This presentation introduce a methodology scaling-up developed by "doers and shapers" internationally known for their expertise in eHealth and digital health

1. 1
Scaling up Telemedicine:
The MOMENTUM-TREAT
Framework
Marc Lange, EHTEL Secretary General
AeHIN Webinar 2015-06-10
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
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Sustainable and large scale
eHealth deployment
requires engagement and synergies
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2. 2
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Terminology warnings
eHealth, telehealth, telemedicine …
= healthcare with the support of ICT for communicating
≠ ICT for healthcare
When mHealth is recommended by doctors,
= eHealth on the move, at home, in your pocket …
When mHealth is an app
downloaded on citizen’s initiative
≠ eHealth
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United Nations Population Division, World Population Prospects, 2004
Revision (Medium Variant, Shared Scaling)
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The landscape: an Ageing Europe
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3. 3
The indispensable modernisation of
the healthcare systems
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QualityofLife
€10,000€1,000€100€10€1
Adapted from Intel
Specialty
Clinic
Community
Hospital
ICU
Acute Care
Assisted
Living
Skilled
Nursing Facility
Residential Care
Independent,
Healthy Living
Prevention
Chronic Disease
Management
Doctor’s
Office
Tele-homecare & mobile care
Re-designing services with telehealth
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Patient’s home Hospital or primary care or eHealth centre
SERVER
PATIENT
REGIONALCENTRE’S
OPERATOR
TELEMONITORING
DEVICES
GENERAL
PRACTITIONER
CARDIOLOGIST
AT HOSPITALOR
LOCALHEALTH
DISTRICT
OTHERINVOLVED
HEALTHCARE
PROFESSIONALS
GATEWAY
& APP
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4. 4
ICT and Service re-design –
the challenge
New Technology + Old System = New Old System
This is about changing from
• Data to services
• Data collection to data integration in processes
• Tools to process redesign / new care pathways
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• Impact on safety and clinical effectiveness
• The Renewing Health services provided are
at least as safe and efficient as regular services.
• Impact on patient satisfaction and health-related
quality of life
• There was a tendency to improve health-related Quality of
Life (SF36)
• In almost all pilots the patients were very positive towards
to the use of telemedicine (SUTAQ)
• Further studies are required on how to use telehealth to
approach the care of those people who were excluded
from the trials in Renewing Health.
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There is some evidence!

5. 5
Open Issues
• The pilots did not show a reduction in the costs per
patient or in efficiency gains, possibly because
– The technology is still too expensive:
• The size of the market is still too small
– The temporary nature of the pilot was not an incentive to
modify the organisation substantially
– The service, technology and organisation needed to
mature even further
– Lessons still need to be learned on which patient groups to
enrol to maximise potential impact
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www.united4health.eu
Ambition
• A deployment study, with emphasis on assessment of:
– organisational aspects
– efficiency gains
– economic aspects
• Deliver evidence
– More diverse than Whole Systems Demonstrator (UK)
– Better (more comparable) data than Renewing Health (EU)
• Commitment of regions to deploy and promote
Telehealth
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6. 6
www.united4health.eu
Supporting trans-national
organisations
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www.united4health.eu
www.youtube.com/user/United4Health
Testimonials and
Conference Podcasts
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7. 7
Tools and methods are needed
to deploy telehealth
Impact assessment framework
The results and lessons learned from Renewing Health
The deployment study of United4Health
Business Model Canvas
Cost and benefit analysis toolkit
Guidelines/Gap Analysis for large-scale deployment
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Webinar
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Momentum: the Project
A CIP ICT-PSP thematic network
Running from February 2012 until December 2014
The consortium: 20 organisations
Telemedicine associations and competence
centres from
Denmark, United Kingdom, Estonia, Norway, Spain,
France, Sweden, Germany, Greece, Netherlands, Poland,
Switzerland
European stakeholder associations representing
Health professionals and health care organisations, health
insurers, technology vendors
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8. 8
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Scaling-up?
From pilot to routine care …
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Testing of Service Routine Care Service
Small Scale
Deployment
Large Scale
Deployment
Hospital Group
Department
Department
HealthCare
System
Piloted Service
Lessons learned from
deployment inside an
organisation
 Local champions
 Limited constraints
(e.g. at legal level)
 Cost and benefit analysis
 …
Lessons learned from
deployment across organisations
(for servicing the healthcare system)
 Institutional endorsement
 Legal constraints (if it is a D2P relationship)
 Need for robust methods
 Socio-economic analysis
 …
From pilot to routine care
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9. 9
2015-06-10
A European
Telemedicine
Deployment Blueprint
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By Doers,
for Doers
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Strategy
& Management
Legal,,
Regulatory
&
Security
Organisation
Implementation
&
Change
Management
Technical
&
Market
relations
Four domains for deployment guidelines
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10. 10
Telemedicine
service
Run
Plan
People
Context
IT & eHealth
infrastructure
16
Legal & sec.
guidelines
13
Legal & sec.
conditions
11
Legal & sec.
experts
14
Market
procurement
18
Service
monitoring
17
Change
management
10
Cultural
readiness
1
Leadership
3
Compelling
need
2
User
friendliness
6
Potential
to scale-up
12
Primary
client
8
Business
plan
9
Privacy
awareness
15
Patient
centeredness
5
Stakeholder
involvement
4
Resource
aggregation
7
Strategy and management
Organisation and management
Legal and security
Technology and market
Enabling service
deployment:
18 Critical
success factors
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Critical Success Factors for
Deployment Strategy
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1. Ensure that there is cultural readiness for
telemedicine services.
2. Ensure leadership through a champion.
3. Come to a consensus on the advantage of
telemedicine in meeting compelling need(s)
4. Put together the resources needed for
deployment.
Strategy
&
Management
Legal,
Regulatory
&
Security
Organisation
&
Change
Mgmt.
Technical
&
Market
relations
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11. 11
Critical Success Factors for
Organisational Change
AeHIN Webinar 2015-06-10
5. Address the needs of the primary client(s).
6. Involve health care professionals and decision-
makers.
7. Prepare and implement a business plan.
8. Prepare and implement a change management plan.
9. Put the patient at the centre
of the service.
Strategy
&
Management
Legal,
Regulatory
&
Security
Organisation
&
Change
Mgmt.
Technical
&
Market
relations
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Strategy
&
Management
Legal,
Regulatory
&
Security
Organisation
&
Change
Mgmt.
Technical
&
Market
relations
Critical Success Factors for Legal,
Regulatory and Security Compliance
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10. Assess the conditions under which the service
is legal.
11. Identify and apply relevant legal and security
guidelines.
12. Involve legal and security experts.
13.Ensure that telemedicine doers and
users are “privacy aware”.
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12. 12
Strategy
&
Management
Legal,
Regulatory
&
Security
Organisation
&
Change
Mgmt.
Technical
&
Market
relations
Critical Success Factors for
Technology Decisions
and Procurement
2015-06-10
14. Ensure that the IT and eHealth infrastructures
needed are available.
15. Ensure that the technology is user-friendly.
16. Put in place the technology and processes
required to monitor the service.
17. Maintain good procurement processes.
18. Guarantee that the technology has
the potential for scale-up
(i.e., “think big”).
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With TREAT
(Telemedicine REadiness Assessment Tool)
A Doer working on a deployment plan
for a particular telehealth service
Will use these 18 Critical Success Factors to assess
his plan – collectively – against a set of indicators
CSF 1. Assure that there is cultural readiness for the telemedicine service
In my organisation/region,
• doctors and other healthcare professionals are ready to share clinical
information with each other and with the patient
• financial and other incentives are aligned with the service to be deployed
• an underpinning culture embraces technology
• an underpinning culture welcomes and even promotes change
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13. 13
MOMENTUM – TREAT workshop
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Based on the results from the online tool
Key players in the telemedicine project are
brought together to examine their local strategy
and their execution targets
Expected outcome:
A common understanding between stakeholders on
the challenges that they are facing
Input for issues that need to be changed or adapted in
existing strategies
A first draft of an action plan for the large-scale
implementation of telemedicine
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Scaling-up?
From pilot to routine care
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14. 14
Testimonials (to date)
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October 2014
April 2015
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Any questions?
More at www.telemedicine-momentum.eu
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Marc Lange
Secretary general
EHTEL Association
49/51, rue de Trèves
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
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