Use of Telemedicine in

perinatal centers within the

perinatal system

25.10.2012

P. Stratulat

Professor,

Tatiana Carauș

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.

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.

Realization

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.

A common network of

telemedicine between level III

Perinatal Center (Mother and

Child Institute) and level II

PCs (Hospital No.1,Chisinau,

Balti and Cahul), within the

first stage and within the IInd

stage another 7 PCs of level II

(Ciadar-Lunga, Causeni,

Edinet, Orhei, Hincesti,

Soroca si Ungheni).

CP Edinet

CP Soroca

CP Orhei CP Ungheni

CP Ciadar-Lunga

CP Hincesti

CP Causeni

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 us

nowadays?

Teleradiology Consultations

”online”

24 hours/7 days a week

Teleconsultations In specialties: obstetrics

and gynecology,

neonatology and

pediatrics (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

• obstetricians / gynecologists (110);

• neonatologists (63),

• imagists (3);

• pathomorphologists (1) traumatologists (1) and other professionals - 37.

obstetricians / gynecologists

52%

neonatologists

30%

others professionals

18%

Distribution of cases placed

at the platform iPath:

• Out of the total number of

636 cases placed at the

platform: obstetrical - 91

(15%), gynecological - 1,

neonatal - 426 (67%),

pediatric (infant) – 1, other

information (guidelines,

protocols, translated articles)

- 117 (18%).

• Comments were provided for

785 cases (1,5 per 1 case).

obstetrical 15%

neonatal 67%

other informations

18%

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 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

Costs for Telemedicine consultation

Versus Transportation

Costs of transportation via Aviasan line

4.500 lei

Costs per Teleactivity 3.38 US$ (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).

Thank you for your attention!