EU Telehealth Lessons learned on deploying telehealth services by scale 1) Stakeholder View eHealth Week Riga, 13 May 2015 Dr Stephan H Schug, MD MPH Chief Medical Officer, EHTEL stephan.schug@ehtel.eu European Health Telematics Association, Brussels, Belgium

EHTEL, founded 1999, is the one multi-stakeholder platform within Europe that brings together all organisations and individuals engaged in eHealth. Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View 13 May 2015

EC eHealth Stakeholder Group Stakeholder Group managed by DG CNECT, Unit H1 Advisory group of > 30 organisations, each Sending 1 Delegate / 1 deputy delegate from EC call Has been working until end 2014 in the framework of the Digital Agenda for Europe Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare Directive 2005/36/EC on the recognition of professional qualifications etc. Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View 13 May 2015

eHealth actions in DAE Key Action 13 (Action 75) Undertake pilot actions to equip Europeans with secure online access to their medical health data by 2015 and to achieve by 2020 widespread deployment of telemedicine services; EMPOWERING Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View 13 May 2015

eHealth Stakeholder Group Reports Four eHSG reports published 11 April 2014 Patient's access to Electronic Health Records (DAE KA 13/1) Health Inequalities and eHealth eHealth Interoperability Telemedicine Wide Deployment (DAE KA 13/2) Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View 13 May 2015

eHSG Telemedicine Report 2014 eHealth Stakeholder Group Report March 2014 Issue Leader: Dr Stephan Schug - EHTEL Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View 13 May 2015

eHSG Main Finding: Service Type 1 Differentiate two types of telemedicine services with diverse legal and organisational contexts: Medical Act type telemedicine services imply that registered medical doctors perform an existing medical practice over a distance (using digital technologies), like remote reading of x-ray images, remote microscopy or remote assessment of skin images (and many more). These services are already widespread and few pending issues remain, mostly related to cross- border use cases. Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View 13 May 2015

eHSG Main Finding: Service Type 2 Telemonitoring type services: These services provide multi-professional care teams with physiological parameters of the patient, with the support of remote monitoring technologies. Telemonitoring supports patients at home as well as mobile citizens/patients on the move, and facilitates self-management and patient empowerment. Telemonitoring is a disruptive innovation: it challenges health care organisation, professional roles and reimbursement rules. Hence, a well- coordinated process for managing innovations jointly with all healthcare actors is needed. Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View 13 May 2015

Re-designing services with telehealth Patient’s home Hospital or primary care or eHealth centre SERVER PATIENT REGIONAL CENTRE’S OPERATOR TELEMONITORING DEVICES GENERAL PRACTITIONER CARDIOLOGIST AT HOSPITAL OR LOCAL HEALTH DISTRICT OTHER INVOLVED HEALTHCARE PROFESSIONALS GATEWAY & APP 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

Chronic Disease Management A common design for disease management with telehealth across 14 pilot sites from 10 countries for supporting patients suffering from Diabetes Chronic Obstructive Pulmonary Disease Congestive Heart Failure Hypertension 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

Ongoing Health Coaching Diabetes Service Ongoing Health Coaching Patient’s home eHealth Centre GENERAL PRACTITIONER SERVER PATIENT GATEWAY TELEMONITORING DEVICE DIABETOLOGISTS AT HOSPITAL OR LOCAL HEALTH DISTRICT 5 REGIONAL CENTRE’S OPERATOR OTHER INVOLVED HEALTHCARE PROFESSIONALS FAMILY DATA TRANSMISSION DATA ACCESS OPTIONAL CONTACT (DIRECT/INDIRECT) 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

Diabetes Service Patients measure blood glucose level. Encourages self-monitoring glucose and lifestyle risk factors Provides ongoing health coaching Process: Patients measure blood glucose level. Device sends data to the gateway which transmits data to the server of a central location. Algorithms assist healthcare professionals to monitor and manage the data. Patients are able to self-monitor 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

RESPIRATORY SPECIALIST NURSE OR CLINICIAN COPD service Patient’s home Hospital or Primary Care PATIENT BRIEFCASE SERVER GATEWAY RESPIRATORY SPECIALIST NURSE OR CLINICIAN GENERAL PRACTITIONER PULMONOLOGITS AT HOSPITAL OR LOCAL HEALTH DISTRICT OTHER INVOLVED HEALTHCARE PROFESSIONALS DATA TRANSMISSION DATA ACCESS TELECONSULTATION (VIDEO OR TELEPHONE) OPTIONAL CONTACT 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

COPD service: Step Down Intervention 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

COPD Service Monitoring according to three risk levels: Process: High Level: daily tele-consultation (via video-consultation or telephone), pulse oximetry and daily symptom questions Moderate Level: daily pulse oximetry and symptom questions Low Level: optional symptom management questions and text message behaviour coaching Process: COPD patient receives a telemonitoring package upon discharge including video conferencing and pulse oxymeter. The respiratory nurse specialist contacts the patient for video / telephone review. 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

CHF Service Patient’s home Hospital or primary care or eHealth centre SERVER PATIENT GATEWAY REGIONAL CENTRE’S OPERATOR TELEMONITORING DEVICES GENERAL PRACTITIONER CARDIOLOGIST AT HOSPITAL OR LOCAL HEALTH DISTRICT OTHER INVOLVED HEALTHCARE PROFESSIONALS DATA TRANSMISSION DATA ACCESS PHONE CONTACT OPTIONAL CONTACT 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

CHF Service Process: The patient uses monitoring devices to measure heart rate, blood pressure, pulse-oxymetry and /or weight at least once per week). Data is sent to the gateway ad transmitted to the system server. If clinical parameters are out of normal range, algorithms alert an operator who checks with the patient before setting in motion alert procedures. If no measurements are received in a week, the system contacts the patient. Clinicians can access and monitor the patients’ data any time. 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

Hypertension Telemonitoring © Patient’s home Regional eHealth Centre SERVER GATEWAY REGIONAL CENTRE’S OPERATOR GENERAL PRACTITIONER TELEMONITORING DEVICES PATIENT DATA TRANSMISSION DATA ACCESS THROUGH HOME CARE PORTAL ALARM MANAGEMENT 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

Hypertension Telemonitoring Process The patient uses monitoring devices (RR, pulse, weight etc.), Results are automatically sent to the information system. A web portal is available to participants and medical staff to access the collected results and some additional information: General information the program (available to everyone); An e-learning module; A complete view of the participant’s file, available only to the participant to the health care program and the authorized medical staff. Email and SMS notifications can be sent to the participant and to the authorized medical staff. 12/11/2018 Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View

eHSG Report Recommendations 1 Patients should have equal access to telemedicine services as part of standard health and social care schemes - and not just case by case - if services are beneficial and cost-efficient. Digital literacy and training in using eHealth tools should become part of the educational curricula of all Health Professionals while no extra qualifications for telemedicine needed. Transparency on the identity of a health professional providing a service must be maintained also for remote medical services, allowing e.g. patient's look-up for licensing and certification Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View 13 May 2015

eHSG Report Recommendations 2 Benefit and added value of telemedicine services should be systematically monitored and evaluated to allow for justified inclusion into guideline supported clinical practice. All telemedicine services - and in particular those involving cross-border transfer of patient data - must safeguard valid data protection including a declaration of informed consent. Health and social care services shall maintain a helping hand to their clients, i.e. telemedicine services shall not replace feasible/useful patient– health professional encounters. Lessons learned on deploying telehealth services by a large scale – 1) Stakeholder View 13 May 2015