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Working Towards an EU-wide Telehealth Strategy

Submitted by on 09 Mar 2012 – 15:20

Working Towards an EU-wide Telehealth Strategy

Working towards an EU-wide telehealthLessons learnt from Deployment  programmemes

Viewpoint:     Josep Roca, MD, PhD

Hospital Clinic (HCPB). University of Barcelona

The results of large deployment  programmes both in Europe and USA, together with the information generated by on-going initiatives like SIMPHS[1] picturing the trends in ICT for Health at EU level, provide the elements needed to progress towards a successful EU-wide Telehealth Strategy.

In our experience, the lessons learnt in NEXES[2] can be generalized to the European scenario. The main aim of the project has been the deployment of Integrated Care Services (ICS) for chronic patients using ICT support. NEXES is build-up around four types of innovative ICS including well standardized patient-centred interventions designed to develop the practicalities of the Initiative for Chronic Care Conditions (ICCC) endorsed by the World Health Organization (WHO)[3].  In NEXES, the enabling role of the ICT platform encompasses several dimensions, namely: enhanced accessibility for both patients and professionals, information sharing among all stakeholders and remote monitoring.

The project has been conducted in three different sites: Barcelona (Spain), Athens (Greece) and Trondheim (Norway). Although the specificities of each site have represented a challenge during the take-up, they are also an opportunity to generate outcomes with validity at European level. Nexes is addressed to target chronic patients with respiratory disorders, mainly chronic obstructive pulmonary disease (CODP); chronic heart failure (CHF) and coronary artery disease (CAD) and diabetes type II. The four services deployed are:

Wellness and training (W&T) – The underlying hypothesis being that enhanced self-management using mobile ICT plus a remotely controlled home-based training  programmeme should have a positive impact on life style, disease progression and use of healthcare resources. The service is addressed to clinically stable chronic patients with moderate to severe disease, recruited in primary care and in hospital outpatient clinics.

Enhanced care for frail patients (EC) - The services within the programme cover a broad spectrum of patients: a) those showing history of frequent exacerbations that generate repeated unplanned hospitalizations; b) post-hospital discharge; c) end-of life care; and, d) patients in primary care showing health or social factors determining frailty. In Nexes, we have identified that categorization of frailty and complexity of care constitutes a key element to properly stratify coordinated care in these patients.

Home hospitalization and early discharge (H) – Home hospitalization is well characterized and its efficacy, as well as cost containment, has been proven. We have explored the use of ICT support is a key component to enhance efficiency of home hospitalization

Remote support to primary care for diagnosis and therapy (Support) - The main aim has been to deploy remote ICT support to both primary care and home services to enhance diagnostic and treatment capacity. During the development of the project, we have identified several new niches for potential extension of this type of service that will likely have a significant impact fostering shared care agreements between levels of care.

A common and most prominent feature shared by all three sites has been the transfer of complexity from hospital to primary care and patient-home. It is of note, however, that the profound differences among sites on the modalities of interactions between hospital and primary care have had a marked influence on the evolution of the project. Interestingly enough, the three sites are somehow representative of three major scenarios that can be faced in a transition toward integrated care:


ü      Primary Care driven transition to integrated territorial care (Norway)

ü      Hospital driven transition to integrated territorial care (Barcelona, Spain)

ü      Fragmentation of the between Primary Care and Hospitals (Athens)


The experience acquired during the lifetime of the project (from mid 2008 to Spring 2012) is generating two main achievements:


ü      First, a convergence toward the formulation of a proposal of a common final model for ICS at European level; and,

ü      Second, specific strategies for the transition period that are largely dependent of the initial adscription to one of the three scenarios alluded to above. Those strategies are tackling well identified barriers for extensive deployment: a) interoperability; b) regulatory issues; c) reimbursement and business models; d) evidence of benefits; and, organizational aspects.


At the end of the project, NEXES has generated a conceptual frame that should facilitate extensive deployment of ICS for chronic patients at European level. Moreover, during the last phase of the project different experiences of collaboration with Nexes are being formulated in several countries. It is expected that some of these experiences might consolidate in Italy, Greece, France and the Netherlands.

We believe that NEXES is contributing to reach maturity for extensive deployment at regional level in the project’s sites. Further cooperative efforts are needed both at site level and with other regions to successfully undertake reshaping of European Health Care Systems.


[1] SIMPHS_Strategic Intelligence Monitor Personal Health Systems. JRC-ITPS -2009-2013.

[2] NEXES: Supporting Healthier and Independent Living for Chronic Patients and Elderly (CIP-PSP pilot B 225025; 2008-2012)

[3] Epping-Jordan JE, Galea G, Tukuitonga C, Beaglehole R. Preventing chronic diseases: taking stepwise action. Lancet 2005;366:1667-71