Health Telematics (AIM) Final Report


	Updated: Feb 1, 97
BRITER

Biosignal Representation, Integration and Telecommunication Services in Rehabilitation

Project Code: A2050

Project value: 1309 KECU

EC contribution: 766 KECU

No of partners: 26

No of countries: 9

Duration: 27 months

Contact:
Arne Talbot
Rigshospitalet, Unit 5111
Centre of Clinical Imaging and Engineering Informatics
Blegdamsvej 9
DK-2100 Copenhagen Ø, Denmark
Tel.: +45-35-45.51.18
Fax: +45-35-45.51.47

Overview

The BRITER project was concerned with development and evaluation of telecommunication services and methodologies for service support within the areas: integrated instrumentation, biosignal handling and telepresence. It was a common effort of five projects of the previous call namely CAMARC II, ESTEEM, IREP, MAGNOBRAIN, and OEDIPE. The telecommunication services were evaluated within rehabilitation centres and trauma centres. In addition, it developed a common communication protocol for communication of biomedical signals and signal related information in order to contribute to the standardisation process for open systems.

Purpose and objectives

The objective was to align and test telecommunication services for biosignals with accompanying clinical information. The two major objectives were:

To develop a common communication protocol covering the clinical specialities within the projects including biosignals and signal related information in order to contribute to a basis for open systems.
To test demonstrator telematic services by aligning currently developed prototype systems and to apply these services under real life conditions. The telematic services tested within BRITER are of 2 types:
1. Store and forward based systems with low volumes of highly structured data. The services include teleconsulting and reference database access Emphasis will also be put on on-line handbook with a directory of services. These services will be tested in a small network of rehabilitation centres.
2. Services based on on-line video systems with high volumes of non structured data (videoconferencing and telepresence). These services will be tested in trauma / acute care centres.

A major part of the project was the development of the BRITER services based on pilot systems already existing in the participating projects (CAMARC II, ESTEEM, IREP, MAGNOBRAIN, OEDIPE). Therefore, the deliverables and other relevant documents from the participating projects have been analysed in order to make a proposal for alignment of tools usable for the BRITER services. The process included a cross-matching of the tools needed for the implementation of the scenarios versus the available "building blocks" coming from those projects and a proposal of alignment of Datasets and Tools, with identification of the conflicts (i.e. multiple and incoherent definition of the same data) or missing elements. The alignment of tools and the clinical trials/evaluation will be focused around scenarios within cerebral.palsy. The project BRITER has also included comparison of applied communication approaches and establishing consensus for common communication protocols and terminology. Furthermore a draft domain information model has been developed following the methodology proposed by TC251 PT 004. Alignment to and contribution to TC251 was considered an essential part. The other part was to establish and evaluate a telemedicine workstation link between the casualty department of remote community hospital and large urban hospital accident and emergency department in Scotland.

Results

The developed trauma care services were based on on-line video based systems with high volumes of non structured data (videoconferencing, teleradiology and telepresence). Throughout the clinical trial period 120 teleconsultations have taken place between the remote community hospital and specialist trauma centre. Transmission of digitised radiological images via the teleradiology system was an integral part of 116 teleconsultation. Videoconferencing formed part of 76 teleconsultation and was judged as very useful. General practitioners appeared to have gained reassurance that through the use of videoconferencing and teleradiology the consultant has been provided with a complete clinical picture.

Communication between clinicians using the telemedicine workstations was able to save the transfer of 70 patients. The patient was guaranteed high quality care within his community. In addition these saved transfers have obviously economic and social benefits for the patient.

The developed integrated BRITER workstation for telematic rehabilitation services have been initially tested in a small network of rehabilitation centres. The project also included the development of a domain information model according to the approach specified by CEN TC251 PT004. A common communication protocol for biosignals with related clinical information was developed according to the approach of CEN TC251 PT004. The communication protocol is specified in detail for EMG, ECG and movement in order to assure the generality of the protocol.

The modular multimedia BRITER workstation developed by the Lyon group will be further developed and tested within a number of teleconsultation project within the 4th framework. The trauma services will remain in the clinical setting at Aberdeen and the services offered via teleconsultation will expand. The expertise obtained are further explored within the G7 program and the MERMAID project of the 4th Framework Programme. The communication protocol work has already been used in the standardisation work within TC251 WG5. It will be further developed and tested for EEG telecommunication within the PRESTIGE project of the 4th Framework Programme.

List of Deliverables

Year 1

Project Status report (R/R)
Assessment of User Needs ( R/R)
User requirements and equipment (R/P)
SCP-Definition of protocol structure and format (R/P)
Integrated services support, Methods and Models (R/P)
Quality assurance report (R/R)

Year 2

Report on the user interface with telepresence in immediate care and rehabilitation (R/R)
Prototype of present feasible telematics network (R/R)
A review and cost-benefit analysis of the Saviour findings (R/P)
Demonstrator for Integrated access to rehabilitation signals and data (R/R)
SCP-High level interchange format/ Future SCP (R/P)
Evaluation report for integrated services (R/P)
Quality assurance report ( R/R)

List of Participants

Prof. Tommaso Leo Universita di Ancona Dipartimento di electronica ed Astomatica Via Brecce Bianche I-60131 Ancona, Italy Tel.: +39-71-220.48.42 Fax: +39-71-280.43.34	Mr Giorgio Orsi TSD projects Via Taramelli 26 I-20124 Milano, Italy Tel.: +39-25-750.21.57 Fax: +39-25-750.20.93 E-mail: gorsi@tsdpro.it
Prof. Paul Rubel INSERM-U121 Rue de Tolbiac 101 F-75654 Paris, France Tel.: +33-72-35.73.72 Fax: +33-72-34.18.76	Dr. George Anogianakis Biotrast UFTP Mitropoleos 111 GR-54622 Thessaloniki, Greece Tel.: +30-31-27.79.04 Fax: +30-31-27.79.60
Dr. Wendy Haston RGIT Survival Centre Ltd King Street 338 Aberdeen, U.K. Tel.: +44-224-61.96.19 Fax: +44-224-61.95.55



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