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Please tell me a little about yourself.

My name is Anton Vladzymyrskyy, I was born in 1977 and still live in Donetsk, Ukraine. I'm a medical doctor, magister in traumatology and orthopedics (Polytrauma Department), Head of the Department of Informatics and Telemedicine at Donetsk R&D Institute of Traumatology and Orthopedics, Deputy Editor of Ukrainian Journal of Telemedicine and Medical Telematics, and Regional Telemedicine Director. In 2003, I defended my dissertation Treatment of Polytrauma with Using Telemedicine Systems. I'm the author of 4 books and about 30 articles on telemedicine.

How did you end up working in Telemedicine?

In 1993 I took part in an investigation for disaster medicine telemetry (it was a students' scientific work in Donetsk State Medical University). From 1993-1999 I did my own research in the theory of telemedicine. From 2000-2004 I worked on clinical telemedicine, research, teleconsultations, Web design and content management.

How did telemedicine first come about in Ukraine?

The first telemedicine activities happened in our country in the 1970s. It was telemetry of physiological parameters for coal miners. The first few teleconsultations in telepathology were carried out in 1995. Today, telemedicine is basically delivered as teleconsultations and distance education. In 2000, at the Donetsk R&D Institute of Traumatology and Orthopedics, Ukraine's first Department of Informatics and Telemedicine was founded. Since 2000 we have constantly carried out teleconsultations in trauma, neurosurgery, orthopedics, oncology, pediatrics, rheumatology, obstetrics, dermatology, etc. We created a program for local implementation of telemedicine; also, we study technical, economical, and ethical problems of telemedicine.

In 1999 at the Donetsk State Medical University we started the first Ukrainian theoretical research and investigations in telemedicine. After a few months we published a book Introduction to Telemedicine (full text Russian version is online at http://www.telemed.org.ua/wwwtm_eng/TM/tmcomn.html).

Over the following three years we studied the world's telemedicine experience, elaborated and implemented our own systems, evaluated the effectiveness of teleconsultations, and analyzed the data.

On January 25, 2000, we carried out our first teleconsultation. Professor M. Nerlich from Regensburg, Germany, consulted a patient with serious pelvis trauma from Donetsk, Ukraine. Since that time we have done about 200 teleconsultations in 15 medical specialties. Nowadays, we work under the national program of telemedicine improvement.

What services do you provide through the telemedicine program in Ukraine at this time?

Our telemedicine program consists of teleconsultations and distance learning. In 2004 the creation of the telemedicine network of the Donetsk region was started. We hope that this network will become a prototype for the whole country.

A new project, "Telerehabilitation (Distance Education + Teleconsultation)," was begun in 2004. This project is provided by Donetsk R&D Institute of Traumatology and Orthopedics, Donbass Institute of Technics and Management, and Donetsk State Medical University. The main goal is distance education by social specialities + teleconsultations + telerehabilitation for young disabled persons.

Do you have a favorite activity or one you're really involved in?

A lot of work I carry out by myself. Also, I cooperate with enthusiasts from different cities of Ukraine (Luts'k, Kiev, Simferopol', etc). The most help is rendered by the employees of my Department.

What population do you serve?

In 2000-2004 we had international links mainly. But we "return" to our region. Nowdays our main goal is the creation of a regional telemedicine network. The Donetsk region is a heavy industrial region in eastern Ukraine (5.5 million inhabitants, more then 1000 coal mines, steel and chemical plants). We want to provide effective medical care in rural and remote parts of our region. Also, we want to establish interregional and international links for the best medical care for our people.

Tell me a little about the hardware and software you're using.

We created a few best practice models in telemedicine. You can see it at our Web site very soon. For any kind of telemedicine procedures it's necessary to create an effective telemedicine work station (TWS) with adequate free and/or licensed software, and to connect the TWS to some kind of telecommunication line. The telemedicine equipment that we use was chosen for cost-effectiveness, standardization, availability, simplicity, reliability of use, and information safety. There are three main areas of technology- equipment for the telemedicine work station, telecommunication lines, and software.

In daily clinical practice we use this TWS: PC (1.0 Ghz and more) with multimedia equipment, scanner (1200 dpi and more), digital photo camera (1.3 to 3 megapixels), printer (laser, 600x600 dpi and more), film-viewer, and Web-camera.

We use a variety of elecommunication lines depending on need.

• Direct and dial-up internet lines for any kind of telemedicine procedures.
• Mobile phone services for emergency teleconsultations.
• Direct Internet lines (256 kbps and more) for intercity and interregional communications.
• Dial-up Internet lines (56 Kbps and more) for intraregional, intracity, and rural-city communications.
• SMS/MMS services for any kind of emergency teleconsultations.

It's possible to use specialized or standard software for telemedicine procedures. We prefer:

• standard licensed software from Microsoft;
• a Web application designed with open source code (optimal for medical establishments with low financial support); and
• special Internet-based telemedicine application (for example, the application Regional Telemedical System).

What else are you doing in telemedicine as far as distance education grand rounds?

In 2002 we created an internet-based system for distance education called TeleTrauma. We use it in postgraduate study for residents. In the next year we want to begin a distant course in antibiotics therapy. Also, we have some investigations in telemetry for obstetrics pathology.

What research is the telemedicine program involved with?

We study the effective equipment sets for different medical areas and economic conditions, the "how and why?" of using telemedicine for different clinical problems, the clinical effectiveness of telemedicine, the ethics and law in telemedicine, information security.

What do you want to do, and in what direction would you like to see your program go in the future?

At present there is no special government program for the development of telemedicine. Ukraine's first Health Care Management of Donetsk Regional State Administration has a program for local implementation of telemedicine. This program consists of 3 stages:

1. creation of telemedicine workstations and internet channels, implementation of not-urgent teleconsultations, staff education;
2. emergency medicine system reform, implementation of urgent teleconsultations; and
3. establishment of national and international telemedicine links and partnership, implementation of distance education.

The main directions of the development of telemedicine in Ukraine are:

• the creation of regional and national programs of telemedicine improvement;
• the use of teleconsultations in treatment of different serious pathology (polytrauma, heart diseases, oncology, tuberculosis, AIDS, etc);
• implementation of distance education;
• staff education for telemedicine workstations;
• improvement of telemedicine in rural areas; and
• scientific research in clinical teleconsultations, special equipment, legal, ethical and deonthological problems of telemedicine and health informatics, testing different equipment for telemedicine workstations.

What do you want your program to achieve in one, five and ten years?

In one year we would like to have a telemedicine network for the Donetsk region, be able to perform an analysis of success and failures, and create a powerful, effective concept for regional and national telemedicine networks. In five years, our goal is to establish telemedicine networks for all regions of Ukraine and create a system for information security (on the basis of digital signatures). Also, the creation of a body of law for telemedicine in Ukraine is important. I'm not sure what technology we will have in 10 years.

I am convinced that one of the most exciting areas in Telemedicine is the potential role it may have in international health care and disaster responses. What is your view?

I agree that it's a very interesting and useful area for telemedicine. We have a little experience in this area. In 2001 we teleconsulted for a few trauma patients after the earthquake in India. It was a very useful experience, both for Indian physicians and for us. I believe it's possible to create an Internet-based international teleconsultation system for urgent responses.

What can be done to continue to promote Telemedicine in Ukraine and Eurasia?

Of course, obtaining more funding is essential, but first people must understand why we need telemedicine. A wide demonstration of the possibilities of telemedicine will help open people's eyes, and reporting clinical results will add credibility. Training for telemedicine is also important so the field can expand.

What do you want to say or add to your colleagues out there? And what words of advice can you offer?

I'm very appreciative for this interview. I believe that telemedicine is like a "collective medical brain" of the whole world. Any serious patient can find a physician with unique experience. It's a great help in clinical decision-making. Telemedicine makes medical care wide, boundless, and accessible. My colleagues and I are open to any kind of cooperation and partnership in telemedicine and e-health. Also I welcome authors and readers for our journal. Feel free to contact me with any questions and comments at avv@telemed.org.ua or avv25@skif.net.

Relevant Links

"Telemedicine in Ukraine", general information, catalogue of Web resources, library, teleconsultations, information for patients
http://www.telemed.org.ua

Ukrainian Journal of Telemedicine and Medical Telematics http://www.telemed.org.ua/UJTMMT/jindex.html

Telemedicine projects
http://www.intermag.kiev.ua
http://www.vokl.lutsk.ua
http://ictm.org.ua/
http://www.srlc.nmu.kiev.ua
http://www.kx.kiev.ua/telemed.html
http://derma-don.org.ua

Ukrainian Affiliate Sites Network of European Health Telematics Observatory http://www.ehto-ukr.cit-ua.net

Health information
http://www.health.gov.ua
http://health.kiev.ua
http://www.ozu.com.ua/ukr/1/index.asp

Equipment for telemedicine
http://www.dx-telemedicine.com