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Telemedicine in emergency responses: reflections from a critical care telemedicine programme between Uzbekistani and German clinicians during COVID-19
  1. Evgeniya Boklage1,
  2. Björn Weiss2,
  3. Johanna Hanefeld1,
  4. Karin Steinecke2,
  5. Andreas Jansen1,
  6. Khikmat Anvarov3,
  7. Abror Valihanov3,
  8. Azamat Alimov3,
  9. Joachim Seybold4,
  10. Claudia Spies5 and
  11. Ulugbek Sabirov6
  1. 1Centre for International Health Protection, Robert Koch Institut, Berlin, Germany
  2. 2Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
  3. 3Republican Research Centre of Emergency Medicine, Tashkent, Uzbekistan
  4. 4Medical Directorate, Charite Universitatsmedizin Berlin, Berlin, Germany
  5. 5Department of Anaesthesiology and Intensive Care Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
  6. 6Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
  1. Correspondence to Dr Evgeniya Boklage; boklagee{at}

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Telemedicine emerged as a tool to support prevention, diagnosis, treatment and management of infectious diseases in remote and low-income settings with underserved populations1 while the pandemic of COVID-19 has accelerated its adoption.2 Different telemedical models exist in the context of acute care. One peer-to-peer approach involving an interdisciplinary team of healthcare professionals, called the ‘hub-and-spoke model,’ facilitates live audio–video interaction at the bedside from a tertiary hospital to remote care providers to assist remote-site physicians in treating challenging cases.3 The ‘hub-and-spoke model’ is a multiprofessional peer-to-peer approach involving an interdisciplinary team of doctors, nurses and allied healthcare professionals under the hybrid model, which combines teleconsultations with training and educational activities. It also enables the delivery of telemedical services across national borders,4 which offers solutions to clinical questions and promotes the exchange of knowledge and experience about the novel infectious disease between healthcare professionals on a global level. Thus, telemedical support has emerged as a potential surge capability not only for the ongoing pandemic but also for future emergencies.5

In March 2021, the Republican Research Centre for Emergency Medicine (RRCEM) in Tashkent, Uzbekistan, connected to a telemedical ‘hub’ at the university hospital Charité in Berlin, Germany, to strengthen critical care capacity for patients with severe cases of COVID-19 in Tashkent. The RRCEM received a specialised telemedical cart and launched a telemedical intensive care unit, joining a hub-and-spoke network of hospitals. Now, partners in Uzbekistan and Germany conduct regular joint telemedical rounds to discuss pre-selected cases. The doctors participate in telemedical rounds at agreed times 3 days a week. Between March 2021 and December 2022, the RRCEM and Charité conducted over 500 joint telemedical rounds involving nearly 200 patients. Several structural patient management improvements have occurred in the RRCEM. These include an antibiotic stewardship programme, a guideline-based approach to delirium management and mechanical ventilation strategies. As a team of clinicians and global health professionals, we identify five lessons that may aid the implementation of similar projects elsewhere, which we summarise in table 1.

Table 1

Summary of the lessons learnt

During the pandemic of COVID-19, the need for remote consultations between patients and doctors and among healthcare professionals increased significantly. With this, many old challenges to the implementation of telemedical initiatives became more evident. Surges made it necessary to treat patients in field-type or small and medium-sized hospitals with varying degrees of experience in treating critically ill patients with acute respiratory distress syndrome and with different levels of readiness to adopt telemedicine. However, facing a public health emergency, patients and clinicians have become more comfortable with digital technologies to deliver healthcare services. They are more likely to appreciate their benefits, including more efficient use of resources and time, better availability, and improved contact possibilities.6

Once healthcare systems begin to recover, countries should build on the momentum to strengthen the position of telemedical technology and practice. Building on what we know, long-standing challenges to the implementation of telemedicine must be addressed systematically through governance, processes, technological infrastructure, and a clear focus on creating a sustainable telemedical workforce. Given the limited resources, it holds relevance for countries with underserved populations. Our project has demonstrated outstanding potential for telemedical programmes in international settings, crossing the borders of healthcare systems when its hard (technology) and soft (training, team building, motivation) components are well considered in the planning phase. With the right approach and commitment, the national government and its international partners in the health sector could use the advances Uzbekistan made in telemedicine during the pandemic to expand the network to the regions to deliver high-quality, affordable healthcare.

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  • Contributors EB conceived the commentary and produced the first draft of the manuscript. BW and JH have contributed important theoretical insights. All authors contributed to critical revision of the manuscript for important intellectual content. EB drafted the final version and submitted the manuscript. All authors have read and approved this version.

  • Funding The project is funded by the German Federal Ministry of Health, grant number ZMI1-2521GHP909.

  • Competing interests CS reports grants from BMG/RKI, during the conduct of the study; grants from Deutsche Forschungsgemeinschaft/ German Research Society, grants from DeutschesZentrum für Luft- und Raumfahrt e. V. (DLR)/‘German Aerospace Center, grants from Einstein Stiftung Berlin/ Einstein Foundation Berlin, grants from Gemeinsamer Bundesausschuss/Federal Joint Committee (G-BA), grants from lnneruniversitäre Forschungsförderung/ Inner University, grants from Projektträger im DLR/Project Management Agency, grants from Stifterverband/ Non-Profit Society Promoting Science and Education, grants from European Society of Anaesthesiology and Intensive Care, grants from Baxter Deutschland, grants from Cytosorbents Europe, grants from Edwards Lifesciences Germany, grants from Fresenius Medical Care, grants from Grünenthal, grants from Masimo Europe, grants from Pfizer Pharma PFE, personal fees from Georg Thieme Verlag, grants from Dr F. Köhler Chemie, grants from Sintetica, grants from Stifterverband für die deutsche Wissenschaft e.V./Philips, grants from Stiftung Charite, grants from AGUETTANT Deutschland, grants from AbbVie Deutschland In addition, CS has a patent 10 2014 215 211.9 licensed, a patent 10 2018 114 364.8 licensed, a patent 10 2018 110 275.5 licensed, a patent 50 2015 010 534.8 licensed, a patent 50 2015 010 347.7 licensed, and a patent 10 2014 215 212.7 licensed.BW reports grants from BMG/RKI, during the conduct of the study; consulting fees from Orion Pharma; honoraria for presentations from Dr F. Köhler Chemie and BARMER Insurance; support for attending meetings from Intouch Health, USA; position as a Committee Chair and Executive Committee Member for ESCIM.

  • Provenance and peer review Not commissioned; externally peer reviewed.