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Correspondent: Dr. Dan Shanit, 7 Holly
Village, London N6 6QJ, UK. Email: 100723.1517@compuserve.com
Dr. Shanit is Director of the Cardiovascular
Research Unit, Edgware, London, and Founding Director of the ICTT at Ben Gurion
University, Israel.
Israel, almost the size of a Texan ranch (20.000
km2), is densely populated and has a population of 5.5 million, with
a doctor /patient ratio of under 1:1000. It is perhaps not the obvious choice
for deploying telemedicine. However a closer look at its demographics, its
geo-political positioning, and its blossoming hi-tech industry offers an
explanation and justification for the development of the newly formed Israel
Center of Telemedicine and Telecare (ICTT), based at Ben Gurion University of
the Negev and at Soroka Medical Center in Beer Sheva (see map).
ICTT is the brainchild of Dr. Dan Shanit, a
cardiovascular researcher and director of a cardiovascular research unit in
London, who has directed tele-cardiology programs in London for the past 7
years and currently shuttles weekly between London and Beer-Sheva. Dr. Shanit
found enthusiastic partners at Ben Gurion University (Prof. Lechaim Nagan, Vice
President; Prof. Alexander Battler, Cardiology; Dr. Ran Giladi,
Telecommunications) and at Soroka Hospital (Dr. Itzhak Peterbourg; Hospital
Director). The Soroka Medical Center is the only tertiary referral center for
the 600,000 inhabitants of the Negev region (many of them recent immigrants
from the former Soviet Union), and until recently, for the 900,000 Palestinians
living in Gaza. The infrastructure of the ICTT is maintained by private
grants.
Once established, ICTT began to identify the medical
needs and priorities of the Israeli and Palestinian population of the Negev.
Most patients in this region are served by local primary practitioners.
However, specialist consultations are mainly afforded through Soroka Medical
Center, and are a significant strain on resources. Currently, general
practitioners in the region do not act as gatekeepers to specialists. This
results in a high proportion of direct referrals to hospitals. It is expected
that by offering timely specialty tele-consultations to patients at clinics,
many hospital referrals will be averted. Another goal of the program is to
enhance the capabilities and on-job comfort of general practitioners by
availing them of expert collegiate support.
Several pan-disciplinary pilot projects have been
initiated. The first phase in the ICTT investigations has been a study of the
impact of a tele-electrocardiography (ECG) diagnostic service on the decision
making process of primary physicians, and on the quality, efficiency, and
accessibility of acute and chronic cardiac care. Funded by the Israeli Ministry
of Science, this study has deployed 12-lead ECGs at clinics or patient homes
which transmit telephonically to Soroka’s central cardiac monitoring
center (Heartline 12-Lead monitoring system, Aerotel Ltd, Holon, Israel). While
the study is not complete, preliminary findings suggest that study participants
perceive the main benefit of the telecardiology service to be the improved
capacity for local physicians to remain in control of patient management. With
increasing pressures on hospital resources, the enhanced capacity of general
physicians to manage the vast majority of their cardiac patients without
referral to hospital is of clear benefit to the health system
infrastructure.
To date, there have been no significant problems with
the technology or medical applications. Forthcoming studies will look at the
role of transtelephonic monitoring and tele-echocardiography in the management
of heart failure. Other studies will be done in teleradiology, teledermatology,
and interactive specialty consultations, and will examine their impact,
efficacy, and cost-benefit implications.
The Negev is a challenging environment. The enthusiasm
of the ICTT team matches the severity of local need -- one that could be filled
by telemedicine and telecare.
Reference:
Shanit D, Cheng A, Greenbaum RA.. Telecardiology:
supporting the decision-making process in general practice. J Telemed and
Telecare 2:7-13, 1996 |
