The Need for a Clearer European Vision for Telehealth

2013 Medetel Luxembourg

The Need for a Clearer European Vision for Telehealth Dr Malcolm J Fisk Health Design and Technology Institute Coventry University [email protected]

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TeleSCoPE

European Telehealth Services Code of Practice www.telehealthcode.eu

12 partners in 7 member states Extensive consultation plus ‘validation’ with various types of telehealth service Beta version release here at Medetel 2013 Fits with EU agenda and new eHealth Action Plan Provides benchmark standard Will influence the shape of telehealth services

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What is Telehealth? How does it fit? Telehealth is …the means by which technologies and related services concerned with health and wellness are accessed by or provided at a distance in order to facilitate the empowerment, assessment or the provision of care and/or support for people and/or their carers (at home or in the wider community).

eHealth Telehealth

Telecare

Telemedicine

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European Perspective Evolving Originally rooted in telemedicine  Clinical orientation for gains around chronic conditions  Wanting cost savings in context of … Unsustainability of existing health services Now … ‘eHealth’ rather than telemedicine  Clinical complemented by public health perspective Responding to widening range of initiatives  Responding to ambivalent evidence around cost savings around chronic conditions  Telehealth beginning to be ‘recognised’  Echoed in TeleSCoPE perspective … European CoP for Telehealth Services 4

Context: European eHealth Action Plan Building trust in eHealth / telehealth … for different stakeholders  Improving chronic disease management  Developing prevention and health promotion practices  Redesigning delivery of care … away from ‘top-down’ approaches Recognising patients’ rights  Supporting access for / empowerment of all citizens … so why the change in perspective?

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European Perspective: Why the change? Impact of eHealth Task Force report recommending … •A new legal basis for health data • ‘Beacon group’ of Member States and regions committed to open data and eHealth • Support for health literacy • Use of the power of data • Re-orientation of EU funding and policies • Changes in service paradigms

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European Perspective: Why the change?  Impact of eHealth Task Force report  Power of European policy perspectives around inclusion and citizenship  Recognition of ‘other’ health crises … not just chronic conditions of older people, but also younger people (obesity, diabetes) – problems for the future!  Recognition of importance of health gains as great as cost savings

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European Perspective: So how should we see Telehealth? Telehealth is

…the means by which technologies and related services concerned with health and wellness are accessed by or provided at a distance in order to facilitate the empowerment, assessment or the provision of care and/or support for people and/or their carers (at home or in the wider community).

Telehealth is

… a means by which health and well-being as a ‘joint enterprise’ can be re-discovered – with clinicians and service users as equal partners; with people’s responsibilities as citizens reaffirmed. This needs changes in attitudes as well as in service approaches (from top-down to bottom-up).

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This is Telehealth?

Older man taking blood pressure for data transmission to healthcare practitioner: NHS Cornwall – Whole System Demonstrator Programme 9

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This is Telehealth?

Younger woman, having taken measure of her blood sugar level, using insulin pump to help control her diabetes. Also sending data, when appropriate, to healthcare practitioner 10

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This is Telehealth?

Older man assisted in compliance by pharmacist dispensed automated medication dispenser. Linking to monitoring and response centre. 11

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This is Telehealth?

Older woman accessing health information or advice via an iPad (also, no doubt, used for other purposes)

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This is Telehealth?

Older man with dementia wearing tracking device to guard against wandering beyond pre-defined area. Alert sent to carer or monitoring and response centre. 13

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This is Telehealth?

Girl with epilepsy being monitored for nocturnal seizures. Alert sent to carer or monitoring and response centre. 14

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This is Telehealth?

Cardiologist in distance consultation with heart patient (in clinic or at home) 15

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Support being given by health advisor via telephone for health-related behaviour change

This is Telehealth?

www.bhru.iph.cam.ac.uk

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1) Vital-signs monitoring 2) Self-management of diabetes 3) Support for medication compliance 4) Accessing health related information 5) Monitoring for wandering 6) Monitoring for night-time seizures 7) Remote consultation 8) Support for behaviour change

Eight Variants of Telehealth … of maybe 88

 Telehealth has a wide remit embracing health (including clinical health) and well-being  From pregnancy to palliative care  It is more than vitalsigns monitoring www.bhru.iph.cam.ac.uk

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European eHealth Action Plan: Key Aims  Overcoming barriers to adoption Lack of trust, awareness, confidence Lack of interoperability Limited evidence of effectiveness Lack of legal clarity Regional differences  Fostering of cross-border care  Promotion of interoperability  Exploitation of mHealth and preventative health opportunities

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European eHealth Action Plan: Some Specific Actions  Guidelines on patient records  Consistent vocabularies and terms  Processes for cross-border services  By 2014 Green Paper on mHealth and health and wellbeing applications

… seen as ‘blurring distinction between traditional clinical care by physicians and self-administration of care and well-being’

 Research and innovation under Horizon 2020  Support for entrepreneurship (products and services)  Enhanced work on data collection and benchmarking

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European eHealth Action Plan: Towards an (even) Clearer Vision  Terminology … from eHealth to telehealth (per move to ‘consistent vocabularies’)?  More emphasis on health and well-being … ensuring that the preventative and public health dimensions are equal to clinical  Hopefully, endorsement of European Code of Practice for Telehealth Services … and its integration, if appropriate, within broader standards  No loss of momentum … because we’re heading in the right direction!

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Thank you!

Diolch yn fawr

Dr Malcolm J Fisk Health Design and Technology Institute Coventry University [email protected] 21