MYREN and Telemedicine

MYREN and TelemedicineDr. Salem Omar

Associate ProfessorDepartment of Medicine

Division of Gastroenterology and HepatologyUniversity Malaya

Consultant EndoscopistEndoscopy Unit

University Malaya Medical Centree-mail: salem@um.edu.my

MYREN International Seminar "Harnesing Technology for Global Colloboration"

27-28 July 2010

Existing Telemedicine

• Photographs (paper, digital)

• Radiographs

• Vital signs

• Electrocardiograms

Ideal Teaching Method (Endoscopy)

The sad fact…

Limitation of current telehealth• Recorded images or videos• No real time procedures from hospitals• Consultation/Meeting/Lecture rooms• Infrequent meetings• Fixed schedule

MYREN and Telemedicine

• Use of ever ready, dedicated high speed international broadband internet network

• Live real time procedures transmitted in uncompressed digital data through Digital Video Transport System (DVTS)– providing high volume error free date transmission

• No loss of quality due to compression of data from coding and encoding processes

MYREN

• Malaysian Research & Education Network• Established in 2005• Currently functions under Ministry of

Information, Communication & Culture (MICC)/Kementerian Penerangan, Komunikasi dan Kebudayaan (KPKK)

• Will be transferred to Ministry of Higher Education (MOHE)/ Kementerian Pengajian Tinggi (KPT) in 2011.

MYREN• MYREN provides a dedicated high-speed broadband network

exclusively for research organizations to link up to each other and carry out collaborative research or applications.

• Domestic Network ranges from 2MB to 8MB (100MB on MIMOS) for phase 1, 10 to 50MB for phase 2

• MYREN is a low-cost alternative to expensive commercial networks.

• MYREN’s high bandwidth capacity allows for data-intensive applications.

• Highly qualified support staff

Telemedicine utilising DVTS

• Need only 2 high end commercially available PCs and DVTS hardware or software

• Free software can be downloaded from http://www.sfc.wide.ad.jp/DVTS/, available for UNIX, Windows, MacOSX platforms, size of Windows platform software only 1.16MB

• Images transmitted at 30 frames per (30 Mbps transmission)

Basic system configuration

Set up at Kyushu University Hospital

• Detailed images of complex human organ images

• Simultaneous transmission patient’s other date such as X-ray, CT scan and MRIs, vital signs possible

• Almost no time lag between stations – help overcome language barrier (comprehension improved via lip reading)

• Provide real time interaction between presenter and audience – increases attention span and prevents lost of interest

• No actual transmission cost• No time limit unlike satellite transmission• Patient’s privacy ensured by cipher security

programme

China

India

Indonesia

Japan

Korea

Laos

Malaysia

Nepal

Pakistan

Philippines

Singapore

Sri Lanka

Taiwan

Thailand

Vietnam

Australia

(Bangladesh, Bhutan and Cambodia)

Austria (ACOnet), Belgium BELnet), Bulgaria (BREN), Croatia (CARNet), Cyprus (CYNET), Czech Republic (CESNET), Estonia (EENet), France (RENATER), Germany (DFN), Greece (GRNET), Hungary (NIIF), Ireland (HEAnet), Israel (IUCC), Italy (GARR), Latvia (SigmaNet), Lithuania (LITNET), Luxembourg (RESTENA), Macedonia (MARNet), Malta (University of Malta), Montenegro (MRnet), Nordic region (includes Sweden, Finland, Denmark, Norway and Iceland) (NORDUnet), Poland (PSNC), Portugal (FCCN), Romania (RoEduNet), Serbia (AMRES), Slovakia (SANET), Slovenia (ARNES), Spain (RedIris), Switzerland (SWITCH), The Netherlands (SURFnet), Turkey (ULAKBIM), UK (JANET)

438 participants

Entire USA

• APAN (Asia-Pacific Advanced Network ) is a non-profit international consortium established on June 3 1997.

• APAN is designed to be a high-performance network for research and development on advanced next generation applications and services.

• APAN provides an advanced networking environment for the research and education community in the Asia-Pacific region, and promotes global collaboration.

• Malaysia is a member of APAN, headed by Dr. Sureswaran Ramadass from University Sains Malaysia

• MYREN, since established, is part of APAN

APAN Medical Working Group

• Established during APAN Taiwan meeting in August 2005

• Currently headed by Professor Shuji Shimizu of Kyoto University

Medical Related Activities Organised at MYREN

• 25th Jan 2007APAN Manila, PhilippinesLaparoscopy gastrectomy for stomach cancer.Surgery took place in Seoul National Bundang University, Korea and was live streamed to Manila and MSC Innovation Centre, Cyberjaya where MYREN NOC is located.There were 30 participants comprising of doctors and networking technical experts in the event.

Professor Jasmi Ali Yaakub, Consultant Surgeon,

Hospital Universiti Kebangsaan Malaysia.

• 29th Aug 2007APAN Xian, ChinaEndoscopic submucosal dissection for early stomach cancer by endoscopist from Japan and was live streamed to China, Korea, Taiwan, Thailand, Germany and MSC Innovation Centre, Cyberjaya.There were 40 participants comprising of doctors and networking technical experts.

• 23rd July 2008Live transmission from Kyushu University Hospital to MYREN.The event took place in MYREN NOC.A teleconference between MYREN and Kyushu University for about 30-40 minutes to hear the presentation of Dr CS Qua from UMMC who was on attachment with the hospital about his experience in Japan using DVTS.

• 25th September 2008Boston International Live Endoscopy CourseThe course was held at Hospital Selayang and Beth Israel Medical Center, Boston.Endoscopic procedures between Selayang Hospital and Beth Israel Medical Centre at Boston with the link provided by MYREN and equipment provided by ASTROThe participants were Hospital Selayang and Beth Israel Medical Centre Doctors.

• 16th June, 2009 MYREN Medical Talk Held at NOC, Cyberjaya 40 participants comprising of doctors and

networking technical experts. 4 speakers presenting current and future

applications of telemedicine and telehealth through MYREN and possible expansion and increase of activities by Medical WG.

Future events from Endoscopy Unit, UMMC

• MYREN 2University of Malaya is the central region POP

NOC (Cyberjaya)

Pusat Teknologi Maklumat

Endoscopy Unit, University Malaya MedicalCentre (UMMC)

1 Gbps

50 Mbps

Upcoming telemedicine conference

• 10th August 2010 Endoscopic teleconference at 30th APAN-Hanoi Theme: “Endoscopic diagnosis: Up-to-date” Local Venue: Endoscopy Unit, University Malaya Medical Centre DVTS_plus: multi-party conference system developed by Network

Research Center of Tsinghua University. Only need a comparatively high equipment PC, free client software ( downloadable from http://conf.dvtsplus.org/, 2.8 MB) and a video camera. Attendee can watch in Low/High Definition.

8 participating stations – Vietnam, Malaysia, Thailand (2), Hong Kong, Taiwan, Indonesia and Japan

Presentation of cases from 4 stations – Malaysia, Thailand, Taiwan and Hong Kong

Limitations

• Government and university hospitals (except UMMC) are not linked to MYREN 2

• Had to outsource technical expertise - cost• Initial high set-up cost (fibreoptic internet line,

dedicated space, high end PC, HD camera, mixers, microphone, speakers)

• Most doctors are not IT inclined and busy with other clinical duties.

Future of MYREN and telemedicine• Connectivity between hospitals from Ministry of

Higher Education, Ministry of Health and private sector – MOH-TC Telehealth Division/MOHE/NEAC initiative for ?10th/11th MP.

10th MP – 4 new and 4 replacement hospitals to be completed within first 2 years of 10th MP, including

National Cancer Centre and Cheras Rehabilitation Hospital.

National Cancer Centre can be the pioneer hospital under MOH to be connected to MYREN2.

Clinical Research Centre (CRC)Ministry of Health

• Collaboration in term of training endoscopists and surgeons doing complex procedures through MYREN, this cutting costs and retaining manpower in respective hospitals and providing remote diagnosis and life saving procedures.

• Setting up of dedicated Department on Medical ICT in every hospital to pool human and state of the art equipments resources under one roof

Global training programme

• Routine daily long distance robotic assisted surgery and endoscopy

• A computer system that simulates the knowledge and expertise of a human doctor

• Virtual reality surgery

• Nationwide and worldwide 24/7 surgeries and endoscopy

Thank you!

salem@um.edu.my