The TelAny system has proved to be successful. Contractors have addressed the issues pointed out in ESA Invitation to Tender (ITT) in 19 months of work, ending in January 2003.
The figures show the Kell J-Hospital diary data representation for one patient using a 7276 dual chamber Medtronic device monitored during the trials in January 2003. All these data (approx. 1000 text and number fields and 10 multimedia signals) have been transferred from the patient's home using the TelAny system. The non-multimedia fields are arranged in forms similar to the following, representing the long set of device parameters.
The multimedia fields are accessible using the dedicated browser. The browser has been developed following physicians recommendations and was one of the main innovations. Having access to both parameters and signals remotely enables a complete view of the clinical situation that earlier needed a complex programmer in order to be viewed. Furthermore, the programmer only gives access to one set of data at a time, while the Kell J-Hospital software stores all data at the Telespazio service center. The Telespazio Evolv-e network is used to enable physicians fast multimedia data access.
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During the pilot trials data from the PC at patient home via Globalstar was also retrieved. The optimisations and compression of data stored and transferred enables access to signals in less than 30 seconds. This leads to the opportunity of a future extension of the system to allow Globalstar/GSM data access to physicians not in their offices.
During the project we learned a lot about about:
- Wounds and sickness in different maritime environments
- User requirements for maritime telemedicine
- Where the medical officer onboard calls in case of emergency
- Evacuation routines
- Experiences from other maritime telemedicine projects
Discussions after demonstrations gave us valuable information about what participants thought about the TelAny system. The response was very positive. The physicians reported that video-conferences in which the patient was included gave important information about the examination. Audio quality was very good. Picture quality was sufficient to examine the patient, but not good enough to look at details when examining a rash for example.
The medical email software (Doris by Well) is a very suitable application. Pictures are very informative. 12 lead ECG is important in cases;involving heart attacks. Temperature, non-invasive blood pressure, heart rate and oxygen saturation are important values in a number of cases. The doctors were not convinced whether sound from the stethoscope could give any relevant information. This must be further investigated. The documentation of a consultation is easier when it is recorded as an electronic record instead of a phone call. Doris gives very good documentation, especially because the question from the boat and the answer from the doctor are recorded together. A relevant problem is education of personnel on new equipment. The following other statements were selected from the discussion with the audience during press conferences which followed demos:
- Telemedicine is very important in a maritime environment. Often the distance between the patient and the doctor is very long. It may take days to transport the patient to a doctor
- Telemedicine is important in those cases where a seaman will make a regular doctor consultation (non-emergency)
- The medical officer wants to make use of this kind of equipment. It is difficult to explain everything verbally
- The verbal communication between shipboard persons and doctors will always be the main thing
- In a number of situations onboard, time is not relevant. This means that the medical officer can use the equipment without any stress
- The emergency dispatch centres must be able to receive multimedia data.
- Telemedicine equipment must be kept simple
- The equipment and applications demonstrated seem to be suitable for a maritime environment, but the seamen need training
Another important point is that most of the above issues apply to on-shore emergency also.