Introduction
The Ukraine health system is strongly centralised with most national referral centres located in Kiev. The organisation of the health system remains hierarchical and expert knowledge is pooled mainly in the capital. The national head specialists in Obstetrics and Neonatology located in Kiev determine the policy and are the clinical reference for the entire health community. Clinical practice guidelines once elaborated on this highest level trickle down through the entire health system until they reach the lowest level of primary health care if ever. This hampers the efficient dissemination of new knowledge.
Continuous medical education (CME) is centralised and takes place sporadically every five years in Kiev. In the time in between clinicians are disconnected from the developments in clinical practice. The circumstances highlighted above lead to the situation where health professionals working at the periphery relay on outdated material which does not comply with EBM standards in their clinical practice.
The main objectives pursued with the integration of telemedicine in the clinical practice are as following:
- Enable health professionals to overcome professional isolation while sharing experiences and expertise with colleagues through all levels of the health system vertically and horizontally.
- Stimulate the self directed learning process of the health professionals and contribute to the increase of professional skills apart from the regular official continuous medical training.
- Provide a platform for a network of health professionals consulting each other in clinical cases and contribute to improved health service delivery.
So far more than 400 clinical cases have been presented for discussion. The main requests of the participants are related to consultations (second opinion) and to a lesser extent the sharing of information. Consultations aim mainly for the confirmation or specification of the diagnosis or treatment procedure and to a lesser extent to medication strategies.
Further aspects of interest to be evaluated are the impact of the application of Telemedicine on patient referral, the amount and relevance of knowledge gained through the network and the response time and acceptable delays for second opinion cases.
