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News: Newsletter 27

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June 16, 2004

In this newsletter:

  • Sony launches compact multimedia videoconferencing systems for the medical arena
  • Monitoring vital signs in stroke
  • EU action plan: eHealth commonplace by end of the decade
  • OECD forum discusses ehealth: Are better-informed patients better treated?
  • Achieving true continuity of care vital to growth of electronic medical records market
  • Moving forward ehealth standardization
  • eHealth solutions for developing countries
  • ISfT presents national member associations at Med-e-Tel
  • Telemedicine & eHealth Directory introduced at Med-e-Tel
  • News from the Med-e-Tel media partners
  • Newsbriefs
  • Conferences


At Med-e-Tel 2004, Sony introduced a new generation of multimedia videoconferencing systems, the PCS-1P, to the healthcare market, a system which is designed to assist medical staff in their daily communications and work practices.
Operating over standard hospital IT networks, the Internet or telephone lines, Sony videoconferencing solutions offer high quality pictures, audio and data exchange that can be equally appreciated by a consultant in a meeting room or a hundred students in a lecture theatre.
The system enables users to connect PCs or laptops to facilitate sharing of high-resolution data, such as x-rays or complex medical photographs, at the touch of a button – irrespective of the number of participants. The PCS-1P can also be used to assist medical practitioners in their teaching, as junior doctors can view procedures straight from the operating theatre, thus reducing training budgets, as well as creating an opportunity for an exchange of information and the ability to obtain a second opinion from other clinicians off-site.
Integrated Telehealth solutions also give the ability to record video and still images for sharing, display, printing or direct integration with hospital PACS systems. Outside of a meeting room, portable Sony VAIO notebook PCs can provide doctors with 'any time, any place' access to video and data conferences via a LAN or ISDN network connection.
As Juergen Thiem, Senior Manager, Sony Healthcare Europe explains, "Today, hospitals are facing the same challenges as other businesses. Increasing efficiency, improving profitability and gaining competitive edge, are balanced by the need to manage travel budgets and other overheads more effectively. That is why medical practitioners, hospitals and scientific institutions are using videoconferencing to improve their internal as well as external communications – bringing people together quickly and easily to share ideas and make decisions, no matter where they are in the world." More information at www.sonybiz.net.


Vox Net, in close collaboration with its partners, University of Rome "La Sapienza" and others, is improving the vital sign monitoring system that was recently presented at Med-e-Tel 2004 in Luxembourg.
Monitoring vital signs in stroke, especially BP (blood pressure), in hypertensive patients, means also checking the incidence of ischemic or hemorrhagic stroke if hypertension is treated accordingly. Regardless of therapy or care, hypertension is controlled only if patients are motivated to stay on their treatment plan. This is why Vox Net and its partners are using an internet model as decision support system that prompts the clinician to advance therapy when a goal has not been achieved. Feedback reminders from any source (computer-based, automated telephone-based, nurse care managers, outside auditors) can be very effective, not only in helping to achieve BP goals but also to alert clinicians in case of an emergency. Such assessment and management is often difficult in general practice, because of time constraints imposed by practice costs and demands of other patients.
Within the next year, with multidisciplinary care outside hospitals, scheduling visits with allied health staff and community health workers, automating collection of clinical findings and test results, Vox Net are confident to have data to improve the model as a normal procedure. More information at www.voxnet.it.


An action plan adopted by the European Commission shows how information and communication technologies can be used to deliver better quality health care Europe-wide. The "ehealth action plan" covers everything from electronic prescriptions and computerised health records to using new systems and services to cut waiting times and reduce errors. The proposals will contribute to better care at the same or lower cost. The action plan sets out the objective of a "European eHealth Area" and identifies practical steps to get there through work on electronic health records, patient identifiers and health cards, and the faster rollout of high speed Internet access for health systems to allow the full potential of ehealth to be delivered. By the end of the decade, ehealth will become commonplace for health professionals, patients and citizens. The action plan is the third element of the Commission's recent activities in the health area. The two other activities address patient mobility and the benchmarking of national reforms in health care, long-term care and social protection.
Information Society Commissioner Erkki Liikanen said: "The challenges facing health care in Europe today require a bold response. The greater use of technologies and services - such as the Internet - as a partner in improving health care must be encouraged. This plan helps us to do this because new technologies and services make access faster and easier, reduce errors, and improve the effectiveness of health care systems."
Today at least four out of five European doctors have an Internet connection, and a quarter of Europeans use the Internet to get information about illnesses and health matters. But ehealth tools or solutions include products, systems and services that go beyond simply Internet-based applications.
With a turnover of €11 billion ehealth is emerging as a new industry in the public health sector, alongside pharmaceuticals and traditional medical devices. By 2010, estimates suggest that up to 5% of national health budgets in the EU will be invested in ehealth systems and services (compared to 1% 4 years ago).
The action plan foresees the following actions:
- By 2005 Member States should develop their own roadmaps for ehealth, and an EU public health portal should be up and running to provide a one-stop shop access to health information.
- By 2006 work should be well advanced on key issues such as developing a common approach to data allowing patients to be identified and putting standards in place allowing efficient exchange of patient information.
- By 2008 health information networks should be commonplace, delivering services over fixed and wireless broadband networks and making the most of networks within so called "Grids" to boost computing power and the interaction between different systems. More information at http://europa.eu.int/information_society/qualif/health/index_en.htm.


The OECD Forum 2004 "Health of Nations", recently held in Paris in conjunction with a Meeting of OECD Health Ministers on the subject of "High-Performing Health Systems", featured a panel discussion on ehealth. The debate mainly focused on e-prescription, smart cards and the growing use by patients of the Internet to gather information on diseases, medications and treatments.
The growth of interest in ehealth derives from the increase in patient knowledge and patient involvement. A study of 8,000 patients in eight EU countries found that almost three-quarters claim that they should lead or participate in providing information on their diseases. This active involvement of patients has led to a much greater need for information, and a greater reliance on information technology to satisfy this need.
"E-prescriptions have proven tremendously effective in reducing medication errors, which account for 5% of medical prescriptions. These errors often result from sloppy handwriting", explained Thomas d'Aunno, Director of the Healthcare Management Initiative at INSEAD in France.
Another aspect of ehealth lies in the introduction of smart card technology to record medical information. Hong-jen Chang from Taiwan's Bureau of National Health Insurance explained that, "using German technology, we implemented a €3.3 billion investment to equip Taiwan's 23 million people and healthcare workers with smart cards. This programme has already saved three times the amount invested."
The importance of the Internet cannot be underestimated. For Per Wold-Olsen, president of Merck's Human Health - Europe, Middle East & Africa division, the Internet has been critical in providing up-to-date information to AIDS or osteoporosis patients.
For Anders Olauson, director of the Agrenska foundation in Sweden, another issue with the Internet is its trustworthiness: "I believe that we should see certification of web sites by medical authorities," he argued.
"eHealth is a jungle on the Internet, that is to say, we can be confronted with the worst and the best," said Daniel Vial, Director of France's Pharmeceutiques magazine and the moderator of the panel.
Mr D'Aunno reiterated that "patients want greater decision-making input". The concern, however, is that physicians are not prepared to deal with more informed patients.
Infrastructure was also on the mind of Marie Smith, President of the AARP in the US, who paraphrased US health secretary, Tommy Thompson, saying "grocery stores (in the US) are more automated than our healthcare", with an estimated US$125 billion spent each year on unnecessary paperwork.
While cost of implementation is a factor, ehealth programmes can also lower consumption of public resources, so lowering medical care costs, by better informing patients, for example, when to go to the hospital and when to stay home. More information on the OECD Forum 2004 and Meeting of OECD Health Ministers webpages.


The overwhelming need for cost-effective and high-quality healthcare delivery is motivating the implementation of IT solutions such as the electronic medical records (EMR) system. But while EMR systems undoubtedly offer multiple benefits, their potential is likely to remain unfulfilled unless true continuity in terms of information exchange is attained.
EMR usage has contributed to improving the overall quality of care delivery. Comprehensive healthcare records have enhanced decision-making processes and decreased medical errors and adverse events while shortening treatment times and duration of hospital stays.
At the same time, demonstrable savings from lowered transcription costs, reduced radiology and laboratory usage and decline in adverse drug events brought about by the deployment of EMR systems is likely to help healthcare departments control spiralling expenditures.
"The EMR system is now acknowledged to be more than a simple repository of patient information," comments Healthcare Industry Analyst Siddharth Saha from Frost & Sullivan. "Organisations use business analytic models to monitor processes and workflows by analysing the information in the EMR. While improving the care delivery process, the system also aids in business process re-engineering and building positive relationships with patients."
Government-sponsored initiatives are expected to catalyse expanded IT adoption in healthcare delivery systems. However, with confusion persisting about standards issues and the legal framework surrounding data security and privacy issues, governments are expected to approach healthcare IT with caution.
Achieving true continuity in terms of information exchange is expected to be a critical long-term challenge for all stakeholders. Until standards are implemented for medical terminology, data exchange and data security, continuity of care as envisioned by the EMR is not likely to be attained. Ownership of responsibility for providing strategic direction to the industry is another key challenge for the long-term.
"One of the major initiatives that can make a big difference to the growth in this industry is the continued collaboration between vendors, providers, decision-makers and the payers to work on developing and perfecting universally acceptable standards," says Mr. Saha. More information at http://healthcare.frost.com. See also here.


The first official meeting of eHealth Standardization Coordination Group (eHSCG), after its initial installment last year in Geneva, took place in Luxembourg during Med-e-Tel 2004. Dr. Gunnar Klein from CEN TC 251 was elected as Chairman and Prof. Yunkap Kwankam, Head of eHealth Department at WHO as Vice-Chairman of this group.
It was agreed that the group is not a new standardization body and does not want to assume this role. The main goal is to promote the coordination among different standard developing organizations (SDOs) dealing with ehealth field issues.
eHSCG will make efforts to strengthen the cooperation among the SDOs involved and improve information exchange between organizations in order to avoid the duplication of efforts.
The Group will be technical (as opposed to regulatory) in nature taking into consideration regulatory, economic, medical and social issues. It will support activities to increase user awareness of the existing standards, case studies, etc.
The work program is under preparation and will be presented soon. See also here.


The session on "eHealth Solutions for Developing Countries" was a great success during Med-e-Tel 2004. Chaired by Prof. Yunkap Kwankam from WHO, assisted by Prof. Leonid Androuchko from ITU-D as Vice-Chairman, the session presented and discussed several ehealth projects in developing countries.
Malina Jordanova and Tsvetan Dachev of the Bulgarian Academy of Sciences presented an ehealth/telemedicine project which is under implementation in their country. The project has been developed for rural and semi-mountainous regions in Bulgaria and focuses on the introduction of telecardiology and telepsychology services. It will introduce, test and evaluate the effectiveness of packet-based wireless access infrastructure connecting a network of 10 villages.
Sri Satyamurthy from the Indian Space Research Organization (ISRO) pointed out that since the start-up of the first ISRO telemedicine pilot projects in 2001, more than 37 hospitals in India located in rural and remote areas are now connected via Indian National Satellite (INSAT) to 13 specialized medical centers in New Delhi and other cities. More than 12,500 patients have been provided with specialty teleconsultation and treatment so far. Some major observations from this project are that doctors are comfortable with the system; patients are more confident by being referred; and many critical cases have been dealt with in cardiology, neurology, neuro-surgery and nephrology.
Leonid Androuchko, Chairman of Telemedicine Group in the ITU-D made a presentation based on results of several pilot telemedicine projects implemented by the Telecommunication Development Bureau of the ITU in selected developing countries, namely Mozambique, Senegal, Uganda, Myanmar, Bhutan, Ukraine, Georgia, Malta, Ethiopia. He provided an evaluation of these projects and in all cases doctors and patients were satisfied with the telemedicine services. Developing countries have an overwhelming need for the provision of medical and health care services, especially in areas outside the cities and telemedicine could be an economic means of achieving national health policy objectives with regard to improvement and/or extension of medical and health care. Forecasts of the potential telemedicine market in developing countries were presented and explained.
Charles Kelly of Medoctor Systems presented an automated medical diagnostic system operating over the Internet in different languages. It is a system that contains over 830 diseases that can be diagnosed with symptoms and easy signs, including the most prevalent diseases in the developing world. Chali Tumelo from Ethiopia pointed out that such systems are urgently needed for all developing countries.
Yunkap Kwankam, Director of eHealth Department at WHO said that in order to offer sound advice to developing countries, it is important to strengthen the evidence base on the impact of telemedicine on structure and process in health care systems and in particular its influence on outcomes. Such an assessment is currently under implementation in the WHO. See also here.


The International Society for Telemedicine (ISfT) presented several of its national member associations at Med-e-Tel 2004. The member associations from Denmark, Germany, Norway, Poland and UK presented several national telemedicine projects and activities that are or have already been successfully implemented. ISfT also promoted new memberships for the Society and in the meantime several new national and other members have been added with several more still to follow soon as well.
The ISfT Board convened during Med-e-Tel. It was decided that Med-e-Tel will become an official ISfT supported event and will also be the yearly ISfT meeting related to practical applications in the field of telemedicine and ehealth.
ISfT exits to facilitate the international dissemination of knowledge and experience in telemedicine and ehealth and to provide access to recognised experts in the field worldwide. For more information about ISfT or ISfT membership application, go to www.isft.net.


The initial version of the Telemedicine & eHealth Directory 2004 was presented at Med-e-Tel 2004 and distributed among all Med-e-Tel participants. The Directory contains a listing of telemedicine and ehealth vendors, manufacturers, associations, institutions, media and projects, and is a cooperation between the International Telecommunication Union (ITU), International Society for Telemedicine (ISfT) and Med-e-Tel. The directory also remains available on the ITU, ISfT and Med-e-Tel websites and is being distributed at various meetings and events attended or organized by these organizations. Updates of the directory will also regularly be produced. If you would like to register for a next update, or if you would like to change your existing profile or add a picture or logo, contact us at . See also for more information.


- For information on publications, journals, magazines, reports and on-line information services that will help you to stay abreast of what is going on in the field of ehealth and to make better informed decisions in your daily business or healthcare practice, check out the list of Media Partners on www.medetel.lu.
- A free home telehealth information service is available from Information for Tomorrow for home care service providers and planners, equipment designers, and industry watchers who need to keep abreast with developments in today's rapidly emerging home telehealth industry. Called the Home Telehealth Community of Care, this bi-monthly topical page provides targeted installments on key options for effective home telehealth delivery. It is available at: www.informationfortomorrow.com/hottopics.htm, and topics featured will include tele-obesity, telehospice, chronic disease management, and telerehab services.


To follow are links to some interesting and recently published articles and studies (if you would like to suggest an article for inclusion into a following newsletter, feel free to send details to ):
- Access and authorisation in a Global e-Health Policy context (International Journal of Medical Informatics)
- Security of health care records in Belgium: Application in a University Hospital (International Journal of Medical Informatics)
- The Malaysian Telehealth Flagship Application: a national approach to health data protection and utilisation and consumer rights (International Journal of Medical Informatics)
- California Hospital Uses Telemedicine to Perform Sexual Assault Examinations (ATSP)
- NASA Researchers Develop Crew Physiological Observation Device (ATSP)
- Better health care through the Internet (Belgacom)
- Groundbreaking eHealth Initiative report offers good medicine for ailing United States Health Care System (Virtual Medical Worlds)
- Interactive Video Specialty Consultations in Long-Term Care (Journal of the American Geriatrics Society)
- Enhancing Telecommunications in the World of Health Care (Advance for Health Information Executives)
- Telemedicine Research Brings Medical Care To People Living In Earth's Remote Regions, Improves Space Medicine (ScienceDaily)
- Robotic Wrist Can Diagnose From Afar (ATSP)
- Patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study (British Medical Journal)
- E-Health On The Horizon: Better broadband connections, aging baby boomers, and a lack of nurses are increasing the use of remote medical care, diagnosis, and monitoring (InformationWeek)
- On Call: Telemedicine Put To Work In The Emergency Room (InformationWeek)
- Keeping IT Healthy with Information Security Policies (Advance for Health Information Executives)
- Emergency! Time for Telemed (Health-IT World News)


- EHTEL, the European Health Telematics Association, organised a seminar on ePrescribing on June 2nd. Supported by NICTIZ, the Dutch National IT Institute for Healthcare, the seminar attracted some 70 participants to discuss the perspectives of ePrescribing in Europe, following presentations from various countries and different stakeholder groups. ePrescribing is one of several subjects currently being analysed by EHTEL's task forces. For more information, consult www.ehtel.org.
- EHTEL is organizing a workshop on "ICT & Quality in Healthcare", jointly with the European Society for Quality in Healthcare and with the support of STAKES, the City of Lahti and the Laatukeksus. The two-day workshop will be held in Lahti, Finland, on Friday 18 and Saturday 19 June 2004. The workshop will seek to explore the role of ICTs in the promotion of quality in the European healthcare agenda, as well as to look into the revolutions and changes brought about by the use of ICTs in health and social care for the many stakeholders involved in these fields. More information is available on www.ehtel.org.
- The Southern Institute for Health Informatics (SIHI) is holding its 6th Annual Conference in Portsmouth, UK on Friday 1 October 2004. Themes of the conference include:
*NPfIT - where are we now and where are we going?
*Information for performance management and evaluation
*Patient information and choice
*E-health as the catalyst for modernisation
*Professional status of health informatics
but other topics relevant to health informatics are also welcomed. More details can be found on the conference website: www.disco.port.ac.uk/hcc/sihi/sihi2004/index.htm.

 
 

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