EH 2_2015

With its 30” 6 Megapixel workspace, 800 cd/m2 maximum luminance and multiple digital inputs, the MD302C6 is the perfect solution for large, high detail colour diagnostics in MRI, CT and other medical imaging techniques. In addition, the feature rich display includes a front sensor, LED backlight and special Anti-Reflection coating which helps to deliver a first- class image quality with reliability over sustained periods and reduced energy consumption. For more information www.medical.nec-display-solutions.com With its 30” 6 Megapixel workspace, 800 cd/m2 maximum luminance and multiple digital inputs, the MD302C6 is the perfect solution for large, high detail colour diagnostics in MRI, CT and other medical imaging techniques. In addition, the feature rich display includes a front sensor, LED backlight and special Anti-Reflection coating which helps to deliver a first-class image quality with reliability over sustained periods and reduced energy consumption. The Quick Screen QA function offers ad hoc DICOM conformance testing and GammaComp MD QA client affords a simple means to keeping the DICOM display to optimum calibration over its operational life. Mehr Informationen zum Thema 4KUHD finden Sie auf www.4kuhd-nec.com Ultimate 6MP Colour Performance NEC_AD_6MP_ColourPerformance.indd 5 21/04/15 13:00 28 IT & TELEMED Digitising the operating theatre Huge telehealth study reveals mixed value, but… The entrance of PACS-Surgery England’s Florence looks like a winner Picture Archiving and Communi cations systems (PACS) are well established for managing radiology images. Could this robust and mature technology now become the back- bone for creating the digital operat- ing theatre? In a hospital, the OT is perhaps the most expensive and labour-intensive area and it is expected that stand- ardising procedures with the help of computer assistance will help to control costs better, as well as ensure that patients benefit from an optimal surgical interventional and treatment. Yet, the operating room is also one of the most complicated areas in a hospital with complex information processing among as many as 30 to 50 medical devices, many of which do not share data with other systems. In Barcelona, at the end of June, the Computer Assisted Radiology and Surgery (CARS) Congress will bring together experts from radiol- ogy, surgery, engineering, informat- ics and healthcare management to focus on a range of interconnected fields to shape the smart operating theatre of the future, an OT with state-of-the-art image processing and visualisation and with model-guided interventions supported by surgical navigation and robotics. Heinz Lemke, a founder of the CARS congress and the Chair of the CARS Organising Committee, is a leading researcher and authority in the field of computer-assisted medi- Report: Cornelia-Wels Maug Given the increasing focus on tel- ehealth and telecare services aimed at improving long-term patients’ living conditions and save costs, numerous pilots in various countries have been conducted for proof of concept purposes. Among these, the United Kingdom’s ‘Whole System Demonstrator’ (WSD) programme is the largest randomised controlled trial. Set up by the English National Health Service (NHS) this aimed to find out the effects of remote care. A core consideration for the design of the WSD programme was to have a sufficiently large sample size, because past studies’ samples were either too small (often focused on under 100 patients), not allow- ing any generalisation, or they did not meet robust evaluation crite- ria. Hence, a large sample incorpo- rating 64 sub-studies with nearly 6,000 patients − affected by seven different health conditions − and 660 caregivers was drawn. The 47 studies that focused only on effects of telehealth included individuals suffering from heart failure/stroke (22 studies), diabetes (22 studies) and chronic obstructive pulmonary disease (COPD) (3 studies) and took place at three sites in England (Kent, Newham and Cornwall). Launched in May 2008, the UK programme ran until December 2009 and was followed up by a lengthy evaluation phase, with the final assessment only becoming available in 2014. The evaluation measured how telehealth affected the use of secondary healthcare (such as emergency room visits), mortality, quality of life and cost effectiveness, and investigated the patient, professional, and organisa- tion factors related to its imple- mentation. In its presentation ‘What impact does telehealth have on long-term conditions management?’ the King’s Fund, an independent charity working to improve health and healthcare in England, came quintessentially to the somewhat disillusioning conclusion: ‘The evi- dence for the positive impact of tel- ehealth is promising but mixed, and mainly limited to specific conditions such as diabetes and heart failure. Significant benefits have yet to be proved....’ Additionally, it provided some disease-specific insights: •15 out of 22 studies on heart fail- ure proved that remote monitor- ing reduced hospitalisation •from the 18 studies on diabetes patients that examined effective- ness of care, 11 reported a posi- tive effect, •research on COPD showed that telehealth cuts hospital admis- sions, but offered mixed results in terms of clinical effectiveness and care experience. All’s well that ends well As disappointing those results may sound, Dr Charles Lowe, Charles Lowe Consulting, who led the bid for Newham to partake in the WSD programme, calls it ‘a visionary approach to kick-starting the use of telecare and particularly telehealth to improve patient outcomes and reduce costs’. He reckons, ‘partly as a result of the trial, equipment cost and functionality have changed so much, and we have learned so much more about how best to deploy and prove the benefits of the technology. Indeed, in spite of published material, all three WSD sites decided subsequently to main- stream telehealth, which is as good an indication as any of its value.’ And Richard Stubbs, Yorkshire and Humberside and North East Coast and North Cumbria Academic Health Science Network (AHSN), who worked with Lowe at the time, remembers: ‘As our clinical staff could support four times as many people with telehealth than they could without, there was a clear efficiency case to be made.’ Outlook – health apps as game changers Since the time the WSD programme was conducted, equipment costs have fallen extensively and func- tionality has improved considerably. The biggest game changer in the provision of telehealth, however, has been the arrival of apps. The fact that they are downloadable onto smartphones both significantly curtails upfront cost and installation time. By setting up ‘Florence’, England’s NHS came up with a simple tel- ehealth strategy based on text mes- saging to manage patients with long-term conditions. Encouraged to become more involved in their own well-being, they text their vital parameters and receive personal- ised advice about managing their condition, or are asked to contact their clinician if their readings or symptoms are beyond a certain predefined threshold. There is no longer the need to involve specialist telehealth hardware. Starting out in Stoke-on-Trent, the Florence has been used by over 70 health and social care organisations and more than 12,000 registered patients. It is growing daily. cine. ‘Speaking about surgery generi- cally is not useful,’ he told European Hospital. ‘We need to speak about specific surgical interventions, each of which has a characteristic work- flow.’ The schematic approach that out- lines each step in a surgical proce- dure is the fundamental logic for PACS systems, a way of organising the process for a computer. By comparison, PACS for radiol- ogy is extremely simple, he pointed out. ‘There are typically five steps of activity for a radiology workflow, and between each step you can go and have a coffee. For one specific surgical intervention we have identi- fied 28 steps. Looking at another, there are 35 steps. For an interven- tion as complex as mitral valve replacement, there are as many as 480 steps. There are hundreds, even thousands of specific workflows for specific surgeries, each of which needs to be modelled,’ he said. The goal with PACS-Surgery is not to have all information always avail- able, as it is to have visualisations driven by the steps in the workflow, to only display what is specifically relevant to the specific activity at a specific moment. According to Elisabeth Beckmann, consultant for IT and PACS at Lanmark, the challenge is more com- plicated than transferring images from radiology to surgery. ‘Many other forms of information are need- ed, such as a pathology report at a specific moment,’ she said. ‘And, in a next step, the question becomes not only when to integrate this informa- tion, but how it should be presented in different ways to different types of people.’ Intraoperative mapping is at the heart of the approach being taken by the Innovation Centre Computer Assisted Surgery at the University of Leipzig where Prof. Lemke is senior adviser on research strategies. Funded by the German federal government, to date the Leipzig group has modelled more than a thousand workflows, he said, col- laborating with research teams in Japan and the United States and coordinating an international effort to advance the digitisation of the operating theatre. ‘My role, in working as a chair for the IHE (Integrating the Healthcare Enterprise) Surgery Domain, is to bring these three projects together around the table with a focus on developing integration profiles that will serve as the basis for an interna- tional guidelines,’ he explained. Once integration profiles are established to standardise workflow for surgical interventions, it creates an opportunity for manufacturers of medical devices to implement the profiles in order to assure their diverse devices in the operating room will work together. The CARS meeting in Barcelona will see the first conference on the human machine interface in a ses- sion called Medicine Meets Virtual Reality, jointly organised by the NextMed group and the International Foundation for Computer Assisted Radiology and Surgery (IFCARS). The international scope of work on the operating theatre of the future is reflected in the CARS congress, with dedicated sessions for the European Society of Medical Imaging Informatics, the International Society for Computer Aided Surgery and the International Society of Optics and Photonics. A professor of Computer Science, Heinz U Lemke PhD teaches and supervises research on Computer Assisted Medicine at the Technical University of Berlin. He is also Research Professor of Radiology at the University of Southern California, Senior Adviser on research strategies at the Innovation Centre Computer Assisted Surgery (ICCAS), University of Leipzig and Visiting Fellow of the Institute of Advanced Studies, Technical University of Munich. He has been the organiser of the Computer Assisted Radiology and Surgery (CARS) congresses since 1983, and editor-in-chief of the International Journal of CARS and executive director of the International Foundation for CARS. Source: Shutterstock/naka-stockphoto ©2015IntuitiveSurgical,Inc. NEC_AD_6MP_ColourPerformance.indd 521/04/1513:00

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