Compendium of Health Telematics Projects 94-98 (Draft)


	Updated: Aug 26, 1998
This is the most recent structured* information on this project. Complementary data can be found on previous documents*
T-IDDM Telematic management of insulin dependent diabetes mellitus

Project code:	HC 1047
Project value:	1417.0 KECU
EC contribution:	710.0 KECU
Number of partners:	8
Number of countries:	3
Duration:	36 months
Starting date:

Contact:	Mario Stefanelli Consorzio di Bioingegneria e Informatica Medica Dipartimento di Informatica Univ. Pavia 27100 Pavia Italy
Tel:	+39 38 25 05 354
Fax:	39 38 25 05 373
E-mail:	tiddm@ipvaim.unipv.it
Web Site:	aim.unipv.it

Overview

The T-IDDM project concerns the design, implementation and testing of an intelligent telematic service to assist IDDM patients, providing the physician with a decision support tool for improving management of patients according with the best current medical practice. The service is implemented through the telecommunication between two modules: a Patient Unit and a Medical Unit.

Purpose and objectives

IDDM is a major chronic disease in the developed countries, characterized by metabolic alterations and long-term invalidating complications. The conventional treatment of IDDM involves 3 to 4 insulin injections per day or continuous subcutaneous infusions, accurate home blood glucose monitoring, strict and frequent surveillance by health care professionals. T-IDDM proposes a shift of the primary focus away from hospital-based information systems and medical practice, to widely-available, decentralized, low-cost assistance. The project goal is to take advantage of the current state of technologies and infrastructures to define, develop, validate and evaluate a set of telemedicine services and applications, to accomplish the following specific aims:

To provide an effective treatment leading to good glycemic control, and achieving a careful balance between insulin therapy, diet and physical activity. Delay the onset and/or slow the progression of chronic complications.
To provide diabetic patients at home or in other non-clinical environments with an appropriate level of continuous and intensive care through telemonitoring and teleconsultation services, taking into account the needs of remote or isolated individuals that are unable to reach frequently the hospital institutions.
To allow a cost-effective monitoring of a large number of patients, automatizing the data collection and the management of a large set of therapeutic protocols.
To support continuing education of patients through teleconsultation services.
To allow the patient to customize the insulin therapy within the bounds established by the physicians.

Methods

The architecture of the T-IDDM system is based on two main components: a Medical Workstation and a Patient Unit, connected by a Telecommunication Service.
The Medical Workstation (MW) is located at the health care center, and must be integrated with existing Hospital Information Systems. The main tasks of the MW are to interpret the available data, to reason on the abstracted data, and to take decisions regarding the protocol to be enforced. Its functionalities hence comprise clinical and administrative data management (patient records, clinical histories, therapy modification log, ...) guaranteeing data privacy as well as analysis by graphical and/or statistical tools; treatment selection and adaptation through patient data monitoring and automatic detection of deviations from treatment targets; physician-patient remote interaction. The methodologies employed at this level come from the Artificial Intelligence (AI) context as well as from modelling and control theory. The current implementation of the MW prototype is being developed in the World-Wide Web environment, in order to take advantage of its low cost and very high availability.
The Patient Unit (PU) represents the interface to the system functionalities and to the communication network for the patient. It contains the software for patient data collection and consultation (past data review, statistics, ...), for data communication and decision making. The PU functionalities hence comprise recording physiological data (self-monitored blood glucose, ketonuria, special events) and patient actions (insulin doses and schedulings, meals, extra physical exercise); suggesting insulin dosage adjustments; providing for local and remote consultations; allowing physician-patient remote interaction, exploiting multimedia facilities when possible. A library of innovative algorithms and heuristic methods (fuzzy, optimal, predictive control techniques) is being implemented and tested in order to achieve the above mentioned functionalities. The PU is currently being implemented on a Personal Computer; moreover, in order to increase the patient's quality of life, an implementation of the PU on a portable device is planned. The Telecommunication System is designed to support the interaction between the PU and the MU, as well as between hospital centers to allow the exchange of clinical information, statistical data, therapeutic protocols. It must therefore offer, through standard-based facilities, a high-bandwith and reliable communication path, that should be continuously available and easy to use. Different public networks will be taken into account in order to cope with such tasks: Public Switched Telephone Network (PSTN), Integrated Services Digital Network (ISDN), Global System Mobile (GSM), Internet.

Results

The Medical Unit and Patient Unit demonstrators have been completed, and the verification phase has started in the four project validation sites.

List of deliverables

Year 1

User needs requirements definition: Final Report (06 PU)
Functional specification definition: Final Report (06 RP)
Patient Unit Progress Report (10 RP)
Medical Unit Progress Report (10 RP)

Year 2

Patient Unit Final Report (18 PU)
Medical Unit Final Report (18 PU)
Verification Phase Progress Report (24 RP)

Year 3

Verification Phase Final Report (27 PU)
Exploitation Plan Progress Report (30 RP)
Demonstration Phase Progress Report (32 RP)
Indexes of Success Report (32 PU)
Demonstration Phase Final Report (36 PU)
Exploitation Plan Final Report (36 PU)
Final Report (36 PU)

List of participants

Name:	PAV
Organisation:	Consorzio Bioingegneria e Informatica Medica
Address:	via Ferrata 1
Country:	Italy
Tel:	+39-382-505354
Fax:	+39-382-505373
E-mail:	tiddm@aim.unipv.it

Name:	GBT
Organisation:	Grupo de Bioingegneria e Telemedicina-Universidad
Address:	Ciudad Universidaria Madrid
Country:	Spain
Tel:

Name:	FDI
Organisation:	Fundacion Diabem
Address:	Sant Antoni M. Claret 167 Barcelona
Country:	Spain
Tel:

Name:	CPR
Organisation:	Consorzio Padova Ricerche
Address:	Corso Spagna 12 Padova
Country:	Italy
Tel:

Name:	PDH
Organisation:	Ospedale di Padova
Address:	via Giustiniani 2 Padova
Country:	Italy
Tel:

Name:	Medicom
Organisation:	Medicom
Address:	Kanslerinkatu 8 Tampere
Country:	Finland
Tel:

Name:	HEL
Organisation:	Helsinki Uninersity Hospital
Address:	Haartmaninkatu 4 Helsinki
Country:	Finland
Tel:

Name:	Sogess
Organisation:	Sogess
Address:	via De Amicis 53 Milano
Country:	Italy
Tel:



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T-IDDM

Telematic management of insulin dependent diabetes mellitus