17.Jahrestagung Deutsch-Chinesische Gesellschaft für Medizin, Hangzhou, 10.-12.Oktober 2002




Abstract: A Telemedicine Application On The Way to Routine Use


Helmut SUSSMANN, Catharina NÄTSCHER, Matvei TOBMAN, Alexander HORSCH

Dept. of Medical Statistics and Epidemiology, Technical University of Munich, Germany




The telemedicine project ENDOTEL [1,2] offers participating physicians the possibility to get advice from a colleague during diagnosing or treating diseases of the intestinal tract. At the moment the service mainly aims to support endoscopic and endosonographic problems.


There are three service levels. On the first level, the treating physician can search the Endoscopy Information System (EIS) via the Internet. He will find a large quantity of reference pictures and example videos about diseases of the intestinal tract. This comprehensive and well structured multimedia offer is combined with describing texts and basic information. If this resource is not sufficient, the physician can switch over to the next support level and formulate an individual inquiry to a colleague by means of the EST.


The second support level offers an asynchronous multimedia consultation facility, the ENDOTEL Store-and-forward Teleconsultation service (EST). If a physician needs a second opinion regarding e.g. an unclear finding, he composes an inquiry with the EST client software. All necessary diagnostic findings and test results (endoscopic/ultrasonic pictures or videos, radiographs, laboratory data etc.) can be prepared within the system, attached to the inquiry and finally sent to a suitable expert. This procedure supports a well-founded clarification of difficult cases before briefing or transferring the patient. Figure 1 shows the software architecture of the EST client.


On the highest support level, the ENDOTEL Video conferencing Teleservice (EVT) will be offered in a later implementation phase. It is a hard requirement to utilize the Internet also for this component in order to realize the full integration of all three service levels. A first prototype of the EVT has been tested at the beginning of the project by sample transmissions by Internet streaming techniques in June and August 2000. The quality was still too poor, so that the subproject was postponed.




Figure 1: Software architecture of the EST client




The handling and the functionality of the first prototype EST Version 1 have been evaluated in a field test with three participating hospitals and 5 GPs from March to July 2001. Over 50 consultations have been performed. Major results from this field test were: 1) Composition of a multimedia query takes 10-15 minutes in average, only; 2) the quality of the video capturing and the scans was still insufficient.


Starting in autumn 2001, a new version of the software has been designed with UML and implemented completely in Java. Video and scan quality have been improved according to the lessons learned from the field test. The new application has a XML-based architecture with high integration abilities. The teleconsultation is now based on the exchange of CDA documents. The testing and evaluation phase for the EST Version 2 will start in July 2002.


To establish the service in the long run it is necessary make the software ready for market. An important objective thereby it to develop interfaces to existing hospital information systems and praxis office software on one side, as well as to diagnostic devices (especially endoscopy processors) on the other side. This integration task is tackled on the basis of existing open communications standards like HL7 and DICOM.


Last not least, the incorporation of computer-assisted visualization and decision support tools is part of ongoing efforts. A special module for the support of endoscopic ultrasound of oesophagus cancer already exists and is integrated as an optional EST feature. It uses image processing and pattern recognition algorithms to help him visualize diagnostically relevant structures (e.g. muscularis) in the ultrasound images when making the decision about the T stage of esophageal tumours.





[1] http://www.endotel.de

[2] Sußmann H, Griebel H, Allescher H-D, Egger K, Sandschin W, Horsch A: The teleconsultation service ENDOTEL - Implementation and first experiences. In: Hasman A, Blobel B, Dudeck J, Engelbrecht R, Gell G, Prokosch H-U: Medical Infobahn for Europe, Proceedings of MIE2000 and GMDS2000, MIE 2000, August 27 - September 01, 2000, Hannover, Germany, Amsterdam et al: IOS Press, 2000, p. 1117-1121 [4] http://www.eis.telemedizin.org





Helmut Sußmann

Institut für Medizinische Statistik und Epidemiologie

der Technischen Universität München

Klinikum rechts der Isar

Ismaninger Straße 22

D-81675 München

Tel.: +49-89-4140-4351

Fax: +49-89-4140-4974

Email: helmut.sussmann@imse.med.tu-muenchen.de