Telemetric medicine is the key to rapid and accurate diagnoses

Remote consultations save from errors

The advisory telemetry center within the Emergency Medical Aid and Catastrophe Medicine Center was established on 01 August 2015.  Its aim is to improve the detection of acute cardiovascular disorders, reducing the mortality and incapacitation of the population. The establishment of this structural unit has provided opportunity for every patient with suspected acute myocardial infarction, acute coronary syndrome, irregular heart rhythm and other complications to receive timely and competent aid regardless of the time of reference and location in the oblast.

When a person feels pain in the heart, dizziness, quick heartbeat or spatial disorientation, (s)he requires immediate medical care. Hence, (s)he calls for an ambulance brigade. And even the availability of equipment for ECG does not guarantee prompt diagnosis. Due to the lack of specialized knowledge or because of unusual course of disease, assessment of a cardiogram is sometimes a difficult task for a medical assistant, a general practitioner or a local hospital specialist.

It is then that a need for a distant consultation by a qualified specialist of the ATC (Advisory Telemetry Center) arises.  Five cardiologists ensure a 24-hour duty willing to help on a real-time basis.

Telemetric medicine-in action

How is it put into life? A cardiography is carried out to a patient on site and its record is automatically sent to the ATC in Vinnytsia. A cardiologist on call reads the received data and remotely provides recommendations for further actions. A copy of the ECG signals is simultaneously forwarded to the medical institution to which the patient will soon be delivered.  As a result, the physicians of a specific department are expecting the patient already having his history of disease and the algorithm of treatment. Therefore, it is possible to save the precious time and avoid diagnostic errors at the prehospital stage already.

Within the first 11 months of work alone, physicians of the ATC have provided 12,446 distant consultations.

In some cases, a patient needs thrombolysis, i.e. clot lysis by means of special intravenous drugs. In others, one needs stenting, i.e. inserting a special device into a damaged artery which will secure the walls of the blood vessel. The world practice shows that stenting is prescribed more often than injection treatment.  The statistics of Vinnytsia oblast does not contradict this fact: within 6 months of the current year – 20 prehospital thrombolyses and 384 stenting. It is because thrombolysis is a procedure that has a number of side effects. Therefore, before its employment, a risk/benefit ratio should be assessed. Therefore, only an experienced cardiologist is able to choose which technique will be more effective in specific circumstances.

In addition, aortocoronary stent deployment in Vinnytsia oblast is only provided by one institution – Vinnytsa Regional Clinical Center for Treatment and Diagnostics of Cardiovascular Diseases. Therefore, it is important that a patient who requires stenting was timely sent to the Center. 

Technical features of the remote diagnostics

Remote counseling is possible due to an integrated equipment support. There are two systems operating simultaneously in the oblast: diagnostic medical complex "Tredex" with ECG-telemetering devices "Telecard" and telemetric cardiological complex UNET with ECG devices "Ucard". In total, 310 devices for online data transmission to the ATC (236 units are in the primary health care facilities, 46 are in ambulances, 28 are in the medical admission rooms of regional hospitals and primary health care facilities) are being operated in the oblast.

It should be noted that they differ in the information transmission. ECG-telemetering devices "Telecard" do not provide for visualization of the examination.  They don't print out, but only transmit the signal to the ATC. A health care professional (physician, medical assistant) can get advice from fellow cardiologists on the phone, and a printout of outgoing ECG - by e-mail from the ATC.

The operation of "Ucard" device is absolutely different. It displays the ECG results on the screen, prints them out and is able to transmit the data to the ATC. Connection is provided by GPS-channels of the mobile operators.  

Thanks to the investment subproject with the World Bank which is now being implemented in the oblast, about 300 ECG telemetering devices and up to 20 ECG devices, as well as 2 telemetering systems system for information reception will be purchased for online data transmission.  It is assumed that the ECG will be available for medical institutions of any level, and the patient will always receive qualified medical support.  

This is part of a large-scale project, the prospect of which is to ensure that:

- early diagnosis of cardiovascular diseases is effective and most close to the people;

- patient's clinical route complies with existing standards.

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