Experience in Designing and Evaluating a Teleconsultation System Supporting Shared Care of Oncological Patients

This poster presents our experience in designing, developing and deploying a Web-based Teleconsultation System based on a Patient Centred Oncological Electronic Medical Record (PEMR) specifically designed to provide clinicians a cooperative work tool supporting the oncological patient management. An evaluation phase in a clinical setting was performed when the system was deployed in the hospitals. A second evaluation phase after two year of utilization has been carrying on

A XML-based tele-dermatology service as patients' management support

The increasing availability of information and communication technology in healthcare organisation is a pushing factor for the development of innovative applications that could enhance the quality of care delivery while keeping its cost at reasonable levels. Furthermore, as the nowadays patients' care is delivered by multiple operators, thus tools allowing effective management of patients are needed. In this study we present a web-based tele-dermatology service developed in order to investigate the feasibility of such tool for the integrated management of dermatology patients. In the Province of Trento, which is a mountainous region in the heart of the Italian Alps, telemedicine application may play a central role for improving patients' quality of life and control healthcare organisation costs. Here work two kinds of dermatologists: "mobile dermatologists" (MoDs), who work in several different dermatology surgeries in the province and "hospital dermatologists" (HoDs), who are specialists working in the central hospital in Trento. In many cases during their practice, MoDs have to decide the care regimen of patients. Traditionally, doubtful cases are directly referred to hospital specialists, and only in few cases they are discussed by phone calls between MoDs and HoDs. A hospital outpatient specialist's visit has high costs both for the healthcare organisation and for the patients, who often need to go to the central hospital from remote valleys. The well-organized management of dermatology patients, especially of those who need surgery, plays a great role in nowadays care delivery in our regio

Design and implementation of a regional tele-oncology project: design and initial implementation phase

In 1997 two tele-oncology projects started in the north of Italy (Province of Trento). The common aim of the projects concerns the design and the implementation of a non-surgical tele-oncology system intended to provide a suitable and flexible computing environment for a joint management of oncology patient on a WAN. The network designed for the first project (funded by Italian Health Ministry) links 5 rural hospitals of the province -lacking of oncology specialists on site- to the central one, where clinical oncology (CO) and radiotherapy services are provided. The specific purpose of the tele-oncology system is to support the rural hospitals oncology care by providing continuos expert remote advice from central site oncology specialists in formulating treatment plans and conducting follow-up sessions. The second project (funded by EC Adapt-bis Programme) is devoted to facilitate the communication between general practitioners (GPs) and the medical staff at the CO department of Trento through a computer network, allowing GPs and hospital specialists to share medical data. To satisfy the overall needs of the two projects an intranet-based OTCS was implemented. The basic component of the system is the multimedia digital medical record. A distributed relational database will allow users to store and retrieve medical records, accessed by a dedicated Web browser. The system incorporates Web-based applications (native and custom) such as synchronized navigation on medical records, image-sharing, audio-conferencing, white-boarding, local notepad, chat and e-mail service. The system provides a synchronous mode for real-time cooperative working between hospital specialists and an asynchronous mode for sharing clinical data between GPs and hospital specialists. Users acceptance during the prototype implementation periods and the training phase was high. Since summer 1999 the OTCS has been deployed in hospital and GPs setting and it is going to be tested in the hospital routin

Design and implementation of an intranet-based system for real-time tele-consultation in oncology

This study describes a tele-consultation system (TCS) developed to provide a computing environment over a Wide Area Network (WAN) in North Italy (Province of Trento), that can be used by two or more physicians to share medical data and to work co-operatively on medical records. A pilot study has been carried out in oncology to assess the effectiveness of the system. The aim of this project is to facilitate the management of oncological patients by improving communication among the specialists of central and district hospitals. Methods and Results: The TCS is an intranet-based solution. The intranet is based on a PC WAN with Windows NT Server, Microsoft SQL Server, and Internet Information Server. TCS is composed of native and custom applications developed in the Microsoft Windows (9x and NT) environment. The basic component of the system is the multimedia digital medical record, structured as a collection of HTML and ASP pages. A distributed relational database will allow users to store and retrieve medical records, accessed by a dedicated Web browser via the Web Server. The medical data to be stored and the presentation architecture of the clinical record had been determined in close collaboration with the clinicians involved in the project. TCS will allow a multi-point tele-consultation (TC) among two or more participants on remote computers, providing synchronized surfing through the clinical report. A set of collaborative and personal tools, whiteboard with drawing tools, point-to-point digital audio-conference, chat, local notepad, e-mail service, are integrated in the system to provide an user friendly environment. TCS has been developed as a client-server architecture. The client part of the system is based on the Microsoft Web Browser control and provides the user interface and the tools described above. The server part, running all the time on a dedicated computer, accepts connection requests and manages the connections among the participants in a TC, allowing multiple TC to run simultaneously. TCS has been developed in Visual C++ environment using MFC library and COM technology; ActiveX controls have been written in Visual Basic to perform dedicated tasks from the inside of the HTML clinical report. Before deploying the system in the hospital departments involved in the project, TCS has been tested in our laboratory by clinicians involved in the project to evaluate the usability of the system Discussion: The TCS has the potential to support a “multi-disciplinary distributed virtual oncological meeting”. The specialists of different departments and of different hospitals can attend “virtual meetings” and interactively discuss on medical data. An expected benefit of the “virtual meeting” should be the possibility to provide expert remote advice from oncologists to peripheral cancer units in formulating treatment plans, conducting follow-up sessions and supporting clinical researche

An evaluation of the users' satisfaction and the use of a tele-consultation system in oncology practice

A three year oncology teleconsulting project was concluded in November 2000. During a six-month study period, 38 clinical physicians and 47 nurses used the system. A total of 617 electronic patient records were created in te oncology department, 297 in dermatology and 24 in gynaecology. There were 45 synchronous teleconsultations involving various participants, lasting a total of 708 min. We conducted surveys of the attitudes of the users to the teleconsulting system both before and after its implementation. There were no significant differences between the two surveys and the results showed that users had a positive reaction to the system and high expectations to its future utilizatio