ARMENIAN ASSOCIATION OF TELEMEDICINE
 
 
 
 

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The extraordinary developments in computing, communications and medical technologies, are making a reality what we have not even dreamt of. Telemedicine & eHealth are revolutionizing the world of health care. If you are, or wish to be involved in this exciting field, the “Future of Medicine”, then this site is for you. Learn how to become AATM member

 
 
 
 
 

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This section contains links to a variety of interactive activities, such as On-line Discussion Groups for health care professionals or general public, and On-line Consultation Services for the patients. If you wish to participate in our on-line discussions, ask physician a question, or apply for a consult, you will need to log in, or register with this web-site.

 
 
 
 
Telemedicine & eHealth

TM & eH at a glance
. Introduction
. What is TM & eH
. Definitions
. Examples
. Brief History
. Facts & Figures
. Types of Services
. Tools & Equipment
. Benefits
. Difficulties
. Future


Telemedicine & eHealth in Armenia

References & Further Readings

Related Resources

Telemedicine and eHealth in Armenia

Telemedicine and eHealth in Armenia: History and Current State

Armenia is a landlocked country and is one of the smallest of the independent states of the former Soviet Union. It has an area of approximately 30,000 km2 with a population of approximately 3 million, of whom more than 1 million live in the capital city, Yerevan. The remaining population lives mainly in rural communities and cities with less developed (as compared to the capital) living standards, telecommunications and health-care provision. The Republic of Armenia has experienced the dissolution of the Soviet Union, independence, continuing economic blockade resulting from the war which followed independence and the difficult economic circumstances that followed. In the last decade, after a cease-fire took place in 1994, Armenia started slowly recovering its economic potential and social settings, and in the recent years was characterized by sustainable high rates of economy growth (averaged 10% annually) [76].

Armenia was one of the most industrialized republics of the former Soviet Union with a sophisticated high technology sector. Nowadays ICT domain is one of the most successful and fastest growing industries in Armenia. During the last 10 years, the ICT industry saw a sharp increase in the number of newly formed companies, both local start-ups and branches of foreign companies. More than 90% of the foreign companies were established in 1998-2008. The number of operating IT companies in 2008 reached 175 representing nearly 17% growth from 1998 to 2008. On average 17 IT businesses were launched annually in 2000-2008. This is in sharp contrast to 1990s when only 5 companies were formed each year. In 2008, Armenian ICT sector generated around $111 million ($38 million in 2003), which constitutes around 1.2% of GDP (the corresponding figure in Germany is 1.3%) [77]. Such progress of ICT opens completely new opportunities in the provision of health care in the country. The capacity of these technologies to reduce many traditional obstacles, especially those of time and distance, makes it possible to use the potential of ICT for the benefit of public health.

However, penetration of ICT applications in health care sector in Armenia remains remarkably low, which partly reflects absence of national strategy and sustained policy in eHealth [13]. The vast majority of country's 140 secondary and tertiary care institutions and almost all primary care facilities do not have sustainable access to high-speed Internet, as well as other modern telecommunication routes. Even major multi-disciplinary tertiary care institutions in the capital of Armenia, city of Yerevan, are lacking necessary IT equipment and communications. Major eHealth operating tools, such as electronic Hospital Information Systems, Electronic Health Records, Picture Archiving and Communication Systems, e-prescription and e-referral, are installed in but a few medical centers [80]. Local web-based activities are as yet sporadic, so those health specialists (and lay public alike) regularly using on-line health related resources rely heavily on access to international health information portals.

At the same time, community health care facilities are facing shortage of medical specialists. Specialty medical care is highly centralized, with most specialists working in large hospitals in Yerevan, or in other major urban sites [78, 80]. Hence, patients from remote, mostly rural areas usually need to travel considerable distance to obtain a specialty consult. The associated costs of transportation and temporary stay in urban, usually metropolitan area may be highly undesirable to limited income households, often delaying necessary medical advice and treatment and leading to development of advanced conditions and complications [82].

Health care professionals in rural communities are also currently insufficiently exposed to contemporary means of continuing medical education (CME) and training, partly because of the above mentioned limited access to Internet resources. Despite current considerable efforts by leading local medical educational institutions, such as Yerevan State Medical University (YSMU), National Institute of Health (NIH), or American University of Armenia (AUA) to provide up-to-date medical educational content, most of the live CME activities take place in Yerevan, leaving community health specialists largely outside their reach. As a result many physicians working in rural areas, especially in primary care, are lacking information about most up-to-date treatments, including data on novel medications available on local pharmaceutical market, and modern diagnostic and therapeutic tools [83].

All above described makes developments in TM and eH applications in Armenia an especially important perspective, with significant potential to overcome current inequities in specialty health care and health education, and to tackle present disparities in health care and pharmaceutical markets between metropolitan and rural communities.

Previous experience with TM and eH applications in Armenia has been limited. The first TM activity in Armenia was the US National Aeronautics and Space Administration (NASA) Telemedicine Space Bridge Program, which was operational in 1989, after the disastrous earthquake in December 1988 [84, 87]. Subsequently several isolated projects have been implemented, at few local medical institutions (such as Diagnostica Medical Center, Emergency Medical Center, YSMU Center of Clinical Pathology, among others) mostly involving “store-and-forward” techniques (medical image and documen­tation transfer over low-band-width connections), in the fields of teleradiology and telepathology [85, 86, 87]. Most recently a number of distance learning and Internet-based CME activities have been executed by joint collaborative efforts of Yerevan State Medical University (YSMU), Arabkir Medical Center, together with Fund for Armenian Relief (FAR), American Austrian Foundation (AAF), and some other local and international funds and organizations.

Below you can find a list of health care institutions and facilities in Armenia that have currently operational Telemedicine and eHealth activities. The list does not pretend to be comprehensive; however, AATM apply every effort to ensure that all running programs are mentioned. We will appreciate any additions to this list, and express our apologies for possible incompleteness of this information. AATM members can also access details of the various applications that other members are running by visiting the Members' forum on this site.

Arabkir Joint Medical Center (Arabkir JMC), Yerevan, Armenia

Armenian Eye Care Project, Yerevan, Armenia

Yerevan State Medical University (YSMU), Yerevan, Armenia

YSMU Department of Clinical Pathology

Prospects for Developing Telemedicine and e-Health in Armenia:

Telemedicine has socio-economic benefits, especially in countries with limited resources such as Armenia. It is clear that telemedicine has advantages and will benefit healthcare delivery, especially in remote and rural areas where there are few specialist doctors. With the rapidly declining costs of computing and telecommunications, the level of interest in TM and eH applications, and the corresponding activity can be expected to increase. In the case of Armenia, the existing medical and academic infrastructure could form the basis of a national Telemedicine and e-Health system, and might represent a model for the other countries in the region to follow.

The affordability of TM and eH services must also be taken into account. High percentages of the local population are at or below the poverty line [22], and cannot afford to pay for their health care in metropolitan centers, or even to travel to specialized centers in Yerevan, and especially to international arena. TM and eH initiatives have the potential to alleviate such difficulties. After proper dissemination activities (through seminars, meetings, mailing-lists, websites), it is expected that more and more health care facilities will get involved in various TM and eH applications on their own financial support. Therefore, the number of users will be gradually increasing with time; in other words, it is expected that sustainability of the activities can be achieved.

The telecommunication infrastructure needs to be gradually modernized and the existing poor-quality equipment step by step replaced. This could allow the use of mobile telemedicine systems in rural and remote areas. Limitations in current Internet provision also present problems for the transfer of large amount of medical information via the Internet.

TM and eH programs in the country need to be properly planned and assessed. The establishment of TM services must be prioritized, to meet the most urgent needs first, such as mobile and emergency telemedicine centers, and TM programs targeting most vulnerable population subsets such as handicapped, children, elderly with chronic illnesses, and women of childbearing age, and especially for the wider population living in impoverished urban and rural areas of the country. A strategic organization is needed to ensure the establishment of an integrated TM structure that includes proper funding from both the private sector and the government, with relevant medical training programs for local doctors to improve their clinical expertise and effectiveness. National telemedicine education and training programs in tertiary institutions need to be established in Armenia. These can be developed from international collaborative links with European and US partners.

The funding of TM and eH projects also needs careful consideration. Most of the previous telemedicine programs in Armenia have been funded by joint US aid and collaborative academic and research institutions such as the World Health Organization, the World Bank, the Armenian General Benevolent Union, NASA and special USAID programs and other Armenian charitable organizations. This fragmented approach has been characterized by the use of technology for limited educational, research, training and private clinical purposes. A more cohesive policy to fund the country’s TM and eH programs is required. This policy should also take into account the sustainability and cost-effectiveness of Telemedicine and eHealth.

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TEMPUS
 
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Med-e-Tel International    Forum on Telemedicine, eHealth and Health ICT
 
European Health Telematics  Association (EHTEL)
 

Swinfen Telemedicine

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AATM Armenian Association of
Telemedicine (AATM)
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Fax:
+ 374 10 58 40 87

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info@armtelemed.org

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