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Development of Informatic System and Telemedicine in Croatian Primary Health Care

1. Croatian ICT Primary Health Care Project Croatia's health ministry has started a health care system internetisation project aimed at strengthening collaboration between health care institutions, expert groups and individuals providing health care. A tender for IT system for PHC (general practice, paediatrics and gynaecology), a vital prerequisite for project realisation, is now closed. Some of the important reasons for undertaking the project are rationalisation of drug utilisation, and potential savings owing to a reduced use of specialists, consultants and hospitalization. Achieving the goals of better cooperation, division of labour, result networking, data quality improvements (via standardisation), and ensuring proper information-based decision making are additional reasons. For the PHC team, it is too time consuming to keep the non standardised and thus hard to process data. The fact that a vast portion of the data collected relates to only a few indicators could lead to the uncovering of important information. Although health authority decisions should rely on evidence and processed information, most of the time these bodies work with the raw data from which their decisions ultimately stem. IT in PHC is expected to enable a different approach. PHC teams should be relieved of the tedious task of data gathering and authorities enabled to work with information, not data. The ICT system consists of three parts: hardware (5000 personal computers for work over the Internet), operative system with basic software (editor, etc.), and PHC software for PHC teams. The system permits bi-directional data exchange between a central database and sources on different levels, across a spectrum from basic PHC teams to local authorities. This will enable the data collection control, comparisons with national averages and prompt distribution of information over the Internet. 2. Telemedicine in Croatian Primary Health Care As a diagnostic tool, telemedicine offers primary health care teams great opportunities. The telemedicine project conducted on the Adriatic islands was an excellent pilot effort for including all primary health care teams in a single ICT and telemedicine system. Today, the recording and reading of relevant diagnostic study findings (ECG, EEG, EMG, ultrasound, X ray scans, CT, color Doppler, MR, etc.) is largely digital. Communication technology allows such records to be transferred and stored rapidly, sometimes even uncompressed. Next, Croatia has an impressive network of specialists, polyclinics and hospitals with experts in the fields routinely using digital records and diagnostic messages. Distant consultation and on line consultations are a reality now. They are also currently used in dealing with emergency diseases and conditions on the Adriatic islands. Shortly, however, they are to be used in the operation of Emergency Health Service or first aid by in-readiness and on duty staffs of the Family Medicine physicians. On line consultations and on-line special medical examinations save the time it takes to establish a final diagnosis, which is especially important in acute diseases and certain chronic diseases. In addition, these procedures also save: - consultant's time (and money) for allowing him then to do only the narrowly specialised task of result reading - family doctor's time (and money) by reducing the number of attendances that a patient needs to make in order to obtain referrals notes for tests and control examinations - patient's time. The sum of all these times may warrant the investments by itself, especially if one takes account of the health benefits and influences on health outcomes. For some, a network of specialist consultation rooms with "open doors for telemedicine" and a network of family doctor consultation rooms using such network is already a reality, to others the near future. In the future, such local clinics will be able to earn more from health systems they will acquire one or two accreditation stars and qualify to enter the worldwide network of telemedicine consultation rooms. Many examples show the usefulness of telemedicine in primary health care, primarily in Emergency Medical Service (portable biochemistry analyzer, remote ECG, emergency coordination, out-of-hospital thrombolytic for A.M.I. attended by emergency teams). In family medicine service, when checking on tests done and in diagnosis setting, telemedicine is useful in the form of on-line urgent examinations, consultant organised examinations, or off-line care. Today, electrocardiography, diagnostic imaging, digital photo transmission and reception, and portable analysers are also simple, inexpensive and welcome aids saving the health fund money by producing results that favour health more. Communication between a primary health centre and first, second and third level hospitals, as well as establishing a special coordination centre are today's reality and need. An evaluation of diagnostic correlation between the consulted and consulting physician found the quality of teleassistance to be superior to the traditional assistance in more than 95% of the cases. 3. Abstract The investment into IT is a strategic one and having no alternative. A cost/benefit analysis has shown that its operation in the primary health care system will give a return on investment in two years. As defined according to Project's priorities (with measurable objectives), new technologies will be introduced by stages.

Informatic System; Telemedicine; Primary Health Care

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