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Expanding Telehealth to Help Address the Healthcare Challenge of the 21st Century

Submitted by on 07 Oct 2011 – 13:20

Expanding TelehealthRegina Haberkorn, Marketing, Robert Bosch Healthcare, Denham, UK

An industry viewpoint
The Challenge

One of the greatest challenges facing all EU member states is the simple fact that EU citizens are living longer. An ageing population, with the associated rise in the number of people with long term conditions and chronic illness, inevitably poses real problems for health policy makers.  Foremost amongst these challenges is the question ‘how can Member States, and the European Commission, adapt health systems to ensure they are able to withstand such demographic change?’

Telehealth, or telemedicine as some prefer to describe it, has the potential to help meet this challenge.  The benefits of using technology to provide communication between the patient at home and their care providers have been well documented. Indeed Commissioner John Dalli remarked in a speech to the CeBIT conference in March 2011 that telehealth can[1]:

  • Improve the quality of, and access to, healthcare;
  • Increase the efficiency of health systems; and
  • Support patient-centred health systems

Our Experience

The Bosch telehealth system have been used by over 150,000 patients and today there are more than 50,000 patients, particularly in the US, who actively use our system.

More than 30 different studies have been carried out using the Bosch telehealth system over the past 10 years  –  and the results have been published in a variety of scientific journals or at medical congresses. The studies were conducted with patients suffering from a variety of diseases and they all highlighted a range of positive results in terms of clinical and cost outcomes. These results particularly support the value of using content-based remote patient monitoring such as the Bosch telehealth system, which provides patients with information that delivers comprehensive patient coaching and education and is not simply focused on vital sign monitoring.

The results have consistently demonstrated that patients benefit from an improved quality of life, enhanced compliance, increased life expectancy and a reduction in hospitalisations.

In particular:

Various Long Term Conditions / Hospital Admissions

A case study from the Care Coordination Home Telehealth (CCHT) programme carried out by the US Veteran´s Health Administration showed for a cohort of over 17,000 people with various long- term conditions a 19.74% reduction in hospital admissions and a 25.31% reduction in bed days of care following enrolment in the programme².

Congestive Heart Failure / Compliance

In a preliminary evaluation of the Dutch TEHAF 2 trial, telehealth significantly improved disease-specific knowledge as well as adherence in terms of fluid restrictions, daily weighing, physical exercising and alcohol restrictions³.

Chronic Obstructive Pulmonary Disease (COPD) / Health-related quality of life

In a randomised controlled trial conducted at the University of Colorado Hospital health-related quality of life in patients with severe COPD significantly improved after just 12 weeks, with reduced costs at the same time. This effect was confirmed in a large scale follow-up trial4.

Reduced costs

An improved patient experience should be the primary objective of all health policy makers, but of course it is also vital in these times to study the financial savings that telehealth can deliver.

A recent demonstration project, the results of which were published in HealthAffairs, highlighted the savings that can be achieved. The key to delivering such savings was to deploy telehealth within a coordinated care delivery approach. The project, using Bosch’s telehealth system, highlighted that telehealth programmes can provide savings from 7.7 to 13.3 percent in healthcare spending per patient per quarter over the two-year period studied5.

Given that the treatment of people with long term conditions accounts for around 70% of health costs across the EU, it is clear that telehealth, used effectively, can deliver very large financial savings.

What needs to happen now?

So what needs to happen for telehealth to become mainstream across the EU? The main actors responsible for the rollout and development of telehealth will remain the Member States who are responsible for the structure of their respective health care systems.

But the sharing of data and research findings across the EU will assist all telehealth providers to increase pressure on national policy makers to implement telehealth. The European Commission can assist with such collaboration – research and pilot studies undertaken in one part of the EU should be easily available across all Member States.  The days when people asked for more evidence and pilot studies should be over.

The European Commission can also play an important role in ensuring that the necessary infrastructure is in place for the wide scale roll out of telehealth – particularly the development of high speed broadband. And the Commission should assist patients across the EU to take a much more active interest in their own health care. Through education, patients can be equipped with the knowledge they need to take a more active role in their care. This can play a key role in reducing the number of emergency admissions to hospital.

Finally, as COCIR highlighted in their report published in 20106, it is important that the Commission works with the Member States to develop a clear legal framework for telehealth across the EU. The opportunities that the use of technology can bring within healthcare require us all to work together and ensure that opportunities are not missed.

References

1 Commissioner Dalli speech http://ec.europa.eu/commission_2010-2014/dalli/docs/speech_telehealth_01032011_en.pdf

² Darkins A, Ryan P, Kobb R, Foster L, Edmonson E, Wakefield B, Lancaster AE. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health 2008;14:1118-26.

³Ramaekers BLT, Janssen-Boyne JJ, Gorgels APM, Vrijhoef HJM. Adherence among telemonitored patients with heart failure to pharmacological and non-pharmacological recommendations.

Telemed J E Health 2009;15:517-24.

4Koff PB, Jones RH, Cashman JM, Voelkel NF, Vandivier RW. Proactive integrated care improves quality of life in patients with COPD. Eur Respir J 2009;33:1031-8.

5Baker, et al, Integrated Telehealth and Care Management Program for Medicare Beneficiaries with Chronic Disease Linked to Savings.

6 http://www.cocir.org/uploads/documents/-40-cocir_position_paper_on_telemedicine_-_17_february_2010.pdf