Telemedicine in Asia-Pacific - Possible expansion to Latin America-
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1 Telemedicine in Asia-Pacific - Possible expansion to Latin America- Chairman of Medical WG, APAN, Director of Telemedicine Development Center of Asia Kyushu University Hospital, Fukuoka, Japan Shuji Shimizu, MD, PhD temdec.med.kyushu-u.ac.jp shimizu@med.kyushu-u.ac.jp @TICAL2012, Lima, Peru
2 Today s menu Medical situation Activities One-to-one Multi-station Directions to go Kyushu Univ., Fukuoka
3 Gallstones Black stones Cholesterol stones Mixed stones Bilirubin stones
4 Surgical development: One example Open Endoscopic
5 Surgical view of new surgery Lift Trocar Instrument Surgery I, Kyushu Univ
6 Dramatic change in surgery 100% 50% Open Endosc 0% 20 years ago Now
7 How to learn new surgery To watch a real surgery is most important. Few hospitals have experts in all fields Limited chance to visit other hospitals Waste of time, waste of money Not continuous, not many people Do you think you can learn it enough?
8 Remote Education: Convenient and Useful! Practically Theoretically But, NOT popular in our clinical situation Why not?
9 Conventional telemedicine ISDN /Narrow band ~1Mbps Still pictures Radiology (CT, MR), Pathology Discussion Slide presentation Surgery: compressed 1. Video transmission was impossible in good quality. 2. Cost for special equipments (even for bad image).
10 Situations dramatically changed in 2002 We use BIG Internet! Hanyang U QGPOP Kyushu Univ Bandwidth 2G Big Broadband Network
11 Key technologies DVTS (Digital video transport system) Academic network (Research and education network) Kyushu Univ., Fukuoka
12 Point Actual 1: Clear bandwidth & Smooth in each Transmission network Mbps Compressed images Telephone line: Still picture Non-compressed images 30 Our project: Video image D: Digital V: Video T: Transport S: System ISDN DVTS Digital Video Internet
13 Point 2: Cheap and simple equipment DV Camcoder DVTS PC Internet IEEE1394 UTP(Ethernet) >30Mbps Microphone DVTS: free but powerful software No special teleconferencing equipment BIG & STABLE network is essential!
14 Point 3: Academic Network for Research and Education Latin America: RedClara
15 Today s menu Medical situation Activities One-to-one Multi-station Directions to go Kyushu Univ., Fukuoka
16 The first live demonstration of surgery OR Surgical movie Aug 1, 2003 Lap. distal gastrectomy Security software used Kyushu Univ., Japan NCC, Korea
17 TV news reports Aug 22, 2003 RKB KBC NHK TNC in the evening news KBC
18 Casual setting to neighbors New endoscopic procedures
19 Live surgery in a big congress From Korea to Japan
20 Telementoring for neurosurgery Hanyang U Kyushu U
21 Live lecture for Medical Students Bundang H/KR Kyushu U/JP Endosc Surg Telemedicine English Video
22 Today s menu Medical situation Activities One-to-one Multi-station Directions to go Kyushu Univ., Fukuoka
23 Asia-Pacific Advanced Network (APAN) General meeting every 6 months
24 APAN-Medical Taipei
25 The first multi-station teleconference by DVTS Pancreatic Transplantation Meeting New technical breakthrough Fukuoka Seoul Taipei Beijing
26
27 Quatre: MCU for DVTS Only equipment for multi-point connection of DVTS Very powerful, stable and useful Support only NTSC, but not PAL Available only in Japan (&Korea) Connection < 8 stations DVTS-Plus: New version from China
28 Live APAN-Tokyo First multistation live demonstration with security Kyushu Tokyo Seoul Taipei
29 Current security system Essential to protect patient privacy Used for live demonstration IPsec Used to be C4-VPN About US$
30 Healthcare Kyushu Univ. Bangkok Singapore Japan Singapore Bandung First connection to APAN-Singapore Thailand Indonesia
31 Bird flu APAN-Manila ID First 8-station PH VN TH CN AU US JP Manila venue Peking U Australia National U Stanford U Nagasaki U Chulalongkorn U National Hosp. of Pediatrics / Hanoi Indonesia U
32 First connection to APAN-Xian Xian, CN Seoul, KR Tokyo, JP Singapore, SN Manila, PH Sydney, AU Bordeaux, FR VIDEO
33 HD-Med Joint APAN-NZ Tokyo Seattle Science Foundation Neurosurgery by Dr Newell HD-JPG2000 & DVTS Venue at Queenstown
34 First to Cape Town in South Africa Kyushu U, JP U Cape Town, ZA Cho Ray, VN VIDEO
35 <Asia Medical Project> 30 countries 188 institutions 312 events Egypt Cairo U Mumbai Tata MH New Dehli ERNET Bangkok Kuala Lumper South Africa Before After Singapore NUS Beijing Shanghai Hong Kong Hanoi Europe HaLong Ho Chi Min Cho Rai Hosp Sapporo Seoul Tokyo Fukuoka Yokohama Manila Philippine U Bandung ITB Taipei Jakarta, UI Jilin Taichung Adelaide Flinder s Hosp Canberra ANU Melbourne Sydney Iwate California Stanford, UC Irvine Hawaii Cairnes Auckland Brisbane Brazil
36 Whole variety of new medical contents Surgery Endoscopy Medical informatics Basic Science Interventional radiology Nursing, Healthcare Bird flu, SARS, HIV Medical students, etc. More tomorrow
37 Today s menu Medical situation Activities One-to-one Multi-station Directions to go Kyushu Univ., Fukuoka
38 World Gastroenterology Organization: - Endoscopic training centers -
39 Training Centers
40 Dr Carlos/BZ Dr Franco/CL Dr Alberto/UY
41 Dr Nicolas/CO Dr Mauricio/MX Dr Pablo/AR Dr Miguel/BO
42 Preliminary connections Not so good TX BR CL MX Seattle
43 Visiting Latin America USP/BR Alemana Hosp/CL Univ. of La Plata/AR
44 Necessary information 1. How big network is there in each country? 2. Who are the contact points?---i would like to meet them all. 3. How big are networks for these hospitals? 4. Who is the network manager in each university/hospital? 5. Do they have adequate instrument? 6. Do they have other solutions like H.323 (HD) unless there is enough network? 7. Is there any way to establish a new network for other hospitals?
45 Check 1. Network to the very end 1) International network 2) Domestic (NREN) 3) Campus Network Point APAN RedClara Network Point INNOVA/AR RNP/BR REUNA/CL Network Point Firewall Big academic network Connected to hospital? Support of engineers Big enough and stable network at all steps
46 Check 2. Instruments
47 Check 3: Team buildup Medical Doctors Local Engineer (Network & Audio-visual) National REN Engineers Medical Doctors Local Engineer (Network & Audio-visual) National REN Engineers The success depends on how good team you can make.
48 First Goal for Our Collaborations APAN-HW Hawaii /-10(+14) Seattle/-7 Jan 13-20, 2013 Brazil/-3 Internet2 Joint Univ. of Hawaii Endosc. session Fiji?/+12 Chile/-4 AR/-3 UR/-3
49 List of the hospitals to be connected Argentina Brazil Brazil Brazil Brazil Chile Uruguay Mexico Bolivia Columbia Costa Rica Medical School of La Plata University of São Paulo Medical School USP Ribeirão Preto U State of Rio de Janeiro U of Rio de Janeiro Universidad de Chile (Clínica Alemana?) Universidad de la República Instituto Nacional de Ciencias Med. y Nutr. Hospital de Clnicas Clinica Universitaria Colombia U Autonoma de Centroamerica
50 Future Challenge-1: Un-compressed HD The first APHPBA Congress G Surgery/HD Operating room/ DVTS Chairman
51 Future Challenge-2: 3D transmission Robotic Surgery 2005 Korea Med 2012 Robot surg
52 Conclusions 1. Image quality, especially for moving images, and its quality control is a key in telemedicine. 2. R&E network has made the clear and smooth medical streaming possible with low cost. 3. We hope that we can have collaborations for better medical education in Latin America. Le us work together!
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