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PROJECT PERIODIC REPORT Grant Agreement number: FP7-ICT-1-215479 Project acronym: MEDNET Project title: Latin American Health Care Network Funding Scheme: Small or medium scale focused research project (STREP/CISCA) Date of latest version of Annex I against which the assessment will be made: 17/12/2007 Periodic report: 1st □ 2nd □ 3rd X 4th □ Period covered: from 01/01/2010 to 31/05/2011 Project co-ordinator name, title and organisation: Despina Rizou , Fraunhofer IGD Tel: +49 6151 155 515 Fax: +49 6151 155 480 E-mail: [email protected] Project website address: www.e-mednet.com PERIODIC REPORT TEMPLATE – MARCH 2008 2 1. PUBLISHABLE SUMMARY Project Objectives During the last year of the project the two final Work packages were fulfilled. The Work package 7 the system demonstration and evaluation where the main objectives, focusing on: • Keeping the pilots on constant run and • Gathering inputs for the evaluation of the deployed platform. The Work package 8 objectives were the promotion of the project results to both the scientific and industrial communities. More specifically the objectives of the WP8 were: • To co-ordinate the dissemination activities of the MedNet project and • To ensure the effective diffusion and exploitation of its results. For Brazil the objectives of Work package 7 were fulfilled. Due to the delays of the project to fulfil its objectives a 5 month extension was proposed by the European Union. During this extension the system was running and many teleconsultations were performed. The most of them were performed in Rio Grande do Sul and Balsas sites. Having the system running, its evaluation and cost effectiveness analysis, concerning Brazil, took place successfully as was initially planned. The objectives of Workpackage 8 were fulfilled by MEDNET consortium. The Brazilian partners disseminate and exploit the project in various conference’s and meetings with local authorities. For Peru the objectives of Work package 7 were not totally fulfilled. The main reason for this was the various political problems in Peru and the rejection of the software from the users. There were some teleconsultations performed, but not the number MEDNET project was targeting. Nevertheless the doctors in the sites show their strong will to work with Telemedicine but due political instability and frequent changes of personnel they failed to keep a continuation. The objectives of Workpackage 8 were fulfilled from the Peruvian partners. A lot of dissemination and exploitation actions for the project took place in various conference’s and meetings with local authorities, but unfortunately with not a lot of success. 3 Teleconsultations results Brazil Reference hospital: Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS). Remote sites: Lagoa dos Três Cantos, Alegrete, Pelotas. In Rio Grande do Sul, MEDNet deployment started in July 2009 with the installations in Lagoa dos Três Cantos using ADSL connection. Dr. Marcus Dalsasso is using the MEDNet system from the first day and now is a routine at the healthcare center in Lagoa dos Três Cantos. Every ultrasound examination was sent to the referral hospital and stored in a DICOM compliant database for future patient control. Rio Grande do Sul (RS) 80 60 74 40 20 3 3 0 Lagoa dos Três Cantos Alegrete Pelotas Number of exams sent per site in RS. City Type of Exam Teleconsulta tions Lagoa Abdomen, 74 dos pelvic, obstetric. Três (U/S) Cantos Alegrete Abdomen. (U/S) 3 Pelotas Cranium, hips, 3 thorax. (CT) The use of MEDNet system gave the opportunity to avoid the transportation of 22 patients from Lagoa dos Três Cantos to the reference hospital in Porto Alegre. This represents almost 30% of the second opinions requested by Dr. Marcus Dalsasso. 4 Exams sent from Lagoa dos Três Cantos 7 6 5 4 3 2 1 0 Jul Okt Jan Apr Jul Okt Jan 09 09 10 10 10 10 11 Lagoa dos Três Cantos Lagoa dos Três Cantos exams per month. Maranhão (MA) Reference hospital: Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS). Remote sites: Balsas, Carolina, Fortaleza dos Nogueiras. The pilot tests in Maranhão started in December 2009 when the satellite installations were finished. In the following figure and the table the number of exams sent by the sites in Maranhão (MA) until March 2011. Maranhão (MA) 300 290 200 100 3 0 0 Balsas Carolina Fortaleza dos Nogueiras Number of exams sent per site in Maranhão. City Type of Teleconsulta Exam tions Balsas Abdomen, 290 obstetric. (U/S) Carolina Abdomen. 3 (U/S) Fortaleza - 0 dos Nogueiras A significant discrepancy is observed when the number of exams performed in 5 Lagoa dos Três Cantos (RS) is compared to the rest of sites in RS. In Balsas (MA), the same behaviour is observed. An essential knowledge in informatics by the users (physicians) has a relevant impact in the project results. This can be seen in the number of exams sent from Lagoa dos Três Cantos (RS) and from Balsas (MA). Both sites have physicians with experience in informatics and feel comfortable using the telemedicine system. On the other hand, the other physicians involved in MEDNet showed resistance using the telemedicine application, despite of the workshops, training and constant support given. The number of exams sent from Balsas (MA) per month from December 2009 until March 2011. From February 2010 until December 2010 there is a period that the system was not operational due to technical problems in the satellite connection. Nevertheless MEDNet activities in Balsas were going on. The physician stored the ultrasound exams in the DICOM Database and when the connection was recovered he sent them to the reference hospital, which has already answered all his requests of second opinion. Exams sent from Balsas (MA) 100 80 60 40 20 0 dez/09 mar/10 jun/10 set/10 dez/10 mar/11 Balsas Balsas Exams per month. Peru In Peru there are in total eight satellite installations including the referral hospital in Huancayo. 6 Geographical position of the sites in Peru. All the sites are located in the jungle area and are very difficult to be approached especially under certain weather conditions. 60 45 50 40 30 22 20 25 10 0 Chongos Alto Pariahuanca Comas Rio Negro Mazamari Pangoa Puerto Ocopa Number of exams per site in Peru. All the teleconsultations in Peru, are Ultrasound consultations. In the following table presents more detailed the number of exams was sent through the system to the other sites and the exams were locally consulted. The main type of exam was obstetric and abdomen. 7 Work Performed from Jan/2010 until May/2011 WP7 – Pilot Execution (D7.1): activities performed during the Pilot Execution phase of MedNet project in Brazil and Peru. In this period, the system was utilized by the end users (physicians) in order to gather information for the evaluation of the deployed platform. This report also describes actions taken to keep the system running. System maintenance, training of physicians and technical staff took part. WP7 – Cost Effectiveness Analysis (D7.2): After having the system up and running, a three level evaluation took place concerning a) Cost analysis of the system, b) User acceptance evaluation, c) Technical evaluation. The evaluation activities for Brazil were completed successfully and the results were positive. Concerning Peru, evaluation was performed under the scope of the problems described in the previous paragraph. WP8 – Dissemination & Exploitation: Sustainability and marketing analysis was performed for the case of MEDNET. Presentations in conference’s and discussions with local authorities took place focusing on the sustainability issues. Main results achieved in 2010 / 2011 1. Several corrective actions were taken in order to achieve acceptable results and to overcome technical and operational problems. Tests results demonstrated that the network topology had to be changed. The network was splitted in two. Two JABBER servers are running in two different machines in SACA’s Datacenter. One serving MA sites and the other one serving RS sites; 2. On-line mode is technically operational in RS and MA; 3. Off-line mode is technically operational in RS and MA. Physicians prefer to use off-line mode because is difficult to match their agendas; 8 4. Physicians in RS and MA prefer to use Skype. They find it more user friendly and easy to install; 5. The internet connection to the satellite network is provided by SACA using a proxy server installed in MA’s JABBER server. The application was configured to enable compatibility between the remote stations and protocols such as: HTTP, SOCKS v4, SOCKS v5 and FTP; 6. Rio Grande do Sul (RS): The system is running without technical problems. The sites in RS are operative and willing to contribute in the project. Lagoa dos Três Cantos is regularly sending exams to SACA’s specialists and has fully incorporated the system in the Health Care Center routine. 80 exams were sent to Santa Casa specialists using the telemedicine network in RS; 7. Maranhão (MA): The applications were tested. Good results during the pilot tests. From January 2010 until March 2010 few exams were sent from Balsas and Carolina. Fortaleza dos Nogueiras never had a chance to use the system during this period because the satellite link in this site worked for only one day since its installation until March 2010. In the second half of October 2010 the satellite link was recovered for all sites in MA. However, in the second half of November 2010 problems with the installation did not allow the exchange of data among physicians. On November 25th, 2010, HISPAMAR solved the problem. Despite of the instability, most of the time the link is up and, since then, 293 exams were sent using the satellite network.

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