(πρόκειται για το δεύτερο μέρος της Διάλεξης που έδωσε ο Αναπληρωτής Καθηγητής Δημήτριος Σωτηρίου, ως προσκεκλημένος Ομιλητής, στη Διεθνή Ημερίδα για την Τηλεϊατρική που οργάνωσε το George Town University των ΗΠΑ στα πλαίσια του Προγράμματος Advanced Research Workshops του ΝΑΤΟ, στην Τασκένδη του Ουζμπεκιστάν μεταξύ 2 και 4 Απριλίου 2001)

The experimental and pilot application period lasted from 1998-1991 where it was demonstrated beyond any doubt the beneficial use of Telemedicine in primary healthcare settings, the majority of which were in island and mountain areas.

The design and implementation strategies of the services were described by the author at the Medical Physics Laboratory of the School of Medicine of the University of Athens. The support centre was established in the Sismanoglion Regional General Hospital, which is located  in the greater Athens area.

The service period started in 1992 with the installation of 12 remote terminals in primary healthcare centres all over Greece. The Sismanoglion General hospital remained and remains even today the supporting tertiary hospital.

Today the Sismanoglion Telemedicine Centre and the hospital clinics and staff support 19 Healthcare Centres and 12 Public Surgeries. Twenty new installations were made in the fist few months of 2001. The new terminals operate with improved software and hardware including electronic healthcare record software and ISDN communication capabilities including video conferencing.

Sismanoglion physicians have been supportive of the distant Healthcare Centres healthcare workers in more than 7,000 cases so far.

The diagram below depicts the number of cases supported yearly in the period 1992-2000. 

The diagram shows an increasing trend in using the services, which is worth noticing.

 In the diagram below the number of cases associated with various specialities as a percent of the total number is depicted.

In the diagram ‘Nutrition’ means that the Nutrition Centre of the Sismanoglion Hospital has been providing advice on Nutritional issues.

The table below gives describes the number of case for which evacuation were suggested initially by primary healthcare physicians but the case were discussed using Telemedicine before they were actually effectuated.

Figures of Years 1999 and 2000 show similar trends

It is very interesting to note that nearly forty percent of the evacuations were averted with considerable cost saving for all parties’ involved and considerable convenience for patients and their relatives.

The results clearly demonstrate in practice several of the key points raised in the beginning of this paper concerning the satisfactory coverage of the needs by implementing Telemedicine services.

13. Other Telemedicine Services

As early as 1998 the Telemedicine Support Centre of the Sismanoglion General Hospital tested an new concept for providing medical services to the primary healthcare centres participating in the Sismanoglion Telemedicine network.

The service was named Tele-surgeries. Patients are requesting a voice or videoconference with a hospital. The local physician who normally treats the patient puts the request for the appointment forward. he local physician participates in the Tele-surgery. Obviously Tele-surgeries are opportunities for in service training as well.

Tele-surgeries have been proven very popular, especially among chronic patients. The Tele-surgeries that are operating include:

• Chronic Lung Diseases
• Chronic Cardiac Diseases and High Blood Pressure
• Liver
• Diabetes
• Centre for Nutrition (Advisory activities,  Health Education)

Nutritional issues have been proved to be very popular. This is perhaps due to the fact experts on the topic are rather very few in primary healthcare settings and obesity concerns an unexpected large number of persons. 

The popularity of the topic has prompted the Nutrition Advice Centre of the hospital to design and deliver a programme on Health Education primarily addressed to school children. The success of the programme has a stunning success better that any expectation.

14. Services offered by other Institutions

Today in Greece several institutions are ready to offer are offering telemedicine services. Many private enterprises have been prepared for this or are preparing to be ready for the new environment which will emerge when the reforms promised by the Government in the Greek National Healthcare System are put in place.

Among the various institutions working on Telemedicine one can mention the following:

• Sismanoglion General Hospital in Athens / General Practice
• Onassis Cardiac Surgery Center in Athens/ Cardiology ( http://www.onasseio.gr/en/index.htm )
• University Hospital of Patras / Tocography
• University of Thrace in Alexandroupolis / Educational network (Huston, Yale, London School etc.)
• University of Athens / Maternity ( http://www.aretaieio.uoa.gr/pages/bgyn_idx.htm )
• University Hospital of Heraclion in Crete / Asthma, Cardiology ( http://www.hygeianet.gr )
• University Hospital of Thessaly in Larissa/ Orthopedic
• University of Ioannina at Ioannina / Health applications with wireless network
• University of Thessaloniki / University Network for Education and Research / Home Care (http://www.med.auth.gr/indexeng.html )

Telemedicine activities are taking place in the private sector as well. One example is the Athens Medical Center,  http://www.iatriko.gr/eng/html/yph/ems/telemed.htm , which has demonstrated the use of telematics for cardiology, ambulance service and teleconsultations among its own units.

15. Lessons learned

The design, implementation and delivery of Telemedicine services have been a marvellous endeavour of 90’s.

Ideas have been flourished along with the tremendous developments accomplished in the telematics domain based on the innovations in hardware and software informatics and communications. The rate of innovations is not going to slow down and probably will be accelerated in the years to come. The healthcare domain has to explore the opportunities and to develop solutions for the benefit of all.

In assessing the developments that have taken place in Greece in the past 10 to 12 years one can clearly see several issues that are related to the rather slow uptake of Telemedicine Services in Greece. We present them here believing that the lessons learned might be helpful to persons interested in pursuing similar endeavours in their own environment.

TMS require the following:

• a new framework for healthcare services delivery
• team work
• suitable medical guidelines and protocols
• complete and unambiguous documentation of all acts
• continuous audit and evaluation
• literacy in telematic

The list indicated where attention has to be placed and what precautions have to be taken to overcome possible obstacles. Hard work, persistence, dedication and knowledge are what are needed to complete successfully a Telemedicine Service project.

Acknowledgements

The author is indebted to the organisers of the Workshop for the invitation extended to him.

He would like also to thank Dr Ken Boddy, his long time colleague on Telemedicine, for the creative collaboration and the opportunity to develop and test many of the ideas presented here.

The author wishes also to thank thee organisers of the Workshop for the warm hospitality extended to him during his stay in Uzbekistan.

References

1. The HERMES 7 Step Methodology, HERMES Project Deliverable 9.3, ‘Functional Specifications and Report on HERMES Future Work / Business Plans, for Harmonisation, Demonstration and Uptake of a * Global 24 Hour TMS Platform for Urgent Response Services Delivered to the Point of Need*’, October 1999  
2. The HERMES Question Set, HERMES Project Deliverable 2.1 ‘Pilot Site Analysis of User Requirements including Functional Marketing Specification and Electronic Service Description Tool’, August 1996  
3. K. Boddy, P. Karpp and D. Sotiriou, ‘Telemedicine and Telecare for the New Information Age’, Financial Times Report, November 26, 1999  
4. The ISO 9000 Family of Standards, ISO Publications and ISO Web Site at http://www.iso.org/iso/en/ISOOnline.frontpage  
5. M. Gatzonis et al., Maternity Telemedicine Services in the Aegean Islands paper presented in the 2nd World Conference on Telemedicine, March 22-24, 2000, Toulouse, France  
6. S. Mavrogeni et al., Supervision of acute myocardial infarction using telemedicine’, Journal of Telemedicine and Telecare, 2000; 6: 54-58

Σωτηρίου Δημήτριος, Αναπληρωτής Καθηγητής
Εργαστήριο Ιατρικής Φυσικής
Ιατρική Σχολή Πανεπιστημίου Αθηνών
Τελευταία αναθεώρηση : 1/1/2006