KosmoMed

Objectives of the service

KosmoMed developed a Satcom based ICT solution providing eHealth application and services supporting private and public institutions, which allow extensive access to health data exchange and create a multidisciplinary platform to provide professional tools and eHealth services for professionals, patients and citizens in the field of eClinical Studies, Counselling and Medical Research.

Information technology associated with satellite communication play a fundamental role in the challenge to dematerialize an healthcare process/service, to make the process asynchronous (e.g. deferred tele-counselling), to render more scalable the use of human and material resources, to automatize the process through a direct acquisition of diagnostic data (machine to machine data acquisition), to bring healthcare operators, diagnostic instruments and apparatus near the patient/citizen.

The KosmoMed project aims at developing a series of innovative products and services based on Information & Communication Technology (ICT) - namely on satellite telecommunication technology in order to improve the quality of healthcare services and sustain the growth of the telemedicine sector. The aim of the Project was to develop a portfolio of ICT applications to provide physicians and other healthcare professionals with efficient telemedicine solutions, regardless the status of deployment of terrestrial IP communications networks.

KosmoMed has developed telemedicine services for market exploitation based on the use of a commercial Satcom solution. These services share a common access for the reservation of the resources; the system provide access to the agenda of healthcare professionals and allow user to book sessions which automatically request of satellite band reservation.

KosmoMed developed and deployed different products for the e-health professional market along the following typologies of services:

Tele-consultation: it is described as a context where two medical specialists have a consultation between them in real time by video-conference and/or they have to share clinical data on their local workstations
Tele-diagnosis: it is described as a context where a physician or a technical operator have a consultation with a specialist in real time by video-conference and/or they have to share with specialist clinical data on their local workstations
Tele-counseling: it is described as a context where a patient has a consultation with a physician or a specialist in real time by video-conference; optionally there can be sharing of data
Tele-validation: it is described as a context where a technical operator has a consultation with a specialist in real time by video-conference and shares with him clinical data so that they can be validated; in this context clinical data are submitted to a validation workflow and to statistical processing

Users and their needs

The telemedicine market is affected by a rapid growth all over the world. The study “Lead Market Initiative for Europe - Mid-term progress report” (2009) of European Commission declare that the health ICT industry has the potential to be the third largest industry in the health sector with a global turnover of €50-60 billion, of which Europe represents one third. eHealth was chosen to be one of the six markets of the Lead Market Initiative due to its market potential in terms of growing demand and market growth opportunities, changing demographics, disease patterns and healthcare capabilities. Without significant reforms, including the better use of eHealth, health expenditure is expected to increase from 9% of GDP at present to around 16% by 2020.

European trust in eHealth depends also on the assumption that without better tailored and more effective health and social care services, these trends will put serious pressure on Europe's social models and public finances. eHealth can help to deliver better care for less money within citizen-centred health delivery systems. It also has strong potential for encouraging innovation and leveraging other market segments such as pharmaceuticals and medical devices.

KosmoMed aimed to answer to various pressing needs that are currently affecting the demand of Healthcare services around the world. The healthcare needs and the main priorities registered in Italy to reduce the impact of the chronic disease on the population, to improve the life styles and to empower the citizens to adopt right behaviour are the same registered at European level:

As the age of population in EU increases, as the demand of health increase as well and technologies converge, a critical opportunity is emerging to transform healthcare as we know it;
Due to age increase all national healthcare systems need more resources. Clinical data exchange and resource optimization can reduce costs.

Starting from the increasing demand for medical data exchange and telemedicine services from professionals and clinical institutions, KosmoMed intends to provide the following benefits:

Increase health personal control by providing instruments and services facilitating a link between the patient and the physician anytime and anywhere; KosmoMed web site is the instrument to provide information and guidelines for patient;
Assure the exchange of heterogeneous health data among different healthcare service providers (connected health) such as hospitals, pharmacies, labs and insurance companies;
Automate the complex healthcare workflow;
Deploy an integrated heterogeneous telecommunication network integrating on demand guaranteed bandwidth using satellite solutions.

KosmoMed is dedicated to change the way we think about telematics medicine and healthcare by developing products and services that are:

Comprehensive (data-driven, including all medical data for prevention, treatment, preferences);

Coordinated across different healthcare professionals, with comprehensive data exchange;
Personalised (including post-surgery rehabilitation);
Planned (including services to screen populations).

Service/ system concept

The figure shows the overall architecture of the services KosmoMed implemented in order to satisfy the user requirements: the platforms and institutions integrated in the overall system and the network architecture are visualized, together with an overview of the services the system provides.

From the above described contexts, four possible actors interacting with the KosmoMed services have been identified: physician, specialist, technical operator and patient. Moreover, two modalities of contact between the actors have been identified:

synchronous way, meaning that the reciprocal interaction between actors and the exchange of data between them take place in near-real-time, as it would happen in a video conference;
asynchronous way, meaning that the exchange of information is realized by means of processes affecting different timings, which is typically associated to a delayed access to the information.

The services included in the KosmoMed platform are represented on the following diagramme:

Space Added Value

Usually the use of satellite communications is the most effective solution to break down the digital divide and enable access to healthcare facilities even in the most isolated areas.

Starting from previous experiences, KosmoMed changed the point of view on satellite which is not only a gap filler but it is necessary to provide the necessary Quality of Service (QoS) in Telemedicine services.

The experience evidenced that Satellite networks can provide a solution where the terrestrial connectivity is not available and cannot bring guaranteed bandwidth profiles. Wired technologies have some critical aspects that Satellite can solve with professional services:

QoS of commercial solutions are not guaranteed;
The impossibility of contracting with a single operator over all sites;
The disadvantages of contracting with different operators;
Technical and contractual differences among the operators’ solutions.

Satellite solutions can bring professional medical services but the use of the satellite access technology for the provision of professional services, which involves video-conference sessions and data transmissions between two specialist for clinical studies and tele-consultation purposes, is limited by the required guaranteed uplink bandwidth.

This task has been addressed in KosmoMed project and it propose a solution to address a new paradigm for Satellite Telemedicine Solution. Satellite in not a gap filler for telemedicine solutions but is the solution for telemedicine. Satellite can offer:

guaranteed bandwidth;
pay per use solutions;
fast deploy with a unique operator.

Current Status

During pilot activity, KosmoMed pilots have substantially confirmed the commercial opportunity that such kind of services could have on the market.

Some pilots have encountered more public success, others, intrinsically different for typology and patients’ requirements, have progressed more slowly.

One pilot that has immediately shown to match the patients’ needs has been the Dermatology Tele Consultation. In about two months of activities has easily reached and, in prospective, overcome the pilot’s targets.

Similar results come from the Children Obesity and the Oncology Counselling. The preliminary analysis shows an effectiveness in covering the patients’ needs that resembles and, for the Children Obesity, overcomes the standard approach. The use of the video conference to monitor the advancements of a youngster in following the dietary indications have found very well acceptance by the patients and their parents.

The validation use of the KosmoMed services to improve the quality of the echographic exams in cardiology clinical studies has been proved valid, reliable and effective in achieving the pilot’s goals (reducing the risk to reject the clinical data due to acquisition error).

The following table summarizes the volume of recruited patients and KosmoMed’s multimedia events

CCN2 Activity

The team extended pilot activities to export Tele-Counselling (Oncology) pilot services of KosmoMed in a pharmacy corner, in addition to this a new service of gynaecological teleconsultation has been validated in this pilot activity. The “business model” has been to provide services offered in a telemedicine corner in a pharmacy. The pilot stage of the main project, in fact, demonstrated that the service is appreciated but the Contract Change Notice 2 (CCN2) has been organized to extend the pilot to assess the system in a pharmacy to validate the attitude of patients to pay for a counselling service and to explore a possible new market, that could emphasize the virtuous role of the satellite technology, connecting remote spots (a pharmacy) to the reference centres or physicians.

The total number of treated patients was 111, during the all pilot period (01 March 2017 – 28 September 2017). The following table summarizes the number of different patients treated in the different studies.

The pilot experience performed by allowing patients to directly accessing Telemedicine-based services in a pharmacy provided some useful insights.

First, patients are more willing to ‘experience’ additional health services when they are ‘visiting’ a pharmacy
Second, patients enjoyed the possibility in connecting with the medical specialist at their most suitable convenience, avoiding problems related to traffic, distance, unavailability of time and so forth. They were therefore prone to eventually pay for extending the service further (several patients – about 50% - privately asked both the pharmacist and the physicians how to ensure a ‘continuative’ service). They will assess as a clear benefit that to perform the visit in the pharmacy, without need to move to hospitals or to the private studios of physicians.

Eventually, also the pharmacist benefited from this cooperation, by strengthening his relationships with clients and acquiring further professional credit and skills. According to the pharmacist’s experience, this kind of tools could also help in delivering even first-aid support or medical advice, as it so frequently occurs.