5.1 International Activities
5.1.1 TRC - Telemedicine Research Center
The TRC, a Clinical Telemedicine Cooperative Group, located in Portland, Oregon, is a non-profit public service research organization incorporated in March, 1994. The TRC was introduced by the dermatologist and medical internist Douglas A. Perednia MD, who is known for his experience in telemedicine applications, such as digital and computer imaging and data delivery. The TRC board includes internationally recognized leaders in telemedicine like Ace Allen, MD., Director of the Telemedicine Evaluation and Research Center in Kansas City, Kansas, or Jim Grigsby, Ph.D., Director of the Center for Health Policy Research at the University of Colorado. The TRC is funded by dedicated telemedicine research and evaluation grants, and contracts with government agencies like the National Library of Medicine (NLM), the Office for the Advancement of Telemedicine (OAT), or the Center for Health Policy Research (CHPR). The objective of TRC is to provide a mechanism for pooling data from many telemedicine projects simultaneously and for evaluating telemedicine activities. It promotes telemedicine research and the creation and management of telemedicine related issues [Perednia, 1995/(4), p. 291]. Further coherent strategies for coordinating federal telemedicine activities are developed [Puskin, 1995/(1), p. 64]. The TRC also maintains a list of telemedicine programs and sources of funding on the Internet25 [Weinberg, 1996/(1), p. 834]. Currently the TRC is involved in four projects: the ‘Telemedicine Information
Exchange’ (TIE), the ‘Rural Telemedicine Grantees Evaluation’, the ‘Telemedicine Outcomes Study’, and the ‘Telemedicine Activity Survey’26.
5.1.2 TIE - Telemedicine Information Exchange
TIE27 is a completely independent source of telemedicine information. Continuously up-dated, it provides the most comprehensive computer library database on telemedicine in the world with a collection of international quality-filtered resources of information about telemedicine and telemedicine-related activities. Internet access is given to the TIE’s bib-liographic database with over 4.000 citations about telemedicine issues, to information about important telemedicine-focused meetings, to current issues discussing journals, to current information about telemedicine projects, research, funding sources, products and services. A main input for this database are journals like the ‘Global Telemedicine Report’, the ‘Journal of Telemedicine and Telecare’, the ‘Telemedicine Business Newsletter’, the ‘Telemedicine Journal’, ‘Telemedicine Today’, or ‘Telemedicine and Telehealth Networks’. Another objective of TIE is to help people to create successful telemedicine programs by providing answers to questions that are frequently asked. Therefore, questions are presented together with answers or published articles from experts in various telemedicine fields. In addition lists about funding sources for telemedicine activities, as well as information about over 200 vendors of telemedicine equipment are presented. The TIE’s content continues to increase and new services are continually added.
25 Retrievable from the TIE on-line database: http://tie.telemed.org; a list of US telepathology sites (1995) and US sources of funding for telemedicine and telepathology is also given by Weinberg, 1996, p. 834
26 More information see: http://trc.telemed.org/about/background.as; Telemedicine Research Center; 7276 SW Beaverton-Hillsdale Hwy;
Suite 404, Portland, OR 97225; fax: (503)-494-6736; voice: (503)- 221-1620; e-mail: trc@telemed.org, or ctcg@telemed.org 27 More information see: http://tie.telemed.org
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5.1.3 ITC - International Telemedicine Center, Inc. Consulting Services
The ITC in Huston, TX, is a telemedicine consulting and training supplier with the aim of mentoring U.S. and international telemedicine initiatives. The reason for doing so was the realization that inadequate planning and training are major reasons why telemedicine pro-grams fail or do not attain their potential. Therefore the ITC provides a full range of serv-ices starting from strategic and operational planning support up to user training and
evaluation services. Consulting activities can be arranged by contacting the ITC’s office via mail, phone, or email28. Like TIE, the ITC in addition provides information about publica-tions in telemedicine (e.g. the Telemedicine Journal, Journal of Telemedicine and Telecare, Telemedicine Business Newsletter, Telemedicine Today), or about meetings and confer-ences where not rarely ITC staff is active participating as conference speaker or as work-shop participants.
5.1.4 ACP - American College of Physicians
The mission of the ACP is the enhancement of health care quality and effectiveness by fostering excellence and professionalism in the practice of (internist) medicine. It has over 83.000 members in the USA. That is why the ACP’s opinion about telemedicine has a huge influence on telemedicine acceptance. The ACP sets up standards and practice guidelines for the delivery of high quality care and offers a wide range of medical education courses.
The ACP develops policies and programs for the improvement of clinical care and medical education through the use of information systems and new technologies. It gives support for managing and integrating medical information and knowledge and helps to satisfy the information needs of internists. Electronic consultation services in form of forums and bulletin boards are offered, where experts provide responses to queries and new research findings. Further the ACP is involved in the development of digital databases for diagnos-tic and therapeudiagnos-tic decision-support, added by features which allow to measure clinical out-comes. And the ACP has a major influence in the design and development of electronic medical record systems. The ACP puts a lot of effort into the design of user-friendly inter-faces. It also drives forward the improvement of interdisciplinary communication for phy-sicians and consultants being able to view data and images simultaneously [Blonde, 1995, pp. 131-137].
5.1.5 IMIA - International Medical Informatics Association
In 1989 the IMIA was established. The IMIA is a non-governmental organization with 35 national members and 18 corresponding members, and with special relations to the World Health Organization (WHO). The objective of IMIA is to promote the specific needs in the application of information science and technology for medicine, health care, and biomedi-cal research. For that reason it serves international cooperation, supports the development of medical applications such as telemedicine systems, subsidizes the dissemination and ex-change of information, and organizes the annual World congress on Medical Information Technology [Ferguson, 1995/(1), p. 44].
28 http://int-telemedicine.com/consulting.htn; International Telemedicine Center, Inc., 7580 Fannin - Suite 101, Houston, TX 77054-1991;
Fax: (713)-797-0461; Tel: (713)-799-2555
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5.2 International Activities Across Boundaries 5.2.1 GHNet - Global Health Network
The GHNet was introduced due to the wish to provide international preventive medicine and public health information. It also offers preventive medicine training and is involved in various health educational activities world-wide. For this, several organizations are col-laborating: the NASA Johnson Space Center in Houston, Texas, the University of Pitts-burgh, the Third World Foundation of North America, and the Pan American Health Or-ganization. Within this collaboration, the Third World Foundation of North America is interested in the development of telemedicine programs with Africa and India, whereas the Pan American Health Organization is focusing its interest on the development of a disaster preparedness and telemedicine network in Central America, South America and the Carib-bean [Ferguson, 1995/(1), p. 37].
5.2.2 DOD - Projects of the Department of Defense
The Office of the Assistant Secretary of Defense Health Affairs is working with a number of federal agencies and industries to develop a Military Health Services System offering telemedical services and computer-based patient records for the support and connection of military treatment facilities. Several vital inputs for these developments came off the De-fense Modeling and Simulation Initiative, which was designed by the DOD to provide ad-vanced distributed simulation war-fighters in geographically distributed localities. Lessons learned from this distributed simulation network concerning architecture, standards, proto-cols, interoperability, information sharing, and distributed data bases were later used for the design of telemedicine systems [Lilienthal, 1995, p. 213].
One medical center that is using the systems of the DOD is the Tripler Army Medical Center based at Hickam Air Force Base in Hawaii. It offers a telecommunications system for medical information support, electronic diagnosis and consultation services within the project ‘Akamai’. Telemedical advises are given to diverse military and civilian user groups, which are often more than one million miles away throughout the Pacific. The Akamai project has features for PACS, telemedicine, teleradiology imaging, digital patient records, new tele-surgery, and telepathology technologies [Ferguson, 1995/(1), p. 38; Tan-galos, 1995, pp. 281 ff.]. A second figure of the Akamai project is the digital imaging net-work system, investigated at the Georgetown University. This netnet-work will offer diagnostic imaging support and computer aided diagnosis. In addition, research and demonstration programs are tested with which pathways should be discovered for the development of the most appropriate utilization of telemedicine capabilities [Mun, 1995, pp. 161, 163].
5.2.3 International Telemedicine Service Providers
Several other health care providers started to offer telemedicine services all over the world.
For example, the Massachusetts General Hospital, Boston, has created a for-profit subsidiary that, for a fee, reads radiographs transmitted from hospitals and clinics in the Middle East.
The Mayo Clinic, Rochester, Minnesota, has built a telemedicine clinic in Amman, Jordan. A multinational venture, the Health Care International Hospital in Glasgow, Scotland, has been established to function as an electronically integrated hospital capable of providing care via telemedicine to patients anywhere in the world. Currently it is targeting international clients from Italy to Saudi Arabia to participate at its network [Perednia, 1995/(3)].
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5.3 Projects of the European Community - Telematics for Health Care
The European Community realized the potential of telemedicine services for the health care sector. Therefore approximately 80 research and development programs, with a volume of more than 100 million ECU (approx. US-$ 350 million), are introduced by the EU29 [Dietzel, 1996, p. 21]. These projects support various advanced communications and telematic applications in preventive medicine, diagnostic, therapy, after-care, research, as well as for administration and statistics. At the same time some projects investigate the standardization of electronic information creation, retrieval and storage to enable an efficient information exchange between all health professionals. Some of these project are introduced in this chapter or listed in appendix III. Unfortunately, although many projects are supported by the EC, many of them have their focus on detail solutions and show shortcomings in generalization [Detken, 1997, p. 75]. That is why for the development of appropriate telecommunication applications in health care and for the assistance of a common service policy standardization is desirable. Doing so, liberalization and regulation aspects,
interconnection and interoperability of networks and services, as well as questions about communication security and universality of services have to be carefully examined right from the beginning of a project. One approach to do so and to guarantee the interoperability of international and national standards is the project FEST.
5.3.1 FEST - Framework for European Services in Telemedicine
The objective of the EC-funded project ‘FEST30’ is the development of a framework which provides support to different types of individuals interested in establishing and operating a telemedicine system. Thus the task of FEST is to guarantee that national telemedicine ac-tivities are conform with international standards. The framework is intended to provide
assistance in planning and evaluating the potential for particular services for the specific needs of the questioner. It also supports the development and installation of telemedicine
applications, up to the assistance in correcting problems in an existing service [Detken, 1997, p. 75]. Tools are available, which help to identify and to address various factors of influence of particular telemedical service types. Several questions have to be answered by the users of the framework. For example questions about the organizational structures, about roles and activities, relationship of the service to its environment, information flows, or technological and engineering considerations, etc. This way the user is led by an interface through the main areas which should be considered at his telemedicine service. In addition users get assistance in answering critical question in form of a set of rules and advises. Further the user is asked to look at so called ‘aspects’, which were developed to guide him through another set of factors and to regard his service from another point of view.
5.3.2 EHTO - European Health Telematics Observatory
The objective of EHTO is, to collect, analyze and present information about the develop-ments in health telematics, to support the development of health telematic applications and to improve the standardization of them in Europe. For this know-how and experience is
29 More information see: http://www2.echo.lu/telematics/health/health-proj.html 30 More information see: http://www2.echo.lu/telematics/health/fest.html
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classified into categories corresponding to the needs of the different actors of a sector.
EHTO aims to helps in the definition of requirements for specific applications. It supports decision makers in their choice of selecting telematic solutions, and influences the industry to deliver more appropriate products.
5.3.3 HEALTHPLANS
The project HEALTHPLAN is a concerted action to support national and regional health authorities in developing plans for the introduction of health care telematics. National key health care authorities and decision makers are put together to share requirements, priori-ties, information, experiences, methodologies and plans for the establishment of health care telematic services. Doing so one objective of HEALTHPLAN is to raise the attention of influential national decision makers on the potential of health care telematics. Another im-portant goal is to foster the development of coherent plans for the implementation of tele-medicine applications at local, regional, national and international levels.