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Telemedicine: The Future of Healthcare Provision?

Telemedicine: The Future of Healthcare Provision?

Our first contributor is Diederick Geerinckx, Managing Director of Vitalsys, a Belgian company specialising in telemedicine integration, systems and services. He provides an introduction to telemedicine, outlines the key benefits for physicians and patients, and describes two interesting telemedicine products.

Telemedicine is the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.
In traditional medicine, patients with chronic diseases have to consult their doctor on a regular basis. Often, patients have to wait a long time in the doctor’s waiting room and are stressed when they have to be examined. Due to this stress factor, the results can be affected and a correct diagnosis isn’t always easy to make. With telemedicine technology, patients can take measurements in their own home while their doctor consults the measurements in real time at his or her surgery or hospital.  

How does telemedicine work?

The idea behind telemedicine is simple but the technology is advanced. Once the measurement is taken by a patient in the home environment, the collected data is sent by SMS or GPRS (General Packet Radio Service) to a special software platform.

“At Vitalsys we have developed a telemedicine software platform called VitalCare,” says Diederick Geerinckx. “Here, the data is analysed and converted into graphical form or a report for physician viewing. In the case of an emergency, the physician is immediately alerted by SMS and immediate action can be taken.”

All-round benefits

The benefits of telemedicine extend to both patient and physician. For the patient, the system must work accurately and be extremely easy to use. “It’s absolutely vital that patients – especially elderly ones – can use telemedicine products quickly and easily to avoid stress,” explains Geerinckx. “We have therefore devoted a lot of resources to making our products totally user-friendly.”

Physicians can follow up their patients over several months; they can consult the data at any given time; and they can change the treatment if necessary according to the results. “Doctors also have fewer patients in their waiting rooms, which reduces their work pressure,” adds Geerinckx. The time savings possible also lead to financial savings. It has been calculated that in Belgium alone, coagulation monitoring via telemedicine could save up to 14 million euros a year.

Diverse application areas

Telemedicine can be used in many different areas of medicine. The most common application areas are weight and blood pressure measurements, but the technology can also be useful for diabetes monitoring, coagulation monitoring and medication compliance.

Vitalsys offers numerous devices focusing on hypertension, heart disease, respiratory problems and diabetes. One device is the CoaguChek XS^®Plus system, which enables healthcare professionals to follow up patients who have been treated with oral anti-coagulants. The device measures the coagulation of the blood and transfers the data to the VitalCare platform for further analysis.

Another device is the Vitalsys automatic pill dispenser. It notifies patients when they need to take their medication, and alerts the doctor when the patient forgets. This kind of medication compliance can only be realised by the use of telemedicine.

“Physicians using any of our telemedicine devices only need a cell phone and access to the VitalCare platform, which allows the secure processing of medical data: reception, transmission, storage, graphical presentation and statistics.” explains Geerinckx. “They can then be up and running with a telemedicine application virtually immediately.”

More information: www.vitalsys.be

Clinical Effectiveness and Cost Effectiveness in Telemedicine

Our second contributor is Christopher Heinrich from Tanaka Business School, Imperial College London. He argues that a proper assessment of the opportunities and risks of telemedicine is needed, and focuses on two issues: clinical effectiveness and cost effectiveness.

Advances in ICT and a decline in cost are making telemedicine much more feasible, both from the technical and economic perspective. However, as it is a major development in healthcare, a proper assessment of the opportunities and risks of telemedicine is essential. Two of the main issues are clinical effectiveness (the extent to which telemedicine improves the patient outcome) and cost-effectiveness (the relation between cost and outcome of the programme).

Clinical effectiveness

Telemedicine helps to provide access to the latest knowledge in healthcare, for example through opening the possibility for remote diagnosis, especially in rural areas. It also increases the comfort of treatment for the patient, by avoiding patient transport, reducing waiting times and enabling access to the latest thinking in special treatments.

“Telemedicine therefore has great potential to increase clinical effectiveness,” says Christopher Heinrich. “However, there are some constraints which challenge the clinical effectiveness of telemedicine.”

These challenges include:

• Legal issues: e.g. regarding responsibility for the treatment or reimbursement
• Confidentiality and security of data: telemedicine implies a greater availability of the patient record, so how can unauthorised access and abuse of data be avoided?
• Impersonality in healthcare, which could harm the doctor-patient relationship
• Lack of technical standards: impeding the information exchange between healthcare providers (for example between physicians and tertiary care providers).

Cost effectiveness

“If telemedicine is proven to be clinically effective, there is still the question as to whether it is cost effective,” remarks Heinrich. The financial factor is a key reason for introducing telemedicine applications (Smith 2005). Cost savings can be gained, for example through moving data instead of the patient or the professional, or through greater utilisation of expert knowledge and equipment (such as CT or MRI scanners).

However, systematic trials show rather poor evidence for cost effectiveness of telemedicine (Whitten et al 2002). “Furthermore, initial costs, for equipment, staff training and patient training, are still very high,” adds Heinrich, “as are telemedicine maintenance costs, for technical updates, training of maintenance personnel, and cost of malfunctions.” 

Balancing the equation

Balancing potential benefits and risks is always going to be a challenge in formulating a strategy for telemedicine applications. “Telemedicine definitely offers added value for the patient through a variety of benefits in the area of clinical effectiveness. However, it should not be regarded as a panacea for healthcare problems, as a variety of challenges have to be overcome. But telemedicine will definitely play an increasingly important role in healthcare provision.”

Smith, D., 2005. The Influence of Financial Factors on the Deployment of Telemedicine. Journal of Healthcare Finance, 32(1), pp. 16-27.

Whitten, P.S., Mair, F.S., Haycox, A., May, C.R., Williams, T.L. and Hellmich, S., 2002. Systematic review of cost effectiveness studies of telemedicine interventions. British Medical Journal, 324(7351), pp. 1434-1437.

Christopher Heinrich is currently studying for a Masters Degree in International Health Management at Tanaka Business School, Imperial College London. He holds a Bachelor Degree in Politics and Administrative Science from the University of Konstanz, Germany. He has considerable experience in business consulting through several years of work for consultancies in healthcare and other industries.

Telemedicine on the High Seas

One area where telemedicine has been used for many years is at sea. As far back as the 1920s, radios were used to link physicians standing watch at shore stations with ships at sea that had medical emergencies.

Current telemedicine solutions for ships must be able to use satellite communication, with the limits to message size and real-time applications that this introduces. The most innovative solutions being developed are highly flexible, in that they are able to use several communication carriers depending on what is available at any time. For instance, video communication may be used when within VSAT coverage, while message based communication could be used in other situations.

One particular challenge facing the further implementation of maritime telemedicine solutions is that the onshore doctor has virtually no knowledge of the patient, apart from the description that is received from the ship. This makes it more difficult to give accurate diagnoses and medical advice. A significant improvement would be a maritime medical card. For such a smart card solution to work, a critical mass of seafarers would need to be enrolled. There would also need to be a common understanding between radio medical centres of what information is needed and in what format. A large-scale trial is also essential.

Funding issues also need addressing: ship owners are entitled to free services, but government funding is at a minimum. International standards for secure communication are also lacking, making universal systems difficult.

However, all these challenges are surmountable, and indeed must be solved to enable seafarers to receive high quality medical assistance.

Another interesting application of telemedicine is described in this month’s Expert View. Viktor Grinewitschus explains some of the capabilities of the new inHaus Centre of the Fraunhofer Institute. Here, innovative product components and system solutions are developed and tested, including healthcare IT and telemedicine systems.

“Telemedicine: Does it work in practice?”

We put this question to Victor Moga from the University of Medicine and Pharmacy in Timisoara, Romania. For the last four years he has been involved in the Romanian-Italian Telemedicine Project.

“This bilateral project is between the Italian regions of Lombardy and Toscana, and Timis County in Romania. It is supported by the Italian Ministry of Foreign Affairs, and led by the Associazione Italiana di Telemedicina e Informatica Medica. The design of the architecture and technical support was provided by Timisoara University, Romania and Milano-Bicocca University, Italy.

“The result is a healthcare network linking two hospitals. It enables teleconsulting between specialists in the Carreggi Hospital in Florence and physicians in the Emergency County Hospital in Timisoara, with regard to patients admitted to the departments of cardiology, radiology and pathology in the Timisoara hospital.

“The main teleconsulting activities are in the cardiology clinic and include the transmission of results of clinical data (images and video files), X-rays and echocardiographic video files. From the radiology department X-rays and clinical images are transmitted.

“Our patients in Romania are extremely enthusiastic. We obtain verbal consent from them before any of their information or images are transmitted. As to the doctors, initially they were quite reserved. As the project progressed they became more positive when they realised the benefits.

“Telemedicine now has a definite place in our clinic and the interest for such projects is increasing. We recently applied for funds to start a new project called CARDIODIAGNET, which is dedicated for proceedings in non-invasive cardiology and of course for e-learning and telemedicine. We hope it will be a consortium with six other partners (including non-EU countries such as South Africa and Israel). We intend to share ECG tests, blood pressure and heart rate Holter monitoring, stress tests, pacemaker data and echocardiography images.

“In my opinion the main benefit of telemedicine is to enhance communication by allowing information to be shared with colleagues worldwide. It also improves the quality of healthcare we can provide our patients.”

With thanks to Prof. Lacramioara and Vasile Stoicu Tivadar from the Medical Informatic Department of the “Politehnica” University of Timisoara; Mariana Moga and colleagues from the IT Department of the Emergency County Hospital Timisoara; and Prof. Francesco Sicurello and Dr. Gianni Pellicano in Italy.

Questions anyone?
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