THE RELATIONSHIP BETWEEN EUROREGIONS AND THE MODERN HOSPITAL
Received for publication: 11th of October, 2005
Revised: 1st of December, 2005
SUMMARY: (Hide the summary)
Nowadays, at the beginning of the XXIst century, any responsible individual involved in medical assistance should be confronted, more or less, with three challenges, namely: promoting high quality medical services, with the lowest costs possible, and with a high accessibility. Over the last few years numerous changes took place in Romania, respectively at the level of exhaustive structures such as the Emergency Clinical Hospital of Timisoara, Romania, there were numerous organisatorial changes, implicitly in the IT infra-structure (significant increase in the number of PCs, INTRANET development, increase in the number of INTERNET users). More than that, new patterns of collaboration and communication emerged. The objective of this paper is to present the development of the IT infrastructure, to describe the INTRANET network, and to indicate some applications based on an IT infrastructure with a permanent ascending trend. The IT technology often got ahead of the mentality of beneficiaries and users. The following key IT technology elements function in the Emergency Clinical Hospital Timisoara, Romania: a large number of PCs, respectively users in various fields, both medical and administrative, INTERNET (www.hosptm.ro), telephony, optical fiber connections. Compared with the scientific data, the IT technology at the level of the Emergency Clinical Hospital Timisoara, Romania represents the fundamental stone in the informational data flow within the hospital.
euro-regions, modern hospital, telemedicine
“Paving the way for a New Neighborhood Instrument”
Commission Of The European Communities, 01.07.2003
In the Communication of the Commission Of The European Communities: “Wider Europe – Neighborhood: A New Framework for Relations with our Eastern and Southern Neighbours” (hereafter “the Wider Europe Communication”), from 1.7.2003, the Commission proposed that “the European Union should aim to develop a zone of prosperity and a friendly neighbourhood with countries whom the European Union enjoys close, peaceful and co-operative relations”. That means that the Union’s capacity to provide security, stability and sustainable development to its citizens will no longer be distinguishable from its interest in close co-operation with the neighbours. One of the elements of the Wider Europe Communication, consists in creating a new tool for cross-border cooperation, focusing on “ensuring the smooth functioning and secure management of the future Eastern and Mediterranean borders, promoting sustainable economic and social development of the border regions and pursuing regional and transnational co-operation”. This new tool regarding cross-border cooperation between EU and non EU countries, will function “on the experience of promoting cross-border co-operation within the PHARE, Tacis and INTERREG programmes”.
According to the Council of Europe, “the transfrontier structures are arrangements for cooperation between units of local or regional government across the border in order to promote common interests and enhance the living standards of the border populations”.
The positive impact of enlargement on current and future Member States and on neighbouring countries will be considerable. At the same time the new opportunities brought by enlargement will be accompanied by new challenges: existing differences in living standards across the Union’s borders may be emphasized as a result of faster growth in the new Member States than in their external neighbours; common challenges in fields such as the environment, public health, the longstanding cultural links across these borders should be enhanced.
The regional and cross-border co-operation will have an important role not only in political and social aspects of people life between the borders but also in domains like cultural, scientific and health program. The particularity of the euro-region DKMT, consists also in the geographic position of the three countries, that have a common border in the Timis county.
As Jean Monnet said: “ We unit people, not states”, our paper is dedicated to novel methods in the field of health care, and one of this is the application of telemedicine.
As a first practical application of the IT technology in the medical field, the debut and the clinical implementation of the Italian-Romanian Project in Telemedicine, with specific applications in pathology, cardiology and radiology, the project aims to provide bilateral medical assistance in two or more euro-regions: Banat, (including Timis, Arad, and Caras-Severin counties), from the western part of Romania and the Region Veneto from Italy with disposability for future applications in the DKMT euro-region (Hungary, Serbia-Montenegro, Romania). Most clinical departments, of the Emergency Hospital Timisoara, use specific archetypes for the Electronic Patient Record (EPR). Patient database is shared by clinical departments, laboratory, pharmacy, administrative and statistical department (fig. 1). However, information exchange between departments still needs improvement. Some image transfer protocols are not functional yet. ICD 10 is used for coding, providing the support for DRG system. However, the payment for various medical services is established by the National Health Insurance House, and most physicians feel that it is inappropriate. We also experience the lack of specialists in medical informatics, despite several training courses organized both by private companies and the hospital computer office staff.
The modularity of this system made us implement the components one by one and it is still being developed (5 computers in 1990 and over 200 now). We have noticed the improvement of the medical staff’s perception concerning the benefits of using computers in various activities. The conditions for implementing top technologies, like telemedicine are already met.
Telemedicine, offers the possibility to increase the role of physicians, by direct person-to-person dialog, using modern IT techniques, like Internet, email, and not at last offers for the patients the possibility to achieve a universality of the health care.
For this purpose, we present the Italian-Romanian Project in Telemedicine, as a bilateral project that is functional since December 2004, between two regions that are not geographically in the same euro region. The Italian Ministry of Foreign Affairs supports this program, and the project leader is the @ITIM – Associazione Italiana di Telemedicine e Informatica Medica.
The Romanian partnership consists in providing health care for all patients admitted by the Emergency Clinical Hospital Timisoara, that covers basically entire SW part of Romania and receiving technical support from the Polytechnic University of Timisoara. The aim of this study is to increase the quality of medical services, provided by the Emergency Clinical Hospital Timisoara, Romania, in collaboration with departments from hospitals from the Regio Veneto (Italy), like Hospital of Treviso and Desio, and in a future project to establish a telemedicine intra-hospital network, involving two or more euro regions.
This project was preceded by bilateral meetings of specialists from both countries in Timisoara, Romania (2003, 2004) and Desio, Italy (2004) – cardiologist, radiologist, software engineers – to establish the value of telemedicine in this partnership. Future aims of this project are the continuous medical education by e-learning and e-health programs, with links to other partners in Europe (like DKMT Euro-region), promoting crossborder cooperation. By creating a telemedicine portal in Timis County, at the Emergency Clinical Hospital Timisoara, initially for cardiology, radiology and pathology, this project will offer health care services for a large number of patients, including the DKMT region and other Euro-regions, for teleconsulting and even telediagnosis. The core of this project is reflected by the concept of the modern hospital, in which, the IT technology is the mile stone for a high quality health care services (fig. 2), nowadays only the team work is a guaranty for a high level of medical activity.
Results and discussions
This project opens new perspectives regarding the development of the existing local infrastructures and support for telemedicine activities in Euro-regions, like DKMT or others, developing future programs in relation with a harmonic cooperation. The dissemination of the results of this project is possible by various techniques (i.e. videoconferences, forums, e-mail, e-learning) the recorded data are saved in the Clinical Image IntegraÒ, the software that is the core of this project, and in which is possible to generate a huge database, recording images and video files. A software key protects the software and runs on commercial PCs and laptops, the unique “inconvenient” is that the software must be installed by the providers (@ITIM Associazione Italiana di Telemedicina e Informatica Medica). Implementing this software and by participating in this project the first beneficiary are the general practitioners (family doctors) from a large geographically area, including the DKMT medical corpus, but also the patients, by reducing health care costs, high level of teleconsulting, and by reducing the time for health care services. Another advantage of this project is reflected by the possibility of developing the scientific and cultural communication, physicians-tophysician and physicians – to – patients. A major opportunity is reflected by the better cross border communication, using this type of projects, for students, general practitioners, and specialists all involved in the complex activity of the health care. Last but not least, these kinds of projects are patient-friendly, basically for those who have no access to high quality consulting.
Telemedicine projects (similar to the presented project) remove barriers between people, countries and regions. So, health care providers offer services to people at distance, or for people in emergency situations. The development of concepts like e-health or e-learning is directly related to telemedicine projects. Our project is open to future cross-border cooperation between DKMT Euro-region and other Euro- regions.
A targeted use of patient-oriented health telematics applications can help:
- to maintain and improve the quality of care,
- to better coordinate patient care between the various providers in the health and social care sectors,
- increase the efficiency and effectiveness of the health system.”
In the light of the DKMT Euro-region we propose to create and develop a telemedicine network related to our region and linked by affiliation to other similar European networks. This kind of project could be a model for other projects in the field or for other activities.
1. Abbot W, Bryant J R, Peel V J (eds) – Information Management in Health Care, Handbook D: Hospital Systems, HISG, Eastbourne, England 1996.
2. Shortliffe E H, Perreault L E (eds) – Medical Informatics, Springer Verlag, New York 2001, 132-211, 359-398.
3. Van Bemmel J H, Musen MA (eds) – Handbook of Medical Informatics, Springer Verlag, Heidelberg 1997, 171-218, 331-356.