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Tele-Ophthalmological Services - Citizen-centred Applications (TOSCA)

Objective

TOSCA is a merger of major European initiatives aiming at the reduction of blindness by the use of citizen-centred telemedical applications in ophthalmology. The focus is on diabetic retinopathy (DR) and glaucoma, which are the most frequent causes of blindness in Europe. Besides the suffering of patients affected, both diseases cause immense costs. TOSCA provides a technical platform based on European and other international standards. On this platform, telescreening services for early detection of DR and glaucoma will be implemented. Image processing and reference image databases improve the efficiency of DR screening and support quality assurance. Compliance and quality of care for glaucoma will be improved by home monitoring, telecommunication among home-based patients and physicians, and a patient-centred glaucoma information system. Services will be implemented and evaluated at three test sites.


Objectives:
TOSCA's overall objective is to establish citizen/patient centred telematic services in ophthalmology. TOSCA will contribute to the reduction of blindness caused by diabetic retinopathy (DR) and glaucoma which are the most frequent causes of blindness in Europe.

In detail TOSCA will:

1) Establish a telemedical platform based on European technological and terminological standards. TOSCA unifies the data and information exchange among the main European initiatives in tele-ophthalmology

2) Improve early detection of DR by implementation of telescreening services, automatic image processing, and a reference image database

3) Improve early detection of glaucoma by implementation of telescreening services

4) Improve compliance and quality of therapy by implementation of a home-monitoring system and a patient-centred telecommunication system for glaucoma

5) Improve compliance by implementation of a patient-centred Glaucoma Information System.

Work description:
To meet the objectives TOSCA is sub-divided into four co-operating undertakings:
1) TOSCA - Infrastructure,
2) TOSCA - Diabetic retinopathy,
3) TOSCA - Glaucoma and
4) TOSCA - Imaging. TOSCA is based on the results and experience of the OPHTEL project (Telematics in Ophthalmology) and other initiatives.

TOSCA - Infrastructure develops the communication infrastructure for the other applications. This infrastructure will be based on existing or evolving international standards for data exchange and integration as XML and DICOM for imaging, and CORBA med. To ensure privacy and security of patient data European standards (e.g., TrustHealth) will be implemented. To achieve data integration on a semantic level, TOSCA will work on a harmonised ophthalmologic terminology. A terminology server will provide descriptive definitions, hierarchical relations among concepts, and language specific terms. Access to services will be managed by a telemedical brokering service. The broker provides users with information on the availability of services (e.g., for telescreening), language of service, the physician or hospital providing the service, etc. The broker has the function of a portal for a virtual teleopthalmologic service centre. Services offered by the virtual centre will be telescreening, monitoring, image processing, and knowledge-based information systems with reference image databases. TOSCA - Diabetic Retinopathy focuses on screening. In several European countries screening and telescreening projects have been developed. TOSCA will help these initiatives to establish sustainable real-life services of high quality. TOSCA - Imaging develops software for automatic assessment of the quality of fund us images and classification of lesions. It contributes to the quality and cost effectiveness of telescreening. TOSCA - Glaucoma develops a telescreening prototype and a monitor to support identification and management of glaucoma patients.

Milestones:
TOSCA projects develops a platform and a set of interoperable services for screening, monitoring and shared care of patients with DR and glaucoma. The results can be transferred to other medical domains.
.At T18 the development of core technologies will be finished and integration will start.
.At T24 integrated services and the broker are available and evaluation in field will start.
.At T36 evaluated services are available. Exploitation and transfer of results will start.
TOSCA, has developed a platform and a set of interoperable services. Telescreening for Diabetic Retinopathy (DR) and Glaucoma as well as telemonitoring for Glaucoma are the main applications in TOSCA. They are realised on the basis of a common telemedical infrastructure enabling all underlying functionality including work flow modelling. The TOSCA telescreening system is based on a standardised protocol which was developed on the basis of the already existing experiences. The Telescreening has been tested in South Wales (UK), Aarhus county (Denmark), Trier/Bavaria (Germany), Dublin (Ireland),and Prague (Czech Republic). Colour fundus images are taken by Topcon and other fundus cameras. These cameras are capable of producing and storing digital images of sufficient quality. These software packages have an interface to the common telemedical infrastructure for communication. Topcon and Occuco were developing this system as a DICOM standard conforming solution in communication with the Medstage communication service.

There are different country-related solutions for the telescreening setting depending on the national healthcare system. The quality assurance policy follows the policy defined at the European level. A three phased evaluation process (Technical Pilot Study, Feasibility Study, Controlled Effectiveness Study) was performed. Training courses were developed and tested for photographers and screeners. Experience exists for both parts. Training is provided in audit techniques which facilitates local control in each country to a common European standard (for details see D3-3). Telemonitoring of glaucoma patients is based on the self-measurement of the intra ocular pressure (IOP) by the patient using a so called self-tonometer provided by EPSa Ltd. Saalfeld Germany. Patients get an individual training by their physicians how to use the technical equipment. Four test patients (from Aarhus, Erlangen, Munich and Thessaloniki) gave feedback on the appropriateness of this solution.

Funding Scheme

CSC - Cost-sharing contracts

Coordinator

GSF FORSCHUNGSZENTRUM FUER UMWELT UND GESUNDHEIT, GMBH
Address
Ingolstaedter Landstrasse 1
85764 Neuherberg
Germany

Participants (9)

AARHUS UNIVERSITY HOSPITAL
Denmark
Address
Noerrebrogade 44
8000 Aarhus
ADAKOS GMBH - ADVANCED KNOWLEDGE SOLUTIONS
Germany
Address
Ingolstaedter Landstrasse 1
85764 Neuherberg
ARISTOTLE UNIVERSITY OF THESSALONIKI
Greece
Address
University Campus, Administraton Building
54124 Thessaloniki
CARDIFF UNIVERSITY
United Kingdom
Address

CF10 3XQ Cardiff
FRIEDRICH-ALEXANDER UNIVERSITAET ERLANGEN - NUERNBERG
Germany
Address
Schlossplatz 4
91054 Erlangen
IMPERIAL COLLEGE OF SCIENCE, TECHNOLOGY AND MEDICINE
United Kingdom
Address
South Kensington Campus
SW7 2AZ London
KING'S COLLEGE LONDON
United Kingdom
Address
Strand
WC2R 2LS London
SIEMENS AKTIENGESELLSCHAFT
Germany
Address
Wittelsbacherplatz 2
80333 Muenchen
TECHNISCHE UNIVERSITAET MUENCHEN - KLINIKUM RECHTS DER ISAR
Germany
Address
Ismaninger Strasse 22
81675 Muenchen