Use of telemedicine in Moldova's perinatal centers
Use of Telemedicine inperinatal centers within the perinatal system 25.10.2012 P. Stratulat Professor, Tatiana Carauș
Telemedicine - is the process ofcommunication by using audioand video system to transmit orexchange the data between patientand doctor or between medicalprofessionals.
Aim:• To create and develop interdisciplinary telediagnostic networks, teleconsultations and teleeducation to improve the quality of medical services provided to mother and newborn and to reduce their costs by increasing the quality of patients’ life.
Objectives:• emergency aid to patients from perinatal centers (Level II) through distant timely consultation;• optimization of financial resources by reducing travel costs for consultants via AVIASAN service;• distance training of specialists from pilot-institutions.
Stages of implementationInitial stage:• During the first stage the pilot-institutions with 40% of the total number of births have been identified. The most serious and premature children are found in these institutions.• Number of workplaces in delivery rooms and reanimation departments, as well as in intensive therapy units have been identified.
A common network of CP Edinettelemedicine between level III CP SorocaPerinatal Center (Mother andChild Institute) and level II CP Ungheni CP OrheiPCs (Hospital No.1,Chisinau,Balti and Cahul), within the CP Hincestifirst stage and within the IInd CP Causenistage another 7 PCs of level II(Ciadar-Lunga, Causeni, CP Ciadar-LungaEdinet, Orhei, Hincesti,Soroca si Ungheni).
Second stage• The MoH Order nr. 285 from 18.08.2009 "On implementation of telemedical consultation system at pilot-centers" (cases, consultants, electronic forms) was developed.• Guidebook for iPath users and guidebook for Perinatal Health group users have been translated and adapted.• 16 computers were purchased, completed with webcams, printers, scanners and digital cameras to document clinical case data• Three notebooks were purchased for on-line presentation of cases (recording monitors, newborns and pregnant women data) for consultations with pilot-centers of level II.• A working place for consultant radiologist was created (continuous Rx stereotypes consulting from pilot-institutions and Mother and Child Institute during the night).
Working groups within the Telemedicine system• 5 working groups were identified and created by the National Working Group with consultants from Switzerland which have been further placed at the international platform iPath:• Test group (allows professionals to obtain skills of working on iPath)• Perinatal health (consultation of clinical and educational cases)• Quality Management (provides consultancy regarding the implementation of quality management: elaboration of protocols, projects)• Regional group (Moldavian-Romanian-Ukrainian) (consulting specific cases for diagnosis and educational cases)• Health Technology Management (HTM working group)
What does the informational system of Telemedicine in Perinatology allow usTeleconsultations nowadays?In specialties: obstetrics and gynecology, neonatology and pediatrics (24 hours / 7 days a week) Teleradiology Consultations ”online” 24 hours/7 days a week Teleeducation
Training – 4 workshops have been organized:• Workshop for initiating specialists in training on diagnosis and teleconsultations• 11th of November 2009 - workshop with specialists from pilot-centers where experts shared their first experience of cooperation within this compartment .• 10th of December 2009 - workshop was attended by the representatives of pilot- institutions, the lecturers from the Technical University of Moldova, representatives of pilot- institutions involved in the implementation of the Moldavian-Swiss Project REPEMOL.• Workshop – in the frame of the Conference “Quality of Perinatal care”
Specialists registered at the Platform:Specialists - 212 others professionals• obstetricians / 18% gynecologists (110); neonatologist s• neonatologists (63), 30%• imagists (3);• pathomorphologists (1) obstetricians / gynecologists 52% traumatologists (1) and other professionals - 37.
Distribution of cases placed at the platform iPath:• Out of the total number of 636 cases placed at the platform: obstetrical - 91 other obstetrical 15% informations (15%), gynecological - 1, 18% neonatal - 426 (67%), pediatric (infant) – 1, other information (guidelines, protocols, translated articles) - 117 (18%). neonatal 67%• Comments were provided for 785 cases (1,5 per 1 case).
Teleeducation – distance learning establishment• During the period 28.04.2012 - 31.05.2012 there were organized 24 on-line lectures for neonatologists from 9 Level II Perinatal Centers.• Within these seminars 30 persons were trained.
Morning videoconferences• Weekly on Tuesdays and Fridays the morning teleconferences take place; specialists from all obstetrical and newborn departments from the Mother and Child Institute and neonatologists from pilot-institutions take part at these conferences.
Problems:• Insufficient cooperation within regional telemedicine group.• Some cases, particularly obstetrical ones, are placed post factum, the electronic form is not completed and this is explained by the lack of time or by complicity.• The quality of placed cases leaves much to be desired (are not fully completed, X-ray images, CTG, Partogram, USG).• Fear to express ones opinion still persists among specialists for not to be criticizes / blamed.
Lessons learnt1. Increase of professional level and, as a result, the improvement of practicies and quality of mother and child care.2. Users role from PCs has changed: from placing cases for consultation to placing cases for training.3. Working in multidisciplinary teams of specialists was developed (neonatologist, radiologist, neuropathologist).4. Strengthening interactive way of communication between professionals5. Some experts have realized the benefit of proper and timely documentation of cases, being open and transparent for discussion, thus getting professional and patient benefits6. Reduction of treated severe cases by consulting them at distance
Costs for Telemedicine consultation Versus TransportationCosts per Teleactivity 3.38 US$ (lei....)Costs of transportation via Aviasan line4.500 lei
Proposals/steps for the future:• Extension of Telemedicine to all maternities of level I• Expanding regional cooperation on sharing experiences in order to promote quality Perinatal services• Conduct on-line video conferences on some priority issues with the partners from Switzerland and from region (Romania, Ukraine).• Creating a distance learning class at the national level at the basis of the Medical University “N. Testemitanu” (obstetrics, perinatology, neonatology and pediatrics).
• Organizing on-line distant training courses for specialists via application of the methodology: videoconference-test, videoconference-seminar, videoconference-lecture.• Performing a cost-effectiveness study of the teleconsultation case (will reduce costs for transportation via AVIASAN, thus saved sources will be reallocated for Telemedicine service to motivate consultants).