Medical Teleconsultation in french guiana a first for France CNES and Cayenne Hospital sign national agreement

Friday 8 June 2001 in Cayenne, French Guiana, GÈrard
Brachet, Director General of CNES (Centre National d’Etudes
Spatiales), and Robert Gutermann, Director of Cayenne Hospital (CHC –
Centre Hospitalier AndrÈe-Rosemon de Cayenne), signed an agreement
concerning a pilot project to set up a satellite-based medical
teleconsultation system for remote areas in French Guiana.

The agreement is the culmination of a joint
demonstration project pursued by CNES and Cayenne Hospital over the last
year to establish the potential benefits of space systems for healthcare
applications in French Guiana.

Telemedicine for remote regions
– a first for France

The agreement sets out the provisions under which
CNES and Cayenne Hospital will cooperate to set up an experimental
medical teleconsultation network in French Guiana. This network will be
built around the satellite-based telemedicine system developed by CNES.

The two partners aim to conduct a six-month pilot
study to validate the clinical, logistical and economic aspects of the
system at four sites typical of the medical and logistics problems
encountered in the more remote areas of French Guiana. To this end,
health centres at Saint-Georges, Trois-Sauts, Maripasoula and
Antecum-Pata will be equipped with a portable telemedicine kit.

This pre-operational, satellite-based civil
telemedicine system is the first of its kind to be deployed in a public
health role in France and on the South American continent.

After validation at the end of the pilot study, the
project will be extended to other remote regions.

Partnership with the medical
profession in French Guiana – one year on

CNES’s Guiana Mission organized a seminar in April
2000 in partnership with socio-professional workers and public health
players in French Guiana on the theme "New technologies for
public health systems: teleassistance, teleconsultation,
tele-epidemiology and telediagnosis."

In October 2000, a teleconsultation demonstration was
organized to evaluate the CNES telemedicine kit, to assess its ability
to meet the needs of the medical profession in French Guiana and to
verify the system’s operational and technical performance in remote
regions of the country.

The project was coordinated within the scope of CNES’
Space and Health action programme, developed through the Space
and Society meetings initiated by the French Ministry of Research and
Technology. The Space and Health programme aims to promote the benefits
of space systems in the healthcare sector.

This theme will also be on the agenda at the yearly
congress of the French hospitals federation in Kourou, French Guiana, in
March 2002.

Press contacts:
CNES/Guiana Space Centre: Marie-FranÁoise Bahloul
– Phone: 0594 33 32 67 – Mobile: 0594 23 09 73

how satellites will benefit Telemedicine

Recent decisions by the French government to
computerize the national health system, the increasing maturity of new
information and communication technologies, and the growth of the
Internet are key factors that will drive development of telemedicine
applications in the years ahead.

Among the unique benefits space-based technologies
can offer telemedicine are:

– anywhere, anytime access to communications
networks;

– cost-effective broadcasting of information;

– global coverage of location and Earth observation
services.

The medical profession has identified three priority
areas where benefits can be expected from satellite-based systems:
teleconsultations in remote regions, teleassistance for high-risk
patients, and tele-epidemiology.

Issues concerning the use of space systems for
telemedicine

The development and implementation of satellite-based
multimedia services involves a number of economic, social and cultural
issues.

From an economic standpoint, we can say that:

– if medicine in the 21^st century is to be
based on prevention, satellite-based approaches must achieve economies
of scale in healthcare spending estimated at between 1.5% and 10% of
national health budgets;

– the impact that new services and careers creating
specialist jobs will have on development is clear, as telemedicine calls
for the organization and distribution of new services, software
developers, telemedicine correspondents and much more besides.

From a social standpoint, satellite-based
telemedicine systems must provide equal access to healthcare for all and
guide planning decisions concerning the retention of operational
structures at local level.

Lastly, from a cultural standpoint, new information
and communication technologies will promote French medical expertise and
help to maintain the sphere of influence of the world’s
French-speaking nations.

The capacity of satellites to provide simultaneous,
wide-area coverage of vast regions, rapid deployment and unrivalled
performance for broadcast services will respond to a vital need: equal
access to care for all. The immediate consequence of this will be to
open up areas poorly served by terrestrial infrastructures due to the
geography of terrain, in the aftermath of natural disasters or as a
result of population influxes.

Consultations in remote regions should logically
benefit from new information and communication technologies, thanks in
part to satellite-based systems offering:

– high capacity for simultaneous communications over
vast geographic zones via broadband, point-to-multipoint, two-way and
other services;

– low-cost distribution of interactive data;

– wide-area geographic coverage, mobility, fast
service and flexibilityóall key assets of satellite-based solutions
for developing wider access to care.

Teleconsultation in remote regions

A medical teleconsultation consists in making a
diagnosis and establishing a course of treatment remotely, most often in
isolated areasóbe it from a fixed site (a geographically remote area,
a disaster area or an offshore oil platform, for example) or from a
mobile site or platform (a ship, aircraft, civil or military overland
expedition, migrant populations, etc.).

In certain cases, non-medical personnel (paramedics,
health officers, flight crew, etc.) will be able to carry out
teleconsultations with support from medical experts located hundreds or
even thousands of kilometres away.

CNES asked the MEDES space medicine and physiology
institute to develop a portable telemedicine kit using new satellite
telecommunications services such as Inmarsat and Globalstar for just
this kind of situation. The system currently in development is a
prototype medical teleassistance kit that can be adapted to different
specialist medical applicationsófor example, cardiology, perinatal
care, biology or medical imaging. The principle is to improve collection
and transmission of objective medical data via satellite to an expert
medical control centre.

The standard telemedicine kitóweighing about seven
kilograms and measuring 47 cm x 38.7 cm x 17.5 cmófeatures:

– a digital ECG recorder (with 1 and 12 leads);

– a digital camera that adapts to a microscope for
anatomy-cytology telediagnosis or for examining haematology slides;

– an automatic sphygmomanometer;

– a pulse oxymeter, infrared thermometer and blood
sugar detector;

– a laptop PC hooked up to an Inmarsat terminal, a
GSM telephone and a GPS receiver.

The standard kit can be adapted to users’ special
needs and available telecommunications systems. For example, it can
serve to set up fixed stations for medical imaging (to image
cross-sections for pathologic anatomy or endoscope imaging), dynamic
stations (for echocardiograms, perinatal examinations and remote
monitoring of high-risk pregnancies) and stations for biology/biochemistry
or electrophysiology (ECG, EMG, EEG).

In response to demand from the user community, CNES
has helped to conduct a number of operational and technical validation
demonstrations in remote areas before initiating full-scale clinical
validation, working with:

– the maritime medical centre in Toulouse and
shipping companies ferrying passengers between France and Corsica;

– the medical department at the French Polar
Institute and the French Navy to provide medical assistance during
summer expeditions in Antarctica lasting several months, which proved a
good test for the robustness of the telemedicine kit;

– MÈdecins du Monde, the French doctors’
association, to enable microscope telediagnosis from a remote site in
Cambodia and transmission of data to expert centres in France;

– Cayenne Hospital and ambulance services in French
Guiana, to provide medical support in remote areas of the Amazon forest.

Technical tests will begin in November 2001 to
validate the portable telemedicine kit on long-haul aircraft (A
340-600).

Lastly, in partnership with FISSA (a UN-affiliated
NGO) and at the request of the Indian government, two feasibility
studies recently got underway aimed at setting up satellite-based
teleconsultation networks in Senegal and India.

Teleassistance

Teleassistance consists in monitoring a patient’s
health data remotely and sending the data to a centre if an anomaly is
detected so that assistance can be provided if necessary.

The patient is linked up to a monitoring, warning and
location system, which is connected to an assistance centre.

Teleassistance proves useful in many circumstances,
for example:

– to keep a check on diabetics taking insulin,
patients with irregular heartbeats and infant apnoea;

– to watch over high-risk patients, such as old
people subject to falling, and to provide assistance for travellers;

– to monitor implanted medical devices.

Satellite-based technologies perform two vital
functions for providing assistance to patients: anywhere, anytime
collection and transmission of data in real time, and accurate location
of a patient’s position to within 10 metres.

Two demonstrations recently started in partnership
with diabetology and geriatrics departments at Toulouse’s hospitals to
remotely monitor diabetic patients on insulin whose diabetes is
difficult to control, and to keep watch over old people with a high risk
of falling.

Partnership with the user community

CNES telemedicine activities are managed as projects.
The first phase of a project sets technical and operational objectives.
This is followed by a full-scale validation phase in which users operate
satellite-based telemedicine systems to demonstrate their usefulness.

These demonstration phases are undertaken in close
partnership with the user community, with support from the French
Ministry of Research, the Secretary of State for Health, the French
defence procurement agency (DGA) and the French Ministry of Foreign
Affairs.

A Steering Committee advises CNES on its policy towards
satellite-based telemedicine and reviews the quality of work and
compliance with ethics and medical codes of practice.