The Telemedicine - COCIR
THEF ILESThe Telemedicinechallenge in Europe ?JUNE-JULY 2010 - n 20 - 10 EDÉCEMBRE 2008 - N 16 - 10 E
E D I T O R I A LTelemedicine - or medicine that is remotely administered – is not a particularly new idea.We were already talking about it in the very first framework programmes financed bythe Commission, and it did give rise to several sample and pilot projects - which rapidlydemonstrated their limitations, either for technical reasons (network performance andmedical devices) or because of acceptance issues among health professionals. Twenty yearson, telemedicine is making a big comeback, and seems to offer solutions that are crediblewich have been tested in real medical situations, to the main challenges facing our society,such as:- the ageing of the population, which leads to an aggravation of chronic conditions (whichrepresent about 70% of healthcare costs)- the growing need for patients to become actors in monitoring their own health- the necessity of controlling healthcare costs whilst maintaining high quality care- the lack of availability of qualified personnel in certain branches of professional healthcareTo avoid readers becoming lost in a sea of complicated definitions, let’s just say for sakeof simplicity that telemedicine is remote medicine. Teleconsultation, teleradiology, teleophtalmology, telepsychiatry, telemonitoring (so useful in monitoring patients withchronic conditions) – are just particular forms of telemedicine (for precise definitions,please consult the article by COCIR on page 34 in this special issue). Some of these forms(teleradiology, for example) are more developed than others, and yet others are still subjectto dispute among professionals (teledermatology, for example). In any case, it is clear thathundreds of pilot projects now exist in all member states – and that telemedicine is not yetentitled to be cited at national level in any one of them. The situation is evolving fast: thenumber of legal barriers is falling and professionals are increasingly interested - occasionallyeven becoming promoters.Gérard ComynVice-President CATEL,(former Head of Unit ‘ICT for Health’, DGINFSO, European Commission)James WardellThe aim of this special edition is to help you take stock of the development of telemedicine,in all its diverse forms, and in a range of different environments. It is a collection ofaccounts and analyses by political and industrial decision-makers, patients and professionalhealthcare representatives, who seem to us to be those best-placed to communicatemessages that are both brief and easily understandable to all audiences. It also aims toclarify the problems which are still holding back the development of telemedicine, and tooutline a sketch of what the medicine of tomorrow might look like. Lastly, it demonstratesthat only an effort on the part of all actors in medical care will be necessary in order fortelemedicine to be accepted by all, and that it will be the role of the political decisionmakers to ensure that inter-ministerial mechanisms are developed in such a way as to takeinto account its multidisciplinary nature.
TA B L E O F C O N T E N TSEDITORIALGérard ComynVice-President of the CATEL associationWhat does telemedicine mean, exactly?The Telemedicinechallenge in EuropeTelemedicine and Infrastructures in Europe4It’s time to put eHealth on the political agenda!6Telemedicine and hospital reform in France7Online health8Neelie Kroes, Vice-President of the EC and Commissionner in charge of the Digital Agenda for EuropeGöran Hägglund, Swedish Minister for Health and Social AffairsRoselyne Bachelot-Narquin, French Minister for Health and SportsTrinidad Jimenez, Spanish Minister for Health and Social PolicyEurope in the age of Telemedicine10The evolution of telehealth11eHealth in Catalonia12Françoise Grossetête, Member of the European ParliamentPierre Lasbordes, Representative of Essonne, French National AssemblyMarina Geli, Catalan Minister for HealthExamples of telemedicine applicationsLiving at home with the new technologies15Telecardiology: evolution and prospects17Telemedicine activities at the Centre National d’Etudes Spatiales19Prof. Alain Franco, Professor of Internal Medicine and Geriatrics (Nice)President of the ISG and President of the CNRSDA (France)Prof. M. Cowie, Professor of Cardiology, and Dr. A. Acosta Lobos, Clinical Research FellowImperial College LondonDr. Antonio Güell, Head of the Application and Valorisation DepartmentMurielle Lafaye, Environment/Climate/Health Programme CoordinatorNathalie Ribeiro Vieira, Health Care For Remote Regions and Telemedicine CoordinatorPascal Faucher, Humanitarian & Risk Activities CoordinatorThe Impact of TelemedicineImpact on the restructuring of healthcare22eHealth – exporting to new markets23Josep-M. Piqué, Vice-Director of the Hospital Clínic - Barcelona, SpainJorgo Chatzimarkakis, Member of the European Parliament
The impact of telemedicine on the medical development of remote regionsProf. Louis Lareng, Director of the European Institute of Telemedicine in Toulouse,and Dr Monique Savoldelli, CHU Toulouse24Telemedicine actorsTelemedicine – Bringing health closer to citizensMarina Geli, Catalan Minister for HealthMaking patient-centred Telemedicine happen – why involving patients mattersWalter Atzori and Liuska Sanna, European Patients’ Forum2729TeleHealth: Making House calls30Favouring the development of telemedicine to respond to the issues of accessto healthcare and quality of life for all31Jeremi Bonfini, Senior Vice-President, Himss Global Servicesand Chuck Parker, Executive Director, Continua Health AllianceDr Jacques Lucas, Vice President for Health Telematics, French National Medical CouncilTelemedicine, an issue for practitioners33Telemedicine: A Tool for Patient Empowerment34Jean-François Thébaut President of the Syndicat National des Spécialistes des Maladies du Cœuret des Vaisseaux (French National Union of Specialists in Heart and Vascular Disease)Nicole Denjoy, Secretary General of COCIR (European Coordination Committee for the Radiological,Electromedical and Healthcare IT Industry)Challenges of TelemedicineTelemedicine for the benefit of patients, healthcare systems and societyFlora Giorgio and Ilias Iakovidis, Unit ICT for Health, DGINFSO, European Commissionand former colleagues Christoph Steffen and Gérard Comyn36Legal aspects of cross-border telemedicine38Legal issues on the agenda in telemedicine40Prof. Peter M. Pattynama, radiologist President, UEMS radiology section UEMS- European Unionof Medical Specialists Erasmus MCStephaan Callens, Professor of Health Law (KU Leuven) and lawyer at the Brussels bar, BelgiumTelemedicine: from technology demonstrations to sustainable servicesArnaud Runge, Engineer for Life and Physical Sciences Instrumentation, Mechanical EngineeringDepartment, Francesco Feliciani, Head of Section of demonstration projects (European Space Agency)Telemedicine and reimbursement, the way forwardPhilippe Sweenen, Project Manager, International Association of Mutual Benefit Societies (AIM)Direction-Administration: Les Dossiers Européens 19, rue Lincoln - Box 1 - 1180 Brussels - Port : 00 (33) 06 60 83 94 36 - @ : ens.fr - www.dossierseuropeens.eu - ISSN 1636-6085Manager and Publication Director: Laurent Ulmann Translator: Cabinet Galith Portal @: galithportal@noos.fr Copyrights: European CommissionEditorial Committee: Laurent Ulmann, Samantha Gompel, Gérard Comyn (CATEL), Corinne Wenner (European Commission, DGINFSO, ICT for Health)4244
Telemedicine and Infrastructures in EuropeNeelie KROESVice-President of theEC and Commissionnerin charge of the DigitalAgenda for EuropeA new era for eHealthEurope’s eHealth sector is in line withthe European Commission’s visionfor the future: knowledge-based,experience-driven, and continuing togrow in tough economic times.The European Commission haslong understood the potentialof information and communication technologies (ICT) to havea positive impact on the lives ofpatients. Having invested over onebillion euros in eHealth researchover the past twenty years, we havemany evidences of how bringingtogether ICT and health can saveand improve people’s lives. The timehas now come to turn the researchresults into real large-scale benefits.Our finances demand it. Our citizensexpect it. And we absolutely need tomaintain the strength of this growingindustry and the high-paying jobs itsupports.In March this year, the EuropeanCommission launched its strategyfor smart, sustainable and inclusivegrowth known as «EUROPE 20201».At the heart of the strategy is aneconomy based on knowledge andinnovation. It promotes a moreresource efficient, competitive andgreener environment and fostershigh employment via economic,social and territorial cohesion.4THEEUR O P E A NFIL E SThe European Commission’s newflagship initiative, the Digital Agenda2for Europe, builds on the foundations of EUROPE 2020. It representsan important step on the road totransforming eHealth from a researchactivity into an integral part of ourdaily lives leading to improved quality of care, reduced medical costsand increased independent living forthe elderly and people with disabilities.Importantly, the Digital Agenda forEurope acknowledges that if we wanteHealth services to reach their fullpotential, we need to provide userfriendly tools and services directly toour citizens and patients. It also recognises that to reach this point, wemust pull down the legal and organisational barriers that are preventingprogress and build up cooperationbetween the EU Member States.We should not get stuck at the stageof delivering electronic patientrecords only. That is, no doubt,a huge challenge in itself. But wealso need to work together to deliver tools for patients that preventhealth problems and personalise thehealthcare services they receive.We already know that Europe’s citizens have a thirst for knowledgewhen it comes to their health.According to a recent study, in 2009,85% of online citizens in the United Kingdom, Germany, France, Italyand Spain turned to the internet andother technologies for health andprescription drug information2.Our vision is that eHealth systemsacross Europe should channel thisenthusiasm for information. Throughsecure and practical ICT based toolsand services citizens can take greatercontrol of their health: whether it bemaking an appointment online withtheir doctor, or getting a second opinion on test results, or learning howto take preventive measures to stayhealthy. This is a feasible step and canmake a real difference for the efficiencyof health systems, and for patients’lives. To help achieve this vision, theEuropean Commission will be active insupporting the deployment of projectsthat provide Europeans with secureonline access to their own health dataand enable online health services. Animportant first step to achieving thiswill be agreeing on a minimum common set of patient data that can beaccessed in a secured way whereverand whenever necessary.Patient PowerUnlocking the Market PotentialOur research has shown that a common element of many successfuleHealth solutions is their capacityto bring into play what are arguablythe two most undervalued resourcesof the healthcare sector: informationand patients.eHealth is the fastest growing ofthe three main healthcare sectorsin Europe (eHealth, pharmaceuticalsand medical devices). I would liketo see the maturity of this marketmatch the maturity of the technologyitself. Health is not like most other
markets – change depends heavilyupon political will. So spreading thebenefits of eHealth to all Europeanscannot happen without the supportof all stakeholders, health authoritiesprofessionals and the industry in particular, with the underlying trust anddemand by patients.In line with the EUROPE 2020 vision,eHealth has great potential to createnew businesses, jobs and save taxpayers’ money. Designated by theEuropean Commission as an EU «LeadMarket», coordinated efforts havealready been made by some eHealthstakeholders to address the legal andorganisational barriers that are holding back innovation and progress.The Digital Agenda now provides anextra stimulus to progress with thenecessary standards, interoperabilitytesting and certification processesthat will consolidate the eHealthmarket and ensure transparency,growth and procurers’ trust. By bringing stakeholders together to takethese often complex but necessarysteps, we will foster competition atEU level and guarantee better qualityand safer eHealth solutions at a lowerprice for the benefit of all.eHealth without BorderseHealth services put patients at thecentre and can only work if patientsand practitioners have the tools and thetrust to be fully engaged. If eHealth isgoing to work across Europe, we needto ensure that we have secure andinteroperable systems in place thatenable safer care across borders. Animportant first step to achieving thiswill be agreeing on a minimum common set of patient data that can beaccessed or exchanged electronicallyacross the Member States. In practicethis would mean, for example, that inthe future any EU citizen with a chronic condition or allergy needing medical assistance in another EU countrycould be reassured that local healthcare professionals can have access, ifthe patient agrees, to the basic vitalinformation to make potentially lifesaving medical decisions.The benefits of eHealth are clear, butlarge scale eHealth success and corresponding benefits for all patientsand our industries will only come asa result from a truly collaborativeeffort. We must now seize the oppor-tunity to step up a gear and enterthis exciting new era for the benefitof all.I am fully aware of just how difficultit will be to achieve this agenda.My new portfolio is very horizontal in nature, and eHealth is amongthe most horizontal of all the partsof this agenda. It involves not onlyevery layer of government, but alsomany industries, many Commissionpolicy areas and huge amounts .europa.eu/LexUriServ/LexUriServ.do?uri CELEX:52010DC0245:EN:NOTTHEEUR O P E A NFIL E S5
It’s time to put eHealth on the political agenda!GöranHÄGGLUNDSwedish Ministerfor Health andSocial AffairsThe time has come to move from wordsto action, and take our National eHealthStrategies from vision to reality. In Sweden, many of the national eHealth solutionswhich we have been preparing for many yearsare now in the final stages of development.They have been procured and are ready to berolled out on a broad scale. The long awaitedNational Patient Summary is now being implemented region by region, and a modern legalframework has been established since July2008 by the new Patient Data Act.We thus leave behind us a period of technological development and enter the nextphase, which will be focused on organisational change. The work of improving information flows and continuity of care with thehelp of new ICT support systems, will notbe able to reach is full potential until working methods, processes and the culture inhealthcare are adapted to this new environment – and adapted to meet the individualneeds of the patients.The involvement of health professionals inall stages of this change process is essential, in order to make the technology reflectthe actual needs of doctors and nurses,and include ICT as a natural part of thebasic medical education and training at ourteaching University Hospitals.eHealth is a catalyst for reform and improvement of the healthcare sector, and we as politicians and decision makers must be better tovisualize and understand how to use this tool toits full potential. A new generation of patientsand health professionals have different expectations for a modern and accessible healthcaresystem well adapted to their individual needs.If we as decision makers in healthcare cannot6THEEUR O P E A NFIL E Smeet these expectations, the trust for our healthcare systems will be seriously damaged.We therefore have to put eHealth firmly on thehealthcare agenda as a key enabler for healthcare reform! Looking back, perhaps too muchof the work carried out in this field has beendelegated to technical experts and has as aconsequence not always reflected the political goals for healthcare or the actual needs ofpatients and health professionals. Often thelack of concrete deliverables and visible benefits for citizens have damaged the credibility.Therefore, a stronger political governance andinvolvement in this field is imperative.The EU and international dimension in healthcare and eHealth is increasingly importantfor all of us. Patient mobility both betweenand within Member States underscores theimportance of strong collaboration at EU level.The majority of Member States are today inthe process of rolling out large-scale eHealthinvestment and implementation programmes.Some Member States have been granted financial support from European Structural Funds inorder to reform national healthcare systems byinvestments in eHealth solutions.Thereby, we have a unique window of opportunity to build these national solutions oncommon European standards that enablescontinuity of care across administrative andnational borders. If we fail, there is a clearrisk that national investments will be less efficient, more expensive and not providing thepotential benefits for the patient that wouldbe possible. Furthermore, the Member Statesface the risk of finding themselves trapped innational solutions for several years without thefinancial capability to adapt them to futurecommon standards.During Sweden’s Presidency of the EU in thesecond half of 2009 we aimed to make substantial progress in this area. The main strategic goal was to create political awareness andcommitment at the highest level. Furthermore,we aim to change the way eHealth is described,so that the added value for healthcare whenimplementing eHealth solutions is understandable and self-explaining for everyone outsidethe eHealth Community.The Swedish Government has a strong commitment to follow-up and further developrecent initiatives in this area, and create astrong political mandate for a closer and moreconcrete European cooperation on eHealth, aswell as a structure for this governance process.We also hope to provide new knowledge, evidence and arguments for why eHealth shouldbe addressed in a new way at European andnational level by issuing a formal PresidencyReport on eHealth1. This report will try tovisualize the value based costs for healthcareof you don’t make the necessary investmentsin eHealth. The cost of doing nothing can bestaggering.In times of financial difficulties, these aspectsare becoming increasingly important But wemust remember that in many cases, the mainproblem is not the lack of resources, it’s thelack of coordination of how existing resourcesare actually used that is the main problem.Huge amounts are invested in eHealth solutionsannually, and we have an obligation to use theseresources wisely. By increasing our exchange ofknowledge and experiences across Europe andglobally, increased cost-effectiveness for ournational investments are self-evident.When large-scale implementation, deploymentand usage of eHealth solutions are on theagenda in the Member States, the Europeancooperation must be aligned to this development, and provide concrete, hands-on supportin areas that cannot be handled only at nationallevel. By joint efforts from Member States andthe European Commission, several projects inthis area has also been launched during 2008,namely the epSOS2 Large Scale Pilot and theCALLIOPE3 Thematic Network. Through theseprojects, the ambition to move from strategiesto services are finally being fulfilled. Sweden isa proud and engaged partner in these projects.We are starting to see the emergence of amodern, accessible, needs-based healthcaresector, and can now – at last – begin to meetour citizens’ long held expectations of an
The impact of telemedicine on the medical development of remote regions 24 Prof. Louis Lareng , Director of the European Institute of Telemedicine in Toulouse, and Dr Monique Savoldelli , CHU Toulouse Telemedicine actors Telemedicine Ð Bringing health closer to citizens 27 Marina Geli , Catalan Minister for Health
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6 Telemedicine Evaluation providers’ cost structures, current and projected future telemedicine service utilization, and the interaction between the two. CHI concluded that the potential savings of telemedicine adoption are reliant on several factors. First, more savings opportunities are available to
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