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Telehealth & legal aspects

Telehealth & legal aspects. … Reimbursement, a prerequisite to a better deployment and use of telehealth … http://www.cocir.org/content.php?level1=14&mode=24&id=58 Telemedicine Andreas Gläser , COCIR. Agenda. Overall Situation (changes of Society & Healthcare needs)

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Telehealth & legal aspects

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  1. Telehealth & legal aspects … Reimbursement, a prerequisite to a better deployment and use of telehealth … http://www.cocir.org/content.php?level1=14&mode=24&id=58 Telemedicine Andreas Gläser , COCIR

  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 Telemedicine Focus Group 2nd March 2010 COCIR

  3. Situation - Changes of Society and Healthcare Proportion of total EU-27 population* % *EUROSTAT Yearbook 2009 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 Telemedicine Focus Group 2nd March 2010 COCIR

  4. 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. „TeleHealth“ (Remote Patient Management) Ambient Assisted Living TeleCare(„House emergency call“) • Teledisciplines • TeleRadiologie • TeleScreening TeleMonitoring(i.W. Vitalparameter) Focus Doc-Doc Focus Doc-Patient Focus Social / Care Telemedicine Focus Group 2nd March 2010 COCIR

  5. Focus on Telehealth 1. Telemonitoring 2. Telehealth • + Behaviour • + Knowledge • Vital parameter • Focus on Vital Signs • Therapy Management • Training & education programs • Emergency management • telephonic care • Simple results logic Telemonitoring is a subset - or often the first implementation stage of Telehealth Telemedicine Focus Group 2nd March 2010 COCIR

  6. Telehealth System Overview Telemedicine Focus Group 2nd March 2010 COCIR

  7. Regulatory Matrix for Telehealth Systems Combination of MD and/ or Non-MD to MD System MDD §12 Patient Interface Telehealth Clinical Interface I/O Validation Telemedical Center Peripheral Telemedical Data center • 2D Risk Management • ISO 14971 • IT Risk Mgt. IT Infrastructure Patient Data Location Rights ISO 27001 Data Security Access Rights Management Data Encryption Management IQ/OQ/PQ Validation IT Infrastructure Update & Upgrade Rules S/W Telemedicine Focus Group 2nd March 2010 COCIR

  8. Existing & Broad Evidence • Compliance improvements • Morbidity andmortality 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 Clinical Outcomes Healthcare Cost Acceptance A large no. of studies and trials have proven the various positive outcomes of Telehealth enabled Healthcare. Telemedicine Focus Group 2nd March 2010 COCIR

  9. Diabetes Mellitus | Mortality with diabetes Chumbler et al. 2009 Clinical Cost Acceptance 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. Telemedicine Focus Group 2nd March 2010 COCIR

  10. Cost | long-term study in US Darkins et al. Telemedicine and e-Health, Dec 2008 Clinical Cost Acceptance 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 Telemedicine Focus Group 2nd March 2010 COCIR

  11. Acceptance | long-term study Eighty-five percent (85%) are in daily compliance with device. Clinical Cost 86% say they better understand their condition and treatment and are better able to manage their chronic condition(s). Acceptance Over 95% are (very) satisfied with the Health Buddy, and most of them would recommend it to others. Source: Boyne et al., 2008, Telemonitoring in patients with heart failure: A feasibility study (TEHAF). European Journal of Cardiovascular Nursing, 7, S20-S21. Telemedicine Focus Group 2nd March 2010 COCIR

  12. 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 Telemedicine Focus Group 2nd March 2010 COCIR

  13. But barrierscontinue to hinder the further deploymentof 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 Telemedicine Focus Group 2nd March 2010 COCIR

  14. 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: • 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 Telemedicine Focus Group 2nd March 2010 COCIR

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