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Telemonitoring in the Management
                of Chronic Diseases


Prof. Dr. med. Harald Korb
Medical Director
Vitaphone GmbH
2
Telemonitoring In The Management
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
Time

 Time                 =              Muscle

Delay between onset of symptoms and start of therapy
           (door-to-needle-time) too long!
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
Patient




                                    Professional Network
                                            Clinic
                                        Rehabilitation
              Telemedical           Cardiologist / Family
          Service Center (TSC)           Physician




          Electronic Patient File
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
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.
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
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
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
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
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
                                                                ?
%                                                               %
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
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
Every journey starts
 with a first step…

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Telemonitoring In The Management

  • 1. Telemonitoring in the Management of Chronic Diseases Prof. Dr. med. Harald Korb Medical Director Vitaphone GmbH
  • 2. 2
  • 4. 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
  • 5. Time Time = Muscle Delay between onset of symptoms and start of therapy (door-to-needle-time) too long!
  • 6. 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
  • 7. Patient Professional Network Clinic Rehabilitation Telemedical Cardiologist / Family Service Center (TSC) Physician Electronic Patient File
  • 8. 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
  • 9. 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.
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. 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 ? % %
  • 15. 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
  • 16. 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
  • 17. Every journey starts with a first step…