1. 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
European Health Telematics Association, Brussels, Belgium

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. 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

17. 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

18. 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

19. 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.
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

20. 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

21. 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