PROJECT FINAL REPORT
Grant Agreement number:
Project acronym: MEDNET
Project title: Latin America health care network
Funding Scheme: Small or medium scale focused research project (STREP/CISCA)
Period covered:
from
01/01/2008
to 31/05/2011
Name of the scientific representative of the project's co-ordinator1, Title and Organisation: Despoina
Rizou, Fraunhofer IGD
Tel: +49615155515
Fax: +496151155480
E-mail: drizou@igd.fraunhofer.de
Project
website
address:
www.e-mednet.com
Final publishable summary report
Executive Summary
“MEDNET – Latin America Health Network” has introduced an eHealth model to the provision of
health services in strongly underserved regions in Peru and Brazil. The implementation of this model
is supported on current telehealth technologies as well as on evidence based medicine. The target
clinical applications include general ultrasound applications such as pregnancy control, urology and
abdomen control. The implemented telehealth networks connect high-level healthcare resources
available in large cities with low-level healthcare facilities in underserved regions. The trial of this
model, reflected in the deployment and pilot tests of telehealth stations, has demonstrated local
health authorities the benefits of information technologies for health provision and social
development.
The MEDNET project consisted of two subprojects in which two main actions in the two target
countries Brazil and Peru have been carried out. The subproject MEDNET-Brazil implemented
teleconsultation services for diagnoses and treatment of pregnancy control, dermatology and
radiology for underserved regions in Brazil by using and adapting an extended version of the
telehealth platform Teleconsult.
In the subproject MEDNET-Peru teleconsultation services for ultrasound examinations such as
OB/Gyn, pregnancy control and urology have been implemented for rural hospitals in Peru, using
also the Teleconsult platform.
Both subprojects were implemented in parallel according to the same work plan that consists of 8
consecutive, technical work packages. In accordance with the workplan in total 8 telehealth pilot
networks in Peru and 7 in Brazil, have been successfully implemented in strongly underserved rural
or remote regions. Seven sites were chosen for the project MedNet in Brazil. Three sites in
Amazonian legal region, three sites in Rio Grande do Sul (RS) , and one in a large urban area Porto
Alegre where the referral hospital is located. In total three (3) remote areas in Amazon were
interconnected through satellite link. Those cities are located in Maranhao states. In Peru the The
main DIRESA Junin hospital in Huancayo was the referral hospital. And it was connected via
satellite with 7 sites in the rural area.
The cases of Peru and Brasil are examined independently. Given the very low utilisation of the
system in Peru and the unwillingness shown in using the system, the assessment follows a more high
level perspective. On the other hand, a detailed evaluation process has taken place for Brasil,
focusing on the acceptance rate of the system by its users, but also taking into account the technical
performance of the network. For both cases the main outcome is that the system can be considered as
successful and characterized as sustainable as long as its potential users get motivated to use it in
their everyday practice. Concerning the costs of the network, in comparison always with the money
saved due to teleconsultations performances, they are considered as affordable for Brazil, but
extremely high for Peru. In both cases it has been proven that the main cost in the total operational
cost is the one related to the satellite communication. Even for Peru, where the operational costs
were considered as extremely high for the financial sizes of the country, it is obvious that less
reliance on satellite communication could be the key for expanding and transferring the MEDNET
network in the whole region.
MEDNET has conducted innumerable dissemination activities such as an international telemedicine
symposium in Brazil that made the project well known as a best practise telemedicine pioneer project
in the public, in the health policy and in health organisations in our target countries Brazil and Peru
but also in the global telemedicine community. The project stimulated the political dialogue in these
countries that leaded already to better basic conditions for broad application of telemedicine.
Conclusively, the knowledge gained from the MEDNET project offers valuable insights for
developing region wide opportunities for eHealth. An option with minimized telecommunication
costs – something that in Brazil is already being offered for the remote sites that have broadband
internet installed – can lead to a sustainable network with many positive effects on the health status
of the population in the remote rural areas.
Summary Description of Project Context and Objectives
It was the main aim of the MEDNET project to implement and demonstrate an eHealth model for
evidence based rural telemedicine based on current information technologies and telehealth systems
by which the access and the quality of public health system resources for those people living in
under-served regions in Latin America can be improved.
The project was organised in eight workpackages (WPs) combining the necessary partners and
expertise for assuring successful execution and accurate market orientation, ending up to a
sustainable project. The leadership of each WP is determined by the principal interests and expertise
of the project partners.
The technological background was offered by partners with deep experience in medical systems and
medical imaging processing and architectures design and development (FhG IGD, MC, TASE, VT,
HISPASAT,HISPAMAR).
Project Workflow
Workpackage list
Work Package No
Work package Name
WP1
Project Management
WP2
Clinical requirements
WP3
Specification of technical requirements
WP4
Technology adaptation
WP5
Organizational and technical preparation
WP6
System deployment
WP7
System Demonstration & evaluation
WP8
Dissemination & Exploitation
MEDNET architecture & technology
MEDNet system architecture and major components are:
 TeleConsult
 Jabber communicator
 AmerHis
TeleConsult
TeleConsult, is the next generation of the software running on the TeleInViVo [4] station and provides
medical doctors with all necessary tools for communicating and exchanging medical information over
different communication channels such Internet, ADSL, or conventional phone lines. TeleConsult provides a
wide spread of possibilities to enrich a given image material with additional information and to send it as a
message. This can happen in offline-mode or in online-mode. Moreover, the online-mode gives the
opportunity to communicate over long distances with a given partner in real time. In this case, both doctors
observe the same image data set and through text messages and transferred mouse actions to the remote PC,
they can discuss interactively over a medical case.
A client/server architecture over Instant Messaging protocol provides the central storage of all data
of a telemedicine center and the access to this data from every fixed or mobile computer station,
which is equipped with the client-software. Members of a telemedicine network store their data in
their local database and send their queries to the consultant centre via Internet, ADSL or any other
available communication channels. The medical history of a patient, necessary for the assessment of
a case, is sent anonymously and automatically along with the messages. In general this application
allows:
 The loading and handling of 2D and 3D medical images

The transmission and reception of messages including annotated medical images over Internet,
ADSL or PSTN line in off-line or on-line mode.

The enrichment of the images with graphical and textual annotations and pictograms.

The interaction of the physicians involved in the on-line mode using chat windows and mouse
movements, while the workstations employed share the same display (“what you see is what I
see)The storage of images, patient relevant information, and exchanged messages in a central
database accessed by doctors belonging to the same network.
Example of the user interface of the TeleConsult platform while visualizing a fetus.
Jabber ccommunicator.
Jabber [7,8] is an open-source, XML-based protocol for Instant Messaging and online-presence.
A jabber instant messaging system consists of a hub server and many remote nodes, which are able
to be connected to the server. The hub is responsible for keeping tracks of users’ presence status and
to forward the messages to the right user.
The communication moduleof the TeleConslt application makes use of jabber protocol for both
exchanging medical data and application synchronization data.
In an on-line teleconsltation session the data are sent to the recipient directly through the jabber
server.
In case of an off-line teleconsultation tha data are stored to the jabber server.
AmerHis
The AMERHIS system integrates a Broadcasting Multi-Media network with an Interaction network by
combining two standards, the DVB-S and DVB-RCS, into one unique regenerative and multi-spot satellite
system. In this manner, the users calling for broadband and interactive services will be able to utilize standard
stations (RCSTs) at both transmitting and receiving sides. In this system, the DVB-RCS return channel
standard is applied by all users to access through a standard uplink to the satellite.
DVB-RCS is a system that allows users receive and transmit capabilities via a geostationary nonregenerative satellite. The DVB-RCS return channel standard is applied by all users to access
through a standard uplink to the satellite. On board, the regenerative payload (OBP) is in charge of
multiplexing that information from diverse sources into one or more DVB-S data streams capable of
being received by any standard IRD equipment. The on board repeater is not only capable of
multiplexing signals coming from the same uplink, but also cross-connecting and/or broadcasting
channels coming from separate uplink coverage areas to different downlink coverage areas.
The Management Station manages all the elements of the system. It also controls the sessions,
resources and connections of the ground terminals. It is composed by: NMC (Network Management
Center), in charge of the management of all the system elements. NCC (Network Control Center),
which controls the Interactive Network, provides session control, routing and resource access to the
subscriber RCSTs and manages the OBP configuration. . The NCC can directly transmit to the
satellite the signaling and timing information for network operation by using the same DVB-RCS
standard and receiving the different return channels via DVB-S signal. NCC_RCST, the satellite
terminal of the MS, supporting modulation and demodulation functions to access to the satellite.
AmerHis architecture outlook
The RCST (or simply terminal) is the interface between the System and external users. These
terminals are able to work in transparent or in OBP-based systems by a simple change of software.
In OBP-based systems they allow different kinds of connectivity: single satellite-hop mesh (unicast
and multicast) connections, single satellite-hop connections with ISDN through the RSGW and
single satellite-hop connections with terrestrial IP networks (Internet, Intranet). It order to provide
more complete Triple Play or Corporate services the RCST can have different equipment attached to
it.
Subproject in Brazil
The areas where the Telemedicine network installation have been done, correspond with the health centres and
reference hospitals where the telemedicine network defined in the project has been finally deployed. For a
continuity of the project after the end of 2010, the number of remote sites could be extended to other areas or
countries in Latin America with similar problematic in an easy and scalable manner.
In Brazil
Referral hospital: Santa Casa hospital in Porto Alegre.
Spokes:
1. Balsas,
2. Fortaleza dos Nogueiras,
3. Carolina
In addition, Santa Casa hospital extended the medical network to three remote hospitals in Rio Grade
do Sul states (Pelotas, Alegrete and Lagoa dos Três Cantos), that need medical tele-consultation on
MRI and CT cases. These three remote sites will make use of ADSL communication for data
exchange.
Partners in Brazil & Roles.
SENAICETA
BR
Research Institution

SACA
BR
Hospital

Facilitating implementation of project in Brazil
Pilots running
Subproject in Peru
In Peru
Referral hospital: Huancayo
Spokes:
1. Chongos Alto,
2. Comas,
3. Pariahuanca,
4. Puerto Ocopa,
5. Mazamari,
6. Rio Negro,
7. S.M. de Pangoa
In total 8 installations in Peru all connected via satellite.
GEOPAC
DIRESA
GRJ
UK
PE
PE
SME

Facilitating implementation of project in Peru

Evaluation of Peru

Provide medical expertise for implementation of
project and run the pilots, communicate problems
and recommendations in order to resolve
outstanding issues.

Supervise implementation of project, identify
synergies with modernisation reforms, and
communicate problems and recommendations in
order to resolve outstanding issues.
Public Health Authority
Local Government
Objectives & Foreseen activities
By utilizing and exploiting these European standards and techniques MedNet has the following
impacts in Peru and Brazil:
1. Strengthen the intelligence gathering capacity of health systems and their ability to use
information for decision making. This contributes to the advancement of medical research,
diagnosis and treatment methods, through the efficient collection and sharing of data on
treatment outcomes and patient demographics.
2. Enhance clinical services - particularly in terms of extending health service coverage to rural
and isolated areas. This enables the efficient and cost effective use of high level and high
quality medical resources available in large cities for improvement of health services for
residents in remote and rural underserved regions. MedNet helps reduce morbidity and
mortality in underserved regions by providing a means for early detection and treatment of
contagious diseases such as malaria and tuberculoses by the use of telematics and e-health
technologies.
3. Capacity building - MedNet allows health care personnel to access information and
programmes of continuing professional development. This directly combats the current sense
of professional isolation, improving levels of personal and professional satisfaction. It also
facilitates knowledge transfer through the use of telematic ultrasound systems that connect
expert's know-how in large cities to remote area.
General objectives
MedNet established a collaborative framework with counterparts in Latin America to promulgate
access in underserved regions of Latin America to efficient, cost effective, high level and high
quality medical resources.
The proposed healthcare database and medical platform directly impacts on patient safety by
enhancing clinical services and improving the primary healthcare in the pilot locations. This was
achieved through advanced diagnosis and treatment methods, efficient collection and sharing of data
on treatment outcomes and patient demographics and collaborative medical research.
This system effectively embedded European medical protocols and standards for medical
information exchange, storing and representation .
Counterparts from Latin America were directly involved in the adaptation and customization of the
medical platform. Additionally, MedNet established a collaboration framework conducive to the
development of e-Health in the region through a dissemination and exploitation plan that identified
and engaged with stakeholders through a series of meetings, showcases, workshops and conferences.
The pilot study locations were connected over satellite communication based on DVB-RCS protocol
utilizing the European AmerHis system. This enhanced the medical network, in terms of add-on
components, scalability and reliability, and provide opportunities to exploit the network
infrastructure by developing platforms for education and commerce.
Summarizing, MedNet covers all the objectives of the call, since it aimed to:
 Knowledge transfer from European to Latin America, in technological and medical levels.
Our Latin American partners had the opportunity to work with well-established medical
application for medical tele-consultations. Technician will acquire knowledge of the
technological background of the medical application and physician got familiar with on-line
medical application and tested it in real situations.

Patient safety. MedNet provided physicians with a tool to follow the patient health status, and
provide in a very short time, medical advices, consulting expert physicians in urban cities.

Electronic health records. The medical application used enables a medical database,
following openEHR. Within the scope of the project was the development of an open health
database where medical cases will be stored, supporting evidence based medicine, for future
references, which was succeeded.

Promotion of the European medical standards. European medical standards for medical
information storing, exchange and representation were supported.
Specific objectives
Nowadays, hundreds of cities in Latin America have no access to primary health care, and moreover
simple tests such as blood tests, ultrasonography, and electrocardiogram cannot be performed
straightforward. Our health network connected isolated regions of Latin America with central
hospitals, where remote physicians could discuss medical cases with specialists.
The cities were connected over satellite communication based on DVB-RCS protocol and making
use of the European AmerHis system which can provide concurrently up to 4/8 Mbits in the upload
and download links respectively. In addition, the medical platform was based on the results of
TeleInViVo, T@LEMED, @HOME project (IST-2000-26083). Our Latin American partners were
involved to the adaptation and customization of the platform. In that way, Latin American
organisation, universities and companies made use and take advantage of the European standards and
techniques.
To conclude, the clinic impact and adding value of MEDNET are:
 To enable the efficient and cost effective use of high level and high quality medical resources
available in large cities for improvement of health services for residents in remote and rural
underserved regions.

To help reduce morbidity and mortality in underserved regions by providing a means for
early detection and treatment by the use of telematics and e-health technologies.

To improve the primary healthcare by the use of telematic ultrasound systems to connect
expert's know-how in large cities to remote area.

To contribute to the advancement of medical research, diagnosis and treatment methods,
through the efficient collection and sharing of data on treatment outcomes and patient
demographics.
MedNet offered the possibility to compare two different access technologies (transparent and
regenerative satellites) in order to assess the benefits of the mesh connectivity offered by
AmerHis and to compare the cost of operation of both alternatives.

These general objectives were split into more detailed specific objectives with a social, clinical or
technical impact in the target countries.
Social impact:
•
•
•
•
To reduce the gap between underserved regions and large cities in medical service levels, and
consequently, contribute to the reduction of the social complication.
The image of equal opportunity of receiving government medical care, especially for
minorities will be created and promoted.
MEDNET aims to increase education and economic opportunities through the provision of
training related to eHealth technology.
To develop strategies for sustainable telehealth services. The telemedical services developed
and implemented in MEDNET will be compliant to and complementary with national health
strategies in the target countries.
Clinical impact:
•
•
•
•
To enable the efficient and cost effective use of high level and high quality medical resources
available in large cities for improvement of health services for residents in remote and rural
underserved regions.
To help reduce morbidity and mortality in underserved regions by providing a means for
early detection and treatment by the use of telematics and eHealth technologies.
To improve the primary healthcare by the use of telematic ultrasound systems to connect
expert's know-how in large cities to remote area.
To contribute to the advancement of medical research, diagnosis and treatment methods,
through the efficient collection and sharing of data on treatment outcomes and patient
demographics.
Technological impact:
•
•
•
•
•
To develop intelligent user interfaces for health professionals and patients to use the
telehealth platform in networks with clinical databases. Electronic guidelines, diagnosis and
treatment results transmitted using information technology will generate the database for
evidence based medicine in the targeted regions.
To increase the public sensitiveness for medical data. The security technology will be used to
protect medical data from unauthorized access. A public key infrastructure for eHealth
application will be implemented and promoted.
Use of DICOM standard for diagnostic image storage, retrieval and transfer or the
Interoperability with Latin American telehealth technology and telehealth network will be
demonstrated.
MEDNET can also develop and promote the “eHealth” community as a forum for
discussions, to exchange experiences about telehealth systems and services and to get and
give advice about eHealth related questions.
Description of the Main S&T Results/Foregrounds
Achievements in Brazil
Study area & backround
Brazilian national health system (NHS) is composed of a large public, government managed system, the SUS
(Sistema Único de Saúde), which serves the majority of the population, and a private sector, managed by
health insurance funds and private entrepreneurs.
The public health system, SUS, was established in 1988 by the Brazilian Constitution, and sits on 3 basic
principles of universality, comprehensiveness and equity. Universality states that all citizens must have access
to health care services, without any form of discrimination, regarding skin color, income, social status, gender
or any other variable.
The public system is still grossly under-funded and lacking quality, though that's been improving greatly in
the last few years. Important legal issues, such as the regulation of Constitutional Amendment 29, are
expected to minimize some of those problems. In 2006, the most notable health issues were infant mortality,
child mortality, maternal mortality, mortality by non-transmissible illness and mortality caused by external
causes (transportation, violence and suicide).
Private Health Insurance is widely available in Brazil and may be purchased on an individual-basis or
obtained as a work benefit (major employers usually offer private health insurance benefits). Public health
care is still accessible for those who choose to obtain private health insurance. As of March, 2007, more than
37 million Brazilians had some sort of private health insurance.
A major issue is the concentration of resources, both material and medical personnel on rich areas (in the
richest regions and in biggest cities), in particular for high complexity.. This affects the health sector in both
dimensions – public and private.
It is important to notice that Brazil lacks a policy for redeployment of medical personnel according to the
needs, physicians as they graduate, are free to work all over the country. Small cities (<80.000) offer high
salaries (often over 10.000 up to 15.000 Euros per month) for physicians but nevertheless are unable to hire
the necessary number of professionals (see http://g1.globo.com/jornal-hoje/noticia/2011/05/faltam-medicosem-hospitais-e-postos-de-saude-no-interior-do-brasil.html).
A survey by the Ministry of Health shows that are missing in rural Brazil, especially anesthesiologists,
neurologists, neurosurgeons, psychiatrists and pediatricians.
According to data released by the FCM - Federal Council of Medicine in 2010, the state capital of São Paulo
has one doctor for every group of 239 inhabitants, above the average of countries with high human
development indices. Germany, Belgium and Switzerland, for example, have a physician in activity for each
group of 285, 248 and 259 inhabitants, respectively.
When comparing the density of physicians throughout the state of Sao Paulo, the average is close to the U.S.:
413 people per professional in Sao Paulo, compaired to 411 in theUnited States. In the Federal District, there
is one doctor for 297 inhabitants, the best average among the units of the Brazilian federation.
Elsewhere, rates are African: in the interior of Amazonas State there is one doctor for every group of 8.944
inhabitants, in Roraima State, also in the Amazonian Region, one for 10.306.
The medical network will connect isolated & underserved areas in Amazon over satellite
communication and particularly in Maranhao state, in Brazil.
Seven sites were chosen for the project MedNet in Brazil. Three sites in Amazonian legal region, see
Figure 6, three sites in Rio Grande do Sul (RS), see Figure 7, and one in a large urban area where the
referral hospital is located. São Borja (RS) city was chosen as a backup site in case that one city
abandons the project in Rio Grande do Sul.
Amazonian legal region map
The health ministry of Maranhao, has already identified three remote site for the system deployment.
The remote rural cities are:
 Balsas

Carolina

Fortaleza dos Nogueiras
In general, after contacting the remote hospitals, we will identify the medical needs for each city. The
requirements of the health network will be consolidated and the design specified. Before the
deployment, application and services will be replicated in the laboratory of TASE in Madrid, Spain.
Furthermore, during that period FhG IGD will elaborate on application enhancement meeting user
requirements.
As soon as the test finish successful, the real deployment of the tested system will go on and the
medical trials will start as soon as the deployment in each city has been accomplished.
After the end of the in-situ tests , between Balsas (remote clinic) and Porto Alegre (referral hospital),
we will continue with the deployments to the rest cities. At the same time the medical trials will start
between Balsas and Porto Alegre hospitals and a workshop will be held to show the health platform
to the physician (experts and non-experts).
Completing the deployment, two more satellite terminals will be deployed to remote clinic in
Carolina and Fortaleza dos Nogueiras cities, respectively.
Remote sites at RS (red circle) and Porto Alegre (red square) where the referral
hospital is located
Deployment in Brazil
In Brazil, there are in total six remote sites. Three satellite and three ADSL installations. The satellite
installations are located in the Amazonian region in Maranhão state And ADSL installations are located in
southern Brazil, in Rio Grande do Sul state. Fig. 2 illustrates the current network topology in Brazil.. The
referral hospital is located in Porto Alegre, in a complex of hospitals, named Irmandade Santa Casa de
Misericórdia de Porto Alegre that provides all types of medical expertise.
Satellite Network - MA
Santa Casa de Porto Alegre - RS
Jabber Server
Satélite / PROXY
192.168.11.6/29
IDU
192.168.11.3/29
Jabber Server RS
200.18.76.44/24
Specialists
Physican
Network
iscmpa
IDU
192.168.11.129
DMZ
Carolina – MA
192.168.11.130/29
IDU
192.168.11.137
Balsas – MA
192.168.11.139/29
IDU
192.168.11.145
Lagoa dos Três Cantos - RS
Fortaleza dos Nogueiras – MA
192.168.11.146/29
Alegrete - RS
Pelotas - RS
RS
Network topology in Brazil.
Geographical position of Rio Grande do Sul (RS) and Maranhão (MA) State
MEDNET Utilization
Internet based network.
Application (& Objective)
Comments
Teleconsult 2.6 (installation, configuration and
basic usage).
The final version of TC 2.6 still doesn’t have an
automatic installation.
Medical data in synchronous mode (TeleConsult
on-line mode)
On-line mode is technically operational in RS.
Medical data in asynchronous mode (TeleConsult
off-line mode)
Off-line mode is technically operational in RS.
Physicians prefer to use off-line mode because is
difficult to match their agendas.
Netmeeting
Removed from Windows 7.
Skype
Physicians in RS prefer to use Skype. They find it
more user friendly and easy to install.
MSN
In RS Skype was chosen by the physicians.
LogMeIn
Teleconsult 2.6 and Skype (Internet)
Web application used for remote maintenance and
support in RS.
The system is running without technical problems.
The sites in RS are operative and willing to
contribute in the project. Lagoa dos Três Cantos is
regularly sending exams to SACA’s specialists and
has fully incorporated the system in the Health Care
Center routine.
Summary of pilot test reports and current utilization in RS.
Maranhão (MA) – Amazonian Region
Satellite based network.
Application (& Objective)
Comments
Teleconsult 2.6 (installation, configuration and
basic usage).
The final version of TC 2.6 still doesn’t have an
automatic installation.
Medical data in synchronous mode (TeleConsult
on-line mode)
On-line mode is technically operational in MA.
Medical data in asynchronous mode (TeleConsult
off-line mode)
Netmeeting
Skype
MSN
UltraVNC
Teleconsult 2.6, Netmeeting, MSN (satellite
network – Amazonian Region)
Off-line mode is technically operational in MA.
Physicians prefer to use off-line mode because is
difficult to match their agendas.
Technically operational during Pilot Tests in MA
sites.
It is not going to be used anymore. This application
was removed from Windows 7.
Physicians in MA prefer to use Skype. They find it
more user friendly and easy to install.
In MA Skype was chosen by the physicians.
Software used for remote maintenance and support
in the computers from MA.
The applications were tested. Good results during
the pilot tests.
From January 2010 until March 2010 few exams
were sent from Balsas and Carolina. Fortaleza dos
Nogueiras never had a chance to use the system
during this period because the satellite link in this
site worked for only one day since its installation
until March 2010.
In the second half of October the satellite link was
recovered for all sites in MA. However, in the
second half of November problems with the
installation did not allow the exchange of data
among physicians.
On November 25th, 2010, HISPAMAR solved the
problem. Despite of the instability, most of the time
the link is up and, since then, 290 exams were sent
using the satellite network.
Simultaneous traffic flows (Validation of the
establishment and maintenance of simultaneous
traffic flows - online and offline)
Validated during pilot tests.
When the link was recovered the system started to
be used, especially in Balsas.
Simultaneous hospital – clinics communications
(Validation of the establishment and maintenance
of
simultaneous
hospital
to
clinics
communications)
Validated during pilot tests.
Satellite communication link was underused.
Summary of pilot test reports and current utilization in MA.
System exploitation
The main goal of MEDNET is to connect isolated areas in Amazonian region from Peru and Brazil
utilizing European technology for satellite communication, providing broadband and quality of
service (QoS) for real-time data transmission and video/audio conference.
In Brazil, the entire network infrastructure was provided by SACA and CETA for the remote sites.
The goal is not to use the system only to request second opinions from the specialists located in Porto
Alegre, but also to make use of other Internet services like, email, Skype, MSN, etc. However, the
instability of the satellite link until November 2010 significantly reduced the usefulness of the
network. After some time the users gave up trying to use it, choosing the local internet service
provider (despite of the slow bandwidth) to access internet services instead of the satellite
connection.
The satellite link was used only to send via satellite connection a reasonable number of second
opinion requests in order to technically validate the system. If the connection was more stable, the
system exploitation would be certainly easier.
Despite of all the problems, CETA can confirm that when the link was up and stable, it worked very
well. A very good bandwidth was verified in Maranhão in January 2011 when a CETA’s engineer
was in the region. It was like to be connected to the Internet at home, in Porto Alegre (RS).
Unfortunately this happened only when the project was already in the end.
The system exploitation is unfeasible considering the price of the satellite connection and the QoS
provided during the Pilot Execution, until November 2010.
Rio Grande do Sul State (RS)
Porto Alegre
The expert doctor’s agenda followed during the project in order to answer in teleconsultations was
the following:
In the end of November 2010 HISPAMAR the performed a preventive maintenance in the
satellite installations at Santa Casa de Porto Alegre. The LNB was very rusty and had to be replaced
by a new one in order to avoid future problems, Error! Reference source not found.. This action
was very important
Timetable
Monday
Tuesday
Wednesday
Thursday
Friday
08:0012:00
Carla Colares
Bruno
Hochhegger
Bruno
Hochhegger
Bruno
Hochhegger
Carla Colares
14:0018:00
Bruno
Hochhegger
Bruno
Hochhegger
Bruno
Hochhegger
Bruno
Hochhegger
Bruno
Hochhegger
SACA’s LNB. Before and after HISPAMAR maintenance.
Lagoa dos Três Cantos
This municipality has one generalist practitioner working exclusively to treat the population of Lagoa
dos Três Cantos. By using the benefit that Lagoa dos Três Cantos has a small population, it is
possible for the physician to have a personal relationship with his patients, this type of physicianpatient is called “family medicine”, because the physician treats the person/family during their whole
life. In addition to physician-patient relationship, the physician usually treats or visits the patient at
home, to provide a better care. He assists the population of the city, maintaining a routine of
preventive medicine and directing more serious cases to the other medical centers in bigger cities or
to the Santa Casa de Porto Alegre Hospital.
Telemedicine using MEDNET system was fully incorporated by Dr. Marcus Dalsasso, (the
responsible physician) routine at the healthcare center. Almost every ultrasound exam is stored in the
DICOM Database for future patient control. Error! Reference source not found. shows Dr. Marcus
Dalsasso’s office in Lagoa dos Três Cantos.
MEDNET installations in Lagoa dos Três Cantos.
Type of Exam
Abdomen, pelvic, obstetric. (U/S)
Number of exams sent for second opinion.
Number of exams
74
Pelotas
Santa Casa de Pelotas hospital has CT and RMI equipments, and was chosen as a pilot in MEDNET
project in order to extend the system to other types of exams, in addition to ultrasound, that has
already been used in other remote sites. However, these equipments are not connected to the hospital
network; the exams are stored locally in a PC. When is necessary to transfer them to another PC the
physicians use Re-Writable CDs. Internet connection was available only in the ultrasound room. For
this reason the PC had to be installed there.
The hospital also has a team of experienced radiologists. This site didn’t have a significant demand
for second opinions because the local physicians could discuss any doubts and questions among
them.
When this situation was detected by the local coordination in Brazil, an effort was made in the sense
of convincing these professionals to send exams in order to validate the system. Even though there is
no doubt concerning the diagnostic.
The results show that this town, like some others in MEDNET as well as in previous telemedine
projects (T@lemed, T@his, e.g.), has not reached the expected levels of adherence to the project
goals.
Type of Exam
Cranium, hips, thorax. (CT)
Table 1 - Number of exams sent for second opinion.
Number of exams
3
Alegrete
Dr. Barradas from Santa Casa de Alegrete requested a new training in TC 2.6, performed on August
11th 2010. Since then many teleconsultations were remotely oriented by CETA. However Dr.
Barradas is still not able to use the system alone.
Type of Exam
Abdomen. (U/S)
Number of exams
3
Number of exams sent for second opinion.
Maranhão State (MA) – Amazonian Region
The system deployment and also the pilot tests were very much jeopardized in Maranhão. The main
reason for that was the delay in the conclusion of the satellite installations.
In the second half of October 2010 the link was recovered. However, the project scenario has
changed in the meantime. We can mention change of staff (physician), equipment layout inside
Balsas’ Clinic and also internet service providers arriving at the region, which in the beginning of the
project not even have mobile phone coverage.
In January 2011, CETA sent to Maranhão an engineer to review the installations and to give support
(if necessary) for the physicians that were still having difficulties with Teleconsult 2.6.
Balsas
Due to a renovation in São Carlos Clinic the equipment layout has changed. The formally
implemented DICOM wireless network stopped working because the wireless signal is too weak to
cross the walls that are in the way now. To overcome this problem a Bridge (LinkSys WAP54G) was
sent to Balsas to be installed in the clinic. The purpose of a repeater bridge is to extend network
connectivity inside the clinic.
Error! Reference source not found. shows the new topology of the wireless DICOM network.
IDU
192.168.11.137
U/S exams
Ultrasound:
172.16.99.100
192.168.11.138
DICOM Server: 172.16.99.101
Bridge – LinkSys WAP54G
New network topology using Bridge repeater.
Type of Exam
Abdomen, obstetric. (U/S)
Number of exams
290
Number of exams sent for second opinion.
Fortaleza dos Nogueiras
The first opportunity to use the system was in the beginning of November 2010.
A video conference between CETA and Mr. Uirajan (health secretary) were performed to test the
video and audio quality. Only audio is OK, videostream (even at 320x240) seems to be too “heavy”
for the allocated 1 Mbps bandwidth.
The former physician, Dr. Percílio, left town. A new responsible physician was allocated in February
2011.
When CETA's engineer arrived in Fortaleza dos Nogueiras the new physician had not started
working yet. The local IT technician was trained to use Teleconsult 2.6 in order to assist the new
physician when he starts working for MEDNET.
In addition to the training, a step by step tutorial (“for dummies”) was prepared by CETA and given
to the local technician aiming to avoid more excuses for not using the system.
Unfortunately, none of these efforts were enough. This site has not sent any exam.
Type of Exam
Number of exams
0
Number of exams sent for second opinion.
Carolina
Contact with Dr. Idalcy was lost. The problem was similar to Fortaleza dos Nogueiras. The former
responsible physician has a new job in another town and is not working at Carolina’s
Videoconference tests were performed with a nurse from the hospital.
The municipality Secretary of Health, Mr. Joaquim Dias Leal, was asked to help in the negotiation
with Dr. Idalcy. CETA explained the importance of their participation in this phase of the project, but
they don’t seem to care. Further contact showed no progress at all.
Type of Exam
Abdomen. (U/S)
Number of exams
3
Number of exams sent for second opinion.
Teleconsultation in Brazil
In Brazil, two different scenarios were put into operation. One in Rio Grande do Sul (RS) state in Southern
Brazil, using ADSL and one in Maranhão (MA) state in Amazonian region using satellite communication over
AmerHis.
Six remote sites and one reference hospital are involved in the pilot: Rio Grande do Sul (RS)
Reference hospital: Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS).
Remote sites: Lagoa dos Três Cantos, Alegrete, Pelotas.
In Rio Grande do Sul, MEDNet deployment started in July 2009 with the installations in Lagoa dos Três
Cantos using ADSL connection. Dr. Marcus Dalsasso is using the MEDNet system from the first day and now
is a routine at the healthcare center in Lagoa dos Três Cantos. Every ultrasound examination was sent to the
referral hospital and stored in a DICOM compliant database for future patient control. Fig. 4 shows the
number of exams sent per site in Rio Grande do Sul (RS).
Rio Grande do Sul (RS)
80
60
74
40
20
3
3
0
Lagoa dos Três Cantos
Alegrete
Pelotas
Number of exams sent per site in RS.
City
Type of Exam
Teleconsultati
ons
Lagoa
Abdomen, pelvic, 74
dos Três obstetric. (U/S)
Cantos
Alegrete Abdomen. (U/S)
3
Pelotas
Cranium,
hips, 3
thorax. (CT)
The use of MEDNet system gave the opportunity to avoid the transportation of 22 patients from Lagoa dos
Três Cantos to the reference hospital in Porto Alegre. This represents almost 30% of the second opinions
requested by Dr. Marcus Dalsasso.
A small testimony of Dr. Marcus Dalsasso about his experience with MEDNet is presented below:
“…some answers sent by the specialists were very useful for me…many patients here won in the lottery,
they got their diagnosis, they were operated, now they are working…this has no price.”
The following figure shows the number of exams sent per month from Lagoa dos Três Cantos (RS) from
July 2009 until March 2011.
Exams sent from Lagoa dos Três Cantos
7
6
5
4
3
2
1
0
Jul
09
Okt
09
Jan
10
Apr
10
Jul
10
Okt
10
Jan
11
Lagoa dos Três Cantos
Lagoa dos Três Cantos exams per month.
Maranhão (MA)
Reference hospital: Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS).
Remote sites: Balsas, Carolina, Fortaleza dos Nogueiras.
The pilot tests in Maranhão started in December 2009 when the satellite installations were finished. The
following figure and table show the number of exams sent by the sites in Maranhão (MA) until March.
Maranhão (MA)
300
250
290
200
150
100
3
50
0
0
Balsas
Carolina
Fortaleza dos Nogueiras
Number of exams sent per site in Maranhão.
City
Type of Exam
Balsas
Abdomen,
obstetric. (U/S)
Abdomen.
3
(U/S)
Carolina
Teleconsultati
ons
290
Fortaleza
dos
Nogueiras
-
0
A significant discrepancy is observed when the number of exams performed in Lagoa dos Três Cantos (RS)
is compared to the rest of sites in RS. In Balsas (MA), the same behaviour is observed.
An essential knowledge in informatics by the users (physicians) has a relevant impact in the project results.
This can be seen in the number of exams sent from Lagoa dos Três Cantos (RS) and from Balsas (MA). Both
sites have physicians with experience in informatics and feel comfortable using the telemedicine system. On
the other hand, the other physicians involved in MEDNet showed resistance using the telemedicine
application, despite of the workshops, training and constant support given.
The following figure shows the number of exams sent from Balsas (MA) per month from December 2009
until March 2011. From February 2010 until December 2010 there is a period that the system was not
operational due to technical problems in the satellite connection. Nevertheless MEDNet activities in Balsas
were going on. The physician stored the ultrasound exams in the DICOM Database and when the connection
was recovered he sent them to the reference hospital, which has already answered all his requests of second
opinion.
Exams sent from Balsas (MA)
100
90
80
70
60
50
40
30
20
10
0
Dez
09
Feb
10
Apr
10
Jun
10
Aug
10
Okt
10
Dez
10
Feb
11
Balsas
Balsas Exams per month.
Achievements in Peru
Study area & backround
The department of Junin is located in Central Peru and consists of two main ecoregions: 46%
Mountainous and 54% Jungle (Error! Reference source not found.). Covering an area of 44, 197
km2, Junin has a population of 1,302,805 (2006). The rural population has been declining and
represented approximately 34.5% of the population in 1993. The result of this migration has,
amongst other things, led to a deterioration in rural areas and increased strain upon urban centres.
The region is characterized by diverse climates and micro-climates. Politically, Junin consists of the
provinces of Huancayo, Chanchamayo, Chupaca, Concepcion, Jauja, Junin, Tarma, Yauli and Satipo.
In 2002, 63% of the population lived in poverty, with approximately 30% living in conditions of
extreme poverty – above average for Peru. The general illiteracy rate (in 1993) was 12.8% - higher
for females at 20.6%2. In 2004 Chronic infant malnutrition (<5 years) reached 31.4%. The reasons
are attributed to Public Health and the level of maternal education, number of children and first
language.
There is a high prevalence of communicable diseases such as Malaria, poor maternal care,
malnutrition and alcoholism. Malaria is endemic in the provinces of Chanchamayo and Satipo.
Classic dengue is endemic in Junin in the provinces of Chanchamayo and Satipo. Yellow Fever is
endemic in Junin, with two river basins Rio Tambo and Mantaro-Ene considered high risk. As a
preventative measure, a vaccination programme began in 2004. As of January 2005 this programme
had 62% coverage. There were 84 recorded cases of HIV-AIDS in 2004, slightly down on 146
recorded in 2003 but there has been a general upward trend since the first case was diagnosed in
19883.
Peru’s administrative network in Junin Department.
There is also a high incidence of prenatal and maternal mortality due to poor maternal care during
pregnancy and delivery. The maternal death rate in Junin during 2004 was 149.44 per 100, 000,
slightly above Peru’s national average of 146. Approximately 65% of these cases occur due to
puerperal fever – hemorrhaging accounting for 64% of these cases. With appropriate health services
and nutrition during and after pregnancy, many of these deaths are preventable. The greatest causes
of mortality are:
 respiratory diseases
2
3

traumas

malignant tumors

chronic degenerative diseases in the adult population.
INEI. Figures from June 2003
Oficina de Epidemiologia. NOTI.
Health service coverage in Junin is low. Approximately 89% of health centres in the region are
delivered by Ministerio de Salud (MINSA), however, 97% of these are “puestos de salud” – a level
of medical attention characterised by limited infrastructure and resources, in both equipment and
professional personnel. With this lack of infrastructure it is difficult to effectively confront the health
problems faced by the population. The region faces health workforce crises due to a lack of trained
physicians in rural areas. Professional health workers perceive there to be a strong sense of isolation
associated with working in rural areas, particularly in terms of continuing professional development.
Telemedicine in this respect is an excellent tool in covering and integrating multiple areas of health
care work, training and education.
Poverty is an important factor in assessing access to health services. In 2000, of 100% of people
declaring symptoms in need of treatment, only 69% received attention from a health care
professional. Approximately 31% failed to access the health service – for economic reasons.
According to a map of poverty produced by MEF in 2004, and the United Nations Human
Development Index in 2006, the poorest districts in Junin were situated in the province of Satipo
(e.g. Rio Tambo has a 50.3% rate of extreme poverty and 54.4 % rate of chronic infant malnutrition,
Llayla 37.2%: 39.9% respectively) and Concepcion.
Geography is another mitigating factor resulting in social exclusion. In the department of Junin, rural
communities have a travel time of 152.78 minutes to their nearest hospital, as opposed to 76 minutes
to the nearest “puesto de salud”4. These times can increase dramatically during heavy rains. The mud
slides (Huaycos) that ensue can have devastating, often fatal, consequences, cutting transportation
links and leaving many communities further isolated.
Deployment in Peru
In Peru there are in total eight satellite installations including the referral hospital in Huancayo.
Geographical position of the sites in Peru.
4
ENAHO 2001
Deployment: WIMAX connection
Following the difficulty of associating a fixed public IP with a domain name for the Jabber Server in
DIRESA Junín, the decision was taken by GRJ and DIRESA Junín to install a WIMAX connection
between the referral hospital at D.A . Carrion and the satellite terminal installed at DIRESA Junín’s
administrative offices in Huancayo, Peru (Figures 1, 3 & 4).
The need to complete a WIMAX installation was not envisaged in the original deployment plan and
DoW but DIRESA Junín were keen to adopt this solution in order to fully connect the MEDNET
infrastructure since it also enhanced the IT infrastructure within Hospital D.A. Carrion. The IT
infrastructure of the referral hospital was poor and hadn’t been updated in a long time. Whilst the
category of the hospital had increased along with the complexity of services offered, its IT systems
had lagged behind.
DIRESA Junín used involvement in the MEDNET project
to justify this WIMAX installation. WIMAX installation
was eventually completed during April 2010 in accordance
with the chronogram presented during the MEDNET review
in Brussels in March 2010 (Figures 1, 2, 3 & 4). With the
installation of WIMAX connection, the IT infrastructure has
received a major boost.
The reason why the satellite terminal was installed in the
administrative offices of DIRESA Junín in Huancayo and
not the referral hospital D.A. Carrion, thus eventually
requiring WIMAX installation, was due to the fact that
during September 2008 an indefinite health professionals
strike in Huancayo highlighted the need to mitigate against
the potential for loss and disruption to the whole of the
network. The decision, agreed by the consortium, was to
install the satellite in Lima, in order to ensure stability of the
service to the remote sites. Following events of mid-2009
the satellite terminal was subsequently reinstalled in the
administrative offices of DIRESA Junín.
Figure 1 Satellite terminal and
WIMAX installation at DIRESA
Junín
The result of the WIMAX connection is that the referral
hospital D.A. Carrion is now connected to the MEDNET
network and appears as an additional connection on DIRESA Junín’s Local Area Network.
Outline of SW direction of signal towards Hospital D.A. Carrion
The distance from the administrative offices of DIRESA Junín to the referral Hospital D.A. Carrion
is 1.72km. Figure 4 outlines detailed parameters of the WIMAX installation.
Details of WIMAX parameters
WIMAX signal
from DIRESA Junin
Signal receiver located outside
MEDNET consultation room
in D.A. Carrion. See
enlargement in figure 6
DIRESA Junin’s
“almacen” is now
connected –
strategically very
important
advancement
Outline of the WIMAX set up at Hospital DA Carrion, Huancayo. Signal from DIRESA Junín is received
and then transmitted to DIRESAs store (blue) and the MEDNET PC (Red).
The WIMAX connection has a capacity of 10 MB and is connecting 1 PC in the hospital. It is also
connecting approximately 14 PCs in DIRESAs "almacen".
WIMAX receiver located just outside the MEDNET dedicated site at Hospital DA Carrion which received
the signal.
The impact of connecting the referral hospital via WIMAX is outlined in the schematic overview of
the current MEDNET architecture presented in the following figure.
Overview of the current MEDNET system with integrated WIMAX connection
MEDNET Utilization
The focus of deliverable 6.1 is the transition towards full utilization of the MEDNET system. Pilot
tests were carried out to assess the systems functionalities was presented.
Application (& Objective)
Comments
Teleconsult
(installation, configuration and basic usage).
- WIMAX installation completed
- Incompatibility issues between u/s and PC.
Medical data in synchronous mode (TeleConsult -Specialists reluctant to participate –
on-line mode)
professional and financial reasons
-Remote medics unwilling to seek second
opinion from colleagues in Huancayo
Medical data in asynchronous mode (TeleConsult -Specialists reluctant to participate –
off-line mode)
professional and remuneration reasons
-Remote medics unwilling to seek second
opinion from colleagues in Huancayo
-Issue of second opinion based solely on jpg
images questionned
Netmeeting and Real time communications (Real -Initial tests revealed some configuration issue
time Comms and Use of Netmeeting application) which reduced available Bandwidth
-Netmeeting application not liked by users and
has been replaced by Skype VC which has been
main form of communication used.
PC Telephone
-Tests repeatedly good and stable – however,
users not keen. Continued use of PC Telephone
might be via separate “IP telephone” /
“Handsfree”
UltraVCN
-DIRESA Junin routinely use this to enter and
make any necessary reconfigurations. It is also
used sometimes to initiate communications
Teleconsult, Netmeeting and PC Telephone None of these applications are being used. From
(Validation of communications between two August 01 a regional directive obliges ALL
terminals with HP and LP connections users to use the MEDNET system.
simultaneously )
Simultaneous traffic flows (Validation of the The system is currently being underused.
establishment and maintenance of simultaneous
traffic flows - online and offline)
Simultaneous hospital – clinics communications Specialists and remote medics reluctance to
(Validation of the establishment and maintenance fully engage with MEDNET
of
simultaneous
hospital
to
clinics
communications)
Summary of pilot test reports and current utilization
System exploitation
The objective of MEDNET was to deploy a system that enabled transfer of medical images via
satellite to a remote specialist, who in turn would review and provide expert second opinion. Users
are currently exploiting the system in a variety of alternative ways including, accessing information
via internet, chatting with colleagues and family and sending weekly epidemiological reports.
Previously, the medic had to either travel to a local internet cafe (where available) or alternatively
make a longer trip to Huancayo. The cost of this was not reimbursed – but the benefit was the trip
itself (to visit family etc).
There have been difficulties in using the system as originally planned as a consequence of several
different factors, including: the delivery of ultrasound machines was subject to long delays
associated with a long public procurement process; when finally delivered, 6 of the 8 ultrasound
machines purchased were/are not compatible with Teleconsult and have resulted in a complicated
and time consuming workflow; training in imaging diagnostics and use of ultrasounds provided but
to some medics who have since relocated to other sites.
As described in deliverable D2.1, a number of stakeholder needs were identified as part of an
assessment of clinical requirements. The principal required was identified as:
“...Lack of basic medical diagnostic equipment: Stakeholders prioritized the need for
ultrasound machines to improve maternal health during pregnancy and avoid the need, or at least
improve preparedness, for emergency deliveries”.
This was a stated health care priority for the Regional Health Care provider - DIRESA Junín - in
2008. Since the clinical requirements Work Package was completed by Geopac and DIRESA Junín /
GRJ, stakeholders may have actually been confirming the health priority as decreed by the regional
health authority (DIRESA Junín). Additional requirements were identified as the need for:
1.
2.
3.
4.
5.
Improved communications (for both the community and access to medical information):
Expert second opinion:
Improved institutional efficiency:
Capacity building programmes:
Stable electrical supply: The local municipality at each remote site agreed to satisfy this basic
requirement.
The MEDNET system, as currently being used, meets the requirements of points 1 and 3. An
interesting socio-professional issue has been raised by Point 2 (discussed in further detail in the
section on Organizational Aspects).
Negotiations to extend the network and utilize the system for professional CPD (point 4) have been
started between DIRESA Junín and the Universidad Peruano Cayetano Heredia (UPCH) whilst the
issue of stable electrical supply (point 5) was resolved by each local municipality involved in the
project.
Although the majority of medics in the remote sites in Peru are competent in ICT, the development
of a system based on u/s image transfer has been challenging. Aside from potential socioprofessional and remuneration conflicts, the Specialist medics in Huancayo have raised doubts about
their ability to provide an expert second opinion based on a .jpg image and have suggested that the
system is too vulnerable on user ability.
Remote site utilization
Rio Negro
Current situation:




Medical images are transferred (approximately 36 per month) using FTP
The Medic Dr Darwin Ruiz Flores, who was trained in imaging diagnostics via ultrasound temporarily
refused to continue execution of ultrasound examinations (reasons why are not fully clear).
Internet is used to send and receive health care information
A technical assistant has been assigned to facilitate all communication links
Dr Karina Bastidas assumed responsibility for the health centre at Rio Negro in Jan 2010. Dr
Bastidas and Dr Darwin Ruiz Flores attended the imaging diagnostics training workshop in April
2010 on behalf of Rio Negro. However, Dr Darwin temporarily stopped this service and an obstetric
nurse took over this duty for a while. Dr Ruiz Flores, in accepting the training delivered by DIRESA
Junín has a duty and responsibility to continue this service. DIRESA Junín reminded Dr Ruiz of this
responsibility and soon after Dr Ruiz resumed full service.
A reluctance to use the referral system to specialists at Huancayo was noted.
At Rio Negro, the effectiveness of DIRESA Junín’s technical assistant system was demonstrated.
Ing. Jesus has proved to be an extremely capable and responsible technical assistant and has
transferred all images taken to date over FTP to DIRESA Junín. Jesus quickly appreciated the
Teleconsult video tutorial and successfully completed online and offline consultations. Jesus will be
the crucial link between the medics and the network operation.
DIRESA Junín have adopted the strategy of designating a technical assistant at each remote site who will
act as coordinator and bridge any gaps between the remote medics and the MEDNET system.
SM de Pangoa




Internet is exploited to send health care information (epidemiological reports etc).
Optimum use of ultrasound machines – 70+ u/s examinations per month
Ultrasound and PC equipment operational – a web cam needs to be replaced
Internal dissemination has been weak – medics seem unaware of MEDNET’s system functionalities
The MEDNET consultation room in SM de Pangoa
There are encouraging signs throughout the MEDNET sites to suggest high levels of ICT
competence and personal eReadiness. Dr Ali Larrca Mego, attending at SM de Pangoa demonstrated
how he is currently using his Blackberry to transfer images informally to colleagues for advice on
treatment (Figure 10). The key issue here is that this consultation is requested from colleagues with
whom there is a prior connection and bon. It is totally informal and storage of images would not
comply with appropriate medical standards. An additional factor is the ease of use associated with a
mobile phone. The current workflow associated with Teleconsult is deemed too time consuming.
The remote medics in Peru are technologically capable. Here Dr Ali Larrca Mego, general surgeon at SM de
Pangoa demonstrates how he seeks expert second opinion from colleagues using his Blackberry
Mazamari





High use of internet (including sending / receiving health care information) and videoconference
Ultrasound machine (TELEMED) was found in storage and is not used. Replaced by alternative, more
advanced, ultrasound model. On average 23+ u/s examinations performed monthly.
Lack of personnel – difficulty in assigning a technical assistant
On a routine visit the satellite router was located in a sub-standard location: advice provided to
mitigate risk
Poor internal dissemination of the MEDNET system
The Director of C.S. Mazamari, Dra Yuli, also confirmed a sense of professional unease at
requesting “second opinions” from the Specialists in Huancayo. The perception felt by Mazamari
(and confirmed in Puerto Ocopa, SM de Pangoa and Rio Negro) is that the Specialists were not open
and approachable. There is a professional unease at seeking advice for fear of ridicule and rejection.
Culturally, negative perceptions towards the jungle region, in part the cause of unequal distribution
of resources, exacerbates this situation. This has been the main reason for a reluctance to fully
engage with the MEDNET project to date.
Another issue to emerge from this reluctance to engage has been a fully to see how the system could
be adapted and exploited to meet specific needs.
The MEDNET consultation room at Mazamari
Mobile coverage has reached all remote sites since the start of the MEDNET project - rapid penetration of
mobile phones is phenomenal – Previously there was limited coverage beyond Satipo.
Puerto Ocopa





Computer equipment and portable computer were inoperative (in storage) and consequently the
satellite platform was not being used
(Frequent) Change of Medical personnel
New personnel untrained in use of Ultrasound machines – training required. Average of 10+ u/s
examinations performed monthly.
Unable to designate a technical assistant: currently personnel identified for this role are located in
Satipo (in receipt of training)
The new PC delivered has compatibility issues (particularly Audio)
Puerto Ocopa is the remotest site in the MEDNET project in Peru. Over 70% of its patients are native
Ashaninka. Connection and configurations to the communications element of the MEDNET
infrastructure (ie everything except for Teleconsult) were completed in December 09. However, the
PC was found to be inadequate and needed to be replaced. Training in imaging diagnostics was
provided to Medical staff but they left their post shortly afterwards.
There then followed a poor chain of command and communication and handover of roles and
responsibilities relating to the MEDNET project resulting in the new Director having very limited
knowledge of the background and content of the project. The new Director, Dra Victoria Dominguez,
also has limited experience in use of ultrasound machines and needs to access training and
capacitation in performing u/s examinations and imaging diagnostics. The current reality is that there
is a certain level of fear with using the current equipment. In order to address this issue, and a symbol
of camaraderie between health care workers within Satipo, C.S. Pangoa has offered to provide
training and practical experience in ultrasound examinations. An additional factor is that the PC
provided is still inappropriate and drivers for the microphone are missing and cannot be covered by
generic drivers.
Dra Victoria Dominguez, the new Director of C.S. Puerto Ocopa
Comas
Medics have been undertaking large number of ultrasound examinations, on average more than 46
per month, although use of Teleconsult is limited.
Pariahuanca
Personnel left their posting shortly after receiving training in April 2010. Their replacements
required training and have been rather reluctant to participate. As a consequence, less than 10 u/s
examinations are performed monthly.
Chongos Alto
Medics have been undertaking ultrasound examinations (average of 15 per month) although use of
Teleconsult is restricted.
In order to stimulate MEDNET activity, DIRESA Junín passed a resolution “obliging” daily
utilisation of the network.
Teleconsultations in Peru
In the following figure we can see the number of exams per site in Peru.
60
45
50
40
22
30
20
10
25
0
Chongos Alto
Pariahuanca
Comas
M azamari
Pangoa
Puerto Ocopa
Rio Negro
Number of exams per site in Peru.
All the teleconsultations in Peru, are Ultrasound consultations. In the following table presents more detailed
the number of exams was sent through the system to the other sites and the exams were locally consulted. The
main type of exam was obstetric and abdomen.
Sustainability
Telemedicine has pioneered the use of communication technologies within healthcare. Hence
telemedicine services are principally available for decades – some even say for as much as 130 years
(referring to an early telephone based medical consultation). Nevertheless, telemedicine in rural areas
is relative new and not so many innovative changes were reported. MEDNET is one of the pilot
telemedicine projects in Brazil & Peru.
MEDNET is a representative proof of case for telemedicine. MEDNET provides second opinion and
sometimes even first opinion, between non-expert doctors in rural areas of Brazil & Peru with expert
doctors located in big cities. Find below a testimony from a non-expert doctor in a rural area in
Brazil who participated to MEDNET:
“…some answers sent by the specialists were very useful for me…many patients here won in
the lottery, they got their diagnosis, they were operated, now they are working…this has no
price.”
The impact of MEDNET in the life of the people in rural areas was mostly huge. Therefore needs to
be finding a sustainable telemedicine plan for Brazil & Peru. Because of the different realities
between the two countries, two different sustainability strategies will be presented in the following
chapters.
In Peru, Telehealth offers the potential for electronic communication between healthcare professionals if expanded
across Junín’s 48 centro salud sites. It needs an emphasis on ultrasound and general electronic communication to create
multi-skilled teams in remote areas. An indicative assessment shows reasonable potential returns. These need confirming
with specific estimates as part of a comprehensive telehealth strategy that complies with several recognised good
practices5 in eHealth, including:
Engagement of healthcare professionals and other stakeholders from the outset
Usability
Utilisation for benefits
Creating effective multi-skilled teams
Regular reviews and corrective action
Focus on benefits and benefit realisation.
Using telehealth at all 48 centro salud sites should maximise the use of terrestrial communications instead of satellite in
some locations which will reduce costs.
An estimated cost is some PEN 27 million over ten years. Estimated benefits are some PEN 35 million with an estimated
socio-economic return of about 24%. This indicative net benefit confirms the potential for these options to be developed,
assessed and one to be pursued.
Sustainability for Brazil
Sustainability strategy is a term used to describe whatever action plan is taken to preserve an existing
resource or maintain a process over a given period of time. What in the case of MEDNET is the service to be
maintained?
Mednet impact in Brazilian rural areas (cities in agricultural regions with population under 20.000 inhabitants)
was very important in the sense that it opened everybody’s mind to the staggering possibilities unveiled by
technology and the rearrangement of existing processes.
Small cities are getting together, clustered in Consortiums, in order to accreditate and hire health services in a
agile, faster and cheaper way. This is also applicable to telemedicine.
Thus, in regions with a chronic difficulty to hire qualified physicians, a new model of health service is
potentially available, at least for those with a minimum connectivity level (see the Brazilian Broadband
National Plan and it’s goals in http://www.mc.gov.br/plano-nacional-para-banda-larga).
Scope
and Goals for 2014
access type
Collective
fixed access
To take broadband access to 100% of the organs of government including:
• 100% of the units of the Federal, States and Municipalities.
• 100% of public schools have not met (more than 70,000 rural).
• 100% of health units (177.000).
• 100% of public libraries (over 10.000).
• 100% of public safety agencies (over 14.000).
Deploy 100.000 new Federal Telecenters 2014.
5
www.ehealth-impact.org www.ehr-impact.eu
The PNBL (Brazilian Broadband National Plan) goals for 2014, although impressive are quite feasible given
the rapid development of communications and IT infrastructure in the country.
This leads to a major reduction in connectivity prices, allowing the planning of internet based services,
including SaS applications (cloud computing).
The sustainability strategy then aims to keep running a service - remote readings, and will use for that
whatever available means. Focus will be in the stability and quality of the service, its traceability and, last but
not least, cost-benefit ratio.
A detailed business plan based on the strategy above can be found in MEDNET deliverable D8.3.
Sustainability for Peru
Demography and geography
A population pyramid for the MEDNET sites reveals a young and expansive population shown in figure 3. Segmenting
the total MEDNET population by eco-region reveals that there has been a significant increase in the population in the
central jungle region, especially Rio Negro, Mazamari, Pangoa and Puerto Ocopa, as shown in figure 4. Population
forecast profiles for 2011 of the seven districts using MEDNET are broadly similar except for Chongos Alto. Here, the
population aged over 50 is a greater percentage of the total population than the other six districts. The age group aged
25 to 44 is a slightly lower percentage. The difference is between 1% and 3% points depending on the narrower age
bands.
Figure 3 - Population Pyramid for Combined Seven MEDNET Sites
Male
Female
The pyramid reveals a young and expansive population. About 40% of the MEDNET population is aged below
15 years.
The total MEDNET population is increasing in the central jungle region. Figure 4 shows the
segmented differences.
Figure 4 - Segmenting the Total MEDNET Population by Eco-region
Population
MEDNET population segmented by ecoregion
200000
180000
160000
140000
120000
100000
80000
60000
40000
20000
0
2004
central jungle region
High Andes
2005
2006
2007
2008
2009
2010
2011
Year
Health issues
There are many health issues and challenges. Infectious diseases like tuberculosis, HIV/AIDS,
malaria, leishmaniosis, Chagas’ disease, dengue, Bartonellosis, yellow fever, anthrax, and plague
remain major public health problems. Most of these are under constant surveillance either using
individual forms or tally sheets for mandatory notification. Acute respiratory diseases make up
nearly 80% of all deaths followed by 28% from urinary tract diseases. Table 2 shows the principles
causes of morbidity in Junín:
Table 2 - Principle Causes of Morbidity Registered in External Consultations June 2008
TOTAL
MALE
FEMALE
CAUSES OF MORBIDITY
Nº
%
Nº
%
Nº
%
TOTAL
1,177,420
100
414,616
100
762,804
100
Acute upper respiratory tract diseases (J00J06)
Diseases of the oral cavity, salivary glands and
jaws (K00-K14)
Intestinal infectious diseases (A00-A09)
257,263
21.8
114,471
27.6
142,792
18.7
109,324
9.3
18,105
4.4
91,219
12
73,442
6.2
35,452
8.6
37,990
5
Helminthiases (B65-B83)
46,965
4
20,929
5
26,036
3.4
Infections with predominantly sexual mode of
transmission (A50-A64)
Disorders of other endocrine glands (E20-E35)
31,924
2.7
804
0.2
31,120
4.1
31,757
2.7
47
0
31,710
4.2
Other acute lower respiratory tract diseases
(J20-J22)
Other maternal disorders mainly related to
pregnancy (O20-O29)
Other diseases of urinary system (N30-N39)
30,380
2.6
15,169
3.7
15,211
2
30,189
2.6
0
30,189
4
26,984
2.3
4,805
1.2
22,179
2.9
Diseases of the oesophagus, stomach and
duodenum (K20-K31)
25,603
2.2
7,622
1.8
17,981
2.4
Lower socio-economic classes exhibit a trend towards mental health problems, alcoholism, obesity
and tobacco abuse6. There is also a high incidence of prenatal and maternal mortality due to poor
maternal care during pregnancy and delivery. With appropriate health services, early detection of
6
Applicaciones de Telecommunicaciones en Salud en la Subregion Andina. Telemedicina. Poliszuk
and Salazar Gomez (2006). OPS/OMS.
high-risk pregnancies, and good nutrition during and after pregnancy, many of these deaths are
preventable.
A lack of trained physicians in rural areas results in an increased demand on healthcare resources in
more urban areas. However, centralised healthcare specialists present an opportunity for
telemedicine. Continuing the improvement in dealing with this wide range of diseases and
conditions, needs increased and sustained investment in the resources for health and healthcare. The
potential role and impact of Telehealth could be a valuable contribution.
Telehealth in the health system
Peru’s continuous healthcare development through its PHS and its successes in improving health since its inception
provide the context for MEDNET. It is another initiative aiming to enhance the performance of PHS, and exploring the
potential of ICT as a new approach to improving healthcare.
There is a plan for Telehealth. In April 2003, the Ministry of Transport and Communications (MTC)
created the National Telehealth Committee (RS Nº 009-2003-MTC). Its members are representatives
of the MTC, National Institute for Research and Training in Telecommunications (INICTEL), the
telecommunications regulator (OSIPTEL), National Institute of Statistics and Informatics (INEI),
EsSALUD and MINSA. It produced the National Plan for Telehealth approved in 2005 by the MTC
(DS Nº. 028-2005-MTC).
The Plan proposed an Integrated Telehealth System to increase the provision of healthcare services
in underserved and remote areas. Most of the policies deal with general ICT matters, developed
outside the health sector. Significantly, there is very low compliance to these policies.
A scoping document for Telehealth in October 2008 designated responsibility to the regional
DIRESAs. Norma Tecnica de Salud de Telesalud (NTS No 067-MINSA/DGSP-V.01). It concludes
that each DIRESAs is responsible for developing a plan to implement the Technical Law in
healthcare establishments under their jurisdiction to incorporate the different telehealth applications,
including information and capacity-building activities. Although recent WHO policy publications
highlight how, if properly applied, telehealth solutions can effectively contribute to the health
MDGs, Peru has still to make progress. Attempts to redress this situation by involving DIRESA
Junín include developing an eHealth network to improve maternal and child healthcare. In 2010,
about 13% of Junín’s population accessed healthcare at a facility benefiting from telehealth
technologies. This could increase to 15% of the population based on current population growth
trends.
These limited telehealth initiatives parallel an uncoordinated ICT strategy for healthcare.
Consequently, there is a fragmented health information system both between the various healthcare
providers and within MINSA. Most ICT projects are individual initiatives developed by universities
and NGOs. Peru is at an emergent stage in eHealth. MEDNET provides an opportunity to advance in
part of this field.
Telehealth in Junín
Organisations
DIRESA Junín is an organ of the Regional Government of Junín. It is legally responsible for
delivering healthcare in the Junín region and regulating the laws concerning doctors in the region.
DIRESA Junín controls seven hospitals, 48 health centres, the centro salud (CS) and 374 more rural
health outposts, the puesto salud (PS).
Healthcare Establishments in Junín Region, Peru.
Region
Valle
del
Mantaro
Jauja
Tarma
Chanchamayo
Satipo
Junín
Total
MINSA/DIRESA Junín
OTHER
Total Hospital CS PS
139
2
25 112
IPSS PNP
2
1
FFAA Private
1
10
153
69
58
51
91
21
429
10
2
2
1
1
18
1
0
0
0
0
2
1
1
1
1
1
7
10
5
3
2
3
48
58
52
47
88
17
374
1
1
1
1
0
5
Total
5
6
3
0
2
26
86
67
57
93
24
480
The regional government in Junín published its vision that by 2012 “the region is healthy,
productive, with a high index of human development, an integrated health system, which is efficient,
united and transparent and guarantees the rights and equal access to a quality service to the most
vulnerable sections of the community”7.
Limited telehealth facilities using MEDNET are deployed at the referral hospital D A Carrion and
seven remote health centres at Rio Negro, Mazamari, SM de Pangoa, Puerto Ocopa, Comas,
Pariahuanca and Chongos Alto. All these are controlled by DIRESA Junín.
Concepcion
Huancayo
Satipo
Comas
Chongos Alto
Pariahuanca
Mazamari
Saint Martin de Pangoa
Rio Negro
Puerto Ocopa
Telehealth and Junín’s eHealth strategy
Two main features of Junín’s healthcare system are:
It faces a wide range of diseases and conditions
Many people have to travel very long distances for healthcare.
These indicate that the goal of an eHealth strategy should be to improve access to healthcare for a
wide range of people and many different types of patients.
At telehealth sites in Junín, many patients have to travel long distances to reach a rural health centre,
the puesto de salud. Often, due to a lack of basic diagnostic equipment and medicines and an
inability to obtain an expert opinion, local doctors refer patients to other facilities, especially district
hospitals. Many patients are unable to deal with this cost, so are either unable to access appropriate
healthcare or are assisted by their doctor’s personal generosity.
Currently, using teleHealth is not part of the regional strategy. Such an initiative is consistent with
Junín’s vision that by 2012 “the region is healthy, productive, with a high index of human
7
Plan Concertado, Regional Government of Junín.
development, an integrated health system, which is efficient, united and transparent and guarantees
the rights and equal access to a quality service to the most vulnerable sections of the community”8.
There is a need to develop eHealth policies, strategies and infrastructure, including developing and
improving standards, protocols, and training in medical and health informatics.
In October 2010, the regional government changed. Initially, the new administration identified a
need for an integrated health information system. This offers new opportunities. Innovations need to
develop locally relevant telehealth solutions for the region. MEDNET offers a way to start the
finance research, development and implementation in this area9.
Health services affected
According to MINSA’s statistics for Human Resources in 2009, 9% of doctors in the Junín region
are involved in the MEDNET project. Three of the health centres, the centro salud, in DA Carrion,
the referral hospital in Valle del Mantaro, and four health centres in Satipo, two centro salud and two
puesto de salud, are part of MEDNET. These represent 2% of healthcare facilities for 13% of the
population.
Number of DIRESA Junín Establishments in MEDNET
Region
MINSA/DIRESA Junín
Total Hospital CS
Valle
del 4
1
3
Mantaro (High
Andes)
Satipo (central 4
0
2
jungle region)
Total
8
1
5
PS
0
2
2
The main health services support by MEDNET are for maternal and child health. Ultrasound
equipment and training is now in place for maternity services, and is available for other conditions.
The infrastructure provides a broadband and Internet link for all healthcare professionals at the sites
to use to connect directly to other healthcare professionals and to health information available on the
Internet.
The range of diseases and conditions that the MEDNET pilot supports is narrower than the health
challenges summarised at 2.3 Health issues. This sustainability plan reviews the potential of
telehealth for all 48 centro salud sites over several years.
This section must be of suitable quality to enable direct publication by the Commission and should
preferably not exceed 40 pages. This report should address a wide audience, including the general
public.
The publishable summary has to include 5 distinct parts described below:

8
9
An executive summary (not exceeding 1 page).
Plan Concertado, Regional Government of Junín.
Curioso, W., Castagnetto, J., et al. eHealth in Peru (2008): A Country Case Study

A summary description of project context and objectives (not exceeding 4 pages).

A description of the main S&T results/foregrounds (not exceeding 25 pages),

The potential impact (including the socio-economic impact and the wider societal
implications of the project so far) and the main dissemination activities and exploitation of
results (not exceeding 10 pages).

The address of the project public website, if applicable as well as relevant contact details.
Furthermore, project logo, diagrams or photographs illustrating and promoting the work of the
project (including videos, etc…), as well as the list of all beneficiaries with the corresponding contact
names can be submitted without any restriction.
Use and dissemination of foreground
Section A (public)
TEMPLATE A1: LIST OF SCIENTIFIC (PEER REVIEWED) PUBLICATIONS, STARTING WITH THE MOST IMPORTANT ONES
NO. Title
1
2
3
E-Health in Practice – No.2 HealthConnect
International
http://www.ehealthnews.eu/content/view/1087/66/
Article: “Para o CETA, o longe não existe” at the
magazine “Revista Indústria em Ação” (Industry
in Action Magazine)
“DVB technologies for an improved World
MedNET: Intelligent DVB Satellite at the service
of Telemedicine”,HISPASAT
10
Title of
the
Main
Number, date
Place of Year
of Relevant
periodical
Publisher
author
or frequency
publication publication pages
or
the
series
June
2008
Permanent
identifiers10
(if
available)
19
July 2009
DVB
World
2010,
Lisbon
A permanent identifier should be a persistent link to the published version full text if open access or abstract if article is pay per view) or to the final manuscript accepted for publication (link
to article in repository).
11 Open Access is defined as free of charge access for anyone via Internet. Please answer "yes" if the open access to the publication is already established and also if the embargo period for open
access is not yet over but you intend to establish open access afterwards.
Is/W
ope
acc
pro
thi
pub
NO. Type of activities12
Main leader
Title
Despoina Rizou present the paper “Satellite based health
network in Brazil and Peru”
TAS-E will present the paper “Telemedicine over remote areas
through AmerHis Regenerative DVB-RCS/S Platform”.
ITAB2008&IS3BHE2008 30-31/5/2008
1
Conference
2
Conference
3
Conference
Wayne Menary: networking opportunity
4
Conference
5
Date
Place
Shenzhen,
China
14th Ka and Broadband
Communications
Conference
IV Regional ATALAAC
MEETING 2008 –
24-26/09/2008
Dimitris Panopoulos will present “MEDNET: Telemedicine via
satellite combining improved access to health care services with
enhanced social cohesion in rural Peru”
ISD2008
Aug 25-27
Conference
Wayne Menary to present “Telemedicine via satellite: linking
eHealth and development in rural Peru and Brazil”
INFOLAC 2008
Oct 30 – 01
Nov
Buenos
Aires,
Argentina
6
Conference
ICS2008
Nov 08
7
Conference
“Health Network in Peru and Brazil”
Despoina Rizou
Wayne Menary to present: MedNET: Establishing a sustainable
eHealth initiative in rural Peru and Brazil
TeleMed & eHealth 08
Nov 24 &25
Tamsui,
Taiwan
London, UK
8
Conference
Exhibition: eHealth via satellite in Peru and Brazil
ICT 2008
Nov 25-27
9
Conference
Jon Haitz Legarreta – Chairman of “Telehealth, Telecare and
Services” – Presents last developments on Vital Sign
Monitoring.
Med-e-Tel
16-18/4/2008
12
Aug 15-17
Panama
City,
Panama
Paphos,
Cyprus
Lyon,
France
Luxemburg
A drop down list allows choosing the dissemination activity: publications, conferences, workshops, web, press releases, flyers, articles published in the popular press, videos, media
briefings, presentations, exhibitions, thesis, interviews, films, TV clips, posters, Other.
10
Conference
11
Conference
12
Conference
Telecom I+D Congress.
13
Conference
“Broadband health care network in Brazil and Peru “
Despina Rizou
14
Conference
15
Conference
“TraumaStation: A portable Telemedicine station”
Despina Rizou
MedNET: TeleMedicine over AmerHis system
Jon Haitz Legarreta presents last developments on Vital Sign
Monitoring.
XXIII Simposium Nacional de la Unión Científica Internacional
de Radio (URSI).
THALES
16
Conference
 Mr. Jon Legarreta (VT)
 Mrs. Cristina Arias Perez (HISPASAT)
 Mr. Antonio Arana (HISPASAT)
 Mr. Ekaitz Gonzalez (HISPASAT)
 Mrs. Ana Solano (TASE)
 Mrs. Carla Salas (TASE)
 Mr. Juan Ramón Gonzalez (TASE)
 Mrs. Ana Yun Garcia (TASE)
 Mr. Floiran Callupe (GEOPAC)
 Mrs. Despoina Rizou (IGD)
 Mr. Luca Salvatore (MEDCOM)
CARS
25-28/06/2008
MEDNET: Intelligent
satellites in the service of
Telemedicine
MEDNET: Intelligent
satellites in the service of
Telemedicine
Eatis2008- Euro
American conference on
Telematics and
Information Systems
EMBC 2009,
23-24/9/2008
IWSSC 2009,
International Workshop
on Satellite and Space
Communications
(IWSSC 2009)
10-11/09/2009
Workshop in Madrid
02/02/0905/02/09
29-31/10/2008
September 1012
2-6/09/2009
Minneapolis,
USA
Italy
Madrid
 Mr. Alex Bernsts Tronchoni (CETA)
17
Conference
“Traumastation: A telemedicine tool”
Despina Rizou
MEDETEL,
14-16/04/2010
Luxembourg
18
Exhibitiom
Rizou Despina: Promotion and establishment of synergies thus
ensuring sustainability and dissemination of MEDNET
CeBIT,
04-06/03/2010
Hannover
19
Conference
Rizou Despina: Promotion and establishment of synergies thus
ensuring sustainability and dissemination of MEDNET
ICT Conference 2010,
27-29/09/2010
Brussels
20
Conference
Rizou Despina: Poster presentation
ITAB 2010,
02-02/11/2010
Corfu
21
Conference
Matelec exhibition
MEDNET poster ,HISPASAT
 HISPASAT representatives (HISPASAT’s president,
directives, sales managers, etc) mention MedNet project
in several European and American congresses and events
related to the Telecommunication and Satellite sector as
well as in interviews offered in press and television.
25/10/2010
22
Exhibition
MEDNET presentation , HISPASAT
Satellite
23
Conference
Dr. Bruno Hochhegger, Santa Casa Hospital, Porto Alegre,
Brazil
Medetel: Latin America
Health Care Network
under the Global eHealth
Strategy Symposium
30-31/5/2008
Washington
Luxembourg
6-8 April 201
Section B (Confidential13 or public: confidential information to be marked clearly)
Part B1
TEMPLATE B1: LIST OF APPLICATIONS FOR PATENTS, TRADEMARKS, REGISTERED DESIGNS, ETC.
Confidential
Click
on
YES/NO
Type of
Rights14:
IP
Foreseen
embargo date
dd/mm/yyyy
Application
reference(s)
(e.g.
EP123456)
Subject or
application
title
of
Applicant (s) (as on the application)
13
Note to be confused with the "EU CONFIDENTIAL" classification for some security research projects.
14
A drop down list allows choosing the type of IP rights: Patents, Trademarks, Registered designs, Utility models, Others.
Part B2
Type
of
Exploitable
Foreground15
Description
of exploitable
foreground
Ex:
New
superconduc
tive Nb-Ti
alloy
Confidentia
l
Click
on
YES/NO
Foreseen
embargo
date
dd/mm/yy
yy
Exploitable
product(s)
measure(s)
or
MRI equipment
Sector(s)
of
application16
1. Medical
2.
Industrial
inspection
Timetable,
commercial or
any other use
2008
2010
Patents or other
IPR
exploitation
(licences)
A
materials
patent is planned
for 2006
Owner
&
Other
Beneficiary(s) involved
Beneficiary X (owner)
Beneficiary Y, Beneficiary
Z, Poss. licensing to
equipment manuf. ABC
In
19
A drop down list allows choosing the type of foreground: General advancement of knowledge, Commercial exploitation of R&D results, Exploitation of R&D results via standards,
exploitation of results through EU policies, exploitation of results through (social) innovation.
16 A drop down list allows choosing the type sector (NACE nomenclature) : http://ec.europa.eu/competition/mergers/cases/index/nace_all.html
Report on societal implications
A
General Information (completed automatically when Grant Agreement number is
entered.
Grant Agreement Number:
Title of Project:
Name and Title of Coordinator:
B
215479
Latin America Health Care Network
Despoina Rizou
Ethics
1. Did your project undergo an Ethics Review (and/or Screening)?

If Yes: have you described the progress of compliance with the relevant Ethics
Review/Screening Requirements in the frame of the periodic/final project reports?
YES
Special Reminder: the progress of compliance with the Ethics Review/Screening Requirements should be
described in the Period/Final Project Reports under the Section 3.2.2 'Work Progress and Achievements'
2.
Please indicate whether your project involved any of the following issues (tick YES
box) :
RESEARCH ON HUMANS
 Did the project involve children?
 Did the project involve patients?
 Did the project involve persons not able to give consent?
 Did the project involve adult healthy volunteers?
 Did the project involve Human genetic material?
 Did the project involve Human biological samples?
 Did the project involve Human data collection?
RESEARCH ON HUMAN EMBRYO/FOETUS
 Did the project involve Human Embryos?
 Did the project involve Human Foetal Tissue / Cells?
 Did the project involve Human Embryonic Stem Cells (hESCs)?
 Did the project on human Embryonic Stem Cells involve cells in culture?
 Did the project on human Embryonic Stem Cells involve the derivation of cells from Embryos?
PRIVACY
 Did the project involve processing of genetic information or personal data (eg. health, sexual
lifestyle, ethnicity, political opinion, religious or philosophical conviction)?
 Did the project involve tracking the location or observation of people?
RESEARCH ON ANIMALS
 Did the project involve research on animals?
 Were those animals transgenic small laboratory animals?
 Were those animals transgenic farm animals?
 Were those animals cloned farm animals?
 Were those animals non-human primates?
RESEARCH INVOLVING DEVELOPING COUNTRIES
 Did the project involve the use of local resources (genetic, animal, plant etc)?
 Was the project of benefit to local community (capacity building, access to healthcare, education
etc)?
DUAL USE
 Research having direct military use
YES
YES
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
YES
NO

NO
Research having the potential for terrorist abuse
C
Workforce Statistics
3.
Workforce statistics for the project: Please indicate in the table below the number of
people who worked on the project (on a headcount basis).
Type of Position
Number of Women
Number of Men
Scientific Coordinator
Work package leaders
Experienced researchers (i.e. PhD holders)
PhD Students
Other
4
2
1
1
7
3
4
0
4.
How many additional researchers (in companies and universities) were 12
recruited specifically for this project?
Of which, indicate the number of men:
9
D Gender Aspects
5.


Did you carry out specific Gender Equality Actions under the project?
6.
Yes
No
Which of the following actions did you carry out and how effective were they?





Not
at
effective
Design and implement an equal opportunity policy
Set targets to achieve a gender balance in the workforce
Organise conferences and workshops on gender
Actions to improve work-life balance
all




Very
effective




Other:
Was there a gender dimension associated with the research content – i.e. wherever people were
7.
the focus of the research as, for example, consumers, users, patients or in trials, was the issue of gender
considered and addressed?
 Yes- please specify

No
E
Synergies with Science Education
8.
Did your project involve working with students and/or school pupils (e.g. open days,
participation in science festivals and events, prizes/competitions or joint projects)?
 Yes- please specify

No

9.
Did the project generate any science education material (e.g. kits, websites, explanatory
booklets, DVDs)?
Project website, Tutorial for
 Yes- please specify
the system use, Manuals for the
software
 No
F
Interdisciplinarity
10.
Which disciplines (see list below) are involved in your project?
 Main discipline17:

Associated discipline17:
 Associated discipline17:
G
Engaging with Civil society and policy makers
Did your project engage with societal actors beyond the research 

community? (if 'No', go to Question 14)
11a
Yes
No
11b If yes, did you engage with citizens (citizens' panels / juries) or organised civil society
(NGOs, patients' groups etc.)?
 No
 Yes- in determining what research should be performed
 Yes - in implementing the research
 Yes, in communicating /disseminating / using the results of the project
17
Insert number from list below (Frascati Manual).

Yes
11c In doing so, did your project involve actors whose role is mainly to 
No
organise the dialogue with citizens and organised civil society (e.g.
professional mediator; communication company, science museums)?
12. Did you engage with government / public bodies or policy makers (including international
organisations)




No
Yes- in framing the research agenda
Yes - in implementing the research agenda
Yes, in communicating /disseminating / using the results of the project
13a Will the project generate outputs (expertise or scientific advice) which could be used by
policy makers?
 Yes – as a primary objective (please indicate areas below- multiple answers possible)
 Yes – as a secondary objective (please indicate areas below - multiple answer possible)
 No
13b If Yes, in which fields?
Education, Training, Youth
Public Health
13c If Yes, at which level?
 Local / regional levels
 National level
 European level
 International level
H
Use and dissemination
14.
How many Articles were published/accepted for publication in 3
peer-reviewed journals?
To how many of these is open access18 provided?
3
How many of these are published in open access journals?
3
How many of these are published in open repositories?
0
To how many of these is open access not provided?
0
Please check all applicable reasons for not providing open access:
 publisher's licensing agreement would not permit publishing in a repository
 no suitable repository available
 no suitable open access journal available
 no funds available to publish in an open access journal
 lack of time and resources
 lack of information on open access
 other19: ……………
How many new patent applications (‘priority filings’) have been made? 0
15.
("Technologically unique": multiple applications for the same invention in different
jurisdictions should be counted as just one application of grant).
Indicate how many of the following Intellectual Trademark
Property Rights were applied for (give number in
Registered design
each box).
16.
Other
17.
0
0
0
How many spin-off companies were created / are planned as a direct 0
result of the project?
Indicate the approximate number of additional jobs in these companies:
18. Please indicate whether your project has a potential impact on employment, in comparison
with the situation before your project:

In small & medium-sized enterprises
 Increase in employment, or

Safeguard
employment,
or
In large companies


None of the above / not relevant to the project
 Decrease in employment,
Difficult
to
estimate
/
not
possible
to
quantify

19.
For your project partnership please estimate the employment effect Indicate figure:
resulting directly from your participation in Full Time Equivalent (FTE =
one person working fulltime for a year) jobs:
18
Open Access is defined as free of charge access for anyone via Internet.
19
For instance: classification for security project.

Difficult to estimate / not possible to quantify
I
Media and Communication to the general public
20.
As part of the project, were any of the beneficiaries professionals in communication or
media relations?
 Yes
 No
21.
As part of the project, have any beneficiaries received professional media / communication
training / advice to improve communication with the general public?
 Yes
 No
22
Which of the following have been used to communicate information about your project to
the general public, or have resulted from your project?

Coverage in specialist press
 Press Release

Coverage in general (non-specialist) press
 Media briefing

TV
coverage
/
report
Coverage in national press


Radio
coverage
/
report
Coverage in international press


Website for the general public / internet
 Brochures /posters / flyers

DVD
/Film
/Multimedia
Event targeting general public (festival, conference,

exhibition, science café)
23
In which languages are the information products for the general public produced?


Language of the coordinator
Other language(s)

English