Conducted by Bob Pyke, Jr.,
Co-Moderator, EurasiaHealth Medical Informatics Knowledge Network (http://www.eurasiahealth.org/index.jsp?sid=1&id=7104&pid=7097)
December 1, 2004

Please tell us a little about yourself.
My name is Anton Vladzymyrskyy, I was born (1977) and still live in Donetsk, Ukraine. I’m a medical doctor, magister in traumatology and orthopedics (Polytrauma department), Head of the Department of Informatics and Telemedicine at Donetsk R&D Institute of Traumatology and Orthophedics, Deputy editor of Ukrainian Journal of Telemedicine and Medical Telematics, and Regional Telemedicine Director. In 2003 I defended my dissertation «Treatment of Polytrauma with Using Telemedicine Systems». I’m the author of 4 books and about 30 articles about telemedicine.

How did you end up working in Telemedicine?
In 1993 I took part in an investigation for disaster medicine telemetry (it was students’ scientific work in Donetsk State Medical University). >From 1993-1999 I did my own research in the theory of telemedicine. From 2000-2004 I work on clinical telemedicine, research, teleconsultations, Web design and content management.

So how did telemedicine first come about in Ukraine?
The first telemedicine activities happened in our country in the 1970s. It was telemetry of physiological parameters for coal miners. The first few teleconsultations in telepathology were carried out in 1995. Today telemedicine is basically developed as teleconsultations and distant education. In 2000 at the Donetsk R&D Institute of Traumatology and Orthopedics was founded Ukraine’s first Department of Informatics and Telemedicine. Since 2000 we have constantly carried out teleconsultations in trauma, neurosurgery, orthopedics, oncology, pediatrics, rheumatology, obstetrics, dermatology, etc. We created a program for local implementation of telemedicine; also, we study technical, economical, and ethical problems of telemedicine.
In 1999 at Donetsk State Medical University we started the first Ukrainian theoretical research and investigations in telemedicine. After a few months we published a book Introduction to Telemedicine (full text Russian version is online at http://www.telemed.org.ua/wwwtm_eng/TM/tmcomn.html).
Over the following three years we studied the world experience of the use of telemedicine for the health care service, elaborated and implemented our own systems, evaluated the effectiveness of teleconsultations, and analyzed the data.
On January 25, 2000, we carried out our first teleconsultation: Professor M. Nerlich from Regensburg (Germany) consulted the patient with serious pelvis trauma from Donetsk (Ukraine). Since that time we have done about 200 teleconsultations in 15 medical specialties.  Nowdays we work under the national program of telemedicine improvement.

What services do you provide through the telemedicine program in Ukraine at this time?

Today telemedicine is basically developed as teleconsultations and distance learning.
In 2004 the creation of the telemedicine network of the Donetsk region was started. We hope that this network will become a prototype for the whole country.
A new project, “Telerehabilitation (Distance Education + Teleconsultation),” was begun in 2004.  This project provided by Donetsk R&D Institute of Traumatology and Orthopedics, Donbass Institute of Technics and Management, and Donetsk State Medical University. The main goal is distance education by social specialities + teleconsultations + telerehabilitation for young disabled persons.

Do you have a favorite activity or one you’re really involved in?

A lot of work I carry out by myself. Also, I cooperate with enthusiasts from different cities of Ukraine (Luts'k, Kiev, Simferopol', etc). The most help is rendered by the employees of my Department.

Please tell me about the demographics of your program: whom do you serve, what’s the number of patients you serve, and from where?

In 2000-2004 we had international links mainly. But we “return” to our region.  Nowdays our main goal is the creation of a regional telemedicine network. The Donetsk region is a heavy industrial region in eastern Ukraine (5.5 million inhabitants, more then 1000 coal mines, steel and chemical plants).  We want to provide effective medical care in rural and remote parts of our region. Also, we want to establish interregional and international links for the best medical care for our people.

Tell me a little about the hardware and software you’re using.

We created a few best practice models in telemedicine. You can see it at our Web site very soon. From the part about equipment and software:
”Background
For any kind of telemedicine procedures it’s necessary:
1) to create an effective telemedicine work station (TWS) with adequate free or/and licensed software,
2) connect TWS to some kind of telecommunication line.
The basic requirements for telemedicine equipment: an opportunity of processing of any kind of medical information, cheapness, standardization, availability, simplicity and reliability of use, technical and information safety.
Main goals
- equipment for telemedicine work station
- telecommunication lines
- software
Decisions
Telemedicine work station
We propose a few sets for TWS.
Classical set for TWS:
- basis PC, SVGA monitor, multimedia equipment, CD-ROM/CD-RW/DVD, network adapter
- high quality scanner
- digital photo camera
- digital video camera
- web-camera
- high quality color printer
- microphone, dynamics
- modem, connector to hospital information system
- sets of special digital equipment for diagnostic and treatment
- auxiliary equipment
Clinical set for TWS:
- basic PC, SVGA monitor, multimedia equipment, CD-ROM, network adapter
- digital photo camera
- printer
- modem
- auxiliary equipment
Minimal set for TWS:
- basic PC, SVGA monitor
- high quality scanner or digital photo camera
- modem
Optimal clinical set for TWS:
- basic PC, SVGA monitor, multimedia equipment, CD-ROM or CD-RW
- high quality scanner
- digital photo camera
- web-camera
- printer
- modem
- auxiliary equipment
For example:
In daily clinical practice we use this TWS: PC (1.0 Ghz and more) with multimedia equipment, scanner (1200 dpi and more), digital photo camera (1.3 to 3 megapixels), printer (laser, 600x600 dpi and more), film-viewer, web-camera.
Telecommunication lines
Best ways:
- direct and dial-up internet lines for any kind of telemedicine procedures;
- mobile phones services for emergency teleconsultations.
Direct internet lines (256 Kbps and more) intercity, interregional communications,
communications between big regional hospitals and medical universities
Dial-up internet lines (56 Kbps and more) – for intraregional, intracity, rural-city
communications
SMS/MMS services – for any kind of emergency teleconsultations
Software
It’s possible to use specialized or standard software for telemedicine procedures. We prefer:
- standard licensed software from Microsoft;
- a Web application designed with open source code (optimal for medical establishments with low financial support);
- special internet-based telemedicine application (for example, the application Regional
Telemedical System).

What else are you doing in telemedicine as far as distance education grand rounds?

In 2002 we created an internet-based system for distance education called “TeleTrauma.” We use it in postgraduate study for residents. In the next year we want to begin a distant course in antibiotics therapy.  Also, we have some investigations in telemetry for obstetrics pathology.
 

What research is the telemedicine program involved with?
- effective equipment sets for different medical areas and economic conditions;
- “how and why?” of using telemedicine for different clinical problems;
- clinical effectiveness of telemedicine;
- ethics and law in telemedicine;
- information security.

How is your program funded?

We have a small government budget.

What do you want to do, and in what direction would you like to see your program go in the future?

At present there is no special government program for the development of telemedicine. Ukraine’s first Health Care Management of Donetsk Regional State Administration has a program for local implementation of telemedicine. This program consists of 3 stages:
- creation of telemedicine workstations and internet channels, implementation of not-urgent teleconsultations, staff education;
- emergency medicine system reform, implementation of urgent teleconsultations;
- establishment of national and international telemedicine links and partnership, implementation of distance education.
The main directions of the development of telemedicine in Ukraine are:
- the creation of regional and national programs of telemedicine improvement;
- the use of teleconsultations in treatment of different serious pathology (polytrauma, heart diseases, oncology, tuberculosis, AIDS, etc);
- implementation of distance education;
- staff education for telemedicine workstations;
- improvement of telemedicine in rural areas;
- scientific research in clinical teleconsultations, special equipment, legal, ethical and deonthological problems of telemedicine and health informatics, testing different equipment for telemedicine workstations.

What do you want your program to achieve in 1 year?

- have a telemedicine network for the Donetsk region
- perform an analysis of success and failures
- create a powerful, effective concept for regional and national telemedicine networks

What do you want your program to achieve in 5 years?

- establish telemedicine networks for all regions of Ukraine
- create a system for information security (on the basis of digital signatures)
- creation of a body of law for telemedicine in Ukraine

What do you want your program to achieve in 10 years?

I’m not sure what technology we will have in 10 years.  A starship, a time machine? Who knows? :)
 

I am convinced that one of the most exciting areas in Telemedicine is the potential role it may have in international health care and disaster responses. What is your view?

I agree that it’s a very interesting and useful area for telemedicine. We have a little experience in this area: in 2001 we teleconsulted for a few trauma patients after the earthquake in India. It was a very useful experience, both for Indian physicians and for us. I believe it’s possible to create an internet-based international teleconsultation system for urgent responses.

What can be done to continue to promote Telemedicine in Ukraine? in Eurasia?
- overcome the “human factor”, training for telemedicine, a wide demonstration of possibilities and best clinical results;
- more funding, of course, but first, people must understand why we need telemedicine
David Balch, who recently retired from the telemedicine center at Eastern Carolina told me that he thought telemedicine as we know it would disappear, that it would be so common on our desktops that we take telemedicine for granted.  The technologies evolve almost every day. Telemedicine also changes. In my opinion today’s “desktop telemedicine” is a digital camera and the internet. It’s inexpensive and widely available to any physician. In the next few years it will be a PDA with a camera and wireless internet.

What do you want to say or add to your colleagues out there? And what words of advice can you offer?

I’m very appreciative for this interview.  I believe that telemedicine is like a “collective medical brain” of the whole world.  Any serious patient can find a physician with unique experience. It’s a great help in clinical decision-making. Telemedicine makes medical care wide, boundless, accessible.
My colleagues and I are open to any kind of cooperation and partnership in telemedicine and e-health. Also I welcome authors and readers for our journal.
Feel free to contact me with any questions and comments: avv@telemed.org.ua, avv25@skif.net.
 

Dr Vladzymyrskyy, I wish you continued success!

Thank you very much!

Relevant Links
“Telemedicine in Ukraine”, general information, catalogue of Web resources, library, teleconsultations, information for patients
http://www.telemed.org.ua
Ukrainian Journal of Telemedicine and Medical Telematics http://www.telemed.org.ua/UJTMMT/jindex.html

Telemedicine projects
http://www.intermag.kiev.ua
http://www.vokl.lutsk.ua
http://ictm.org.ua/
http://www.srlc.nmu.kiev.ua
http://www.mfs.dsmu.edu.ua
http://www.kx.kiev.ua/telemed.html
http://derma-don.org.ua

Ukrainian Affiliate Sites Network of European Health Telematics Observatory
http://www.ehto-ukr.cit-ua.net

Health information
http://www.health.gov.ua
http://health.kiev.ua
http://www.ozu.com.ua/ukr/1/index.asp

Equipment for telemedicine
http://www.dx-telemedicine.com