Online zajednica za telehematološke
i druge telemedicinske konzultacije
Online community for
telehematological and other telemedical consultations
First experiences in the
outpatient hematological teleconsultations on the Croatian islands.
Mirjana
Sever-Prebilic, Anamarija Margan, Igor Prebilic,
Senka Stojanovic, Antica Duletic-Nacinovic, Damir
Prebilic, Zeljan Zic.
The Virtual Polyclinic – Island Telemedicine Project enabled several GP and specialist medical units on remote islands of the Croatian Adriatic to practice diagnostically safe and cost-effective telemedicine, delivering multidisciplinary specialist care provided by 33 consultant specialists. Over 300 teleconsultations have been done through an FDA approved system, using ISDN lines, secure servers and encrypted email (optional). Several hematological patients diagnosed and treated, proved this system to be efficient in supporting the local doctor and patient during the diagnostic/therapeutic process and follow up period. The increased frequency of virtual visits and medical education for both, patients and island doctors, contributed to the hematology related medical care in remote units.
Reported at the European Hematology Association Meeting 2002, Firenze, Italy
Emerging aspects in the telemedical follow up of remote hematologic patients
Sever-Prebilic M, Prebilic I, Stojanovic S, Kovacic L,
et al.
An existing Picture Archiving and Communication System
(PACS), introduced in 2001 by the Croatian Academy of Medical Sciences into
several remote island communities along the Croatian coast, enabled
hematological teleconsultations between GP's and hematologists located in the
mainland clinical hospital centers. As reported at the EHA-7, the system has
been used in a variety of diagnostic and treatment procedures, including
hematological teleconsultations and support to the local doctors handling
patients with anemia, lymphadenopathy, coagulopathy, anticoagulant treatment and
lymphoma, as well as non-hematological disorders requesting hematological
councelling. Limited by the lack of telemedical legislative and reimbursement
policies, the system has been used mainly to improve the frequency and quality
of specialist's virtual visits by creating a continuous information flow during
the follow up process of remote patients previously treated at our Department.
Furthermore, the initial purpose of connecting remote physicians with mainland
hospitals for diagnostic purposes has been overcome by horizontal specialist
interdisciplinary counselling including second opinion requests, while in the
vertical communication between the Department and remote physicians, educational
and supportive/interventional aspects have prevailed, especially in the
prehospital management of hematologic patients. Cost-effectiveness aspect
remained positive in comparison with remote patient's travel expenses satisfying
one of the system's main objectives, however awaiting a redesign in the
developmental strategy and services offered in order to accomplish the expected
utilization of the system's potentials. As the system evaluation continues, the
emerging aspects of the current telemedical practice, as well as possibilities
given by new communication technologies and cost-effective modalities, require
us to abandon a firm array of system objectives and accept a mosaic of possible
hematological applications at different levels of telehematological practice,
all subject to the telemedical legislation, yet to be defined.
Reported at the European Hematology Association Meeting 2003, Lyon, France