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Use of Telemedicine in Perinatal Centers
1. Use of Telemedicine in
perinatal centers within the
perinatal system
25.10.2012
P. Stratulat
Professor,
Tatiana Carauș
2. Telemedicine - is the process of
communication by using audio
and video system to transmit or
exchange the data between patient
and doctor or between medical
professionals.
3. 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.
4. 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.
6. Stages of implementation
Initial 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.
7. A common network of CP Edinet
telemedicine between level III
CP Soroca
Perinatal Center (Mother and
Child Institute) and level II CP Ungheni CP Orhei
PCs (Hospital No.1,Chisinau,
Balti and Cahul), within the CP Hincesti
first stage and within the IInd CP Causeni
stage another 7 PCs of level II
(Ciadar-Lunga, Causeni, CP Ciadar-Lunga
Edinet, Orhei, Hincesti,
Soroca si Ungheni).
8. 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).
9. 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)
10. What does the informational system of
Telemedicine in Perinatology allow us
Teleconsultations
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
11. 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”
12. 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.
13. 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).
14. 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.
15. 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.
16. 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.
17. Lessons learnt
1. Increase of professional level and, as a result, the
improvement of practicies and quality of mother and child
care.
2. User's 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
professionals
5. Some experts have realized the benefit of proper and timely
documentation of cases, being open and transparent for
discussion, thus getting professional and patient benefits
6. Reduction of treated severe cases by consulting them at
distance
18. Costs for Telemedicine consultation
Versus Transportation
Costs per Teleactivity 3.38 US$ (lei....)
Costs of transportation via Aviasan line
4.500 lei
19. 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).
20. • 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).
