Remote monitoring will happen! Integrating ICT in health care is about progress and who can stop the progress? Also, patients are about to demand for it. Have in mind their current interest for mHealth and note that in a large number of trials, the feedback received from patients and their carer is positive: they feel more secure when receiving feedback on the data they sent remotely and if attention has been paid to educate them in interpreting the data they are sending, they can become a full partner of the care team! Finally, remote monitoring services – combined with self-care – offer strategic opportunities to modernise health care systems by enabling them to become more proactive, better empower patients and citizens and, in the end, use health care resources more efficiently. To identify future directions for research, this lecture will consider remote monitoring from three viewpoints: what evidence is still needed, how best to support decision making in favour of doing remote monitoring, and how best to support the deployment of remote monitoring in routine care. Results and lessons learned from two European Commission co-financed projects, Renewing Health and United4Health , will be used to illustrate the messages.

1. Remote monitoring:
Future Directions for
Research
Marc Lange, Secretary General

2. Competence
Centre
Health Care
Authorities
Industry
Health Care
Delivery
Citizens/Patient
Representative
Innovation
Agency
Insurers
Social Care
Dissemination
Organisation
European Health TELematics
A cross-(any)border and multidisciplinary
collaboration forum
Sustainable and large scale
eHealth deployment
requires engagement and synergies

3. United4Health
Remote monitoring +
self-care
in routine care
in 14 European regions

4. Remote monitoring + self-care
will happen!
• Prevention (secondary and primary)
• Chronic disease management
• Health coaching
• Patient empowerment
Strategic added values for our health care systems
• From reactive to proactive healthcare
• From caring to coaching

5. The missing evidence
The decision-making dashboard
The deployment in routine care
roadmap

6. Today’s evidence
From an RCT with 21 remote services in 9 Regions
 Safety and clinical effectiveness
• At least as safe and efficient as regular services
 Patient satisfaction and health-related quality of life
• Tendency to improve health-related Quality of Life (SF36)
• Very positive Patients (SUTAQ) in almost all pilots
▲ Costs per patient or in efficiency gains, no reduction, possibly because
• Technology market still to expensive
• Sub-optimisation of the organisation of care
• Inadequate scaling of the service

7. Lessons learned: the impact of
non-clinical parameters (1)
Why the service is considered for roll-out
• The values of the health care system
• Its objectives with the service
What technology is being used
• Connectivity, device ownership, sophistication
Who will benefit from it
• Enrolment process, eligibility criteria
Where the service is running
• The organisations and the workforce profile in charge
Model for Assessment of Telemedicine (MAST)

8. Lessons learned: the impact of
non-clinical parameters (2)
How the service is designed
• With a focus on primary or secondary care setting
• Limited to health care setting or with the implication of the
social care sector
When the service is being studied,
• The cost of the technology will decrease because of the
market and the opportunities to mutualise the cost of the
supportive infrastructure
+
Summative or formative assessment
Model for Assessment of Telemedicine (MAST)

9. Directions for Research?
Evidence on the relationship
between outcome and environment
• What is the profile of the patients that can benefit the most?
• What are the best technological options, for what type of
patients, having in mind the “moving target” aspects of
technology?
• How to organise the responsibility/liability chain?
• How best to obtain efficiency gains?
• How to address the fact that nurses will often be the first line of
response?
• …

10. (Evidence-based health care)
Clinical evidence
• Based on RTC
(the gold standard)
• Summative assessment
 “Clinicians [may be] ready
to believe that there is an
objective determinable
“right answer” to research
questions.”1
Management evidence
• Based on use cases,
lessons learned …
• Formative assessment
 “Managers may, quite
rightly, view the results of
research are more
subjective, and contingent
on the context and on the
characteristics of the
researchers themselves” 2
1&2. Walshe K. and Rundall TG. – 2001 – Evidence-based Management: from Theory to Practice in Health
Care (Milbank Q. 2001; 79(3): 429-57, IV-V.)

11. The missing evidence
The decision-making dashboard
The deployment in routine care
roadmap

12. (Decision making)
Clinical decisions
• Decision-support systems
• Many decisions, individual
cases, in a short time frame
• Often made individually
• In a relatively unconstrained
context
• Often with immediate
feedback
Management decisions
• Heterogeneous processes,
including intuition
• Fewer but larger decisions
in a longer time frame
• Made in concert with others
• Constrained by resources,
policies and procedures,
stakeholders’ views …
• With results more difficult to
discern
Walshe K. and Rundall TG. – 2001 – Evidence-based Management: from Theory to Practice in Health Care
(Milbank Q. 2001; 79(3): 429-57, IV-V.)

13. Lessons learned:
the need for action research1
For evidence-based tools for decision-making in healthcare
• The results of the research need to be action-oriented and
accessible to managers
• The question for the research need to be strategic
• A match is required between the timing of the research and
the decision-making
1; Walshe K. and Rundall TG. – 2001 – Evidence-based Management: from Theory to Practice in Health Care
(Milbank Q. 2001; 79(3): 429-57, IV-V.)

14. Directions for Research?
Strategic management and entrepreneurial tools
adapted to healthcare and remote monitoring + self-care
• Maturity modelling
for assessing the readiness of an environment to host an
innovative services and identify strategic actions to undertake
• Service Innovation Governance modelling,
for guiding the creation of innovative services
• Business modelling,
for assessing the conditions for sustainable remote monitoring
• Socio-economic evaluation, Cost & Benefit Analysis
for measuring the potential for impact of an innovative service
• …

15. The missing evidence
The decision-making dashboard
The deployment in routine care
roadmap

16. (Deploying)
In Pilot environment
• Minimal organisational
changes
• Temporary setting
• Selected patients
• Project staffing
• Project funding
In Routine care
• Service redesign
with necessary
organisational changes
• There to stay
• Patient inclusive
• Regular staffing
• Healthcare system funding

17. U4H
Initial lessons learned (1)
Organisation
• The whole spectrum of healthcare stakeholders need to be
involved and engaged, from patients through to politicians …
Culture
• Local benefits by local ownership of local problems
• Telehealth is to be seen as a journey, not as a destination
Conclusions
• In routine care = Service redesign = Change management

18. U4H
Initial lessons learned (2)
Technology @ scale
• Lack of connectivity @ scale creates access inequalities
Procurement and interoperability
• Procurers need solutions that are proven to work now
• Local challenges with interoperability and integration in
primary care
Conclusions
• KISS - Keep It (the technology) Simple and Stable
• Do not underestimate the tension between
standardisation and legacy

19. Directions for Research?
Evidence-based guidelines and tools
for helping the demand-side on
• Leadership for ICT-based innovation in healthcare
• Public Procurement of Innovative solutions in healthcare
• Managing change in a healthcare service re-design context
• Implementing legal, security, safety rules (including compliance
check lists)
• Accreditation tools for remote monitoring + self-care
(e.g. health apps for clinical practice) and
• …

20. Summary
Evidence on how to design remote monitoring
+ self-care in a given environment
Action research for evidence-based
decision-making
Guidelines and tools for
helping the demand-side

21. Happy to answer any
questions
Marc Lange
Secretary general
EHTEL Association
rue de Trèves 49-51,
B-1040 Brussels Belgium
Tel: +32 (0)2 230 15 34
Fax: +32 (0)2 230 84 40
Mobile: +32 (0)475 27 71 45
Marc.Lange@ehtel.eu
www.ehtel.eu
www.united4health.eu
www.renewinghealth.eu
www.telemedicine-momentum.eu