Diagnostics & Imaging Week

VIENNA – "When you are testing interoperability, it is rare that the problem is only on one side. That is the big advantage for Connectathon because both companies can work out the problems and solve it quickly," said Claudio Saccavini of Arsenal.it.

Five companies connecting 36 hospitals in Italy's Venato region came to the European Connectathon here with Arsenal.it for five days of final tests before implementation of their systems for cross-community access (XCA).

It was the most robust testing of the XCA integration profile developed by Integrating the Healthcare Enterprise (IHE), which had been introduced in 2008.

Where document sharing within a regional or community healthcare technology network using the IHE cross-enterprise integration profile (XDS) has grown substantially, the sharing of document between closed communities using XCA is still in its infancy.

This consortium of Italian companies from the Venato region is now completing the second phase of an e-health project named Health Optimum, designed to facilitate consultations for four different medical specialties by linking smaller community hospitals with expert physicians and surgeons at seven regional medical centers.

With €20 million in funding from the European Union under the Framework Six Program, the Health Optimum consortium also includes 23 healthcare providers in the Veneto region and five European Member States: Italy, Spain, Denmark, Sweden, Romania.

Four medical specialties to be enabled with this new capability:

• Neurosurgical Telecounseling: To give fast and formalized answers to neurosurgical counseling requests for Emergency cases of cranial trauma, from a peripheral hospital to the Neurosurgical Centre.

• Telelaboratory: With the introduction of new devices is possible to carry out test on site and then to receive immediately the lab results.

• Oral Anti-coagulant Therapy: A service dedicated to patients under anti- coagulant therapy with the goal of reducing patient travelling while maintaining high quality analysis and specialist support.

• Stroke Management: A consultative modality to facilitates care of patients with acute stroke at underserviced hospitals by specialists at stroke centers.

The modality being tested at European Connectathon was for stroke management, where physicians of a community hospital or clinic identifies symptoms of a potentially suspect acute stroke for a patient in an emergency-receiving setting.

After evaluating the case, the local neurologist completes a form, digitally signs it and sends the form with computer tomography (CT) images to a neurologist at the central reference hospital for authorization to begin a tPa treatment and to arrange for the patient transfer.

The electronic form contains a patient's personal data and necessary clinical and medical histories.

The consulted neurologist writes and signs electronically his opinion and then sends this form to the peripheral unit, either contradicting the diagnosis or confirming the condition should be treated with tPa therapy and agreeing to accept the patient at the reference hospital.

The step-by-step development of the Health Optimum network include realization of the exchange of documents and images within each of the seven areas inside the Venato region, and then the integration of the platform with the introduction of gateways according to IHE XCA integration profile.

This integration of community hospitals with full system interoperability at their regional level then allows the exchange of documents and images between area networks, bringing for the first time the potential for sharing the local hospital requests among seven expert centers.

"The adoption of a gateway at the border of each domain, and the standardization of the communication method among different gateways, allows interoperability on the platform whether domains internally are adherent to XDS profile or whether they are structured according to legacy solution that are not XDS compliant, explained Saccavini.

"For example, imagine that within the Venato region, the reference center at Treviso is overloaded with work and the local hospital physician needs to ask a different neurologist for an opinion," said Saccavini. "It sounds so simple when you say it, but it is very complicated to accomplish."

"Here at Connectathon we are testing this switch for the physician located in the Treviso community network to consult with a neurologist in another community network within the region, a referral out-of-the community, using the IHE approach," he said.

"There are a lot of factors that need to come together, which becomes easier to do at Connectathon," he said, adding, "The idea is that once we test the platform, if we need to add another company with a cardio vascular device or an imaging device, then we have the tools and the experience to test these new actors and see whether they are able to enter into the system."

Saccavini said Connectathon requires the five companies in the consortium to work with other companies they have never met before, either pulling images and documents or sending data to systems for the first time.

"These other systems are not necessarily focused on telemedicine, and it is very useful to test between different systems," he said.

"It is easier to do it all in one week and to be working tech-to-tech," he said, explaining that because there are not any customers at Connectathon, the technical staffs can work free from requirements to collaborate with commercial representatives.

Telemedicine not different than e-health

In 2008, the European Commission (EC) launched an ambitious large-scale program to exchange patient medical information among 12 participating Member States, called European Patient Smart Open Services (epSOS).

This year the EC is launching a second program to support telemedicine, the remote monitoring of patients' conditions from their home.

Yet the nuance between e-health and telemedicine was lost on the technicians working at the IHE-Europe Connectathon in Vienna as they tested different integration profiles for sharing patient information among healthcare information tecnology (HIT).

"People continue to view telemedicine as a peer-to-peer connection of devices with systems, for a consultation or for monitoring," said Claudio Saccavini with Arsenal.it who leads the EC's Health Optimuum program to connect community hospital HIT.

"Peer-to-peer is an old view of telemedicine because what we are really doing is sending out information from a device that needs to be shared with all the actors within the continuity of care for a given patient," he said.

"This is e-health, pure and simple, and there is no need to create a new telemedicine domain when we already have the cross-enterprise and cross-community infrastructure for exchanging this information," he said.

If a company introduces a monitor that gathers glucose values, for example, and then marks that data with its own codes, or does not structure the data to conform to forms accepted by the rest of the system, then that data can not be shared by others caring for the patient, he said.

Eva Deutsch, the healthcare lead for IBM-Austria (Vienna), agrees that with the emerging and open back-end solution for processing health information, the idea that separate systems are needed to enable remote monitoring for telemedicine is out-of-date.

"The market is going from directed peer-to-peer communications to open communication where under strict security rules doctors and all other actors involved in the continuum of care get the information they need when the need it for a specific patient," she told Diagnostics & Imaging Week.

Alexander Schanner, who is the program manager for the emerging Austria electronic health record, Arge ELGA (Arbeitsgemeinschaft Elektronische Gesundheitsakte), told D&IW, "a lot of software out there right now is going to disappear and we will see a major consolidation."

He said software used in doctors' offices and for personal health monitors that encode data in a manner to capture and keep customers will be out of synch with the move toward open, cross-community sharing of patient data.

"We have already seen a consolidation of players here in Austria," he said, including the market leader for general physician software, Gruber ADV (Enns, Austria), which was purchased by CompuGroup CEE (Vienna), an affiliate that CompuGroup Holding AG (Koblenz, Germany) created expressly to acquire e-health businesses in the region.

Diabetes monitoring device for EU project

Hardware, software and sensors for a device platform to measure and predict personal blood glucose levels has been delivered by Toumaz Technology (Abingdon, UK) to complete the first phase of a large-scale European Union (EU) project for diabetes patients.

Toumaz is responsible for the device work package that is part of the EU's DIAdvisor project developing a prediction-based tool using historic and current blood glucose measures to optimise the therapy of Type I and developed Type II diabetes with the goal of minimizing the occurrence of diabetic complications and reducing healthcare costs.

DIAdvisor is being developed by a consortium of 13 companies coordinated by Novo Nordisk (Bagsv rd, Denmark), a leader in diabetes care that includes the European Division of the International Diabetes Federation.

DIAdvisor received €7.1 million ($9.5 million) under the EU's Framework Seven Program in April, 2008.

The Toumaz device platform integrates a non-intrusive body-worn wireless vital sign sensor from Sensor Technology and Devices (Belfast, UK) and a non invasive glucose sensor from Ondaly (Montpellier, France).

Data collected from the sensors is processed onboard the body-worn device with the Toumaz Sensium chip and transmitted using Toumaz ultra-low power Advanced Mixed Signal (AMx) technology that continuously sends and receives data packets using batteries that can be as small as a slip of paper and not larger than a hearing aid battery.

Cardinal Health (Dublin, Ohio) and Texas Instruments (TI; Dallas) have licensed the Toumaz technology to develop intelligent medical devices.

Data sent from an individual monitor in theDIAdvisor project will be processed with software developed by RomSoft (Iasi, Romania) using models developed at Lunds University (Lund, Sweden) and algorithms developed at Johannes Kepler University (Linz, Austria).

The DIAdvisor device will allow patients to actively and accurately predict short-term blood glucose at any moment automating an analysis of glucose measurements, insulin delivery data and specific patient parameters.

Prediction data will be wirelessly transmitted to a designated healthcare provider which in turn will transmit recommended action and treatment advice for display on a patient's handheld mobile device.

Toshiba debuts high-end CT unit for Europe

For European radiology centers on a limited budget, Toshiba Medical Systems Europe BV (Zoetermeer, the Netherlands) has introduced the Aquilion Premium, a 160-detector row computed tomography (CT) scanner with software and hardware options allowing an upgrade to research-quality images equivalent to the flagship 320-slice AquilionONE.

Three systems have been sold with two currently being installed in Russia and one in Italy, Toshiba' Europe's senior manager for marketing, Jack Hoogendoorn, told Diagnostics & Imaging Week.

"Aquilion Premium is the only system that can be upgraded from eight centimeter to 16 cm coverage to unlock all the advantages of our AquilionONE CT dynamic volume scanner, which means a safe and sound investment for future for customer needs," he said.

The Aquilion Premium scanner covers 80 mm with a 160-detector row in a single rotation and by using the reconstruction algorithms in the coneXact software, the scanner generates a 320-slice, 3-D volume image.

The good news regarding the narrow coverage of the 160 in-line Quantum detectors is a smaller detector aperture of just 0.5mm, the world's smallest available in CT technology, according to Toshiba, providing fine and fast dynamic volume images for functional CT at low radiation dosages in a single rotation.

The downside is the Aquilion Premium restricts the range of clinical applications to narrow coverage areas, such as the heart or the brain.

The Aquilion Premium can be upgraded with a retrofit to 320-detector rows and 160 mm coverage, generating 640 slices per rotation, the same as the AquilionONE.

Aquilion Premium customers are given a range of software packages on six-month trial basis to experience the advantages of advanced clinical imaging and if convinced of the clinical benefits and able to come up with the budget, can progressively upgrade capabilities.

"Experience teaches us that the selection of optional software packages can be difficult, and is complicated by budget restrictions," explained Hoogendoorn, adding that as clinical needs emerge a customer may find a need for a different choice of software than originally selected.

For the moment the scalable, upgradable Aquilion Premium platform is only available in Europe, he said.

Eighteen months ago Toshiba made waves at the 2007 Radiological Society of North America meeting in Chicago when it introduced the AquilionONE, a CT scanner featuring a world-first 320-slice architecture, announcing it had pre-sold five units and then winning a purchase from the National Institutes of Health.

The new capabilities of a wide, dynamic volume approach created several clinical advantages by eliminating the stitching of multiple images that create image artifacts, and by lowering radiation doses by as much as 80% according to Toshiba.

The Aquilon Premium is loaded with Toshiba's trademark IT capabilities, including on board, storage for up to 800.000 images for immediate access retrieval and what the company is calling "Enhanced DICOM" (Digital Imaging and Communications in Medicine) that increases the transfer speed up to 10 times so that the transfer of 1,200 images, which would normally take over three minutes, is completed in 20 seconds.