All-Ukrainian telemedical network of urgent ECG diagnostics "Telecard" in 2005-2008

More than four years have passed since the telemedical network of urgent ECG diagnosis “Telecard” was created and launched in Ukraine. Now this network covers all regions and all levels of health care.

Possibly, it is expedient to remind that during 2004-2005 the Ministry of Health of Ukraine, within the scope of the program of rural medicine development, has purchased 570 transmitting devices and 57 central receiving stations of the equipment for transtelephonic electrocardiography “Telecard” (medical diagnostic set “Tredex”). In total 52 Remote diagnostic centers (RDC) have been created. At the first stage (delivery in 2005) the RDC were created in district centers (in total 25). The transmitting devices have been installed in 270 Central Regional Hospitals (CRH) of the corresponding districts.

At the second stage (delivery in 2006) the RDC were created in the CRH of the majority of districts of Ukraine, as well as in the system of emergency medical care (in total 26). Three hundred transmitting devices have been installed in rural and family ambulances, as well as in ambulance cars. Over the past years, due to sponsor help and means of local budgets the regional telemedical networks “Telecard” have been deployed in Dolina region of Ivano-Frankovsk district, Vasilkov region of Kiev district, Lokhvitsa region of Poltava district. Besides, the “Telecard” equipment has been purchased for usage in ambulance cars of the Nikolayev City Emergency Medical Care station and Kharkov City Clinical Hospital of Emergency Medical Care. More than 50 transmitting devices have been purchased in various regions of Ukraine in order to widen the existing network of transtelephonic ECG diagnostics. Thus, for the first time in the post-soviet countries a multilevel, actually operating digital telemedical system was built, oriented at providing urgent diagnostic assistance at all levels of the health care system. The results demonstrated from the first months of its operation turned out to be sufficiently convincing and lead to its further development and expansion to new regions and spheres of health care that were not covered before by the remote ECG diagnostics.

The operation results of the All-Ukrainian telemedical network “Telecard” have been several times discussed on the national and international conferences, presented at the International telemedical exhibition Med-e-Tel in Luxemburg in April 2008.

This article is the third, which has become already traditional, overview of problems and achievements in the course of the “Telecard” network development. The material of this article is based on the data collected in the course of annual monitoring carried out by the initiative of the TREDEX LLC enterprise – the developer and manufacturer of the “Telecard” equipment.

It must be noted that the value of the number of transmitted electrocardiograms taken as the basis for estimating the efficiency of the system operation, demonstrates a dynamic stable growth from year to year. Namely, over 2005-2006 more than 12 thousand ECG have been transmitted and analyzed, over one year 2007 – more than 16 thousands of ECG , and in 2008 this value grew up to 24 thousand ECG. Totally in Ukraine over 2004-2008 more than 53 thousand, and taking into account Emergency medical care service – more than 64 thousand transtelephonic ECG were transmitted. Tables 1 through 3 present this information in greater detail, traditionally in “District-Region” profile.

For comparison, Table 3 gives the data on the usage efficiency of transtelephonic equipment in various districts of Ukraine. In this case the results of the regional and district level were summed.

As in previous years, among the permanent leaders are Vinnitsa, Poltava, Chernigov, Donetsk and Kherson districts. Kirovograd and Chernovtsy have dramatically increased the efficiency of work, Zakarpatskaya district has demonstrated a powerful sprint, catching up already habitual leaders.

The example of Zakarpatye is especially significant, because in the period from 2005 till 2007 this district was permanently among the outsiders, and the management of the district Health Care Administration has informed the developers that it has no need in telemedical ECG consultations. So the more amazing is almost eightfold growth of the number of transmitted ECG in 2008 compared to 2007. Perhaps the specialists at the places have at last appreciated the advantages of the remote ECG diagnostics, which is especially important in mountainous and hard-to-reach terrain. Maybe, some changes in the governing structures also took place, which obviously benefited the cause.

Last year Lutsk City Clinical Hospital began its work. It should be noted that in Volyn district, the only one among the districts of Ukraine, the receiving RDC was deployed in 2005 not on the basis of the district hospital or district cardiologic dispensary, but on the basis of the city hospital. Such approach did not permitted to organize at once the effective operation with the CRH of the district, and as the result the equipment in 2005 – 2007 was virtually idle. So the pleasanter is the beginning of work of the Lutsk RDC in 2008.

Also, after the dead time of 2005-2007 the work is started in Chernovtsy DCD as well. Thus, the perfectly organized work of remote diagnostics of Storozhynets CRH of Chernovtsy district has been completed at the district level.

Unfortunately, the results of Kharkov DCH and Ternopol DCCH substantially lowered. The management of Kharkov Health Administration and the new chief cardiologist of the district undertake substantial effort to improve the “Telecard” network operation. The requirements to restore the workability of all transmitters and more widely use the possibilities of transtelephonic diagnostics are included in a number of instructions and orders for the district. According to the estimates of the district RDC management, a substantial growth in the number of remote ECG consultations was recorded already in the first months of 2008 due to the undertaken efforts.

Positive changes in Dnepropetrovsk DDC begin to show. Lugansk DCH and Ivano-Frankovsk DCD demonstrate some animation, although 50 and 20 remote consultations per year cannot be called impressive, and only at the background of zero results in 2007 these figures become noticeable.

Unfortunately, we have no exact data for Sumy DCD. In 2007 due to a number of objective reasons ECG were not received. At the end of the year the “Telecard” receiving equipment was repaired and comprehensive support was given at the district level to the district RDC service. According to the available data, in 2008 Sumy DCD has restored the operation of the receiving center and began coming back to the leaders of remote ECG diagnostics, which it worthily occupied in 2005-2006.

Having failed to organize the operation of the district RDC, Kiev DCD has refused from its equipment in favor of Vasilkov CRH. The absence of results is also demonstrated by Zaporozhe DCD, Odessa DCH and Crimea RCD. There is nothing to do but to hope that the vast positive experience of utilization of transtelephonic ECG diagnostics in other districts of Ukraine will not leave the administration of these institutions, as well as district Health Administrations indifferent, and optimistic data from these places will appear already in the next review.

In general, at the district level the growth of the number of transtelephonic consultations equals 32.8 per cent.

The efficiency of the transtelephonic ECG equipment utilization sharply increased at the regional level. Znamenka CRH of Kirovograd district ceded as to the volume of remote diagnostic work only to Vinnitsa and Poltava district RDC. The number of received ECG thereat compared to 2007 has increased almost by 3.5 times and reached 3029. Excellent result!

Ten more regional RDC have demonstrated the growth from 3 to 688 per cent. In this case the total number of ECG transmitted at the regional level has increased compared to 2007 by 83.6 per cent. In 2008 the “Telecard” receiving equipment was installed in Vasilkov and Lokhvitsa CRH. Judging by the successful beginning of work, the new RDC can become serious competitors to the existing centers. In total, over 2005-2008 at all levels of the “Telecard” network 53121 remote ECG consultations were given. Another 11 387 ECG were added only during 2008 by Nikolayev Emergency Aid Station. In this case the growth in respect to 2007 without distinguishing between the district and regional levels was 50.7 per cent.

These figures are the best answer to skeptics, who from year to year gloomily harp that the transtelephonic ECG diagnostics has no future in Ukraine, and the domestic medicine has no need in remote electrocardiography. By a twist of fate, these arguments are put forward by the representatives of those medical institutions, which over four years failed to organize the operation of the “Telecard” telemedical network in their regions.

Let us take the liberty to remind you once more that over the last decade in the majority of countries serious structural changes take place in the field of health care, connected with broad implementation of information and telecommunication technologies. The main goal of implementation of the mentioned novelties is the realization of the rights of citizens for highly qualified medical assistance regardless their location. Ultimately exactly and laconically this goal is formulated in the Concept of development of telemedical technologies in Russian Federation approved by the order of the Ministry of Health of Russian Federation No. 344/76 from 08/27/2001.:

“The most important task of health care of a civilized state, which promotes the stability of the society, is to ensure the rights of a citizen for medical service regardless his/her social position and residency... However, while the problems of providing medical and preventive institutions with adequate financing, equipping with state-of-the-art equipment and other resources can be solved at least theoretically, the problem of staffing each regional hospital with word-class specialists cannot be solved even in theory. Solution of such problem is possible only by implementing telemedical technologies in the everyday practice of medical institutions”.

In foundational state programs developed by the Ministry of Health of Ukraine the same thought is contained in a number of statements.

Unfortunately, these paragraphs are only declared yet, and still have no actual financing, which must be foreseen for practical realization of the programs of Ukrainian Ministry of Health. The problem of development of remote ECG diagnostics was discussed two times, in 2007 and 2008, at the hearing of the Committee of Verkhovna Rada of Ukraine for Health Care. The results of the hearings recommend the Ministry of Health of Ukraine to undertake efforts for further implementation and development of the transtelephonic ECG diagnostics. In 2008 this problem was at last recognized as one of the promising directions of development of the domestic medicine. Measures have been taken to make the necessary amendments in the budget of Ukraine for 2009. According to these amendments the items existing in the State program must obtain financial support.

However, the next political and then economical crisis occurred in the country. As the result, the development of transtelephonic ECG diagnostics at the local level in 2009 remains the lot of the heads of district and regional health care administrations, chief district specialists, head doctors of DCD, DCH and CRH, as well as the primary level administrators and heads of local councils.

It must be said that this way is hard, but not hopeless. Due to wisely organized work of the district RDC on informing the managers in charge, search of off-budget means and promotional work with industrial and agricultural enterprises, in 2008 only in Poltava district alone 22 transmitters and one central “Telecard” station were purchased (Lokhvitsa CRH).

Under the conditions of commencing crisis and difficulties with the centralized budget, the experience of Poltava district should be adopted by other districts of Ukraine as well. Taking into account the relatively low cost of “Telecard” transmitters, comparable to the cost of a one-channel electrocardiograph, independent purchases of transtelephonic equipment by interested medical institutions and their sponsors can lead to a substantial widening of the “Telecard” remote ECG diagnostics network and, as the result, to a substantial improvement of medical aid to citizens of Ukraine, especially to those who live in rural and remote regions.

It also must be noted that serious hopes appeared of eliminating the gap between the academic science and top management of health care of Ukraine from one part, and actively growing practical telemedicine from the other part. In 2009 the National Scientific Center “Institute of cardiology name of Academician N.D.Strazhesko of AMSU” and State Enterprise “Institute of therapy name of L.T.Malaya of AMSU” plan to join the all-Ukrainian network “Telecard”. If the cooperation succeeds, the obtained over the last years results and experience in the field of transtelephonic electrocardiography can obtain a serious scientific basis, the citizens of Ukraine, who live far from Kiev can obtain diagnostics and treatment at the level of the capital city, and the “Telecard” network – prospects for future growth and development.