Telehealth/Telecare Overview

1. Telehealth/Telecare Overview Dr David Craig Senior Lecturer/Geriatrician Queen’s University/Belfast Health and Social Care Trust

6. Telemedicine - the provision of healthcare services at a distance • Role in prevention, diagnosis, treatment and follow-up • Transmission of medical data and information • Text • Sound • Images

7. Forms..... • Teleradiology • Telepathology • Teledermatology • Teleconsultation • Telemonitoring* • Telesurgery • Teleophthalmology • Call centres/online information centers • Videoconferences between health professionals.

8. Rationale • Society is getting older • More individuals living with chronic diseases • Medical attention may be restricted: • remote areas • difficulty accessing certain specialties

9. Rationale • QoL chronically ill improved • Reduce hospital stays • Teleradiology and teleconsultation • Shorten waiting lists • Greater use of resources • Economic value in business development

10. What telemedicine is doing.... • 2 million prescriptions made via the internet in Sweden (2007) • Cardic telemonitoring 44% reduction in admissions to hospitals • MRI scan waits in England ↓ - reported through • USA, 240 000 teleconsultations /year Department of Veterans Affairs

11. Uncritical roll-out... • Problematic • Technology is expensive, • ? reorganisation of care • Infrastructure support • Clinical risk • Studies small scale and too heterogeneous

12. Telemedicine services limited • Market fragmented • Most initiatives: small-scale projects • not integrated into healthcare systems

15. Telemonitoring • Health data entered by patient • Automatically through monitoring devices • Active patient collaboration (e.g. by entering weight or daily blood sugar level  web-based tool) • Processed, shared with health professionals

16. Heart failure • >6 million (Europe) • Dyspnoea and/or rapid increase in weight • key parameters to monitor on a daily basis, • Early modification of treatment based on the monitoring data may • stabilise the condition • make consultations unnecessary • avoid or shorten hospital stays

17. Heart failure • 2 systematic review papers [11] & [12] • telemonitoring might be an effective strategy for disease management, especially in high-risk heart failure patients • evidence base for telemonitoring in heart failure is still very limited and that cost-effectiveness, scalability, safety and acceptability to patients need to be further assessed [11] Louis AA et al. A systematic review of telemonitoring for the management of heart failure. Eur J Heart Fail. 2003 Oct;5(5):583-90. [12] Chaudhry SI et al. Telemonitoring for patients with chronic heart failure: a systematic review. J Card Fail. 2007 Feb;13(1):56-62.

18. Teleradiology • Developed ~ shift in medical imaging from film-based to digital-based technologies • Cope with peak workloads • Round-the-clock services • Reduce waiting lists for specific examinations • Cut costs • The telemedicine example in the most advanced stage of deployment. • An outsourced service, on a commercial contract basis. • Cross-border mode • ?Legal clarity ?assurance of high quality in patient care.

20. European Commission • ”The Commission will support the development, by 2011, of guidelines for consistent assessment of the impact of telemedicine services, including effectiveness and cost-effectiveness. This will be based on the work of experts in the field, Commission-supported studies, large-scale pilot schemes and relevant research projects”.

21. European Commission • Member States are responsible for the organisation, provision and funding of national healthcare. The leadership of their health authorities in achieving wider deployment of telemedicine is essential. Collecting evidence and sharing good practice on implementation of telemedicine services and reimbursement schemes are therefore critical in order to secure the necessary acceptance and commitment on the part of the health authorities.

22. Legal clarity • Lack of legal clarity • Licensing • Accreditation (GMC revalidation - telemed not mentioned) • Registration of telemedicine services and professionals • Data protection • Liability • Reimbursement • Jurisdiction – e.g. cross border provision of telemedicine services also require legal clarification with regard to privacy

23. Bottlenecks • Broadband access / full connectivity • Interoperability and standardisation • ICT-based services rigorous testing / agreed standards

29. American Geriatrics Society, 2009 TELEHEALTH SERVICES: AGS supports Centers for Medicare & Medicaid Services proposal to continue to.... require direct physician evaluation of nursing facility residents, and agrees that Federally-mandated initial physician visits and subsequent periodic visits in SNFs should be furnished in person and not via telehealth. We believe that telehealth services do have the potential to bring geriatric expertise to the bedside when appropriately structured and performed. We also note that if consultation services are eliminated, the impact on telehealth services reporting and coverage will need to be considered. AGS would be pleased to work with CMS as those issues are reviewed and resolved.

30. American Geriatrics Society, 2009