Telemedicine on the Grid. Cambridge eScience Centre.

Telemedicine on the Grid

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CeSC Location

CeSC is located in the new Centre for Mathematical Sciences on the West Cambridge site, with office space and conference room for AccessGrid.

Strong links with the Cambridge-Cranfield HPCFPostal address:

www.escience.cam.ac.uk

Cambridge eScience CentreCentre for Mathematical Sciences Wilberforce RoadCambridge CB3 0WA

Cambridge eScience

Cambridge eScience Centre

National Institute for Environmental eScience

Centre for Mathematical Sciences

Cambridge Computational Biology Institute

Cambridge eScienceCeSC Industrial Partners:

IBM, Sun Microsystems

Microsoft Research

Unilever, Siemens Medical Solutions

Macmillan Cancer Relief

BAE Systems, Rolls Royce

Cambridge Computational Biology

Institute• Link Cambridge expertise in medicine, biology,

mathematics and the physical sciences. • World centre that will develop new knowledge and its

application to health, quality of life and wealth creation.

• Research topics: New MPhil Course– basic genetics of bacteria– developmental biology– evolutionary biology– complex cell biology of human disease– systems biology.

• Multidisciplinary approach using advanced informatics techniques:

Seeking Cross-Research Council funding….

Background

• NHS Cancer Plan– Network– MDT Meetings– Specialisation– Data sets

• e-Government• e-Science

“Delivering public services in new and electronic ways to be more convenient, more joined-up, more responsive and more personalised:”

e-government

• building services around citizens’ choices• making Government and its services more

accessible• ensuring social inclusion• using information better

Existing Teleradiology

ISDN Workstation

CT ScannerCT Scanner

DICOM 3.0DICOM 3.0DICOM 3.0DICOM 3.0

Strongly authenticatedStrongly authenticatedconnections:connections:

CHAPCHAPCLICLI

Access listsAccess lists

Strongly authenticatedStrongly authenticatedconnections:connections:

CHAPCHAPCLICLI

Access listsAccess lists

128 kbps 128 kbps

ISDN RouterISDN Router

ISDN RouterISDN Router

Bandwidth limited: doctors travel to case conferences

The West Anglia Cancer Network

The West Anglia Cancer Network

• Cancer Centre– Addenbrooke’s/ Papworth

• Cancer Units– Bedford– Peterborough– West Suffolk– Harlow– Hinchingbrooke– King’s Lynn

RequirementsRequirements

• Multi-site videoconferencing

• Access to pathology & radiology images– Live microscopy– DICOM

• Access to remotely stored patient records through organisational LANs

The NHS Solution The NHS Solution

• Integrate existing commercial VVID system with medical needs– Low entry cost– Simple to operate– Integration with other network services, e.g. DICOM

• Generic solution for clinical collaboration– Advanced collaborative environment for teaching and

research• Initial aim was to roll-out across 8 WACN Hospitals in

year 3.• Key staff: Martin Graves, Radiology, PI/Kate Caldwell

CeSC

Technologies

• Videoconferencing/multimedia• Medical image transfer and archiving

– Digital Communication in Medicine (DICOM)

• Real-time microscopy imaging– PathMeeting (HTTP)

• Data mining– Legacy interfaces/XML

• Dedicated ISDN lines (pending NHSnet upgrade)

Funding

• Macmillan Cancer Relief– £70,000

• Siemens Medical Solutions– £145,000

• eScience funding– £171,974

• NHS Trusts - each has invested in its own dedicated room, now used for MDTs, management, teaching etc. (Typically £40-50,000 per trust).

Telemedicine Project Objectives

• Year 1– Installation of an appropriate voice, video and data

hardware and software demonstrator in a sub-set of WACN hospital sites, using the best available network connectivity.

– Train NHS staff in the effective use of the system.– Produce a detailed specification of NHS needs (data

formats, user interfaces and security requirements).– Prototype the CeSC facilities for medical VVID services

using experience gained from the demonstrator.– Develop additional code, compatible with the Grid Core

Program software kit, to ensure secure VVID services over the Grid.

Telemedicine Project Objectives

• Year 2– Integrate remote visualisation of volumetric medical

image data into the system.– Customise the system with NHS-specific

requirements based upon the demonstrator and the prototype CeSC system into a package suitable for deployment within the entire WACN.

– Integrate demonstrator hardware and software with system

Year 3 Full implementation and evaluation of the NHS

specific system across the eight WACN sites.

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The Reality!The Reality!

Live MDT in progress

Goals met in 18 months

Progress • Telemedicine has been adopted by most

cancer MDTs in Cambridge, and is also used for training, management and general communications by the participating trusts.

• Telemedicine has been rolled out to 5 other Cancer Networks, and a National Programme is under discussion.

• Telemedicine is proposed for use in CancerGrid, for running clinical trials, as part as a broader data management project.

• Collaboration with Australia to exchange expertise.

Lessons from our experience

• Problems are not as expected– NOT security (use encryption, control access to

MDT sessions)– NOT technology (NHS is far behind the cutting edge

of IT - needs simple, reliable, effective tools)– NOT ethics (no example so far of any ethical/patient

problems)

• Some problems are obvious, with easy solutions– Bandwidth on NHSnet was inadequate - implement

private ISDN lines to demonstrate system. Migrate with NHSnet upgrades.

• Peer review system can miss real issues - reviewers taken from bleeding edge advocates, rather than practitioners?

…more lessons…• Problems are sociological and organisational

– NHS personnel are heavily loaded and underfunded– Resistance to shiny new technological fixes– Resistance to imposed external “expertise”– NHS IT has high level of security paranoia

• Need to engage community from outset with sensible/sensitive project leads (Martin Graves/Kate Caldwell)

• Launch with simple, effective solution to real problem

• Build on success to more ambitious solutions, with community push

• Funding agencies create obstacles to incremental rather than revolutionary solutions.

Future work

• Further develop use of the system by extra users• Implement telemedicine for National Radiology

Academies• Set up demonstrator for Paediatric Intensive Care

• Aim to exploit developments of PACS to use more volume visualization data

• Also develop solutions for Telepathology• Leading role in roll-out of solutions across the NHS

Volume Visualisation

Very high quality data now available, not fully exploited

Telepathology

Digital archiving and curation can help with diagnosis, treatment, research and teaching.

Conclusions• Telemedicine has proved itself to be highly

popular with NHS clinicians• Now an everyday part of working practice in East

Anglia• Increasing takeup nationwide

• New opportunities with the NHS IT programme investment….

• …but risk of “management paralysis” when chronic underfunding meets sudden investment…

• …existing NHS projects will need careful nurturing!