MEI 2012 Thessaloniki - HELLAS

Ιδανικό...

Πραγματικό...

Operational problems in “Intensive Care” Decisions must be taken immediately Multiple & complex problems Data stored in different locations Several inputs from different devices Patients’ history unknown Integration based on local experience Remote retrieval impossible

TRENDS IN TOTAL NUMBER OF HOSPITAL VS ICU BEDS ICU BEDSHOSPITAL BEDS

Institute of Medicine (IOM): Patient safety is “indistinguishable from the delivery of quality health care” Harteloh PPM (Health Care Analysis. 2003;11(3):259–67) “Quality [is] an optimal balance between possibilities realized and a framework of norms and values.”

Why do we need e-Learning / telemedicine in the ICU environment? • Informed decision – EBM practice • Emergency teleconsultation and patient’s triage in remotely located ICU’s • Home care / rehabilitation • Patients’ safety control – regular external audit • Second opinion in difficult cases from remotely located experts • Training in ICM

Interactive tele-education session between IsMeTT (Palermo) and UCY (Cyprus)

Interactive multipoint tele-consultation during laparoscopy (OP 2000 (Berlin), FMPC (Casablanca), CICE (Clermont-Ferrand)

Tele-consultation between OP 2000 (Berlin), ANDS (Algiers) and IsMeTT (Palermo)

Κέντρο eICU

Cyprus ICU pilot Network Installation sites in Cyprus

Satellite terminal at the NGH

Project Scenarios (cont.) Medical teletraining session

Όχι μόνο για παιχνίδια…

The kinect sensor

Αποκατάσταση με εξοπλισμό ιδεατής πραγματικότητας

Ιπποκράτειο ρητό “Ὁ μὲν βίος βραχύς, ἡ δὲ τέχνη μακρή, ὁ δὲ καιρὸς ὀξύς, ἡ δὲ πεῖρα σφαλερή, ἡ δὲ κρίσις χαλεπή …” Ιπποκράτους αφορισμοί 1.1 « … Life is short, [the] art long, opportunity fleeting, experience misleading and judgment difficult. …» Hippocrates, Aphorism 1.1

“Half of what you are taught as medical students will in 10 years have been shown to be wrong. And the trouble is, none of your teachers know which half” My students are dismayed when I say to them: “Half of what you are taught as medical students will in 10 years have been shown to be wrong. And the trouble is, none of your teachers know which half” Dr Sydney Burwell Dean of Harvard Medical School

Percentage of current EB knowledge known to physicians after medical school graduation p<0.001 Shin et al CMEJ 1993 % years from graduation 15 years 35%

ACP Journal Club NEJM, Ann Intern Med JAMA, Arch Intern Med, Circulation, Lancet, Am J Med, BMJ, J Intern Med

Technologies needed • Electronic patient record with bio-signals store • Data from home care • Database and statistical analysis of data • Electronic syllabus / curriculum • Repository of educational material (PACT) • Virtual patients bank / simulation • A platform that integrates all

Μητρώο σε χαρτί στη ΜΕΘ

Δωμάτιο ΜΕΘ με σταθμό εργασίας ΚΠΣ

Σταθμός εργασίας ΚΠΣ

Παράδειγμα βιοσήματος σε κλινικό δεδομένο Παρακολούθηση του καρδιογραφήματος από συσκευή παρακολούθησης βιοσημάτων

Technologies needed • Electronic patient record with bio-signals store • Data from home care • Database and statistical analysis of data • Electronic syllabus / curriculum • Repository of educational material (PACT) • Virtual patients bank / simulation • A platform that integrates all

ΠΙΛΟΤΙΚΗ ΥΠΟΔΟΜΗ ΤΗΛΕΪΑΤΡΙΚΗΣ ΜΕΤΑΦΟΡΑ ΔΕΔΟΜΕΝΩΝ

Φορητή συσκευή καταγραφής βιοσημάτων για το έργο Τηλε-Ιπποκράτης

Περιβάλλον διάδρασης ιατρού

Technologies needed • Electronic patient record with bio-signals store • Data from home care • Database and statistical analysis of data • Electronic syllabus / curriculum • Repository of educational material (PACT) • Virtual patients bank / simulation • A platform that integrates all

Γενικό Νοσοκομείο Λευκωσίας Μονάδα Εντατικής Θεραπείας Γενικό Νοσοκομείο Ηρακλείου Μονάδα Εντατικής Θεραπείας PROSAFE C ONSORTIUM GiViTI (Italian Group for the Evaluation of Interventions in Intensive Care Medicine) “Mario Negri” Institute, Italy Semmelweis University, Hungary Warsaw Medical University, Poland General hospital Novo Mesto, Slovenia Nicosia General Hospital, Cyprus Intensive Care Forum NGO, Cyprus Friedrich-Schiller-Universitat Jena, Germany UCL Center for Intensive Care Medicine & Bloomsbury Institute of Intensive Care Medicine, United Kigdom

internet Proxy: machine with a specific address that grants a safe internet access using a trusted networking with autentication. master client server CC If the proxy exist, softwares(like browser) must know its address and autentication credentials Prosafe tries to guess the system proxy settings. If it is not able to get settings, you will be able to set them. master

ICU n. 57 Calibration curve expected mortality observed mortality

VLAD: Variable life-adjusted plot patient 1 expected mortality= 6.5% outcome = alive SUCCESS: 6.50 patient 2expected mortality = 46.4% outcome = died FAILURE: 53.6 patient 3expected mortality = 16.8% outcome = alive SUCCESS: 16.8 patient 4expected mortality = 95.1% outcome = died FAILURE: patients 5 6

ICU n /291 vs. 92 / more deaths (95% CI: 5 – 21) if I would have performed as the previous year, how many death would I have observed?

Technologies needed • Electronic patient record with bio-signals store • Data from home care • Database and statistical analysis of data • Electronic syllabus / curriculum • Repository of educational material (PACT) • Virtual patients bank / simulation • A platform that integrates all

Γενικό Νοσοκομείο Λευκωσίας Μονάδα Εντατικής Θεραπείας Γενικό Νοσοκομείο Ηρακλείου Μονάδα Εντατικής Θεραπείας Competency-Based Training in Intensive Care Medicine in Europe

Methodology Phase 1 survey on national methods of training, assessment and accreditation Phase 2 identification of competencies and classification Phase 3 development of guidelines for the assessment of these competencies Phase 4 Identification of training material and link between the competencies and material

Technologies needed • Electronic patient record with bio-signals store • Data from home care • Database and statistical analysis of data • Electronic syllabus / curriculum • Repository of educational material (PACT) • Virtual patients bank / simulation • A platform that integrates all

Επαγγελματίες Υγείας Ασθενείς / Συγγενείς Ασθενών Εκπαιδευτές The materialization of an innovative project who will address the educational needs of health care practitioners with enrichment of their work environment with learning elements Κύριοι στόχοι έργου The adaptation of the platform to the needs of patients and their families from the hospital to the home based care &

• Depict and translate clinical needs to educational processes • Select and organize educational material • Adapt and integrate the proposed solution to the ICU environment Process analysis KNOWLEDGE DIFFUSION

e Infrastructure requirements outline Tele-education rooms – Interactive boards – Teleconference systems – Simulation tools Physical and virtual “points of training” in the work place and in their every day life Lessons / Training program management Educational material management Teleconferences management Tele-education platform

“ … Where is the Life we have lost in living? Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information? …” T.S. Eliot’s The Rock (1934)