TEMOS-telemedicine for the mobile society telemedical support for travellers and expatriates

Abstract

For six decades mass tourism has been growing rapidly. Eight hundred and ninty eight million tourist arrivals worldwide were registered in 2007 alone. Furthermore, hundreds of thousands of expatriates live and work in foreign countries. Among all 20 to 70 percent of the collective of international travellers suffer from health related problems while travelling, 1 to 5 percent of them need medical support during their stay and 0.1 to 1 percent of them are repatriated by air each year. Travel related illness is strongly increasing in parallel with the climatic and cultural contrast between the traveller's country of origin and the destination country. In addition, the length of stay as well as the selected means of travel increase the risk for a disease. Thus, not only travelling in countries with special risks like communicable diseases increases morbidity. The demographic change in countries like Germany for example results in a growing proportion of older travellers very often suffering from chronic diseases like cardiovascular disorders or diabetes mellitus. Therefore the need of medical safety for travellers is growing especially in this group. When visiting countries with special health risks or another culture, travellers often do not know where to go in case of an emergency abroad, whether the diagnosis of the foreign doctors is reliable, whether the quality of treatment is all right or whether repatriation is necessary. This chapter describes the globally active TEMOS project (TElemedicine for the MObile Society). TEMOS mainly focuses on optimizing health care and medical treatment for travellers and expatriates worldwide. This includes the Certification of medical institutions worldwide according to the TEMOS quality standards, which documents the compliance of the institutions' medical care with the state of the art as well as infrastructural or service requirements, Organization of a competence network of TEMOS certified medical institutions Provision of validated information about the medical and non medical services of medical institutions acting at the state of the art, Support of physicians worldwide in terms of medical expertise of specialists participating in the TEMOS telemedical network. TEMOS additionally aims at an improvement of continuous medical education (CME) by providing electronic lectures and online teaching involving international specialists. The TEMOS certification system for hospitals has been developed and is now firmly established. The TEMOS database currently contains information on 1.185 hospitals and clinics in 48 countries. Presently 26 medical institutions providing high quality medicine are members of the TEMOS network. A satellite and Internet based communication platform allows the exchange of knowledge for continuous medical education (CME) and the secure exchange of patient data for teleconsultation and second opinion services. The appropriateness of the different communication channels used within the project has been studied in a comparative analysis of satellite-, Internet-and ISDN-based communication for telemedicine within the project. The results clearly demonstrate that Internet based communication is the most cost effective tool when sufficient bandwidths are available for each participating site. Satellite based telemedicine is suitable for regions lacking of a high speed terrestrial communication infrastructure like in many developing countries, on small islands or in rural regions. The certification of hospitals has turned out to be beneficial for different potential customers of a future TEMOS company as well as for the travellers and hospitals themselves. The database and associated information system of international hospitals together with CME and expert consultation via the TEMOS telemedical platform as parts of the Integrated TEMOS Services seem to improve medical care for travellers abroad significantly and allow a more secure travelling for elderly and chronically ill patients. © 2009 Springer Netherlands.