It’s not easy to wake up one day and discover that you are denied the most fundamental form of human interaction. However, during the last year the world has adapted to another reality, virtual reality. In these times of social distancing imposed by the COVID-19 pandemic, when we do not meet friends and colleagues face to face, what happens when doctor-patient communication also requires careful, measured steps?

The crisis that has altered the course of daily life has also coincided with the most dynamic phase of development of the digital era. Thus, instead of stopping, the world has been given a new lease of life; by rearranging many vital details, we have acquired a new reality that has stepped in to prevent total paralysis.

What initiatives were implemented in Georgia during the pandemic?

“I believe that COVID-10 inherently opened the opportunity for more active implementation of digital technologies, and we will try to use it to the maximum.”  

Tamar Gabunia, Deputy Minister of Health

Deputy Minister of Health Tamar Gabunia explains that by using digital services, the Georgian health system has kept pace with the challenges caused by the pandemic, with several initiatives successfully rolled out, and others in the process of implementation.  

In these efforts, Georgia enjoys the support of the European Union, whose EU4Digital initiative contributes to the development of key areas of the digital economy, market and digital society in line with EU norms and practices, including in the area of eHealth, where the project supports the development of common guidelines for the rollout of electronic health services and data management, and cross-border collaboration on common challenges.

The pandemic and ensuing lockdown has forced Georgia to step up the development of digital solutions in eHealth in order to manage the effective provision of health care, support the epidemiological strategy, and best protect the population. From the first COVID-19 case until today, nothing was more urgent than the coronavirus monitoring system. The development of remote virtual services was vital, says Tamar Gabunia, stressing the effort of the health system to enable the necessary platforms from the very first days.

“So-called online clinics were developed, which give the patients advice in virtual mode –equivalent to regular medical consultations, but delivered online. The clinics were gradually expanded. We started with 25 online clinics and now we have 87 throughout the country,” says Gabunia, adding that online clinics facilitate not only communication with COVID-19 sufferers, but the management of asymptomatic patients as well.

The portal for COVID-19 monitoring is actively functional in the health system, recording both hospitalised patients, as well as those discharged.

“Registration on this portal enables us to track patient numbers. But not only this, the severity of their clinical status, patients in intensive care, as well as those on artificial ventilation are also registered here. This, in return, gives us the opportunity to monitor the availability of resources,” Gabunia explained. 

However, in order to manage COVID-19 effectively, observation of the infected patients and assessment of severity of their condition is not sufficient. It is equally important to fully monitor the route the patient covers while countering COVID-19.

“To achieve this, information systems are vital. Several portals were set up to allow the monitoring of the patient’s route from the beginning to the end. One of them under the National Health Agency, registers the patient’s route, starting from the patient crossing the border, self-isolation, or if hospitalised,” the deputy minister says.

Gabunia says the management of these processes has not been easy, and explains why it is important to have quarantine and self-isolation platforms as well. She says that such programmes help the health system to identity what conditions are allowed for each case, to register it in the unified database, and track patients required to go into self-isolation at home or quarantine in approved facilities.

In order to be placed in self-isolation, a person fills out a request form indicating the reasons: why s/he requires to be transferred, does s/he have relevant symptoms. As Gabunia explains, self-isolation is permissible only in particular cases, and the time for considering the application is five days on average. After this, the patient will know which is better for him/her – self-isolation or quarantine.

In April, Georgia rolled out a COVID-19 application to support contact tracing and monitoring of the pandemic. The STOP COVID application enables to restrict the spread of the virus by immediately informing people who have been in contact with an infected person.   

Bluetooth, GPS and other technologies are used to detect smartphones that have been in close contact with one another. Encoded information about the interaction of application users is stored locally in both users’ applications. If any of these persons is identified as a confirmed COVID-19 case, those who had contacts with this confirmed case will receive a warning through the application together with instructions – to stay in self-isolation and to apply to the relevant institutions immediately.

“If the person next to me is a confirmed COVID-19 case, and s/he enters the unique code of his/her positive test into the application, I receive the signal that I was definitely in contact with this person. Therefore, I apply to the relevant organisation for medical examination,” explains Gabunia.

She says that at this stage about 400,000 users have downloaded the application, but emphasises this is not enough, and that wider use is necessary to increase efficiency.

“If all of us have this application, it will definitely reveal the contacts; but insufficient downloads will not allow for the active detection of the disease. The application has revealed a number of cases and enabled identification of contacts. But I cannot say it is widely used. However, many countries do use it very successfully, and we are trying to support the wider implementation of this application through information campaigns. If at least million people have this application, the identification of cases would be much easier,” Gabunia said.

A special government Hotline – 144 – was also developed during the pandemic, and has met with an overwhelming response, providing timely and comprehensive information, whether you have symptoms, or about the disease in general and current restrictions.

“The hotline will guide a patient on how to behave, who to apply to, whether to go to hospital or stay at home. The organisation of these online primary care clinics was very important for us, and initially the emergency 112 hotline was incorporated in their service, but now it has been replaced by the hotline related to communication with family doctors. There is also the ministerial hotline – 1505 and 11 522 – staffed by those directly involved in COVID-19 management. It helps the patients to understand where to go for testing, to solve any problems they have. Simultaneously, this acts as a central online clinic that monitors the other online clinics, to ensure calls are not left unanswered,” she says.

Tamar Gabunia says a centralised laboratory network has also been established in Georgia during the pandemic, helping the health system to maintain COVID-19 statistics.

“This is an electronic module developed by the Lugar Laboratory, and supported by legislation. In particular, a ministerial order requires organisations to upload all test results, whether positive of negative, within a maximum of three hours. This helps us to register statistics accurately. This is done by all laboratories, whether private or state. This enables us to do analysis according to dates of testing, dates of taking a swab, etc.,” said Gabunia.

What is planned for the future?

What would you say if you were able to get medical service comfortably at home, instead of standing in long, tiring queues? It would be hard to believe were it not for the existence of just such a practice in the form of telemedicine.  The full implementation of this service in Georgia is planned for the future, with EU support, but as Tamar Gabunia tells us, online consultation between the doctor and the patient is already possible. 

“Rural primary care doctors are already equipped with computers. They can make these contacts with district level clinics. Similarly, if a patient is able to connect and contact the doctor using any platform, this is also possible,” Gabunia said.

“In Georgia, this model will be finally put into service in spring 2021. In particular, it will make it possible to perform medical examinations, receive and store data on patient health, and reveal diseases at early stages.”

The Ministry of Health website sets out what the system will be able to achieve: “Equipment for telemedicine has the potential to measure human body mass index, weight, height, oxygen concentration, blood glucose, uric acid, cholesterol; it can identify body fat level, measure body temperature, blood pressure, perform an electrocardiography test, lipid profile. There are large, as well as portable devices with fairly powerful functions and the ability to explore various organs, including the possibility to examine the fundus of the eye, throat, ear, or oral cavity problems. They can also perform electrocardiography and ultrasound tests. It is possible to diagnose cardiovascular and respiratory abnormalities using the digital stethoscope device. Results of examinations are forwarded to the unified database.” 

Deputy Minister Gabunia said that with EU support, Georgia would purchase technology for telemedicine development for 50 outpatient clinics.  

“This is very important. This model will focus on primary care. A family doctor will be enabled to contact more experienced and specialised institutions in the centre, and get additional advice about the patient and his/her condition,”she said.

EU support will not only strengthen technical capacities through the provision of telemedicine equipment, but also support equitable access to telemedicine service, and promote and increase public awareness on telemedicine solutions.

According to the Ministry of Health, implementation of telemedicine in primary care will reduce the need for emergency care, while according to international data, telemedicine can lower the number of hospital cases and their cost by 30%. 

In parallel with the introduction of such innovations, the volume of information increases. Often society has difficulty keeping up. Gabunia says citizen awareness is therefore particularly important. 

“On the one hand, there is level of awareness, and on the other hand, expectation of and trust in virtual communication and digital technologies. Both patients and doctors prefer direct communication. Undoubtedly, this is a challenge to a certain degree, and simultaneously, it is the opportunity,” Taman Gabunia states. 

Why the implementation of digital services is important

“In the period of transformation of our world by the Internet and digital technologies, digitalisation of the economy will have to bring tangible benefits to citizens, business and the state. The significance of digitalisation of services and the economy was made obvious to us by the current situation across the world, brought about by the pandemic.” 

Nino Esakia, EU4Digital country coordinator for Georgia

Nino Esakia is the EU4Digital country coordinator for Georgia. As she explains, the full potential of the digital field is yet to be fully realised, not only in Georgia, but even in the European Union.

“In the period of transformation of our world by means of the Internet and digital technologies, digitalisation of the economy will have to bring tangible benefits to citizens, business and the state. The significance of digitalisation of services and the economy was made obvious to us by the current situation across the world, brought about by the pandemic,” says Esakia.   

She explained that development of the European Union’s digital single market was one of the 10 political priorities of the European Commission, based on three main principles:

• Accessibility — better access to digital goods and services for customers and business across Europe;
• Environment – ensuring equal conditions for the fast development of digital networks and innovative services;
• Economy and society – increasing of the growth potential of digital economy to the maximum.

These priorities also aim at dismantling regulatory barriers and enabling the transition from individual national markets to EU-wide common rules, helping to improve online services with lower prices and wider choice. 

The pandemic has clearly increased the need for use of digital technologies and services. It has triggered even faster implementation of tailored and practical applications. By accelerating the digitalisation of the health system, the pandemic has made it easier to overcome existing challenges and barriers, and to fast-track the implementation of these services in such a way that they will be part of daily life in the future.

In the framework of the EU4Digital programme e-health aims to ensure patient access to information at right time and right place, simultaneously ensuring continuity and quality of health services to improve health outcomes. It establishes new ways of health care provision, simplifies collaboration between diverse health institutions and enables sharing of significant information by putting into action new forms of patient relations.   Find out more about EU4Digital on the website: eufordigital.eu

The full story was published on on.ge.