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  • Telehealth

    1. 1. Telehealth & legal aspects … Reimbursement, a prerequisite to a better deployment and use of telehealth … Telemedicine Andreas Gläser , COCIR
    2. 2. Telemedicine Focus Group 2nd page 2 Agenda  Overall Situation (changes of Society & Healthcare needs)  Introduction to Telehealth  Definition  Examples  Evidence of Telehealth outcomes  Clinical Outcomes  Cost parameters  Users acceptance  Barriers hindering Telehealth deployment  COCIRs call for action
    3. 3. Telemedicine Focus Group 2nd page 3 Situation - Changes of Society and Healthcare 0 10 20 30 40 2005 2015 2025 2035 2045 2055 65 ye a rs a nd m o re 0 to 14 ye a rs Proportion of total EU-27 population* % Demographic Change…  leads to an increasing proportion of people with (multiple) chronic conditions -> rising demand -> rising healthcare spendings  ageing caregivers -> reduction supply  need for preventive action *EUROSTAT Yearbook 2009
    4. 4. Telemedicine Focus Group 2nd page 4 Teledisciplines - TeleRadiologie - TeleScreening Focus Doc-Doc Focus Doc-Patient Focus Social / Care „TeleHealth“ (Remote Patient Management) TeleCare („House emergency call “) TeleMonitoring (i.W. Vitalparameter) Ambient Assisted Living The Bigger Picture - What is Telemedicine? Telehealth/medicine: delivery of healthcare services by use of Information and Communication Technologies (ICT) while actors are not at the same location.
    5. 5. Telemedicine Focus Group 2nd page 5 1. Telemonitoring 2. Telehealth  Focus on Vital Signs  telephonic care  Simple results logic  + Behaviour  + Knowledge  Vital parameter  Therapy Management  Training & education programs  Emergency management Focus on Telehealth Telemonitoring is a subset - or often the first implementation stage of Telehealth
    6. 6. Telemedicine Focus Group 2nd page 8 Telehealth System Overview
    7. 7. Telemedicine Focus Group 2nd page 9 Regulatory Matrix for Telehealth Systems WWW Telemedical Center Clinical Interface Patient Interface Telehealth Telemedical Data center IT Infrastructure I/O Validation Patient Data Location Rights ISO 27001 Data Security Access Rights Management Combination of MD and/ or Non-MD to MD System MDD §12 Data Encryption Management IQ/OQ/PQ Validation IT Infrastructure Update & Upgrade Rules S/W 2D Risk Management - ISO 14971 - IT Risk Mgt. Peripheral
    8. 8. Telemedicine Focus Group 2nd page 10 Acceptance Clinical Outcomes Healthcare Cost  Compliance improvements  Morbidity and mortality reduction  Better Health-related Quality of Life  Direct cost reductions: Hospitalisation, emergency incidents, GP visits, medication, etc.  Patient usage of service and satisfaction  Physician acceptance of new service Existing & Broad Evidence A large no. of studies and trials have proven the various positive outcomes of Telehealth enabled Healthcare.
    9. 9. Telemedicine Focus Group 2nd page 11 Diabetes Mellitus | Mortality with diabetes Acceptance Clinical Cost Chumbler et al. 2009 Mean Survival Time: 1348 vs. 1278 days (p=0.015) Crude Mortality Rate: 19% vs. 26% (p<0.05) Source: Chumbler et al. (2009), Mortality risk for diabetes patients in a care coordination, home-telehealth programme. Journal of Telemedicine and Telecare, 15: 98–101.
    10. 10. Telemedicine Focus Group 2nd page 13 Cost | long-term study in US Condition # of Patients (rounded) % Decrease Utilisation Diabetes 9,000 20% Hypertension 7,500 30% CHF 4,100 26% COPD 2,000 21% PTSD * 130 45% Depression 340 56% Other Mental Health 650 41% Single Condition 11,000 25% Multiple Conditions 6,100 26% Darkins et al. Telemedicine and e-Health, Dec 2008 Acceptance Clinical Cost Source: Darkins et al. 2008, CCHT: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veterans with Chronic Conditions, Telemedicine & e-Health, 14(10), 1118-1126
    11. 11. Telemedicine Focus Group 2nd page 15 Acceptance | long-term study Eighty-five percent (85%) are in daily compliance with device. 86% say they better understand their condition and treatment and are better able to manage their chronic condition(s). Over 95% are (very) satisfied with the Health Buddy, and most of them would recommend it to others. Acceptance Clinical Cost Source: Boyne et al., 2008, Telemonitoring in patients with heart failure: A feasibility study (TEHAF). European Journal of Cardiovascular Nursing, 7, S20-S21.
    12. 12. Telemedicine Focus Group 2nd page 16 Evidence Summary | Expected Benefits Telehealth can fill a crucial gap in the continuum of care. Telehealth solutions support a multi-dimensional model of care for individuals with (complex) chronic conditions who are often either elderly and frail and/or disabled. The benefits of Telehealth are immediate, tangible and significant to clinical staff, patients and society.  Reduced hospitalizations  Increased quality of life of patients  Reduced mortality  Early detection of exacerbations, impairment of health  Patient empowerment, education, behavioural reinforcement and motivation  Individualized, efficient, exception based interventions
    13. 13. Telemedicine Focus Group 2nd page 17 But barriers continue to hinder the further deployment of Telehealth While the potential benefits of Telehealth are enormous, a number of barriers continue to hinder the introduction of Telehealth, or prevent them from achieving optimal benefits. Among them are:  No reimbursement or sustainable funding  Missing incentives, accordingly business models for care providers  Missing IT standards and issues on interoperability  Lack of awareness and confidence in maturity and positive results  Many smaller pilots addressed individual issues, but not overall solution  Two parallel infrastructures for Telehealth (new) and Telecare (existing)  Unclear legal responsibilities, different regulations within EU states
    14. 14. Telemedicine Focus Group 2nd page 18 COCIR’s Call for Action to promote the further deployment of Telehealth To overcome the barriers to make the benefits of Telehealth available to European citizens, COCIR calls to: 1. European Commission and Member States to establish an appropriate legal framework with effective transposition at country level 2. Strengthen cooperation between healthcare stakeholders to “best practice health strategies” supporting telehealth adoption in routine clinical practice 3. Finance more and sustainable large scale projects with health economic evaluation to assess the impact of telehealth solutions 4. Integrate telehealth into existing care delivery structures and ensure interoperability of telehealth solutions 5. Establish sustainable economic model for telehealth by starting dialogue between healthcare stakeholders