Cost-effective telemedicine for efficient health care management on smaller Greek islands still ignored

Tilos 30 May 2001VMW was happy to receive a new and updated report from Dr. Giuseppe Zocco about TimTem, the long-term "Tilos Medicine & Tele-medicine" project, managed by the Department of Surgery at the University of Pisa. This account covers the period between September 2000 and April 2001, following the dynamic tele-sonography experiment of last summer. The overall message is that circumstances remain "still the same", as Bob Seger puts it in his song about the gambling queen. Instead of working seriously to organise a permanent telemedicine service on the island of Tilos with skilled operators, Athens keeps sticking to expensive heli-rescues in cases of emergency. In spite of an excellent performing ISDN connection for both tele-consultation and tele-guided examinations, and a believing local population, the Greek health care authorities care very little about the convincing TimTem telemedicine results.

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The recent Pisa report states twelve heli-rescue operations in the period from September 2000 to April 2001 but also expresses serious doubts about possible misuse of this type of medical intervention. Some cases might have been evaluated in a different way, taking into account that 10 cases out of 12 happened when the resident physician-mayor was not on the island, due to his involvement in public administrations affairs. His substitutes are young physicians lacking experience, which probably could have led them to transfer the cases in emergency. None of these cases' outcome was recorded after transfer and treatment at the reference hospital in Rhodes. Considered on a winter island population of some 250 people, 12 heli-rescues represent almost 5 percent of the whole population with an enormous cost of about 20.000 to 23.000 euro.

Compared to these expenses, the telecommunication services offered by Pisa are much cheaper. The ISDN connection used for Internet and e-mail, works at a speed of 115.200 bps, which allows to perform video-conferencing with Netmeeting in audio or written dialogue with "instant message". In July 2000, this system, enhanced with a video-camera, has been applied for tele-sonography and can be used for tele-consultation as well. It can also be integrated with a digital photo-camera to transmit fixed images in high quality resulting in a very detailed scan of cutaneous diseases or eye lesions for instance. In the spring of 2001, the team established a remote computer control from the central station in Pisa, which was fully demonstrated with a trained remote operator who manipulated the computer keyboard in Tilos, thus acting directly on the programmes.

A training has been planned for the physician and nurse on the island which has to enable them to use the computer in English. According to the report, the health of the local population can be kept under control easily as far as chronic diseases, previously recorded in the database and now updated, are concerned. In turn, the number of ambulatory services has barely changed, including an average of 40-45 cares per week, and of 7-8 cares per day for the whole island. The global annual number has increased by 15-20 percent due to the presence of tourists in summer time. The annual average of actual ambulatory services for diagnosis and treatment still amounts to about 11 cases corresponding to 18 percent of the services. The trends in demands and drugs distribution for either daily or pre-ordered population needs are similar, as Dr. Zocco and his colleagues report.

The major obstacle blocking the implementation of a permanent telemedicine station on Tilos remains the issue of human factors, such as deeply rooted habits and a typical feeling of fatalism. Missing links involve the absence of skilled and expert operators for training, and an efficient reference hospital which is fully equipped for telemedicine services. The new Rhodes Hospital indeed only provides a good range of services for low and medium speciality treatments. The health care problems on smaller islands are still managed by an organisation which is not particularly interested in telemedicine, as the Pisa team noted in its report. For detailed news on the tele-sonography experiment, please consult the VMW November 2000 article Tilos TimTem team to experiment with tele-sonography for remote diagnosis.


Leslie Versweyveld

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