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Telemedicine – learnings so far

Join us for a seminar on May 27th, 2019, to learn about the current state of telemedicine, examples of large-scale deployments, and the key learnings from these initiatives. Topics include funding, IT platforms and governance, project management and implementation, logistics and support, legal issues, and more.

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Telemedicine – learnings so far

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  1. Telemedicine– learnings so far Cachet Ph.d. seminar May 27th 2019

  2. Topics • What is telemedicine and why? • Examples of large scaledeployments • Learnings - whatseems to work

  3. Knowledge center for Telemedicine…Weareflexible Funding Funding Othersectors and regions IT platform & governance Project management & implementation PROJECT Logistics & support Legal issues (GDPR)

  4. How do we define telemedicine? • Tele (distant) • Medicine (practice of the profession) • Via digital medias • Focused on chronic patient Two main categories • Video conferences (distance is the primary challenge) • Home monitoring (prevention is often the primary challenge) • Mix of the above • Bordering areas • PRO • Machines (algorithm) practicing medicine?

  5. Why telemedicine? • Efficiency improvements • Empowerment • Better data healt care professionals can act upon • Substitution effect • Quality of Life • Sense of safety • Less transport • Empowerment Drivers • Ministry of Finance's efficiency agenda • Lately a shift towards QoL: Value-Based Healthcare and the principle of subsidiarity (nærhed) Fewer admissions & outpatient visits

  6. Telemedicine and the hype cycle Telemedicine

  7. Examples of large scaledeployments

  8. Nation widedeployment 1Home monitoring for COPD patients • Based on: RCT with 1.200 patients (TeleCare Nord) • Aim: Preventing hospital admissions • Framework: Financial agreement 2016 (ØA16) • Launched via 5 regional programs. Municipalities and GP’s have a central role. • Approach: Follow patients (GOLD Gr. D) via measurements and symptom questions • Estimatednumber of patient in the RH is 2500

  9. Nation widedeployment 2Woundcare via telemedicine • Based on National Strategi for Digitalisering af Sundhedsvæsenet 2013-2017 • Aim: Improving wound care in the municipalities (faster healing) • Framework: Financial agreement 2017 (ØA17) • Launched via 5 regional programs • Approach: Direct communication between the municipality’s home care team and the hospital’s wound center through a shared patient record • Estimatednumber of patient in the RH is XXX

  10. Nation widedeployment 3Pregnant women with complications • Based on: The KIH project • Aim: Shortening hospital admissions cause by preeclampsiathrough home monitoring • Framework: Financial agreement 2018 (ØA18) • Unrolled via ... (organization) • Approach: • Estimatednumber of patient in the RH is XXX

  11. Learnings - whatseems to work

  12. Validating telemedicine: Two approaches Traditionally RCT is the standard BUT: • Expensive and lengthy - technology must be kept constant • Sample size often too small • Multi-intervention: What’s the decisive factor? • A challenge when deploying elsewhere The alternative • Qualitative evaluation • Assumption: The treatment is the same, just delivered differently • Giving the clinicians a technical platform - letting them mold the organization themselves

  13. Get to know the organization! …it’s a nitty gritty • Hospital departments are finely optimized organizations • Staffs have great ownership to their specific patient pathways • Benefits in telemedicine are usually gained through improving workflows and the interaction with the patient • Organizational variations can be a barrier for scalability • Notice! Most telematic projects use “old technology” Technology is secondary

  14. It’s the prognosis, not the diagnosis! …Avoid over-threatment • Home monitoring is expensive • Therefore, specification of the target group for different initiatives is crucial …but also difficult! • The technological perspective sometimes has a one-eyed focus on the diagnosis or diagnosing • COPD • Apps for identifying skin cancer • Apple watch: Heart arrhythmia The risk is over-treatment, no savings and worried patient

  15. Don’tbuild a new technical platform • IT organizations already have too many IT systems to run Instead • Use a platform already implemented • The Capital Region has OpenTele • Build plugings • Ex. DreamMed - A plugin for Glooko and Tidepool ….Don’t use cloud services

  16. Research in demand - within telemedicin • Processing of data (AI / Big Data) • Home monitoring is data collection • Avoid future data overload • New types of measurement (hardware) • Access to new data sources • Understanding patient's interaction with technology and treatment (anthropology / psychology) • Effect is most often achieved through behavioral change

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