1. E-Health and Telemedicine development perspectives in Latvia and EU 2005-2015 (The Model of Riga Telemedicine centre) RĪGA, IST4Balt RĪGA, IST4Balt 2006 April 7

2. Egils Stumbris-Stumbergs, MD, Neurosurgeon, Flight surgeon, German Flight Lufthansa Academy Baltic Telemedicine Institute

4. Telemedicine – the guarantee of equality in accessibility and quality of health care services

5. Main Goal of Health Care System in Latvia and EU To improve health care services in terms of: To improve health care services in terms of: o quality o cost efficiency o rational accessibility

6. Current Situation in Latvia and EU Specialized secondary and highly qualified tertiary health care services are mostly available in two or three city hospitals Specialized secondary and highly qualified tertiary health care services are mostly available in two or three city hospitals

7. Electronic Data Protection Decision of the European Commission of 27 December 2004 amending Decision 2001/497/EC as regards the introduction of an alternative set of standard contractual clauses for the transfer of personal data to third countries (notified under document number C(2004) 5271), text with EEA relevance, 2004/915/EC. Done at Brussels, 27 December 2004. Decision of the European Commission of 27 December 2004 amending Decision 2001/497/EC as regards the introduction of an alternative set of standard contractual clauses for the transfer of personal data to third countries (notified under document number C(2004) 5271), text with EEA relevance, 2004/915/EC. Done at Brussels, 27 December 2004.

8. Decrees by the Latvian Government in respect of e-Health and Telemedicine development  In the Declaration adopted by the Latvian Government on 6 December 2004 Supporting of introduction of modern information technologies in organising healthcare system for financial accountability and storage of patients’ data  Development programme for ambulatory and stationary health care service providers, approved with the Cabinet of Ministers’ Decree No 1003 of 20 December 2004. 6. To make rational use of medical technologies and ensure its accessibility to residents.  In 2004, the e-Health in Latvia guideline project was developed and submitted to the Latvian Ministry of Welfare.  On 16 August 2005, the Latvian Cabinet of Ministers adopted guidelines on e-Health in Latvia Guidelines provide for the development of e-health in Latvia through investments totaling LVL 25 million or EUR 30 million over the period of 10 years.

9. e-Health and Telemedicine is implemented in Latvia through: State investment programmes State investment programmes Local municipalities Local municipalities Mixed public, municipal and private investment Mixed public, municipal and private investment

10. The benefits for residents from the implementation of Telemedicine in Latvia Solves the availability problem irrespective of the distance – services are available at any patient’s locality: Solves the availability problem irrespective of the distance – services are available at any patient’s locality: - at home; - at a GP’s office; - at an ambulatory clinic; - at any clinic.

11. The benefits for residents from implementation of Telemedicine in Latvia Solves the quality problem Solves the quality problem – ensures high quality services in all health care establishments, including those lacking highly qualified specialists and modern technologies

12. The benefits for residents from implementation of Telemedicine in Latvia Promotes cost efficiency Promotes cost efficiency - Prevents any costs arising from services of poor quality and services not provided in due time (e.g. treatment of complications of illness, direct and indirect costs associated with disability etc.)

13. The Riga Telemedicine implementation model in the European Union

14. Administration Director Director’s adviser Secretary – desk officer Clerk – desk officer Accountant Development Project and Economic department Head of Department Senior Project Manager Project Manager Teleradiology and Videoconferenc ing Department Head of Department Home Telemedicine Department Head of Department Data Protection and Public Information Department Head of Department Adviser Technical Support Department Head of Department 4 computer operators Clinical Videoconferenc ing Division Head of Division 2 computer operators Telecardiology Division 4 doctors cardiologists 8 assistants (24/7 ) Telepulmonolo gy Division Doctor 2 assistants WEB Videoconferenc ing Division Head of Division 2 computer operators

15. Principal scheme of Telemedicine centre Telemedicine Centre ISDN, Internet Administration Other local public telemedicine centres Foreign Telemedicine centres in/outside the EU Medical insurance companies- State EU World

16. Costs of Telemedicine centre EUR 450-600 thousand per year EUR 450-600 thousand per year Premises lease Premises lease Salaries Salaries Project development Project development Communication costs etc. Communication costs etc.

17. Development Project and Economic Department

18. Develops project applications for State investment programs Develops project applications for State investment programs Develops EU projects Develops EU projects Performs marketing activities for the implementation of telemedicine Performs marketing activities for the implementation of telemedicine

19. Teleradiology and Videoconferencing Department

20. Launches Teleradiology systems in hospitals (RIS and HIS) Launches Teleradiology systems in hospitals (RIS and HIS) Provides videoconferencing to hospitals (international televideoconferences, consultations, Intensive Care Unit Test Bed) Provides videoconferencing to hospitals (international televideoconferences, consultations, Intensive Care Unit Test Bed) Provides WEB conferences for chronic patients and patients receiving social care services Provides WEB conferences for chronic patients and patients receiving social care services

21. Implementation of Teleradiology System will ensure a gradual transition to filmless radiology that will save approximately 50-80% of the resources for purchasing and developing X-ray films and storing of X-ray images

22. Principal scheme of teleradiology system for a multi-profile hospital

23. Computerized workflow in radiology Clinical conference Reading on dedicated stations (display protocols, multiplanar reformatting) 30 connected modalities Clinical review

24. The chain of events Patient installation Examination

25. The chain of events Radiologist: Image review Report dictation With Clinician: Diagnosis presentation