MEETING REPORT

Second Balkan Intensive Seminar on Telemedicine and e-Health

October 2123, 2007 Tirana, Albania
Charles R. Doarn, M.B.A.,1 Rifat Latifi, M.D.,2 and Ronald C. Merrell, M.D.3 Department of Surgery, University of Cincinnati, Cincinnati, OH University of Arizona, Tucson, AZ 3 Department of Surgery, Virginia Commonwealth University, Richmond, VA
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ABSTRACT
The First Intensive Balkan Telemedicine and e-Health Seminar was held in the war-ravaged capital of Kosova, Prishtina, in 2002. This event was created under the auspices of the International Virtual e Hospital (IVeH). This organization, the brain child of Rifat Latifi, M.D., was established with the intent to establish a medical capability using telemedicine in an environment where the health infrastruc-

ture had been totally destroyed by war. Recently, the IVeH opened six regional telemedicine centers in Kosova. These centers are in the cities of Gjilan, Prizren, Gjakove, Peja, Skenderaj, and Mitrovica. These centers cover the entire country through a telemedicine network. Recently, the Second Intensive Seminar was organized and held October 2123, 2007, in Tirana, Albania. It was organized to broaden the concept of telemedicine and e-health in the Balkans region, and to introduce telemedicine in Albania, which was an ideal choice for holding the seminar. The seminar represented a significant step for Albania as it embraces the concept of telemedicine. These important events have shaped telemedicine development in the Balkans and are serving as a model for the rest of the South Eastern European countries to embrace telemedicine and e-health. This paper summarizes the events of this second seminar and addresses the importance telemedicine has for the region.

Table 1. The Seminars International Faculty

FACULTY MEMBER
Richard Bakalar, MD Flamur Bekteshi Charles R Doarn, MBA Ekaterine Kldiashvili Leo Kronberger, MD David Lam, MD Rifat Latifi, MD Frank Livens Maurice Mars, MD Ronald C. Merrell, MD Christine Miner

ORGANIZATION
IBM Global Healthcare Telemedicine Centre of Kosova University of Cincinnati

COUNTRY
USA USA Kovova USA

FACULTY MEMBER
Michael Nerlich, MD M. Oberholzer Bill Parlette Ronald Poropatich, MD Zhaneta Shatri, MD Klaus Simonic, MS

ORGANIZATION
University of Regensburg University of Basel The iPath Verein U.S. Army TATRC USAID/Albania Medical University of Graz

COUNTRY
Germany Switzerland Switzerland USA Albania Austria USA / Slovenia France USA Albania

Michael DAlessandro, MD University of Iowa College of Medicine

Georgian Telemedicine Union Association Georgia Medical University of Graz U.S. Army TATRC University of Arizona / IVEH Med e Tel Nelson R. Mandel University Virginia Commonwealth University U.S. State Department Austria USA / Belgium USA / Kosova Luxemburg South Africa USA USA

Mateja de Leonni Stanonik University of Virginia Giuseppe Tritto, MD Ronald Weinstein, MD Bernard Zeneli World Academy of Biomedical Technologies / UNESCO University of Arizona UNDP / Council of Ministers of Albania

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SECOND BALKAN INTENSIVE SEMINAR ON TELEMEDICINE AND e-HEALTH

A NEW BEGINNING

Summary of Day 2
The first full day of the seminar was officially opened with remarks from His Excellency Professor Sali Berisha, Prime Minister of Albania. A cardiologist by training, the Prime Minister gave his full support of the conference and to the concept of telemedicine in Albania. His comments are in italics below. The Prime Minister was joined by Dr. Arben Ivanaj, Deputy Minister of Health of Albania, and other high ranking officials from the Albanian government. Their remarks were presented from the stage along with remarks from Dr. Michael Nerlich (University of Regensburg, Germany and the International Society for Telemedicine and e-Health), Dr. Ronald C Merrell (Virginia Commonwealth University, USA), Ms. Christine Miner (U.S. Department of State, Bureau of Education and Cultural Affairs), and others. In addition, Dr. Mateja de Leonni Stanonik read a statement from his Excellency Dr. Janez Drnovek, President of the Republic of Slovenia, who served as an Honorable Chairman of the seminar. Both of these distinguished leaders pledged their support to telemedicine in each of their respective countries and stressed the importance of telemedicine and e-health for the region. Their comments are key to embracing evolutionary changes in healthcare in Albania, Slovenia, and the region.

ealthcare reform and access to healthcare, as well as information, are enhanced through the enabling technologies of telemedicine and e-health. No better place to start than where there was anything at all! When the former Yugoslav Republics broke apart, inequities and insufficiencies in healthcare became apparent. The striking contrast of health in Kosova versus other areas in the region was stark. Academic medical centers and point-of-care were in ruin and had to be re-established. This provided an opportunity for the creation of the International Virtual e-Hospital (IVeH) (www.iveh.org). This organization established a foothold at the University in Prishtina with the well-recognized telemedicine program in Kosova and grew as a hub-and-spoke telemedicine system, providing education and medical care across the Balkans, which has a diverse geography and a proud people. Through the relationships of the IVeH founder, University of Arizona trauma surgeon Rifat Latifi, M.D., funding was garnered from several sources. The purpose of these funds was to conduct a discipline-specific seminar to further demonstrate the value of telemedicine in the region. The site of the Second Intensive Balkan Telemedicine and e-Health Seminar was chosen as Tirana, Albania. Sponsorship of this seminar was from the U.S. Department of States Bureau of Education and Cultural Affairs, the U.S. Agency for International Development (USAID)/Albania, the U.S. Armys Telemedicine and Advanced Technology Research Center (TATRC), Polycom, and VitelNet. The seminar was held over three days (Appendix). The faculty consisted of world-recognized telemedicine experts from the United States, Europe, South Africa, and the Republic of Georgia (Table 1). The curriculum was designed to reflect the state-of-the-art in telemedicine and e-health thinking and application. Table 1 highlights the faculty that participated. Several participated virtually, and several were involved as organizers.

Remarks from His Excellency Professor Sali Berisha, Prime Minister of Albania
Honorable Dr. Latifi, honorable representatives of the United States Department of State, Ministry of Health, representatives of other institutions of the United States, and representatives of other Balkan countries, present in this conference: First, I would like to greet you wholeheartedly, thank you, and acknowledge your efforts for this initiative in organizing this seminar on current principles and practices of telemedicine and e-health. This represents a significant development in our efforts to modernize our medical system and is a significant event in our overall efforts to bring Albania to the digital age. The development of telemedicine along with other digital procedures and practices in our country, represents a fundamental mechanism to improve the healthcare for our patients, repre- Fig. 1. Dr. Sali Berisha, Prime sents a fundamental mechanism in the Minister of Albania.

Summary of Day 1
On Sunday, October 21, 2007 the assembled group participated in a one-half day pre-seminar workshop. This workshop served as an introduction to the concepts, principles, and practices of telemedicine and e-health, and discussed the many clinical disciplines where telemedicine is being applied. Dr. Latifi opened the session with a review of the agenda and the vision of where telemedicine is going. The faculty gave presentations focused in two separate panels: From Basics to Global Approaches of Telemedicine and e-Health, and Examples of Clinical Telemedicine Applications. Each panel had two chairs and 4 presentations each. Each presentation was highly relevant to the issues at hand in the Balkans. See Appendix A for the seminar agenda.

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MEETING REPORT

development and management of our medical institutions and medical services in our country, and finally represents a most significant mechanism through which Albania will become part of global development. The digital age is crucial for every country, but it is especially important and signifies the beautiful future of countries such as Albania. In this context, our efforts to develop telemedicine and ehealth, and, in general, digital procedures and the digital age, are attempts to substitute for lost time, are attempts and efforts to narrow the gap created by decades of underdevelopment. Telemedicine and e-health are concentrated on the most important and basic elements of humankindhealthcare. In this context, this practice will make it possible for all Albanian citizens, not only citizens of Tirana but those of rural Albania, to benefit from the best expertise in the country, the best expertise in the region, and the best expertise in the world. This represents a huge advantage in prevention, early diagnoses, and modern and proper treatment of diseases. To this end, I would like to assure you that the Government of Albania is determined to invest in developing telemedicine and e-health in our country, as this goes along with a few other initiatives that our country has undertaken. With the help of the United States, within only two months we have started online procurement and online taxes, we are finishing electronic registration of all businesses in Albania, and in the coming days we will institute electronic identification cards and electronic passports. Recently we have signed a memorandum with Microsoft which will open innovative centers in the country. Bringing Albanians into the digital age is one of the biggest priorities and most noble goals of my government. We are determined to increase the governmental investment in this, and I guarantee that the government will make every effort to make Albania a modern place of telemedicine and e-health, in order for Albanian citizens to be able to benefit from all the attributes and contributions of advanced and information technologies. In the end, let me thank you one more time for this seminar and this initiative, and assure you that the government of Albania will collaborate fully and fruitfully with you in order to make this initiative a reality in Albania, and for Albanian citizens to enjoy the benefits of this. Thank you very much.

Remarks from Dr. Janez Drnov ek, President s of the Republic of Slovenia and Founder of the Movement for Justice and Development
Ladies and Gentlemen: Why are we here? I say and I believe, Da zato ker v srcu dobro mislimowe are here to change and to improve the world. This is no small task. Yet, if we believe we can do it, then we will succeed. As you well

know, when we try to do something without really believing it will happen, then it definitely won't. If we are sure, if we are in no doubt, then it is very likely, that what we are trying to achieve will in fact happen. I was first formally introduced to telemedicine when Slovenias marathon swimmer, Martin Strel, decided to swim the Amazon River. This was no small task, from a human as well as from a medical point s of view. Yet, it does not compare Fig. 2. Janez Drnov ek, to the changes the International President of Slovenia. Virtual e-hospital (IVeH) has been working to accomplish in Kosovo and adjacent regions. To build medical systems where none exist, to bring modern medical care and expertise, as well as compassion and hope to the remotest of the remote, to build sustainable telemedicine and e-health programs, one country at a time, by building international cooperation is a task that I am sure seems impossible at times, but at the same time also displays the best of what we can offer our fellow human beings in need of help. And we will all need help eventually. When I was first approached to support the work being done within the International IVeH, it was the positive energy of the IVeHs leadership, which so pleasantly surprised me; it was the genuine love of IVeHs leadership for their respective home countries which impressed me the most. We need a great deal of positive energy to succeed in our task of changing the world, and in doing that we will generate more energyin each moment, in each place. Our surroundings will begin to improve. More and more people will join in with a positive attitude and will want to improve the world around them. And more and more people will be creating positive energy. Professor Latifi has already infected Kosovo with his positive energy, and in that has caused changes of imminent proportions. Let us all help IVeH to make sure that this infectious goalimproving the worldstarts to spread abroad well beyond Kosovos borders as well. Thank you for attending this important conference. And I wish you a very successful seminar and the best of times in Tirana. Dr. Latifi thanked the two world leaders for their thoughts and support of the seminar. The faculty gave presentations focused in four separate panels: (1) Telemedicine 2007: Where Do We Stand and Where Are We Going; (2) Telemedicine from Primary Care to Medical SchoolEnsuring Sustainability; (3) Military Telemedicine and e-

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Health from Laboratory to Battlefield: Lessons for Civilians; and (4) Advances in Telemedicine. Each panel had two chairs and as many as six presentations each. Each presentation was highly relevant to the issues at hand in the Balkans (see Appendix 1 for the Seminar Agenda). The presenters and panel chairs interacted with the attendees, who even with the challenge of English-Albanian interpretation, were transfixed by the knowledge that they know will make a difference in their country and this region of Southeastern Europe (Fig. 3). The faculty and participants were honored to be in the presence of Dr. Francisca Praprotnik, M.D., specialist in Fig. 3. A small representation of the faculty and participants at the seminar. pulmonology and critical care medicine, and Sister Miriam Nun, Sisters in Christ, who has served the people of and participants from the region. All participants were engaged in the Kosova for 35 years treating tuberculosis, and since 1999 has been presentations and discussion, which sparked effective dialogue and working in the costal town of Durres in Albania. She has worked interest in building telemedicine in the region. Figure 3 illustrates closely with Albanias own Mother Theresa, and she indicated the some of the faculty and participants of the seminar. They learned importance of healthcare as an effective tool. She, too, thought that about telemedicine from an outstanding faculty both present and telemedicine will have a significant role in Albania. by videoconferencing. This seminar has set the stage for evolutionary change in Albania. Having already spilled across the border into Kosova, one can see that telemedicine growth in the Balkans is a Summary of Day 3 recipe for success. The third day consisted of two panels: (1) Clinical Telemedicine and (2) New Frontiers of Advanced Technologies. Each presentation was highly relevant to the issues at hand in the Balkans (see ACKNOWLEDGEMENT Appendix 1 for the Seminar Agenda). The authors acknowledge the efforts of Dr. Zhaneta Shatri, As the seminar was coming to a close, Dr. Latifi presented an Professor Myqerem Tafaj, Ms. Christine Miner, Dr. Ismet Lecaj, Mr. Albanian movie made in 1986 to summarize the importance of teleFlamur Bekteshi, Astrit Hoxha, Ms. Kalterina Latifi, Nikolin Kolaj, medicine. This movie, entitled Kur hapen dyert e jets (in English, Ms. Qendresa Latifi, Petro Mersini, Dr. Erion Dasho, Mirgjind Tefiku, When the Doors of Life Open), was directed and written by Rikard Matthy Thim, Bernard Zeneli, and Tudor Bercan. This seminar Ljarja and produced by Shqipria e re (New Albania). The main role was made possible through a grant from U.S. State Department was played by Petrit Malaj, who is today director of the Academy of Bureau of Education and Cultural Affair, USAID/Albania, U.S. Army Film and Art of Albania. TATRC, and sponsorship from Polycom, VitelNet, and Albanian This movie had a scene where a young physician had to perform Fiber Backbone. an abdominal operation on a patient during a blinding snowstorm. Located in an isolated and rural area, he was connected to one of his Send correspondence to: professors in Tirana using the plain old telephone and he conducted Rifat Latifi, M.D. the procedure successfully. This cinematic treasure illustrates that in a University of Arizona closed society, which Albania was for nearly 40 years after the Second The University Medical Center World War, telemedicine took root before anyone knew what it was. Tucson, AZ Phone: (520) 626-1988 Fax: (520) 626-1537 CONCLUSION This first-ever seminar on this subject matter in Albania was a E-mail: latifi@surgery.arizona.edu tremendous success. It was attended by international faculty (Table 1)

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