Health Check: The Rise of Telecare in Europe
Telehealth services are on the brink of taking off. The UK and France are among the European countries leading the way and showing just how it can be done.
March 17 , 2013
Streets of half-timbered houses with steeply sloping red-tiled roofs suggest change comes slowly to Colmar, the city at the heart of France's Alsace wine region.
But when it comes to providing healthcare its authorities are breaking with tradition. Since January, residents of Colmar's care homes for the elderly have been trialing an ambulatory video-conferencing service that links doctors via a high definition camera to patients under their care. Nurses wheel the video-conferencing unit, which is installed on a trolley, between patients and help them with the consultation.
Alsace hopes the video-conferencing service will cut the time doctors spend travelling between eight nursing homes, thereby enabling them to see patients more regularly, and improve access to remote specialist care.
"It allows doctors to see patients more often and for shorter periods, which allows for better overall patient care," says Christine Lecomte, director of Alsace E-Santé, Alsace's telehealth project. The health authority also aims to reduce emergency hospital admissions.
"We'll do an economic study…but cost will not necessarily be the most important aspect. We will also be looking at quality of care," explains Lecomte. "Life expectancy decreases with each hospital admission." During 2013 Alsace E-Santé will extend trials to five additional organizations, including prisons and care homes for the handicapped, she adds.
Alsace E-Santé is one of several trials in France, and recent research suggests telehealth is finally on the brink of growth. In 2012 only 308,000 patients worldwide were monitored remotely for conditions including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, hypertension and mental health conditions, according to InMedica, a division of IHS Research. It forecasts telehealth services will reach 1.8 million patients worldwide by 2017 (see chart).
Europe's most ambitious program is in the UK. Unlike France, where private insurance pays for a percentage of an individual's medical cost, the UK's National Health Service (NHS) acts as both the payer and provider of healthcare, giving it greater freedom to undertake trials that have unproven financial benefit.
"Healthcare providers want to do it for the quality of care, but the financial side doesn't always add up, so the insurance company doesn't want to get involved," says Theo Ahadome, senior analyst at InMedica, IHS. "The UK can take a longer-term view."
In January 2012, the UK government announced the "3 million lives" project which aims to extend the uptake of telecare and telehealth services. Three million represents the number of people with long-term medical conditions and/or social care needs whom the government estimates can benefit from such services.
The 3 million lives program grew out of the UK's Whole System Demonstrator, a randomized set of telecare and telehealth trials involving 6,191 patients across 238 medical practices which began in May 2008. The trials showed a 20% reduction in emergency admissions, a 15% reduction in A&E visits, a 14% reduction in elective admissions, a 14% reduction in bed days and an 8% reduction in tariff costs, according to the UK government. Perhaps most strikingly of all, it claims the trials demonstrated a 45% reduction in mortality rates over the period.
Large scale trials are essential if the medical and financial benefits are to be proven, says Ahadome.
Paul Rice, Telehealth Lead, HIEC, Yorkshire and Humber, agrees: "Unless there is a robust evidence base for remote telemonitoring one would struggle with detractors."
Authorities in the Yorkshire and Humber region have run multiple telehealth trials and projects, which have involved between 1,500 and 2,000 patients.
"The business and moral case for teleconsultation is irresistible, how could we justify poor access on the grounds of geographical remoteness or lack of specialist expertise when the technology enables us to bridge that gap seamlessly?" asks Rice.
"Patients with confirmed diagnosis of chronic disease are inevitably on an arc of deterioration. The question is how do you smooth that arc…and build an effective community-based model of care enabled by technology? We cannot warehouse patients," says Rice.
Routine monitoring enables doctors to determine whether a patient's condition is stable or deteriorating, enabling them to take action before the individual is in need of emergency treatment.
"Every COPD [chronic pulmonary] admission will be thousands of pounds, and admission may result in a lack of independence or transferal to a residential home," says Rice.
Telehealth provides the potential to "get the right physician to a patient… [create new] decision support tools, and [build] a richer dialogue with the patient," says Rice.
The economics and usage of telehealth are being helped by a change in how equipment and service suppliers are working with health authorities, says Rice. "
"Suppliers are moving away from per-box pricing…and have come to understand that the model has to be more sophisticated. They are looking, for example, at charging for how many hours that technology is being used for," says Rice.
The spread of smartphones and connected TVs could also simplify telehealth deployment, enabling healthcare authorities to connect more widely with patients both in their homes and on the move.
"Today there are still medical-looking white boxes in the corner of the room," says Rice. "Three to five years out patients won't be using anything like the products we're using today. The data is the compelling thing: not …which device is used," says Rice.
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