Telemedicine in a state of war. Opportunities and prospects

At the time of preparation of this information, according to the official data of the Ministry of Health of Ukraine, 135 hospitals were damaged, of which 9 cannot be restored and 43 emergency medical teams were fired upon. As you can see, the destruction of medical infrastructure is one of the objectives of the enemy. Unfortunately, these numbers are only increasing every day. Thus, in two weeks the number of damaged hospitals increased from 34 to 135. We see the targeted destruction of medical infrastructure.

About 6.5 million citizens are considered internally displaced persons. Most of them are residents of the regions where hostilities are taking place and the occupied territories. Since the beginning of the war, 3.3 million people have left Ukraine, many of them moved to Poland. Consequently, the humanitarian crisis tends to spread to other European countries if the situation does not change radically in the near future.

So, by analyzing  the situation, we can clearly identify some large-scale problems, that either already exist or are expected in the near future in the Health System.

An extremely topical issue is how to provide the necessary medical care to people, who were forced to leave their homes and temporarily residing in other areas. There are about 6.5 million of them today! This is the first global question. But there is one more thing, no less important.

People who have experienced acute stress, in a third of cases in the short term will suffer from post-traumatic stress disorder. The expected number will reach more than 2 million only within the country. This problem is also relevant for more than 1 million refugees who have received temporary asylum in European countries.

In fact, there will also be great difficulties. We must remember that effective professional psychological assistance can only be provided by native speakers – Ukrainian or Russian, who are difficult to find abroad. Very few refugees speak the languages of Europe at such a level that they can receive psychological assistance at a professional level.

The key issues outlined above need to be addressed urgently.

Given the circumstances, the most relevant mechanism for accessing health care is now remote. It is the means of telemedicine, that make it possible to radically influence the situation by providing access to medical care in such extreme conditions. Ukrainian doctors intuitively come to this decision.

In most cases, they independently offer their patients to seek advice, using messengers and telephones. There are hundreds of such offers from doctors on social networks. Among them are family doctors and medical specialists.

We are seeing initiatives from many medical institutions offering remote access to their doctors. Most of them actively used such consultation tools in peacetime as well. This experience allowed them to quickly optimize the treatment and diagnostic process using telemedicine in a state of war.

There is also an initiative of the Ministry of Health, announced last week. The message said about the ability to call a single number, where your call will be forwarded to the specialist you need. The initiative of the MoH is extremely important and useful, but the question arises, how effective is it for almost seven million internally displaced people?

 It seems that this can only be the first, emergency step, which should be followed by systemic decision. And our Association is ready to assist in resolving this issue. Let me remind you that it was our specialists who were directly involved in the creation and implementation of telemedicine in Ukraine, including the development of the entire national regulatory framework for this area.

Now let’s return to the second large-scale problem – providing psychological assistance to the population and preventing the occurrence of consequences, including post-traumatic stress disorder. We remember the scale of these challenges – the extremely large number of internally displaced persons and refugees. And this number will grow.

It is clear that this cannot be solved only by volunteer initiatives. Timely and urgently needed volunteer help is the first reaction of the society to systemic and large-scale challenges. The next step should be the activity of the state. It is at this stage that systemic assistance from other states and international donors will be invaluable. They can join the implementation of specific tasks in this direction right now and during the reconstruction of the health care system after the war.

We see many proposals from colleagues from different countries. Some of them are ready to come to Ukraine and provide medical care in the conditions of Ukrainian medical institutions. Other countries are deploying mobile hospitals. Such actions are highly respected.

If we focus on telemedicine, then we see a lot of proposals from colleagues from abroad who offer their own telemedicine platforms. Thanks to this, many doctors from different countries can consult as a volunteer. Unfortunately, there are certain barriers. According to our analysis, practically none of these platforms currently has a user interface in Ukrainian or at least in Russian. This is important for the user interface for both medical staff and patients. First of all, this is of great importance for the user interface for patients.

When it comes to psychological help, other questions arise. Psychological assistance can be most effective only when the psychologist or psychiatrist communicates in the patient’s native language. Unfortunately, there are very few such specialists abroad, and those who could work remotely from Ukraine are themselves suffering from the war.

In our opinion, it is necessary not only to coordinate these initiatives, but also to prepare an effective action plan to minimize the consequences of the humanitarian crisis in the field of healthcare organization.

Let’s be honest, this is the first time since World War II that Europe is facing so many refugees and other challenges of war in Europe’s largest country. To date, there is no experience in eliminating the consequences under such conditions. . This experience is being formed today before our eyes.

In this situation, we must combine our efforts and direct them to a situational analysis of the current situation and the development of effective steps to solve problems.

Also, we want to make an appeal to our partners from ISfTeH – International Society for Telemedicine & eHealth. It is this international organization that unites 108 countries from all over the world to create, develop and implement modern Information systems, including Telemedicine.

Our Association has been representing Ukraine in ISfTeH for 9 years. The real potential of ISfTeH is based on the foundations of the diverse experiences of its member countries. First of all, these can be examples of the use of telemedicine technologies and the use of digital medicine in various, including crisis conditions. Therefore, we hope that this experience can now be used to solve health problems in Ukraine.

Therefore, we appeal to the leadership of ISfTeH with a request to be the coordinator of the efforts of ISfTeH members to exchange experiences and help implement the best solutions for organizing assistance to Ukrainians, including refugees and internally displaced persons.

As a possible option, it would be useful to establish a Working group to coordinate efforts and implement activities. Perhaps other options for cooperation can be offered. Our Association is ready to act as a reliable communicator between the International Initiative and Ukraine.

Ukraininan Association Development IT in Medicine

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