UNIVERSITÀ DEGLI STUDI DI TRIESTE XXIII CICLO DEL DOTTORATO DI RICERCA – SCUOLA DI DOTTORATO DI RICERCA DI INGEGNERIA DELL’INFORMAZIONE INNOVATIVE ICT SOLUTIONS IN TELEMEDICINE TO SUPPORT CLINICAL PRACTICE AND RESEARCH IN HOSPITALS Settore scientifico-disciplinare ING-INF/06 DOTTORANDO MICHELE BAVA FIRMA: _________________________________________ DIRETTORE DELLA SCUOLA PROF. WALTER UKOVICH – UNIVERSITÀ DI TRIESTE FIRMA: _________________________________________ RELATORE PROF. AGOSTINO ACCARDO – UNIVERSITÀ DI TRIESTE FIRMA: _________________________________________ ANNO ACCADEMICO 2010/2011 A mia figlia Maria Ginevra. 2 Index/Summary Introduction .............................................................................................................................. 5 Chapter 1 Telemedicine ........................................................................................................... 7 1.1 A definition .......................................................................................................................... 7 1.1.1 Telemedicine services ....................................................................................................... 7 1.1.2 Delivery mechanisms ........................................................................................................ 8 1.1.3 Health information technology ......................................................................................... 9 1.2 Relevant telemedicine services ............................................................................................ 10 1.2.1 Tele-monitoring ................................................................................................................ 10 1.2.2 Tele-radiology ................................................................................................................... 11 1.3 Telemedicine: actual and future challenges ......................................................................... 12 1.3.1 Effectiveness of telemedicine services ............................................................................. 12 1.3.2 Regulations and legal clearance ........................................................................................ 13 1.3.3 Technical issues ................................................................................................................ 13 1.4 Research projects in telemedicine …………………..………..…………….………...…... 14 Chapter 2 Tele-radiology ………………………………….................................................... 15 2.1 State of the art and questions in tele-radiology ................................................................... 15 2.1.1 The all-inclusive approach in tele-radiology .................................................................... 16 2.2 International projects in mobile tele-radiology .…….......................................................... 17 2.2.1 EU projects ....................................................................................................................... 18 2.2.2 A Canadian tele-radiology project .................................................................................... 20 Chapter 3 ICT systems and solutions in telemedicine for the hospitals ............................. 21 3.1 Web sites and portals for telemedicine …………………………………….……………... 22 3.2 Internet and intranet telemedicine services …………………………………………...…... 23 3.3 IT Security and technical infrastructure ……………………………...…………………… 24 3.3.1 The information security plan ........................................................................................... 24 3.3.2 Information risk analysis ................................................................................................... 26 3.3.3 Conclusion ......................................................................................................................... 28 3.4 Tele-radiology at home ......................................................................................................... 28 3.5 From home to mobile? ………………………...……………………………………........... 30 3.6 Innovative technologies and systems for mobile tele-radiology .......................................... 31 3.6.1 Tablets for tele-radiology .................................................................................................. 31 3.7 Adopt – Anti Doping Teleconsulting ................................................................................... 33 3.8 Tele-presence and tele-monitoring ....................................................................................... 33 3.8.1 HUB-SPOKE model for ultrasound tele-consult .............................................................. 33 3.8.2 Innovative devices for tele-monitoring ............................................................................. 35 Chapter 4 Innovative methods and solutions for telemedicine oriented web-portals ....... 37 4.1 A hospital web-portal for telemedicine ................................................................................ 37 4.1.1 Web-portal characteristics and requirements .................................................................... 37 4.1.2 Methods, developments and results .................................................................................. 38 4.2 The web “social turning point” ............................................................................................ 41 4.2.1 The techniques .................................................................................................................. 42 4.2.2 The services ...................................................................................................................... 43 4.3 Conclusions .......................................................................................................................... 49 Chapter 5 Innovative methods and applications in designing intranet services ……........ 50 5.1 Intranet services and solutions for corporate organization and business ............................. 51 5.1.1 Methods and materials ...................................................................................................... 52 5.1.2 Development and implementation .................................................................................... 53 5.1.3 Results and discussion ...................................................................................................... 56 5.1.4 Conclusion and actual developments ................................................................................ 57 3 5.2 Intranet solutions for management evaluation ..................................................................... 57 5.2.1 Purpose .............................................................................................................................. 57 5.2.2 Methods ............................................................................................................................. 59 5.2.3 Results ............................................................................................................................... 61 5.2.4 Discussion ......................................................................................................................... 68 5.2.5 Conclusion ......................................................................................................................... 69 5.3 Intranet solutions for clinical care ........................................................................................ 69 5.3.1 Objective ............................................................................................................................ 69 5.3.2 Methods …......................................................................................................................... 70 5.3.3 Results ............................................................................................................................... 72 5.3.4 Discussion ......................................................................................................................... 73 5.3.5 Conclusion ......................................................................................................................... 73 Chapter 6 Mobile tele-radiology: a present approach for the future................................... 75 6.1 Mobile tele-radiology – a clinical approach ......................................................................... 75 6.1.1 Materials and methods ....................................................................................................... 76 6.1.2 Results ................................................................................................................................ 78 6.1.3 Discussion .......................................................................................................................... 78 6.2 Mobile tele-radiology – an engineering approach ................................................................ 79 6.2.1 The evaluation of electronic display devices ..................................................................... 79 6.2.2 IT security issues ................................................................................................................ 81 6.3 The assessment of a measurement protocol for mobile tele-radiology ................................. 83 6.3.1 Objective ............................................................................................................................. 83 6.3.2 Materials and methods .......................................................................................................