Remote monitoring:

Future Directions for

Research

Marc Lange, Secretary General

Competence Centre

Health Care Authorities

Industry

Health Care Delivery

Citizens/Patient Representative

InnovationAgency

Insurers

Social Care

Dissemination Organisation

European Health TELematics

A cross-(any)border and multidisciplinary

collaboration forum

Sustainable and large scale eHealth deployment

requires engagement and synergies

United4Health

Remote monitoring +

self-care

in routine care

in 14 European regions

Remote monitoring + self-care

will happen!

• Prevention (secondary and primary)

• Chronic disease management

• Health coaching

• Patient empowerment

Strategic added values for our health care systems

• From reactive to proactive healthcare

• From caring to coaching

The missing evidence

The decision-making dashboard

The deployment in routine care roadmap

Today’s evidence

From an RCT with 21 remote services in 9 Regions Safety and clinical effectiveness

• At least as safe and efficient as regular services

Patient satisfaction and health-related quality of life

• Tendency to improve health-related Quality of Life (SF36)

• Very positive Patients (SUTAQ) in almost all pilots

▲ Costs per patient or in efficiency gains, no reduction, possibly because

• Technology market still to expensive

• Sub-optimisation of the organisation of care

• Inadequate scaling of the service

Lessons learned: the impact of

non-clinical parameters (1)

Why the service is considered for roll-out

• The values of the health care system

• Its objectives with the service

What technology is being used

• Connectivity, device ownership, sophistication

Who will benefit from it

• Enrolment process, eligibility criteria

Where the service is running

• The organisations and the workforce profile in charge

Model for Assessment of Telemedicine (MAST)

Lessons learned: the impact of

non-clinical parameters (2)

How the service is designed

• With a focus on primary or secondary care setting

• Limited to health care setting or with the implication of the

social care sector

When the service is being studied,

• The cost of the technology will decrease because of the

market and the opportunities to mutualise the cost of the

supportive infrastructure

+

Summative or formative assessment

Model for Assessment of Telemedicine (MAST)

Directions for Research?

Evidence on the relationship between outcome and environment

• What is the profile of the patients that can benefit the most?

• What are the best technological options, for what type of

patients, having in mind the “moving target” aspects of

technology?

• How to organise the responsibility/liability chain?

• How best to obtain efficiency gains?

• How to address the fact that nurses will often be the first line of

response?

• …

(Evidence-based health care)

Clinical evidence

• Based on RTC

(the gold standard)

• Summative assessment

“Clinicians [may be] ready

to believe that there is an

objective determinable

“right answer” to research

questions.”1

Management evidence

• Based on use cases,

lessons learned …

• Formative assessment

“Managers may, quite

rightly, view the results of

research are more

subjective, and contingent

on the context and on the

characteristics of the

researchers themselves” 2

1&2. Walshe K. and Rundall TG. – 2001 – Evidence-based Management: from Theory to Practice in Health

Care (Milbank Q. 2001; 79(3): 429-57, IV-V.)

The missing evidence

The decision-making dashboard

The deployment in routine careroadmap

(Decision making)

Clinical decisions

• Decision-support systems

• Many decisions, individual

cases, in a short time frame

• Often made individually

• In a relatively unconstrained

context

• Often with immediate

feedback

Management decisions

• Heterogeneous processes,

including intuition

• Fewer but larger decisions

in a longer time frame

• Made in concert with others

• Constrained by resources,

policies and procedures,

stakeholders’ views …

• With results more difficult to

discern

Walshe K. and Rundall TG. – 2001 – Evidence-based Management: from Theory to Practice in Health Care

(Milbank Q. 2001; 79(3): 429-57, IV-V.)

Lessons learned:

the need for action research1

For evidence-based tools for decision-making in healthcare

• The results of the research need to be action-oriented and

accessible to managers

• The question for the research need to be strategic

• A match is required between the timing of the research and

the decision-making

1; Walshe K. and Rundall TG. – 2001 – Evidence-based Management: from Theory to Practice in Health Care

(Milbank Q. 2001; 79(3): 429-57, IV-V.)

Directions for Research?

Strategic management and entrepreneurial tools adapted to healthcare and remote monitoring + self-care

• Maturity modelling

for assessing the readiness of an environment to host an

innovative services and identify strategic actions to undertake

• Service Innovation Governance modelling,

for guiding the creation of innovative services

• Business modelling,

for assessing the conditions for sustainable remote monitoring

• Socio-economic evaluation, Cost & Benefit Analysis

for measuring the potential for impact of an innovative service

• …

The missing evidence

The decision-making dashboard

The deployment in routine careroadmap

(Deploying)

In Pilot environment

• Minimal organisational

changes

• Temporary setting

• Selected patients

• Project staffing

• Project funding

In Routine care

• Service redesign

with necessary

organisational changes

• There to stay

• Patient inclusive

• Regular staffing

• Healthcare system funding

U4H

Initial lessons learned (1)

Organisation

• The whole spectrum of healthcare stakeholders need to be

involved and engaged, from patients through to politicians …

Culture

• Local benefits by local ownership of local problems

• Telehealth is to be seen as a journey, not as a destination

Conclusions

• In routine care = Service redesign = Change management

U4H

Initial lessons learned (2)

Technology @ scale

• Lack of connectivity @ scale creates access inequalities

Procurement and interoperability

• Procurers need solutions that are proven to work now

• Local challenges with interoperability and integration in

primary care

Conclusions

• KISS - Keep It (the technology) Simple and Stable

• Do not underestimate the tension between

standardisation and legacy

Directions for Research?

Evidence-based guidelines and tools for helping the demand-side on

• Leadership for ICT-based innovation in healthcare

• Public Procurement of Innovative solutions in healthcare

• Managing change in a healthcare service re-design context

• Implementing legal, security, safety rules (including compliance

check lists)

• Accreditation tools for remote monitoring + self-care

(e.g. health apps for clinical practice) and

• …

Summary

Evidence on how to design remote monitoring + self-care in a given environment

Action research for evidence-based

decision-making

Guidelines and tools for helping the demand-side

Happy to answer any

questions

Marc Lange

Secretary general

EHTEL Associationrue de Trèves 49-51,

B-1040 Brussels Belgium

Tel: +32 (0)2 230 15 34

Fax: +32 (0)2 230 84 40

Mobile: +32 (0)475 27 71 45

Marc.Lange@ehtel.eu

www.ehtel.eu

www.united4health.eu

www.renewinghealth.eu

www.telemedicine-momentum.eu