TIMTEM Project: Our Experience in a Remote Area

Abstract

We report our experience, begun in 1998 on a small island in the Dodecanese area of Greece, which has been called TIMTEM. The aim of this project was to improve care for people living on islands, creating a model exportable to other rural areas. The operative setting of the TIMTEM project is the island of Tilos (Greece); local authorities take part in it under the guidance of the only physician available on the island. The University of Pisa-Italy (Department of Surgery, Post-graduate School of Emergency Surgery) manages the scientific and organizational part of the project. Tilos is a rocky Mediterranean island with a surface of 64 km(2) and a population of about 500 inhabitants (with a peak of 2,000 tourists in July and August). A physician and a nurse are responsible for the only medical care on the island, and they also dispense drugs. The project was implemented on three phases. During the first phase, a campaign was held to encourage the population to cooperate with clinical data collection; a temporary telemedicine station was established, and a complete screening of the population was performed. The second phase was focused on the application of telesonography. During the third phase, a telematic and/or direct participation for reference hospital physicians (Regional Medical Society-Dodecanese) and for Greek physicians was planned. As well, a fully equipped central telemedicine station in the reference hospital was established under the local jurisdiction. The results of the third phase are still incomplete; the data presented here are preliminary. But all indicators show that the project is exportable to remote areas elsewhere.

Telesonography: Foundations and Future Directions

“…Some of the earliest research projects using clinical telesonography were applied to subspecialties such as cardiology and obstetrics 7 . Although early projects were limited by the transmission bandwidth and signal degradation, early successes with transmitted echocardiograms and fetal scans have spurred continued interest and research in counties and continents such as Canada, Great Britain, Europe, and Australia 4 – 6 , 8 , 9 . Within the past decade, several studies have shown the clinical feasibility and patient and physician acceptance of telesonography systems to provide care to remote populations.…”

“…Most telesonography research focuses on its use within an ambulatory care setting with a continued emphasis on obstetric imaging 14 , 21 , 22 ; however, infectious disease applications, 23 , 24 nonobstetric transabdominal scans, 3 musculoskeletal scans, 25 FAST scans, 6 , 26 and even the use of a robotic arm to perform scans 27 have also been explored. In addition to telesonography, many studies have proven the effectiveness of store‐and‐forward telemedicine, including such fields as dermatology, 28 dentistry, 29 and neurology, 30 including several projects based in developing nations 31 – 33 …”

“…Among the efforts to overcome such shortages, the use of remote telesonography is one technical strategy that continues to gain popularity. Remote telesonography has yielded promising results in several domestic and international projects aimed at providing basic sonography services 3 – 6 . The judicious use of remote telesonography within the ambulatory care setting has the potential to contribute to accurate patient triage and, in turn, efficient use of limited medical resources 3 .…”

Telesonography - the 5th dimension of ultrasound examination

“…Telesonography networks experimentally developed to follow the principle of "fulfillment of needs", were designed for assessment and monitoring of certain isolated communities or certain pathologies. Therefore, projects were carried out on the islands [17][18], on ships [19], on remote locations or even in space [20][21][22].…”

Teledermatology by videoconference: Experience of a pilot project

“…Teledermatology is and has been practised in many parts of the world, including Norway, Finland, the USA, Canada, Australia, New Zealand, Northern Ireland, the Marshall Islands and the Greek island of Tilos. 4,5,6,7,8,9 Telemedicine services have broadly evolved into two categories: store and forward telemedicine, and synchronous or real-time telemedicine. Store and forward telemedicine, as its name implies, involves forwarding information which has already been saved in an electronic format to a consultant who reviews the case in his or her own time.…”