Teleradiology and tele-echocardiography are scheduled to take lead roles in phase two of a telemedicine network established between Italy and Egypt. The network is based on a web portal that opens a teleconsultation pipe to support difficult clinical cases. The portal also serves as an e-learning avenue to improve information dissemination among Cairo and Palermo hospitals. Phase one involved a telepathology link between the 105-year-old Italian Hospital "Umberto I" in Cairo and the Civico Hospital in Palermo. A July paper documents the application of static and dynamic telepathologic techniques in the first phase (Diagn Pathol 2008 Jul 15;3 Suppl 1:S2). "We consider this a successful pilot experience for this type of medical cooperation between an advanced country (Italy) and an emerging country (Egypt)," said Dr. Essam Ayad, chief of the telepathology at the Italian Hospital in Cairo. Once phase two of the web portal is up and running, clinicians will be able to transmit and access patient medical records, data, radiological images, digital pathological slides, and electrocardiogram signals in support of teleconsultation in real-time for conferences, or second opinions in deferred time. Phase two will also support tele-endoscopy. At the core of both phases is a teleconsultation solution called Clinical Image Integra, which supports a large enough database to handle digital image and audiovideo file traffic. The portal project began in 2003. Recent participants include Ospedale S. Giovanni e Paolo in Venice, Charing Cross Hospital in London, and the University of Pittsburgh Medical Center. "During the past five years, we consulted on many problematic pathological cases with these different specialized pathological centers in Italy, the U.K., and the U.S.," Ayad said. Ayad estimates that 10% of Egyptian cases cannot be easily diagnosed.

Expected benefits of phase one telepathology, however, were achieved:

• better medical service
• more distributed specialization
• savings of time and money
• increased knowledge exchange

Following success of phase one, the researchers are now in the process of establishing a Digital Telepathology Center in Cairo University's pathology department, which will include use of whole slide imaging, the latest pathology digital imaging technique, Ayad said.

"We believe this will help us improve and extend diagnosis for our difficult pathological cases and that the discussion of our cases will facilitate and ensure increased e-learning opportunities for staff and students both in Egypt and in the longer term in the wider Eastern Mediterranean," Ayad said.