Project Report on Telemedicine: What We Learned about the Administration and Development of a Binational Digital Infrastructure Project

Pediatric Hematology and Oncology Center Integrated by Telemedicine: Experience, Challenges and First Results of a Cross Border Network

This article reports on the development, implementation and management of a German-Polish telemedicine network in the field of pediatric oncology and hematology in the Euroregion Pomerania. The achievements and challenges of joint medical case reviews involving patients and their care givers, as well as cross-border education activities for physicians, students and nursing staff, are presented. In addition to a progress report, the results of an evaluation of the participants and teachers, likewise the measurement of knowledge growth, are given.

Hereditary Breast and Ovarian Cancer Service in Sparsely Populated Western Pomerania

The German Consortium Hereditary Breast and Ovarian Cancer (GC-HBOC) consists of 23 academic centers striving to provide high-quality regional care for affected individuals and healthy at-risk family members. According to the standard operating procedures defined by the GC-HBOC, a Familial Breast and Ovarian Cancer Center was implemented at the University Medicine Greifswald over a four-year period from 2018 to 2021, despite the COVID-19 pandemic. Genetic analyses were performed in a total of 658 individuals, including 41 males, which paved the way to local annual risk-adapted breast cancer surveillance for 91 women and prophylactic surgery for 34 women in 2021. Our experience in the North Eastern part of Germany demonstrates that it is possible to establish a high-risk breast and ovarian cancer service even in a sparsely populated region. Major facilitators are the interdisciplinary collaboration of dedicated local experts, the support of the GC-HBOC, fruitful clinical and scientific cooperations and the use of technical improvements. As a blueprint, our project report may help to further expand the network of specialized and knowledge-generating care for HBOC families.

Quality Assurance of a Cross-Border and Sub-Specialized Teleradiology Service

BACKGROUND

The current literature discusses aspects of quality assurance (QA) and sub-specialization. However, the challenges of these topics in a teleradiology network have been less explored. In a project report, we aimed to review the development and enforcement of sub-specialized radiology at Telemedicine Clinic (TMC), one of the largest teleradiology providers in Europe, and to describe each step of its QA.

EVALUATION

The company-specific background was provided by the co-authors-current and former staff members of TMC. Detailed descriptions of the structures of sub-specialization and QA at TMC are provided. Exemplary quantitative evaluation of caseloads and disagreement rates of secondary reviews are illustrated. Description of Sub-specialization and Quality Assurance at TMC: Sub-specialization at TMC is divided into musculoskeletal radiology, neuroradiology, head and neck, a body, and an emergency section operating at local daytime in Europe and Australia. Quality assurance is based on a strict selection process of radiologists, specific reporting guidelines, feedback through the secondary reading of 100% of all radiology reports for new starters, and a minimum of 5% of radiology reports on a continuous basis for all other radiologists, knowledge sharing activities and ongoing training. The level of sub-specialization of each radiologist is monitored continuously on an individual basis in detail. After prospective secondary readings, the mean disagreement rate at TMC indicating at least possibly clinically relevant findings was 4% in 2021.

CONCLUSION

With continuing and current developments in radiology in mind, the essential features of sub-specialization and innovative QA are relevant for further expansion of teleradiology services and for most radiology departments worldwide to respond to the increasing demand for value-based radiology.

EU-Funded Telemedicine Projects – Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic

The SARS-CoV-2 health emergency has demonstrated the need for developing structured telemedicine systems to protect citizens from the spread of the virus. Thereby, their importance and the necessity to tailor their diffusion at large scale for providing services both at a distance and in time has been shown. For these reasons, the European Union advocates the digital transition of health systems for the next 5 years. The main aim of this work is to revisit the telemedicine research projects financed by European Community during the period 2000-2020 with particular respect to the results derived from their application. The analysis showed that some integration of tele-care and tele-health could be obtained with tele-monitoring systems and the implementation of Electronic Personal Record (EPR). Furthermore, telemedicine allows enhancing health care in critical environments, to protect health and life of the most vulnerable patients, and to encourage cross-border dialogue. The criteria of “from distance” and “timely delivered” are granted, but the effectiveness of the overall offered services highly depends on the availability and the quality of the input data. Unfortunately, this remains a relevant problem in the SARS-CoV-2 pandemic.

Determinants of Sustainable Cross-Border Cooperation: A Structural Model for the Hungarian Context Using the PLS-SEM Methodology

The importance of this research stems from the need to ensure the sustainability of cross-border cooperation through a better understanding of its determinants and causal relationships. While having common features and patterns, cross-border cooperation is always expressed through the relations of specific countries and peoples. Therefore, based upon the PLS-SEM methodology, the authors consider the fundamental factors influencing the external cooperation of Hungary’s transboundary regions. The advantage of the PLS-SEM method is that it enables researchers to simultaneously identify and approximate hidden connections between input data and to construct a regression model describing the relationship between input data. Despite widespread application in economic studies, the authors have not found the use of PLS-SEM for studying cross-border cooperation issues in the current scientific literature. The authors have built a model to assess the hidden factors of cross-border cooperation and to identify the indirect influence of certain factors. The novelty of the research is to identify the determinants of sustainable cross-border cooperation and the relationship between them in a multi-level system of cross-border interaction between businesses, people, and the State. In the Hungarian context, transport infrastructure and business travel are shown to have a direct positive impact on cross-border cooperation. For the first time, tourism and socio-economic conditions have been shown to have powerful but indirect impacts. This work could be the beginning of gathering new evidence on the determinants and causation of cross-border cooperation in the context of other countries. An important finding of the study is the growing importance of indicators of the new, post-industrial economy. As for recommendations, the authors focus on state, regional, and municipal support measures, awareness of the possibilities of cross-border cooperation, the need to develop e-commerce, and alternative energy as a modern basis for converting Hungary’s cross-border position into a competitive advantage.

Obstacles and Solutions Driving the Development of a National Teleradiology Network

Background: Teleradiology has the potential to link medical experts and specialties despite geographical separation. In a project report about hospital-based teleradiology, the significance of technical and human factors during the implementation and growth of a teleradiology network are explored. Evaluation: The article identifies major obstacles during the implementation and growth of the teleradiology network of the Berlin Trauma Hospital (BG Unfallkrankenhaus Berlin) between 2004 and 2020 in semi-structured interviews with senior staff members. Quantitative analysis of examination numbers, patient numbers, and profits relates the efforts of the staff members to the monetary benefits and success of the network. Identification of qualitative and quantitative factors for success: Soft and hard facilitators and solutions driving the development of the national teleradiology network are identified. Obstacles were often solved by technical innovations, but the time span between required personal efforts, endurance, and flexibility of local and external team members. The article describes innovations driven by teleradiology and hints at the impact of teleradiology on modern medical care by relating the expansion of the teleradiology network to patient transfers and profits. Conclusion: In addition to technical improvements, interpersonal collaborations were key to the success of the teleradiology network of the Berlin Trauma Hospital and remained a unique feature and selling point of this teleradiology network.

Diabetes nurse practitioners in the shadow of the COVID-19 pandemic: Challenges, insights, and suggestions for improvement

PURPOSE

The study examined the role of diabetes nurse practitioners (DiNPs) and their contribution to the quality of care of individuals with diabetes during the COVID-19 pandemic. Specifically, we examined the benefits and barriers of using telemedicine for managing diabetes.

DESIGN

A descriptive qualitative research using content analysis of interviews.

METHODS

Participants were invited through the National DiNPs' Forum. Semi-structured interviews were conducted with 24 licensed DiNPs (age range, 37-58 years) who were involved in the clinical care of individuals with diabetes during the COVID-19 pandemic. The interviews were recorded and transcribed, and content analysis was then used for extracting themes and their related categories.

FINDINGS

Content analysis revealed five themes: (a) Benefits and barriers of remote diabetes treatment; (b) Teamwork and its implications to DiNPs; (c) Technological challenges, resourcefulness, and creativity; (d) Changed perception of DiNP roles; and (e) Cultural diversity and improving communication skills. The benefits of telemedicine included improved control, efficiency, convenience and satisfaction, while the disadvantages of this method included the inability to provide optimal practical guidance on technical aspects of physical assessments and care. Sectors with limited digital literacy and language barriers had difficulties using telemedicine. Teamwork was reported as a facilitator to managing treatment. Telemedicine provided an opportunity for DiNPs to become more efficient and focused and to clearly define their role in the organization.

CONCLUSIONS

The COVID-19 pandemic has posed new challenges. Along with the need to adapt the therapeutic approach to remote care, DiNPs improved their professional status, acquired new skills, and were satisfied with their personal and professional growth.

CLINICAL RELEVANCE

Telemedicine should become an integral part of diabetes management to enable access to populations who cannot come to the clinic. Patients should be guided on using telemedicine platforms.