1. Trieste 1/4/2011 Alessandro Taddei 1 ICT for collaborative health care in the Mediterranean area Alessandro Taddei DIT 108La, Lions Club Pescia National Research Council of Italy Alessandro Taddei DIT 108La, Lions Club Pescia National Research Council of Italy

2. Trieste 1/4/2011 Alessandro Taddei 2 Telemedicine Information and Communication Technology allowing collaborative health care “anywhere - anytime” “anywhere - anytime” Tele-diagnosis, Tele-monitoring, Tele-assistance, … Developing telemedicine networks for international multi-center cooperation in medical decision making and care planning

3. Trieste 1/4/2011 Alessandro Taddei 3 Off-line tele-consulting Medical Image Standard (DICOM) PACS technology Exchange of multimodal diagnostic examinations (US, XA, RX, CT, MR, …) “STORE-and-FORWARD” Transmitting DICOM images through network (Internet) 2nd opinion review from reference specialized clinical center Open-source technology DICOM server www.dcm4che.org/ DICOM viewer/processor www.osirix-viewer.com/

4. Trieste 1/4/2011 Alessandro Taddei 4 Live tele-consulting Need for real-time interaction between operators and specialists is often crucial during imaging examination for scanning of anatomy Tele-echocardiography is the typical application

5. Trieste 1/4/2011 Alessandro Taddei 5 Tele-consulting for early diagnosis of congenital heart malformations Today echography equipment allow to recognize cardiac abnormalities, even in the foetus Actually less than 20% of diseases are detected in the prenatal period because often experience and training are not adequate Thus newborns, suffering by critical cardiac disorders, are often transferred urgently to specialized and remote cardiac units while early care planning, before delivery, would limit both risks and costs

6. Trieste 1/4/2011 Alessandro Taddei 6 Collaborative Diagnosis and Care of Congenital Heart Malformations Project by Heart Hospital of CNR / Tuscany Region “G. Monasterio” Foundation, supported by “Un Cuore un Mondo” Association” and Tuscany Region, for medical cooperation with Balkan Countries  2008-2009 “Progetto per il cuore dei bambini dei Balcani” Clinical Centre, Banja Luka, BIH - Kantrida Pediatric Hospital, Rijeka, KR  2009-2010 “Progetto cuore Balcani / Albania” Gynaecology University Hospital "Koco Glozheni", Tirana  Next projects (Bosnia, Montenegro …)

7. Trieste 1/4/2011 Alessandro Taddei 7 Cooperation issues Developing telemedicine network for both collaborative diagnosis and care planning of heart malformations by tele-echocardiography training of remote health care teams by videoconferencing Supporting local organizations for improving health care of congenital heart diseases Supporting patient transfers to specialized centers for surgery intervention

8. Trieste 1/4/2011 Alessandro Taddei 8 Live Tele-consulting Upload Internet bandwidth > 512 Kbps Videoconference equipment (25 fps, criptography) audio Video INTERNET Echo equipment Tele-consulting Video -

9. Trieste 1/4/2011 Alessandro Taddei 9 Tele-echocardiography in neonates from Clinical Center Banja Luka (BIH) t

10. Trieste 1/4/2011 Alessandro Taddei 10 Tele-ecocardiography from Pediatric Clinical Center Rijeka (KR)

11. Trieste 1/4/2011 Alessandro Taddei 11 Fetal tele-echocardiography from Gynecology Hospital Tirana (AL)

12. Trieste 1/4/2011 Alessandro Taddei 12 Open-Source solution for low-cost medical tele-consulting Video streaming on-line teleconsulting INTERNET DICOM data transfer Workstation at remote specialized center Workstation at diagnostic examination site PACS

13. Trieste 1/4/2011 Alessandro Taddei 13 Open-Source Tele-consulting System ON-LINE teleconsulting (live session) OFF-LINE teleconsulting (Storage/Forward) DICOM not DICOM (archived studies) videoconferencing for on-line interaction web-based user interface over Internet (reserved access by data encryption) ON-LINE teleconsulting (live session) OFF-LINE teleconsulting (Storage/Forward) DICOM not DICOM (archived studies) videoconferencing for on-line interaction web-based user interface over Internet (reserved access by data encryption)

14. Trieste 1/4/2011 Alessandro Taddei 14Conclusions ICT & medical standards allow implementation of tele-consulting systems for collaborative diagnosis and care planning of medical pathologies Tele-echocardiography was applied successfully in the project for clinical cooperation with Balkan Countries in heart malformations Low-cost technology (open-source) solutions for tele-consulting (live, off-line) are challenging for promoting diffusion anywhere, potentially in any medical field

15. Trieste 1/4/2011 Alessandro Taddei 15 While technology offers affordable solutions for collaborative medical decision making, it is crucial to set up projects for collaboration between health-care institutions the Lions have a potential roleGiven their international and distributed organization, the Lions have a potential role in promoting and supporting important initiatives for collaborative health-care along the path to integration of Countries Conclusions