Abstract: Concept and Realisation of the Telemedicine Project ENDOTEL
M. Tobman, H. Sußmann, C. Nätscher, W. Reverey, A. Horsch
Institut für Medizin. Statistik und Epidemiologie, TU München, Ismaninger Str. 22, 81675 München
The project ENDOTEL establishes an integrated 3-level telemedicine service that enables participating physicians to ask a colleague for advice when diagnosing or treating diseases of the intestinal tract. The service emphasizes the support of endoscopic and endosonographic investigations.
On the first, i.e. the basic level, the treating physician can search in the Endoscopy Information System (EIS) on the Internet. He will find a large quantity of reference pictures and example videos about diseases of the intestinal tract. It is a comprehensive and well structured multimedia offer, combined with describing texts and basic information. An ergonomic online authoring system enables high topicality, allowing competent persons to make changes fast and easily. If this offer is not sufficient, then the physician can switch over to the next support level and formulate an individual inquiry to a colleague by means of the ENDOTEL Store-and-forward Teleconsultation (EST) service.
This second support level offers an asynchronous multimedia consultation facility. If a physician needs a secondary opinion regarding e.g. an unclear finding, he composes an inquiry with the EST client software. All necessary test results (e.g. endoscopic/ultrasonic pictures or videos, radiographs, laboratory data) can be prepared within the system, attached to the inquiry and sent to a suitable expert. The consultant does not have to interrupt his workflow for to give an immediate answer. He can work up all incoming inquiries at a suitable time chosen by himself. He finally sends his answer back to his colleague, again asynchronously and via Internet. This procedure supports a profound clarification of difficult cases before briefing or transferring the patient.
On the highest support level, the ENDOTEL Video conferencing Teleservice (EVT) will be provided in a later implementation phase. A first prototype of the EVT has been tested at the beginning of the project by sample transmissions by Internet streaming techniques.
The improved EIS Version 2 is available on the Internet free of charge since March 2002 (www.eis.telemedizin.org). Up to now (May 2002) it contains 349 pictures and 21 videos (160 MB). The texts will be completed by information about current standards for diagnostics and therapy. Handling and functionality of the EST Version 1 was evaluated in a field test with the participating hospitals and GPs from March to July 2001. 38 consultations have been performed. Starting in autumn 2001, a new software was developed. It has a XML-based application architecture with high integration abilities. The teleconsultation is now based on the exchange of CDA documents. The integration of computer-assisted visualization and decision support tools is work in progress. A special module for the support of the endoscopic ultrasound of oesophagus cancer already exists and is integrated as an optional EST feature. The testing and evaluation phase for the EST Version 2 will start in July 2002.