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TAIEX Multi-country seminar on e. Health Brussels 14 -15 July 2011 Tele-neonatology: Ukraine-EU-Russia-Turkey cooperation TAIEX Multi-country seminar on e. Health Brussels 14 -15 July 2011 Tele-neonatology: Ukraine-EU-Russia-Turkey cooperation Anton V. Vladzymyrskyy M. D. , Ph. D. Head of Department of Informatics and Telemedicine, Donetsk National Medical University, President of Association for Ukrainian Telemedicine and e. Health Development

One slide about e. Health and telemedicine in Ukraine - first tele-ECG center in One slide about e. Health and telemedicine in Ukraine - first tele-ECG center in 1969 - modern telemedicine since 1999 - last 3 -4 years – lawful base for telemedicine and e. Health - Association for Ukrainian Telemedicine and e. Health (national membership in ISf. Te. H) - national tele-ECG industry - national-wide tele-ECG network “Telecard” - wireless tele-ECG for ambulances - national-wide VC-based network “Mobile medicine” - regional telemedicine networks in Donetsk, Dnepropetrovsk, Lviv, Odessa, Vynnytsa, Volyn etc… - telemedicine scientific center in Donetsk - “Ukrainian Journal of Telemedicine and Medical Telematics” (since 2003) - annual international telemedicine conferences in Donetsk (since 2005), in Lviv (since 2007) - official postgraduate studing for telemedicine - clinical telemedicine projects and networks in traumatology and orthopedics, dermatology, MFS, neonatology, tuberculosis, posture disorders telescreening… TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Tele-neonatology – complex utilization of the telemedicine technologies for the planning and providing of Tele-neonatology – complex utilization of the telemedicine technologies for the planning and providing of the special medical care in neonatal period (0 -28 days of life) TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Telemonitoring Teleconsultation Su F. et al, 2002, F. 2002, Qi H. et al, 2002, Telemonitoring Teleconsultation Su F. et al, 2002, F. 2002, Qi H. et al, 2002, H. 2002, Pan J. et al, 2002, J. 2002, Löfgren N. et al, 2003, N. Kerner R. et al, 2004, R. 2004, Di Lieto A. et al, 2006, A. 2006, Barratt C. et al, 2007 C. 2007 Rinaldi A. et al, 2000, A. Deodhar J. , 2002 J. , Korzhinskyy Yu. et al, 2007 Ryaskova O. et al, 2009 Tele-ECHO Randolph G. et al, 1994, G. Rendina M. et al, 1998 -2001, M. Woodson K. et al, 2004, K. Mc. Crossan B. et al, 2008 B. Telescreening Yen KG et al, 2000, Roth DB et al, 2001, Ells AL et al, 2003, Wu C et al, 2006, Chiang MF et al, 2007, Skalet AH et al, 2008, Lajoie A et al, 2008, Photo-ROP Cooperative Group, 2008, Silva RA et al, 2009, Lorenz B et al, 2009 al, E-Learning Cronin C. et al, 2001 C. Telecare visits Gray J. et al, 2000 J. Ketelaar P. et al, 2008 TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Tele-Neonatology in Ukraine – for what and how - “bring” special care to the Tele-Neonatology in Ukraine – for what and how - “bring” special care to the patient - fast and effective clinical decision making - solving problems with staff, knowledge, availability of care - low-resource, easy-to-use, “any Internet-to-use” Clinical aspects Management aspects Teachnig aspects Telemedicine consultation + Clinical Telemonitoring TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 e. Health,

TELEMEDICINE NETWORK Ukraine Association for Ukrainian Telemedicine and e. Health Development Donetsk National Medical TELEMEDICINE NETWORK Ukraine Association for Ukrainian Telemedicine and e. Health Development Donetsk National Medical University Regional Clinical Hospital Municipal Clinical Hospital N 6 Kiev, Ivano-Frankivs’k, Luts’k, L’viv, Simferopol’ regions Tertiary (regional) and Primary (area) hospitals Ukraine-Swiss Mother and Child Health Programm Industry partner – “UTAS Company” TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Austria Medical University of Graz Deutschland University Clinic of Regensburg, Charité, Campus Virchow-Klinikum France Austria Medical University of Graz Deutschland University Clinic of Regensburg, Charité, Campus Virchow-Klinikum France Le CHU de Nice Hungary Madarasz Children Hospital Romania Institute for Mother and Child Care Alfred Russescu Russian Children Clinical Hospital, Moscow Children Municipal Hospital N 1, Sankt-Petersburg Switzerland University Hospital of Basel, University Hospital of Berne, Oberärztin Centre Hospitalier Universitaire Vaudois of Lausanne , Neonatologie UKBB of Basel Turkey Inonu University, School of Medicine, Turgut Ozal Medical Center USA University of Iowa TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Asynchronous telemedicine consultations Synchronous telemedicine consultations Tele-ECG consultations TAIEX Multi-country seminar on e. Health, Asynchronous telemedicine consultations Synchronous telemedicine consultations Tele-ECG consultations TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Asynchronous telemedicine consultations TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 Asynchronous telemedicine consultations TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Asynchronous teleconsultations in rural hospitals allows to: - prenatal teleconsultations with tertiary level centers Asynchronous teleconsultations in rural hospitals allows to: - prenatal teleconsultations with tertiary level centers - dynamic supervision via regular teleconsultations - preventive care for the infants with low weight - e. Registry for the infants with congenital abnormalities - telediagnosis TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Indications for asynchronous teleconsultations in rural hospitals: - problems with diagnosis - complications, bad Indications for asynchronous teleconsultations in rural hospitals: - problems with diagnosis - complications, bad disease flow - non-effective treatment - background for the invasive actions - atypical, rare clinical case TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

TOOLS e-Mail Web-platform E-Mail TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July TOOLS e-Mail Web-platform E-Mail TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Case history. doc, . rtf short case histories Diagnostic visualization. jpeg, . tiff digital Case history. doc, . rtf short case histories Diagnostic visualization. jpeg, . tiff digital x-rays, CT, MRI digital pictures, echograms Electronic medical records SAFETY: Inform consent and anonymity TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

1 -4 experts (from EU, Russia and Turkey) per each clinical case Questions Recommendations 1 -4 experts (from EU, Russia and Turkey) per each clinical case Questions Recommendations All recommendations has positive influence at the clinical strategy TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Web-platform www. telemed-ipath. org. ua TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 Web-platform www. telemed-ipath. org. ua TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Registration with full data about work-place TAIEX Multi-country seminar on e. Health, Brussels, 14 Registration with full data about work-place TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Clinical cases list TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 Clinical cases list TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Austria Deutschland France Hungary Romania Switzerland - regions with staged system - external experts Austria Deutschland France Hungary Romania Switzerland - regions with staged system - external experts (national and international) TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Ivano-Frankivsk, Vinnytsia, Volyn, Crimea - regions with staged system Tertiary perinatology hospital (regional) Area Ivano-Frankivsk, Vinnytsia, Volyn, Crimea - regions with staged system Tertiary perinatology hospital (regional) Area hospital (rural) TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 External experts (national, international)

Teleconsultations with external experts Female, 12 days. Femur hypoplasia, congenital hip dislocation Asynchronous teleconsultations Teleconsultations with external experts Female, 12 days. Femur hypoplasia, congenital hip dislocation Asynchronous teleconsultations via i. Path between Volyn and Donetsk for determination of the terms and stages of the surgical treatment TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Teleconsultations with external experts Male, 14 days Congenital ichthyosis Asynchronous teleconsultations via i. Path Teleconsultations with external experts Male, 14 days Congenital ichthyosis Asynchronous teleconsultations via i. Path between Volyn, Donetsk and Graz (Austria) for determination of the treatment strategy TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

35% of the teleconsultations made by international experts from EU TAIEX Multi-country seminar on 35% of the teleconsultations made by international experts from EU TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

First - Re-sended recommendations from international experts… TAIEX Multi-country seminar on e. Health, Brussels, First - Re-sended recommendations from international experts… TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Then – personal involving of the international experts TAIEX Multi-country seminar on e. Health, Then – personal involving of the international experts TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Extremely important thing: evidence-based opinions and recommendations (teleconsultations with clinical examples, randomized trials etc) Extremely important thing: evidence-based opinions and recommendations (teleconsultations with clinical examples, randomized trials etc) TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Synchronous telemedicine consultations TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 Synchronous telemedicine consultations TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

TOOLS Desktop videoconference Web-platform + SMS-alert TAIEX Multi-country seminar on e. Health, Brussels, 14 TOOLS Desktop videoconference Web-platform + SMS-alert TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

2 DAYS old boy after obstetrical injury E-mail+SMS-alert Desktop VC 27 min. Donetsk Regional 2 DAYS old boy after obstetrical injury E-mail+SMS-alert Desktop VC 27 min. Donetsk Regional Trauma Hospital Desktop VC Volnovakha Area (rural) Hospital 2 days old boy with femur fracture RESULTS AFTER TELECONSULTATION: No unnecessary and dangerous transportation Non-surgical treatment Excellent outcome Regensburg University Clinic

Female, 10 days Thermal burn of the head and arm (with scull bones charing) Female, 10 days Thermal burn of the head and arm (with scull bones charing) Asynchronous teleconsultations via i. Path between Volyn and Donetsk for the treatment strategy Child was immediately transported to the National Children Burn Center CITO cases without alerting – prolongation!

Web-platform + SMS alert TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July Web-platform + SMS alert TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Expert’s first answer after 19 min. Realtime teleconsultation in-progress TAIEX Multi-country seminar on e. Expert’s first answer after 19 min. Realtime teleconsultation in-progress TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Realtime teleconsultation in-progress TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 Realtime teleconsultation in-progress TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Final conclusion Stabilisation Follow-up TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July Final conclusion Stabilisation Follow-up TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Special steps for the urgent teleconsultations organisation have to be done!!! - more comprehensive Special steps for the urgent teleconsultations organisation have to be done!!! - more comprehensive management of the experts’ duties and reactions - desktop videoconferences as obligatory part/tool of telemedicine web-platforms TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Tele-ECG consultations TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 Tele-ECG consultations TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

1 newborn from each 5 has clinical and ECG-sign of the cardiology pathology… 40 1 newborn from each 5 has clinical and ECG-sign of the cardiology pathology… 40 -70% of infants after perinatal hypoxia has cardiology pathology… Rate of heart congenital abnormalities - 3 -10 per 1000 newborns… Terrible ecology… TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Tele-Echocardiography Internet MPEG ISDN EXPERT Tele-Echocardiography Internet MPEG ISDN EXPERT

Cardiology Diagnosis Echocardiography Tele-Echocardiography ECG No-peopleware Expensive, no-peopleware, technical problems TELE-ECG TAIEX Multi-country seminar Cardiology Diagnosis Echocardiography Tele-Echocardiography ECG No-peopleware Expensive, no-peopleware, technical problems TELE-ECG TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Telemedicine system UNET ь 12 -channel ECG ь in-build telemedicine unit ь wireless transmission Telemedicine system UNET ь 12 -channel ECG ь in-build telemedicine unit ь wireless transmission in SCP -ECG (EN 1064) standard ь LCD and printer ь memory TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Tele-ECG for the infants in Neonatal ICU Indications for the tele-ECG teleconsultations in neonatology Tele-ECG for the infants in Neonatal ICU Indications for the tele-ECG teleconsultations in neonatology ICU • perinatal or intranatal asphyxia or hypoxia • prenatal pneumonia • congenital abnormalities suspicion • clinical signs of cardiovascular pathology (cyanosis, heart murmurs etc) • monitoring of the medication therapy (dopamin) efficiency TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Request point – Neonatal ICU of Municipal Hospital TAIEX Multi-country seminar on e. Health, Request point – Neonatal ICU of Municipal Hospital TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Regional Hospital 3 G data transmission Neonatal ICU Duration of the tele-ECG consultations - Regional Hospital 3 G data transmission Neonatal ICU Duration of the tele-ECG consultations - 10 -15 min TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011 University Clinic

Expert Center – Cardiology Dep. of Regional Clinical Hospital TAIEX Multi-country seminar on e. Expert Center – Cardiology Dep. of Regional Clinical Hospital TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

ECG Interpretation In-build head- and microphones Tele-ECG consultation TAIEX Multi-country seminar on e. Health, ECG Interpretation In-build head- and microphones Tele-ECG consultation TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Results of the tele-ECG consultations Ø Changes finded at ECG - 73% Ø Objective Results of the tele-ECG consultations Ø Changes finded at ECG - 73% Ø Objective verification of the clinical diagnosis – 100% Ø Fast correction of the medication therapy - 36, 4 % Ø Real background for calling of cardiosurgeon Ø Average in-hospital stay - 10, 5+6, 1 days Ø Good clinical outcomes - 90, 9% TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

Conclusions Tele-neonatology – is a fast growing area of the telemedicine. It is become Conclusions Tele-neonatology – is a fast growing area of the telemedicine. It is become obligatory part of the national health care system. Experience with tele-neonatology in Ukraine are very positive and promissive. International collaboration allows to orginase telemedicine network at evidence-based principles and solve clinical and teaching problems. TAIEX Multi-country seminar on e. Health, Brussels, 14 -15 July 2011

THANK YOU VERY MUCH! Welcome to Donetsk for EURO-2012! doctelemed@gmail. com Skype: anton 251977 THANK YOU VERY MUCH! Welcome to Donetsk for EURO-2012! [email protected] com Skype: anton 251977