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Telemonitoring In The Management
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Telemonitoring In The Management

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  • 1. Telemonitoring in the Management of Chronic Diseases Prof. Dr. med. Harald Korb Medical Director Vitaphone GmbH
  • 2. 2
  • 3. Telemedicine provides a suit of solutions for: health-conscious individuals at risk acutely affected chronically ill individuals therapeutical & prevention risc stratification diagnostics emergency management Rhythm Coronary Artery Congestive Disturbances Disease Heart Failure
  • 4. Time Time = Muscle Delay between onset of symptoms and start of therapy (door-to-needle-time) too long!
  • 5. reaction time emergency department transport to hospital time between onset of bedside treatment definite therapy symptoms & call for help 225 min STEMI 15 30 15 80 up to 540 min Non-STEMI 0 min 680 min 300.000 patients approx. 50% die approx. 130.000 with myocardial before reaching die infarction/year hospital approx. 800.000 approx. 60% patients contact 80% of them with (450.000 emergency no pathological patients) are findings department due hospitalized to chest pain
  • 6. Patient Professional Network Clinic Rehabilitation Telemedical Cardiologist / Family Service Center (TSC) Physician Electronic Patient File
  • 7. Evaluation of telemedicine in acute myocardial Aim syndrome Design prospektive, controlled 290 cardiovascular patients - Male: 194 (67%), age: 68 +/- 6.6 years Patient - Female: 96 (33%), age: 66 +/- 7.7 years collective Inclusion criteria - coronary heart disease, post MI, post CABG, post PTCA Observation 6 months / patient period
  • 8. 12% 3% < 15 Min. - 60 Min. > 60 Min. 85% 88% of pts contact the TSC during the first 60 min. after onset of symptoms 12% prolonged reaction > 1 hour 95% of all pts classified as emergency by TSC physicians claimed for help during the first 60 min.
  • 9. reaction time emergency department transport to hospital time between onset of bedside treatment definite therapy symptoms & call for help 225 min STEMI 15 30 15 80 up to 540 min Non-STEMI 0 min 680 min time between onset of symptoms & call for help 44 15 30 15 is dramatically reduced by telemedicine 0 min 105 min signifi- cohorts mortality cance ACSIS 3899 9,7% Telemedicine 699 4,4% p < 0,0001
  • 10. Telemedicine provides a suit of solutions for: health-conscious individuals at risk acutely affected chronically ill individuals therapeutical & prevention risk stratification diagnostics emergency management Rhythm Coronary Artery Congestive Disturbances Disease Heart Failure
  • 11. Profound reduction in quality of life Extremely reduced long-term prognosis Extreme burden on the health budget estimated 2% to 3% of the total budget = 5 – 10 Billion € / year Extreme workload for physicians in clinics and surgeries No. 2 reason for medical consultation 5% of all hospital admissions No. 1 reason for hospital admissions of patients > 65 years up to 50% readmission in the first 6 months after dismissal Frequency (tendency increasing) 2,5% of total population up to 15% of people > 65 years Inadequate therapeutical management with insufficient medical and non-medical therapy
  • 12. Integrated care model access to electronic patient file with illness and patient related data VitaView ECG Patient patient intake providing medical direct communication data for EPF Blood pressure Professional network Weight „Chronic Illness“ Clinic Glucose Telemedical Rehabilitation Service Center (TSC) Cardiologist / Fam. Physician wireless transmission of various vital parameters transmission of data in Transmission of data after TSC with entry in EPF primary analysis Electronic Patient File emergency management / providing actual clinical findings VitaCheck Tele-Care-Monitor providing health economical & health political data Insurance Consultancy Telemedicine as information & service platform in integrated care models
  • 13. Is medical quality improved by telemedicine? Reduction Increase physician contacts quality of life emergency dispatches risk reduction hospitalisation rate coping with fears length of hospital stay therapeutic management cost / clinic; ICU management in emergency long-term damage self-responsibility ? mortality – CHF, CHD, stroke life expectancy ? % %
  • 14. Are telemedical services accepted by the patients? 100% 90,2 90 88,2 80 77,1 70,7 72 69,9 70 64 60 50 40 30 20 13,3 10 0 Rapid help in  Better  Higher degree  Better coping  Increased  More self  Reduced risk No conflict with  case of  therapeutical  of personal  with fears quality of life responsibility respect to the  emergency management security contact to the  family  physician
  • 15. Is telemonitoring of CHF patients economically viable? Reduction in hospital admissions Reduced duration of stay at the hospital 9 8.17 8 7 6 5.29 5 4 3.09 2.47 2.4 3 2 1.23 1 0 NYHA II NYHA III NYHA IV Telemedicine Control
  • 16. Every journey starts with a first step…