To effectively evaluate technology and innovation, the MITAC develops
and conducts a number of testbeds. International testbeds offer
a unique opportunity to understand cultural diversity and remoteness.
Healthcare Online Medical Exchange Repository (HOMER)
With telemedicine testbeds in several countries, MITAC needed to mange and
integrate various types of patient information into one electronic medical record (EMR)
system, irrespectively with their locations and languages. This EMR system serves the
purpose of clinical consultation platform, and an interactive tool for distance education.
Collaborations with American University of Beirut
MITAC is working closely with the American University of Beirut
(AUB), School of Medicine in mutually beneficial areas of telemedicine
and distance education. MITAC is integrating telecommunication applications,
and multimedia data streaming into the medical education curriculum.
Integration of distant education for content delivery from VCU to
AUB will provide AUB faculty and students with a unique opportunity
to participate in distance learning in a variety of disciplines,
Communication links are currently being tested between MITAC and
AUB to permit regular videoconferencing for collaboration in the
areas of telemedicine, distance learning, and distance surgical
education. Additionally, MITAC's telemedicine course will be translated
into Arabic for access to a wider audience in Beirut. MITAC's postdoctoral
research fellow, Dr. Hatem Halabi, who is interning this year at
AUB, will mentor this course.
Telemedicine Collaborations in Romania
The MITAC is working closely with three different institutions in
Romania in mutually beneficial areas of telemedicine and distance
learning. These different institutions include: (1) the Fundeni
Clinical Institute in Bucharest, (2) the University of Medicine
and Pharmacy of Craiova in Craiova, and (3) the Faculty of Medicine
and Pharmacy of Constanta in Constanta. The purpose of these projects
is to improve the delivery of health care in the region and to promote
telemedicine and distance learning.
efforts with Fundeni are conducted towards the transmission of live
surgery clinics every week and participation in the VCU's Surgery
Grand Rounds. MITAC will also assist in establishing a Romanian
Telemedicine Association and in developing a regional plan.
The University of Medicine and Pharmacy in Craiova is working closely
with the MITAC in seeking an infrastructure grant from NATO. Mr.
Charles Doarn, MITAC executive director, will serve as the project
director, providing feedback to NATO on the progress of the collaboration.
This collaboration is to build an infrastructure between several
medical facilities within Craiova to support telemedicine, education,
and high resolution image transfer.
The work in Constanta is focused on the use of telemedicine to
provide healthcare in remote locations of the delta of the Danube
River, establishing a Center of Excellence in surgical training
and telemedicine, transmission of VCU's Department of Surgery Grand
Rounds in real time, and participation in a project on maritime
telemedicine on the Black Sea.
Robotics in Surgical Education
is working with a variety of computer controlled robots, provided
by Computer Motion to better assess surgical skills in an open surgical
field projected on standard video monitors. Computer Motion, Inc.
is an industrial affiliate of the MITAC. It has provided both donated
hardware and inkind labor in a mutually beneficial collaboration.
One of the robots is the voice-activated AESOP robotic arm. Through
voice control, AESOP can precisely place a 10mm laproscopic camera
in close proximity to the sterile surgical field. This permits a
very useful view of the open surgical field for collaborators within
the operating room or those outside of the immediate area. The goals
of this effort are to assess surgical skills with the surgeon and
assistant viewing the test surgical field exclusively on video monitors.
Surgical tasks are timed as they are carried out under various angled
camera placements. Skill assessments are done to evaluate surgical
adaptability if one is limited to visualizing the surgical field
to a 2 dimensional image on the monitor.
This kind of work will provide validation of more efficient tools
and methods for collaboration and teaching.
MITAC Provides Telemedicine Support in Mongolia
A group of University of Chicago archaeologists recently visited
the Republic of Mongolia on a mission to confirm the site of Chinggis
Khan's tomb. The American-Mongolia expedition consisted of 60 individuals,
the majority of which were Mongolian. The tomb site is believed
to be in the northern provinces near Ulaan Bataar. The team had
access to medical care from Dr. Gregory Merrell, an orthopedic resident
from Yale University. In addition, an individual with EMT training
was also present. The nearest hospital was 12 hours by 4-wheel drive
MITAC provided Dr. Merrell the necessary hardware and software to
conduct telemedicine from this remote location. Telecommunications
was supported by an InMarSat phone, digital camera, and laptop computer.
In addition, there was a full complement of medical capability on
the ground with the expedition.
During the mission, the telecommunications link was used for four
clinical cases. The cases included a pit viper bite on the ankle,
an anthrax epidemic in the valley due to cattle, eye injury, and
skin rash. In all cases, information was provided to physicians
at the Virginia Commonwealth University's Health System and MITAC.
Responses were prepared and returned within 24 hours.
Dr. Merrell summarized, "Timely response is crucial. If it
is concerning enough to hook up the sat phone, then it is likely
urgent enough to require a timely response."
This project clearly demonstrates the need and efficacy of mobile
and remote communications in support of health care delivery in
extreme and isolated environments. Additional information about
the mission can be found at http://www.cmes.uchicagnews.htm
Telemedicine Support in Kenya and Brazil
During the summer of 2002, VCU physicians, allied health personnel,
and medical students traveled to two unique environments, Brazil
and Kenya. Both missions were focused on medical relief in the area
of infectious disease. Both teams were connected to VCU's MITAC
via communication tools to support telemedicine interaction. The
team in Brazil was equipped with an Iridium phone and personal digital
assistants (PDA) for epidemiological data collection. The team in
Kenya was equipped with PDAs and an InMarSat phone for communications
between sites in Kenya and MITAC. The locations in Kenya are remote
and without electrical power. MITAC developed and implented a power
capability using two deployable solar panel grids, which provided
charging power to an automobile battery. The battery in turn provided
electrical power to the lap top computers and the satellite phone.
Both systems were capable of sending medical information from remote
sites to MITAC for interaction with medical personnel.
During this mission, data was transferred between remote clinical
sites in Kenya and MITAC. MITAC's purpose was to examine utility,
utilization, and cost.
Telemedicine in Ecuador
Ecuador is an ideal location for conducting test beds in telemedicine
and telementoring to explore how nascent technologies can be integrated
into medicine in remote and extreme places. Beginning in May 1999,
MITAC developed a project in Ecuador to demonstrate that telemedicine
was a cost-effective way to pre-operatively evaluate patients in
remote villages. The project has expanded to include telementoring
of medical or surgical consultations to very remote areas where
a general practitioner or a layperson might be the only healthcare
provider. Through lessons learned and experience, project objectives
have expanded to include examination of the prospects for 1) continuation
of telemedicine as a pre- and post-operative tool; 2) expansion
of telemedicine beyond surgery so that medical advice could be provided
from larger medical centers to remote villages; 3) development of
an electronic medical record so that transmission of information
would be easier; 4) development and implementation of an electronic
database to expand knowledge of indigenous medicines and treatments;
5) train our partners at the Fundacion Cinterandes in Cuenca and
other Ecuadorian groups to become self-sufficient with regard to
teleconferencing and transferring data to and from remote areas
of Ecuador; and 6) evaluation of high frequency radio as a mode
of transmitting medical data.
the past two years, several successful trips to Ecuador have taken
place to advance the project objectives. Teams of medical and technical
personnel have completed many objectives, including: electronic
transmission of preoperative patient data; installation of Electronic
Medical Record (EMR) in Ecuador and training of collaborators in
entering, exporting, and importing data; transmission of text files
(10kb) from remote villages to larger cities using high frequency
radio; transmission of EMR-exported data file from Taisha to Macas
using high frequency radio, radio modem and software; transmission
of data from Macas to Cuenca via Internet; and a telesurgery conference,
Cuenca to Richmond -- transmission of live hernia surgery from a
mobile surgical truck with images from laparoscopic camera held
by alpha-port, while surgeons in Richmond identified key structures.
MITAC's industrial affiliate, Televital
has been a key partner in accomplishing MITAC's plans and objectives
additional project in Ecuador has been to communicate with the Shaman
of the indigenous people to collect data on their treatments and
use of medicinal plants. With the collaboration of scientists familiar
with the area and the people, the teams have been collecting information
on the indigenous medicines and practices and entering it into an
electronic database, with the goal to create a CD of pharmacopoeia.
Some of the future plans with partners in Ecuador include self-sufficiency
for the Fundacion Cinterandes: telemedicine techniques and use of
video-conferencing in the OR and remote sites; data collection using
EMR; imaging studies; and preparing a mobile surgical boat. MITAC
has partnered with Fundacion Cinterandes, Salesian Procura - Province
of Morona-Santiago, Clinic Luxemburg of Morona-Santiago, and the
Hospital San Jose de Thaisa.
Anesthetic Monitoring with the RDTU in Ecuador
an extension of previous work with telesurgical monitoring of both
laparascopic and open surgery, the project in Ecuador has extended
MITAC's capabilities to include the monitoring of basic physiologic
parameters during surgery. In much the same way that surgical consultation
has been enabled by use of the RDTU, anesthesia consultation is
now available for remote situations. During the December 2001 trip
to Ecuador, surgery was performed in the Cinterandes Foundation
Mobile Surgical Facility in Sucúa. The surgery, an open cholecystectomy,
saw the first known transmission of real-time physiologic parameters
for distant anesthetic monitoring. Dr. Lynne Gehr, a faculty anesthesiologist
at MCV/VCU monitored the transmitted data in the MITAC laboratory,
while Dr. Patricio Escandon, a member of the faculty of Yale University's
Anesthesiology Department, was the local attending anesthesiologist.
Much of the clinical data transmission was made possible and more
effective by MITAC partner Televital's
Telemedicine in the Former Soviet Union
continues to work closely with several organizations in Russia and
FSU. The Russian Institute of Surgery Science and Research (ISSR)
has been a key focal point during the year. In addition to the main
profile, ISSR is also a training clinical facility for students
from the Moscow Medical Academy. MITAC is collaborating with ISSR
in a mutually beneficial arena of telemedicine and distance education.
These activities include:
MITAC has been providing lectures on Telemedicine and Medical Informatics
to M5 students from MMA's Student Surgery Club with weekly videoconference
Working with a computer-controlled robot (AESOP) MITAC's team was
able to significally improve the quality of on-line tutoring in
surgery. The students and faculties from ISSR had an opportunity
to test the new features and advantages of the new method during
the series of surgeries transmitted from MCV to ISSR.
MITAC also continues close collaboration in distance education
with Space Biomedical Center for Training and Research (SBCTR),
and the Faculty of Fundamental Medicine (FFM) at Moscow State University.
With technical support from SBCTR, medical students from MSU had
an opportunity to attend the series of lectures on Medical Informatics
given by Dr. Merrell and Charles Doarn.
In 2002/2003 MITAC has signed two agreements on collaboration in
Telemedicine and Distance Education with Kazakhstan National Medical
University (Almaaty, Kazakhstan) and Medical Faculty of Kazan State
University (Kazan, Tartarstan).
More details regarding our work with Former Soviet Union can be
viewed on line here.
Grand Rounds in the Caribbean 2000
Thursday, March 1, 2001 Surgical Grand Rounds were presented from
the Cornwall Regional Hospital in Montego Bay, Jamaica. MITAC supported
the interactive conference using a state-of-the-art, portable satellite
system used for telemedicine initiatives around the globe. The Templeton
Lecture was introduced by Drs. Ronald Merrell and Charles Bagwell
and presented by the Permanent Secretary of Health, Dr. George Briggs.
This joint collaborative effort with VCU is designed to promote
telehealth in the islands of the Caribbean and beyond. Exchange
of data, research and clinical issues will help to promote quality
healthcare in Jamaica and serve as models for other developing countries.
You may hear Dr. Briggs' presentation by clicking here.
During July and August of 2000, MedITAC participated with researchers
from NASA, other educational institutions, and private organizations
in the Mars Arctic Research Project. The
MARS project, officially NASA Haughton-Mars Project 2000 (HMP-2000)
consisted of field researchers from all branches of space science
converging on Devon Island in the Arctic Circle to study and test
a multitude of space-related technologies.
The MedITAC research consisted of field testing the Vital Signs
Monitors as well as testing the medical protocols for a simulated
emergency on the surface of Mars, where a 22-minute delay in each
direction makes communication considerably more difficult. The protocol
test consisted of a simulated medical emergency on-site at Devon,
with wireless transmission of physiological data back to monitoring
physicians in the US, Canada, and Ecuador. In addition, the general
public could access the physiological data in real-time (with 22-minute
delay to simulate Mars communications), to show the possibilities
of future health monitoring technology in daily life on Earth. More
details can be found at /mars/.
Turkey Project 2000
sent two of its members to Turkey with the Physicians for Peace
(Norfolk, VA), to assemble a multimedia course on landmine victim
rehabilitation. Much of southeastern Turkey is heavily infested
with landmines, and victims that survive often lose one or more
limbs. The Physicians for Peace mission consisted of surgeons and
prosthetists to fit victims with much needed prosthetic devices.
Our efforts focused on developing an onsite multimedia curriculum
that can be used for landmine relief efforts anywhere in the world.
The Turkey Project 2000 report can be viewed online here
Dominican Republic Initiative
March 18, 2000, the team departed for a mission, our goal was to
provide surgery and medical care at the Hospital of Samana, Dominican
Republic. Test beds such as this allow us to fully assess the feasibility
of sending live images over low-bandwidth connections with today's
H.323 video conferencing applications like CuSeeMe, NetMeeting,
etc. The team connected by a point-to-point method and multipoint
server via the Internet. This enabled patients to be monitored from
a remote clinic, (in this case VCU) for diagnosis of the patient.
Once the data was collected from the patient to populate a database,
a collaborating surgeon shared database tools and whiteboards during
a live videoconference.
established a relationship with the Ministry of Health in Egypt.
This relationship included the exchange of faculty, site reviews
as well as the participation of several Egyptian medical personnel
and computer specialists in the MITAC's Principle of Telemedicine
at Yale University, a MITAC member, have collaborated with several
medical organizations in Greece, including Red Cross Hospital, University
of Thrace, Hatjikosta Hospital, and Macedonia University.
Everest Extreme Expedition
In April and May of 1999, a group of Yale physicians and researchers
embarked on a mission to Mt. Everest. The 1999 activity was called
Everest Extreme Expedition (E3).
Encamped at Everest Base Camp (EBC) (17,700 feet), physicians and
scientists supported telemedicine activities, monitored several
climbers as 'physiologic ciphers', evaluated new technology, and
conducted research to further the understanding of cardiovascular
response in extreme environments.
A vital signs monitor, developed by FitSense (Boston, MA) for
monitoring climbers on the mountain, was demonstrated. This technology
shows promise as a useful tool in monitoring a climbers' position
and physiological status. During the expedition, grand rounds
were conducted between EBC and Yale University through a 128 kbps
link. On several occasions, real life-threatening medical emergencies
occurred during these real-time interactions, such that the medical
staff at EBC were consulted by and mentored by the medical staff
at Yale University.
E3 was made possible in part from financial support through a
partnership with Olympus of North America, St. Charles Hospital,
LECO, Millennium Health Care Solutions, and the Explores Club.
A number of other organizations, including Bectin - Dickinson,
Kodak, Nestle, and CamelBak donated supplies, including food,
clothing, film, and medical supplies. In the coming months, 13
manuscripts will be prepared and submitted to refereed journals
for publications. Two have already been submitted, one to JAMA
and one to the Telemedicine Journal.
The expedition provided a unique opportunity for school children
to get involved in the expedition. Several video teleconferences
were conducted between EBC and schools in on both the east and
west coast. In addition, daily activities of E3 team members and
progress of the mission were posted on the Web at /e399/.
During the expedition, the number of hits to the Web site were
over 1 million.