to select and buy the necessary equipment, and to control its installation, for the transmission of Web-enabled clinical patient information. Already in March, SMS has ordered C-Phone's H.324 video phones. Now, it has chosen the new ITV TV set-top Internet access device, developed by the same video communication products designer, in order to provide an Internet connection for the WWW-based information systems in this DoD telemedicine pilot project.

Cruise ship offers "On Board Virtual Emergency Room"
The Grand Princess cruise liner sails the Mediterranean Sea under the protection of SeaMed, an innovative telemedicine application based on digital visual communications technology developed by Imageview, Inc. and VTEL Corporation. SeaMed links the Princess Cruise Lines' latest pride directly with the emergency department team at Cedars-Sinai Medical Centre in Los Angeles to treat passengers aboard the luxurious and expensive cruise ship, who are suffering from cardiac, pulmonary, orthopaedic or neurologic affections.

Digital dog tag invention inspires DoD to launch a Personal Information Carrier bid
In 1995, inventor Hal Woodward highly impressed the American Department of Defence (DoD) with his "digital dog tag", a small but resistant device containing a computer chip which holds a soldier's medical and personal data for quick access in the field. Woodward's four-person company Data-Disk developed the Medi-Tag in response to the Army's request for a digital version of the dog tag, which already exists since 1906. As a result, the Pentagon decided to establish the Personal Information Carrier (PIC) project, in order to settle a definite standard. Although Data-Disk was first to develop the Medi-Tag, the Telemedicine and Advanced Technology Research Centre currently is checking out the products of five competitors, participating in the dog tag programme. According to the Washington Post , an official request for the PIC-project will be issued, in the autumn of 1998, as to attract even more companies.

New centre speeds up drug approval process
Before the Food and Drugs Administration (FDA) can clear new drugs to enter the market, they are extensively tried and tested by clinical development organizations. Procedures such as clinical data management, adverse event surveillance, statistical analysis, and regulatory submissions, have to be performed in an integrated clinical development systems environment. In order to enhance the productivity and pace of the entire process, Sun Microsystems and NetForce have joined forces to design a Clinical Systems Integration Centre (CSIC). CSIC allows pharmaceutical companies to use state-of-the-art application software from several manufacturers for integrated management of drug trials, harmonized data access and distributed operations.

Teleradiology centre send patient images over the net
Physicians in New Jersey and neighbouring states do not need to send their patients to the hospital for testing. Bergen Medical Imaging (BMI) has optimised its services towards doctors and patients through the design of an innovative teleradiology system. This imaging centre receives the patient in a comfortable, relaxed and private setting for efficient, smooth and swift digital image acquisition. The results are directly made available to the physician for remote viewing from his office, home or notebook computer via an Internet connection. Transmission of the data to a separate folder, which is strictly assigned to the responsible doctor, safely protects the patient's privacy.

Telemedicine network brings Everest expedition down to earth
Telecommunications giant AT&T has been working together with ACT Videoconferencing, a specialist in teleconferencing products and services, to establish a video bridge for the integrated telemedicine network between the Mount Everest expedition, which took place in May, and an AT&T location in the United States. The climbers' health data travelled via satellite, transoceanic fiber and global ISDN from the physicians' team in the base camp at 18.000 feet on the mountain to the Yale University School of Medicine in New Haven, Connecticut, and the MIT Media Lab in Cambridge, Massachussets, for further analysis. At the same time, live video and medical data on the climbers' condition were made available on the Internet for everyone to consult.

HPCN in neural network applications for industry and medicine
The Department of Biophysical and Electronic Engineering (DIBE) at the University of Genova can build on a vast experience in neural network research. Since January 1997, the DIBE team is working on the ESPRIT Programme funded RAIN project for the realisation of four demonstrators of artificial neural network (ANN) applications through the use of High Performance Computing and Networking (HPCN) technologies. For this purpose, they have chosen the popular Multi Layer Perceptron (MLP) network and developed a companion learning algorithm, referred to as Back-Propagation (BP). This cost-effective architecture will operate through a WWW-based interface, any Java-enhanced browser is able to administer, and constitutes an appealing solution for a variety of industrial and medical applications.

EU approach is citizen centred care
The Directory General XIII of the European Commission (EC) has just issued a report on the "Needs and options for future research in Information Society applications of general interest". Special attention has been paid to the quickly changing innovations in sectors like health and education. The content is based on the findings of the "Strategic Requirements Group", founded in February 1996, to prepare the general structure and themes of the upcoming Fifth Framework Programme. The group consists of external experts as well as of Commission staff, people who have published separate sectoral reports describing in detail which direction to follow in each research activity field. We present in this article the major issues, objectives, mission and vision, as laid out in the specific report on health care within the Telematics Applications Programme.

Is the EU's Fourth Framework Programme in a healthy state ?
The Strategic Requirements Board, responsible for the health care report on "Needs and options for future research in Information Society applications", has tried to make a concise analysis on behalf of the European Commission's DG XIII, of both the positive and negative aspects of health care related results within the Fourth Framework Programme. The reporters have divided some critical remarks into four paragraphs, referred to as SWOT, which stands for Strengths , Weaknesses , Opportunities , and Threats .. This review should serve as a useful guideline for the Fifth Framework Programme, since it addresses the mistakes as well as successful initiatives that preferably should be continued or extended.

Fear and negligence slow IT breakthrough in health care
In the report on "Needs and options for future research in Information Society applications for health care", a separate chapter has been dedicated to the various obstacles that prevent a smooth integration of innovative information technologies (IT) in the European health care landscape. The report has recently been drawn up by the Strategic Requirements Board of the European Commission, DG XIII, in order to prepare the Fifth Framework Programme. Unlike other information intensive domains like banking, insurance and airlines, electronic data transmission via interconnected systems has not properly been launched in the health care environment. Responsible experts have analysed the situation and detected the deeper causes of this withdrawal.

Is there a European healthcare market for SME's ?
From the viewpoint of Small and Medium sized Enterprises (SME's), the implementation of Information Society Technologies (IST) in health care is not a question of research and product development. There is sufficient choice in all kinds of medical IT applications. The problem is situated at the level of how to create a European market for innovative health care solutions. The Strategic Requirements Board has addressed the issue in its report on "Needs and Options for Future Research in Information Society applications for health care", published by order of the European Commission's DG XIII. A detailed analysis of the various aspects forming part of the market and health care environment, has led to several useful recommendations.

Fast computers enable perfect 3D view of the heart geometry
In the industrialised countries, cardiovascular diseases constitute the first life-threatening illness among the population. Exact diagnosis and proper treatment include accurate manual or computational measurement of the patient's heart geometry. The 3D HeartView project, funded under the European ESPRIT programme, introduces innovative software for the creation of a 3D heart model out from a sequence of 2D X-ray angiographic projections. The system makes use of High Performance Computing (HPC) on parallel platforms in order to reduce the modelling time to less than ten minutes, which is considered acceptable by clinical standards. The practical project aims are to have the software validated by the physicians of the partner clinics and to convince the industrial key-players of the upgrading value this new technology has to offer to their existing equipment.

Mobile Assistant is first belt top computer
At the International Conference on Wearable Computing, which took place in Fairfax this May, the Xybernaut Corporation presented the Mobile Assistant, a hands-free computer with dozens of practical applications. As this handy companion is suitable to be taken into the field, it could prove useful to physicians visiting their patients or to nurses providing care in hospitals or at home?

Chernobyl patients remotely diagnosed by Japanese specialists
The Nagasaki University and the Nippon Telegraph and Telephone Corporation, both situated in Tokyo, are planning an on-line medical service for 1998. This telemedicine system has been set up to help patients in the former Soviet Union who suffer from ailments, due to the Chernobyl nuclear plant accident in 1986.

Internet is therapeutic for Nordic psychiatric patients
In Norway, a psychiatric rehabilitation service is being set up on the Internet to offer patients a chance to actively participate in their recovery process. Various hospitals and mental health facilities are ready to collaborate with the Telemedical Competence Centre in Tromsø in order to create an interactive platform for people suffering from psychiatric illnesses. This has been reported by Internettavisa Telecom ..

Telemedicine benefits are all in the mind
In Finland a research project has been set up to analyse the actual benefits telemedicine has to offer in comparison with conventional hospital services. First results show that telemedicine applications imply more costly investments but produce greater satisfaction in the minds of both patients and medical staff, according to the most recent edition of Tekniikka & Talous ..

Telehomecare initiative starts in Singapore
Health Online, an online service provider for medical information and services, has launched a new telemedicine initiative for the citizens of Singapore. >From within their homes, people now can get assistance from their family doctor for minor ailments through high-speed connection over the SingaporeOne online network. This was announced by the Singapore and Strait Times ..

Digital picture diagnosis saves African islanders
The Times has told a story of two nurse using a digital camera to take pictures of sick inhabitants of Ginnack, an isolated island situated on the north bank of the Gambia river. They take the images to the hospital of Banjul, where they are examined by a doctor, who offers advice on the right medication, which should be administered to the patients. Regularly, Ginnack people die from ailments that can easily be cured with inexpensive medicine.

Advanced health care marketing discussed in Hawaii
This May, the Japan-America Institute of Management Science (JAIMS), a pioneer in intercultural management education, organised a workshop on advanced technologies for successful medical marketing, to offer health care professionals, providers, and consultants a chance to meet two internationally renowned experts in marketing and research.

Ethernet medical network links Pacific islands
The Queen's Medical Center in Honolulu, has selected Bay Networks' high-speed network upgrade. The network connects medical resources throughout the islands. It provides physicians and medical staff access to medical information, patient histories, medical transcription, imaging and decision support. The combination of BayStack 303 Ethernet desktop switches, BayStack 350T 10/100 Autosense switches and Fast Ethernet Switches delivers scalable 10/100 Mbits per second across the desktop, server connection and the backbone.