Article

The Greek National Telemedicine Network
June 2020 Antonis Charalampakis,
Principal Product Marketing Engineer, ICT Services & Solutions, Intracom Telecom
The 'EDIT' Telemedicine Project

Difficulties in accessing healthcare have long been a common event among citizens living in remote areas of Greece. Providing health services relevant to those of the large continental cities, while also diminishing the inequality in healthcare access between citizens living in continental Greece and those in remote Greek islands, was the ambitious goal set by the EDIT project. Moreover, continuous medical training, education and access to high quality specialized medical knowledge was the second pillar which EDIT had envisioned and developed.

EDIT is the National Telemedicine Network in Greece and it is a project financed by the European Community.

In 2014 the Ministry of Health released an RFP for the first phase in order to cover 43 sites of the 2nd Regional Healthcare Administration, 30 of them remotely and 13 urban located (see below in red color). The project was awarded to the union schema of OTE and Intracom Telecom, implemented with high quality standards and timely delivered. And, for the last five years the Greek National Telemedicine Network is successfully operational.

Last year, on September 2019, the Ministry of Health released a new RFP for the second phase of the EDIT project. As an expansion of the previous one, this phase aimed at covering 28 new remotely located sites of the 2nd Regional Healthcare Administration (see below in blue color). Once again, the union of OTE and Intracom Telecom was the winning schema of the bidding procedure. The new project is currently under deployment and is expected to be operational during the first quarter of 2021.

Due to the great success of the EDIT project a new RFP is soon expected to be released from the Ministry of Health. The design of the third phase has already started as an expansion of the existing National Telemedicine Network, with the ultimate goal to expand telemedicine coverage throughout Greece. 13 more urban located sites will be created to enhance the existing infrastructure in order to be able to serve the expanded Telemedicine Network.

map presenting health coverage of the project EDIT
The Telemedicine Solution

EDIT's infrastructure has been designed in order to support a variety of operational needs, further enhancing existing functions and structures of the National Healthcare System. The Network uses the connectivity of the Public Data Network SYZEFXIS and incorporates 71 telemedicine units, connecting major hospitals in Athens and Piraeus, as well as hospitals located in large densely populated islands, like Samos and Lesvos with health centers located in remote islands.

Telemedicine services are offered through the technological support of Cisco TelePresence video conferencing technology, integrated with CARENATION Telemedicine Software Platform and properly customized for the healthcare industry. Every telemedicine unit has been adjusted to simulate a traditional doctor visit and enhance the doctor-patient relationship.

The urban located site also called "doctor's end-point", is equipped with the video conference system that is able to provide a real-time communication through high definition video and digital sound. It is also equipped with the Telemedicine PC, which allows the GUI to schedule medical appointments, initiate the conference and receive the patient’s vital signs measurements.

high level architectural diagram of a telemedicine room

The remote located site also called "patient's end-point", is additionally equipped with medical devices for the patient's examination. A typical set comprises a general purpose camera, a derma scope, a vital signs monitor, an otoscope, a digital stethoscope, an ophthalmoscope and a cardiograph. Particular specifications for the patient’s end-point construction should be followed concerning the lighting, ventilation conditions and furniture. An access control system has to ensure the authorized-only personnel entry.

The Telemedicine Services

Core telemedicine services provided by the EDIT project are:

Tele-consulting:

A doctor-to-doctor communication for a second opinion of a medical case:

  • Monitoring of chronic diseases
  • High expertise diagnosis
  • Routine health checks
Emergency telemedicine:

Timely and immediate medical care in emergency cases:

  • Heart attack
  • Stroke
  • Accident injured persons care
Tele-training:

Educational seminars for doctors and rest medical staff and administration:

  • Public awareness on emergency cases (pandemic phenomenon)
  • Academic community use for doctors and students of medical schools
Tele-psychiatric:

Various adaptations on this sensitive group of patients:

  • Urgent remote monitoring and evaluation of difficult cases
  • Remote doctor's supervision
  • Child-psychiatry family consulting

The use of telecommunications technologies and connectivity has largely impacted real-world patients in the remote areas where the EDIT project has been implemented. The program allows for real time monitoring and interaction with patients, as well as ability to address timely and efficiently patient problems. The results have been extremely positive, based on physician/patient feedback and the platform’s related metrics. Furthermore, there have been notable improvements in key areas, such as effortless access to specialists, increasing patient satisfaction, improving clinical outcomes, reducing emergency room utilization, limiting unnecessary aerial transfers, all of which result in cost savings and upgraded patient services.

Based on the Ministry's recent accounting statistic reports:

Tele-consulting:
  • ~360 teleconsultations per month
  • 25 medical specialties
  • ~7,500 patients treated
  • ~8,500,000€ in total savings so far
Emergency telemedicine:
  • 365 emergency teleconsultations performed from 7 medical specialties
  • All patients were treated safely
  • ~800,000€ in savings from emergency medical airlifts
Tele-training:
  • Over 450 trainings performed
  • 30 medical specialties covered
  • Interactive training from international acclaimed institutions
  • CME accreditation to participating physicians
Tele-psychiatry:
  • Weekly sessions on:
    • Family consulting
    • Emotional support groups
    • Child-psychiatry
    • Individual patients
  • Over 250 sessions to date

Successfully implementing the program in the pre-existing hospital and health center infrastructure has been a challenging task for the union of Intracom Telecom and OTE. However, the encouraging results and the constant need to address the issue of providing efficient and effective healthcare services in remote areas of Greece with limited medical resources, either island or rural, provides the necessary motivation to expand the program, covering the majority of the Greek population.