Telemedicine/ Telehealth Connected Health Leadership Summit - 2009 Engagement Dr. Sascha Henke, Bosch HCTM

Connected Health Leadership Summit - 2009 1. Situation / 2. Motivation Communication of EU Commission on Benefits of Telemedicine for EU citizens (11/2008) Statement Ilias Iakovidis, January 13th, 2009: “ In 2009 our priorities are interoperability and telemedicine”, “ Personal health systems have become a priority area“, “ Current economic crisis could offer a huge opportunity to invest in e-health to stimulate jobs and economic growth“. („Health is wealth“) E-Health Europe

Communication of EU Commission on Benefits of Telemedicine for EU citizens (11/2008)

Statement Ilias Iakovidis, January 13th, 2009:

“ In 2009 our priorities are interoperability and telemedicine”,

“ Personal health systems have become a priority area“,

“ Current economic crisis could offer a huge opportunity to invest in e-health to stimulate jobs and economic growth“.

(„Health is wealth“)

E-Health Europe

Connected Health Leadership Summit - 2009 2. Motivation What can we expect from Telemedicine (benefits) ? Interactive flexible RPM solutions support individuals with chronic conditions, by telehealth and clinical-intelligence for physicians and nurses to make directed interventions. Fill a gap in the continuum of care Early detection of exacerbations / impairment of health Efficient, exception-based, individualized interventions Patient empowerment, education, behaviour change, motivation -> Reduced Hospitalizations + Improved Quality of Life

What can we expect from Telemedicine (benefits) ?

Interactive flexible RPM solutions support individuals with chronic conditions, by telehealth and clinical-intelligence for physicians and nurses to make directed interventions.

Fill a gap in the continuum of care

Early detection of exacerbations / impairment of health

Efficient, exception-based, individualized interventions

Patient empowerment, education, behaviour change, motivation

->

Reduced Hospitalizations + Improved Quality of Life

Connected Health Leadership Summit - 2009 2. Motivation What can we expect from Telemedicine Industry ? Technology ` Invented for life `, which means … reliable technology, designed to last … technology that accompanies people for a good part of their lives … intelligent, innovative and beneficial technology to help make peoples lives easier and more enjoyable

What can we expect from Telemedicine Industry ?

Technology ` Invented for life `, which means

… reliable technology, designed to last

… technology that accompanies people for a good part of their lives

… intelligent, innovative and beneficial technology to help make peoples lives easier and more enjoyable

Connected Health Leadership Summit - 2009 End-to-End Solution to provide a holistic Model of Care System technology based on well established Appliance User friendly appliance base station and peripheral biometric devices, Clinical content designed to patient condition(s), Patient management software and secure IT/data infrastructure. Implementation and management support provided by TM suppliers Organisational support to build, integrate and operate clinical workflows, Management reporting and clinical trials/health economic outcomes. TM regions: Local services provided by local partners 1st level technical and clinical triage, patient home installation, training and refurbishment. Patient empowerment Effective clinical intervention

System technology based on well established Appliance

User friendly appliance base station and peripheral biometric devices,

Clinical content designed to patient condition(s),

Patient management software and secure IT/data infrastructure.

Implementation and management support provided by TM suppliers

Organisational support to build, integrate and operate clinical workflows,

Management reporting and clinical trials/health economic outcomes.

TM regions: Local services provided by local partners

1st level technical and clinical triage,

patient home installation, training and refurbishment.

Connected Health Leadership Summit - 2009 System View

Connected Health Leadership Summit - 2009 Patient empowerment by helping to understand their Illness and motivate Change in Behaviour ‘ The start’: Understand health risk Identify potential problems and address causes (including co-morbidities and psycho-social factors) ‘ The training’: Strengthen behavioural change Identify change in health status Knowledge Behaviour Symptoms Knowledge Behaviour Symptoms Knowledge Behaviour Symptoms

‘ The start’: Understand health risk

Identify potential problems and address causes (including co-morbidities and psycho-social factors)

‘ The training’: Strengthen behavioural change

Identify change in health status

Connected Health Leadership Summit - 2009 Consistent and unparalleled Results High Patient Acceptance Improved Clinical Outcomes Reduced Health Care Cost New four-year VA study shows 19% drop in admissions, 25% decrease in bed days with population of >17,000 University of Colorado COPD study with Kaiser shows decreased symptoms, increased exercise tolerance, and decreased smoking rates, and was associated with decreased mortality Long-term unpublished controlled study shows continuously dropping health care costs: Quarter 10 of study showing 32% drop in costs on intent-to-treat basis 85% of patients in VA are using the Appliance daily 90% recommend use of System

New four-year VA study shows 19% drop in admissions, 25% decrease in bed days with population of >17,000

University of Colorado COPD study with Kaiser shows decreased symptoms, increased exercise tolerance, and decreased smoking rates, and was associated with decreased mortality

Long-term unpublished controlled study shows continuously dropping health care costs: Quarter 10 of study showing 32% drop in costs on intent-to-treat basis

85% of patients in VA are using the Appliance daily

90% recommend use of System

Connected Health Leadership Summit - 2009 Consistent and unparalleled Results Dr Darkins et al, 2008 Condition # of Patients % Decrease Utilization Diabetes 8,954 20.4 Hypertension 7,447 30.3 CHF 4,089 25.9 COPD 1,963 20.7 PTSD (Post Traumatic Stress Disorder) 129 45.1 Depression 337 56.4 Mental Health, other 653 40.9 Single Condition 10,885 24.8 Multiple Conditions 6,140 26.0

Connected Health Leadership Summit - 2009 Goal: Telehealth Applications all across the Continuum Fit & healthy Critically ill Guided training (depends on fitness level) Instruction on health- conscious behavior Motivation and instruction on active, healthy lifestyle Monitoring of symptoms and self-assessment Acute state monitoring and emergency interventions Wellness At Risk Chronic Conditions High-Risk / Complex Future Today Health management for individuals at any location, at any time from multiple sources

Guided training (depends on fitness level)

Instruction on health- conscious behavior

Motivation and instruction on active, healthy lifestyle

Monitoring of symptoms and self-assessment

Acute state monitoring and emergency interventions

Connected Health Leadership Summit - 2009 3. Action Challenges in RPM calling for action: Reimbursement Recognized IT/ interoperability standards ( ⇒ scaling) Acceptance (physicians and patients; medical content; usability) Integrated end2end Solutions (industry cooperation with medical/ political) Cross EU – regions activities/comittees

Challenges in RPM calling for action:

Reimbursement

Recognized IT/ interoperability standards ( ⇒ scaling)

Acceptance (physicians and patients; medical content; usability)

Integrated end2end Solutions (industry cooperation with medical/ political)

Cross EU – regions activities/comittees

Connected Health Leadership Summit - 2009 Project Group Engagement: Actions to facilitate market growth and CH acceptance and Ensuring that development informed by feedback from all stakeholders. Definition of CH , Identification / systematic categorisation of CH applications (use cases) To what extent do European and US markets differ ? Does this limit the value of knowledge transfer or other forms of information/experience exchanges ? Analysis of benefits/risks from CH by stakeholder groups (Customers, Payors, Users, Provider and Policy makers).

Project Group Engagement:

Actions to facilitate market growth and CH acceptance and Ensuring that development informed by feedback from all stakeholders.

Definition of CH ,

Identification / systematic categorisation of CH applications (use cases)

To what extent do European and US markets differ ?

Does this limit the value of knowledge transfer or other forms of information/experience exchanges ?

Analysis of benefits/risks from CH by stakeholder groups (Customers, Payors, Users, Provider and Policy makers).

Connected Health Leadership Summit - 2009 Group Engagement Key adoption barriers : Identification: Scientific and pragmatic evidence of clinical outcomes. CHF policy and reimbursement schemes, effective business models and service models Are there potential acceptance roadblocks/issues that will restrict the growth of CH – and if so what areas and how might these be overcome?

Group Engagement

Key adoption barriers :

Identification:

Scientific and pragmatic evidence of clinical outcomes.

CHF policy and reimbursement schemes, effective business models and service models

Are there potential acceptance roadblocks/issues that will restrict the growth of CH – and if so what areas and how might these be overcome?

Connected Health Leadership Summit - 2009 Key adoption Barriers Development of key measures to overcome adoption barriers: Which stakeholder groups (e.g. Individuals, communities, healthcare professionals, policy developers), most require CH awareness, education. Does CH need cohesive and systematic media management ? How are products tested and accredited for usability and do we anticipate that user acceptance will be linked to European, national and/or local approvals? Is sufficient investment being made in human factors research, What techniques can be adopted to reduce product design failures?

Key adoption Barriers

Development of key measures to overcome adoption barriers:

Which stakeholder groups (e.g. Individuals, communities, healthcare professionals, policy developers), most require CH awareness, education.

Does CH need cohesive and systematic media management ?

How are products tested and accredited for usability and do we anticipate that user acceptance will be linked to European, national and/or local approvals?

Is sufficient investment being made in human factors research,

What techniques can be adopted to reduce product design failures?

Connected Health Leadership Summit - 2009 Group Engagement Key adoption Barriers Idenfication of accepted benefits and ways to use those to strenghten CH use To what extent can user/stakeholder demand for CH capabilities drive public policy development? Do we have evidence/examples of good CH dialogue practice, examples of effective CH ecosystems, and CH empowered communities?

Group Engagement

Key adoption Barriers

Idenfication of accepted benefits and ways to use those to strenghten CH use

To what extent can user/stakeholder demand for CH capabilities drive public policy development?

Do we have evidence/examples of good CH dialogue practice, examples of effective CH ecosystems, and CH empowered communities?