Telemedicine an evolution

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Telemedicinean evolution

• Paul Epping, MSc
• Consultancy TM e-Health, Info mngmt
• Secretary OIZ
• Chairman NEN Messaging
• info_at_ep-con.nl
• www.ep-con.nl

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TM in physicians office?
That it will ever come into general use,
notwithstanding its value, is extremely doubtful
because its beneficial application requires much
time and gives a good bit of trouble, both to the
patient and to the practitioner because its hue
and character are foreign and opposed to all our
habits and associations.
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Agenda

• Positioning of telemedicine
• Examples of applications
• An agenda for telemedicine implementation
• The fit into the broader context of CPR
• Discussion

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Definition

• Provision of medical care precisely there where
  the intervention(s) takes place in the primary
  process (and continuum of care) and the use of
  information and communication technology
• Including tele-education, tele-consultation and
  telemonitoring.
• Further integration with domotica (smart home).

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Its not just about technology
Strapping new technology on old processes will
not propel you in the right direction!
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Health Care e-volution
Management Model
Objective of Care
Demand driven
Supply driven
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Life expectancy is still growing in Europe
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Costs of the DutchHealth Care in 1999
42,1
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Composition of the Dutch population
RIVM, 2004
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Average costs per age group
Total costs per age group
Source RIVM, 2001
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eHealth Challenges

• 120 million seniors in Europe (defined by Senior
  Watch as age 50)
• The current project is strongly related to
  socio-demographic variables, lifestyle, and
  functional restrictions.
• Review of TM project learned that 50 complain
  about design, 21 are considerably functionally
  restricted, 31 are want nots
• North/South gradient 6.1 IST (EU program gt
  results framework 4) devices/applications are
  used on average in Sweden 2.8 in Greece
• data from Senior Watch

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The eHealth Promise

• A better model of care is possible
• Crisis care ? Coordinated care
• eHealth Networks and Technologies A Powerful
  Enabler

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Importance of content

• Availability of information for proper decision
  making gt decrease of errors
• Sharing of information gt top priority
• Use of best practices
• ? requirements
• Flexible systems
• Use of (international)standards terminologies
  (HL7v3, Dicom, XML, SnomedCT)

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Customer Mobile Medical DomainAccess to Personal
Medical Domain

• Mobile monitoring
• WAP / GPRS / UMTS phone
• Medical device
• Telco subscription
• Local application
• Automatic upload
• Automatic medical validation
• Automatic medical registration
• ..

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The next 5 years?

• EMBEDDED SYSTEMS
• installed intelligence
• Smartcards
• Lab on a chip
• RFiD
• Prices ?

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The next 5 years?

• EMBEDDED SYSTEMS
• biochips

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In summary

• Increase of chronic patients
• Decrease of human capital
• 4 Waves of innovation
• Internet
• Everything Mobile
• Embedded systems
• Interoperability

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Conclusion information flows increasingly
faster, cheaper and easier
across the world and TM is based on it.
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Examples within Health care

• medical call centre
• interdisciplinary consult
• ? tests at patients home
• surgery from distance
• tele psychiatry
• home care technology
• biochips
• bionic organs
• genetics
• cloned organs

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TM areas of application
Diversity of disciplines applications
Cardiology tele-monitoring Gynaecology tele-c
onsultation Pediatry tele-diagnosis Oncology
tele-(home)care Radiology tele-treatment Ophtal
mology tele-surgery Traumatology Dermatology Di
abetes Rehab
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What is already available (1)

• Blood pressure online
• Buddy
• CamCare
• Camea for a careless life
• Dermatology applications
• Digital Experiences Record
• Dokter.nl
• Wireless CPR
• Electronic diary for hemophilia patients
• ExoZorg
• GigaBroCa
• GigaCoMed
• Heart rhythm diagnosis

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What is already available(2)

• HealthCareSystem
• HeartsPoint Medical Service Center
• HeartsPoint Thrombosis patient measures and
  applies doses themselves
• GP ECG/EKG
• GP lung function examination
• Interapy
• Cancer, who helps in Limburg?
• KSYOS
• LiverDoc
• Map of Medicine
• My-SOS
• MobiHealth.org
• Nightly home hemodialysis A difference of day
  and night

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What is already available(3)

• Pre-hospital triage and trombolysis
• Project ZIJN
• Care for elderly
• Sint Maarten (radiology)
• Smashing
• Strengthening the autonomy of chronically ill
• Tele Dermatological Consultation
• Telebaby
• Telebeguiding with COPD and congestive heart
  failure
• TeleCare
• Telesurgery
• TeleFysi III
• Telekit distance support patients with asthma
  and COPD
• Telecare and monitoring for chronic illness
• Trustsline
• Vincent 50
• Vitaphone Telemedicine Disease management for
  Heartfailure Patiënten

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Some thoughts about consequences of TM
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Temedicine stages of growth meaning for the
organisation (no implementation stages!!!)
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e-Health and TM stages of growth value

• Brochure web site
• Basic product/ information about plans
• Limited interactivity
• Policy and procedures

• Info. about current health situation
• Searchable contant geared to personal situation
• Global communiction with client
• On-line forms

• Client centered portal creation of loyalty
• Prevention and triage tools
• Community building
• Treatment compliance

• INDS
• Self-service functionality
• Call center replaces contact center
• Web-based applications (EPD)

• Patient is in the center
• Integrated Disease Management
• Empowered consumeners and self directing care
• Integration of care providers, pharma suppliers
• End-to-end supported processes
• Convergence in PHR

Value Curve
Encyclopedic Communication
Self-realisation
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Expected hurdles
Telemedicine Doubter
TM Some
TM Hardly
Possibilities
Consequences
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Change Management
To be successful, each component needs to be
incorporated into the change process
Skills
Incentives
Resources
Action Plan
Successful Change
Vision
If any component is missing
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Professional developments

• Determine who will be involved.
• Determine how services will be offered via TM and
  what the impact is on existing services.
• 3. Determine expected influence
• 4. Development of long term vision

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Implementation steps
Stage 1 Detection of areas of success and
determination of needs Stage 2 Development of
business case and use of best practices Stage 3
Interdisciplinairy collaboration within the
organisation Stage 4 Technical
implementation Stage 5 Transformation of the
organisation Stage 6 Collaboration in virtual
organisations
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Clinical Processes that will be impacted

• Register Patients
• Schedule Services
• Manage Patient Accounts
• Manage Patient Encounter
• Engage and Manage Referrals
• Community Outreach
• Sales Marketing

• Collect/Review Health History/MDS
• Assess Patient (exams, tests, procedures, results
  review)
• Confirm Diagnosis(es)
• Develop Plan
• Educate Patient/Family
• Prescribe
• Administer Medications/Treatments/Therapies
• Document Care and share multidisciplinary
• Monitor Patient Progress

• Manage Human Resources
• Provide Legal Services
• Regulatory Compliance
• General Administrative Management
• Materials Management
• Business Process Improvement
• Asset Management

Patient/Provider

• Billing
• General Accounting
• Cash Management
• Accounts Receivable
• Capitation Management
• Contract Management
• Capital Development

• Store Policies, Procedures, Standards of Care
• Develop, Deploy and Monitor Best Practices
• Document Quality/Appropriateness of Care

• Perform Quality Improvement/Research Studies
• Acquire and Analyze Data
• Use Data to Identify Areas for Improvement,
  Support Education / Improve Care
• Support Reporting Requirements
• Manage Data Quality
• Provide Continuous Learning
• Administer Educational Programs Manage Student,
  Resident Experiences

• Facilitate Communications
• Provide Decision Support
• Manage the Patient Record

Project Focus I-V Phase I Bold Italics Longer
Term Italics
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Recommendations

• Work asap (nationally) on political and legal
  issues
• Focus on organisation and processes determine
  similarities
• Establish asap problems that can be solved by
  using IT
• Investigate best practices do not reinvent
  wheels
• Project management (special)
• Technical aspects (standards TCP/IP, CORBA, SQL
  Database Engines, XML, PKI, Java, .Net, HL7 v3
  etc.
• Financial aspects ? business model
• Aspects related to integration (continuum of
  care)
• Technical integration (middleware) and use of
  standards
• for multimedia medical data (DICOM, IHE)
• for CPR (e.g. prEN 13606)
• for communication (HL7 v3, DICOM)
• for professional communication (terminology
  systems e.g. SNOMED CT)

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Thank you for your attention

• Discussion