11381916434428441.ppt

8/14/2019 11381916434428441.ppt

1/37

Claus Duedal Pedersen

Head of Unit

Odense University HospitalRegion of Southern Denmark

8/14/2019 11381916434428441.ppt

2/37

2

It all takes time

RENEWING HEALTH in a nutshell

Evaluating telemedicine

Results & Expectations

Table of Content

8/14/2019 11381916434428441.ppt

3/37

In 1747

Scurvy =Skrbug/Skrbjugg/Skorbut/Niekingas/Keripukki/Szkorbut

Scurvy rife, massiveimpact on cost of life,capacity to fight

James Lind tested 12 illmen with treatmentsincluding lemon juice(vitamin C)

Successfulfirst clinicaltrial?

So it was adopted

in 1800

In 1747....

3

8/14/2019 11381916434428441.ppt

4/37

8/14/2019 11381916434428441.ppt

5/37

Need for knowledge

EU commission found:

Lack of high quality evidence on the

effectiveness of telemedicine:

A main barrier for wider use

And the EU project, RENEWING HEALTH, was

funded as a pilot A, PSP-ICT project.

8/14/2019 11381916434428441.ppt

6/37

6

Project start date: 1stof February 2010

Project duration: 47 months

Total budget: 14.000.000 Euros EU contribution: 7.000.000 Euros

26 pilot sites, grouped in 10 clusters and

distributed over 9 EU regions

RENEWING HEALTHin a nutshell

8/14/2019 11381916434428441.ppt

7/37

7

8/14/2019 11381916434428441.ppt

8/37

8

It comprises all the relevantstakeholders

Regional Health Authorities

Regional Healthcare Providers Competence Centres in Telemedicine

Patient and professional (through their

associations)

Industrial companies (through their

associations)

Consortium

8/14/2019 11381916434428441.ppt

9/37

Region Syddanmark DenmarkRegione del Veneto ItalyNorrbottens Lns Landsting (County Council of Norrbotten) SwedenLulea Tekniska Universitet - Centre for Distance-spanning

Healthcare SwedenHelse Nord RHF - Northern Norway Regional Health Authority NorwayUniversitetssykehuset Nord-Norge HF (Norwegian Centre for

Integrated Care and Telemedicine) NorwayMinisterio de Salut - Generalitat de Catalunya SpainAgncia d'avaluaci de Tecnologia i Recerca Mdiques

(Catalan Agency for Health Technology Assessment and

Research) SpainEtel-Karjalan sosiaali- ja terveydenhuollon kuntayhtym(South Karelia Social and Health Care District) FinlandAnaptyxiaki Diadimotiki Eteria Psifiakes Polis Kentrikis Elladas

AE OTA (Intermunicipal Development Company Digital Cities

of Central Greece S.A.) GreeceAnaptyxiaki Etaireia Dimou Trikkaion Anaptyxiaki Anonymi

Etaireia OTA (e-Trikala AE) Greece

Consortium

9

8/14/2019 11381916434428441.ppt

10/37

Municipality of Trikala GreeceDiikisi 5th Ygionomikis Periferias D.Y.P.E. Thessalias kai

Stereas Ellados (Regional Health Authority of Sterea &

Thessaly) GreeceEuropean Patients Forum LuxembourgEuropean Health Telematics Association BelgiumContinua Health Alliance Private Stichting BelgiumFundaci TicSalut SpainKrankenanstalten Betriebsgesellschft AustriaLand Krnten AustriaPflegewerk Managementgesellschaft Germany

Consortium

10

8/14/2019 11381916434428441.ppt

11/37

11

Consortium

Regione Veneto (I) Norrbotten County (S)

(DK) North Norway (N)

South Karelia (F) Catalonia (E)

The Regions

8/14/2019 11381916434428441.ppt

12/37

12

Consortium

Carinthia (A) Central Greece (GR)

Berlin (D)

The Regions

8/14/2019 11381916434428441.ppt

13/37

13

Consortium

The Competence Centres

8/14/2019 11381916434428441.ppt

14/37

14

Consortium

The patients, industrial andeHealth Associations

8/14/2019 11381916434428441.ppt

15/37

Objectives

15

Quality

ofLife

10,000

1,000

100

10

1

Adapted from Intel

SpecialtyClinic

CommunityHospital

ICU

Acute Care

Assisted

Living

Skilled

Nursing Facility

ResidentialCare

Independent,

Healthy Living

Community

Clinic

Chronic Disease

Management

Doctors

Office

Tele-homecare

8/14/2019 11381916434428441.ppt

16/37

16

Clinical objectives improving the quality of life of chronic patients who,

for just the three chronic diseases addressed in theProject, account for well over 15% of the EU adult

population by removing anxiety about health conditions

reducing the need for the patient to use emergencyservices and/or hospital stays

avoiding and/or slowing down the worsening of their

disease and the insurgence of complications providing clinical evidence that, at least for certain

chronic diseases, a telemedicine-based delivery networkcan supply healthcare services at least of the same clinicalquality and reliability as those supplied through a

traditional healthcare delivery network

Objectives

8/14/2019 11381916434428441.ppt

17/37

17

Patient/user perspective objectives providing coherent clinical services through ICT thattake into proper consideration patients andprofessional users needs, capabilities, risks andbenefits

implementing solutions that support theempowerment of the patients and increase patientssatisfaction

demonstrating that the implementation oftelemedicine services improves the professionalsatisfaction of the involved healthcare professionals.

measuring patients, relatives, informal caregiversand healthcare professionals satisfaction (through

questionnaires)

Objectives

8/14/2019 11381916434428441.ppt

18/37

18

Economic objectives containing the cost of care for chronic

patients to maintain the health system

sustainable in spite of the demographic

changes

reducing the reliance of chronic patients on

the expensive care facilities and replacing

them with more affordable homecare

Objectives

8/14/2019 11381916434428441.ppt

19/37

19

Organisational objectives cutting across the traditional fences among

different levels of care

creating an organisational model for

telemedicine services that ensures a safe, clearand efficient pathway for patients in theirjourney through the healthcare system

promoting active participation of the patients

in the organisational model

measuring the organisational impact oftelemedicine in both a qualitative andquantitative manner

Objectives

8/14/2019 11381916434428441.ppt

20/37

20

Size 20 partners + 5 Competence Centres 7.900 patients in the Intervention Group

21 pilot sites

10 different telemedicine services Multicultural character

Partners come from 11 different EUcountries nicely covering Northern, Central

and Southern Europe

Evaluation methodology

Randomised Controlled Trials

MAST

The numbers

8/14/2019 11381916434428441.ppt

21/37

RH Organisation

03/11/2013 21

7158 patients

84 centres

21 pilots

10 clusters

3 diseases

9 countries

1 observ.

9 RCTsDM

COPD

CVD

8/14/2019 11381916434428441.ppt

22/37

RH clusters

Cluster

PATHOLOGY

VENETO

SYDDANMAR

K

NORRBOTTE

N

NORWAY

CATALONIA

S.KARELIA

THESSALY

CARINTHIA

BERLIN

N

Cluster 1

DM

X X X X 755

Cluster 2 X X X 930

Cluster 3 X 400

Cluster 4

COPD X X X 826

Cluster 5 X X X 625

Cluster 6

CVD

X X 475

Cluster 7 X X 465

Cluster 8 X 2080

Cluster 11 X 450

Cluster 10 X 152

TOTAL 7158

8/14/2019 11381916434428441.ppt

23/37

23

Why clusters

The concept of clusters has been introduced for: grouping existing telemedicine services,

although using heterogeneous technological

platforms, according to their aim, timing and

duration of the intervention increasing the statistical power of the trials by

aggregating data from the various pilots of a samecluster

promoting close collaboration and sharing ofexperience among teams which have neverworked together before RENEWING HEALTH

i i i

8/14/2019 11381916434428441.ppt

24/37

24

Minimum requirements

for a cluster

All pilots belonging to a same cluster willshare a common set of primaryindicators

Each cluster of pilots will operate as amulti-centre clinical trial (aggregationof data)

For each cluster a Scientific Trial

Protocol will be elaborated thatincludes, a.o., a detailed description ofobjectives, design, methodology,

outcomes, statistical considerations

8/14/2019 11381916434428441.ppt

25/37

Two examples of services

8/14/2019 11381916434428441.ppt

26/37

Patients situation (at home) Hospital (Odense University Hospital & Svendborg Hospital)

PATIENT

NURSE

ALARM

6

2

DATA TRANSMISSION DATA ACCESS ALARM MANAGEMENT

3

HOSPITAL VIDEO

INTERFACE

PATIENT

BRIEFCASE

1

HOSPITAL

INFORMATIO

N

SYSTEM

MONITORING

5

TELEMONITORING

DEVICES

4

Cluster 4: COPD

Southern Denmark (DK)

26

8/14/2019 11381916434428441.ppt

27/37

Cluster 4: COPD

Southern Denmark (DK)

1. A COPD patient admitted with exacerbation is discharged fromhospital and a Patient Briefcase with video interface is installed in thepatients home

2. Daily for 1-2 weeks, a specialised nurse will make a scheduled tele-consultation with the patient, who is at home

3. Through her computer at the hospital, the nurse can connect to thepatient via video. Beside the video screen, she has access to thepatients electronic patient record on a second screen

4. During the video consultation, the patient is asked to use the twomeasurement devices (spirometry and pulse-oximetry), which theyreceived along with the Patient Briefcase

5. The data from the devices are transmitted through the Briefcase to aseparate system at the hospital. The nurse can view themeasurements on a third screen in her office. Based the conversation,observations and measurements, the nurse is able to assess thepatients condition and take appropriate actions

6. If a patient experiences a worsening in their condition during the day,they can use an alarm button on the Briefcase and they are in direct

contact with the hospital.

Cl t 1 M bil lf h l

8/14/2019 11381916434428441.ppt

28/37

Patients situation Intermediary Organisation Research server

52

DATA TRANSMISSION GP ACCESS THROUGH CARE PORTAL (FUTURE!) CONTACT BY HEALTH COACH, CLINICIANS (GP/SPECIALIST)

31

4

PATIENT GENERAL

PRACTITIONER

DATABASE

HEALTH COACH RESEARCHER

TELEMONITORING

DEVICE

GATEWAY

& APP

28

Cluster 1: Mobile self-helptool for T2 diabetes

Northern Norway (NO)

Cl t 1 M bil lf h l

8/14/2019 11381916434428441.ppt

29/37

Cluster 1: Mobile self-helptool for T2 diabetes (NO)

1. Patient set goals for what kind of food intake and physical exercisethat is wanted the next period.

2. Patient measure blood glucose level with glucose meter

3. Glucose meter transfer data automatic to mobile phone byBluetooth

4. Patient adds food intake and activity manually on the phoneapplication

5. Patient gets response from application on how the personal setgoals are met within the defined period.

Parallel activities to this registration process:

Patient will have contact with the health coach in parallel to usingthe application, where relevant health related questions and resultsare discussed.

The patients will have regular consultations with their physicianwhere they will be able to share their application data, if theychoose to do so.

Responsibility and control of their data lies 100% by the patient.

8/14/2019 11381916434428441.ppt

30/37

Evaluating the services

8/14/2019 11381916434428441.ppt

31/37

31

The MAST model

If the purposes of an assessment of telemedicine applicationsare:

To describe effectiveness and contribution to quality of care

AND

To produce a basis for decision making

The relevant assessment should be defined as:

The assessment of telemedicine should be a multidisciplinary process thatsummarizes

and evaluates information about the medical, social, economic and ethicalissues related to

the use of telemedicine in a systematic, unbiased, robust manner.

MASTModel for ASsessment of Telemedicine

MAST

8/14/2019 11381916434428441.ppt

32/37

Purpose of MAST To generate knowledge for evidence-based decision-making, by

guiding the assessment of studies on effectiveness of telemedicineimplementation

Definition of proposed assessment:

Based on scientific methods and studies

HTA approach

A multidisciplinaryprocess that summarizes and evaluates information

about the medical, social, economic and ethical issues related to the use oftelemedicine in a systematic, unbiased, robust manner.

MASTPurposes and basis

32

8/14/2019 11381916434428441.ppt

33/37

Multidisciplinary assessment (domains):

1. Health problem and characteristics of the

application

2. Safety

3. Clinical effectiveness

4. Patient perspectives

5. Economic aspects

6. Organisational aspects7. Socio-cultural, ethical and legal aspects

Elements in MAST

Transferability

assessment:

Cross-border

Scalability

Generalizability

33

8/14/2019 11381916434428441.ppt

34/37

Current status

8/14/2019 11381916434428441.ppt

35/37

Results so far

We have recruited 75 % of all patients in the

studyi.e. xxx patients

We have 3 PhDs in the pipeline

We are aiming for at least X of scientific

articles

8/14/2019 11381916434428441.ppt

36/37

Conclusions

We have recruited 75 % of the patients: Appr. 5500

RENEWING HEALTH is the largest ongoing Randomised

study of telemedicine in EU

Results? December 2013but so far it looks good!

Follow: www.RenewingHealth.eu

8/14/2019 11381916434428441.ppt

37/37

i h lth

Thank You for yourattention