FIRST EXPERIENCE WITH WEB-INTEGRATION OF ANAESTHESIA INFORMATION.

Sh.Batchayev, E.Flerov, O.Broytmann, I.Sablin, A.Bankov

National Research Centre of Surgery named after B.V. Petrovsky,
2, Abrikosovsky per.,Moscow, Russia, 119991
http://tele.med.ru

Introduction: Informational foundation of modern anaesthesiology is comprised of data arrays derived from measurements obtained as a result of clinical monitoring and research. These data undergo statistical processing and become material upon which formulation of practice guidelines, scientific monographs, articles and presentations is based. Ability of immediate access and personal contact for providing feedback plays a key role as well. Until recently, using one source to obtain all of this was not possible. With modern computer and telecommunication technologies the whole multitude of information can be integrated with creating a single access point.
Designing such a system for anaesthesiologist’s workplace is a matter of current importance. “Web-Integration” in that context represents an approach for uniting the data from different sources into one informational field using diverse Web applications and technologies.


Study Goal: Conceptual development and primary realization of Web-integration of anaesthesia information from 4 operating rooms of the Department of Cardiac surgery at RSCS by building site http://tele.med.ru and evaluation of its suitability for remote consultation and distant learning in anaesthesiology, as well as creating “second safety layer” for patient during anesthesia.


Material and Methods: computer network, connecting 4 PC-based monitoring workstations for automated anaesthesia record keeping with database for more than 5000 patients; web servers based on Linux and Apache with software for integration of anaesthetic and surgical video-information and securing remote access via Internet channels; web cameras “Sony SNC-RZ30” and “Panasonic BLC10”; video servers “AXIS 241QA”, systems for videoconference (H.320 and H.323) and VoIP video telephone “Skype”.


Results:
Created informational site http://tele.med.ru represents first steps in Web-integration of anaesthesia-related information. Database of computerized anaesthesia records with real time access capability constitutes the main part of the site. From any connected to Internet computer one can review the data for ongoing cases, anaesthesia records for last 3 years, as well as digital photographs of operating field during key stages of surgical procedure. Anaesthesia record automatically collects haemodynamic, ventilation and gas exchange parameters (compressed spectral array of EEG signal was used until September of 2007 as well) with drop down menus and free typed entries for drugs used, stages of procedure and comments. Transfer of information on line was initially based on using “thin client’ technology, after remodeling of the ORs in the end of 2007 the following algorithm of data transfer is used: multi-parameter S/5 GE anesthesia monitor-> PC -> Intranet server -> Internet server: http://tele.med.ru . All digital parameters available for download in .csv format for further processing.
The views of operative field are available online real time from four Web-cameras “Sony SNC-RZ30” with remote PTZ control over the Internet and x25 optical zoom, one for each OR. This allows clear visualization of surgical #8-0 sutures, for example. “Panasonic BL-C10” webcam gives the panoramic view of the OR. All cameras have been integrated into the site as pop-up windows, which are more convenient for navigation and do not require opening of other full-scale windows or inserts.
In addition, the same site delivers the visual images from the 4-channel video-servers “Axis 241 QA” that are used for high definition viewing of TEE, X-ray and anesthesia monitor screens.
Webcasting as a new and effective distant learning tool used in several subsections of the site, such as “Web presentations”, “Web video”, “Podcasts”, “Stream video”, “Publications”. The former consist of lectures in anesthesiology and intensive medicine from leading specialists. Each presentation opens in the separate pop-up window without leaving the main page with the list of topics, making navigating easier. Presenting materials as Flash applications allows smaller file size, faster loading and start before the full download took place. They are also viewable across different platforms/ operating systems.
Web video section presented as list of video files where anesthesiologist can familiarize with high quality videos in topics of interest - master classes in anesthesia, anesthetic techniques, demos in catheterization of central and peripheral vessels, key elements of surgical procedures, recording of remote consultations etc. Flash technology is used as well.
Podcasts represent a newer subsection hosting small to medium size materials on different subjects. They are in fact videoblogs based on use of RSS format. Podcasts are uploaded to and hosted by Apple terminal and made available via our site. The target audience is anaesthesiologists using portable computers and media players with Internet access. Any physician in our center can record their own podcast addressing specifics or nuances of previously conducted anesthetic and share their experience with colleagues.
The “Streaming video” section is used in real time during events like conferences, symposiums, scheduled courses for distant learning/ CME translated from auditoriums or ORs. For that purpose we often use Apple computers with Mac OS-X “Quick Time Broadcaster”, which allows creating a video stream from any video device, resulting in .mov file that is stored in a designated place. Since video streaming is possible in Wi-Fi networks, it makes this technology truly mobile and easy to establish from any point with Internet and local network access.
The News section of the site hosts up to date information regarding significant events, current meetings and other relevant facts.
The PDA and WAP versions of the site guarantee anesthesiologist access to all resources using palm computer or mobile phone.
Use of IP video-telephone Skype in the OR in parallel with access to Web camera views, video-information from servers and real time anaesthesia record access allow virtual presence in the OR and facilitate supervision and feedback to anesthesia providers. Complex cases can be easily escalated to senior team members who will have ready access not only to snapshot picture of the situation, but to ongoing trends and pertinent preceding events as well.


Conclusion: Created site http://tele.med.ru/ can serve as one informational source for essential practical, scientific and educational support of anesthesiologist. Wider use of the Web integrating approach in anesthesiology should be the basis of its further development; it also allows effective use of methods of telemedicine.


Опубликовано в материалах Annual Meeting of the European Society for Computing and Technology in Anaesthesia and Intensive Care (ESCTAIC). 01 - 04 October 2008, Goldegg, Austria.