Diagnosis and treatment through Telemedicine

Author : Sergeeva Galina
Date added : 2003-09-10

Brief Project Background

The project started in 1995 when the American International Health Alliance (AIHA)-through a program that creates partnerships between US healthcare professionals and their counterparts in Central and Eastern Europe and Eurasia-established Learning Resource Centers (LRCs) at partnership institutions in the region, including Bishkek, Kyrgyzstan. AIHA healthcare partnerships rely upon the exchange of knowledge and information to foster more effective delivery of health-related services. By providing partners with a broad range of opportunities to communicate with one another and share information, AIHA's information and communication technology (ICT) initiatives have contributed significantly to the past and current success of these partnerships. ICT has also opened up a number of different channels for replication of best practices among partners, as well as other health institutions in Central and Eastern Europe and Eurasia.
AIHA's ICT initiative has supported these partnerships by developing relevant communication and information infrastructures at partner institutions in the region as a way to support intra- and cross-partnership collaboration and learning through videoconferencing capabilities, among other things.

The LRC model is remarkably simple and relatively easy to replicate and adapt to local circumstances. The concept is built on two capacity-building components. The first is technological, involving the establishment of one or more dedicated computer workstations with Internet access. The second equally important component is the staff resource embodied by the LRC manager, also known as the information coordinator. This individual holds the key to successful implementation of the LRC model. The information coordinator promotes the widest possible use of the LRC by providing training and assistance to colleagues who are seeking information, working closely with institutional administration to improve appropriate use of information technology, and continuously developing his or her own knowledge and skills. In combination, these two components-dedicated resources and trained personnel-provide the necessary elements for successful application of information and communication technologies to healthcare improvement.
The primary responsibility of the information coordinator is to educate staff on the benefits of using the Internet. To accomplish this, information coordinators organize outreach activities such as lectures, presentations, and training workshops. In addition, the information coordinator provides assistance to staff looking for data and research materials, as well as those using various Internet technologies for communications and tele-consultation activities.
Because of the LRCs created within the framework of AIHA’s partnerships programs, members of these partnerships from Central and Eastern Europe and Eurasia have the opportunity to consult with other clinicians on patient cases. This is especially important when faced with an unusual case or when doctors find it difficult to treat patients effectively given the information and resources readily available to them. When asked to assist a clinician who wants to discuss a particularly challenging case with colleagues and experts from around the world, an information coordinator prepares a patient history, translates it into English, scans X-ray, CT, MRI, or histology slide images, and often takes a digital photograph of the patient. This detailed package is then sent electronically to AIHA partner mailing lists and other more specialized list serves worldwide. In most cases, the responses come quickly-some as soon as the next day. The success rate of these tele-consultations in Bishkek, for example, is high and we have received many useful recommendations and up-to-date chemotherapy protocols. In no time, regardless long distances between the countries, E-mail provides staff with a great opportunity to discuss difficult cases with experienced practitioners around the world. These consultations can be either "second opinions" in diagnostics or recommendations on management and therapy of patients.
This process is advantageous to patients as well because it is a fast, convenient way to discuss a rare or severe case with partners from the United States and experts from all over the world. It allows clinicians in the region to verify diagnoses, to ascertain the opinions of various colleagues-many of whom are noted experts, to obtain specific advice on appropriate methods of treatment, and to save time and a great amount of money that otherwise would have been spent on traveling to see medical specialists and undergoing numerous clinical examinations.

Results

The first successful tele-consultation was carried out at the Kyrgyz National Ocology Center in January, 1997. Doctors were about to perform an emergency surgery on a 17-year-old girl who had a tumor in the temporal lobe of her head, causing severe health problems. The case record was translated into English, scanned CT and MRI pictures of the brain were sent by E-mail to Mark Story, head of AIHA’s ICT program in Washington, DC, along with the request to assist in tele-consultation efforts regarding the case. Storey then sent these files to partners in both the United States and throughout Central and Eastern Europe and Eurasia. In total, the files were sent to 25 hospitals. Dr. Bruce Branson from Orlando, Florida, was able to confirm that the cyst did not mark any displacement of brain structures. At the same time, originals of documents were delivered to the Oncology Center’s American partners at University of Kansas Medical Center. Prof. Solomon Batnitzky, along with several of his colleagues, agreed that the patient had a benign cyst that did not require surgery. Thus, the diagnosis was made and an unnecessary surgery was averted. The young woman’s condition improved after medications prescribed by an endocrinologist were administered. This girl successfully graduated from the Technical University in 2003.

Since then, clinicians at the Kyrgyz National Oncology Center have worked hand-in-hand with LRC staff to conduct such tele-consultations on more than 50 difficult or unusual cases. Many of these cases involved different forms of cancer.
The Kyrgyz doctors implemented the recommendations of their American colleagues, modifying methods of treatment for dysgerminoma in young women, retinoblastoma in children, lymphomas and leukemias.

Other tele-consultation requests have been sent out on patients with toxoplasmosis, hyperhidrosis, osteoarthritis deformans, noma, spinal cord injuries, and many other cases.

The following two-part article illustrates how these tele-consultations can have an impact on the level of care our healthcare professionals are able to provide thanks to advanced training and the connections made possible through the LRC Project, as well as how this enhanced care can change the lives of countless patients. Reprinted with permission of AIHA.


“Using Internet Technology to Help Diagnose and Treat a Girl's Cancer”

As head of the pediatric oncology department at the Kyrgyz National Oncology Center in Bishkek, Dr. Damira Baizakova oversees the cases of each patient who comes to the department for treatment. When Baizakova first met Nargiz, an 11-year-old girl who suffers from a rare form of cancer that disfigured her face with tumors, she was struck with a host of emotions. "When I reviewed her file, which was filled with histological reports and inconclusive findings from numerous physicians, I felt as if I was in a blind alley . . . but I was determined to do my best to help the child." Helping is not always easy though, Baizakova admits, especially when a patient suffers from a rare or unknown condition. "I have a very narrow professional profile-there are only a small number of oncohematologists in Kyrgyzstan-so I often have no one to consult with on difficult cases. This was what happened with Nargiz."
After diagnostic surgery and an unsuccessful course of hormone therapy, Baizakova turned to the Institute's Learning Resource Center for assistance. "Previously, Moscow was our only source of information and knowledge," Baizakova explains, "but, thanks to the information technology available at the LRC, we now have access to nearly limitless data on oncology." Baizakova-along with Galina Sergeeva, information coordinator of the Bishkek/Kansas City partnership-was able to consult with clinicians from around the world on Nargiz's case. After receiving a number of responses from their AIHA partners in Kansas City and another specialist in the Czech Republic, Baizakova decided to try chemotherapy. She used information compiled by Sergeeva to explain the treatment procedure to Nargiz and her mother and thereby to help alleviate some of their fears about the operation.
"I felt so sorry for the shy and unsmiling little girl and wanted to do my best to help her as soon as possible," says Sergeeva. As information coordinator at the Institute's LRC, she conducted clinical research using the Internet and a wide range of information technology resources for healthcare professionals, medical students, and patients from Bishkek and surrounding areas.
"The physicians here make good use of the LRC when they are faced with cases that are difficult to diagnose or treat. On average, I received 10 requests for information and one or two calls for tele-consultations using the Internet each month," Sergeeva notes. When asked to assist a clinician who wants to discuss a particularly challenging case with colleagues and experts from around the world, Sergeeva would prepare a patient history; translate it into English; scan X-ray, CT, MRI, or histology slide images; and often take a digital photograph of the patient. This information package was then sent electronically to AIHA partner mailing lists and other more specialized oncology list serves worldwide. "In most cases, the responses come quickly-some as soon as the next day. The success rate of these tele-consultations is high and we have received many useful recommendations and up-to-date chemotherapy protocols," she explains.
Nargiz is getting better and better with each treatment, Sergeeva says, and when she comes to the Center, she always visits the LRC to have her picture taken. "Now she smiles and is no longer so painfully shy and embarrassed. . . . She seems much more active and full of joy. Nothing can compare to the feeling of pleasure I get from watching a sick child smiling and enjoying life."
Calling these teleconsultations a marvel of modern medicine, Dr. Damira Baizakova agrees, stating, "My job is a difficult one. It is never easy to see a child suffer. Sometimes I want to give it up just so that I can sleep peacefully at night, but successful cases such as Nargiz' s make it all worthwhile. Thanks to AIHA's partnership program, the people of Kyrgyzstan-especially ill children-are able to get effective care and treatment. So many of my colleagues have had the opportunity to learn new techniques, improve their professional skills, and-more importantly-find cures that save lives."

Lessons

Firstly, we have learned that success of the AIHA LRC Project is depending on close partnership relationships. A great number of partners has been involved into making decisions of problems associated with the difficult and disputable cases and diseases. The exchange of different opinions is highly beneficial both for the heath providers and the patients. The advantages of the consulting by email are doubtless.

Secondly, we have learned that in most cases it is necessary to extend the communication contacts and involve most competent partners to compare the second opinions of the medical experts so that we could select a better and more appropriate decision for diagnosis and therapy.

Thirdly, we have learned that making the project more successful and sustainable needs new ways for the development. One of them is the creation of the national network of medical institutions within the framework of the Telemedicine Project in Kyrgyzstan. Funds for this project will be raised through the grants.

Development Impacts

Nowadays telemedicine in Kyrgyzstan has been entering a new level. The Kyrgyz State Medical Academy jointly with the Kyrgyz Telecom company and Belgium experts has been working out a project on setting up a Teleconsultation Center. It would allow to create a network of medical institutions connected to the medical academy teleconsultation center in Bishkek and regions of Kyrgyzstan and Uzbekistan. The project will also involve the telemedicine centers of Russia, USA, Belgium, and Germany.
The grant proposal envisages that the Teleconsultation Center should be accordingly equipped to provide the appropriate consulting of patients both by online videoconferences and by email. The experts-teleconsultants will be promoting the distance learning conferences for health professionals and help patients define and cure diseases using Internet. The recommendations received from the highly experienced doctors will significantly save not only the time but also money needed for travel and medical examinations. This would contribute to alleviation of poverty of the people of Kyrgyzstan and Uzbekistan. As an information coordinator I shall be coordinating the activities at the Telemedicine Center.

Project Information

Organisation : Kyrgyz State Medical Academy Medical Center
URL : http://www.aiha.com; http://www.ahonco.elcat.kg:http://medcenter-ksma.elcat.kg
Total budget in US$ : 40,000
Country of activity: Kyrgyzstan [KG]

Are there any partners involved : American International Health Alliance;
Kansas University Medical Center;
Universities of Nevada and South Florida
What is partners role?: First of all, the American International Health Alliance has provided the NIS Learning Resource Centres with funding for access to the Internet. This represents a significant opportunity for Kyrgyzstan, as a developing country, to join the global community after the collapse of the USSR. AIHA has supported the LRCs by providing the necessary equipment, as well as by organizing and holding training workshops and seminars on ICT, and in particular, on tele-consulting.

Partners from the University of Kansas Medical Centre helped consult on Kyrgyzstan’s difficult cases via E-mail, sent their recommendations for therapy, faxed clinical protocols, E-mailed full-text articles regarding specific forms of cancer. We became able to share knowledge, experience, and innovation with the other AIHA partners in the region and around the world.

Contact Information

Sergeeva Galina
m_center@mcma.elcat.kg
1,Tynystanov, 720020, Bishkek, +996-312-543962

Disclaimer: No stories on this website shall be reproduced or stored in any other retrieval system without the written permission of the infoDev/IICD. Although every precaution will be taken in the preperation and maintenance of this collection of stories, neither infoDev, IICD or the submitting parties assume any responsibilities for errors or omissions. In addition, no liability is assumed fordamages resulting from the use of the information supplied in the stories.