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DEVELOPPEMENT ET EXPLOITATION. The principal application was executed in 1996 by Tunisian and French doctors working in kids scholarly healing facility of Tunis and in LaTimone clinic of Marseille France :. Every USER TERMINAL IS EQUIPPED BY :. * A Basic PC with great screen 19\"* A Network interconnexion TCP/IP Mode, utilizing ISDN Network 128 Kb/s* Standard MS Office Tools* Internet Browser* So

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Video cam ISDN DEVELOPPEMENT ET EXPLOITATION Telemedecine application was distinguished in 1995 in the Health Telematics Plan Studies – (1996 – 2000) period. The main application was actualized in 1996 by Tunisian and French doctors working in youngsters scholastic healing center of Tunis and in LaTimone doctor's facility of Marseille France : * Exchange Medical Data Package : X Ray pictures, Medical archives and Informations about Patient * Remote Assistance : Telediagnosis, Teleconsulting, Teleassistance * create examine participation * Exchange some preparation Case - Supports EACH USER TERMINAL IS EQUIPPED BY : Hospital * A Basic PC with brilliant screen 19" * A Network interconnexion TCP/IP Mode, utilizing ISDN Network 128 Kb/s * Standard MS Office Tools * Internet Browser * Software Medical Document Management (Sigmacom) * Document Scanner * X Ray picture Scanner A3 Scanner A4 Printer Documents Video cam L A

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Video cam Scanner A3 Scanner A4 ISDN The second application was executed in 1996 by doctors working in the anticancerous foundation of Tunis and Lacassagne Anticancerous Hospital of Nice France * It finishes the primary experience by telepathology application and Videoconferencing application * Exchange finish therapeutic information bundle : filters, X-RAY picture , PATOLOGY ANATHOLOGY picture, analysis, reports. * Real time checking of apparatuses (Microscope) * Medical archive acces amid the meeting * Training and bolster informations EACH USER TERMINAL IS EQUIPPED BY : - Basic PC (Pentium) - High Quality Scren 19" - Standard MS Office Tools - Network bury association on TCP/IP Mode : * ISDN connxion 128 Kb/s speed for telemedicine applications (Transfer,monotoring) * ISDN association 384kb/s speed for Videoconferencing Internet Browser - Conferencing gear (Tv Monitor - Mobile camera, settled camera, receiver, amplifiers… .) - Conferencing programming on H320 standard. - Real time procurement/checking Interfaces. - Software restorative archive administration (Mediolis). - Image standard transformation DICOM3/JPEG - restorative Peripherals (Scanners And Micoscope Medical Devices) – Telemedecine station Hospital Printer Documents Video cam L A

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THE TELEMEDECINE COMMITEE The Development Of Information Society over the world, The meaning of a strong national approach on data innovation in Tunisia The vital telecomunication speculation advance in Tunisia The Vertiginous development of telecomunication advances and interactive media frameworks The accessibility of PCs abilities. The positive telemedecine encounter assessment and sudden awarness of it advantages. Proposed to the Health Ministry to characterize Telemedicine approach : * For characterizing technique and keeping of the arrangement accomplishment a national board of trustees of telemedicine was constitued by pastor choice on 15 May 1996. Individuals ARE : * General Director of Health - Public wellbeing Ministry * Representative individual from Science Research and Technology secretary of state. * Representative individual from Informatics and Internet secretary of state. * Representative individual from Public media transmission Operator : Tunisia Telecom Working accomplice is the wellbeing service informatics focus. Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP

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TELEMEDECINE APPLICATION : The Telemedecine system is constitueted by : 3 FRENCH SITES : Acces mic doctor's facility - Latimone Marseille - Lacassagne Nice - CHU Grenoble 4 Specialized HEALTH Centers IN TUNISIA : - Children Hospital - Tunis -   Cancerous Institute - Tunis -   National Neurology Institute -   National Orthopedic Institute 3 GENERAL ACADEMIC HOSPITALS -   Rabta Hospital -   Charles Nicolle Hospital -   La Marsa Hospital 3 REGIONAL HOSPITALS : -   Le Kef Hospital – Western North -   Gafsa Hospital – Western Saouth -   Gabes Hospital – Eastern Saouth THE APPLICATION ARE : TELERADIOLOGY – TELEPATHOLOGIE AND VIDEOCONFERENCING

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Video cam Scanner A4 ISDN Technical Architectue of a Telemedicine Solution : Exemple : TELERADIOLOGY Hospital 1 Scanner A3 3x 128Kb Printer Hospital 2 Router Documents Video cam ISDN – 1x128Kb Imagery equipement RJ 45 L A Router Imagery equipements LAN Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP

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TECHNICAL CONSIDERATIONS Adoption of commun measures : an absolute necessity for savvy trade of any data : - Facilitate ther catching , sase correspondence and organized administration - TCP/IP Network Protocol - DICOM 3 : Direct aquisition of picture equipement convention - HL7 : Direct Acquisation off Laboratory Results convention - H320 – H323 : Videoconferencing convention to give voice – Data and Video - NTSC, PAL , SVGA : arrange Video - G711 – G722.1 Standared Audio - T120 : Remote sharing application convention - JPEG – MPEG : Imaging Format Protocol - HTML : Document Format Protocol This to fulfill : Compatibility and Interoperability between diffirent systemS Adoption of picture information and formally dressed security method - User : Profile and Institution - Content : Primarely informations and learning - Usage : Management and administration - Technological candidates : Computing, Networking and Telecomunication

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APPLICATIONS REPARTING NEW STRATEGY TO HAVE PRIORITY Defined in Health Telematics arrange studies for 2001-2005 period. Comprise to go on national healthnet over which would collaborate on sharing patient records. 4 Academic specific doctor's facilities : * Tunis Children Hospital * Tunis Anticancerous Institute * Tunis Orthopedic Institute * Tunis Neurological Institute 8 General Academic doctor's facilities: * Charles Nicole Hospital in Tunis * La Rabta Hospital in Tunis * Aziza Othmana Hospital in Tunis * Mongi Slim Hospital in Tunis * Farhat Hached Hospital in Sousse * Fattouma Bourguiba Hospital in Monastir * Tahar Sfar Hospital in Mahdia * Habib Bourguiba Hospital in Sfax

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2 Regional doctor's facilities arranged in Western North: * Le Kef Regional Hospital * Jendouba Regional Hospital 2 Regional doctor's facilities arranged in Western South : * Gafsa Regional Hospital * Tozeur Regional Hospital 2 Regional clinics arranged in Eastern South : * Zarzis Regional Hospital * Gabes Regional Hospital participation with European establishment * 4 French Academic Hospital s : Marseille – Nice – Grenoble - Toulouse * 1 Belgium Hospital: ERasme Hospital * 1 Italian Hospital : ST.Rafaelle Hospital Rome All these associations are prepared by * Teleradiology arrangement * Telephatlogy arrangement * Videoconferencing arrangement

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ISDN ERasme Hospital Bruxelles ALGERIA { Tunis Jendouba Le Kef WESTERN NORTH Sousse Sfax { } Gafsa Tozeur Grenoble WESTERN SAOTH Zarzis Gabes EAST SOUTHERN Purpan Toulouse Hospital La Cassagne (Nice) LYBIA Latimone Marseille ST.Rafaelle Hospital Rome Sit Expo – 2004 CASABLANCA – MAROC - Mongi MILED – Expert TIC – DG CIMSP

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SOUSSE MONASTIR 1 3 1 2 1 36 2 1 Hospital and Medecine Universities Health Map 15 Acadimic doctor's facilities 3 Regional doctor's facilities 1 Medecine Faculty 2 Hight School of wellbeing Science And Technologies Bizerte TUNIS 2 Acadimic doctor's facilities 1 Regional doctor's facilities 1 Medecine Faculty JENDOUBA BEJA NABEUL ZAGHAOUN LE KEF SELIANA 1 Acadimic doctor's facilities 2 Regional doctor's facilities 1 Medecine Faculty 1 Hight School of wellbeing Science And Technologies KAIRAOUN KASSERINE MEHDIA SIDI BOUZID SFAX 2 Acadimic doctor's facilities 3 Regional doctor's facility 1 Medecine Faculty 1 Hight School of wellbeing Science And Technologies GAFSA ALGERIE DJERBA TOZEUR GABES ZERZIS MEDNINE Regional doctor's facilities KEBILI BENGERDEN TATAWINE LIBYE

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OBJECTIVES : Extend proficient administrations and employments of gear to remote and provincial zones Raise the level of finding administrations Contribute to the value of access by all the populace to quality care administrations Avoid unfruitful departure of wiped out patients to scholarly doctor's facility from territorial doctor's facility Increase the efficiency of the every day work of wellbeing experts or authorities Provide capable joint effort device for at the same time staff work when the case concern a basic circumstance or a basic approach matter Improve the support on determination and proposed treatment (Neurology crises - Orthopedic crises… ). Give intelligent Video conferencing capacities and teleradiological perusing sending information and Images Plan the telestaff and keep experts and masters in contact with the last advancements. Upgrade inquires about and therapeutic logical productions joined by Image and patient archives. Build up a huge wellbeing data framework. Spread the restorative training to any individual from system scattered over scholarly, territorial doctor's facilities or neighborhood mind focuses.

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EVALUATION  Encourage the value through offering same wellbeing utilities of all nationals. Telemedecine applications will : Encourage doctors, specialts and youthful experts to work in the long path district in the local and nearby healing facilities. Guarantee a supported preparing and experience for all medicinal segment. Stay away from the unrewarding patient transport and unless examination (X-RAY, pathology, loboratory investigation) Enhance the medicinal research and the support in worldwide research programs Permit to create preparing to have entry to general knowlege bases Au vu des objectifs arrêt é s Partage des connaissances entre praticiens

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Meilleur usage des é quipements m é dicaux lourds standard : Le Parr