Telehealth Innovations for Europe
There is a general consensus on the urgent need for redesigning European Healthcare Systems to overcome current dysfunctions and to achieve mid-term financial sustainability. Four major factors have been identified as driving forces for the change in healthcare in Europe:
- Ageing of the population
- High prevalence of chronic conditions
- Excessive use of avoidable complex procedures
- Increasing demands of citizens
It is widely accepted that adoption of the Chronic Care Model (WHO), constitutes the most appropriate solution to deal with current healthcare dysfunctions and to ensure sustainability of the system. It is of note, however, that a full implementation of such model of care in a given territory of the European Union has not been achieved so far. Extensive deployment of integrated care services (ICS) for chronic patients supported by Information and Communication Technologies (ICT) constitutes a first priority toward the development of a new health paradigm.
There is increasing evidence that adoption of integrated care with support of ICT will not only enhance efficiency of healthcare by improving clinical outcomes while generating cost-containment, but it will also modulate the natural history of chronic disorders improving patient’s prognosis. EU deployment programs (e.g. CIP-PSP) with projects like NEXES play a pivotal role fostering the transition towards sustainable integrated care settings supported by ICT. The truth is that ICT not only plays a role as enabler of ICS, but it opens new avenues for healthcare, as indicated by the concept 4C Medicine:
Continuity – ICT facilitates longitudinal analysis of events. Consequently, it is extremely useful to integrate information beyond clinical episodes facilitating the study of processes as well as the management of patients through programs. A direct consequence is that ICT fosters Preventive Medicine in front of the current practice based on Reactive Medicine.
Communication – Among equipments, among actors and between actors and measurement systems is greatly facilitated by ICT. Moreover, the potential for data integration and generation of information has prompted the concept of Predictive Medicine and the development of new disciplines such as Systems Medicine, that are triggering a revolution in healthcare (Personalized Medicine) within the current decade.
Collaboration – Communication leads to interoperability among actors, with measurements systems and higher accessibility to the healthcare systems. Two immediate consequences are that ICT enables integrated approaches and facilitates an active role of the patient (Participatory Medicine)
Confidentiality – Technological advances together with maturity of ethical and legal aspects allow that ICT can become a tool to ensure confidentiality and provide further support to Participatory Medicine.
We would like to summarize this evolving, and exciting, scenario indicating that ICT by facilitating 4C Medicine is fostering the basic features of the medical practice for this decade. That is 4P Medicine (Preventive, Predictive, Personalized and Participatory). The Figure below displays a realistic roadmap for the key milestones for the current decade. Consolidation of deployment of Integrated Care (2010-2013) will be followed by further expansion of mobile technologies with enhanced user interfaces (2012-2015) and medical application of the current concepts of Systems Biology fostering Systems Medicine (beyond 2015)
The transition toward 4P Medicine will be done in a rapidly evolving healthcare scenario whose main features will be:
- Human resources will be more stretched
- Social care will blend with healthcare
- Healthcare providers will need to focus on sustainability – both financial and environmental.
- Patient experience will matter more – patients will have more choices and will be more able to act on them
- Hospitals of the future will be mostly dedicated to those procedures requiring high technology skills and infrastructure. Therefore, they will be based on intensive and intermediate care units, and day-care units.
- Chronic patients management will be based on community healthcare, where multidisciplinary teams of professionals will work around the patient’s needs. Home care organization supported by ICT will be the key player.
The expected results at the end of this transition should include:
a) enhanced prevention and treatment capabilities
b) innovative healthcare systems with implementation of follow up procedures directly at citizens home
c) slowing down of health expenditure increase
d) development of novel interdisciplinary training curricula
e) better structuring of translational research for chronic diseases.
 The Future of Healthcare in Europe (The Economist conferences, Geneva, 17 March 2011)
 Epping-Jordan JE, Galea G, Tukuitonga C, Beaglehole R. Preventing chronic diseases: taking stepwise action. Lancet 2005 Nov 5;366(9497):1667-71
 Horton R. The neglected epidemic of chronic diseases. Lancet 2005;366(9496):1514
 NEXES Supporting Healthier and Independent Living for Chronic Patients and Elderly (Pilot B, CIP-PSP, 2008-12, contract 225025
 Kitano H. Foundations of Systems Biology. MIT Press. 2001
 Bousquet J et al. Systems medicine and integrated care to combat chronic noncommunicable diseases. Genome Med. 2011;3(7):43