Claus Duedal Pedersen Chief Consultant Odense University Hospital Region of Southern Denmark

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1 Claus Duedal Pedersen Chief Consultant Odense University Hospital Region of Southern Denmark

2 Table of Content It all takes time RENEWING HEALTH in a nutshell Evaluating telemedicine Results & Expectations 2

3 In 1747 In Scurvy= Skørbug/Skörbjugg/Skorbut/Niekingas/Keri pukki/szkorbut Scurvy rife, massive impact on cost of life, capacity to fight James Lind tested 12 ill men with treatments including lemon juice (vitamin C) Successful first clinical trial? So it was adopted in

4 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.

5 RENEWING HEALTH in a nutshell Project start date: 1 st of February 2010 Project duration: 47 months Total budget: Euros EU contribution: Euros 26 pilot sites, grouped in 10 clusters and distributed over 9 EU regions 5

6 6

7 Objectives Tele-homecare Independent, Healthy Living Chronic Disease Management Community Clinic Doctor s Office Residential Care Assisted Living Skilled Nursing Facility Acute Care Specialty Clinic Community Hospital ICU Adapted from Intel ,000 10,000 7

8 Objectives Clinical objectives 8 improving the quality of life of chronic patients who, for just the three chronic diseases addressed in the Project, account for well over 15% of the EU adult population by removing anxiety about health conditions reducing the need for the patient to use emergency services 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 network can supply healthcare services at least of the same clinical quality and reliability as those supplied through a traditional healthcare delivery network

9 Objectives Patient/user perspective objectives 9 providing coherent clinical services through ICT that take into proper consideration patients and professional users needs, capabilities, risks and benefits implementing solutions that support the empowerment of the patients and increase patients satisfaction demonstrating that the implementation of telemedicine services improves the professional satisfaction of the involved healthcare professionals. measuring patients, relatives, informal caregivers and healthcare professionals satisfaction (through questionnaires)

10 Economic objectives 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 10

11 Objectives Organisational objectives 11 cutting across the traditional fences among different levels of care creating an organisational model for telemedicine services that ensures a safe, clear and efficient pathway for patients in their journey through the healthcare system promoting active participation of the patients in the organisational model measuring the organisational impact of telemedicine in both a qualitative and quantitative manner

12 RH Organisation 7158 patients 9 countries 84 centres DM COPD CVD 21 pilots 10 clusters 3 diseases 9 RCTs 1 observ. 03/10/

13 RH clusters

14 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 same cluster promoting close collaboration and sharing of experience among teams which have never worked together before RENEWING HEALTH 14

15 Two examples of services

16 Cluster 4: COPD Southern Denmark (DK) Patient s situation (at home) Hospital (Odense University Hospital & Svendborg Hospital) PATIENT PATIENT BRIEFCASE ALARM TELEMONITORING DEVICES 6 HOSPITAL VIDEO INTERFACE HOSPITAL INFORMATIO N SYSTEM 2 NURSE MONITORING 5 DATA TRANSMISSION DATA ACCESS ALARM MANAGEMENT 16

17 Cluster 1: Mobile self-help tool for T2 diabetes Northern Norway (NO) Patient s situation Intermediary Organisation Research server PATIENT TELEMONITORING DEVICE GATEWAY & APP DATABASE GENERAL PRACTITIONER HEALTH COACH RESEARCHER DATA TRANSMISSION GP ACCESS THROUGH CARE PORTAL (FUTURE!) CONTACT BY HEALTH COACH, CLINICIANS (GP/SPECIALIST) 17

18 Evaluating the services

19 MAST The MAST model If the purposes of an assessment of telemedicine applications are: Model for ASsessment of Telemedicine To describe effectiveness and contribution to quality of care AND To produce a basis for decision making 19 The relevant assessment should be defined as: The assessment of telemedicine should be a multidisciplinary process that summarizes and evaluates information about the medical, social, economic and ethical issues related to the use of telemedicine in a systematic, unbiased, robust manner.

20 MAST Purposes and basis Purpose of MAST To generate knowledge for evidence-based decision-making, by guiding the assessment of studies on effectiveness of telemedicine implementation Definition of proposed assessment: HTA approach A multidisciplinary process that summarizes and evaluates information about the medical, social, economic and ethical issues related to the use of telemedicine in a systematic, unbiased, robust manner. Based on scientific methods and studies 20

21 Elements in MAST Multidisciplinary assessment (domains): 1. Health problem and characteristics of the application 2. Safety 3. Clinical effectiveness 4. Patient perspectives 5. Economic aspects 6. Organisational aspects 7. Socio-cultural, ethical and legal aspects Transferability assessment: Cross-border Scalability Generalizability 21

22 Current status

23 Results so far Renewing Health have recruited 75 % of all patients in the study Appr patients We have 3 5 PhDs in the pipeline We are aiming for at least 8-10 of scientific articles

24 Conclusions We have recruited 75 % of the 7158 patients RENEWING HEALTH is the largest ongoing Randomised study of telemedicine in EU First two articles have been submitted and results will start to be available from December 2013 Follow:

25

26 Thank You for your attention

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