Dr. Drago Rudel
Director MKS Electronic Systems Ltd., Ljubljana, Slovenia.
Co-founder, Telehealth Quality Group EEIG.
A large scale European deployment project United4Health (UNIversal solutions in TElemedicine Deployment for European HEALTH care) finished in January 2016. The project objectives were to assess the impact of innovative healthcare services for the remote monitoring of patients with chronic conditions: Congestive heart failure (CHF), diabetes (DM) and Chronic Obstructive Pulmonary Disease (COPD). The project aimed to demonstrate that telehealth service models validated in previous EU projects could be successfully transferred to other regions.
There were 14 deployment sites in different parts of Europe that posed different challenges for telehealth; and offered opportunities to implement and test different service models – using different technologies and organisational infrastructures. A key message from the study is that introducing telehealth in Europe calls for standardisation at all levels of the service provision.
Aims of the United4Health Project
The United4Health project (CIP-ICT PSP-2012-3 No.: 325215; www.united4health.eu
) finished in January 2016. It assessed the impact of innovative healthcare services for the remote monitoring of patients with three chronic conditions: Congestive Heart Failure (CHF), diabetes (DM) and Chronic Obstructive Pulmonary Disease (COPD). The partners, 35 of them, were from 9 European countries. These comprised CZ, FI, DE, GR, IT, NO, SLO, SP, UK (Scotland and Wales) and some international organisations (COCIR, Continua Health Alliance, GSMA and EHTEL). A brochure describing the different models is available on the EHTEL (European Health Telematics Association) website at http://www.ehtel.eu
(search on Telehealth in Practice – Care Delivery Models from 14 Regions in Europe
The aims of the project were to:
• Demonstrate that telehealth / telemedicine service models already validated in previous EU projects can be successfully transferred to other regions;
• Enable further telehealth / telemedicine deployment for uptake of the services at pan-European level;
• Promote adoption of remote patient monitoring and treatment on a large scale (scaling-up);
• Measure telehealth / telemedicine services clinical efficiency; and
• Assess telehealth / telemedicine cost effectiveness (with evaluation using the MAST methodology).
The MAST methodology was developed within other European projects and endeavours, where applicable in project evaluations, to ensure consistency in and comparability of results.
The project partners have been harvesting the results of the project. A number of the lessons learnt and the benefits for patients, clinicians, telehealth industry, etc. have been presented in different project deliverables – some of which are publicly available (http://united4health.eu/deliverables/
). Others will be forthcoming.
Seventeen service models were, in fact, deployed in 14 regions within 9 European countries. There were 4 different models at 6 sites for COPD, 4 models at 4 sites for CHF and 9 at 9 sites for DM telehealth services. The variety of models is a reflection of different conditions at the deployment sites at the project start. Some partners, like NHS 24 / the Scottish Centre for Telehealth and Telecare, tended to build on services already in place – using their technological infrastructure and service organisational models. Some deployment sites utilised by other partners took a similar approach where the technological infrastructure and measuring equipment was in place for patients. Other partners had to ‘start from scratch’ before services could become operational. In Slovenia, for instance, partner MKS Electronic Systems Ltd. had to develop a new telehealth service.
The United4Health project funds were not, however, sufficient to establish new platform and implement equal service model in all partnering regions. The selection of service models was, therefore, in part determined by local circumstances so that the partners were able to recruit and engage with an appropriate range and number of patients / service users. This approach is somewhat in contrast to that adopted in other European pilot projects where there has been greater consistency in approach. A consistent approach is recognised as helping project evaluation and the analysis of outcomes but it can also run counter to the fact of cultural differences, varied needs and circumstances of the regions.
Towards Better Standards
The multi-model approach in the provision of telehealth services, therefore, opened several new questions like:
• How to provide telehealth services at equal quality level throughout a country and across regional or international borders?
• How to achieve data interoperability to enable cross-border services to operate effectively?
The answer lies, it is considered, in using some kind of ‘standardisation’ that goes beyond that which relates to the technologies and signalling protocols. This should be done, it is suggested, at the level of the services – embedding standardised approaches to their different elements. With this in mind the “International Code of Practice for Telehealth Services” is a good tool to set-up or to adjust a telehealth service. The Code is downloadable at http://www.telehealth.global
and offers an international quality benchmark that can be used either as a standard or as a reference point for existing services.
Also relevant is the report by COCIR (European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry), a member of the United4Health project ‘Industry Advisory Team’. This highlighted the use of standards for technology solutions and interoperability at the point of procurement. It can be downloaded from http://www.cocir.eu
(Deliverable 5.6). The COCIR report points to the fact that only few partners procured ‘standards’ based solutions – for example sourcing Continua certified devices. Continua now operates within the Personal Connected Health Alliance (www.continuaalliance.org
) and aims to ‘transform healthcare through personalized, interoperable connected health solutions.’
Having said this, standards and interoperability were not a mandatory requirement in most of the sites. In those sites that did specify some standards based solutions, some vendors baulked – stating that (a) the prices would be higher; and (b) that the relevant devices were not available in the local marketplace. Limited time for procurement was also an issue as all sites needed solutions to be up and running before the project would end.
An important lesson learnt, therefore, from the United4Health project was that introducing telehealth in Europe calls for greater standardisation at all levels of the service provision but there are some barriers to achieving this