Extending e-health to rural areas : geographical context

1. Extending e-health to rural areasTuxtla, 18-19 May, 2006Alcatel Alenia Space broadband telemedicine solutions

2. Extending e-health to rural areas : geographical context • French initiative in South East of France, Department of les Alpes Maritimes • 4 valleys whose access is very difficult • Landslides, snow in winter are blocking roads • Aging population • Local medical staff isolation

3. Extending e-health to rural areas : objectives Professionals • Maintain general practitioners in mountainous/isolated areas • Maintain qualified staffs in local hospitals • Provide remote assistance / expertise to local staff to treat patients Patients • Accelerate recovery at home or in usual environment • Provide locally new services avoiding travelling to urban hospitals • Reduce hospitalization frequency, transfer and cost • Increase population’s confidence into local teams • Deal with medical but also social aspects • Maintain quality of life

4. Extending e-health to rural areas : set up of a specific program • To achieve the objectives, setting up of a specific program including medical training, teleconsultation & tele-expertise with relevant partners • Strong partnership : • General Council Alpes Maritimes • telemedicine local development, • contractual matters and funding, • planning, communication • Nice Faculty of Medicine • provides medical expertise, specialists coordination, • referents in local hospitals, • training program • Alcatel Alenia Space leader for • satellite technology, telemedicine Workstation and e-health applications, • network installation / configuration / optimisation, • end-users support, technical training • supervision, maintenance

5. Extending e-health to rural areas : Satellite network architecture • A9780 DVB-RCS based satellite network • Hub and applications platform hosted at Alcatel Alenia Space France premises and managed by AASF technical team • 12 sites : 8 local hospitals (isolated area) and 4 Hospitals in Nice (urban area)

6. Extending e-health to rural areas : DVB-RCS technology • Two ways satellite broadband technology. Ground network independency (2W architecture) of the DVB-RCS satellite solution enables customers currently suffering of the lack of terrestrial broadband networks, to access value added services • DVB-RCS standard compliant : mature and fully operational technology implementing DVB-S norm (DVS-S2 ready) on the forward link & offering powerful capabilities (up to 2 Mbps return) on the return link to access and transmit over satellite from anywhere. • DVB-RCS system ensures interoperability with heterogeneous network like terrestrial, mobile, wireless and secures customer investments in infrastructure • It supports current and upcoming IP services , providing network functionality to support new generation of interactive and multimedia applications (high quality video based applications)

7. Extending e-health to rural areas : SIT installation • Ease of installation of the DVB-RCS satellite terminal allows fast installation of a new site and its integration into the overall network. • Ground, wall, roof • Vehicle • Container

8. Extending e-health to rural areas : DVB-RCS technology & telemedicine requirements • 2W design & High Rate on return link (medical training, teleconsultation, tele-expertise/telediagnosis) • High quality video transmission from teacher/specialist side (H264) • Asymmetric/Symmetric traffic • Applications interactivity (videoconference, questions/answers) • Very high image quality transmission • QoS mechanisms (medical training, teleconsultation, tele-expertise /telediagnosis) • Robust audio communication • Guaranteed BW • Multicast (medical training) • Satellite is the best solution (coverage, terrestrial multicast nodes) • Point to multipoint architecture • Videostreaming • Push of contents

9. Extending e-health to rural areas : Medical training • Doctors, nurses, auxiliary nurses, pharmacists • 3 hours sessions (1-2 per months) • Management of end-of-life care : physical, psychological, social, spiritual, and practical needs of patients and caregivers • Emergency : introduction to the use of a Semi-automatic defibrillator • Geriatrics : disorders of sphincter / swallowing risks and elimination • Gastroenterology : repercussion of non-steroidian anti-inflammatory (NSAI) drugs usage • Proctology : acute pain identification and treatment • Psychiatry, Gynaecology, Endocrinology, Dermatology

10. Extending e-health to rural areas : Medical training DVB-RCS HUB Management tools Security Applications & services Contents Presentation DVB-RCS Remote SIT End user WS • Each participant connects to the Alcatel Alenia Space broadband medical training application • Return : 256kbps remote participants/512kbps teacher

11. Unlimited number of participants Meeting room with several participants and video-projector and wall screen Remote pointer session recording for further use Extending e-health to rural areas : examples

12. Extending e-health to rural areas : teleconsultation • Nurses, doctors, specialists • Regular ½ hour point to point sessions • Psychiatry : patient with personality or mental disorders, mortality / morbidity related disorders (suicide, injuries from accidents, substance abuse) • Elderly • Nutritional disorders • Kinesytherapy: evaluation, diagnosis, rehabilitation in locomotion • Cognitive disturbances • Orthoepy: speech and swallowing troubles • Dermatological or rheumatologic disorders • Gerontology : Care of scabs, podology and chiropody

13. Extending e-health to rural areas : teleconsultation DVB-RCS HUB Management tools Security Applications & services Telemedicine WS • Each participant connects to the same core application • Patient transfer, local hospital recovery ? • Return : 256-512kbps

14. Extending e-health to rural areas : tele-expertise / telediagnosis • Specialists • ½ hour point to point sessions • Specific tele-expertise application with advanced image processing capabilities • Interconnecting with DICOM compliant modality • Radiology (fractures, angiogram, mammography, ..) • Dermatology (melanoma or dermatitis or pictures/MRI examination, tissue microscopic examination) • Cardiology (prevention, investigation and treatment of diseases involving the cardiovascular system) • Anatomo-pathology

15. SIP Extending e-health to rural areas : tele-expertise / telediagnosis DVB-RCS HUB Management tools Security Applications & services

16. Extending e-health to rural areas : tele-expertise / telediagnosis • DICOM compliant • Acquisition from DICOM modalities • Image manipulation (any manipulation is remotely reproduced) • zoom • contrast, brightness • black & white • magnifying glass • measurements, annotation • window levelling • scrolling • Tele-cursor • Diabetic eye disease examination • Return : 512 kbps • Echography • Return : 1024 kbps

17. Conclusion • Leading position in telemedicine using satcoms • System and solutions integrator, not only a supplier • Take advantage of Alcatel Group competencies for network architecture definition (terrestrial, mobile, satellite, wireless) and integration of end users applications for medical uses • Build robust partnerships for industrial solutions (cost sharing, roadmap) and commercial deployments success (user acceptance) • Design and provide end-to-end solutions for e-Health vertical market (unique interlocutor) • Have got a unique experience in Europe of deploying and exploiting an operational medical training and teleconsultation network • Is the coordinator of the Healthware European project (Aeronautics & Space program – European Commission 2005-08), which is the reference in Europe regarding telemedicine by satellite and the driver for the development and the deployment of DVB-RCS based telemedicine applications : http://healthware.alcasat.net

18. Contacts Pascal LOCHELONGUE (technical manager) Pascal.lochelongue@alcatelaleniaspace.com Olivier AUTRAN (marketing manager) Olivier.autran@alcatelaleniaspace.com Pierre LEON (local marketing manager) Pierre.leon@alcatel.com