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ISBN 978-619-90601-5-5 A Century of Telemedicine: Curatio Sine Distantia et Tempora A World Wide Overview – Part IV Editors: M. Jordanova, F. Lievens 2021 Editors: Malina Jordanova and Frank Lievens A Century of Telemedicine: Curatio Sine Distantia et Tempora A World Wide Overview – Part IV 2021 All rights reserved. No part of this book may be reproduced, stored in a retrieval system or otherwise used without prior written permission from the authors and publisher. © Malina Jordanova, editor, 2021 © Frank Lievens, editor, 2021 © Malina Jordanova, Publisher, 2021 Sofia, Bulgaria, 2021 ISBN 978-619-90601-5-5 Content Content i Preface v Armenia: History and Current State of Digital Health, 1 eHealth and Telemedicine in Armenia Chaltikyan G. V., Fernandes F. A., Khachatryan D. G., Essayei L. Introduction 1 The History and Economics of the Republic of Armenia 1 The Healthcare System of the Republic of Armenia 4 The Information and Telecommunications Industry in 11 Armenia The History of Telemedicine in Armenia 13 Telemedicine Activities in the 90s 15 HyeBridge Telehealth Armenian Telemedicine Program 16 since 2004 Establishment of the Armenian Association of 16 Telemedicine (AATM) and Its Early Activities Pilot Telemedicine Projects by AATM in 2010 19 First International Congress on Telemedicine and 23 eHealth "ARMTELEMED: Road to the Future" of 2011 Pilot ECG-Telemonitoring Project of 2012-13 25 German-Armenian Telepathology Project 26 Activities by the MoH to Provide Telemedicine Access 27 in Rural Hospitals and Other Telemedicine Activities in Armenia Educational and Public Awareness Activities 28 Armenia Eye Care Project 32 German-Armenian Telemedicine Project 33 Web-based International Telehealth Platform "Global 35 Virtual Clinics" The History and Current State of eHealth in Armenia: 36 The Integrated Health Information System of Armenia i (IHISA) History of the Development of the National eHealth 36 System Authorities in Charge of the National eHealth System 41 Legislative Framework Supporting The eHealth 42 Infrastructure The ARMED Electronic Healthcare System 46 Sponsor, Funding, Business Model 66 Deployment, Adoption and Acceptance 66 Upcoming and Future Developments 70 Armenian Digital Health Initiative 73 Conclusion 77 Acknowledgment 78 References 78 Authors’ info 80 Côte D’Ivoire: Telemedicine in Côte D’Ivoire 82 Nanan I. M., Ehua F. S., Kpon R., Diby F.K., Bléhiri F. S., Berthé A., Traoré Y. B. Introduction 82 Early Stage 83 RAFT Network 85 Tele-Cardiology Project 88 AGA KHAN Foundation Tele-expertise Project 90 The Growth 92 References 95 Authors’ info 96 Pakistan: Journey of Telemedicine in Pakistan 98 Khoja S., Durrani H. Introduction 98 eHealth Readiness in Pakistan: Technology, Human 103 Resources, Policy History of Telemedicine initiatives in Pakistan 105 Improving Health Services in Remote Health Facilities 106 Improving Referral System Between Primary Care 108 ii Facilities And Tertiary Hospital Providing Telemedicine Services To People On Phone 109 Institutional Collaboration for learning 110 Current Telemedicine Initiatives 113 Impact of Telemedicine in Pakistan 118 Impact on Health Systems 118 Impact on Health Professionals 120 Impact on Patients and Communities 121 Key Learnings 122 Future Direction 124 References 125 Tunisia: Telemedicine and e-Health in Tunisia: 128 Towards Digitalization and Interconnected Health Gouider R., Mrabet S., Kacem I., El Matri A. Introduction 128 Initiatives of Telemedicine in Tunisia and Historical 131 Overview Organization and Structures 132 Achievements 136 Perspectives 139 Conclusions 142 References 143 Author’s info 143 United Kingdom: The History of Telemedicine in the 145 United Kingdom Fisk M. J. Preamble 145 Introduction 147 Phase 1 (Before 1914): ‘Bridging the Tyranny of 154 Distance’, Telegraph and Telephone Setting the Context 154 The Beginnings of Telemedicine 158 Sidney George Brown 162 Phase 2 – World War One to 1970: ‘A Spirit of 163 iii Endeavour’, Towards the Founding of the NHS Developments in Communications Networks 165 Towards the NHS 165 Phase 3 – 1970-1998: ‘The Creeping Amoeba of 167 Automation’, Towards the Modern Era of Telemedicine Early Telemedicine Services 174 Phase 4 – 1999-2020: ‘Blindingly Obvious’, The New Era 176 of Telemedicine Smart Homes 177 Behaviours, Lifestyles and Activity Monitoring 180 THE BT and Anchor Trust Trial 180 NHS: Early Strategic Approaches for Telemedicine 182 NHS Direct and Its Equivalents 184 The Policy Push and Early Telecare Developments in 187 England Initiatives in Scotland 189 Overall UK Initiatives up to 2004 190 Tunstall Telecom (SAFE 21) 194 DERA / QinetiQ 195 Taking the Agenda Forward 197 Telemedicine Initiatives: England 201 The Whole System Demonstrator (WSD) Project 204 Telemedicine Initiatives: Scotland 206 Telemedicine Initiatives: Wales 209 Telemedicine Initiatives: Northern Ireland 212 Three Million Lives (3ML) and the DALLAS 214 Programme End of Phase 4: To 2020 217 Flo (Florence) 217 A Mixed Picture 224 Phase 5 – From 2020: ‘Sinking the Titanic?’ Into the 225 Future The UK Response to COVID-19 228 A New Place for Telemedicine? 230 End Notes 233 References 236 Acknowledgements 243 Author’s info 243 iv Preface Dear Reader, The fourth volume of the series “A Century of Telemedicine. Curatio Sine Distantia et Tempora: A World Wide Overview” is in your hands. The goal of the series is to present different national and cultural points of view on the development and implementation of Telemedicine/eHealth and to share the information with international, national and regional institutions and policy makers as well as with all groups and individuals involved with healthcare. It provides directions of a wide variety of decisions, able to affect the form and functioning of the healthcare sector and offers clues towards the expected future of health organization at community level. The results and guidelines presented apply to all – national and local administration, individual practitioners, group practices, healthcare systems, as well as to providers of health-related services where there are Telemedicine/eHealth interactions either directly to the patient or from provider to provider for the purpose of healthcare delivery. The series “A Century of Telemedicine. Curatio Sine Distantia et Tempora: A World Wide Overview” is especially important now, in the time of COVID pandemic as Telemedicine/eHealth comes in many shapes and sizes and offers numerous advantages over the traditional healthcare treatment. Before the pandemic, Telemedicine/eHealth was often neglected. The COVID threat quickly changes the attitude towards it. This volume presents a historical approach of Telemedicine and eHealth/Digital Health in five countries – Armenia, Côte D’Ivoire, Pakistan, Tunisia and United Kingdom. Thus, the total number of countries introduced in all four parts reaches 21 (Fig. 1)! Each chapter reveals different solutions for the treatment of patients and wellbeing of citizens, provides a glimpse and summarizes the best practical achievements, governmental policies, existing solutions and experiences in one country. The editors are convinced that this volume offers useful information to those who are preparing to expand Telemedicine/eHealth/Digital Healthcare in their regions or countries. It will allow them to rely on the experience of the others and make them aware of the benefits and problems that were encountered during and after implementation of systems or services, and as such, will help to possibly avoid mistakes and reduce potential problems. It is necessary to remind that as in the previous books: Each chapter covers various areas of Telemedicine/eHealth in one country; v The countries presented in the volume are chosen on basis of a random selection method; Chapters are listed alphabetically, following the countries names; The original style of the authors is respected as much as possible; Despite the amount of information included in each chapter, no doubt that many services, projects and facts are still out-of-sight. We hope to be able to fill these gaps in the later editions. We firmly believe that everyone involved in Telemedicine/eHealth will Figure 1. Countries presented in all four parts find this book not only interesting, but most valuable as well. Enjoy your reading! The Editors Malina Jordanova, MD, PhD Space Research & Technology Institute, Bulgarian Academy of Sciences Bulgaria Frank Lievens Executive Secretary of the International Society for Telemedicine & eHealth (ISfTeH) Belgium & Switzerland vi Armenia History and Current State of Digital Health, eHealth and Telemedicine in Armenia G. V. Chaltikyan1,2, F. A. Fernandes1, D. G. Khachatryan2, L. Essayei2,3 1Deggendorf Institute of Technology, European Campus Rottal-Inn (DIT-ECRI), Max-Breiherr Str. 32, Pfarrkirchen 84347, Germany, [email protected] 2Armenian Association of Telemedicine (AATM), 5/19 Mashtots Ave., Yerevan 0015, Armenia, [email protected] [email protected]; [email protected] 3Northwell Health, North Shore University Hospital 300 Community Drive, Manhasset NY, 11030, USA, [email protected] Introduction The Republic of Armenia is a landlocked country located in the South Cau- casus. As one of the oldest nations and centers of civilization in the world, Armenia has a rich history and a unique culture. The geographical landscape is mostly mountainous with iconic scenery. Located in the northwestern part of the Armenian Highland, is a combination of lofty mountain ranges, deep river valleys,