Sesión Paralela S-4: "Casos prácticos sobre proyectos conjuntos, cooperación científica e investigación en Sanidad"
Parallel Session HC-4: "Case study on joint projects and scientific cooperation and research in Health Care"

The present day Telematics revolution featuring the alliance between both the computer and telecommunication technologies is rapidly changing the course of history of mankind, influencing almost all walks of life. Following the June 1994 Bangemanns's report, The European Council adopted some established recommendations regarding " Europe and the global information Society". The G7 countries have digressed on the issues of telecommunication networks and infrastructures, identifying Health sector among the six sub-pilot projects, with international impact and orientation. In the light of this development, Telemedicine, which is a derivative of Telematics has gained ground, paving way for distant medical services, even across the globe.

The original plan is to demonstrate the ways and manner by which the benefits of Telemedicine can be brought to everyone's disposal including those in the least favoured nations. The initial step is to establish and implement a pilot Telepathology exercise employing the ISDN (Integrated Service Digital Network) broadband communication Network(1) between Belgrano Public Hospital, Buenos Aires, Argentina and the Research Laboratory for Biomedical Informatics, Amersfoort, the Netherlands. While addressing the priorities, the need to optimise the existing resources as well as the possibility of having access to other telemedical services and network will be addressed.

While aiming at broadening the scope in a later stage, a field research was conducted in April 1997, by LBMI in the Latin America and especially in Argentina (6), to access the essence of the initiative taking into considerations available infrastructure and technological requirements.

 The Technical Requirements

In order to accomplish this goal, the Informatics division of the Belgrano Hospital has now been equipped with the ISDN Telecommunication facilities and infrastructure.

• ISDN - card.
• Video card, which supports NTSC/PAL and S-Video input.
• Conferencing and communication software.

The ISDN line is available on both sides.

• Two different B channels each of which has a bandwidth of 64 Kb/s.
• One Data Channel for transmitting connection signals (e.g. the phone number)

• Device 1: RAD FCD-2.
• Device 2: Narrow Band Multiplexer -Newbridge-
• Device 3:Pairgain HRE 420

The Digital microscope System that will be employed during the course of this pilot project has been designed and developed at LBMI. This development of the LBMI digital microscope (LBMI-DIMI) features the integration of three principal hardware components. These include mechanical, electrical and electronic devices.

On either side of the remote stations, both the human knowledge resources and the speciality data banks should be made available for international consultation. The demonstration exercise will link the Pathology dept. of the Belgrano Hospital to LBMI where the visiting consulting Pathologists will enter into direct dialogues with there Latin American counterparts. Images will be transferred from both ends for mutual discussion.

Due to the standardised technology and infrastructure it is expected that this initiative will result in a smoothly running demonstration exercise(3).

An elaborate electronic library system would be highly required to satisfy the high demand for information accessibility. Furthermore, the need for distant learning is imperative.

A more detailed but concise education is suggested for the selected personnel involved in the project, disregarding their respective professions or status. This education should be centred on the Fundamental Principles of Telemedicine in general and in particular, the Fundamental of Modern Telemedicine in Latin America(4). This education, while opening grounds for awareness and consciousness, should certainly involve the Policy makers. The proposed education which should be locally centralised within the country, should be developed with special affinity for the various and diversified situations in Latin America, taking into consideration, a number of factors including population, literacy level, social, economic and cultural backgrounds.

Maximum priority should be given to local products in the Latin America. Where ever necessary, co-operation should be established between the ELATI consortium and the major suppliers of Healthcare instrumentation and software to examine the possibilities of building-in some special purpose telecommunication interfaces. Both installation and testing would be perfectly handled by the local technicians in the Latin America.

The project should follow a general 5-phase model, including the (i) the user requirements, (ii) the translation of the user requirements into functional specifications, (iii) the development of the demonstrators, (iv) the validation of the demonstrator and (v) the exploitation.

Obviously, the different phases are to be delimited by Milestones, necessitating the presentations of a number of deliverables at different intervals of the project. Furthermore, check points (go/no go criteria) should be established, based on the fulfilment of the general, special and measured objectives

Evidently, this pilot project underlines the paramount importance of associating developing countries to the new telemedicine era and its benefits. It is thus imperative to establish strategies which will enable the individual countries to draw on and learn from the experiences of others. This will obviously reflect on the world-wide collaboration between health professionals as well as between health authorities.

1. Oberholzer M, et al, Telepathology with an integrated Service Digital Network -A new tool of Image Transfer in surgical pathology, Hum Pathol 1993; 24:pg. 1078-1085
2. Adeyinka M, Telepathological (Image transmission) Configuration, The proceedings of the Int. Conference on Telemedicine and Telecare, London, 8-9 Nov. 1995, pg. 43-48
3. Schwarzmann P, Schmid J, Binder B and Burkart J, Field test to evaluate telepathology in telemedicine, The proceedings of the Int. Conference on Telemedicine and Telecare, London, 8-9 Nov. 1995, pg. 37-42
4. Adeyinka M, Fundamentals of modern telemedicine in Africa, Methods of Information in Medicine 36(2):95-98(1977)
5. Adeyinka Michael, Aplicaciones de la Telematica en los Servicios de Emergencias, Internet, Telematica y Salud, 1er Congreso - Exposicion de Internet, Intranet y Web, Editorial Medica Panamericana S.A., Buenos Aires, pg. 437-440, 1997
6. Jares Daniel and Rodas Eduardo, Desarrollo de las Redes Informaticas de Investigacion y otras Aplicaciones en la Republica Argentina, Internet, Telematica y Salud, 1er Congreso - Exposicion de Internet, Intranet y Web, Editorial Medica Panamericana S.A., Buenos Aires, pg. 354-360, 1997

Dr. M. B. Adeyinka