Health Care Without Borders: Promoting Partnerships Through Technology

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From a proliferation of medical information available through the Internet to teleconferences that link colleagues across oceans to computer programs that allow nearly instantaneous transmission of complex radiology images, information technology is changing the face of medicine around the world. For health care professionals in the countries of Central and Eastern Europe (CEE) and the New Independent States (NIS) of the former Soviet Union, the information age has ushered in the potential for profound change.

Throughout the decades of communist control, doctors and nurses in the NIS and CEE worked in a climate in which they were virtually isolated not just from each other, but from current health and medical information. But, today, a neonatologist in Slovakia can read online the latest journal articles on antibiotic use for infants. Health care professionals who care for patients with diabetes in Dubna, Russia can hold training sessions via satellite about advances in treatment with peers in LaCrosse, Wisconsin. Doctors in Kiev, Ukraine can consult with physicians in places as distant as Tbilisi, Georgia and Philadelphia, Pennsylvania about diagnosis and treatment of a boy with a mysterious infectious disease.

These are a few examples of how the American International Health Alliance (AIHA) is promoting the effective use of technology among its health care partners in the NIS and CEE. Although health care institutions in many countries are faced with considerably more difficult obstacles in terms of telecommunications and computer infrastructure, as computer usage grows and as more affordable technologies are developed, NIS and CEE partners will have the opportunity to take advantage of a multitude of resources that are transforming medicine.

Whether it is through simple e-mail messages between hospitals or sophisticated teleconferencing, health care practitioners in AIHA's more than 40 partnerships have growing access to technology and information resources that allow them to enhance communications and learning. AIHA has invested in the technological infrastructure of each of its partners by providing them with computers, modems, printers, photocopiers, and fax machines. In addition, AIHA has sponsored partnership access to Internet and e-mail accounts. These investments lay the foundation upon which the partnerships have been able to sustain communications and information-sharing as a complement to the face-to-face interactivity that takes place during conferences and partnership trips.

To help create new opportunities for distance learning, AIHA has made available to partners in Czech Republic, Slovakia and Hungary one of the first mobile videoconferencing units operating worldwide. Through a satellite link-up in the mobile unit and stationary videoconferencing centers in the NIS, health care professionals are using the technology to deliver training sessions on topics as diverse as health management, diabetes, nursing, and disaster medicine. Other partners are using various kinds of specialized software programs that allow them to perform teleradiology consultations or deliver slide presentations over regular phone lines across the globe.

But providing technological infrastructure is only part of the path to effectively navigating the information highway and utilizing the sometimes bewildering array of high-tech equipment. To help partners feel comfortable with their immersion in the Information Age, AIHA's technology strategy also encompasses comprehensive training.

Learning Resource Centers at each partnership institution are designed to facilitate use of information technology for health care practitioners. Each center serves as a hub for communications and information sharing and has been equipped with access to the Internet as well as several CD-ROM-based and online health and medical databases. Each partnership institution designates a volunteer information coordinator who is responsible for maintaining the LRC and providing training and support for staff.

Information coordinators participate in an ongoing series of training workshops and then serve as a training resource for other health professionals at their institutions. During the first two years of the Learning Resource Center project, the curricula developed by AIHA have progressed from basic Internet training and the creation of World Wide Web home pages to the application of evidence-based medicine to analyze treatment options and use of advanced Internet technologies for teleconsultations. These workshops expose partners to the capabilities of technology, and information coordinators are now beginning to play a role at their institutions in developing strategies to apply information technologies in other settings like clinical databases and patient record systems.

AIHA's World Wide Web site provides one of the most comprehensive collections of translated health information on the Internet as well as links to a host of medical sites that offer comprehensive explorations of such areas as women's health and infectious disease. The Web site also contains news about partnership activities and AIHA programs in both English and Russian.

But the cornerstone of AIHA's technology and information program is the integration of the new opportunities offered by technology into the day-to-day work of partners, from nursing to emergency medicine. Partners across CEE and the NIS are embracing these new technologies and using them to enhance their medical knowledge-- and ultimately their patients' health.

In Almaty, Kazakstan, children with asthma use the Internet to "chat" with kids in Tucson, Arizona who also have the disease. Ambulance dispatchers in Vladivostok, Russia use a new computer database to log and prioritize calls. Physicians in Bishkek, Kyrgyzstan transmit brain scans to doctors around the world for advice on treating a teenage girl's brain tumor. These and numerous other examples illustrate the potential for technology to transform medical education and practice, and to create communications channels that bridge time and distance. They illustrate a new world, where finding the cure for a sick child halfway around the globe may be as close as a keyboard.

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