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Network
of Excellence
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PatiMon
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36
Berg
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Dr.
med. Bernhard Clasbrummel
BG-Kliniken
Bergmannsheil
Bürkle-de-la-Camp-Platz
1
44789
Bochum
Telefon
+49 234 302 6383
Fax
+49 234 302 6790
Bernhard.Clasbrummel@ruhr-uni-bochum.de
The
centre for telematic Traumatology TELTRA is one of eight centres for medical
technology in Germany, designated by the BMBF (Bundesministerium für Bildung
und Forschung) which is the German office for education and research.
Due
to the common interest between the universities of Bochum and Karlsruhe TELTRA
developed a centre for telecommunication and computer science telemedical
applications. This group is located on the hospital grounds of Bergmannsheil
University Hospital associated with the Ruhr University in Bochum. The spectrum
of the development offered by TELTRA Ltd. includes a range of products ranging
from a new form of virtual ward rounds (called Televisite) to online therapy for
blindness (such as Spectros and Nethera).
The
strengths are in the following areas:
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Organisation
of clinical multi-centre studies
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Development
of medical mobile human machine interfaces (HMI)
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Medical
education
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Standardisation
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Telediagnostics
TELTRA
is part of the Berufsgenossenschafltiche Kliniken Bergmannsheil, Bochum. The
Bergmannsheil Bochum is closely connected to the central hospital administration
of the university clinic with a total of 21 hospitals, institutes and
departments. Bergmannsheil was originally established for the medical care of
the coal-miners in the Ruhr Basin, Germany. The Institute for pathology, the
German mesothelium carcinoma register, the employment cooperation for the
research institute for industrial medicine (BGFA), Institute for dangerous
material research (IGF) and the orthopaedic workshop are also supervised by this
central administration. With an annual budget of about 118 million Euros, more
than 2,000 co-workers in the Bergmannsheil clinic are actively responsible for
over 60,000 ward and out-patients.
European-wide
medical standards are not uniformly defined with human diseases, such as
diabetes mellitus, patients with wounds or therapy for frequent injuries
including follow-up care. This also means that optimal therapies for certain
illnesses are not provided nation wide. The reasons for this include lack of
information, of which there may be too much available on the one hand, or on the
other hand there are different types of therapy for a particular illness.
Another
important cause is due to a lack of multi-center studies, which allocate the
effects of individual types of therapy. The fundamental goal of the planned
clinical european-wide multi-center study is for selected diseases
(diabetic foot wounds, patients
with open wounds and follow-up care of patients with joint injuries or
endoprothetic joint replacement). Collected
data could be cost effectively transmitted via a wireless (GSM, UTMS) connection
to a telemedical service center. European-wide mass data can be collected
and assessed for illness-specific statistical evaluation, comparing the
most diverse therapy principles of the multi-center studies. We expect that
improved strategy principles for frequently occurring illnesses can be derived.
A major part of the studies will be an economic analysis of patients’
courses and rehabilitation results. Thus, types of therapy be selected which
would guarantee a high quality of life for the patients while providing cost
effective therapy with maximum rehabilitation success.
Current
status of science and technology
Around
10 % of all ward hospitalisations (about 4.5% of 45 million patients in the
European Union) are treated for wounds. An important cost factor in the health
service would be considered to avoid unnecessary ward hospitalisations or late
ward hospitalisations due to wound complications. Telematic monitoring of such
patients has already begun in individual european centers.
Wide implementation of such initiatives has to a large extent been
inhibited due to a lack of financial support for the research projects.
Moreover, during the past 3-5 years the more economical portable systems for
collecting data and pictures of the wounds were not well-known.
Plans
for implementation of the project
With
the help of new camera systems, by which pictures and data could be transferred
with mobile data communication technologies such as UTMS, HSCSD or GPRS, wound
care normally carried out by the nursing staff in outpatient clinics could be
possible. In a multi-center study it was arranged for
approximately 300 european patients to take weekly photographs of their
wounds at home to be conveyed to a telemedical service center. The mobile user
system should contain the simplest possible user interfaces and technologies
with problem-free service, simplicity of questions about findings, pain,
rehabilitation progress and the anticipated duration of the employment
disability. Furthermore, it should be easy to convey responses without problems.
Fundamental
tasks of the telemedicine research group are: Specification, planning of field
tests, organisation of the clinical multi-center studies, data analysis and
derivation of future recommendations.
Chances
of success:
Due
to the high costs of hospitalisation for wound treatment (4.5 million patients
per year in the european region), there is currently a large trend toward
out-patient treatment. Telediagnostics with the help of mobile medical care will
presumably lead to the following advantages:
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reduction
of unnecessary hospitalisations
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earlier
hospitalisation following complications
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improved
quality of life
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shortening
the length of stay
Only
reliable, user-friendly and cost effective systems for diagnostics would be
widely accepted in Europe. As prominent partners from european-wide industries
and research organisations are supporting the project a high chance of success
can be expected of the intended multi-center study.
Goal
/ Motivation
The
success of mobile electronic systems depends considerably on a simple intuitive
interface with clinically relevant data for patients and physicians. With a
telemedical service one must pay particular attention to the security and high
quality of the data communication, in order to recognize possible complications
promptly. In addition, the system must be economically durable and easy to
clean, for example using disinfectant wipes.
In
order to achieve wide acceptance the system interfaces need to be standardized
to comply with European norms. This would subsequently form the basis for the
development of future designs of telemedical
interfaces which could be used by patients with special physical disabilities (eg.
handicapped or geriatric users). For nursing personnel and physicians simple
standardized disease curves could be meaningful, which would diagrammatically
demonstrate the clinical course of the patient’s diseases.
In
certain areas of medicine, in particular with handicapped or geriatric patients,
extensive efforts have already been undertaken to make sure symbols and writing
are clearly legible and recognisable by these patient groups (http://www.design-for-all.org,
www.ehto.org).
The
aim of this project is to develope and standardize man-machine interfaces
(portable electronic monitor systems) for patients and doctors.
Close co-operation between developers of hard and software interfaces is
crucial in order to guarantee reliable collection of data streams for medical
purposes. Furthermore, it is necessary to explain certification in detail,
including diagrams of software coding which explain the function of the whole
system.
Clearly
structured standards were established based on EU norms. From the set criteria,
field tests were developed to validate the ease of use by patients and
physicians. An additional important requirement is close cooperation with
project partners resposible for IT security and management of the medical data.
The
success of telemedical products and services depends mainly on how well actual
or future needs can be covered by telemedical services.
The aim of telemedical services must always be to offer a high level of
medical service in a defined space of time at a realistic price.
In order to achieve this aim risk evaluation must be done taking all
aspects of national and European health services and the interests of health
insurances into consideration. The needs of patients and doctors must also be
respected. Future technological
trends and their costs must be scrutinized in order to achieve acceptance
amongst the purchasers.
The legal aspects with regard to the security of telemedical services
need to be considered as medical complications could lead to expensive legal
action.
When
all these conditions are fulfilled and incorporated in a complete telemedical
concept the next consideration is the constant maintenance of telemedical
services and their adaptation to the requirements of patients, doctors,
insurances and owners. Medical
adaptation can only be done by medical personnel or institutions with wide
experience of clinical routines and open views concerning new, innovative
products.
In
order to achieve European acceptance of telemedical services extensive
logistical requirements must be fulfilled in order to offer competent contact
persons speaking their own language within a reasonable time frame. In addition,
it should also be possible to contact specailists who could advise or offer
therapy (within an acceptable geographic distance).
Current
status of science and technology
In
national and European telemedical projects to date, local and international
applications such as telecardiology, telepathology or teleconsiliary services
have been implemented. The
discontinuation of most telemedical projects was mainly due to lack of
consultation with insurances and a lack of business plans.
Data protection laws and legal problems were a further hindrance
to
the spread of telemedical services (e.g. electronic prescriptions).
Plans
for implementation of the project
Risk
analyses of each medical application will be carried out taking the following
interests or conditions into consideration:
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EG norms of the MPG (?)
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National strategies of health organisations
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Needs of the patients
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Doctor’s requirements
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Future technology trends
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Cost-benefit analysis
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Legal
restraints
An
organisation of boards of experts to advise patients in cooperation with
specialist societies and quality conferences should secure the mentioned medical
advice center.
Chances
of success:
Certain
future telemedical services have a high potential to make savings, such as
travel expenses or the cost of running outpatient departments with waiting rooms
and examination rooms which would no longer be necessary.
The basic assumption is made that patients‘ needs will be fulfilled
(and not fantasies of technology freaks).
A
robust telemedical service which can reliably provide a connection to
patient or specialist has a high chance of continuing success. The
partners selected for this project are extremely suitable for the job of
presenting the requirements and using a network of excellence to its full.
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TELTRA
Center of Competence in Telemedicine, BMBF;
Sept. 00 ‑ Aug. 05
A
medical technology project from the University of Bochum was selected by an
expert jury in Bonn as one of eight authority centres for medical technology. A
main project, among other things, was the defibrillator for non-professionals.
This defibrillator device was developed with Cardiology supports which function
by using telecommunication and computer science. In addition, the Televisite
with its web-based service was designed with virtual ward rounds for
outpatients. By improvement of the information management, the organisational
structures and operational procedures would not only lower costs but also result
in an improved patient support.
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DIPRO
(Digital
Quality Safety in the Endoprotheses with miniaturised Sensor of Acceleration),
Main assembly of the Employer’s Liability Insurance Association; Aug. 00 -
Jul. 03
The
loosening of endoprostheses is clinically a substantial problem, especially in
the prostheses of the hip and knee-joints, where about 7 to 10 % of the
prostheses loosen after 10 years. There is a postoperative risk of more than 2 %
that an implant will loosen after a revision operation. With acceleration
sensors, which are integrated in the prostheses, loosening of the implant would
be promptly recognised (via diagnostics, quality assurance system) and could
affect future new developments.
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VESIMA
MED (Vertical
Structured Intelligent Micro-conductor Array – Application Areas in Medicine,
BMBF; Okt. 98 - Sept. 01
In
this joint research project the development of an implantable telemetric unit
and its adaptation to acceleration sensors lies in the foreground. The system is
to be used for the monitoring of fracture
healing among other things. There are 2 industrial and 3 university partners
also participating in this project.
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ITES
(Implantable telemetric Endosystem), BMBF; Jan. 95 - Jun 98
In
the group project ITES a miniature, implantable pressure measuring system was
developed by a consortium of six industrial companies, three technological
institutes and a hospital partner (Bergmannsheil Clinic). Clinical areas of
application include continual wireless blood pressure measuring, brain and
compartment pressure monitoring. The implantation of this device is a minimally
invasive procedure in which catheter associated infections should be avoided.
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Our
employees created websites for our various projects.
It
was developed in co-operation by the Nethera firm with the medical faculty of
the Ruhr University Bochum to provide the therapy for half lateral visual field
disturbances.
The
OTCB website provides an online therapy for cortical blindness.
The
Association "BioMedTec Ruhr" is
based on an open network for biomedical technology bundling of authority in the
Ruhr district.
Based on wide experience in numeric programming on mainframe computers he is
also focusing on design of medical end-user friendly software modules and
redundant application server systems.