Zviad Kirtava Conference

e-Health and m-Health applications for Cardiology and Dermatology: Experience from Georgia

Kirtava Zviad1,3,4, Simonia Gaiane1, Shulaia Teona2, Kiladze Natalya2, Kashmadze Kakhaber3,4, Jorjoliani David4.
1 – Dept of Therapy, Tbilisi State Medical University (TSMU); 2 – ADDaSOD, Dept of Dermatology, TSMU; 3 – Dept of e-Health, Chapidze Heart Center; 4 – Partners for Health NGO; Tbilisi, GEORGIA. Esta dirección electrónica esta protegida contra spam bots. Necesita activar JavaScript para visualizarla

e-Health (Telehealth) encompasses a range of services or systems that are on the edge of medicine/healthcare and Information and Communication Technologies (ICT). e-Health is considered by WHO as one of the potential and powerful solution to dealing with existing challenges of healthcare services’ disparities globally and locally and as a main tool promoting integrated and efficient patient-centered healthcare. m-Health (mobile health) represents an important recent sub-segment and a rapidly growing branch of e-Health, which covers the practice of medical and public health, supported by mobile devices and mobile communication, for health services and health information.
We have investigated feasibility, effectiveness, Quality of Service (QoS) and Quality of Experience of e-Health and m-Health in fields of Cardiology (73 patients with Cardiac Arrhythmias and 32 patients with Arterial Hypertension) and Dermatology (106 patients).
Telecardiology#: m-Health and e-Health telecardiology applications were used for remote for m-telemonitoring (m-TM) of Arrhythmia and Hypertension outpatients after discharge from hospitals, or - change of medication.
According to Quality of Experience survey results both patients and physicians assessed arrhythmia m-TM as highly satisfactory, convenient, acceptably priced, and easy to use service, which was perceived by great majority of them better than expected. Cost-efficiency of m-TM was rather impressive, allowing to have similar to inpatient monitoring at home by 2.7 times less costly m-Health service.
Ambulatory blood pressure (BP) night-time e-Health monitoring in hypertensive patients revealed inversed circadian rhythm of blood pressure, mostly - in elderly persons. At the same time, m-TM of Hypertension patients was found not cost-efficient in our studies.
m-Health Dermatology (m-teledermatology): 106 outpatients from Tbilisi and two big rural regions with high insolation have undergone teledermatoscopy investigation for skin cancer screening by using DermLite DL3 dermatoscope attached to Samsung Galaxy S4 (Android) smartphone. Dermatoscopy assessment was carried out by H. Kittler’s pattern analysis algorithm based on which special automatic recognition/evaluation software for EMRs is being currently developed and tested in our project.
Numerous dermatological and onco-dermatological pathologies were correctly diagnosed by teledermoscopic investigation: actinic keratosis, basal cell carcinoma, keratoacantoma, melanoma, squamous cell carcinoma, Clark’s nevi, Sutton nevi, “blue” nevi, Unnae, Miescher, spilus, Reed and congenital nevi.  Each difficult case was consulted for second opinion using m- health network of Georgian and foreign partners. For future follow-up and comparisons system of Electronic medical records and e-Registry were developed. Cost of m-telemonitoring was 3.1 times (around 300 times in case of International teleconsultation) lower than in traditional consultation.
Our study confirmed that dermatoscopy is a method of choice for skin cancer screening, e-Registry and EMR, and that m-teledermoscopy represents feasible and particularly cost-efficient methodology for rural primary care with provision of second opinion and further monitoring, improving patients’ safety due to early stage recognition of neoplastic transformation.  

# - Cardiology patients’ evaluation, results and conclusions are in more details discussed in paper #430 of CLAIB 2014 proceedings.