Squado Arsenal tests cross-community access with 5 systems at Connectathon

"When you are testing interoperability, it is rare that the problem is only on one side. That is the big advantage for Connectathon because both companies can work out the problems and solve it quickly," said Claudio Saccavini with Arsenal.it.

Five companies connecting 36 hospitals in Italy's Venato region came to the European Connectathon in Vienna with Arsenal.it for final tests before implementation of their systems for cross-community access.

This consortium of companies -- the Squado Arsenal, or Team Arsenal -- are now completing the Initial Deployment, or phase two, of a telemedicine project named Health Optimum designed to facilitate consultations for four different medical specialties by linking smaller community hospitals with expert physicians and surgeons at seven regional medical centers.

With €20 million in funding from the European Union under the Framework 6 Program, the Health Optimum consortium also includes 23 healthcare providers in the Veneto Region and five European Member States: Italy, Spain, Denmark, Sweden, Romania.

The four medical specialties to be enabled with this new capability are :

* Neurosurgical Tele-counseling: To give fast and formalized answers to neurosurgical counseling requests for Emergency cases of cranial trauma, from a peripheral hospital to the Neurosurgical Centre.

* Telelaboratory: With the introduction of new devices is possible to carry out test on site and then to receive immediately the lab results.

* Oral Anti-coagulant Therapy : A service dedicated to patients under anti- coagulant therapy with the goal of reducing patient travelling while maintaining high quality analysis and specialist support.

* Stroke Management : A consultative modality to facilitates care of patients with acute stroke at underserviced hospitals by specialists at stroke centers.

The modality being tested at the European Connectathon was Stroke Management where a physicians of a peripheral Emergency unit identify symptoms of a potentially suspect acute stroke. After evaluating the case, the local neurologist completes a form, digitally signs it and sends the form with CT images to the neurologist at the central reference hospital for authorization to begin a tpA treatment and arrange for the patient transfer. The form contains a patient's personal data and all necessary clinical and medical histories.

The consulted neurologist writes and signs electronically his opinion on a special and standard form and then sends it to the peripheral unit confirming the condition should be treated with tPa therapy and agrees to accept the patient at the reference hospital.

The step-by-step development of the Health Optimum network include realization of the exchange of documents and images within same provinces and then the integration of the platform with the introduction of gateways according to IHE XCA (Cross Community Access) integration profile.

This integration of community hospitals with full system interoperability at their regional level then allows the exchange of documents and images between regions, bringing for the first time the potential for sharing the local hospital requests among seven expert centers.

"The adoption of a gateway at the border of each domain, and the standardization of the communication method among different gateways, allows interoperability on the platform whether domains internally are adherent to XDS Profile or whether they are structured according to legacy solution that are not XDS compliant," explained Saccavini.

"For example, imagine that within the Venato region, the reference center at Treviso is overloaded with work and the local hospital physician needs to ask a different neurologist for an opinion," said Saccavini. "It sounds so simple when you say it, but it is very complicated to accomplish."

"Here at Connectathon we are testing this switch for the physician located in the Treviso community network to consult with a neurologist in another community network within the region, a referral out-of-the community, using the IHE approach," he said.

"There are a lot of factors that need to come together, which becomes easier to do at Connectathon," he said, adding, "The idea is that once we test the platform, if we need to add another company with a cardio vascular device or an imaging device, then we have the tools and the experience to test these new actors and see whether they are able to enter into the system."

Saccavini said Connectathon requires the five companies in the consortium to work with other companies they have never met before, either pulling images and documents or sending data to systems for the first time.

"These other systems are not necessarily focused on telemedicine, and it is very useful to test between different systems," he said.

"It is easier to do it all in one week and to be working tech-to-tech," he said, explaining that because there are not any customers at Connectathon, the technical staffs can work free from requirements to collaborate with commercial representatives.

Another advantage of Connectathon, he said, is the expert consultation available through the 31 monitors at the event.

"These are some of the best people in the field of health information technology," he said, "and when there is a problem you can not figure out, they are there to help."