The NEST network in Germany brings together over 28 participants from across the healthcare sector to improve healthcare through telemedicine. It develops new treatment approaches, products, and services through joint projects. Examples include the StrokeNet telestroke system and a telemedical care system for use on aircraft and ships. The network also explores challenges of an aging population through ambient assisted living projects involving home monitoring and care. Success depends on innovative partnerships, neutral management, identifying solvable healthcare problems, and involving users.

1. FROM IDEAS TO STATE OF THE ART
PROJECTS. THE GERMAN
TELEMEDICAL NETWORK NEST
June 17th 2009
Santander
Mr. Ywes Israel, M.A.
III Meeting on eHealth and Telemedicine

2. Agenda
 Introduction NEST
 Joint Projects
 StrokeNet
 Tele Care System (TCS)
 The new Challenge - Examples
III Meeting on eHealth and Telemedicine

3. Networks in Germany
 In Germany many company-networks with different focuses
(as for example on security issues or medical applications)
exist.
 Also the German Government supports enterprises in
forming networks. While some networks develop innovative
products/ services or international co-operations others fall
apart very quickly.
 Purpose of this presentation is to show promising factors,
based on the example of NEST.
III Meeting on eHealth and Telemedicine

4. Network for integrated
Systems in Telemedicine
 Why in Berlin-Brandenburg?
 widely acknowledged research and science community
 High concentration of hospitals, clinics, and medical
research and care facilities
 the region is recognized as a centre of innovation in
health care
 International health projects and patients
NEST pools the available resources in the field of telemedicine
and taps the full potential.
III Meeting on eHealth and Telemedicine

5. Health City Berlin
 67 Hospitals
 17.700 Physicians  Fields of Specialization
 3.700 Dentists
 180.000 people working in  German Heart Center Berlin
the health industry  First Laser Hospital
 50.000 employees in science  First completely digitalized
and research
Hospital
 22 pharmaceutical
businesses  First Clinic for minimal
 150 Medical-engineering invasive surgery
enterprises  Institute for Proton-therapy
 160 Biotechnology firms  First Neuro-imaging Center
 70 Independent Research  http://www.gesundheitsstadt
institutions -berlin.de/
 4 Universities
 7 technical colleges
III Meeting on eHealth and Telemedicine

6. Telemedicine in Berlin
 Berlin offers a huge range of hospitals, research institutions
as well as companies in the health care sector
 One of them: NEST- Network for integrated Systems in
Telemedicine
 NEST involves more than 20 participants from all
healthcare-domains, i.e. hospital operators and service
providers, universities and research institutions, small and
medium sized companies with special focus on IT solutions
for the healthcare sector
 Driven by hospital and medical needs
III Meeting on eHealth and Telemedicine

7. Network for integrated
Systems in Telemedicine
 founded in 2005, supported by Federal Government
 NEST involves more than 28 participants from all
healthcare-domains,
 i.e. hospital operators and service providers, universities and
research
 institutions, small and medium sized companies with focus
on IT solutions for healthcare and on medical technology
from Germany
 Common objective: improving healthcare through
telemedicine, by developing new treatment paths, products
and services
III Meeting on eHealth and Telemedicine

8. NEST bundles
competencies in
 Virtual microscopy, Telemonitoring, object tracking, blood
pressure measuring tools, patient records, anonymisation
and pseudonymisation, middleware, modular clinical paths,
support for clinical trials, efficient documentation
procedures,
 research on knowledge based systems, semantic web,
functional telemedical standards
 Healthcare service for international patients
 NEST aims to support the network partners in developing
and marketing products, systems and methods in the area
of “eHealth / telemedicine”.
III Meeting on eHealth and Telemedicine

9. NEST Partner
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10. NEST Partner
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11. Management by
TimeKontor AG
TimeKontor is working as a business enabler.
 established between politics, economy and science
 activities focused on areas, where ICT play a key role,
 expertise in IT security, eHealth, and Serious Games
 within the network management TimeKontor supports in
 Identification of business opportunities
 Initiating and accompanying innovative projects and
cooperation and its financing
 Knowledge transfer (organization of international
workshops and conferences)
III Meeting on eHealth and Telemedicine

12. NEST at international
Events
 Arab Health 2006
 Zdravoochranenije 2006
 Arab Health 2007
 II International Moscow Conference on
Information and Telemedical
Technologies in Healthcare 2007
 Zdravoochranenije 2007
 Arab Health 2008
 Hospimedica India 2008
 RomMEDICA 2008
 2-nd International Conference on
Telemedicine: Myths and Reality
 Partnering Day in Tel Aviv and
Jerusalem 2008
III Meeting on eHealth and Telemedicine

13. International Cooperation
 Cooperation with international partners
 Cooperation with APAN –
Japanese telemedicine association
(September 2007)
 Scientific Exchange between the Medical
State University in Moscow and the ALS
Ambulance in Berlin on Amyotrophic Lateral
Sclerosis (April 2008)
 Cooperation with Ukrainian Telemedical
Association
 Cooperation with Aserbaidschan &
Kazakhstan
III Meeting on eHealth and Telemedicine

14. Agenda
 Introduction NEST
 Joint Projects
 StrokeNet
 Tele Care System (TCS)
 The new Challenge - Examples
III Meeting on eHealth and Telemedicine

15. NEST- network
 Driven by hospitals and their medical needs
 Focus of NEST:
 enabling partners to tackle new joint projects
 developing and marketing innovative products and
convenience solutions
 Topics within the network:
 Interfaces (TM7)
 Symptom related projects (ALS-Manager)
 Disease related projects (StrokeNet)
 TimeKontor- network management
 eHealth and security
III Meeting on eHealth and Telemedicine

16. Joint Projects
 TM7- Development of a standard for telemedicine
 which combines the ease of existing standards (Dicom,
HL7) with the excellence, precision and functionality of
proprietary solutions from its partners
 TM7 will be used for transmission of (picture, sound) data,
communication of devices as well as for tele- controlling of
medical equipment
III Meeting on eHealth and Telemedicine

17. Joint Projects (1)
 ALS Manager
 Development and establishment of an internet platform
for patients with ALS (Amyotrophic Lateral Scleroses)
and their caregivers
 for more efficient clinical studies and a qualitative
 improvement of patient provision
III Meeting on eHealth and Telemedicine

18. Agenda
 Introduction NEST
 Joint Projects
 StrokeNet
 Tele Care System (TCS)
 The new Challenge - Examples
III Meeting on eHealth and Telemedicine

19. Joint Projects (2)
 StrokeNet
 Development of a telemedicine system for Ambulances
 transmitting monitoring and vitality functions, picture and
sound between mobile intensive care units and a
specialised stroke unit
 use expertise of stroke specialists for the immediate
treatment
 Patients and their caregivers benefit from reduced
assistance requirements and shorter rehabilitation
periods
III Meeting on eHealth and Telemedicine

20. StrokeNet - in brief
 telemedical system in ambulances, stroke
units and cooperating hospitals for stroke-
treatment
 2-year R&D-project: nov. 05 bis oct. 07
 area of application: Berlin
 Aim: Use of mobile communication
infrastructure to improve the preparation of
stroke-treatment
III Meeting on eHealth and Telemedicine

21. Stroke - the problems
 patient at an inappropriate hospital
●
no bed available
●
no Stroke Unit
●
no thrombolytic therapy
●
no interventioanl therapy
●
no neurosurgical department
frequent hospital transfers
 time-delays pre-/ intrahospital
●
many departments have to be informed and involved
III Meeting on eHealth and Telemedicine

22. Stroke - the NINDS*
recommendations
(1) Neurological consultation 10 min
(2) ECG, temperature, blood glucose, blood pressure
20 min
• CCT 25 min
• CT-interpretation 45 min
• time taken to arrive at Stroke Unit 60 min
(-> 80% success rate)
 Time is Brain
 Reducing Time-to-needle
* TheNa na
tio l Instituteo Ne lo ic l Dis rd rsa Stro
n uro g a o e nd ke
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23. Stroke - the bottleneck
'Imaging'
80
70
60
50
[min]
40
2003
30
2004
20
target
10
0
neurolog t
is cT
C StrokeUnit
III Meeting on eHealth and Telemedicine

24. StrokeNet - project
•emergency call
•Patient comes to the next appropriate hospital
•Medical stuff/ patient has early support by a (stroke –
experienced) neurologist
•StrokeUnit neurologist ...
●
is informed about the patient in advance
(time, syndrome)
●
can schedule further treatment (info to: ward, radiologie)
●
support treatment within ambulance
III Meeting on eHealth and Telemedicine

25. StrokeNet - project
technical approach
mobile arm
ambulance
Telemedical Center
stationary arm
StrokeUnits
co-operating hospitals
(with of without SU)
III Meeting on eHealth and Telemedicine

26. Agenda
 Introduction NEST
 Joint Projects
 StrokeNet
 Tele Care System (TCS)
 The new Challenge - Examples
III Meeting on eHealth and Telemedicine

27. Joint Developments
 Tele Care System:
 Medical care aboard an aircraft via
satellite or Pico cell, transmitting vital
parameters of the passenger to an
expert on ground
 combined with videoconferencing
between the flight attendant and the
expert,
 thereby enabling the flight attendant to
perform diagnostic and therapeutic
measures
III Meeting on eHealth and Telemedicine

28. In Case of Emergency
 No doctor at patient side
 Helper without emergency experience
 Medical solutions only by “telephone”, no vital data
 No much time to make a right diagnosis
 High potential of secondary damages
 Wrong decision can cause deaths (and cost)
 Interruption of the journey
III Meeting on eHealth and Telemedicine

29. TCS of GHC
 12-lead ECKG, SPO2,
Blood pressure integrated
 Temperature, blood glucose extern
 Defibrillator (1-lead-ECG) integrated
 Videoconferencing, Chatting
 Audio-visual, textual and graphical
instructions
 Medical Help
III Meeting on eHealth and Telemedicine

30. TCS Modules
(1) Main module
(2) Housing
1
(accessories)
2
(3) Diagnostic module
(4) Therapy module
3
4
III Meeting on eHealth and Telemedicine

31. Aviation Market
 Number of passenger is
growing
 200,000 life-threatening
emergencies/year
 About 12 deaths at one
airline/year
 Main cause:
cardiovascular problems
 Cost of diversion:
several 100,000 $
III Meeting on eHealth and Telemedicine

32. TCS Aviation
 Prototype available
 Tested on long-haul flights
 Co-operation with Charité,
Deutsche Lufthansa
 Next pilot utilization
sponsored by the ESA
III Meeting on eHealth and Telemedicine

33. Maritime Market
Profile: Emergency and
Monitoring
 Injury (e.g. fracture)
 Infection/ inflammation
 Cauterization (e.g. chemical
burn)
 Internal medicine (e.g.
cardiovascular disease)
III Meeting on eHealth and Telemedicine

34. TCS Maritime Pilot
Utilization
 Pre-phase for testing
 Prototype available
 Tested on Oil and Container
Tanker
 Testing Trial with Hapag-Lloyd
Shipping Company
III Meeting on eHealth and Telemedicine

35. Agenda
 Introduction NEST
 Joint Projects
 StrokeNet
 Tele Care System (TCS)
 The new Challenge - Examples
III Meeting on eHealth and Telemedicine

36. The new Challenge
demographic change
 more and more people getting older and older
 more time for (aged-based) leisure activities
 longer need for (special) medical care
target
 ambient assisted living
 keeping autonomy
 support at home and on the way
 social services
III Meeting on eHealth and Telemedicine

37. The approach
how can telemedicine support those needs?
 move the data, not the patient / physician
 Home Care
 monitoring of patients
 offering a feeling of security Home Care
 combing telemedicine and local based services
examples for projects in realization
Home Monitoring
Home Care Devices
III Meeting on eHealth and Telemedicine

38. Example 1: pain -
treatment
 implantation of a spinal-catheter
 connection of a mobile device
via Bluetooth
 instant monitoring of analgesic
dosage
 additional information about
state of health and mood of the
patient
 using lbs: in case of emergency,
an ambulance can be send to
the patient wherever he is
III Meeting on eHealth and Telemedicine

39. Example 2: decubitus-
prevention
Bedsore (decubitus)
 affecting ~ 800.000 patients/ p.a.
only in Germany, causing costs ~
2 Bill. Euro/ p.a.
 developing a sensor-mat, which
measures and monitors the self-
mobility of bedridden patients
 target: gaining information on
"perfusion-stimulating" movement
to prevent decubitus
 additional "intelligence" for
wound-management by
integrating a camera
III Meeting on eHealth and Telemedicine

40. Example 3:
peritoneal dialysis
 90.000 patients in with PD,
haemodialysis (HD) or kidney-
transplantation
 focus: aPD at night
 main targets:
 HD>PD to be changed
 telemedical interface:
• getting additional vital
parameter like weight, blood
pressure
• additional A/V-connection
 social aspects of PD
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41. The bigger picture
all 3 projects have a strong relation to other diseases
 diabetes
 hypertension
 stroke
 cardiac insufficiency
 heart attack
III Meeting on eHealth and Telemedicine

42. Success factors
 Find innovative partners, interested in close cooperation
and knowledge transfer
 Find a management institution, that is neutral and
experienced in management of networks
 Identify problems in healthcare, that could be solved trough
telemedicine
 Involve the users in the process: i.e. physicians and
patients
 Look out for partners in other countries and try to initiate
joint projects with them (participate in conferences, fairs,
partnering events)
III Meeting on eHealth and Telemedicine

43. Thank You very much for
Your attention!
Ywes Israel, M.A.
COO
TimeKontor AG T: +49 30 390087-0
NEST Network for integrated Systems in Telemedicine F: +49 30 390087-25
Schönhauser Allee 10 – 11 E: ywes.israel@timekontor.de
10119 Berlin, www.timekontor.de
Germany www.nest-telemedizin.de
III Meeting on eHealth and Telemedicine