Health 4.0

Prof. Dr. O.Ferrer-Roca

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PREVISIONESCon respecto a 2011, el gasto en TI de los países de la Europa Occidental se espera que

alcance los 12.240 millones de dólares, de los que 523 serían españoles (unos 390 millones de euros, dependiendo del cambio).

Por contra :• Gran Bretaña se iría a 4.130 m$, • Francia a 2.203 m$, • Alemania a 2.099 m$, • Italia a 767 m$ y • Holanda 543 m$.

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1. Las agendas de los Departamentos TIC vendrán fuertemente impactadas por las reformas disruptivas de las organizaciones a las que prestan sus servicios (ahorros, racionalización de infraestructuras, monitorización..)

2. Habrá un importante auge de despliegues de Cloud Privados

3. Atención Primaria será el campo más atractivo para despliegue de Cloud para la historia clínica electrónica

4. La revolución 2.0 disipará la m-Salud (uso de dispositivos móviles para soluciones sanitarias)

5. Los sistemas de Historia Personal de Salud integrados promoverán la atención y monitorización a domicilio en lugar de residencias sanitarias. Habrá foco en políticas de promoción de la salud y de gestión de crónicos.

6. La receta electrónica se generalizará.

7. La colaboración de diferentes actores en el ciclo de gestión de la salud implicará inversiones importantes en diversas áreas de seguridad y cumplimiento de normativas.

8. Fuerte impulso de los sistemas de Inteligencia de Negocio para acercarse a una inteligencia clínica casi en tiempo real.

9. Se generalizará la virtualización del puesto de trabajo en el punto de cuidado al paciente para agilizar el proceso clínico.

10. El crecimiento desbordado de los datos clínicos, en especial los multimedia, exigirán nuevas arquitecturas orientadas a este nuevo paradigma, más abiertas y neutrales con respecto a los fabricantes.

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Discriminación Sanitaria

RACIAL SEXUAL EDAD DISCAPACIDAD

ESTETICA IDEOLOGIA-RELIGIO

Faltaría incluir la discriminaciónSanitaria, según la comunidad Autónoma en la que viva

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Health 2.0 Health 3.0 Health 4.0

2011(c)CATAI - iPhone in Telemedicine

Prof. Dr. O. Ferrer -Roca 2010

HEALTH 4.0 (Ferrer-Roca 2010)

OFR2010 6

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TABLETAS MEDICAS

• Ya estan aquí.

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IPS- Inter plane switchingName IPS S-IPS AS-IPS IPS-Pro

Year 1996 1998 2002 2004

Main advance Wide viewing angle

Colour shift free

High transmittance

High contrast ratio

Transmittance 100 100 130 156

Contrast Ratio 100 137 250 313

Plane View of Electrode Structure and LC Molecules

Enlarged front view of a pixel

http://www.pctechguide.com/43FlatPanels_In-Plane_Switching.htm

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Ordenadores transparentes

pantalla OLED realmente transparentes en un 38%

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iPhone sensors.

Proximity sensor – This sensor can determine how close the iPhone is to your face. This sensor is what helps the iPhone turn off its screen automatically whenever you hold the phone up to your ear. This is necessary to prevent accidental button clicks by the side of your head when talking. Motion sensor/accelerometer – This sensor enables the iPhone’s screen to automatically switch from landscape to portrait modes and back again based on whether you’re holding the phone up and down or sideways. This sensor is also present in the iPad.

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iPhone SensorsAmbient Light sensor – This sensor can determine how much light is available in the area surrounding the iPhone and iPad and automatically adjust the brightness of the screen in order to conserve battery life.

Moisture sensor - The iPhone also contains a fourth sensor, though this one isn’t related to the interface. The water sensor is a little red tab that appears in the dock connector when the phone has been submerged in water. It can also appear as a red dot in the headphone jack.

iPhone 4 GyroscopeThe iPhone 4 adds another sensor: a three-axis gyroscope. When combining the gyroscope with the accelerometer, this gives the iPhone 4 six axes on which the it can operate. This is designed to make the iPhone 4 more sensitive, responsive, and powerful for gaming.

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NFCWith rumors suggesting that Apple may add near field communication (NFC) capabilities to the 5G-iPhone to enable mobile payments, observers have been looking for additional signs of the such an addition.

According to Phone Scoop, Deutsche Telekom today gave a presentation at Mobile World Congress in Barcelona outlining its adoption of NFC technology for mobile payments, and during the course of the presentation noted that it expects an NFC-enabled device from Apple to debut sometime this year.

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Aprobación FDAhttp://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHInnovation/ucm242067.htm

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CE-Label

Advances in Telemedicine: Technologies, Enabling Factors and Scenarios,Book edited by: Georgi Graschew,ISBN: 978-953-307-159-6, Publisher: InTech, Publishing date: March 2011

Chapter 12: Quality control in Telemedicine. “CE-Label”. Prof.Dr.O.Ferrer-Roca

http://www.intechopen.com/articles/show/title/quality-control-in-telemedicine-ce-label

Type I- NON INVASIVE PRODUCTS . These comprise allPSANI-Producto Sanitario Activo No Invasivo

INVASIVE PRODUCTS FOR A SHORT PERIOD OF TIME (less than 60 min) and those in natural orifices.

Type II-ALL INVASIVE PRODUCTS, including the PSA-Productos Sanitarios Activos.

IIa- MDs USED for A LIMITED PERIOD OF TIME (up to 30 days).IIb- MDs USED FOR LONG PERIODS OF TIME (more than 30 days).

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2000: Sonda veterinaria

IMÁGENES 8 BITS- 256 niveles gris

IMÁGENES MÉDICASUS-images

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2007: ACUSON Siemens

FDA,CE Mark, MD-License Health Canada.

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Signostics 2009Diagnóstico inicial en procesos intrabdominales, como embarazos ectópicos, aneurismas de la aorta abdominal, evaluaciones carotídeas en la sala de Urgencias de pacientes con episodios transitorios de isquemia, y también para asistir en la colocación de una vía arterial. Por ahora el sistema carece de Doppler para estudios de flujo.

Incremente el número de procedimientos y aplicaciones que pueda realizar con los transductores de 3.5MHz ó de 7.5MHz. El cambio de una frecuencia a otra se facilite mediante el uso de transductores enroscables y desenroscables.

FDA,CE Mark, MD-License Health Canada.

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2009: VSCANFDA,CE Mark, MD-License Health Canada.

6000€

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VSCAN

OFR2010 19

• 400 gr peso• Doppler color• 2D• 60 min

Enero-2010 – Se testea en 3 hospitales UE: Francia, Alemania y el Hospital Clínico de Madrid. En Madrid hay 4 unidades: 2 Hospital Clínico y 2 centros de atención primaria. El objetivo: utilizar el ecógrafo como sistema de screening e identificar pacientes que requieren un examen más exhaustivo.

Validation: 12 leading clinical sites throughout the world to help determine how the technology will impact patient workflow and focused exams in primary care, critical care and the cardiology practices. The ultimate goal is to develop a structural protocol for Vscan exams.

TM off line usando equipo sobremesa

Sonda fija Grabación voz Estación USB

FDA,CE Mark, MD-License Health Canada.

PoC imaging

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2009: Washington University in St. Louis

Sonda USB acoplable a los telefonos 3G-4G con Windows mobile. Diseño y la operabilidad de la sonda desde consumo electrico a velocidad transmision como el algoritmo de generacion imagenes.

Low-power probe electronics design. He began working on ultrasound system designs 25 years ago, and in that span he has shrunk the electronics from cabinet-sized to a tiny circuit board one inch by three inches.

William D. Richard, Ph.D., WUSTL associate professor of computer science and engineering

David Zar, research associate in computer science and engineering Software open source

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MobiUS from MobisanteFDA 2011

La sonda vale 2000 $, querían comercializarlo a

500 $.

Software MOBILEUS, o lo que es lo mismo MOBILE-US, es decir el control de las sondas de Ultrasonidos-US a través del puerto USB de los moviles en open source. http://sourceforge.net/projects/mobileus/ Ideal para paisas en desarrollo.

FDA,CE Mark, MD-License Health Canada.

Precio actual 10.000 $

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Sondas USB disponibles. Interson CA. PRODUCT PRICE

AB 3.5 MHz Probe   99-5535   * $2,900

AB 5.0 MHz Probe   99-5534* $2,900

VA 7.5 MHz Probe  99-5537 * $3,900

EB 7.5 MHz Probe  99-5921* $3,900

http://www.interson.com/

Sondas Sectoriales

Voltaje aplicado a todos los elementos faseSuperficie plana y pequeñaNo utilizan multiplexaciónNo necesitan circuitería adicional3.5 a 5 MHz

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US-iPhoneInterson Corporation a leading U.S. manufacturer of portable, point-of-care ultrasound imaging probes has had developed a Bespoke version of VNC Pocket Office Pro for the iPad by Parys Technografx Ltd to use alongside there range of ultrasound products.

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Requerimientos• Para recibir los datos:iPad con instalación del Real time remote Ultrasound app en iTunes

•Para transmitir datos:1. PC con una sonda de US instalada.2. Una copia del VNC server instalada ( se recomienda el UltraVNC)

http://www.uvnc.com/download/1082/ (open source).3. Puerto 5900 del router abierto ( redes virtuales).

http://remote.control.goverlan.com/?source=GAW_Img_GRC&gclid=CO_21bPT36cCFQMlfAodSSKk9Q

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http://www.singleclickconnect.com/

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Seguridad militar

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Cabinas inteligentes en avionesMobile TC that delivers electronic charts (an Android app for Honeycomb tablets like the Motorola Xoom is due later this year).

February 2011, the Federal Aviation Administration authorized private jet charter Executive Jet Management to begin using the app as an alternative to paper aeronautical charts.

Qantas subsidiary Jetstar is close to using iPads as in-flight entertainment units on selected Airbus A320 and A330 aircraft

An iPad application for the wireless control of cabin management systems(CMSs) is available for aircraft equipped with an approved Wi-Fi source.

FAA.

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STARR- COW-VOW

COW = Computer on wheels Global stroke interface

21 Enero 2010: El primer hospital en tener una COW (Computer on Wheel) esta en Barcelona en el hospital de Vall d´Hebron y utiliza el RP-7 de IntouchHealth, que en España esta distribuido por Palex Medical. Mide 1,65 m., pesa 100 Kg. , es capaz de girar 360º, cuesta 160000 euros y ya hablamos de él en entradas anteriores sobre robots quirúrgicos.http://www.palexmedical.com/es/index.cfm

http://catai.net/blog/2010/01/la-primera-cow-en-vall-d%c2%b4hebron/

FDA,CE Mark, MD-License Health Canada.

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Zero footprint viewer -TelestreamingThe total market for medical applications on mobile devices is expected to total $80 million in 2010, with exponential growth anticipated in the next several years.

•The FDA approved the first diagnostic radiology application in February 2011 and• Research teams at major hospitals worldwide are already testing iPhones and iPads for preliminary diagnosis of selected studies. • Hospitals are also starting to use mobile devices to provide patient images and information to referring physicians.

A zero footprint viewer enables physicians to review patient images and reports from a mobile device while moving within a hospital or their practice.

FDA,CE Mark, MD-License Health Canada.

As hospitals tested the use of mobile devices for imaging applications, the major problem reported was not image quality or security concerns—it was extremely slow download speeds.

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BASIS OF zero footprint viewer

The benefits of VirtualViewer® Page on Demand™ provides a Web-Based Viewer that can extract single pages so you can forget about waiting for multiple documents to download.

VirtualViewer’s document viewer technology means you view only what you need when you need it. Forget about waiting for large multiple page documents to download and forget about waiting for the native application to open. Page on Demand provides the high-speed document and image viewing you need quickly and without straining network bandwidth.

Enhance colleague collaboration through powerful document and image redaction and annotation functionality.

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OSIRIX http://www.osirixviewer.com/

Requirements:-Access to a DICOM source of images through WiFi network-Works best with OsiriX 3.3.1 desktop software running only on a Mac available for free at www.osirixviewer.com.Limitations:- images are limited to 1024x1024 pixels, bigger BW images are down-sampled and bigger RGB images are refused.

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OSIRIX MD- Class II MDOsiriX MD is cleared by the FDA, as a Class II Medical Device, for diagnostic imaging in medicine.OsiriX MD is based on the well known open-source project, OsiriX. OsiriX MD is not identical to OsiriX, because of the FDA regulations: each user is registered in our database and have a unique serial number to run OsiriX MD; each modification to the software has to be validated, strictly tested and described; each plugin has to be cleared by the FDA.

These regulations will guarantee to the registered users that OsiriX MD is fully certified for medical imaging, including for primary diagnosis.

http://pixmeo.pixmeo.com/

FDA,CE Mark, MD-License Health Canada.

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OSIRIX-MD

OsiriX MD is the result of more than 5 years of research and development in digital imaging. OsiriX MD fully supports the DICOM standard for an easy integration in your workflow environment. OsiriX MD offers advanced post-processing techniques in 2D and 3D. OsiriX MD offers a complete integration with any PACS, including the well known open-source project, dcm4chee.

OsiriX MD supports 64-bit computing and multithreading for the best performances on the most modern processors. By adopting OsiriX MD, you did the good choice: standards support, simplicity, unlimited power and evolutivity!

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OSIRIX-MD

FDA-Cleared (K101342) - Class II FDA Device - 64-bit - Manual - 499$ USDOsiriX MD is the first FDA-Cleared version, developped, validated and certified by the

OsiriX Team.

Approved for diagnostic imaging in medicine

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Por que la FDA?

H.264/AVC hardware encoder

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CLOUD

Acuo is the latest technology to join the AT&T ForHealthSM portfolio of mHealth, cloud-based, and telehealth products and solutions.

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SmartPHR & HealthVault

2011(c)CATAI - iPhone in Telemedicine

Health Vault or Google Health access, the interoperable HIPAA-compliant SmartPHR automatically pulls clinical summaries and diagnostic images from many sources and pushes information you select to recipients you authorize including your Health Vault and Google Health accounts.

http://www.smartphr.com/

Automatic and manual entries are structured in industry-standard HL7 continuity of care format, cannot be altered or deleted, and identify the source of entry.

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i-BUS // MD-BUS (Cerner)

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Microscopia-Dermatoscopia- Oftalmología

2011(c)CATAI - iPhone in Telemedicine

Microscopios 60x por 18 € DermOscope 8€ + hardware (100€)

Near-Eye tool

MERCADO NO HA ESTABILIZADO LOS PRECIOS!!

http://www.mobile.brando.com/iphone-4-microscope-with-white-2-led-and-note-detector-led_p05863c0921d092.html

ISO 10940:1998, Ophthalmic instruments -- Fundus cameras

4M: Microscopios Multi-Modales Miniaturizados

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Handyscope – 5x & 20x

Data are kept in the encrypted application and can be password protected. Also email transfer supports SSL allowing to send secure data

11,99€

590.00 €

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EyeRoute Image Management System

retCam shuttle

http://www.youtube.com/watch?v=uOnoLWm-zJg

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PathXchange

With over 8600 members from 168 countries and hosting over 2000 pathology cases, PathXchange is the largest online pathology community

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Interpath v1.3

179 $

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eDNI en el movil

THANK YOU

Y mañana su información genética y medica…….Sin olvidar la biopsia y la pMedicina.