Moving telemedicine from pilot to scale – Quick Guide to the 18 Momentum Critical Success Factors

The answers to the question “What is needed to deploy telemedicine or telehealth?” include the right context, involvement of the key people, good planning and sound “running” of the process.

The Momentum blueprint already offers critical success factors and performance indicators that help decision makers to scale up healthcare services from a distance through information technology. It also delivers a self-assessment toolkit that helps an organisation determine whether it is “ready” for telemedicine deployment. The Blueprint and supporting documents will remain available in this website at http://telemedicine-momentum.eu.

The recent Momentum in a Nutshell Leaflet provides a good overview how the Blueprint may help your service to scale up.

Although Momentum ended in January 2015, key experts and contributors to Momentum will remain available to provide support on how to use the Momentum toolkit, and can be contracted to help an organisation or region deploy telemedicine and share their experience.

Portugal-Flag-128

Telemedicine in Portugal

Portugal’s health and care system organisation

The healthcare system in Portugal consists of three coexisting systems: the   National Health Service (NHS), special social health insurance schemes and voluntary private health insurance. The Portuguese Ministry of Health is in charge of managing the NHS, which is financed through general taxation. According to the Human Development Report (2010), the average life expectancy in Portugal was 79.1 years. The Portuguese NHS was ranked number 12 in overall performance by the World Health Organization in a 2000 report ranking the health care systems of each of the 190 UN member nations. Portugal’s infant mortality rate has dropped sharply since the 1980s: from 24 of 1000 newborns died in the first year of life to now around 3 deaths per a 1000 newborns.

Primary healthcare covers all population and has been recognize as a case study (WHO, 2008). Primary-care is mainly delivered in NHS health centers, now agregated in Health Centers Groups. In 2009, Portugal had 186 hospitals (86 private) with a total capacity of 35,593 beds (26,077 in public hospitals). Health human resources in Portugal have been characterized by a higher emphasis on specialist hospital care. In 2009, there were 166 specialist for 100 non-specialist physicians (general practitioners). Overall, the number of physicians per 1,000 population is currently above the EU average. The ratio of nurses to physicians is much lower than in most countries.

Portugal’s health and care system financing

The Portuguese healthcare system has three coexisting and overlapping systems: the NHS, a universal, tax-financed system; public and private insurance schemes for certain professions (which are called health subsystems); and private voluntary health insurance. This system has a mix of public and private funding. The NHS, which provides universal coverage, is predominantly funded through general taxation. The health subsystems, which provide healthcare coverage to between 20 and 25 percent of the population, are funded mainly through employee and employer contributions (including contributions from the state as the employer of public servants). Close to 20 percent of the population is covered by private voluntary health insurance.

About 30 percent of total expenditure on healthcare is private, mainly in the form of out-of-pocket payments (both copayments and direct payments by the patient), and to a lesser extent, in the form of premiums to private insurance schemes and mutual institutions.

Financial resources dedicated to healthcare have reached a high level relative to the country’s wealth. Approximately 10 percent of the Portuguese GDP is devoted to health expenditure, which puts Portugal among the countries with the highest level of health spending within the European Union (EU) and the Organization for Economic Cooperation and Development (OECD). Since the mid-1990s, the trend in public health expenditure has been of steady and fast growth, with private expenditure remaining constant, relative to GDP. Recently the European crises have lead to reorganization of services and considerable cuts in costs.

Portugal’s telemedicine strategy and legislation

Portugal launched its national telemedicine startegy in 2000, and has adopted specific legislation that deals with telemedicine.  The legislation has clarified liability issues.

Overview

What is needed to deploy telemedicine in routine care? The right context, involvement of the key people, good planning and sound “running” of the process.

The Momentum Blueprint offers critical success factors and performance indicators that help decision makers to scale up healthcare services from a distance through information technology. It also delivers a self-assessment toolkit that helps organisations determine whether they are “ready” for telemedicine deployment. The Blueprint and supporting documents are available on the Momentum website.

“Telemedicine deployment is not rocket science: it will work if the critical elements are in place” says Marc Lange, coordinator of the Momentum project and General Secretary of EHTEL. “The Blueprint distils the key learnings from the Momentum project: it can be used as a kind of cookbook or set of guidelines for doing telemedicine scale-up.”

The Momentum Blueprint builds on two earlier versions which were released in May 2014 and December 2014. As a result of the feedback from various audiences invited to validate the Blueprint as well as personnel from the Sørlandet hospital and University of Agder (in Kristiansand, Norway) who were invited to test it, the Blueprint has been substantially edited and abridged; the explanations and the order of the critical success factors were improved; and the self-assessment toolkit was added. This toolkit is a combination of the Telemedicine Readiness Self-Assessment Tool (TREAT) and Momentum’s critical success factors. Used in the right circumstances, the toolkit helps to gauge the level of readiness of an organisation by way of a comprehensive questionnaire and a consultative workshop involving all the relevant stakeholders. It ensures that the people in the organisation share the vision of scaling-up and are committed to its success.

The Blueprint comes from the Momentum project, a three-year initiative of European eHealth stakeholder associations and competence centres that was co-funded by the European Commission . The project contributed to the achievement of the second part of Key Action 13 of the Digital Agenda, set out in the Communication of the European Commission of 19 May 2010 (COM (2010) 245): “[…] to achieve by 2020 widespread deployment of telemedicine services”.

Although Momentum ended in January 2015, a mechanism and business model is being developed for Momentum consortium members to be made available on contract to help an organisation or region deploy telemedicine and share their positive experiences with others.

A proposal for support in learning more on the Blueprint and in using it can be obtained by contacting the consortium via info@telemedicine-momentum.eu.

Momentum, 25 February 2015

How to move telemedicine from pilot to scale

Brussels, 5 February 2015:  What is needed to deploy telemedicine?  The right context, involvement of the key people, good planning and sound “running” of the process.  The Momentum Blueprint, published today in its final version, offers critical success factors and performance indicators that help decision makers to scale up healthcare services from a distance through information technology.  And it delivers a self-assessment toolkit that helps an organisation determine whether it is “ready” for telemedicine deployment.  The Blueprint and supporting documents are available here:

Momentum Blueprint (validated, final version) (pdf, 0.9 MB)

Momentum test phase report (pdf, 1.4 MB)

The Blueprint comes from the Momentum project, a three-year initiative of European eHealth stakeholder associations and competence centres that was co-funded by the European Commission.  Although Momentum ended in January 2015, key experts and contributors to Momentum will remain available to provide support on how to use the Momentum toolkit, and can be contracted to help an organisation or region deploy telemedicine and share their experience.

“Telemedicine deployment is not rocket science:  it will work if the critical elements are in place” says Marc Lange, coordinator of the Momentum project and General Secretary of EHTEL. “The Blueprint distils the key learnings from the Momentum project:  it can be used as a kind of cookbook or set of guidelines for doing telemedicine scale-up.”

The final Momentum Blueprint builds on two earlier versions which were released in May 2014 and December 2014.  This final version was substantially edited and abridged; the explanations and the order of the critical success factors were improved; and the self-assessment toolkit was added.  The toolkit is a combination of the Telemedicine Readiness Self-Assessment Tool (TREAT) and Momentum’s critical success factors.  Used under the right circumstances, the toolkit helps to gauge the level of readiness of an organisation by way of a comprehensive questionnaire and a consultative workshop involving all stakeholders.  It can ensure that the people in the organisation share the vision of scaling-up and are committed to its success.

About the project:
The Momentum project convened telemedicine experts and stakeholders from more than 20 organisations in Europe. The project ended in January 2015.  The website and the Blueprint remain online.  Key contributors are also committed to preserving the project legacy and to help other organisations in their own journey to scale.  The project was funded as a thematic network under the ICT Policy Support Programme (ICT PSP) as part of the Competitiveness and Innovation Programme of the European Commission.  More information is at www.telemedicine-momentum.eu.

Presentations of the fourth and final workshop on 26 September 2014

On 26 November 2014 the Momentum consortium held its fourth and final workshop as part of the annual EHTEL Symposium in Brussels.  The session featured was titled “Three paths to telemedicine deployment” and featured the following speakers and presentations:

Welcome (pdf, 0.2 MB)
Michael Strübin, Continua Health Alliance

Introduction: The Momentum Success Factors (pdf, 6 MB)
Diane Whitehouse, EHTEL

Adapting the Momentum Success Factors in Scotland (pdf, 0.9 MB)
Dr Margaret Whoriskey, Joint Improvement Team, Scotland

Innovative Healthcare Services: Going “beyond the pill” (Presentation not available)
Guy Eiferman, Health Solutions & Services at Merck & Co., France

The Momentum Blueprint and TREAT, a Self-Assessment Tool Tested in Real Life (pdf, 0.9 MB)
Claus Duedal Pedersen and Lise Kvistgaard Jensen, Region of Southern Denmark
Ulrike Knarvik, Norwegian Centre for Integrated Care and Telemedicine,
Wenche Tangene, Sørlandet Hospital, Kristiansand, Norway

The discussion played a vital role in validating the final version of the Momentum Blueprint which is expected to be released on 30 January 2015.

All links to the presentations lead to the EHTEL website where all Symposium presentations are available to the public.

 

Deploying telemedicine is hard, but now there is help.  Today the Momentum project released the European telemedicine deployment blueprint to assist “telemedicine doers” introduce healthcare services at distance through information technology.  Telemedicine can make healthcare delivery safer, better and more efficient and thus help address challenges to our healthcare systems, but it can disrupt conventional medicine.  The blueprint for doers describes 18 critical success factors for telemedicine deployment with detail, context, indicators, and descriptions, including an attachment with case studies.  The document can be accessed here:

Momentum Consolidated Blueprint (pdf, 112p, 6MB)

Attachment to Momentum Consolidated Blueprint (pdf, 0.5MB)

The Momentum blueprint builds on an earlier and shorter version of the 18 critical success factors that was released in May 2014.  Since then, healthcare stakeholders from across the EU Member States joined dozens of conference presentations, moderated workshops and online fora to provide feedback on the critical success factors and to contribute to a more detailed and refined document.  The Momentum consortium added in-depth research and consolidated the document in the period since August 2014.

“This consolidated blueprint is the main deliverable of the Momentum project. It caps almost three years of hard work”, says Diane Whitehouse, EHTEL eHealth expert and lead author of the document.  “The whole consortium hopes that this blueprint will help telemedicine doers with their implementations, and make a substantive contribution to the body of knowledge on telemedicine deployment.”

The Momentum project convenes telemedicine experts and stakeholders from more than 20 organisations in Europe. The project will end in January 2015, and the focus in the remaining weeks will be on building its legacy.  This will include a Momentum self-assessment tool and a process to facilitate telemedicine deployment through stakeholder engagement; a thoroughly updated and revised website (which EHTEL, the project coordinator, is committed to maintain after the project end); and the online Momentum forum on LinkedIn that will continue to host discussions about Momentum themes and the online tool.

For more information contact info@telemedicine-momentum.eu.

Two Momentum speakers presented at the ISfTeH Annual International Conference/Carrefour de la Télésanté conference, 16-17 October 2014, in Paris, France:

Tino Marti (TicSalut), member of the EXCO, presented “Momentum success factors and the ITACA project” (pdf, 1.3 MB).

Marc Lange (EHTEL), project coordinator, presented “The secrets of the Telehealth: how to deploy these services at a large-scale?” (pdf, 2MB)

Both speakers appeared in session 5 “Methodological support and efficiency of eHealth”, on Friday, 17 October 2014.

For the full programme and more information go to

http://en.carrefourtelesante.fr/sessions_eng.html

Momentum telemedicine service descriptions

HOME MONITORING DOPI IL TRAPIANTO / HOME MONITORING AFTER TRANSPLANTATION (IT)

Objectives, expected outcomes, main beneficiaries

Seventy-four adult patients who underwent liver transplantation at ISMETT and were discharged between 15 July 2011 and 30 April  2013 were included in the study. Sixty-six of these patients completed the follow-up period (3 months). Because the entire liver transplanted population for our study period was included in the study, we used the liver transplanted patients discharged home in an equivalent period between July, 2009 and June, 2011 as a control group. The average length-of stay after transplantation in the home-monitoring was 19.8 days, considerably lower when compared with the control group (25.4 days). No urgent re-admission was observed in the study group, compared with four urgent admissions (for an overall length of stay of 25 days) in the control group.

We can affirm that the introduction of this new monitoring system increased ISMETT physicians’ confidence in discharging patients and sending them home because of an improved ability to monitor their progress without requiring any travel.

The questionnaires administered to the patients showed that the system was well accepted, and it improved the patient experience in such a critical period as the first days after a liver transplant.

In terms of economic benefits, the saving related to the reduction of the length of stay in hospital was €396,000, about nine times higher than the annual cost of home-monitoring (€44,550 for 66 patients followed for 3 months). The project is still ongoing for 2014 and on.

Targeted population, number of patients

Patients after receiving transplantation at ISMETT, about 75/85 patients per year. The number can gradually increase over the next few years.

Type of telemedicine service

To implement this new service, the ISMETT team had to find a partner able to provide the necessary technology, with a significant presence in the region, and able to support patients in their homes. This partner had to provide complete service, including:

  • Telemedicine equipment, including all the interfaced devices.
  • Equipment installation at the patient’s home.
  • Equipment configuration to connect to the patient’s Internet connection, or installation of a new Internet connection at the patient’s home.
  • Training for the patient and family members.
  • Helpdesk service for technical issues.
  • Removal of equipment after the monitoring period.
  • Cleaning of equipment before the next installation.

Moreover, the technology partner had to provide a secure server that would allow the physician to see the patient parameters and the videoconferencing sessions with the patient. The required system would combine a home patient device with an online interface that is accessible on the Internet and accessible to properly authorized physicians. The Web interface allows physicians to monitor patients’ health status and remotely manage care progress. The device installed at the patient’s home had to be easy to use, even by people with no computer experience. Patient interaction with the system had to be supported by a touch screen.

Among the functions of the home monitoring system the ones considered essential by the project team were:

  • The possibility of delivering to the patient questionnaires prepared by the physicians, to better evaluate the patient’s progress.
  • The possibility of displaying multimedia material concerning the patient state of health, prepared by the physician remotely and upgradeable via the Web interface.
  • The possibility of displaying a calendar of activities prepared by the physician.
  • The possibility of displaying reminders via audio /visual aids to encourage the patient to follow treatment protocols.
  • The possibility of having teleconferencing sessions between the patient and the referring physicians.
  • The possibility of performing periodic measurements of the patient’s vital signs, with automatic registration in the system.

Using the home monitoring device, patients have to be able to measure vital signs, answer the questions of health assessment, and receive educational and motivational information. Once the session is completed, the results have to be made available to authorized health care professionals, who can use the latest recorded information to assess the state of the patient’s health and, if necessary, to modify the patient’s care plan.

The selected system is able to connect to a variety of devices, both wired and wireless, and allows for monitoring and acquisition of measurements of the patient’s parameters. The parameters that can be measured are blood pressure, blood glucose, pulse oximetry, spirometric data, and weight.

All parameters can be part of a routine defined for the particular patient. In this case the system will alert the patient of the measure to be performed.

Set-up that was being replaced

Hospital re-admission of patients after transplantation.

Outcomes and results expected after introduction

It is believed that this increased intensity of disease monitoring and management will create improved patient health, with resulting reduction in acute and chronic complications, and that these will translate directly into decreased consumption of expensive emergency health care resources (emergency room visits and re-hospitalizations), and decreased long-term disease complications. This, in turn, should translate directly into decreased consumption of expensive medications, personnel, equipment and hospitalization days required to manage those long-term complications. This pilot study demonstrates that the introduction of a home monitoring system to support the patient during the first three months after discharge can produce all these benefits.

The home monitoring system is an important solution, not only for early discharge from the hospital, but also for better day-to-day monitoring of transplant patients, which can be carried out more frequently, and without patients having to travel to the hospital for routine check-ups. This is particularly true in the first three months after a transplant, an extremely delicate moment from the clinical point of view, when patients need to be constantly connected with their health care team.

Tele-health monitoring is not only useful in reducing health care costs, but actually enables a two-way dialogue between patients and the health care staff (medical practitioners, transplant coordinators, therapists and psychologists), making patients feel better monitored and allowing them to ask for immediate support.

The results obtained in this study can be considered a “proof of concept”: home-monitoring is a safe and effective solution not only in stable chronic patients, but also in unstable patients facing difficult issues in clinical and therapeutic management.

Detailed description

As defined by the American Telemedicine Association’s, “Home Telehealth is a service that gives the clinician the ability to monitor and measure patient health data and information over geographical, social and cultural distances.” The objective is to improve disease management and undertake “earlier and proactive interventions for positive outcomes.”

The technology to be used is usually determined by clinical needs, health objectives, and available resources. Home monitoring and remote monitoring systems are usually used for patients who have the following clinical conditions: asthma, diabetes, chronic obstructive pulmonary disease, chronic heart failure, or mental health problems (anxiety and depression).

Remote monitoring technologies have the potential to improve clinical management of chronic diseases. There are currently several clinical conditions for which home monitoring is being used, and this approach has been found to produce benefits in a number of research trial.
There is little in the literature on the use of remote monitoring for non-chronic patients, and no experience has been reported on the monitoring of post-transplant patients.

Even if tele-home-care and remote monitoring are usually viewed as supplements to normal in-person care and not as substitutes, patients involved in this pilot used remote monitoring as the primary contact option between the patient and the ISMETT specialists. The patient was contacted daily by the transplant hepatologist, but the entire multidisciplinary physician team of ISMETT was involved in the project and, using the system, the patient could receive indications for care from all the specialists.

In order to implement this new service, the ISMETT team had to find a partner able to provide the necessary technology, with a significant presence in the region, and able to support patients in their homes.

This partner had to provide complete service, including:

  • Telemedicine equipment, including all the interfaced devices.
  • Equipment installation at the patient’s home.
  • Equipment configuration to connect to the patient’s Internet connection, or installation of a new Internet connection at the patient’s home.
  • Training for the patient and family members.
  • Helpdesk service for technical issues.
  • Removal of equipment after the monitoring period.
  • Cleaning of equipment before the next installation.

Moreover, the technology partner had to provide a secure server that would allow the physician to visualize the patient parameters and the videoconferencing sessions with the patient. The required system would combine a home patient device with an online interface that is accessible on the Internet and accessible to properly authorized physicians. The Web interface allows physicians to monitor patients’ health status and remotely manage care progress. The device installed at the patient’s home had to be easy to use, even by people with no computer experience. Patient interaction with the system had to be supported by a touch screen.

Among the functions of the home monitoring system the ones considered essential by the project team were:

  • The possibility of delivering to the patient questionnaires prepared by the physicians, to better evaluate the patient’s progress.
  • The possibility of displaying multimedia material concerning the patient state of health, prepared by the physician remotely and upgradeable via the Web interface.
  • The possibility of displaying a calendar of activities prepared by the physician.
  • The possibility of displaying reminders via audio /visual aids to encourage the patient to follow treatment protocols.
  • The possibility of having teleconferencing sessions between the patient and the referring physicians.
  • The possibility of performing periodic measurements of the patient’s vital signs, with automatic registration in the system.

Using the home monitoring device, patients have to be able to measure vital signs, answer the questions of health assessment, and receive educational and motivational information. Once the session is completed, the results have to be made available to authorized health care professionals, who can use the latest recorded information to assess the state of the patient’s health and, if necessary, to modify the patient’s care plan.

The selected system is able to connect to a variety of devices, both wired and wireless, and allows for monitoring and acquisition of measurements of the patient’s parameters. The parameters that can be measured are blood pressure, blood glucose, pulse oximetry, spirometric data, and weight.

All parameters can be part of a routine defined for the particular patient. In this case the system will alert the patient of the measure to be performed.

The home monitoring system installed at the patient’s home is connected to a Web-based service, with restricted access through encrypted connections. This Web-based service allows physicians to configure the calendar of the patient, and to define a series of questions to be transmitted to the terminal of the patient, or plan the “measurement sections” during which the patient data are collected. All the patient’s responses and data collected are stored in a central database and can be reviewed by the physician using a standard computer connected to the Internet.

One of the typical concerns in the home monitoring project is the possibility of having a good Internet connection at the patient’s home. The possibility of connecting the equipment to the Internet was critical for the success of the project. In order to allow the smooth flow of images during the video conferencing sessions, the Internet connection must have enough bandwidth and reduced latency. This meant that the service required of the commercial partner included a preliminary on-site visit to the patient’s home in order to verify whether the patient had an Internet connection or whether it was possible to install an ADSL line. If these two options were not possible the vendor had to provide a 3G modem for data transmission and support the connectivity costs.

In order to maintain data privacy all the data transferred by the system had to be encrypted, and the connection between the telemedicine equipment and the server had to use encrypted VPN connections.

After a rigorous analysis of the available solution on the Italian market, ISMETT decided to use the “Guide” developed by Care Innovation. Care Innovations is joint venture, formed in January, 2011, between Intel Corporation and GE. Its mission is to create technology-based solutions that give people confidence to live independently, wherever they are. With the combined expertise of its parent companies – GE’s in health care and Intel’s in technology – Care Innovations developed a user friendly tool that meets patient and physician needs. For health care professionals involved primarily in remote monitoring, Care Innovations offers the FDA-cleared and CE-cleared Intel-GE Care Innovations™ Guide, which allows seamless interaction with health care providers and home-based patients monitoring their health.

The system was delivered to the patient’s home by Vivisol, the Italian distributor of The Care Innovations™ Guide, and a leading European company in the field of home care services, with a significant presence in Sicily in terms of nursing and technical personnel available.
The system allows direct and visual contact between patients and physicians through a reliable system of video conferencing. It creates conditions similar to those of a hospital medical examination, with the advantage that the patient does not need to leave home, and with all the resulting benefits in terms of comfort. Through a special kit, the device allows for the periodic assessment of vital parameters, such as blood pressure, heart rate, and blood oxygen concentration, and the automatic entering of the results into the system. The system includes an integrated camera, microphone and speakers for interactive video-conferences, offering face-to-face support to the patient-physician interaction. Clinicians and patients can take advantage of videoconferencing to discuss and evaluate the patient’s condition, and patients have the opportunity to express their thoughts and voice any current concerns.

Using the this telemedicine system, patients have access to a variety of multimedia educational content, including text, audio, and video. Health care professionals can add content as part of a health session, and patients can access that content to help them gain a deeper understanding of their disease state, health status, and care protocol.

Moreover, the physicians can design for each patient a personalized care path that defines which measurements have to be performed and how frequently, which assessment questionnaires have to be filled out, and what educational and motivational sections the patient has to study.
The system empowers patients by giving them the means to actively manage their conditions, live as independently as possible, and engage them in their care path.

Operational status

The service is included in ISMETT’s routine activity. After the Italian Ministry of Health has released the Italian telemedicine guidelines, now the Region of Sicily – as well as other Regions – will have to include the service, and similar ones, into the regional reimbursement system.

Further information

Website: www.ismett.edu

email: tpiazza@upmc.it

The Momentum project released today five key documents that follow the release of the 18 critical success factors (CSFs) for the deployment of telemedicine last May.

Four of the documents represent a further development and honing of the 18 CSFs, coming after critical feedback from stakeholders and experts from within and outside the network.  The documents, subtitled “blueprint validated by ‘doers’ and stakeholders”, provide more context for each success factor and illustrate how they have applied in selected successful telemedicine deployments examined by Momentum.

The fifth document, Momentum test methodology (D3.3), delivers an action plan for testing Momentum in a real life setting.  The region of southern Norway will apply the critical success factors, in combination with the Telemedicine REadiness Assessment Tool (TREAT), including both an online self-assessment and a facilitated workshop involving all key players.

Interested in learning more?  Download all documents and more at

http://telemedicine-momentum.eu/resources-documents/

Project deliverables

The following deliverables are ordered chronologically, with the most recent ones on top.

D3.4 Momentum Validated Blueprint (February 2015)
This deliverable is the final blueprint. It offers a revised version of the 18 critical success factors ordered in a new logic.  And it delivers a self-assessment toolkit that helps an organisation determine whether it is “ready” for telemedicine deployment. An annex, Test phase report, discusses process and learnings from the test in Kristiansand, Norway, in autumn 2014.

D3.2 Momentum Consolidated Blueprint (December 2014)
This deliverable describes 18 critical success factors for telemedicine deployment and adds more information, context, indicators, and descriptions. It includes D3.2a Attachment with case studies of successful telemedicine implementations in Europe.

D3.3 Momentum test methodology_v10 (September 2014)
This deliverable describes the methodology for testing the Momentum blueprint and the critical success factors in practice.

D4.2 Momentum SIG1 Strategy and management (September 2014)
A description and analysis of the critical success factors relevant for strategy and management.

D5.2 Momentum SIG2 Organisational implementation and change management (September 2014)
A description and analysis of the critical success factors relevant for organisational implementation and change management.

D6.2 Momentum SIG3 Legal, regulatory and security issues (September 2014)
A description and analysis of the critical success factors that address legal, regulatory and security issues.

D7.2 Momentum SIG4 Technical infrastructure and market relations (September 2014)
A description and analysis of the critical success factors that address technical infrastructure and market relations.

D2.5c Momentum Workshop & Outreach Report (September 2014)
A report on outreach activities and the May 2014 workshop.

D4.1 Momentum SIG1 strategy (July 2013)
A summary of the strategic and management aspects that emerged from the evidence collected through the Momentum questionnaire.

D5 1 Momentum SIG2 organisational (July 2013)
A summary of the organisational and management aspects that emerged from the evidence collected through the Momentum questionnaire.

D6.1 Momentum SIG3 legal (July 2013)
A summary of the legal and regulatory aspects that emerged from the evidence collected through the Momentum questionnaire.

D7 1 Momentum SIG4 tech (July 2013)
A summary of the technology aspects that emerged from the evidence collected through the Momentum questionnaire.

D2.5b Momentum Workshop & Outreach Report (July 2013)
A report on outreach activities and the April 2013 workshop.

D1.1 Momentum Governance & Operations Manual (April 2013)
The manual for the internal organisation of the project.

D3.1a Momentum Report on the Knowledge Gathering (February 2013)
A summary and analysis of the evidence gathered through the Momentum questionnaire.

D3.1b Momentum Blueprint Outline (February 2013)
The proposed structure of the Momentum Blueprint.

D2.5a Momentum Workshop & Outreach Report (October 2012)
A report on outreach activities and the June 2012 workshop.

D2.1 Momentum Dissemination Plan (October 2012)
The plan for the project’s outreach activities covering the website, events, social media and others.

Momentum telemedicine service descriptions

Cardiauvergne (FR)

Objectives, expected outcomes, main beneficiaries

The Cardiauvergne service is for serious heart failure patients (stage III or IV of the New York Heart Association functional classification) who have been hospitalised at least once during the previous year to:

    • Improve the prognosis of this disease which is one of the deadliest (5-year survival rate: 31%);
    • Reduce the re-hospitalisation frequency of patients (estimated at between 28 and 40% per year);

The service improves the quality of life of these patients and reduces the cost of their care between €15,000 and €20,000 per year.

Targeted population, number of patients

Between 2 to 3 percent of the French population experiences heart failure, and this share of the patient population continues to grow due to both France’s ageing population and better management of acute coronary syndromes. For patients who are aged 60 years or older, heart failure is the primary cause of hospitalisation. In the Auvergne region, the number of patients that is most affected is estimated at 2,000.

Type of telemedicine service

Telemonitoring (“telesurveillance”) was considered in Cardiauvergne because of the geographic and demographic configuration of the region: patients live in isolated areas where there are few healthcare professionals, whether they are general practitioners or specialists in the field of heart failure.

To avoid unnecessary hospitalisations, a telemonitoring infrastructure was set up to perform the following actions:

    • Monitor the patient’s daily weight (using connected scales);
    • Send the measures to a nurse’s smartphone at intervals depending on the severity of the condition;
    • Send the results of medical tests taken by the biology laboratory;
    • Send and deal with information provided by the pharmacist.

Information and data are entered into the patient’s electronic health record. An IT system generates alerts or alarms depending on pre-defined parameters. A coordination unit (consisting of two cardiologists, two nurses and one secretary) manages these alerts and alarms. The coordination of various healthcare actors’ interventions (such as those by general practitioners, cardiologists, nurses, pharmacists, physiotherapists, dieticians) contributes to improving care management.

Set-up that was being replaced

Repeated hospitalisations for heart failure, with average lengths of stay exceeding 13 days, were caused by inadequate care paths. There was evidence that better monitoring of patients and their therapeutic education can improve this situation.

The objective of the new service is to improve patient survival and reduce hospital readmissions for heart failure patients. The key idea is to improve treatment by monitoring the patients and their adherence to hygiene and nutrition measures, and to adjust and change the treatment quickly if needed to avoid hospital readmission. Patient education is ensured by phone contact and by making ad-hoc appointments at the nearest pharmacy.

Outcomes and results expected after introduction

An initial assessment was carried out on the first 558 patients after two years of operation (the average length of monitoring of each patient was 355 days):

    • Mortality was reduced by 12 % per year (which is double compared to classical patient monitoring);
    • The rate of re-hospitalisation for patients with new onset of heart failure is reduced by 13.6 % per year, with an average length of stay of 9.2 days (as compared to 13 days before).

Detailed description

The priority of this new service is to entrust telemonitoring tools to patients and make patients more active and involved agents in the management of their condition. Therefore, it is essential that these tools are easy to use.

The following factors have guided the implementation of the service and certainly contributed to its success:

    • Involving the patients has helped the patients to “own” their condition.
    • The simplicity and convenience of the monitoring solution (a single connected scale) has strengthened acceptance on the part of both patients and healthcare professionals.
    • The service contributes to overcoming institutional barriers between the two services of general practice and hospital medicine. It supports healthcare professionals’ new modes of practice. Over the period analysed, 444 general practitioners, 95 cardiologists, 76 biologists, 355 pharmacists and 980 nurses joined the health coordination group.group.

Operational status

Cardiauvergne is one of the most nationally known telemedicine services in France. It offers a new mode of care coordination that is proven to be effective and inexpensive. It respects the role of local professionals who have accepted the service well. Its deployment is at a regional scale (the Auvergne region gathers together four French departments).

The service should soon be replicated in other regions.

Further information

More information is available at www.cardiauvergne.com or by contacting Cardiauvergne’s director, Professor Jean CASSAGNES: jcassagnes@cardiauvergne.fr

Momentum telemedicine service descriptions

KSYOS TeleConsultation (NL)

Picturetaking
At the dermatologist…

Objectives, expected outcomes, main beneficiaries

With KSYOS TeleConsultation a general practitioner can refer a patient digitally to a medical specialist in order to replace a physical referral. In the case of TeleDermatology, the general practitioner sends digital images of the skin and the patient’s medical history to the dermatologist to whom the practitioner would usually otherwise refer the patient physically. The dermatologist will answer the TeleConsult and will include diagnostic considerations and therapeutic advice in the response.

The general practitioner benefits from the action as he or she learns from TeleConsultation. The patient benefits as the answer is given within one working day instead of the several weeks generally spent waiting for a physical referral. The medical specialist benefits as he or she often likes to perform TeleConsultation so as avoid unnecessary referrals and strengthen his/her working relations with the general practitioners with the general practitioners that usually refer the patients physically. The health insurer benefits as TeleConsultation leads to a 20 – 50% cost reduction.

Targeted population, number of patients

A2 poster teleDermatologie
… and on screen (click to enlarge)

TeleConsultation between primary care and secondary care clinicians has proven its efficiency in  enhancing potential in fields such as cardiology, dermatology, ophthalmology and pulmonology (i.e., conditions related to the heart, skin, eyes and lungs). However, KSYOS is expanding TeleConsultation to many other medical specialities, including ear nose and throat, psychology, and nephrology (kidney-related conditions). Patient groups come from all of these fields of condition.

The general practitioner mostly selects those cases in which he or she is in doubt as to whether to refer the patient to a specialist or not, or is in doubt about how to treat the patient.

Type of telemedicine service

kloes2
Eye exam…

KSYOS TeleConsultation is an integrated service consists of all the following elements:
– A definition of the medical process, organization in the region, and the role of health workers involved.
– A KSYOS Electronic Health Record, which is integrated in the health IT infrastructure.
– Education, support and training in the general practitioners practice.
– Financial and legal support; contracting.
– Medical liability and insurance.
– Quality management and reporting.
As a health institution, KSYOS is responsible for the entire TeleConsultation service. KSYOS TeleMedical Centre is responsible for the medical and legal relations with the patient.

Set-up that was being replaced

Teleopthamology

… and on screen (click to enlarge)

 

 

 

 

TeleConsultation replaces physical referrals from primary care practitioners to secondary care specialists.

Outcomes and results expected after introduction

After selection of the appropriate patients by the general practitioner, TeleConsultation avoids 70% of all physical referrals. In 90% of the TeleConsultations, the general practitioner experiences a learning effect. The mean response time of the medical specialist is 4.8 hours instead of the many weeks that a patient generally spends on waiting lists otherwise. Overall, TeleConsultation leads to a minimum cost reduction of 20%. (van der Heijden JP, de Keizer NF, Bos JD, Spuls PI, Witkamp L. Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. Br J Dermatol. 2011 Nov;165(5):1058-65)

Detailed description

A more detailed description is available at these links:

www.ksyos.org
www.ksyos.org/english/
www.ksyos.co.uk

A bibliography of relevant scientific publications in Dutch, English and others is at

www.ksyos.org/onderzoekers/wetenschappelijke-publicaties/

Operational status

KSYOS has been considerably scaled-up since its foundation. KSYOS is part of mainstream service delivery. KSYOS started TeleDermatology Consultation in the Netherlands in 2005. Since then, KSYOS is active in TeleDiagnosis (TeleFundusScreening, TeleSpirometry, TeleECG, TeleHolter ea), TeleConsultation and TeleMonitoring in many medical fields. KSYOS has now contracted over 7,000 general practitioners, medical specialists and paramedics in various EU countries who physically or digitally will see over 100,000 patients in 2014.

Further information

For more information contact:

Prof. Dr. L. Witkamp, Director
l.witkamp@ksyos.org
+31 20 600 00 60

0_Andrea PAVLICKOVA

1_CSFs

2_KSYOS

3_Puglia

4_Norway

5_Scotland

7_Steffen_Sonntag

 

 

France-Flag-128

Telemedicine in France

France’s health and care system organisation

The French healthcare system is supported by a pluralistic organization of health care provision. This organization is based on a network of multiple structures, particularly in the hospital field consisting in three types of institutions: public hospitals, non profit hospitals and private clinics. As far as actors are concerned they include liberal health professionals working in ambulatory healthcare system.

The health system is mainly piloted by public authorities at national level. Competences in public health and health care provision are spread over three levels.

  • National level: For the funding and organization of healthcare provision; a financing law adopted by the parliament defines objectives for health expenditure per year and global provision based on health priority policy driven by health ministry. Public and private sectors are concerned.
  • Regional level: The regional health agencies (ARS) ensure:
    • repartition of this provision between these 2 sectors,
    • coordination of care,
    • efficient management of resources and quality access to cares.
    • adaptation of national policies to regional contexts taking into account country planning.
  • Local level: Under the ARS’ supervision healthcare actors organize themselves to facilitate patient’s management according to his/her situation.

France’s health and care system financing

The French health care system is funded in part by obligatory health contributions deducted from all salaries, and paid by employers, employees and the self employed; the global insurance health system is based on a “third party system” and a “patient’s contribution”(small fraction to be paid by the patient as regard to medical act cost).

France’s telemedicine strategy and legislation

The official announcement of telemedicine has been promoted by official law in July 2009.  A decree published in October 2010 has defined the main telemedicine fields (teleconsultation, teleexpertise, telemomitoring, teleassistance and telesurveillance), the implementation of  telemedicine (in particular authentification of health professionals involved in the telemedicine act, identification of the patient, access by the professionals to patient’s data) and telemedicine organisation (by programs, contracts or agreements). This decree has been inserted in the public health code, which is a way to consider, from legal point of view, telemedecine as a standard medical act (which adds to and does not replace current medical acts).

As far as strategy is concerned the Ministry of Health has identified five priority areas to facilitate the deployment of telemedicine in France and to move from a pioneering to a more effective phase. Guidelines are provided from central level to Health Regional Agencies (ARS) for the development and implementation of  the regional programs of telemedicine, to set up contracts for the development of an organisation ensuring quality and security of care, and towards health professionals about their own engaged responsibilities in the development of telemedicine act.

An experimentation on financing telemedicine acts is going to be implemented in several regions and cities in health and medico-social fields (e.g. are concerned elderly, cares and service access, accommodation…). This should help finding a better repartition of teleservices on the territory and a better monitoring of patients at home, especially those who suffer from COPD.

© Momentum

digitalhealth

International Digital Health and Care Congress
10-12 September 2014
London, UK

The International Digital Health and Care Congress offers a fantastic opportunity for professionals from the world of health and care services to learn more about the innovative way in which health can be improved through the use of technology. The three-day forum of the King’s Fund will feature a diverse mixture of activities, including keynote speeches from leading international experts in the area of digital health; a poster exhibition; a pre-congress seminar for academics looking at the latest research and evaluation methodologies and considerations; and two days of plenary and breakout sessions focusing on the advancements and benefits of digital health and care.

For more information and to register go to

www.kingsfund.org.uk/events/international-digital-health-and-care-congress

Momentum telemedicine service descriptions

Telecardiology Puglia (IT)

Objectives, expected outcomes, main beneficiaries

The full name of the service is “Telecardiology applied to Apulia regional 118 public healthcare network”, or Telecardiologia nel servizio di emergenza 118 della Regione Puglia.  The service helps and supports all ambulance doctors in their daily routine activity providing emergency care. Through the telecardiology service, a specialist cardiologist in the Cardio On Line Europe telemedicine service centre (CST) is available 24 hours on seven days a week for online and telephone consultations for doctors and patients alike. Anybody with a 12-lead electrocardiogram (ECG) recording can send it within three minutes to the CST and receive a consultation and assessment in real time in the same telephone call.  The telecardiology service reduces cost by avoiding inappropriate admissions, and improves the quality of life for all citizens in Puglia.

Targeted population, number of patients

The potential beneficiaries of the telecardiology service (part of the public healthcare system) include all 4,200,000 inhabitants in the Puglia region. Each may benefit from the telecardiology system in case of a cardiovascular event. In addition, the service also has private clients in other parts of Italy and beyond.

Type of telemedicine service

The telecardiology service is easy to use. In case of an emergency an ambulant doctor or anybody else who is trained can record in twenty seconds a standard 12-lead ECG, and transmit it via a normal telephone to Cardio On Line Europe.  The specialist cardiologist will, in real time, analyse the recording and, on the basis of anamnesis, share findings with the ambulance doctor and, in the same call, send a report. The ambulance operations centre then determines where to refer the patient. An online platform is available for viewing – in real-time – all electrocardiograms. The parties involved include the public healthcare system, Cardio On Line Europe, and all regional hemodynamic centres.

Set-up that was being replaced

When the service was introduced in Puglia for the first time in 2004 (a first for a public healthcare system), it filled a void. In Italy, the Puglia region is still the only region to use this service. In the first month of activity the service handled about 600 calls for ECG; today there are more than 10.000 calls for ECG every month. This reflects a high level of trust in the healthcare and in the telemedicine system.

Outcomes and results expected after introduction

Telemedicine supports the normal activity of patient care. In five years of use, the telecardiology service has contributed to cutting Puglia’s mortality rate for acute myocardial infarction by half (based on public data published by the official national epidemiology centre).  In terms of cost, the telecardiology service has produced considerable savings in term of avoidance of unnecessary care and inappropriate admissions.  The service has also helped reduce time from diagnosis to treatment:  based on a study in an important cardiology journal, the median time is 41 minutes for infarct patients.

Detailed description

Cardio On Line Europe was founded in 1996 with the mission to perform telemedicine, in particular telecardiology. In 2004, Cardio On Line Europe in accord with a pharmaceutical society and Puglia region started to deliver the telecardiology service to all points of emergency in the regional public healthcare. It consists of a device (12-leads electrocardiograph), a telemedicine service centre (CST) staffed round the clock by operators and cardiologists, and a telephone line. The CST can receive an ECG report from a specialist and deliver a consultation in the same phone call. Emergency teams find the devices and the service easy to use. Within minutes, they know whether the patient with angina pectoris or other symptoms can be placed in their home or needs to be hospitalised. Latest report data (available on www.cardioonlineeurope.com) shows that only 20 percent of patients calling emergency services need to be taken to the hospital, while the remaining 80 percent can be treated at home. This means real cost savings. Studies published from University of Foggia and posted on the website document cost savings, reduced time to treatment, improved clinical impact, prevention and rehabilitation as a result of the telecardiology service.

Cardio On Line Europe is certified ISO9001 for quality and ISO/IEC27001 for security of all sensible data. All software and all devices are certified as medical devices. Cardio On Line Europe staff report a high degree of dedication and passion for their work.

Operational status

The telecardiology service for regional emergency public healthcare has been working since October 2004. It was started initially with outside funding, but results have been so convincing (in terms of life quality, clinical effects and cost savings) that the Puglia region has agreed to support the service through public funds.  Cardio On Line Europe hopes to extend this telemedicine service to other regions or to extend a similar service to the chronic patients in the region (which is already being trialled in some social-health districts in Puglia).

Further information

For further information, please visit www.cardioonlineeurope.com or contact:

  • Mr. Claudio Lopriore, Cardio On Line Europe General Director;
  • Mr. Giuseppe Di Giuseppe, Cardio On Line Europe ICT Director (author of this text)
  • Md. Francesca Avolio, Regional Responsible Healthcare Agency of Apulia;
  • Md. Natale Daniele Brunetti, University of Foggia (Puglia) and Cardio On Line Europe consultant.

Momentum telemedicine service descriptions

DIABSAT (FR)

Objectives, expected outcomes, main beneficiaries

DiabsatTruck1

A Diabsat truck in rural France

Diabsat is a telemonitoring service for people with diabetes using mobile screening.  The aim is to improve medical monitoring of people with diabetes  near their home.  The service uses a mobile truck with medical equipment. It works primarily in rural areas with a dearth of health service providers so that the recommendations of the French Health Authority for annual screenings can be met.  In the short term the expected outcomes included tested and more robust technology and increased familiarity among people with diabetes and healthcare providers with the use and potential of remote monitoring.  In the future healthcare services may also be re-organised.  In the long term there is hope of a reduction in complications of patients experiencing diabetes as well as cost savings.  The main beneficiaries of the service are people with diabetes who live in rural areas who may be facing difficulties in identifying and consulting specialist physicians including diabetologists, podiatrists or ophthalmologists.

Targeted population, number of patients

DiabsatTruck2

Diabsat nurse

The target population is people with diabetes living in remote areas.  In France about 2.2 million people (four percent of the population) have been diagnosed with diabetes, of whom 92 percent are type 2 diabetic.  Of those, about 400,000 people are estimated to live in France’s rural areas: this is the number of eventual potential beneficiaries of the service.  Currently, the service is deployed in Midi-Pyrénées region in which the type 2 diabetic population is estimated to be 92,000. Other French regions are interested in developing this service on their area and partnerships are being built to transfer technology and know-how.

Type of telemedicine service

Nurses in a mobile truck tour rural France to perform screenings on selected patients. They enter the screening results in the patient record (including the fundus graph that shows the width of the retinal eye vessels, and the foot print graph). Then they transfer the data via satellite to a secure online data centre. From their offices, medical specialists (diabetologists, ophtalmologists and podiatrists) access and analyse the results and prepare a report online which contains their interpretation, diagnosis and care recommendations. The reports are mailed to the patients and their physicians. The service was initially made ​​available for diabetic patients informed by the mayor, pharmacy, their nurse or doctor in rural areas, as part of a broad campaign of communication. Thereafter, the service was requested by groups of physicians, multidisciplinary home health, nursing homes for patients in rural areas. A recent campaign was also conducted in some urban areas in precarious populations.

Set-up that was being replaced

The purpose of this service was not to replace a conventional treatment. Rather, it was to reinforce medical monitoring for people with diabetes by supporting general physicians in rural areas where the supply of medical specialists (especially diabetologists, ophtalmologists, podiatrists) is dwindling.  Patients face difficulties in seeing specialists at recommended annual intervals either because of long distances or waits for appointments. They may not be aware of the need for annual medical exams so as to avoid further complications in their diabetes.

Outcomes and results expected after introduction

The service trial (from 2010 to 2013):

  • Established good technical feasibility of mobile screening:
    • good data flow and low cost of internet with new satellite technology
    • average time between screening and mailing report : ~15 days
  • Improved medical monitoring of diabetic complications for people with diabetes
    • 1,545 screened patients
    • 228 days of screenings
    • Screening results: 50.7 percent of patients were diagnosed with at least one complication:
      • 48.6 percent of eye screening test performed and interpreted, 18.7% pathological
      • 53.1 percent of renal screening test performed, 32.0% pathological
      • 86.2 percent peripheral artery screening test performed, 17.2% pathological
      • 93.2 percent foot sensitivity screening tests performed, 28.3% pathological
      • 93.0 percent assessment of foot wound risk by grading: 66.7% low risk (grade 0 or 1); 26.2% high risk (grade 2 or 3)
    • Better sensitisation of people with diabetes and their physicians about medical monitoring of diabetes’ complications.
  • A high degree of satisfaction:
    • 75 percent of patients’ returned their questionnaire; with regional variations, between 92 and 100 percent of respondents considered the screening useful, relatively painless and fast.
    • Depending on the area, between 6 to 18 percent of physicians returned their questionnaire; they found screening campaigns useful to educate patients about the need for annual screenings to detect complications (particularly eye and foot complications). Between 44 and 75 percent of respondents considered the time between screening and receiving the report “fast”.
  • Improved organisation of care following the screening tests and reduced health care costs. 
(The trial is awaiting the data analysis from the National Health Insurance Agency.)

Detailed description

The DIABSAT 2 (Diabetology satellite assisted) program integrates the following devices:

DiabsatTruck3

There are specific screening devices, medical furniture (hospital bed, table, chairs, washbasin, etc.), computers and a connected satellite antenna.

The nurses welcome patients and interview them to collect administrative, socioeconomic and medical data. Then they ask the patients about their annual medical follow-up. If the patient had not had one or more of the recommended examinations, they perform the screening tests to detect ophthalmic or renal or neurological or foot infections which are specific to diabetes.

The retinograph collects images of fundus (the width of the retinal eye vessels), and a device for semi-quantitative measure of microalbuminuria detects  a loss in renal function .

The nurses also perform clinical examination of the patient’s legs and feet. They looks for potential loss of foot sensivity (monofilament test), peripheral artery disease (measure of Systolic Pressure Index) and risks of foot ulcer (foot prints record).

DiabsatWorkflow

Diabsat workflow

Operational status

The service has been running for four years. The trial lasted from 2010 to 2011. Since 2012, this service has been funded by the regional network in diabetes care (DIAMIP) and by the University Hospital of Toulouse. We are still looking for sustainable funding to carry on the telemonitored screening campaigns. Partnerships have been launched in various regions of France and overseas departments (départements outre-mer) to deploy the service.

Further information

www.Diabsat.fr

www.diamip.org

Or contact Dr Jacques Martini (MD), Diabetologist, president of the regional network for diabetes care (DIAMIP), at Martini.j@chu-toulouse.fr.

Momentum hosted a session at eHealth Forum in Athens on 14 May 2014.

The Secrets of Telehealth: how to deploy services in routine care

For decades, telemedicine and telehealth projects have been receiving a lot of attention from innovative health care professionals. However, only few projects have successfully shifted from lab to routine care. Even fewer have gone from small- to large-scale deployment. Lack of clinical evidence, user adoption, reimbursement and business models have often been identified as the main explanations for this situation. An element that has been much less studied is the lack of deployment method. Unquestionably, this is also a pitfall.

Several organisations and key players in telemedicine across Europe have decided to join forces. They have launched the Momentum project to work on how to deploy telemedicine, by analysing those initiatives which have been successfully deployed and identifying the reasons why they were successful, i.e. their Secrets!

This session was the first opportunity to access the first results of the project, a list of Success Factors which are Critical for the deployment of telemedicine in routine care on a large scale.

Presenters:

pdf-iconThere are more pilots in telehealth than …
Marc Lange, EHTEL and project coordinator for Momentum (Belgium)

pdf-iconCritical Success Factors for a deployment strategy
Rachelle Kaye, AIM and Maccabi Healthcare Services (Israel)

pdf-iconCritical Success Factors for managing organisational change
Peeter Ross, eTervis (Estonia)

pdf-iconCritical Success Factors from a legal, regulatory and security perspective
Ellen K. Christiansen, Norwegian Centre for Telemedicine (NST) (Norway)

pdf-iconCritical Success Factors from an ICT perspective
Tino Marti, TicSalut (Spain)

pdf-iconThe case of “German society for patients assistance” (DGP) for validating the Momentum Success Factors
Dr. Steffen Sonntag, Gesellschaft für Patientenhilfe DGP mbH, Munich, Germany

Moderator: Andrea Pavlickova, NHS24 and Action Group B3 on Integrated Care of EIP on AHA

Information about eHealth Forum is available at http://ehealth2014.org

Download here the Momentum_18 Critical Success Factors for Telemedicine Deployment (version 01, 6 May 2014.pdf

 

Athens, 14 May 2014 –Today the Momentum project published a list of 18 factors that are critical to deploying telemedicine successfully into routine health care.  Distilled from an analysis of telemedicine practices by experts from across Europe, these factors will help telemedicine “doers” to build sustainable implementations from the ground up or move experimental pilots into routine care.  Telemedicine, which is care where the healthcare professional and the patient are not in the same room, holds promise for European healthcare systems.  Its widespread deployment will help to improve safety, quality and efficiency of care, and to ensure that citizens have access to healthcare services where and when they need it.

The 18 critical success factors cover overall context (ie, cultural readiness, financing), management aspects (the need for leadership, for a business plan, for change management), legal and security issues (including liability or the regulatory environment for data management), and technology considerations (including interoperability).  They are collected in a short document with annotations available at Momentum_CSFs_v01_6may2014.

These factors require more validation, and the publication of this list begins a public consultation phase.  Momentum invites interested parties to comment via Momentum’s social networks (LinkedIn, Twitter or Facebook), by email to the consortium, or face-to-face in dissemination events like today’s session at eHealth Forum 2014 in Athens entitled “The Secrets of Telehealth: how to deploy services in routine care”.

Telemedicine in Europe suffers from ‘pilotitis’, a glut of technology experiments that have received start-up subsidies from public or commercial sources to get them off the ground, but which cease to exist once the subsidy is withdrawn,” says Marc Lange, Secretary General of EHTEL and coordinator of the Momentum project. “Our success factors will help the ‘doers’ move their projects into routine care and scale them up to provide real benefits to patients in Europe.”

The Momentum project convenes telemedicine experts and stakeholder organisations from more than 20 organisations in Europe.  The final outcome of the project will be a blueprint for telemedicine deployment which will be published in December 2014.  The project invites all interested parties to comment on the critical success factors, to submit successful practices, and to join the Momentum network.  More dissemination events will be held between May and September 2014.  For an ongoing list and more information go to www.telemedicine-momentum.eu.

About the project: Momentum is a thematic network designed to share knowledge and experience in deploying telemedicine services into routine care. Working together, Momentum’s members who come from all corners of Europe will develop, test and finalise a blueprint for telemedicine deployment that offers guidance for anybody who seeks to move telemedicine from an idea or a pilot to daily practice. The project is funded under the ICT Policy Support Programme (ICT PSP) as part of the Competitiveness and Innovation Framework Programme of the European Commission, and runs from 2012 to 2014.  More information is at www.telemedicine-momentum.eu.

 

Download here the Momentum_18 Critical Success Factors for Telemedicine Deployment (version 01, 6 May 2014.pdf

The Momentum project has published 21 case studies of successful telemedicine deployments in nine countries.

Based on responses to the Momentum questionnaire in 2012 and 2013, these service descriptions reflect the current operations of telemedicine services that are part of normal healthcare delivery in their countries. They are accompanied by eight country reports that analyse the policy and legal environment for telemedicine.

All reports can be accessed at http://telemedicine-momentum.eu/europe/

The Momentum project invites other telemedicine doers in Europe to submit additional descriptions of services. The sole criteria for the service:

  • It has to be a telemedicine service in daily operation,
  • It is part of the regular way of providing care or treatment to a significant number of patients/citizens,
  • It is funded or reimbursed as part of the normal funding or reimbursement system in your healthcare system.

To submit your service description, please complete and submit the Momentum service description template (Word, 66 KB).

Momentum publishes telehealth testimonials

Momentum publishes a section featuring anecdotes, descriptions and testimonials from across Europe and beyond where telehealth interventions have made a positive difference in the lives of real people. The descriptions come principally from material collected by the Campaign for Telehealth in support of Integrated Care, an initiative of Brussels-based organisations started in 2011.  

To read the testimonials and to learn more about this campaign, go to testimonials.

Newham Whole System Demonstrator: four testimonials (UK)

Tackling Congestive Heart Failure – Emelie’s story

Emelie’s heart has lost the ability to pump blood efficiently. The result is that her body doesn’t get as much oxygen and nutrients as it needs, leading to problems like fatigue and shortness of breath. Although in the past few years her condition has improved somewhat, the concern for Emelie is that her blood pressure could go up very quickly without warning.

What is the Telehealth intervention how does the technology work?

Since 2009, Emelie has been using a Telehealth system allowing her to manage her own health at home, with the supervision of health professionals. Emelie is now able to take her own blood pressure, weight, pulse and oxygen levels each day, with special equipment linked to a set-top box connected to her television. The results are automatically uploaded to a team of healthcare professionals who view them daily and can contact Emelie if anything is out of the ordinary. 

Outcome of telehealth intervention for Emilie

Emelie is enjoying the part she is now playing in managing her own health and she is more conscious of changes in her readings. “I can see how my readings are related to my diet and how much physical activity I do… if they change, it makes you think “What have I done? What did I eat?‟ and when you remember, you say to yourself “no wonder my readings have gone up!”

Telemonitoring service to treat COPD – Frank’s story

ATICO case study – Robert Bosch Healthcare GmbH
COPD is a chronic and progressive disease that damages airways and causes breathing dysfunction because of the amount of mucus present in the lungs. It can lead to pneumonia, pulmonary hypertension and heart failure.

What is the Telehealth intervention how does the technology work?

Every morning, Frank captures his vital signs, such as oxygen saturation and heart rate, through a simple electromedical device. He also answers a few questions on his symptoms – coughing, sputum and difficulties in breathing – and on how he is feeling. The information is then automatically sent to a data analysis center. The system issues a listing of all patients, with a color code: green if all goes well, red if there are reasons to worry. A nurse opens the red files to assess the seriousness of the situation and contacts the patients to ask them further questions on their condition. If she notes that Frank’s condition has deteriorated, she will immediately put him in contact with Dr. Werne

Outcome of telehealth intervention for Frank

If something is wrong, I’ll be notified and taken to hospital or my doctor will be in touch. That gave me so much security and confidence, that I could do things again. It motivates you to get moving. I used to be pretty passive, but now I try to walk as much as possible.”  Frank

 “The idea is that routine visits are diminished and emergency visits, when necessary, can be made at exactly the right time. It is more important that patients come in such cases, rather than for routine examinations, when there is nothing wrong.” Dr. Werner

 

Carol’s story


In addition to diabetes  58-year-old Carol also suffers from a heart condition which means she has an irregular heartbeat and palpitations. Her blood pressure often drops very low and,  the concern for her and her husband is that it  could  happen quite rapidly with little time to recognise the symptoms.

What is the Telehealth intervention how does the technology work?

Since 2009, Carol has been using a TeleHealth system connected to her television, enabling her to take her own blood pressure, weight, pulse, blood sugar and oxygen levels every day. Data is automatically received and reviewed by healthcare professionals. Once, they noticed Carol’s blood pressure was too low; an ambulance was sent to her house, and she was taken to the hospital early enough to avoid serious complications.

Outcome of telehealth intervention for Carol

Every morning I look forward to seeing how my readings are. Before I would just do it but not really understand or take the time to see a pattern,” said Carol. Carol is now playing a much more active role in the management of her own health and is more conscious of any changes in her readings.

Ahmed’s story


Ahmed was diagnosed with diabetes 18 years ago and has been battling with his condition for the past ten. At the end of 2008, his health deteriorated so much that he lost all feeling in his body from the neck down and was hospitalized. Ahmed’s health has since stabilized but he is concerned about his health deteriorating again. Ahmed realized diabetes is a serious disease when he suffered complications including an amputation.

What is the Telehealth intervention how does the technology work?

Ahmed has been monitored by telehealth since November 2008. He is able to take his own blood pressure, weight, pulse and blood sugar readings each day. The readings are taken with special equipment which is linked to a set-top box connected to his television. The results, which Ahmed can view on his television, are automatically uploaded to a team of healthcare professionals who view them daily.

Outcome of telehealth intervention for Ahmed

In one instance, Ahmed noticed his blood pressure readings were not right and as he was feeling dizzy as well, he called his GP. He was told his symptoms sounded like he may have had a stroke and that he should call an ambulance. On arrival at the hospital he found out that he’d had a minor stroke. Getting the advanced warning may have saved him from something more major.

TeleHealth is really great for a person with an illness. Someone is always looking out for me and that is a big support. I’m always aware what is happening about my health.” Ahmed

The system helped him (Ahmed) to learn more about the disease in the first place, learn about the importance of good treatment and learn how to control his diabetes.” Doctor Kumar

For further information

http://www.newhamwsdtrial.org/

(July 2011)

Back to testimonials

All the help in one place12Commonwell

Integrated Social and Health Care Services for patients with COPD – Milton Keynes Council, United Kingdom

Common Platform Services for Ageing Well in Europe

Mr. Sydney Nightingale is 81 years old and lives with his wife (who is considerably younger). Mr. Nightingale enjoys walking, spending time in his garden and cooking. He walks to the local Newsagent to collect a newspaper on a daily basis. He is independent in all activities of daily living. Mr Nightingale has Chronic Obstructive Pulmonary Disease (COPD), Hypertension, and Mild Heart Failure. His COPD was diagnosed approximately 10 years ago. He visits his GP Surgery for general assessment as required.

His wife likes to visit her mother on a regular basis and stay overnight as she lives out of the area. The concern about his condition has increased the stress and anxiety levels for the both of them. Mrs N was concerned that whilst away her husband would become ill, inform no one and be admitted to hospital. He was worried about the stress this was causing his wife.

Mr. Nightingale’s condition is not uncommon but he is concerned that his health may deteriorate that he will become a nuisance to everyone, be more dependent on his wife for care, or have to rely on assistance for his care from the Community Services and Health and Social Care. He had several unplanned hospital admissions recently relating to exacerbation of COPD. His condition had deteriorated to the extent that he developed bilateral pneumonia and was seriously ill necessitating a hospital stay of three weeks.

In the course of the three year pilot project CommonWell, co-funded by the EU, the Milton Keynes Council developed, implemented and currently trials an ICT-supported, integrated social and health care service aimed at their COPD patient population. Mr. Nightingale agreed and consented to be part of the CommonWell Project, a telehealth monitor and community alarm were then installed.

The Milton Keynes initiative’s intervention

Unsynchronised care service delivery, confined to the separated “silos” of social and health care, is the norm rather than an exception in care provision across Europe and beyond. This leads to inefficiencies, duplication of resources, and potentially to reduced levels of quality of care, and in extreme cases to premature death. Older people are particularly affected by this situation, since they often need both types of services, such as support with daily living activities and chronic disease management. There are 15.4 million people with a long term condition in England and this number is expected to rise. The Milton Keynes Council recognized that there is a need to move away from “one size fits all” approach of reactive care which is often delivered in a hospital set up to a patient centered, responsive, adaptable flexible service.

Milton Keynes Council Community Alarm Service is a 24/7 operation with links to other out of hours services but Telehealth is only a Monday – Friday service. If a patient takes their readings outside of office hours these readings will not be looked at or actioned until the next working day. This potentially means that a hospital admission may be necessary. Patients who have long term conditions such as COPD may also benefit from other Telecare equipment such as fall detectors or environmental sensors to enable them to remain independent and able to live at home. Before CommonWell, because the patient information is kept on two separate systems there was no comprehensive co-ordination or assessment of need as this is managed by two separate teams.

24quote1

For CommonWell, the Community Alarm/Telecare Service carried out the installation of the equipment in the patient’s home. Full instructions’ regarding the use of this equipment was given by the Technician, together with a Patient Quick Reference Guide. Each day the patients measure their vital signs including heart rate, weight, blood pressure, oxygen saturation levels and temperature. Alert limits of the vital signs are set by their lead Clinician. The monitor also asks a series of clinical questions to further determine their current health condition. The readings are transmitted via a web application to the community matrons or district nurses for clinical triage and to the Alarm Centre for technical triage. The reading takes the patient approximately 5-6 minutes.

The benefits of the CommonWell pilot project

24quote2Increased quality of life of patients: Hospital admission avoidance, empowered and informed service users and patients, better support in critical situations and early intervention and prevention, support for families and carers of patients with Long term Conditions, reduction in anxiety for patients and carers as they feel more engaged with clinical staff, increase patients’ understanding and knowledge of their condition – self management

Increased quality of service: Faster response to clients’ requests, more targeted response to clients’ requests, complete data accessed on one system instead of two, and data available to clinicians via web based application.

Increased efficiency of service: Decreased number of face to face visits to clients for health and social care staff, increased efficiency of data exchange, reduced hospital admission costs, opportunities for early discharge from hospital, reduction in call outs to GPs and urgent care facilities, enable staff to prioritise visits, reducing travelling costs and carbon emissions.

To ensure these aims, the pilot is accompanied by a rigorous evaluation scheme. The evaluation
encompasses impacts on the patient (health-related quality of life, disease-specific outcomes and hospital admissions, perception of the service and its benefits, satisfaction with the devices used and others), impacts on service staff (impacts on job/role performance, workload, job satisfaction) and impacts on the service provider organisation (appropriate targeting of responses to particular events, development and change management and service utilisation).

At this stage of the pilot it can already be said that patients are overall satisfied with the service and perceive it as a useful support to their own efforts of managing their condition. Patients reported that they are now more aware of their condition and symptoms which has enhanced the self-management of the condition and also their understanding. The Community matrons work very closely with the Respiratory Team at the hospital and this team is able to access information from ICP Triage Manager regarding patients prior to or during their attendance at an outpatient’s appointment. Staff members have expressed enthusiastic feedback as the information is extremely valuable as it gives them an overview of what has been happening over a period of time rather than just assessing the patients as they appear on the day of their appointment.

ICT-Supported Integrate Care across Europe – the CommonWell Project

The pilot trial carried out by the Milton Keynes Council is part of the project CommonWell that develops, implements and pilots integrated services at four sites in Europe: the autonomous region of Andalusia in Spain, and the cities of Bielefeld in Germany, Milton Keynes in the UK and Veldhoven in the Netherlands. The project is co-funded by the European Commission within the CIP ICT Policy Support Programme (Grant agreement no. 225005). 10 partners are cooperating in the project, developing services to support chronic disease management and independent living of older people in general.

Andalusia and Bielefeld are the sites focusing on improving services for independent living for older people. In Andalusia, CommonWell provides users with a high quality service by integrating the information from both emergency and social care services into one common platform. The CommonWell approach in Bielefeld is being applied to a major gap in service provision for older people at German care provider Johanneswerk. It relates to a necessary improvement in the effectiveness of co-operation between social care and healthcare providers on admissions to hospital, and subsequent discharge.

Milton Keynes and Veldhoven are the pilot locations that address chronic disease management for older people suffering from Chronic Obstructive Pulmonary Disease (in Milton Keynes), and Chronic Heart Failure (in Veldhoven, see above). The CommonWell services here improve communication between health and social care providers, helping to reduce anxiety and improve health outcomes for people with chronic conditions and those who need support when leaving hospital.

The integrated services are currently being piloted at the four sites for a duration of 12 months. The results of evaluating the pilot operation will be used to extend service provision and promote the wider uptake of this model of care across Europe. The pilots are evaluated to gain a better understanding of the new services’ added value, user benefits and acceptance, quality of life impacts and economic viability. The evaluation takes into account the nature of the services to be implemented as well as the diverse national care systems, the regulatory and legal conditions, and the local circumstances under which services are to be delivered. The evaluation encompasses the different stakeholder groups involved: end users; informal carers; formal health and social care staff and the provider organisations. A multi-dimensional and multi-method approach has been adopted which can be flexibly applied across sites.

For further information

To learn more about CommonWell, please visit www.commonwell.eu

(July 2011)

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The National Patient Summary, Sweden23logo

Implementing Sweden’s National Health Strategy for E-Health

The National Patient Summary’s role in Sweden’s E-health Strategy

The National Patient Summary service is a very important part of the work on implementing the Swedish national Strategy for e-Health through common e-Health solutions that improve patient safety, accessibility and quality of care. It operates as a secure and accessible database for patient information and is based on the need for an efficient tool that provides authorised health care and social services staff with access to critical patient information across organisational boundaries.

The National Patient Summary is the first of several such shared county council e-Health solutions and will help break ground for necessary security solutions and infrastructure. All 21 county councils and regions in Sweden support the launch and will subscribe to this service. Örebro county council and municipality were first to conduct a trial of the system in 2009 when the interface, technology and, above all, the benefits to their activities were tested and evaluated. The goal of the joint action plan of the county councils and Regions is for the National Patient Summary to be introduced in all county councils by the end of 2012 and used to a significant degree for communication between county councils, municipalities and private care providers.

The right information in the right place, at the right time, and for the right users

The following patient information is collected, stored within the system:

Information type Contains data on
Patient Personal identification, next-of-kin, possible need of interpreting services, etc.
Attention and alert signals Hypersensitivity to drugs, severe illness/on-going treatment, healthcare restrictions, infectious diseases, out-of-structure attention signal
Diagnoses Diagnoses
Care services Primary care, specialist care, home help, home care, disability services, special residential needs
Medication Pharmaceuticals prescribed by the care provider,
dispensed at Swedish pharmacy
Care contacts Historical and future contacts (hospital, primary care unit or private)
Care documents Final report, admittance report, daily report, primary care notes, primary care summary, specialist notes, other documents
Status PADL, functional disabilities
Care plans Various type of care plans for the patient
Examination results Clinical chemistry, microbiology, ECG with sound and pictures over a link, image diagnostics with sound and pictures over a link, consultations

The Patient Summary in operation

The National Patient Summary is accessed via a web interface and requires a login with strong authentication. Information displayed in the National Patient Summary has been defined by a large number of service representatives. The first version includes information such as diagnoses, pharmaceuticals that are ordered, prescribed and dispensed, appointments attended and scheduled, functional status, health care and welfare documents, and results of examinations such as clinical chemistry, microbiology, ECG and medical imaging. The functions and content of the National Patient Summary will be expanded over time to meet the needs of the service.

The Patient Data Act provides the framework for keeping coherent records Sweden’s new Patient Data Act, which entered into force on 1 July 2008, provides the legal framework for keeping coherent records and for a service such as the National Patient Summary. The Act is adapted to modern technology and is designed to facilitate the exchange of information between care providers, and between care providers and patients, but always with the integrity of the patient in mind. For example, only staff with whom the patient has a current care relation, and to whom the patient gives his or her consent, are entitled to read the journal.

All health care and social services staff are bound by professional secrecy, and it will always be possible to see who has had access to the records. The patient has the right to access information that has been logged. Anyone who does not want his or her information to be available in one coherent journal that is kept between different care providers can request that it be blocked.

Implementing the National Patient Summary requires a high level of security, secrecy and traceability when information is shared between different organisations. This is why all health care and social services staff who have access to patient information must be listed in the national electronic catalogue service that is used to clarify who works for which are provider and what function each employee has. Care staff must also be able to identify themselves by means of a special electronic ID card. A national security infrastructure that uses a number of different services to help ensure patient integrity and manage access control, traceability and other security issues is also being implemented.

Outcomes of the National Patient Summary initiative

Patient information is available at all times which has improved the patient safety, and new information that enters the system is immediately available. There is no waiting for paper copies in traditional mail. As a result, there are less administrative burdens by referring to National Patient Summary as the source for information.

The outcomes of the Patient Summary for the patients themselves can be seen in the increased mobility, freer choice of care provider and greater specialisation in care mean that patients today often have contact with several different care providers (principals), each of which registers and stores its records locally. The National Patient Summary service now makes it possible for authorised health care and social services staff, with the consent of the patient, to access care information that has been registered with other county councils, municipalities or private care providers. More actors being able to access the same information creates more efficient and safer care.

Better quality of care: A comprehensive picture of the patient’s previous diagnoses, test results and medication makes it easier to establish the correct diagnosis and provide the proper treatment in time. It also facilitates working with preventive care and being able to jointly plan and coordinates care measures between county councils, municipalities and private care providers.

Better patient safety: The right decision-making data reduces the risk of incorrect treatment or incorrect medication. For example, being aware of matters such as hypersensitivity means that treatments involving risks and/or discomfort to the patient can be avoided. Evaluation and treatment are also easier in emergency situations when there is no time to wait for information from other care providers.

Better efficiency: Shared information reduces costly duplication. For example, the same tests do not need to be run or examinations repeated. The patient does not have to retell his or her entire care history when meeting a new care provider, and records do not have to be sent by post.

Greater influence: The National Patient Summary shows whether the patient has consented to making information accessible. The patient can block information that he or she does not wish another care unit to see. In the long term, the National Patient Summary will also make it easier for a patient to gain greater insight into, and influence over, his or her own care.

For further information

Contact Britt Marie Horttana

(May 2011)

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Regaining Control while living with Emphysema16-pic

NHS, North Yorkshire and York

Pauline’s Story

When 56 year-old Pauline Waite was diagnosed with a respiratory disease called Emphysema seven years ago, it made a huge impact on her life. Even simple day-to-day activities such as carrying shopping bags and going for short walks became a struggle. After Pauline was admitted to hospital in October 2009 with pneumonia, she knew she wasn’t coping well with her illness. “I felt like I was the only person in the world suffering from emphysema. I used to panic if I felt ill. I didn’t want any more admissions into hospital, so my nurse suggested Telehealth.” In December 2009, Pauline had a telehealth device installed in the comfort of her home.

“At first I was skeptical,” she says. “I didn’t know anything about it and questioned its reliability. But my nurse was really helpful and explained what Telehealth was and how it would help me. Telehealth saved me an admission to hospital between Christmas and New Year, when there was an abnormal reading on Boxing Day and the following two days. I was really grateful as having to go to hospital would have really spoiled my Christmas.”

What is the Telehealth intervention?

“The device is so simple and easy to use and the step-by-step instructions are clear and easy to follow. It measures my blood pressure, oxygen levels and temperature once a day at 10 a.m., which only takes five minutes out of my day. If there are any abnormal readings it alerts the clinic and I get a phone call from a nurse at York Hospital the same day.

A focus on empowering the patient

16cap“I was struggling to cope with my illness before Telehealth was fitted, either waking up or going to sleep feeling uneasy or ill. Telehealth gives me a sense of reassurance to know somebody is keeping a check on me every day. It feels like a godsend, I feel much more at ease with the different aspects of coping with my illness.”

There is an increased feeling of self-control in Pauline’s case as well. “If I don’t feel quite right I can take measurements at any time in the day and the majority of the time everything is okay,” she says. “Before the device was fitted I would worry my blood pressure was too high and whether my body could cope with the things I had to do that day. Now I feel I have the confidence to get on with my daily activities without the thought constantly being at the back of my mind.”

From a Healthcare provider’s point of view, Judith Norell, a Community Respiratory Specialist Nurse, has said, “I’ve seen the impact of Telehealth first hand and it’s incredible to see the peace of mind and reassurance it can give to patients.” Pauline is now far more confident in going about her day-to-day activities knowing that her condition is being monitored more closely. “I am thrilled with the new technology and can see that it will benefit many more patients in the future.”

For further information

For more information about this initiative please visit www.nyytelehealth.co.uk.

(April 2011)

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Telehealth tackling hypertension 15pic

NHS, North Yorkshire and York

Jacqueline’s Story

Jacqueline, a fifty-two year old Harrog­ate resident was diagnosed with Asthma from a young age. Over the past 15 years this has developed into brittle asthma. Jacqueline also has heart disease and hypertension. After needing frequent visits to hospital and her General Practitioner, Jacqueline felt she had no control over her condition. Telehealth was installed into her home in October 2010.

“I first heard about telehealth from my community matron. She showed me a patient case study and asked me if I would consider having it. After reading how telehealth had helped the patient I thought it would be a good idea for me, too.

“At first I was nervous, but I liked the idea of being able to manage my condition from home. Before telehealth I felt like I was in and out of hospital almost every other week. I had very little confidence and felt I had no control over my condition. Originally my telehealth was a three month trial, but I liked it that much I decided to keep it. When it was installed in my home, the engineer only had to show me how to use it once and I was away – it’s a lot easier than I first anticipated, it’s really simple and I’m sure everyone would think the same.”

What is the Telehealth intervention?
Managing multiple conditions in an easier manner

“Since having telehealth I have only been in hospital twice overnight. While there I explained that I have telehealth at home and feel confident about monitoring my condition along with the help from my community matron. I have everything I need here and I would much rather recooperate in my own home where I feel I can get better quicker and I am much more comfortable. Telehealth has changed my life and given me so much confidence. I feel as though I have a new lease of life and am much more at ease. I really like being able to manage my condition from home it has lots of benefits. There is nothing I don’t like about telehealth.

15jacqueline“I particularly like the fact that I can monitor all the different parts of my condition, like my weight for example. I need to reduce my weight to be healthier and to help my heart. Taking my readings three times a week means I can’t slip out of a routine. This really helps motivate and encourage me to stay on track and work towards a goal, which is go back to swimming once a week, this will help with my heart and asthma and I really enjoy it. That’s my goal and I know I’ll get there now with the help of telehealth.

“If any of my readings are high, I get a call the same day either to take a re-test or to ask if I am okay. Telehealth is great because it enables me to have independence and manage my own health but I still have a really close relationship with my community matron. If my readings are okay but I feel ill in myself I can still get in touch with my community matron and she will come straight down, she is always on the other end of the phone.”

Jacqueline’s telehealth experience has also allowed for newly developed conditions to be identified and treated, says Wendy, her community matron. “Hypertension has been identified since usage of telehealth and Jacqueline is now taking appropriate medication. Jacqueline’s medication has been altered frequently so it is now easier to monitor how this is affecting her medical status.”

For further information

For more information about this initiative please visit www.nyytelehealth.co.uk.

(April 2011)

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The Gesundheitsdialog: Advanced Therapy Management for  Diabetes Patients based on mHealth

AIT Austrian Institute of Technology GmbH, Graz, Austria
Versicherungsanstalt für Eisenbahnen und Bergbau (VAEB), Vienna, Austria

Management of patients with chronic diseases, and in particular Diabetes mellitus, requires a dedicated infrastructure to support patients and doctors to communicate and collaborate intensively, without the need of frequent face-to-face meetings. Pervasive healthcare is a term that draws on mobile communication devices and the Internet as well as concepts like ubiquitous computing and ambient intelligence. The term “mHealth” is more and more used to encompass these ideas of patient-centered, prevention-oriented, and decentralized health management and treatment of chronic conditions using mobile and wireless communication technologies.

In 2010, the Austrian Social Insurance Institution for Railways and Mining Industry (Versicherungsanstalt für Eisenbahnen und Bergbau, VAEB) started with a proof-of-concept telediabetes project, called Health Dialogue (“Gesundheitsdialog”). The project aims at setting a new standard in the management of chronic diseases by integrating different healthcare elements across different healthcare sectors: the patient, general practitioners, specialized clinics, and hospitals. Initially, the project primarily addresses Diabetes mellitus but it will be extended to other chronic diseases (such as cardiovascular diseases) and towards prevention programs for patients with known risk factors (such as obesity, pre-diabetes). The overall aims of the “Gesundheitsdialog” are to increase the quality and efficiency of healthcare. The project’s ultimate goals for the patients are to optimize the health status, to reduce risk for long term complications, and to increase the quality of life.

mHealth’s technological intervention

14-oneA central element of the project is the use of mHealth to establish a tight link between patients and their caregivers so as to bridge the barriers in terms of space and time. In the course of the “Gesundheitsdialog” diabetes patients are equipped with a mobile phone based telemedicine system based on Keep-In-Touch (KIT) technology. KIT is a concept for intuitive human computer interfacing that uses wireless technologies like Near Field Communication (NFC) and Radio Frequency Identification (RFID). KIT enables patients to collect information from health related items of their daily life by simply touching those things with their NFC enabled mobile phones.

Patients are equipped with NFC enabled mobile phones with a pre-installed Diabetes application, individual RFID-based ID cards for identification and authentication, and a varying set of medical measurement devices (glucose meter, blood pressure device, weight scales). This depends on their disease conditions (type 1 or type 2 Diabetes mellitus, type of therapy and medication). A dedicated mHealth service platform provides mobile phone and web-based access for patients and doctors. It features a diabetes specific electronic patient record, communication via email and SMS, data storage and processing, trend curve visualization, as well as support for device management and logistics. “Because of their regular updates, I am able to coordinate my diabetes patients’ appointments, offer them security, and gain a high degree of trust. Apart from the check-ups in my office, DiabMemory offers me the chance to give my patients weekly feedback,” says Dr. Thomas Rössler (General practitioner).

14-bpcThe system is designated “DiabMemory” and provides for all common Diabetes mellitus therapy options, an electronic diabetes diary for patients as well as features to support communication, i.e. for doctors to send individualized feedback to patients. As Dr. Harald Eckmann describes, “Constant and continuing tracking of relevant data  empowers us to respond to the glucose level fluctuations and delay long term complications or even prevent them.”

Up to now, the majority of patients have been enrolled at a special rehabilitation facility of the VAEB in Breitenstein (in Lower Austria). Patients stay there for a period of one to three weeks to receive education on all aspects relevant to their health and medical conditions like nutrition, physical activity, and psychological elements. This setting is ideally suited to offer patients an easy way to enter the “Gesundheitsdialog” and, if they decide to do so, receive the equipment and training on how to use it properly. Staying in the special rehabilitation facility in Breitenstein is considered a factor of success in the project. Patients receive care from Dr. Martin Lischnig and his medical team as they help to change their lifestyle in order to cope better with their disease. In addition, patients learn how easy it is to handle the system of “DiabMemory” and integrate it into their everyday lives. After their stay in Breitenstein, the participants are able to use “DiabMemory” without further help. If needed, the VAEB assists the patients at their healthcare support centers which are located in six locations throughout Austria.

14-cap

Currently, physicians use the web system using their individual credentials. Interfaces to electronic patient record systems are already in the planning phase. In the future, we intend to provide all participants with additional access possibilities by linking the DiabMemory system up to the forthcoming Austrian national electronic health record system.

Outcome

 

The project is subject to an extensive evaluation program, carried out by an institution which is not involved in the operational aspects of the “Gesundheitsdialog.” Among the issues to be assessed includes the various measures of patient and physician satisfaction, patient compliance, and medical outcomes and health economic impact. Assessing the latter will depend on a sufficient number of patients have been observed for a sufficiently long period of time.

Recently, initial results on the compliance in a first group of 169 patients have been analyzed and published. A persistence (i.e. the percentage of patients staying in the program) of 84% and a concordance (i.e. the percentage of measurements transmitted as compared to the number according to the predefined recording and transmission schedule) of 54% for type 1 and 89% for type 2 diabetes patients indicate that the concept is well accepted by the patients.

This notion is further supported by the results of the first round of patient interviews which have been done in the framework of the evaluation program. Similarly, involved healthcare providers (physicians, nutritionists) expressed a high degree of satisfaction with the concept in the course of the initial evaluation phase. Some potential for further improvement has also been identified which will result in a system update currently in the development phase. Additionally, a system “scale up” is under way to prepare for the increasing number of users (patients and health care professionals).

Based on a survey, the participating physicians see the most significant benefits of the Health Dialogue in the rise of motivation, a higher compliance in therapy, and a boost of self-discipline on the side of the patients. More than half of the doctors polled think that the therapy of Diabetics got more effective with DiabMemory the software behind the Health Dialogue. Nearly fifty percent of the health professionals who participate in this project miss the personal contact to their patients. As Dr. Peter Grabner (senior physician at the VAEB) emphasizes, “Diab Memory” was not developed as a replacement of periodical consultations between a patient and doctor. Rather, it is meant to connect the patient and doctor in a less bureaucratic manner and establish easy means for a patient to receive feedback without having to secure an in-office appointment every time a consultation is needed.” And while this limitation exists, the number of new participants in the program has been increasing further at a rate of about fifteen to twenty patients per month.

For further information

 

Harald Eckmann, Martin Lischnig, Helmuth Badjura
Versicherungsanstalt für Eisenbahnen und Bergbau (VAEB)
Vienna, Austria
helmuth.badjura@vaeb.at

Peter Kastner, Günter Schreier,
Safety & Security Department, AIT Austrian Institute of Technology GmbH, Graz, Austria
guenter.schreier@ait.ac.at

(November 2011)

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Innovating through decentralized Teledialysis care

University of North Norway and Tromsø University Hostpital, Norway

Decentralised treatment

Dialysis and transplantation are the two treatment forms when kidneys are failing. Dialysis must be used when the kidneys are no longer able to excrete waste products and regulate fluid balance in the body. There are two main types of dialysis: haemodialysis (blood or machine dialysis) or peritoneal dialysis (abdominal or dialysis bag).

Haemodialysis is the most used dialysis form in Norway and is mainly provided in hospitals. This type of haemodialysis “binds” the patients three times a week for five hours to the hospital, in addition to the travel time needed. Some patients receive treatment at so-called satellites, which are smaller hospitals and other health institutions with no formally recognized specialist in kidney diseases. The administrative and professional responsibility for patients receiving haemodialysis in satellites is placed in a cooperating hospital with nephrologists.

An effective manner for hospitals without specialists in kidney diseases (nephrologists) to gain access to specialist expertise is through what is known as teledialysis. The service provides better health care in rural areas by giving professional support to health workers on site. In Norway, haemodialysis is mainly performed in hospitals with nephrologists. Each of these hospitals has at least one satellite. In total there are 34 satellites in Norway where dialysis is performed. And at each satellite, dialysis is run by specially trained nurse team on site.

The purpose of the teledialysis service is to improve the offer to patients by providing dialysis closer to the patients’ home, and to increase integration of satellite personnel. Teledialysis contributes to ensure implementation of common quality standards at both satellites and their mother unit. Dialysis patients at the satellites did not have the same follow-up as the patients at the hospital. With the possibility of teledialysis the patients benefit from greater continuity and regularity in check-ups and treatment, as well as the opportunity to talk to their kidney specialist directly.

Development of teledialysis

Telemedicine service in nephrology (teledialysis) has been in operation since 2001 in Northern Norway, following a successful pilot project. Satellite dialysis units are situated as far as 900 kilometres from the main university hospital in Tromsø, and during the last few years, teledialysis has been introduced in other health regions in Norway as the demand has increased both nationally and internationally, where the Norwegian solution has also been put into use in Scotland. The aim is to improve the quality of patient care by providing patients and nurses at the satellite units with the same quality of follow-up care and support as that received by patients and health staff at the hospital. To achieve this a videoconference link between the hospital and the satellites was established.

Secure videoconferencing supports the teledialysis treatment

Videoconference can be used for clinical consultations, administrative purposes, rounds, education and staff development. Kidney specialists, like Mark Rumpsfeld at the University Hospital of North Norway (UNN), has his weekly consultation with a patient in Hammerfest, a city almost 550 kilometres north of Tromsø. This is performed by means of telemedicine. “How are you today?” asks Doctor Rumpsfeld at UNN, to the patient who is connected to a dialysis machine at Hammerfest Hospital. The videoconference utilizes a closed network, known as the Norwegian Health Net, which makes it possible for kidney specialists to conduct secure consultations even though the patient is not physically present at UNN. The setup is quite simple. The doctor uses an ordinary television set with a large camera on top. At the same time, the nurse team in Hammerfest, consisting of specially trained personnel, hooks up their system. This all allows the physician and patient to see and hear each other.

Reducing the travelling commitment: benefits for patients and hospitals alike

As administering dialysis can be both time-consuming and fatiguing for the patient, teledialysis has stepped in to help mitigate some of the stress and worry for the patient. There are also increased, added benefits for hospitals facing human resource shortages, in particular specialists. One of the patients in Finnmark County undergoing dialysis supported by telemedicine notes, “Since we do not have a kidney specialist at the hospital in Hammerfest, it is reassuring that the nurses here can quickly get in touch with a specialist in Tromsø if something irregular occurs.” Previously this patient had to travel by plane to Tromsø several times a week for dialysis and consultations with the kidney specialist. The side effects of such treatment were fatiguing: “I’d get very sleepy and tired after dialysis. It’s therefore a relief not having to go by plane, oftentimes with long waiting periods at the airport. Now I can go right back to my couch or bed afterwards,” he explains.

Kidney specialist, Markus Rumpsfeld, sees the value for professionals in rural areas as well. They will have better and closer follow-up through the use of telemedicine. He thinks videoconferencing is important to prevent professional isolation of highly specialised workers outside hospitals. It is the belief among experts in Norway that dialysis treatment given by satellite units and supported by telemedicine is going to rise in the coming years, particularly in response to a large demographic of aging adults suffering from coronary heart disease or diabetes around the world. Decentralized dialysis treatment tailored to the needs of the patient is one option for people depending on dialysis treatment. While not a solution in and of itself, teledialysis is an important tool that supports this overall treatment option.

(July 2011)

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12Commonwell

All the help in one place

Integrated Social and Health Care Services for patients with Chronic Heart Failure – Velhoven, Netherlands
Common Platform Services for Ageing Well in Europe

When Henry de Vries climbs the stairs in his small house in Veldhoven in the Netherlands, he has to sit down and rest three times on the way up. A friend once told him about a chairlift, but he does not know how and where to get one. Today, his living room is therefore the place where he spends most of his time. Here, everything is arranged so that he can easily reach it: a large chair with a table nearby, on it his glasses, the TV remote, a bottle of water and a box full of medication that he has to take every day. Six years ago, Henry was diagnosed with chronic heart failure after an emergency admission into hospital. Since then, the condition more or less determines his life and that of his wife. He spends a lot of time worrying about his health and what would happen to his wife if something happened to him. He is afraid that his heart might give out again suddenly and without much prior notice, sending him into hospital and leaving his wife alone to look after herself. Henry receives a lot of help from his family, some neighbours and his long-time physician, but fears that this might still not be enough.

Henry’s situation is not uncommon among people suffering from chronic heart failure, in the Netherlands and elsewhere. With increasing severity of their condition they need comprehensive support on different levels and close observation by health care professionals to detect any worsening of the situation as soon as possible.

The service and intervention provided through telehealth procedure

Unsynchronised care service delivery, confined to the separated “silos” of social and health care, is the norm rather than an exception in care provision across Europe and beyond. This leads to inefficiencies, duplication of resources, and potentially to reduced levels of quality of care, and in extreme cases to premature death. Older people are particularly affected by this situation, since they often need both types of services, such as support with daily living activities and chronic disease management.

The need for an integrated care programme targeted to chronic heart failure (CHF) patients was recognised by the primary care organisation PoZoB, a network of approximately 200 General Practitioners working in the Southeast of the Netherlands. Apart from better coordinating care activities and bringing together social and health care components into a holistic approach, PoZoB also realized the potential of modern telecare and telehealth technology to not only improve health outcomes, but also to increase the efficiency and quality of service delivery. In the course of the three year pilot project CommonWell, co-funded by the EU, PoZoB developed, implemented and currently trials an ICT-supported, integrated social and health care service aimed at their heart failure patient population.

From a call-centre available 24 hours, 7 days a week, a specially trained Case Manager is available for PoZoB’s heart failure patients to monitor health status, follow-up on critical situations, answer patients’ questions, liaise with GPs and other professionals, and coordinate social care issues. To facilitate this, the Case Manager has access to an integrated electronic patient file, bringing together data from telehealth and telecare sub-systems in one interface.

The Case Manager contacts the different social care providers who offer the needed service and make sure it is delivered. A practice nurse, specialized in cardiovascular problems, takes care of the planning and coordination of the chronic care of the patients together with the GP. The case manager cooperates with the GP and practice nurse to manage and offer the needed care.

Via a telehealth monitor and connected weight scale and blood pressure meter, the patients’ health status is monitored regularly. If the values are out of range the Case Manager at the call-centre is alerted and immediate action can be taken to early detect and prevent possible exacerbations.

The patients are also equipped with a social alarm connected to the call-centre to be able to call for help immediately and at all times. In this way the patients have one central access point for urgent as well as non-urgent social and medical care.

The benefits of the CommonWell pilot project

The new service is currently being piloted with about 100 users. The main aims of the pilots are as follows:

  • Successful implementation of a care programme for chronic heart failure patients for more regulated care following specified protocols.12Stroosmaquote
  • Decreased workload for GPs and their offices, by introducing a Case Manager who guides both the medical and the social care for the heart failure patients.
  • Realisation of a more complete picture of the heart failure patient (data record) for all care givers (Case Manager, practice nurse, GPs, Cardiologists) including both medical (telehealth) and social (telecare) data to faster take adequate action and coordinate the care for the patients.
  • Increased quality of life for the heart failure patients, by means of security and comfort in their home environment and prevented hospital stays.
  • One access point for heart failure patients and caregivers for all issues concerning both medical and social care.

12Vriesquote

To ensure these aims, the pilot is accompanied by a rigorous evaluation scheme (see below). The evaluation encompasses impacts on the patient (health-related quality of life, disease-specific outcomes and hospital admissions, perception of the service and its benefits, satisfaction with the devices used and others), impacts on service staff (impacts on job/role performance, workload, job satisfaction) and impacts on the service provider organisation (appropriate targeting of responses to particular events, development and change management and service utilisation).

At this stage of the pilot it can already be said that patients are overall satisfied with the service and perceive it as a useful support to their own efforts of managing their condition. Vis-à-vis the Case Managers in the call centre, patients repeatedly say that they feel well taken care of and that the regular telehealth monitoring helps to better understand their own disease. In several cases, exacerbations could be detected at an early stage and countered, so that a visit to the hospital was not necessary. The Case Managers report that after an initial period of familiarisation, the service is now running smoothly and begins to show that people are better cared for than before. Through the use of the integrated patient file, services can be delivered in a targeted and efficient manner. Niels van Elderen, director of PoZoB, sees the emergence of a new model of care provision to people with heart failure but potentially also with other chronic conditions. Under this new model, he says, PoZoB will not only provide high-quality care, but can also deliver services with greatly improved efficiency, giving them an edge in an environment where budget cuts are becoming ever more frequent.

ICT-Supported Integrate Care across Europe – the CommonWell Project

The pilot trial carried out by PoZoB in Veldhoven is part of the project CommonWell that develops, implements and pilots integrated services at four sites in Europe: the autonomous region of Andalusia in Spain, and the cities of Bielefeld in Germany, Milton Keynes in the UK and Veldhoven in the Netherlands. The project is co-funded by the European Commission within the CIP ICT Policy Support Programme (Grant agreement no. 225005). 10 partners are cooperating in the project, developing services to support chronic disease management and independent living of older people in general.

Andalusia and Bielefeld are the sites focusing on improving services for independent living for older people. In Andalusia, CommonWell provides users with a high quality service by integrating the information from both emergency and social care services into one common platform. The CommonWell approach in Bielefeld is being applied to a major gap in service provision for older people at German care provider Johanneswerk. It relates to a necessary improvement in the effectiveness of co-operation between social care and healthcare providers on admissions to hospital, and subsequent discharge.

Milton Keynes and Veldhoven are the pilot locations that address chronic disease management for older people suffering from Chronic Obstructive Pulmonary Disease (in Milton Keynes), and Chronic Heart Failure (in Veldhoven, see above). The CommonWell services here improve communication between health and social care providers, helping to reduce anxiety and improve health outcomes for people with chronic conditions and those who need support when leaving hospital.

The integrated services are currently being piloted at the four sites for a duration of 12 months. The results of evaluating the pilot operation will be used to extend service provision and promote the wider uptake of this model of care across Europe. The pilots are evaluated to gain a better understanding of the new services’ added value, user benefits and acceptance, quality of life impacts and economic viability. The evaluation takes into account the nature of the services to be implemented as well as the diverse national care systems, the regulatory and legal conditions, and the local circumstances under which services are to be delivered. The evaluation encompasses the different stakeholder groups involved: end users; informal carers; formal health and social care staff and the provider organisations. A multi-dimensional and multi-method approach has been adopted which can be flexibly applied across sites.

For further information

To learn more about CommonWell, please visit www.commonwell.eu

(July 2011)

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Distance Consultation: collaborating between specialist and primary care

Norrbotten County, Sweden
Luleå University of Technology

Norrbotten County is situated in the northernmost part of Sweden and covers 25 percent of the surface of Sweden – as large as the area of The Netherlands and Belgium together with a population of 250,000 inhabitants. Norrbotten is the least populated region in the European Union, with a population density of only 2.6 people per km². This means that many residents have to travel far to get access to a specialist in hospital. A need for health services with high accessibility, medical safety, quality of healthcare and productivity has therefore been created. There are 36 primary healthcare centers (PHC) and five hospitals in the county. The main hospital, where most of the specialist care is located, is situated in Luleå. This means that for many patients and their relatives there are long distances to travel to see medical specialists.

During a period of ten years referrals from general practitioners to the dermatology department at Sunderby hospital increased from 2,100 referrals per year to 3,800 per year. The waiting time for patients to doctor visit increased and in 2007 the waiting time to see a dermatologist was 18 months. There were too few appointments to meet the increased need. The care process and patient flow were not optimal, neither externally towards primary care nor internally within the dermatology department. There were many re-bookings and cancellations of appointments since the time for appointment did not fit into the patients’ schedule. It was also difficult for the patients to reach the reception via telephone. The dermatology department started an improvement work to optimize their care process and patient flow and did improve their results. Despite this, the number of referrals continued to increase and the doctors and staff felt this system needed further improvement to fully meet the needs.

Based on a needs assessment an exploratory study was conducted by Luleå University of Technology (LTU) and the Center for Distance-Spanning Healthcare (CDH) in 2008 in order to examine the conditions for collaboration between primary care and specialist care. It examined how ICT could be used as a tool for consultations on distance between Primary care and Specialist care. A workshop – based on the results – was arranged with participants from primary care, specialist care and LTU/CDH.

Clinicians, managers and researchers gathered and discussed which disease areas that would benefit the most by increased use of ICT as a tool for increased collaboration. During the Workshop the need of consultations between dermatology department and primary care was revealed, as well as highlighting the need for competence-raising measures and a transfer of knowhow from the consulting dermatologists to the General Practitioners in order to better meet the needs of the patients when they need care and on the optimal level of care. After the workshop a project team was put together with doctors, nurses from primary care and dermatology department, staff from ICT department, researchers from LTU/CDH (EIC) and a Process Development Manager from NLL. The Project team agreed to start a Pilot project testing consultations on distance in real time between five selected PHC and the Dermatology department. The pilot went into effect in January 2010.

How does this Telehealth program work?

A Fact Electronic patient record (VAS) helps synthesize healthcare administration…

This program is supported through the development of Norrbotten county council’s (Norrbottens Läns Landsting, or NLL) own electronic health record system called VAS. The development of VAS started early in 1990 and is today also used in the County of Halland and the County of Jämtland. In total VAS covers 670.000 citizens in Sweden. VAS is a complete EHR system including the healthcare administration and is used in all hospitals, PHC and dental care centers in the County of Norrbotten. The development is done in close co-operation with the users, and it provides tailor-made tools to assist in the planning, management and monitoring of virtually all healthcare activities. VAS supports the manifold needs of healthcare professionals working in primary and specialist healthcare, in PHC and with hospital based in-patient and out-patient activities. Consisting of well integrated modules, the system provides an unbroken chain of information. The core module is the patient’s EHR which can be accessed from all hospitals and healthcare centres in the county. Other functions include internal electronic referrals of e.g. lab results, electronic prescriptions and tools for the planning and follow up of all types of care. All referrals between county council units are transmitted electronically within VAS. The involved care-provider always has correct information available whenever needed. VAS is used by all the County Councils personnel.

…feeding into a hybrid approach to consultative care

The GP meets the patient during an ordinary appointment. But instead of sending a referral to the Dermatology department an appointment for a consultation on distance is arranged. The appointment is set in the electronic health record, VAS, via a secure message function. The times for consultations were scheduled every Tuesday morning, and every very individual consultation lasted on average between 10 to 15 minutes (whereas a regular outpatient visit at the dermatology department normally lasts 30 minutes). The consultation is held via a PC based videoconference solution from Polycom called CMA desktop. The webcam used is a standard model (Logitech). The camera gives a picture quality that is good enough for a Dermatologist to give recommendations for further treatment and processing. The dermatologist examines the patient and gives instructions to the GP on how to move the webcam during the examination. During the session the dermatologist gives recommendations for treatment in dialogue with the GP and the patient. Documentation is made both by the GP and the consulting dermatologist. When needed, there is also a possibility within the electronic patient record, for the both doctors to read each other’s documentation afterwards to reduce the risks of malpractice and misinterpretation.

Outcome

For patients particularly in rural areas, consultation at a distance implies that less time is spent on travelling to a specialist for consultation at the hospital. Furthermore, close relatives or family member do not have to take time off from work to accompany the person to a consultation, as a consequence cost for travelling is reduced. There are also a number of environmental benefits.

Preliminary results show that patients appreciated to have their own primary health care physician by their side at the consultation. The Patients expressed for example that the consultations on distance are good and feel safe. In addition they state that it also saves time since travelling is avoided.  Furthermore, preliminary result show that primary health care physicians expressed that they had benefit of learning from the specialist and also that they were given the same information as the patient at the same time as the patient. The GP´s expressed that it is an advantage that there is a dialogue online with the Dermatologist and the patient since all the questions can be asked and answered directly.

The Dermatologists state that there are multiple positive effects; less referrals and shorter waiting time, easier for the patients – less travelling, the possibility to discuss with the GP to give advice and also teach them at the same time. Other benefits are the collaboration between clinical practice within healthcare and research at the university and also better/increased collaboration between primary care and specialist care. During the Pilot project a total of 145 consultations on distance were performed (January 2010-June 2011). And there is an interest from several PHC to get access to the service in a near future.

That being said, one disadvantage with the set-up of the service today is that the patient needs one extra visit to their GP to take part in the consultation, since the appointment needs to be scheduled in advance. In the future there could be a possibility that the dermatologist on call is available for consultations at one time to avoid the extra visits.

E-Health Innovation Center – EIC

Luleå University of Technology (LTU) is the host of the e-Health Innovation Center (EIC). The EIC creates innovative products, services and processes available in a unique research environment that combines the health sciences, system science and electrical engineering. Scientific communities have merited through international research projects and have industrial growth and products as target. It is internationally known as a center of excellence in the areas of health and welfare, where information and communication technology (ICT) is used to give people the best possible care. The center formation will be an important resource to try out new solutions in health care and support for wide dissemination through education and cooperation with the thriving global e-health sector.

(August 2011)

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Mobile and Wireless Social and Healthcare Services with the Mallu (Mobile Clinic)

The South Karelia District of Social and Health Services, Finland

The Mallu: taking advantage of ICT solutions for preventive care in rural areas

In South Karelia a large number of aging people are living in less-populated areas from where it is often difficult to have transportation to centers where the social and health services are located. Eksote launched a Mobile Clinic in November 2010 to address to these difficulties. The first duty of the Mobile Clinic (Mallu in Finnish) was to deliver influenza vaccination campaign to less-populated areas. Beginning in 2011 the Mobile Clinic began stopping at different appointed villages in South Karelia providing nurse’s consultations and social services for the older people living in less-populated or rural areas. Through the Mobile Clinic, nurses give health guidance, conduct small operations such as removing stitches and clearing ears, give vaccinations, and take blood work for analysis. The ability of the Mobile Clinic to serve citizens in the less-populated areas will increase dramatically as the nurses’ roles are expanded to prescribe some medications, renew prescriptions as well as conduct small examinations or procedures currently only carried out by doctors.

The technology fuelling the Mobile Clinic

The personnel working in the wireless Mobile Clinic uses laptop computers and antennas attached to the vehicle that can be directed on site to the best direction ensuring sufficient connections in the entire operating region. The Mobile Clinic utilizes @450/3G-network for real-time connection to IT-department’s Citrix-server. ICT enables professionals working in the Mobile Clinic to have a secured access to Eksote’s common Electronic Patient Record, Web Lab and the Internet. The built in wireless network can also be accessed outside the vehicle when needed (for consultations in nearby buildings). The nurse writes entries into the system during the consultation in the mobile unit the same way the entries are written in any other health care unit within Eksote. Additionally, a common system for making appointments is being used. Some challenges concerning the telecommunication connections have emerged during the testing period in the rural areas.

Eksote’s Electronic Patient Health Record (EPR) solution is provided by a national company and contains the whole medical record of a patient. All information concerning primary or secondary care as well as dental health record can be found from the same place. A health care professional working anywhere in Eksote’s region, including the Mobile Clinic, can utilize information on the patient’s whole care process when needed (e.g. the reasons for using health care services, any operations made and the time of being discharged from the hospital).  A health care professional can also make use of the system for printing prescriptions and other useful forms.  In addition, the system allows for the collection of useful statistical information. Access to the EPR allows the professionals to assess the patient’s situation in a broader perspective and health issues that might not otherwise be detected may now be noticed with the help of the information available on EPR.

Mallu and the European-wide RENEWING HEALTH initiative

RENEWING HEALTH, (Regions of Europe Working together for HEALTH), is a European project, which aims at implementing large-scale real-life test beds for the validation and subsequent evaluation of innovative telemedicine services using a patient-centered approach and a common rigorous assessment methodology.

Eksote, which is the official Finnish partner in the RENEWING HEALTH project, has been undergoing trial remote patient monitoring (RPM) and combining it with health coaching. Recent studies show that RPM should be accompanied by human support, such as Health coaching, in order to be effective.

The trial is targeted at self-management of type 2 diabetes (200 participating patients + 75 controls) and heart disease (200 participating patients + 75 controls) patients in the Eksote region. The research patients involved in the project are provided with measuring device for home use to support managing their self-care, along with the support from their personal health coach. The patients are able to record the values that they have measured at home (e.g. weight, blood pressure), in the data base by using a mobile phone. They can also see their measuring results in the data base and their health coach is able to utilize the results in health coaching.

The Mobile Clinic concept can benefit from the experiences gained from the RENEWING HEALTH project. There is discussion of incorporating health couching as one of the Mobile Clinic’s services in the future. Patients living in less-populated areas could meet health coaches regularly in connection to Mobile Clinic’s visit. The health related information the patients have measured at home could then be accessed in the Mobile Clinic by the health care professionals. These solutions would provide an excellent possibility to support citizens living in rural areas to manage their self-care as a part of an integrated healthcare service.

Outcome

Follow-up with patients showed that delivery service of prescription medication and the services of a physiotherapist were the most hoped for services that could possibly be offered in connection of Mobile Clinic’s visit in the future. The role of ICT solutions in developing and providing new add-on services is substantial, as these solutions can optimize collaboration between different actors.

The new model supported by the Mobile Clinic increases the equality of citizens in terms of access to health care, as well as benefits for efficient allocation of time and resources. The nurses can make a preliminary assessment and recommend only those patients to a doctor’s appointment who really need such a consultation. This enables the doctors to concentrate better on their own tasks and therefore has a significant effect on the development of health centers and on the doctors’ interest in working in public sector health centers which have suffered from lack of available doctors.

The economics of the Mobile Clinic project

The municipalities are paying a fixed share of the social and health care costs to Eksote. As a result, the municipal borders are therefore no longer a hindrance to the routing of the Mobile Clinic. The clients can use the services of the Mobile Clinic also outside their own municipality. The Mobile Clinic has its role also in providing health care to summer residents. The RENEWING Health project is partially funded under the ICT Policy Support Program by the European Community.

(July 2011)

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Telehealth transforming care for CODP patients in rural areas

Argyll and Bute Telehealth Project, Scotland

Background

This Telehealth project began in early 2009 and was specifically aimed at helping elderly people in remote and rural Scotland – in particular the Isles of Bite and Luing – manage their long term conditions better and stay well in their homes longer. For the health services the objective was to avoid unnecessary admissions which can often involve the use of a helicopter for those living on islands. The people who were targeted for the project lived were generally older (range 61-102 years). The mean age was 73 years in Bute and 71 years in Luing.

What is the technological intervention and how does the technology work?

The main solution chosen by Argyll and Bute CHP was Telehealth Solutions’ HomePod.  This device enables remote monitoring of patients’ vital signs and answers to questionnaires, on a daily basis, via a secure link to a server accessible only by clinicians.  As a result it enables patients to feel empowered to be part of their own condition management.

Depending on condition, the HomePod can be attached to a wide range of peripherals (such as pulse oximeter, scales, sphygmomanometer, glucometer, peak flow meter). This device uses a touchscreen with large white-on-dark-blue writing that prompts users to take vital signs readings, poses questions on their condition, and sends responses to a central server. This server raises alerts to the community nursing team if any combination of vital signs and/or responses is outside pre-set parameters, and provides a full set of data including historical trend analyses for triaging and assessing care plans for patients. These touch screen devices are designed to enable patients to measure and record a range of key variables, including their own weight, body mass index (BMI), oxygen saturation, pulse and blood pressure without on-site clinical supervision.

Information gathered from the patient HomePod is sent securely either wirelessly or via broadband to the Telehealth Solutions secure server that maintained by a third party and behind the NHS firewall. Nominated community nursing teams check this website daily and are alerted to any changes in the patient’s condition, to enable appropriate patient follow up where necessary. Texts and e-mail alerts can also be sent to the clinician to make them aware as soon as possible to any pending alerts.

The innovation of the HomePod

In contrast to many other telehealth implementations, this project combined a number of care methodologies. It completely redesigned the management of COPD patients in Bute by integrating remote monitoring and access to specialist COPD expertise, as well as pulmonary rehabilitation and medicine usage reviews. Tied in with the remote monitoring, the nursing staff has also introduced regular pulmonary rehabilitation classes with a particular focus on those that are being monitored remotely.

Another important innovation is that the use of remote monitoring has enabled the health practitioners to establish a review mechanism allowing nurses to oversee all the patients’ progress and be on hand to give advice when required. This was especially practical given that many patients were living in very rural areas and not in the vicinity of the nearest specialist and respiratory nurse in Oban, which is two hours away from Bute (including a ferry ride), and even further from the Isle of Luing. Nurses were able to provide for full medicine usage review which continues to deliver significant benefits as giving advice on medication has a direct effect on patient conditions.

Outcome of the Argyll and Bute Telehealth program

The Bute community nursing team has become far more skilled in COPD management, including the use of COPD modules at the local university and the introduction of nurse prescribing.  As a result, there is now scope for the specialist nurse to begin a new project elsewhere, and to make the changes self-sustaining.

Capturing patient’s experience was also a very important exercise for the nursing staff. What telehealth had done for them and how they are affected by their condition were all comments that were collected by the patients. To capture this Argyll and Bute, together with an external evaluation, ran a digital voices workshop and have now published a selection of digital stories about telehealth that only the storyteller can tell.

Overall the feedback has been very positive, and only a very few amount of patients had difficulty in engaging with the technology. In these cases, this was resolved with further instruction and support. In all, the majority of patients felt consciously aware of a (positive) change in their condition, as well as an enhanced feeling of security about being monitored in this manner. In addition, statistical evidence has shown that admissions to hospital fell by 91%, Attendances at a General Practitioner fell by 41%, and Inpatient bed days fell by a total of 89%.

(August 2011)

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Living a more harmonious life with dementia: an EU-focused Telehealth in action

Frederikshavn Municipality, Denmark
Aalborg University, Denmark
Trikala, Greece 

ISISEMD: an EU-funded Telehealth pilot program

ISISEMD, which stands for “Intelligent System for Independent living and Self-care of seniors with cognitive problems or Mild Dementia,” is an international pilot project, co-funded by the European Commission within the Competitiveness and Innovation Framework Programme–Policy Support Program (CIP-PSP). The purpose of the project is to create affordable, user-friendly and demand-driven intelligent services to help the elderly with self-care and to reduce the care stress from the informal caregivers and to help the formal caregivers in their jobs. In the project, there are regional partners from Denmark, Finland, Ireland and Greece who have been testing the services in real-life conditions for a period of one year. Hence, in each country, the ISISEMD services are being evaluated continuously in order to accommodate the needs for an increased quality of life among users.

How the ISISEMD Telehealth program integrates technology and care

ISISEMD is supported by a combination of a touch-screen computer (called a Carebox), home safety sensors and reminders for the elderly in the form of alarms and notifications which support caregivers in their daily interaction with the elderly with mild dementia. The ISISEMD Carebox is a computer with a touch screen interface that gathers and displays information that is important to the older adult during their daily activities. The Carebox displays reminders to take medications, when a nurse will visit, and incorporates activities for mental stimulation including pictures from the person’s life, called a memory lane service –consisting of a slide show with personal pictures. The Carebox enables the elderly to send a request for help or a contact a family member or caregiver by text message or email when help is needed. This service creates an enhanced communication with and to relatives and neighbors (referred to as “informal caregivers”) and care providers (“formal caregivers”) and creates a safer everyday life for both users. From the care providers’ perspectives, the ISISEMD Carebox system is beneficial for the elderly for fostering independence, helping them to create structure of the day and feeling safer. Relatives also experience the impact of the system as it saves money and time in their daily interactions.

In addition, a simple GPS device (called a Lommy) ensures person’s safety outside the home. Lommy services allow for the caregivers to pin-point the location of the person with dementia through a computer program. Some caregivers check the location before driving to the home for a visit, to see if the elderly is home while others may simply have it as a back-up safety precaution in case of a distressing situation.

Effective collaboration between caregivers and patients with ISISEMD’s services

The integrated care of ISISEMD’S services is recognized in the primary care towards relatives. In this way, there is a transfer of care tasks from social care providers to informal care providers, such as family. In this connection, the family caregivers are provided with technological tools to integrate in their strategies for addressing the disease. This also increases the dignity of the elderly people, as personal problems are discussed only in the family and are not disclosed to an external person. As one person has explained, “Now I feel safer because I know that I can get in touch with my relatives quickly when it is needed.”

ISISEMD’s telecare services contribute to the safety, security and to the independency of the elderly with mild dementia. Results from an intermediate evaluation of the functionality and impact of ISISEMD’s services show that elderly people with mild dementia and their informal care providers are satisfied with the system implemented into their homes, acknowledging the positive impact. Informal care providers have noticed a difference from before they had the ISISEMD system. ISISEMD’s services provide for reassurance and peace of mind, as well as a reduction of care stress and increased quality of life of the family caregivers as they are given more freedom for their personal life and interests.

Among the elderly people, the Lommy device and home safety services such as fire alarm, cooking monitor and the memory lane service are those most appreciated. The Lommy device has had very practical benefits for family members as well, as one family caregiver describes: “I can observe my mother through the portal when she goes for a walk outdoors as she carries the Lommy device. Now I am not anxious at all because if she gets confused and cannot find her way home, she can press the help button on the Lommy  and then we can  follow her position as visualized on the map and help.”

Depending on the country, some services are more attractive than others, and thus program features are tailored. For instance, due to the colder climate in Finland, intelligent front door sensors are more frequently installed than in Greece. Furthermore, elderly and relatives find the reminders system helpful with reminder prompts, when they are in that particular room at the time. Orientation for current day, date and time is highly appreciated by both elderly and family caregivers. The cooking monitor service not only prevents fire in case of forgotten cooking of food but also detects reduced cooking activity, which can imply degradation in the cognitive state. Another caregiver has noted that: “Throughout a longer period using the ISISEMD services, I had observed that an elderly woman living alone had lost weight over some time. The elderly woman´s son explained he had noticed this as well. We saw that the elderly´s cooking sensor had not been on for some time and so she was cooking more seldom. I had her son create reminders on the Carebox for her to remember to cook her food.”

Statistics on ISISEMD user satisfaction show that all users are willing to keep using the services in the future. Satisfaction evaluations illustrate a positive support from users, ranging from 75% to 100% for the relatives´ willingness to continue using the services. For the general satisfaction of the services and their functionality and usefulness, the statistics show a satisfaction rate of up to 90% among relatives. In conclusion, among the elderly people with mild dementia, there is a satisfaction rate of up to 92% with the services. With the ISISEMD system, benefits include more independency so that the elderly can sustain their daily activities and live a longer and safer life in their own homes. This ultimately leads to an increased quality of life for the elderly and their relatives.

The economics of the ISISEMD program

The program has been co-funded by the European Commission.

For further information about this EU initiative

www.isisemd.eu
http://ec.europa.eu/cip/

 

(July 2011)

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The role of Telehealth in synthesizing Palliative Oncologic care

Careyn Home Care, The Netherlands

The development of a Palliative Oncologic care path

Palliative care approaches improving the quality of life of patients and their families facing the problem associated with life-threatening illness through preventing and relieving suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. This Telehealth initiative has attempted to include this broad interpretation within the “care path,” with the nursing approach of the patient forming a holistic viewpoint. Fluctuation of patients’ symptoms and therefore their needs asks for a quick and adequate response of oncology nurses. Our current care consists of home visits and telephone consultations, based on a global estimation of upcoming suffering of symptoms. In between contacts quite often the patient’s situation deteriorates, sometimes leading to admittance into a hospital. Questions have arisen on ways to avoid this scenario. We have developed a way to communicate via “screen-to-screen” through the use the Personal assistant for Life (PAL4). This was developed by Careyn Utrecht together with other healthcare organisations and Cura Healthcare Innovation (www.focuscura.nl). This pilot program includes 15 patients.

What is the Telehealth intervention and how does the technology work?

Personal assistant for Life (PAL4) is a concept which is meant to facilitate living at home as long as possible, preventing admission to a nursing home. In place since 2006, and implemented in more than 25 Dutch healthcare organization, it is based on the idea of focusing on creating an environment where people have social contacts once again. In this community informal and formal care is available. People can have a chat with anyone using PAL4. They can find the necessary information on activities in their own community as well as on their health. It also contains news, a lot of games and you can browse on the internet.

One of the main issues in the care path is the digital Utrecht Symptoms Diary (USD), which we integrated completely in the PAL4 system. The diary has been developed based on research and the existing ESAS (Edmonton symptoms assessment schedule) questionnaire. It informs the nurse about the medical state and mental state of the patient. Patient and nurse agree upon the frequency to fill out the digital questionnaire.

The symptoms diary and screen-to-screen consultation are two major components of our palliative care path.  Specifically designed for elderly people, the device consists of a computer with a touch screen. In the near future, we will be moving to include the use of tablets. The symptoms diary and screen-to-screen consultation are joined by a digital information set that is available to all patients with a focus on well-being and general self-management items. Subjects like nutrition, relaxation, energy and emotions are dealt with in a down to earth, friendly style in an environment of warm colours and friendly pictures. PAL4 also has special COPD and Diabetes care programs.

Family care-givers can find information to suit the specific needs of the patient through functions like the “family-caregiver” touchscreen button and a “chapters systems.” This information set has been written in collaboration with renowned organisations working regionally and countrywide for the benefit of cancer patients in the Netherlands.

Outcome of Telehealth intervention

The oncology nurses give screen-to-screen consultation twice a day when necessary, in addition to also being available by phone. Ben, one of the oncology nurses involved notes, “We are learning each day to make the best use of this new approach to nursing. Frequent use of a symptoms diary in conjunction with screen-to-screen intervention brings new possibilities for professional caregivers but also poses new questions to us. It is important to facilitate the patient to contact us. It is impossible and not even desirable, to catch every symptom or question with the USD. These people are in the most vulnerable stage of their life. To listen to the patient and support him dealing with his problems and concerns is what we do. Technology can be a great help in that, no more than that.”

07vanDijkImplementing the PAL4 approach has involved finding a healthy balance between in-person and screen-to-screen interaction with patients, on the part of healthcare providers. As Ben describes, “Do we dare to be outspoken towards patients and families in bringing screen-to-screen appliances to their homes? We had to let go of our natural hesitance to intrude in daily life of our palliative patients. This is a still on-going process. Also, we are beginning to appreciate more how to use screen-to-screen generated patient information combined with the experience of home visits. On the one hand some topics can be addressed better in the intimate setting of a home visit. On the other hand we also find that in the process of getting to know our patients, the screen-to-screen contacts are more easily used for discussing sensitive topics.”

One of the people involved in the pilot, Mr. van Dijk (61) has had diabetes for 29 years now, and 11 years ago was diagnosed with lung cancer, in additional to recently having a heart attack. He stays at home a lot, but still wishes to be part of the community. So far he has found the PAL4 system quite appealing.

The service brings advantages to both patients and professionals. As Ben concludes, “The results help me to make a picture of the situation of the patient. If he [Mr. van Dijk] feels worse I will contact him more often or I will arrange appropriate help for him. For patients it’s a tool which helps them recognise the symptom or its pattern earlier. The signal comes sooner now, so I can advise more adequately. It also gives the patient information about his own situation, which can be taken to the general practitioner.”

The economics of the Telehealth device

There is no scientific outcome yet as to items like cost savings, improved quality of life or reduction of hospitalizations. It would require a much larger group of participants to do comparative scientific research. For Careyn as an organization, aside from the quality of care, cost saving is an important notion in implementing e-health care. At this point in time, specific patient groups are defined, each of which can get access to a specific “care-menu” that consists of a mix of house calls and screen tot screen contacts. In the future, this will result in a well-fitting, cost effective package for each group.

For further information

Ben Berkvens, Oncology Nurse
b.berkvens@aveant.nl

Bea van Stappershoef
b.vanstappershoef@aveant.nl
+31 3 02 588 212

 

(July 2011)

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Improving treatment response time with Stroke Angel

Neurologische Klinik Bad Neustadt/Saale, Bayerisches Rotes Kreuz Bad Neustadt/Saale, FZI Research Centre for Information Technology Karlsruhe, and medDV with the support of Stiftung Deutsche Schlaganfall-Hilfe

The Stroke Angel system: addressing the treatment process chain

First introduced in 2006, the Stroke Angel’s purpose is to shorten the time required for the entire process chain from finding and diagnosing the stroke victim to the patient’s admission and treatment in a hospital. Typically, the main problem in stroke care is insufficient communication between EMS and hospitals. Critical time is lost when the patient is not transported to an appropriate hospital immediately (for example, one that continuously operates a computer tomo­graphy [CT] scanner) or when hos­pitals are not prepared for the patient’s arrival. Therefore, the chief purpose was to meet the short timeframe in which stroke patients can be treated by thrombolytic therapy. The first three hours after a stroke are crucial for a successful therapy and the patient’s sub­sequent quality of life.

The technological intervention

technology

The Stroke Angel system consists of a Handheld-PC connected to a patient card reader that records the patient’s personal and insur­ance data and communicates with a mobile phone via Bluetooth. The Paramed­ics use Stroke Angel along with conventional medical devices, such as electrocar­diographs. Stroke Angel device supports stroke diagnosis with the help of a structured checklist: the para­medic checks and en­ters various indicators of neurological prob­lems, such as delayed speech or movement, guided by the system. Based on this data, the system calculates the likelihood of a stroke. If a stroke is suspected, the system initiates an alert and recommends the patient’s immediate admission to a specialized hospital and sends all relevant data to the hospital via wireless network technologies (Gen­eral Packet Radio Service/Universal Mobile Telecommunications System) including the emergency protocol. Secure Sockets Layer (SSL) encryption secures data transmission through both cli­ent and server authentication. According to one paramedic, “More and more patients survive the stroke and suffer less from disablements.” (Uwe Kippnich)

When the new patient data is received at the hospital, the Stroke Angel server trig­gers an alert, which initiates all necessary pre­parations for stroke treat­ment while the patient is still en route. The system automatically files a new electronic patient record in the hospital information system on the basis of the incoming Stroke Angel patient data and after confirmation by reception.

Gerhard Helbig’s story

Helbig

“At around 3am, I woke up feeling a desire to void my bladder. When I sat up, I immediately noticed several impairments: I was suffering from rotatory vertigo and speech disturbance. In addition, my right hand did not function properly and I could not stand on my right leg. My wife recognized the symptoms immediately, as a similar case had occurred in the family previously. An emergency call was made straight away.

The EMS, including an emergency physician, was on the spot within ten to twelve minutes. The emergency physician performed the primary medical treatment and administered care in the ambulance. The ride to the, a distance of about 34 km, was very quick, as the ambulance was driving with flashing blue light and siren. At the time of my arrival at Neurological Hospital in Bad Neustadt, the hospital staff was ready at the emergency room and they administered a CT immediately.

The entire procedure from the EMS to the hospital ran smoothly. Within a few minutes, I was getting a continuous intravenous drip infusion, which probably saved me from the severe consequences a stroke can have. I am very happy that everything worked out well for me, and I am convinced that the fast communication between the EMS and the hospital improved my chances a lot. And while I did not notice anything of the actual process and the application of the Stroke Angel technique in this situation, it was wonderful to know that behind the curtain everything was running smoothly thanks to telemedicine.”

Outcome of Telehealth intervention: increasing processes and facilitating diagnosis

The time needed to com­plete the first diagnosis at the scene or in the ambulance slightly increased because the para­medics seemed to need more time to enter the data. However, time is saved through the development of a number of new solutions. The Stroke Angel has made inroads by ensuring patients are transported directly to specialized hospitals without detours to other hospitals. And it has also improved the hospitals’ decision-making procedures, pa­tient registration, and preparation of the neurological unit – in particular, by starting the CT scanner before the pa­tient arrived. As a result of this, “time-to-imaging” (from entering the hospital to brain imaging) has decreased by 30%. The medical staff in­volved considers these medical benefits as the most positive. “The earlier the diagnosis is made and therapy is started, the less is the middle and long-term disablement that remains. This is positive not only for the patient and his or her relatives but also for society as younger people can go back to work earlier and the elderly are less in need for care and help.” (Marion Gottwalt, leader social services) This positive feedback by the medical staff was a main factor helping with the introduction of Stroke Angel to routine use. In 2011, the reengineered system was in use in 40 ambulances and one emergency rescue helicopter in eight regions of Germany. Further regions are planning to introduce the systems in the future as well.

Although the preclinical time has changed significantly, the intersectional information transfer induces a clinical time reduction of around 50%. Until September 2010, the preclinical time as well as the time from admission in the hospital to the interpretation of the CT images (so called door-to-Imaging) kept constant. However, the clinical time from the entrance at hospital to the performance of lysis therapy could be reduced to less than the 30 minutes previously needed. This is quite significant, comparing to a mean of more than 60 minutes prior to the introduction in 2005. In the preclinical rescue phase, the maintenance of the time needed is due to the fact that the EMS first needs more time to insert all important data (something that before was done after the patient’s handover at hospital). Due to early information transfer during transportation, the personnel in the hospital are already prepared at the time of arrival. Therefore, a CT scan can be performed immediately on the patient who is suspected of having had stroke, consequently allowing lysis therapy to be performed earlier. “Stroke Angel supports the communication between the different divisions. With the help of scientific support and transparence, the acceptance of the processes could be increased.” (Prof. Dr. Bernd Griewing)

There have been pros and cons to this novel treatment system. The people using the system expected a reduction of the time needed for medical care of stroke patients altogether and considered the Stroke Angel checklist a helpful support when making a diagnosis on the ambulance. Respondents to a questionnaire appreciated that recording via Handheld-PCs helped facilitate their work. Another positive observation was implementing a standardized procedure resulting in a complete documentation of the operation. However, the additional expenditure of time for the input of data into the Handheld-PCs was noticed as negative. This was traced back to the fact that inputting data was very difficult while the ambulance moved due to the small screen and the imprecise manipulation with the electronic pen as an interface device. With the introduction of bigger displays on the Handheld-PCs, this problem was addressed and ultimately solved.

The economics of the Telehealth device

There are several positive economic effects for society as well as for hospitals and patients that are due to telemedicine. For society, each patient with an ischemic stroke that is treated with a lysis therapy leads to a remarkable reduction of costs for rehabilitation and follow-up care. A Canadian study shows that an increase of the lysis rate by 10% reduces costs by 3.8 Mio CAN$ (YIP et al. 2008). Patients who are treated with lysis therapy can return to daily routine faster and their ability to work as well as their quality of life is maintained for longer.

Furthermore, for a hospital, there are several economic benefits. Due to advance announcement, the allocation of resources can be scheduled better and the whole process can be planned in line with the demands before the patient’s arrival. As a result, idle actions such as a long waiting time for the EMS can be avoided. Additionally, the patient’s data is electronically available in advance, allowing an early initiation of all administrative processes. Before the implementation of the Stroke Angel technique, all data of the patient (e.g. name, insurance data) had to be entered into the system by hand at a later stage. Usually, this saves about ten to 20 minutes for the post-processing of a rescue mission. However, the main economic component can be found in the patient management. Thanks to a close coordination with the EMS, it can be ensured that a stroke patient is transported to a stroke unit in any case and is not brought to an inappropriate hospital. Based on this analysis of data, the best possible capacity utilization of the stroke unit can be planned and implemented. An emergency case turns from an unpredictable disturbing factor into a process that can be smoothly integrated into daily clinical routine. “The project leads to a continuous observation of all processes in the medical care of stroke patients. As a consequence, the procedures in all participating divisions could be synchronized much better.” (Dr. Volker Ziegler)

For the EMS, the documentation is facilitated: when using telemedicine, they can assure that their services are documented correctly and are financed adequately. Moreover, the EMS personnel can leave the hospital faster and are available for further rescue missions earlier. For the professionalization of the EMS, it is important to apprehend it not as a transport organization but as a decisive link in the rescue chain and to highlight the relevance of the pre-clinical collaboration of the EMS and the hospital.

For further information

Rashid
Dr. Asarnusch Rashid
FZI Forschungszentrum Informatik
Haid-und-Neu-Str. 10-14, 76137 Karlsruhe
rashid@fzi.de, +49 721 9654 562
www.strokeangel.de

 

 

(June 2011)

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st_eriks_puff21

Phone Availability in Sweden

St. Eriks Eye Hospital, Stockholm

Callback enabled tele-counselling, improved working environment and phone availability

St. Eriks eye hospital is one of the largest eye specialist centers in the world. Gunilla Wallin is responsible for telecommunications at the hospital. When she started working at St Erik’s, the hospital suffered from a lack of an organized way to handle the many inbound calls. Both the nurses and office assistants were stretched thinly for time to document the patients’ data in the medical record systems. The patients had trouble getting in touch with the staff, and had to call several times to get through.

In 2006, Gunilla Wallin decided to introduce “time scheduled callback” at the hospital. The departments subsequently organized their schedule for handling calls according to their work schedules, and now they can provide both tele-counselling and tele-rehabilitation through the call back system. The nurses can review the patient’s file before they call and be better prepared, which makes their calls more effective and professional. The schedule leaves time for the nurses to document the conversation in the patient record system before the next call. Since introducing the system call time are able to be determined by the needs of the patients and are continually optimized to improve accessibility. Today, St. Erik’s Eye Hospital has reached an accessibility rate (by telephone) of 99%. This is in sharp contrast to accessibility rate of 84% when the service first began.

The technology behind the Callback System

St. Erik’s Hospital’s callback system uses Aurora’s TeleQ and CallControl technology, allowing the organization to handle more calls with the same or less number of operators. All of Aurora Innovation’s services are cloud based and can be used with or without a switch board.

Quick Facts:

  • Number of County councils using the call back system: 16 (out of a total of 21 councils in Sweden)
  • Phone availability among regions using the call back system: 94%
  • Overall phone availability in Sweden: 90%
  • 69% of the Swedish population reaches health care through a call back system

Outcomes of the Callback System in a hospital setting

There have been immediate benefits for the overall efficiency and cohesiveness of the working environment at the hospital for the staff and their interaction with the patients. Increasing the availability to get in contact with health care contributes to a more cost efficient health care, more efficient use of public resources and in the end, a healthier population.

Better cohesion in the work place

Head Nurse Monika Lundell sees big advantages with time scheduled call back. “The system has reduced the stress level in our workplace and I think everyone feels better. Before the phone rang all the time but now we have a quiet working environment. Scheduling is also an important function. Today, we can take our breaks together, an important contributor to cohesion in the workplace. Many of today’s issues are discussed in the lunch room. And having the opportunity to see each other and socialize with colleagues is important.

More satisfied patients

Hedda Karlen, who works as an office assistant, says she feels that her work flow is much improved now that the hospital uses callback. Instead of the patient waiting in a phone queue, Hedda now calls the patients herself which puts her in control of the conversation. “Patients are really happy with the time scheduled callback. They don’t have to wait on the phone any more, which puts them in a better frame of mind. And since I have the time for a proper documentation, I am more certain that the important patient data is correct.” says Hedda.

For further information

Stina Lantz, Aurora Innovation AB
+46 18 19 44 72
stina.lantz@ain.se 

About St. Erik Eye Hospital

St. Erik Eye Hospital was created in 1990 through the merger of three regional ophthalmology centers, thereby consolidating expertise and resources in order to provide patients with unsurpassed quality and ensure that the hospital offers every possible advantage in medical care. Today, St. Erik is one of the largest eye specialist centers in the world. St. Erik Eye Hospital Ltd is wholly-owned by the Stockholm County Council.

For more information go to www.ain.se/teleq/sa-tycker-vara-kunder/st-eriks/

Watch the movie from St. Erik’s eye hospital at http://www.ain.se/nl/klanten/dit-vinden-onze-klanten/st-eriks-oogziekenhuis/ 

(March 2011)

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Guldborgsund

Using digital images in wound care

MedCom and the Municipality of Guldborgsund, Denmark

Frank and Liz’s stories

Frank is 85 years old and lives at a care home, suffers from several co-morbidities and is very difficult to mobilize. While Frank’s social network is very limited, he is very fond of the home care and feels safe with the healthcare staff. When a member of the hospital’s staff found that Frank developed a pressure sore, Frank opted to remain being treated from the security and comfort of his home, since he found being hospitalized to be very stressful.

Liz is 50 years old, and was recently screened for breast cancer, which showed the presence of a tumor. And while she underwent a surgical procedure, she must continue with radio and chemotherapy treatments. While recovering at her home, a visiting nurse discovered a wound that had developed in the cicatrix from Liz’s operation. While a specialist has been recommended to consult Liz’s condition, the road to the nearest out-patient clinic is very long, and severe winter weather makes it difficult to even get there.

Expediting collaboration, assessment though a “web-based wound record”

One of the local visiting nurses with wound care expertise visits Frank at the care home and uses her smart phone to take images of the pressure sore. The images are then sent to a doctor at the hospital via a web-based wound record. The record is also used for planning Frank’s course of treatment, including the use of antibiotic, bandage, and pain management. The visiting nurse then carries out the treatment. This transfer of images and planning of treatment take place at least once a week until the pressure sore has healed.

As a result of the distance and weather conditions, Liz’s specialist began taking images of the wound with her phone and sent them to the web-based wound record. At the home care center, the image was assessed by one of the visiting nurse’s colleagues with wound expertise. After collaboration with Liz’ General Practitioner, who also has access to the wound record, the nurse with wound expertise then planned the treatment plan for Liz’ wound.

During subsequent visits to Liz, the specialist uploaded images of the healing wound along with a note to the wound record. The image and the note were examined by the doctor at the outpatient clinic, who in return uploads recommendations for the future treatment. Liz was offered access to the wound record herself, and if she was at any time worried about her cicatrix, she could use her own smart phone to take an image and upload it to the record, where she could also write notes. Due to the help of this focused treatment and the cross-sectorial communication, the wound in question has healed, and Liz can continue with her therapy.

Outcome of the Telehealth intervention

Both patients have enjoyed how the non-intrusive technology has improved the care they have received, and by seeing the images of his pressure sore, they and their relatives were able to get a better understanding of the pain both patients have felt, and the restrictions they experienced during their treatment.

For further information

Jane Clemensen and Aske Denning, MedCom
Else Sværke Henriksen, Municipality of Guldborgsund

(March 2011)

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OUH

Reducing Stress through the Patient Briefcase initiative

Odense University Hospital, Denmark

Tackling Chronic Obstructive Pulmonary Disease (COPD)

The Patient Briefcase initiative is on-going project involving Svendborg Hospital and Odense University Hospital, Denmark and patients suffering from Chronic Obstructive Pulmonary Disease (COPD). More than 2500 consultations with patients have already been carried out by a team of eight nurses via the Patient Briefcase, and new patients continue to become engaged in the program. The Patient Briefcase was developed through a cooperative effort between Odense University Hospital and MediSat® – the technological provider.

What is the Telehealth intervention? How does the technology work?

The Patient Briefcase is about the size of a large laptop. It is easy to operate and allows care assistants to collect valuable data about the patient’s lung function and the amount of oxygen in the blood. This in turn helps nurses to provide patients with the information they need to master their chronic condition. Patients are able to participate in live video consultations without leaving the comfort of their living room, while care assistants are then able to collect valuable data about the patient’s lung function and the amount of oxygen in the blood. This helps nurses to provide patients with the information they need to control their chronic condition.

The device is installed in the patient’s home by a technician who also assists the patient through the first consultation. The nurses are all specially trained to consult patients on screen beforehand. This technological initiative allows patients to participate in live video consultations without leaving the comfort of their home environment. “I am often greeted by patients welcoming me into their living room,” says Bente, one of the nurses involved. The Patient Briefcase remains in their home for approximately 7 days, with online consultations lasting between 10 to 30 minutes. In general the practitioners have found that the “fear” of technology usually disappears quickly, and the Briefcase provides for a flexible interface which is easy to operate. “I normally ask them [the patients] whether they have problems turning on their TV or picking up the phone, and I tell them that it’s all the technical knowledge they need to operate the Patient Briefcase,” adds Bente.

Outcome of telehealth intervention

This initiative has yielded immediate benefits to both the patient and the healthcare provider. Patients recently diagnosed with COPD can be confused and insecure when discharged from hospital. There is also the issue of transportation, which can be a hindrance to COPD patients with a limited air supply. Daily consultations with a nurse in the comfort of their own homes can be of great value to these patients. “The Patient Briefcase makes it easier for COPD patients to return home and continually incorporate new knowledge about their condition into their everyday lives,” says one nurse. The new consultation practice has proved less stressful for both patients and nurses. “Hospitalisation is a stressful experience and patients often forget important information such as how to take their medicine correctly,” noted another nurse currently conducting online consultations with COPD patients.

The goal of the Patient Briefcase is to bring down the number of hospitalisations for patients diagnosed with COPD. Online consultations has helped to address this goal. Previously, nurses were able to visit 3-4 patients on an ordinary work day. Today, Bente and her colleagues consult three to four times as many without ever leaving the hospital. As a result the nurses can focus entirely on their interaction with the patients and do not need to adapt to changing environments while visiting patients.

For further information

Anne Dichmann Sorknæs, PhD, Nurse
Odense University Hospital and University of Southern Denmark
Anne.dichmann.sorknæs@rsyd.dk

(March 2011)

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Telehealth testimonials

This section features anecdotes, descriptions and testimonials from across Europe and beyond where telehealth interventions have made a positive difference in the lives of real people. The descriptions come principally from material collected by the Campaign for Telehealth in support of Integrated Care, an initiative of Brussels-based organisations started in 2011.  To learn more about this campaign, go to the bottom of this page.

Reducing Stress through the Patient Briefcase initiative

Using digital images in wound care

Phone availability in Sweden

Improving treatment response time with Stroke Angel

The role of Telehealth in synthesizing Palliative Oncologic care

Living a more harmonious life with dementia: an EU-focused Telehealth in action

Telehealth transforming care for CODP patients in rural areas

Mobile and Wireless Social and Healthcare Services with the Mallu (Mobile Clinic)

Distance Consultation: collaborating between specialist and primary care

All the help in one place: Commonwell Veldhoven

Innovating through decentralized Teledialysis care

The Gesundheitsdialog: Advanced Therapy Management for  Diabetes Patients based on mHealth

Telehealth tackling hypertension

Regaining Control while living with Emphysema

The National Patient Summary, Sweden

All the help in one place: Commonwell Milton Keynes

Newham Whole System Demonstrator: four testimonials (UK)

About the Campaign for Telehealth in support of Integrated Care

The Campaign for Telehealth in support of Integrated Care was an informal collaboration of Brussels-based organisations in support of awareness about the benefits of telehealth.  The grouping included:

– AIM, the International Association of Mutual Benefit Societies (www.aim-mutual.org)
– EHMA, the European Health Management Association (www.ehma.org)
– EPF, the European Patients’ Forum (www.eu-patient.eu)
– COCIR, the voice of the European Radiological, Electromedical and Healthcare IT Industry (www.cocir.org)
– CONTINUA, the Continua Health Alliance (www.continuaalliance.org)
– EHTEL, the eHealth Focal Point for Europe (www.ehtel.eu)
– HOPE, the European Hospital and Healthcare Federation (www.hope.be)

A special thank you goes to Intel for editorial support of the telehealth testimonials.

TELEHEALTH SUCCESS STORY 7:

Telehealth in support of integrated care

For most people most of the time the home environment is the embodiment of independent living, where technology is serving to enhance and support optimal quality of life. Home based Assistive Technologies are often used to enable users of health and care services to remain at home, for as long as it is safe and desired, and continue to be an active and productive part of their local communities.

Remote healthcare provision (Telehealth) is found to be both efficient and effective, in terms of costs and clinical outcomes, and a powerful interface to support person centred integrated care. In most Telehealth services the technology is supporting the management and delivery of preventative and curative services, as well as the maintenance of wellness amongst patients with long term healthcare needs.

Empirical evidence also supports the assertion that Telehealth is a valuable patient driven tool, empowering users to report their symptoms on a regular basis.  In this way the clinical team gets access to appropriate and timely data in an attempt to detect and promptly prevent rapid deterioration in patients’ condition. Managing treatment and related symptoms in this way is especially critical in cancer care, where many more patients now are being cared for at home.

However, can such ‘living technologies’ also support patients at their ‘end of life’? Can remote provision of service be used in terminal care to support the very emotional experience of grief and the sense of personal loss? Can this be done when the patient is a child and the entire family is involved in their care?

At The Scottish Centre for Telehealth and Telecare, we believe the answer to all these questions is YES and john’s story, below, is but one example of the care at home service that is being rolled across Scotland.

John’s story

John and his family were known to the oncology team for a number of years, since before diagnosis at the age of 4. His lively character and the hardship experienced by the family made a big impact on the entire clinical team. The periods where he was admitted for prolonged treatments were characterised by all as ‘memorable’ and the challenges in coordinating care across various care environment were significant. Yet, despite much loving, support and excellent care John’s prognosis was poor and after 2.5 years of battling with cancer the focus of treatment was turned from curative to palliative care. The main effort was on enhancing John’s quality of his life during the precious few months he had left with his family.

The parents knew that they wanted to spend as much time together at home where John could be with the people who love him most. The clinical team were adamant that everything must be done to enable this family to exercise real choice in the place of death for their child. Indeed, despite the argument that care at home for children at the end of their life can be less expensive and less emotionally stressful for family members, the great majority of children in the UK still die in hospitals.

It was the clinical team who first thought of Telehealth, as a mechanism to link the home environment to the specialist services offered by the hospital based team. Video Conferencing technology is already used extensively across all inpatient units in Scotland where children and young people are being cared for. Most of the remote interactions are concerning clinician to clinician – case reviews – information exchange. However, many more clinical interactions are taking place where Telehealth is used to link patients in remote and rural locations to specialists in large urban centres of excellence.

Gaining the consent of the parents to using Telehealth at home and with total support from John, the laptop unit was installed in the home, tested and training was given to all users. We specifically chose to use laptops at homes as it is a common technology that enabled us to place specific content (guidelines and protocols) on the desktop for easy reach. Getting used to remote interaction via a small computer screen was the next hurdle to be conquered. Unsurprisingly, John adjusted very quickly to talking to his nurse on the screen. For the clinical team this was a very effective tool in the clinical management and the delivery of remote services when and where they were needed.

John died at home in the arms of his mother a few hours after the team visited him for the last time. The house call was prompted following a scheduled Telehealth session where it was clear that the end of life phase was nearly over. It was this call that made such a big difference and enabled John to experience a good quality of death – something that would have been more difficult without being able to establish the Telehealth link.  Returning the unit shortly after John’s death, the mother wanted to stress that is was the machine and the effective link that made her feel safe at home. She only wished she could have had the use of Telehealth earlier on

Baby R

The policy drive to shift the balance of care from acute hospital settings to provision of care closer to or in the home environment is being supported by Telehealth. The story of Baby R is another example where Telehealth is making a significant contribution to the lives of families across Scotland

Baby R was born with a medical condition that left her with severe disability, requiring extensive and intensive care and support. After an emergency operation, shortly after birth and weeks of inpatient care it was decided that she was ready to go home, for a short period before further surgery was performed. Living in one of the most remote and rural parts of Scotland  it was suggested that along with the drugs, oxygen and special mattress Baby R would also be given a care at home unit, to link the family to the specialist surgeon.

Regular sessions were conducted between the family home and the treating clinician in the acute hospital. These were focused on parental support and education as well as surveillance of overall growth and development. The surgical wound site and the healing process was also monitored remotely. On some occasions primary care team members were also involved in the remote interaction and a joint action plan was agreed by all. The continuity of care, the personal attention and support were critical to ensuring that optimal care was delivered to this baby within her remote location.

BabyCam

However, for some patients and in some conditions the specialist input can only be delivered in hospital. Neonatal care is one example where interventions can only be provided in a specialist location and the story below is set to capture the impact Telehealth has amongst those service users.

Telehealth is already having a significant impact of the lives of families, neonates, children and young people across Scotland. Capitalising on our success in rolling out national ‘technology enhanced’ care solutions will enable us to go even further and offer the type of a National Health Service our users demand and deserve.

Sharon Levy
Marcia Rankin
Lorraine Clydesdale
TelePaediatric team
Scottish Centre for Telehealth and Telecare

(May 2011)

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