T4MOD - Remote Assistance for Medical Teams Deployed Abroad

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15 February 2014 - Status date: 24 April 2014

T4MOD project aims at defining, developing, realising, qualifying and validating a user friendly Telemedicine system, through an interoperable IP overlay satellite network associated with an intelligent end-to-end communication platform, capable of supporting different medical specialities. This solution, to be validated in a military environment, could also be extended for future exploitations in civilian field for organisations (for example national health systems) operating in underserved and/or geographically isolated areas (such as in the case of natural disasters or humanitarian crises) and to develop new medical protocols for a cooperative medical work of diagnosis and therapies. T4MOD involves as users the health Department of four Ministries of Defence: France, Germany, Italy and Spain.

Project Objectives

  • Developing a system capable to fulfil different needs in terms of applications and services for the provision of healthcare in the frame of military peace keeping missions, with the possibility of evolving towards civilian utilisation (for disaster relief and humanitarian missions);
  • Leveraging collaboration among public institutions within their national contexts and among the four representative member states;
  • Enabling the medical experts on the reference site to assist the remote site in case of a medical emergency or during a planned consult;
  • Provide an easy to use solution able to be operated by medical and non-medical (but trained) personnel;
  • Procuring technical elements (satellite capacity, IT elements, critical breakthrough medical technology, etc.) to implement the designed system;
  • Ensuring inter-operability (with other systems used by the same Medical Service) and intra-operability (among different Medical Services of the four MoDs) via the overlay provided by the T4MOD system;
  • Providing an intelligent and cost effective solution requiring minimal training, installation, maintenance and running costs;
  • Developing and enabling an optimised shared approach for the satellite capacity to minimise the communications costs;
  • Providing a comprehensive framework for evaluating the applications and the project overall outcomes.
  • Deploying the system both in peaceful and mission environments, performing field trials to validate the capabilities and usefulness of the system.

Product Benefits

The implementation of telemedicine services on a large scale is inherently affected by a number of barriers that the T4MOD project tries to overcome with the support of institutional entities such as MoDs, National Space Agencies and ESA.

This common effort should mitigate the hurdles of barriers, helping the project to develop an effective solution and address all the necessary issues with adequate answers.

The T4MoD project is expected to deliver costs reduction due to the utilisation of medical information for better decision (e.g. avoiding non necessary medical evacuations), cooperative use of shared technical resources, decrease of medication errors, improved labour productivity and additional health care.

Product Features

T4MOD aims at offering an innovative architectural solution in terms of a system and associated operational Telemedicine services; strong points will be the provision of broadband communications over very wide coverage in mesh topology, the ability to manage dynamic on demand access using a simple and user friendly interface for the end users and the ability to handle different resources booking according to the four reference Medical Services needs. The proposed solution presents some characteristics:

  • A satellite capacity will be shared between the users and made available via a suitable scheduling or on priority basis;
  • A distribute deployment: hospitals have to create an ad-hoc structure in terms of logistics, inventory stocks, skilled personnel devoted to maintenance, help desk and management of satellite infrastructure distributed on single sites;
  • An on-demand solution, based on assignment of satellite resources according to the needs, consequent to the non-continuous nature of the T4MOD service;
  • An integrated algorithm also able to manage and assign medical resources and specialists;
  • The T4MOD Network Control Centre (TCC), main core of system and located at the Fucino Space Centre (FSC, Central Italy).
  • Security: authentication and confidentiality thanks to the security  framework implemented at the MoD sites.

In the following figure the high level T4MOD architecture is depicted:
T4MOD Architecture

 

Key Issues

In this project a number of critical elements will be addressed. The most important of them are those concerning the characterisation of medical services in a military environment, those related to interoperability issues (analysing the technical aspect and implementing a common application layer) and finally those involving the security considerations (aiming at dealing with the aspects of IP acceleration, compression and security that will guarantee the compliance of the architectural proposed solution with the security norms and regulations that are applicable for telemedicine service).

User Needs

The main need refers to Medical Services deployed for peace keeping and humanitarian missions in geographically isolated and underserved areas, with the most difficult environmental and operational conditions due to the lack of local medical specialists. The T4MOD project will use two space assets (i.e. satellite communications and use of a technology initially developed for manned spaceflights: robotised tele-echography).

Service Concept

The following telemedicine services will be the primary focus of the project:

  • Radiology
  • Microbiology
  • Cardiology
  • Dermatology
  • Trauma surgery
  • Neurosurgery
  • Intensive care
  • Emergency medicine (casualty care and management)

A high layer application will be developed with the purpose of managing the services within and inter- and ita-operable environment. This layer will simplify the system operations and integrate elements that could simplify the standard medical workflow while keeping the compliance with the working procedure of the end users. Finally it will help to extract, in the friendliest and automatic way, those parameters that could contribute to measuring the clinical performance gain. These important advantages will be enhanced by means of an efficient satellite architecture.

Space Added Value

T4MOD relies on two main assets coming from space technologies: on the one side satellite communications, and on the other side a robotized tele-echography solution initially developed to support crews onboard the International Space Station.

Target Users

The system is addressed at end users belonging to Military Health Services in France, Germany, Italy and Spain. The hospitals involved in the pilot will be in Europe and in some remote areas of operations.

Current Status

The DQR (Demo Qualification Review) milestone took place on 24 July 2013 in Fucino, Italy. This meeting was the opportunity to repeat in front of ESA a subset of the most important tests performed by the consortium until the DQR and documented into the System Verification Document. In particular, tests included a large medical imaging data (MRI DICOM file) transfer via satellite from Fucino to the Spanish MoD Hospital Gomez Ulla in Madrid and some telemedicine sessions with different scenarios in order to assess the performances of the different components (e.g. Antari, Covotem, Spontania) integrated into a single service. Another demonstrated capability was the possibility to free and reallocate effectively satellite capacity from a planned tele-consultation in order to support an emergency telemedicine session (for instance an urgent neurosurgery).

The DQR allowed to identify a set of features to be optimized in order to make the  system fully in line with the needs of the MoDs..

On 26 March 2014, the system was fully qualified by ESA and the DQR considered passed, which marked the start of deployment for the T4MOD Telemedicine Stations to equip the European Reference Hospitals of the MoDs. This phase will end at SDA (System Deployment Acceptance) milestone foreseen in May 2014.

Before the SDA, the User documentation (e.g. user manual) shall be finalised and medical users shall be trained to operate the system. Moreover, the T4MOD sustainability analysis will be updated, comparing ASSIST tool outcomes and costs breakdown belonging to the project initial business plan.

 

The deployment of the Remote Hospitals Telemedicine Stations will then start immediately after the SDA to start the pre-operational trials stage.

Prime Contractor

Leader Company Name: 
Telespazio S.p.A
Leader Company Country: 
Italy

Subcontractor

Company Name: 
GMV Soluciones Globales Internet S.A.U.
Company Country: 
Spain
Company Name: 
NDSatCom GmbH
Company Country: 
Germany
Company Name: 
Covalia
Company Country: 
France
Company Name: 
Dialcom Networks S.L.
Company Country: 
Spain
Company Name: 
DLR e.V.
Company Country: 
Germany

Project Managers

Contractor Project Manager

Aldo Vincenzi
Via Tiburtina 965
00156 Rome
Italy

ESA Project Manager

Francesco Feliciani and Arnaud RUNGE
ESA/ESTEC, Keplerlaan 1
2201 AZ Noordwijk
Netherlands