World Academy of Science, Engineering and Technology 23 2006

TELMES - Regional Medical Telecenters

Sorin Pucoci, Hariton Costin, Cristian Rotariu, Bogdan Dionisie, and Forin erbanescu

available in Romania.
This paper presents the concept, structure of a pilot model
for a regional medical telecenters network, based on TELMES
platform, for the implementation of complex medical
teleservices applications for GPs and patients. This TELMES
network also includes the capability for transmission and
acquisition of medical records and remotely updating the
medical regional database developed within the project.

AbstractIn Romania, the diversification of telecommunication

networks and advances in communications technologies, including
the Internet, has considerable potential as a medium for telemedicine
applications. In this context, The National Communication Research
Institute INSCC develops a Romanian telemedicine project,
Multimedia platform for Complex medical teleservices
implementation TELMES. The main propose of this project is to
implement scalable medical telecenters networks, based on the new
ITC technologies available in Romania. This paper presents the
concept, structure for a pilot model of a regional medical telecenters
network, based on TELMES platform, and consisting from a enabling
to implement applications from the complex medical teleservices
category for GPs and patients. The TELMES network also includes
the capability for transmission and acquisition of medical records
and remotely updating the medical regional database developed
within the project. Therefore, the regional telecenters will be a
support for the developing of a regional medical database, that
should serve for a complex range of teleservices such as
teleradiology,
telepathology,
teleconsulting,
telediagnosis,
telemonitoring and it should also be a center for continuous training
tasks, by telelearning
for medical personal or for
informing/educating of patients.

II. CONCEPT
The TELMES project proposes to develop a pilot
multimedia network, with integrated teleservices for the
medical area, using the most recent IT&C technologies.
These teleservices should help optimize the medical
decisions to increasing of quality, with the decreasing of
costs for the medical act, and also the expanding of the
services range in the healthcare, by introducing medical
teleservices.
A telemedicine system can be divided into three
different components:
People - Telehealth Users & Providers at remote
and main location(s): health care providers, patients,
communities, researchers and health administrators.
Telehealth Application Technology at remote and
main location(s): hardware, software and peripheral devices.
Telecommunications and Network Links between
remote and main location(s): plain old telephone systems,
dial-up digital telephone lines, asynchronous transfer
modes, Internet and virtual private networks.
The proposed project enables to design a secure
multimedia transmission (medical telemetry, digital images,
video, and text) and a secure medical records acquisition
system in order to enhance the telemedical consultancy
services. The main objective of this project is to enable
personalized teleservices delivery and patient safety
enhancement based on an earlier diagnosis with medical
telemetry using and images, video, text transmissions, and also
applying the suitable treatment according to the remote
medical experts recommendations.
The TELMES project
intends to enable a diverse medical staff to provide complex
medical teleservices; this could be done due to a regional
telecenters network.
Therefore the complex medical
teleservices could enroll for the positive trend in Romania, for
using the ITC technologies in the field of the public services
(e-commerce, e-government, e-health, etc.).

KeywordsTelemedicine, teleservices, multimedia, medical

record, telelearning, medical telecenter, medical database.

I. INTRODUCTION

ELEMEDICINE the use of electronic information and

communications technologies to provide and support
health care when distance separates the participants, has
significantly impacted the delivery of health care services.
Telemedicine is part of the expanding use of communications
technology in health care being used in prevention, disease
management, home health care, long-term care, emergency
medicine, and other applications. In Romania, the
diversification of telecommunication networks and advances
in communications technologies, including the Internet, has
considerable potential as a medium for telemedicine
applications.
In this context, National Communication
Research Institute INSCC develops a Romanian
telemedicine project, Multimedia platform for Complex
medical teleservices implementation TELMES. The main
propose of this project is to implement a scalable medical
telecenters networks, based on new ITC technologies that are
Sorin Puscoci is with the National Communications Research Institute,
Bucharest Romania (e-mail: sorp@gmail.com ).
Hariton Costin, Crsitian Rotariu and Bogdan Dionisie are with the
University of Medicine and Pharmacy "GR. T. POPA IASI" Faculty of
Medicine, Faculty of Bioengineering - UMF IASI, Romania (e-mail:
hcostin@gmail.com).
Florin Serbanescu is with the Quickweb Info company, Bucharest, Romania
(e-mail: florin.serbanescu@quickweb.ro).

A. Main Objectives
The TELMES project has the following main objectives:
To develop a scalable medical telecenters network, in
order to provide the complex telemedicine services;

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World Academy of Science, Engineering and Technology 23 2006

Hosting a central server to ensure the telecenters access to

the network;
Hosting the central database;
Hosting software applications used for network
management services;
Ensures the connectivity between regional telecenters,
within the TELMES network.

To give solutions to organize, exploit and manage a

regional telecenter together with the related teleservices;
To organize a network access and network management
solutions for medical teleservices;
To implement solutions providing the information
security in the teleservices network;
To develop a secure multimedia system for the acquisition
of the medical records in order to implement the medical
databases, at the county level;
To develop specialized software applications for medical
teleapplications and for continuous training dedicated to the
medical personnel and educational programs for patients
target groups.

c) Medical data base

Medical database represents a well defined data structure
for defining and managing all system dates. For each region
we define a regional database that will contain all patients
and doctors that resides inside that region. On a higher level
we define a central database that will manage all regional
information.
TELMES database use standard SQL for managing data.
Because one of the main system architecture is to define a
database independent layer we are able to interact with
different database systems that support standard SQL
language.
Current implementation supports MySQL,
Posgress, MS SQL database systems.
TELMES database contains the following main information
categories:

III. TELMES NETWORK STRUCTURE (DIAGRAM)

The TELMES network consists of a lot of medical
telecenters connected within a multimedia platform, enabling
to implement some applications from the complex medical
teleservices category.
At this moment were developing a pilot network with two
regional telecenters, located in two Cities in Romania - Pitesti
and Iasi, Fig. 1.

1) Doctors related data

Regional Medical Telecenter gathers family doctors and
specialists that belong to the local medical institutions.
The database will define and manage the following main
data structures:
Medical institutes dates that contains general information
and services provided
Assurance institutes dates that manages assurances types
and sources that interacts with hospitals
Family doctors information like contact dates, medical
identification dates, relationships with assurance and
medical institutes
Specialists that belongs to a medical institution or to the
regional telecenter

Fig. 1 The TELEMS platform concept

The TELMES network has the following main component

parts:

2) Patients related data

Each patient will be registered in the regional database
according to their home address. The main structures Handled
contain:
Patient data that contains main contact and personal dates
General medical data
Patient relationships with doctors, medical institutions
and assurance companies
Entire medical history of the patient that include:
Medical procedures and results
A complete imagistic database of the patient
Observation forms from the hospital treatments
Diagnostic history

a) Medical telecenters
A medical telecenter there is an entity with the following
functions:
Hosting a local server to assure the users access to the
network;
Hosting the medical regional database;
Hosting software applications used for telemedical
services;
Hosting
software
applications
used
for
information/training services;
Has implemented applications to ensure the security of
personal user information;
Ensures the connectivity with other regional telecenters,
within the TELMES network.

3) Teleconsulting
A family doctor that will perform a teleconsult will be able
to register all information inside patient records. Also a
diagnostic or treatment can be established so that the patient
will be sent to other medical institutions that will have access

b) Network management center

A network management center represents an entity with the
following functions:

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World Academy of Science, Engineering and Technology 23 2006

to the teleconsult data. Therefore TELMES database contains

data structures related to:
Teleconsult procedure
Teleconsult diagnostic
4) Telemonitoring
A telemonitoring application, from pacient, collect
biological parameters, resulted from measurements with
specialized medical devices, and transmits them through a
telemonitoring network to a distant server. The data base
dedicated for telemonitoring services has these medical data
transpose in a form requested by the doctor in order to be
analyzed through a specialized application.

On-line teleconsultation is a type of remote

consultation
involving
real
time
network
communication systems: video, chat, ICQ etc. This
type of teleconsultation is used for emergency
(urgent) medical care.

In routine medical practice these techniques can be

combined: an off-line teleconsultation may be expanded
through real time dialogue between the consulting and
inquiring physicians through the chat or video conferencing;
a real time video conference may be preceded by exchange of
medical information through email and so on.

5) Medical procedures
TELMES database contains the standard set of medical
procedures as stated in International Classification of
Diseases and Health Problems CIM-10-MA) used both in
public and private health institutions.
Beside data
management, a regional and national database has the
responsibility of defining and managing:
Access rights. Users of the system have restricted access
in order to assure data confidentiality of the patient.
Data integrity and security. Health services provided
contains several confidential information.

Database security represents one of the base security levels

that have to be provided to the entire system.

IV. APPLICATIONS
From user point of view, TELMES project is addressing
especially to the segment of generalist medicines in order to
allow:
Access to the qualified information, by direct cooperation
with specialized medicines;
Efficient management of the chronic ills;
Covering the rural and remote areas.
We are considering that making of such tool available for
the GP or for a doctor placed in a rural environment covering
a large area, allowing him to call for a group of experts by
means of a telecenter, and without need to move the patients,
sometimes on hundreds of kilometers away, is a real gain for
the medical practice in this field.
Further, we present applications that were experienced still
now:

Teleconsultation service can be used for:

determination (confirmation) of diagnosis;
determination (confirmation) of treatment;
determination of diagnosis and treatment of rare,
severe diseases or diseases with a non-typical
course;
determination of complication prevention methods;
lack of immediate specialists in the necessary or
adjacent medical field or lack of sufficient experience
for diagnosis or treatment of the disease;
the patient doubting diagnosis, treatment and its
results, complaint analysis;
decrease of diagnostics and treatment cost without
impairment of quality and efficiency;
search and selection of medical establishment most
suitable for urgent and planned treatment of the
patient, coordination of terms and conditions of
hospitalization;
medical care for patients located at considerable
distance from medical centers, when geographical
distance between the patient and health-care provider
cannot be overcome.
search for alternative solutions for clinical tasks;
obtaining of additional knowledge and skills
concerning a given medical problem.

B. Telemonitoring Services
Telemonitoring service represents a set of activities
necessary for planning and deployment of medical
telemonitoring
applications.
Medical
telemonitoring
application represents the transposition of distance medical
monitoring activities, through a dedicated communication
network. Telemonitoring system must comply with the
interoperability principle: anytime, anywhere, by anyone
which is authorized and in any manner.
Within a TELMES platform we develop two telemonitoring
models.

A. Teleconsultation Services
Teleconsultation - remote discussion of the concrete
clinical case for the answer to precisely formulated questions
for the help in acceptance of the clinical decision.
We want to introduce two types teleconsultation: off-line
and on-line.
Off-line teleconsultation comprise a type of remote
consultations not involving real time network
communication (video, chat etc.). Consulting and
inquiring physicians exchange information via email,
FTP-servers, Internet forums. This type of
teleconsultation is used for routine medical practice.

a) The family doctor model

Within this model, we enable the GPs (family doctors), to
supervise a lot of chronically patients. GPs have the possibility
to connect to medical regional telemonitoring data base TmDB dedicated for telemonitoring activity, and to get access
to their own patients related information.
The patients will have, at their home, a medical
telemonitoring unit MTmU, that records the data from the
specific medical devices used for measurements, store it in a

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World Academy of Science, Engineering and Technology 23 2006

In this way the patients will not need anymore to own an

MTmU, and will be helped by the medical assistant to perform
the monitoring needed measurements. The GP could access
the database where the measurements results are recorded and
make decisions on the treatment emergencies based on the
gathered data.

local buffer memory and then transmit all the information to

the data base, Fig. 2.
The information stored in the buffer memory is locally
processed, meaning that the values received from the
measurement device are compared with the limit monitoring
values (that were settled by the doctor).

The conditions for running of the service:

The patient who is a chronically ill will not need a
device for medical measurement;
The doctor that performs the telemonitoring is the
family doctor of the patient, running the activity at his
own office, even if patients are, geographical, at
distance in a rural area.
V. CONCLUSION
In this paper was presented the TELMES project that aims
to develop a secure multimedia system designed for medical
consultation teleservices.
The main goal is to build a
complete pilot system that will connect several local
telecenters into a regional telemedicine network. This network
will enable the implementation of complex medical
teleservices (teleconsultation, telemonitoring, homecare,
urgency medicine, etc.) for a broader range of patients and
medical professionals, mainly for family doctors and those
people living in rural or isolated regions. Thus, a multimedia,
scalable network, based on modern IT&C paradigms, will
result. It will gather two inter-connected regional telecenters,
in Iai and Piteti, each of them also allowing local connection
of hospitals, diagnostic and treatment centers, as well as a
local network of family doctors, patients, and even educational
entities. As communications infrastructure, we aim to develop
a combined fix-mobile-internet (broadband) links. As a first
step we implemented and tested teleconsult and telemonitoring
applications.

Fig. 2 The family doctor model

Therefore, the information that is send from the MTmU to

the TmDB contains the patient identification data and also
data regarding the way in which the measured values are not
exceeding the established limits. If the MTmU finds out an
exceeding of the limit that were fixed by the doctor, an alert
signal will be send, as an alert message to the mobile phone of
the GP.
The conditions for running of the service:
The patient who is a chronically ill, is owning a device
for the medical measurement;
The patient has the skills to perform himself the
measurement that are asked by the doctor;
The doctor that performs the telemonitoring is the
family doctor of the patient, running the activity at his
own office.

ACKNOWLEDGEMENT
This work is supported by a grant from the Romanian
Ministry of Education and Research, within CEEX
programmer
(www.mct-excelenta.ro),
contract
No.
26/10.10.2005.

b) The telemonitoring in the rural environment model

Within this model, we enable the GPs (family doctors), to
supervise a lot of chronically patients in rural environment.
GPs have also the possibility to connect to medical regional
telemonitoring data base TmDB.
In this approach a medical assistant responsible for a certain
rural area, has a dedicated telemedical kit - MTmK, Fig.3, to
perform medical measurements and to capture the data from
the specific medical devices. MTmK will store the data in a
local buffer memory and is capable of sending the data
collected from all patients to the regional TmDB.

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