Case Study: Lucerne Cantonal Hospital

Evolutionary processing optimisation using the Cybermedical Community

Today, the Lucerne Cantonal Hospital (LUKS) is the largest non-university hospital in Switzerland. The LUKS includes the central hospital in Lucerne, the two primary health care hospitals of Sursee and Wolhusen, and the Alpine Clinic Montana. But it was not always like this. The fusion of the central hospital with the primary care hospitals took place only a few years ago, with the aim of guaranteeing optimal medical care for the population of the Canton of Lucerne.
However, the distribution of the medical services over several locations also brought with it new challenges for optimal coordination. So it was necessary for the key specialists to repeatedly commute between the locations for the required reports, which led to considerable time and financial expenditures. The same was true when it came to the question of mutual training of the medical staff.

Deciding for the Cybermedical Community brings us the optimal benefit of communication in the hospital group and our future collaboration strategy with external partners.

Dr. Peter Steinmann Manager of Informatics Lucerne Cantonal Hospital At the Gastspital (Guest Hospital) Symposium 23 September 2009

Therefore, the task was to reduce these transfer times and despite this ensure the optimal coordination of the information and know-how processes. For that reason, an in depth look was taken at the topics video conference telemedicine, the hospital community and Swisshealth Collaboration. During the discussions it was decided that the Lucerne Cantonal Hospital would take on a pioneering role in the Central Switzerland hospital network. The aim of this favourite role was to find a solution that not only embraces the current needs of the Lucerne Cantonal Hospital, but would also enable in the future an optimal expansion for the support of collaboration. This resulted in requirements that fulfil important services such as:

Characteristics PC, MAC or mobile devices Full HD Videochat (1080p) Dicom image resolution 2048 Bit encoding No data transfer without deliberate intervention Easy to use (intuitive use) Low bandwidth requirement below 1 MBit Easy integration into the established ITenvironment Ad hoc communication (guest access)

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Optimal organisation of communication Optimal, fast and effective collaboration Easy integration into the established hospital systems Easy operation by the user Greatest possible flexibility regarding access Simple networking of the hospitals Simple to expand (integration of new services) Use of standard HW-equipment Communication with legacy devices These and other key points induced the Lucerne Cantonal Hospital to check the possibilities presented by the products available on the market. After numerous demos and visits to manufacturers, in April 2009 for this purpose the Lucerne Cantonal Hospital issued a tender for a trial installation, which was sent to all the large providers in the video conference market. This was meant to ensure that all the relevant points in the specification sheet were fulfilled. Just how important the topic was for Lucerne Cantonal Hospital was demonstrated in the one-month test phase, during which all the points were checked. Cybermedical fulfilled not only all the requirements, but it also became apparent that the points in the tender were only a minimal part of the efficiency that Cybermedical could actually achieve.
The Cybermedical Community offers fast and the most comprehensive support during process optimisation:

A B C

Relationships between the parties involved can be established in a straightforward manner. The direct dialogue enables the rapid recognition that there are differing interpretations of the same facts. The visual relationship establishes trust (mutual trust of service providers among each other and/or to the patient) Direct clarification and treatment of a concrete problem A direct reaction can be given to possibly differing interests within the relationship The combination of telemedical, telemonitoring and video-based services offers a comprehensive service The treatment of a patient can also be supported quickly and competently over large distances, e.g. if the case lies beyond the core competence of the person treating

D E F G

Requirement, integration and implementation

After Cybermedical was successfully awarded the contract in Lucerne Cantonal Hospital, various concepts were discussed. It became apparent that the version Cybermedical Community would be implemented as the clear favourite. Cybermedical Community enabled the hospital to network the four locations Lucerne, Wolhusen, Sursee and Montana in the simplest way possible. In doing so, Montana should be able to perform video conferences in the same quality, using a normal ADSL connection, as the other locations. The outposts Wolhusen and Sursee were connected with each other using the existing LUNET connection. At the main site Lucerne, the central access to the internet has been used. Additionally, Lucerne Cantonal Hospital wanted to have the possibility of performing external and mobile video conferences, be this via UMTS, Home ADSL or PWLAN of a hotspot, while maintaining the internal security policy. The data protection had to be guaranteed at all times. This was ensured using a new encryption technique. These requirements should support the future strategy of LUKS in the optimal care of its patients through close collaboration with regional, national and international partners. To do this, the Cybermedical Community offers the optimal preconditions as an international professional network, because these specialists can be linked very simply using the existing processes and communication, irrespective of where these are.

Cybermedical Community The first international, interdisciplinary medical professional network for specialists, hospitals, physicians and medical institutions The aim of the Community is that hospitals, medical networks, medical institutions, physicians and specialists can exchange medical know-how and information in a simple and protected manner, via voice, video, images and data using a standardised platform.

Open, but secure technology standards - a clear advantage for the "shared value" of a community
In a hospital, the sourcing of new technology is always a question of follow-on costs. Can the new technology be operated with the existing infrastructure or does it require substantial adjustment in the IT architecture and support? Since a community brings with it not only the technical requirements within an organisation, but also those for communication with external partners, it must be easy to integrate the different HW of the respective partner without requiring a huge effort for the adaptation of the technical interfaces.

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This point was a further factor that crystallised out to be a clear advantage of the Cybermedical Community during the trial installation. Because the solution is based on an international standard, it can be used on the already existing computers. Only in special rooms, such as operating theatres, we do recommend powerful computers. Medical data are highly sensitive and must be handled as absolutely confidential. In order to rule out unauthorised access to these data, the clinics placed particular emphasis on security during communication and system access. Cybermedical is technologically constructed in such a way that communication is only possible over two specific ports, without reduction in the quality or performance. With the use of the ports TCP 80 and 443, which moreover must be only open externally, a further killer criteria of the Lucerne Cantonal Hospital tender was fulfilled.

Additionally, however, due to the concept of the Cybermedical Community to only use connections over the Internet, new network protocols had to be established. One of these protocols is H.264. SVC (Scalable Video Coding). This enables us to hold video conferences in very good quality with low band width and with latency of more than 20%. During the classical video conference and the combined viewing of medical images, videos or reports and laboratory values, absolutely no data are "cached" in the receiver PC and, therefore, can also not be saved. Only if hostital systems are connected via a secure middleware integration with the Cybermedical Community, a data transfer can be established. Since the transmission therefore involves "encrypted" privacy-related personal data, it is not possible for an unauthorised third party to obtain access to these data.

The functions in practice

In addition to the technical and organisational criteria, it was already defined before the trial installation that the user should himself evaluate the solution for its functionality and usability. To this end, three live transmissions were organised. A large number of people took part in this, in order to generate an impression of the solution and to visualise the functions in their environment. To generate a meaningful summary, every participant recorded his impressions on an assessment sheet.

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Today LUKS uses the following solution:

For an interdisciplinary report room a version with two monitors (Fig. 1) is generally used. These monitors are at least 42" large, depending on the size of the room. Additionally, this configuration is also used in standard conference rooms. The software is installed on a standard LUKS client PC.

The second version is the client version, which is only installed on the normal LUKS clients. This can be a laptop or a standard work station (Fig.2). What is important is that all the versions are available using the same functions. The user, therefore, only needs to be trained in one system and can then use all the versions. This approach saves the hospital training costs and reduces the support effort. Additionally, it enables the user to use the solution in other infrastructures, as long as theses have access to the internet. As final version is the version presented, which is mainly intended for the operating theatre. The functions and operation are the same, the difference is that several input signals can be used, e.g. direct from the camera or the laparoscopy device. To use it in this way it requires an Intel Quadcore computer with 8 GB RAM, to process the wide range of video signals. At this point it is important to note that the computer does not need to be in the OP, but rather can be installed in a separate room outside, as only the video signals are transmitted. Each of the versions has the same functions: Dynamic layout change during the conference Mute switch for camera, microphone and speaker Content transfer by PACS, CIS etc., images in the original resolution Play video sequences Preview your own camera Select one of various content transfers to other destinations Send an ad hoc invitation per e-mail Display of the status of other users in the hospital, as well as of the external experts, who are connected to the Cybermedical Community platform.

Further information
www.cybermedical.ch www.cyberfish.ch

Cyberfish AG
Due to these and further functions, Lucerne Cantonal Hospital, together with the informatics department and management, decided to use the Cybermedical Community. Last but not least, the moderate costs and the possibility of simple expansion and collaboration with other hospitals, institutes and medical professionals for the exchange of information and know-how, were deciding features.
Schindellegistrasse 71 8808 Pfffikon / Switzerland Telephone +41 55 417 50 00 E-mail info@cyberfish.ch

2012 Cyberfish AG. All rights reserved. Cyberfish and other trademarks used herein are trademarks or registered trademarks of Cyberfish AG or their respective owners. All specifications subject to change without notice, system specifics may vary. The products and services are covered by one or more Swiss and/or foreign issued and/or pending patents.

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