Teleradiology is the most advanced telemedicine application in Germany. CHILI GmbH from Dossenheim is one of the companies that has contributed to driving the development of teleradiology forward. The company specialises in PACS and teleradiology systems and helps connect clinics and physicians.
When the CHILI software was placed on the market in 1997, nobody could foresee the impact digitisation would have on peoples’ lives over 20 years later. Dr. Uwe Engelmann, computer scientist André Schröter and Prof. Dr. Hans-Peter Meinzer were pioneers of teleradiology who developed and marketed the CHILI software at the Steinbeis Transfer Center for Medical Informatics in Heidelberg. "The CHILI software originated from a project called MEDICUS that involved developing a teleradiology system for DeTeBerkom GmbH, a Telekom subsidiary. The project was undertaken when we were still German Cancer Research Center (DKFZ) scientists in Heidelberg, and it enabled us to connect thirteen hospitals with each other. After the successful outcome of the project, the project partners wanted to continue using the software,” says Dr. Uwe Engelmann, medical computer scientist and CHILI GmbH CEO. Building on their experience from the initial project, the three scientists went on to develop the CHILI software in the Steinbeis Transfer Center for Medical Informatics and established CHILI GmbH in 2002.
Using teleradiology systems, standardised digital radiographs (DICOM standard: Digital Imaging and Communications in Medicine) can, for example, be transmitted to a radiologist who is not present at the site of examination. In addition, the systems can be used to organise teleconsultations involving several radiologists. “A scientific evaluation was also part of the original MEDICUS project. We noticed that in the majority of cases the doctors did not really do teleradiology, i.e. transmit images, with the programme at all, but instead looked at and interpreted the images," says Engelmann, who studied and completed his doctorate at the University of Heidelberg. "We then further improved the image-interpretation function and designed the software accordingly." So-called PACS systems are used to medically evaluate, process and archive images from various imaging modalities, such as X-ray or computed tomography (CT) systems. PACS stands for picture archiving and communication system. PACS systems also enable access to data from hospital information systems (HIS) and radiology information systems (RIS). The data can be displayed and processed at radiological work stations equipped with two monitors that have been approved for medical interpretation. Our evaluation also showed that teleradiology should not be an alien system used only ‘at night’ in an emergency situation when everybody is nervous and cannot remember the passwords required. It should be part of daily routine,” explains the CEO. This is why teleradiology functionality is integrated into every CHILI product. This allows any teleradiology system to be expanded to a full PACS should this become necessary. On the other hand, every CHILI PACS can transmit radiological patient images. It is therefore not surprising that Uwe Engelmann compares the software with a box of Lego. This is because all systems are built on the same software base, in which the same elements are always combined.
Different hospital departments often use different systems to manage the data they are collecting. Although the data can be exchanged, the organisational effort involved is usually considerable and complex. Telemedicine records can be used to store all of a patient’s data, such as medical and diagnostic findings, DICOM images and other laboratory data. The CHILI Telemedicine Record is used, for example, in the Heidelberg Ion Beam Therapy Center (HIT) at the Heidelberg University Hospital. The web-based record can be adjusted, viewed and edited by HIT’s staff as well as external partners; information is stored as an image, text or in a data table. Engelmann believes that the record is particularly interesting for organisations like the HIT, because it can also be used as an electronic documentation system for clinical trials.
"The data is uploaded to the Internet in encrypted form; personal data are therefore never transmitted via the network," says Engelmann. The record is currently only available to medical care providers. But the medical computer scientist can also imagine patients accessing the information stored; the system is flexible and can be adjusted by users according to individual requirements. For example, general practitioners who continue treatment can also access the data through a specific link. "It will soon no longer be necessary to send CDs,” said the medical computer scientist. He envisages that even the transmission of alphanumeric data that is not yet well standardised and structured, will improve over time.
Furthermore, the telemedicine record at Heidelberg University Hospital is also used to recruit international patients and to collect all images and findings from preliminary examinations via the Internet in advance of their treatment in Heidelberg.
CHILI GmbH participates every year in the so-called IHE Connectathon organised by IHE-Europe in order to improve communication between the systems of different providers. The Integrating the Healthcare Enterprise (IHE) event is an initiative of international healthcare professionals and healthcare IT system manufacturers that aims to standardise and harmonise the exchange of data between different systems.
At the one-week event, systems developed by over 100 different manufacturers are thoroughly tested under the supervision of international reviewers for interoperability with each other. "International standards are the alpha and omega of IT systems. For the past thirteen years, we have been using the successful tests at the event to demonstrate that the entire application-related workflow chain, such as an entry in a hospital information system and subsequent referral to a radiology department, complies with existing standards,” says Engelmann.
The CHILI software complies with the German Medical Devices Act and the new EU Medical Devices Regulation. Engelmann has some tips for founders who are looking to place their software on the medical device market: “I’d recommend potential company founders to set up a quality management system (QMS) right from the outset, because a QMS is mandatory for commercialising a medical device. With an audited QMS, manufacturers can check and confirm the conformity of their own software against relevant standards and laws. And if this is done cleverly, then a QMS actually facilitates and improves the quality of your work rather than acting as a constraint.” The product should also meet the needs of the market and the user rather than being a product for which a market has to be created. “This was one of the advantages of our developments. From day one, we always asked the users of our software what they needed. And we continue to do so to this day,” says Engelmann.