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Teleconsultations and the hospital network
Patients in the districts can now receive the same diagnostic service as if they were in Tirana, thanks to telemedicine. Teleconsultations between doctors in the districts and those at university centers have made it possible to avoid sending many patients to the capital and to treat them in their own towns. It should be said that, alongside telemedicine, investment in regional hospitals and more modern equipment also deserves credit for this.
On 3 April, the newest telemedicine center, the Teletrauma Center, was inaugurated at the University Trauma Hospital (SUT). It is a continuation of the project to integrate telemedicine into the country’s health system, which began in 2009 but has taken more concrete steps over the past year, particularly in expanding the specialties covered. The project is supported by USAID and the Ministry of Health and implemented by the International Virtual e-Hospital Foundation (United States).
The United States Army Corps of Engineers (KIUShB in Albanian) also contributes by renovating the premises where the program is housed. Coordinator Arian Boci spoke to Shekulli in more detail. “Telemedicine makes it possible to reduce the number of unnecessary referrals to university hospitals.
“This practice not only improves the quality of patient care but also reduces these institutions’ financial costs.
“The 2014 data are promising and show a significant increase in teleconsultations, which reached 608 across about 30 different specialties. Teleradiology, teleneurotrauma and telestroke account for the largest number, but other services are not far behind, such as pediatrics, neurology, gastrohepatology, abdominal trauma and pulmonology.
“Of these teleconsultations, about 70% of the cases received specialized treatment in regional hospitals. This is a substantial figure with a direct impact not only on ensuring timely, quality healthcare for patients but also on reducing the financial cost of the entire system,” said Boci, the telemedicine program coordinator.
Today, telemedicine is a tangible reality. The National Telemedicine Center (PITSHE), located at QSUT, coordinates a network linking 11 regional hospitals in different districts of Albania and four university hospitals: the Mother Teresa University Hospital Center (QSUT), the University Trauma Hospital, the Queen Geraldine University Obstetrics and Gynecology Hospital (SUOGJ) and Shefqet Ndroqi University Hospital (the Sanatorium). Until recent years, shortages of equipment and qualified staff meant that patients were sent to Tirana for better diagnosis or treatment.
Now, however, telemedicine allows consultations between medical teams in the districts and in Tirana, making real-time, high-quality diagnosis by the best specialists possible. Boci also said telemedicine was contributing to doctors’ Continuing Education Program through virtual training, teleconferences and the electronic library.
“The distance continuing medical education program has been implemented successfully since 2010. The first, inaugural lecture was given by Prof. Mentor Petrela, head of Neurosurgery and one of the pioneers and leading supporters of telemedicine over the years. To honor his contribution to telemedicine, PITSHE organizes an annual series of teleneuroscience lectures. Over the years, respected professors from different countries, such as Prof. Rifat Latifi (USA), Prof. Henri Marsh (England) and Prof. Engelbert Knosp (Austria), have delivered scientific presentations.
“This year, the teleneuroscience lecture held in March was honored by the participation of the American academic Ronald Merrell,” Boci says. The program’s (PITSHE’s) ultimate objective is a presence in every hospital in the country. The aim is to integrate the network with the healthcare system and thereby establish a presence in every national and regional hospital.
The platform will then contribute to transforming the health system by using telemedicine and the electronic platform to provide greater support for clinical, educational and research activity.
Progress so far. Boci explains that the Telemedicine Program has so far successfully put three components into practice: clinical telemedicine, the virtual education program and the electronic library. “Clinical telemedicine provides remote diagnostic and treatment services, while the virtual education program allows doctors, nurses and students at the faculties of medicine and nursing to take part in events that help improve their professional skills.
“We have also made progress with the virtual electronic library, which promotes the Continuing Medical Education Program by providing access to online libraries such as HINARI (a World Health Organization program with more than 13 000 scientific journals and 29 000 electronic books, all in 30 languages) and PubMed (which contains more than 24 million citations of medical literature).” 
What has been done so far
There have always been many difficulties in dealing with accident cases, which also cause the most frequent trauma emergencies at SUT. One of the most widely discussed problems has been the transfer of trauma patients, their transport to health centers and then to the National Trauma Center. The lack of training among nurses and rapid-response staff has repeatedly been highlighted.
The program for remote care of trauma patients has progressed in this direction with USAID support.
Establishing this program and putting it into operation was one of the main objectives of USAID representatives, particularly during October 2011-September 2013, when the first steps were taken. As part of this development, the Teletrauma Center was established and included in the United States Army Corps of Engineers’ renovation program for 2014.
It should be said that, over the past 5 years, USAID has worked with the Corps and Albanian authorities to establish and improve telemedicine centers throughout the country. Through the same cooperation, an analysis of trauma and the trauma system in Albania was carried out, draft clinical protocols for trauma management were prepared, and a draft guide for transferring trauma patients was developed.
Thanks to this support, the Teletrauma Program was the first to achieve full and sustained development within clinical telemedicine. USAID Albania’s Director of Development Programs, Marc Ellingstad, who attended the opening of the newest telemedicine center, said: “The focus on improving trauma patient care in Albania is to be commended. There is still much work to do, but these signs of progress show that we are moving in the right direction.”
SUT’s request for a Trauma Department
Shekulli has previously covered the need for trauma-focused specialization for staff at the University Trauma Hospital (SUT), but this need now appears to have become a concrete request. Hospital director Gjovalin Bushi said an urgent request had been made to the leadership of the University of Medicine to create a Trauma Department.
This statement was followed by a plea from Health Minister Ilir Beqaj to respect academic freedom, avoid giving orders and work together so that the specialty could open in October. Bushi, the hospital director, first recalled SUT’s condition a year earlier, emphasizing that it had debts of 1 million euros. He said: “The pharmacy lacked medicines and medical supplies, the emergency department had no laboratory for examinations and everything was done privately, the CT scanner was not working because its tube was damaged, and intensive care lacked medical supplies.”
These problems found solutions through donations and intervention by the ministry.
After mentioning the repair of the CT scanner, plans to purchase and put a new scanner into operation, resolution of the drug-supply problem, the opening of the new examination laboratory, replacement of all intensive care beds and installation of monitors and ventilators, director Gjovalin Bushi said: “An urgent request has been made to the rectorate and the dean’s office of the Faculty of Medicine to establish a Trauma Department.” This statement did not go unchallenged by Health Minister Ilir Beqaj, who said in his remarks:
“Gjovalin, because he runs a trauma hospital, issued something of an urgent request to the University of Medicine. But please, I ask for your understanding: let us respect the University of Medicine’s academic freedom and not issue it an ‘urgent’ order for a Trauma Department, but work together. I have spoken with both the rector and the dean so that in October, when we open the new specialties, we can also open the trauma specialty. I believe that, if we all work together, this is an optimal and acceptable deadline.
“The time has come for us too to begin developing this specialty, because we need it.”
Published in “Shekulli” on 7/04/2015