CeBIT 2009, 3 to 8 March- Telemedicine gathers momentum in Germany

CeBIT 2009, 3 to 8 March- Telemedicine gathers momentum in Germany

10.12.2008: * TeleHealth 2009 takes an in-depth look at telemedicine Doctors checking on pacemakers via the Internet. Emergency treatment for stroke patients carried out with advice from a specialist communicating over a video link. Patients suffering from g

    * TeleHealth 2009 takes an in-depth look at telemedicine

Doctors checking on pacemakers via the Internet. Emergency treatment for stroke patients carried out with advice from a specialist communicating over a video link. Patients suffering from glaucoma or cardiac insufficiency taking their own readings and sending the results to an online patient file. And the pathologist asking his colleagues for a virtual second opinion on breast biopsies.

Surely these are all just pilot projects whose future is uncertain? Not a bit of it! Telemedicine is fast becoming a part of the standard patient care regime offered by Germany's healthcare system - and as such it is one of the dominant themes of the upcoming TeleHealth Conference and Exhibition.

The term 'telemedicine' refers to medical services that are delivered at a distance with the aid of modern information and communication technology (ICT). This kind of remote care was for a long time only possible under experimental conditions. It raised difficult legal issues and even more difficult issues of funding. All that is now changing.

Doctors are now paid for the remote monitoring of medical devices
The best example is the new billing tariff for outpatient medical care in Germany, introduced in 2008. For the first time this document contains billing codes that allow GPs not only to use telemedicine in certain situations, but also to charge for it. So now virtually all manufacturers of cardiac pacemakers and defibrillator implants offer devices that can be monitored remotely via the Internet.

At predetermined intervals these devices transmit operating data to a secure Internet platform. These data indicate to the doctor whether or not the pacemaker or defibrillator is still working properly. If something is wrong, the cardiac specialist assigned to the patient is informed by e-mail, telephone or text message, so that he can then - and only then - ask the patient to attend his clinic.

Such systems offer enormous benefits for doctor and patient alike. The patient no longer has to visit the heart rhythm specialist for routine check-ups, which often involve hours of travelling - and the doctor saves valuable time because remote monitoring only takes a few seconds.

 This leaves the doctor more time to spend with patients who really need him. The problem in the past has been that doctors were paid for patient appointments, but not for remote monitoring of patient devices. Now a billing code has been created to remove this anomaly. As a result, the remote monitoring of implants is likely to become standard practice very quickly.

Live link to the tele-community nurse
Similarly calculated to advance the cause of telemedicine in Germany is the new system for billing delegated medical services that is currently being put in place. This is in response to the telemedicine project known as 'Sister Agnes', which was initiated several years ago by the Institute for Community Medicine at the University of Greifswald in North Germany.

 'Sister Agnes' is a community nurse equipped with a tablet PC who makes house calls to bed-ridden patients on behalf of the doctor in regions where there is a low ratio of doctors to patients. The scheme was first piloted on the Baltic island of Rügen. In the meantime there are 'tele-community nurses' - to give them their official title - in other regions of Germany too.

Patient information is recorded by the nurse on her mobile computer, and the data are transmitted to the practice PC in the doctor's surgery. Consequently, he always has the information he needs, and if necessary he can even 'sit in' on the house call via a live video link.

Tele-care for glaucoma patients saves unnecessary journeys

The state of Mecklenburg-Vorpommern, home to the university hospital in Greifswald, is also the setting for one of the most recent telemedicine projects in Germany, which involves the remote treatment of patients suffering from glaucoma. In glaucoma patients the dangerous build-up of internal pressure in the eye has to be reduced with medication. If this is not done, there is a risk of blindness.

 It is particularly important in the early phase of the disease to check the pressure at regular intervals until the medication has been correctly adjusted. With the collaboration of the university eye clinic a small suitcase has now been developed, which the patient keeps at home while his medication is being adjusted. The suitcase contains all the necessary equipment for carrying out 'teletonometry' - the measurement of the intraocular pressure by the patient himself at prescribed intervals.

A modem then transmits the data over a phone line to an electronic patient record. These data can be accessed by the experts at the university hospital, and also by the patient's GP or eye specialist. If necessary, the medication is adjusted. Techniker Krankenkasse is the first health insurance company to offer this telemedical option to its policyholders - not as a pilot scheme, but as part of its standard patient care coverage.

Cardiology: spearheading the telemedicine revolution in Germany
The telemetric monitoring of patients with a chronically weak heart has likewise moved well beyond the pilot project stage in the German system of healthcare. The latest example is the AOK Plus telemonitoring project, launched in Saxony at the end of June 2008, which enables patients suffering from severe cardiac insufficiency to be monitored for a year using a set of digital scales and a digital blood pressure meter.

The readings are sent in encoded form to a telemedicine centre, which gives patients advice and guidance over the telephone. If necessary, the centre can bring in the supervising doctor or clinic for assistance. The aim is to detect any early signs of water retention in order to spare the patient long stays in hospital by adjusting the treatment in good time. This improves the patient's quality of life and reduces costs for the health insurance companies.

There are now more than twenty similar projects up and running in Germany. One company in North Rhine-Westphalia has signed up numerous health insurance companies to offer similar monitoring programs for cardiac patients. At the Charité teaching hospital in Berlin and the Robert Bosch Hospital in Stuttgart, the health insurance companies Barmer Ersatzkasse and Bosch BKK are participating in the care project known as 'Partnership for the Heart'.

This project is currently being followed with great interest because it is designed as a clinical study that will yield data in 2009 for the cost-coding of outpatient telemonitoring for medical insurance purposes. Like pacemakers and defibrillators, telemedical treatment for cardiac insufficiency will then be accepted as part of the standard patient care program offered by the German healthcare service.

Meter calling patient file: blood sugar level is up!
Among the organs of the human body, the heart is seen as the prime candidate for telemedicine. But it is by no means the only one. Thanks to new measuring devices, the wireless transmission of blood sugar readings to online patient files - obviating the need for repeated manual input of new data - is gradually finding acceptance. One such system was unveiled at TeleHealth 2008 by German-based company BodyTel.

Other suppliers are also active in this market sector. The benefits are obvious: wherever a patient happens to be, he can give his doctor access to his current blood sugar levels, so that any problems with medication dosage can be quickly and easily resolved.

The remote monitoring of diabetics is of particular interest to health insurance companies in the context of integrated healthcare concepts. Last spring saw the publication of the first results of the Diabetiva study, set up to evaluate the telemedical care of diabetics from both a clinical and an economic perspective. The key finding: the number of hospital admissions after six months was a fifth lower than for the control group, and the average length of a stay in hospital was down by as much as a third.

Stroke victims: the consultant can sit in via a live video link
Hard data are also available for the medical benefits of telemedicine in the treatment of stroke patients. Much of the pioneering work in this field has been done by the South German stroke network TEMPiS, which is seeking to improve the care of stroke patients in small local hospitals without their own department of neurology. Some stroke patients can benefit significantly from lyse therapy, a treatment that thins the blood to disperse clots.

However, complications can occur with this treatment, so that non-neurologists often shy away from prescribing lyse therapy in an emergency. So the TEMPiS network has established video links between these small local hospitals on the one hand, and two specialist stroke units in Munich and Regensburg on the other. If a stroke patient is admitted to the A&E department of one of these small hospitals, a live video link is set up with a consultant sitting in Munich or Regensburg, who can then look at the patient and the computer tomography scans of his head and sit in on the examination.

The decision on whether to proceed with lyse therapy is taken jointly. And it works: three months after the introduction of teleconsultations, the number of patients with poor treatment outcomes - and in stroke cases that normally means long-term paralysis - had been reduced by ten per cent. The quota of patients undergoing lyse therapy rose significantly. TEMPiS is financed through a special lump-sum payment negotiated with the health insurance companies.

The future of pathology is also going digital

The benefits of telemedicine are not always so immediately apparent to the patient. To improve efficiency in mammography screenings, the Professional Association of German Pathologists has established a teleconsultation server that enables pathologists to get a second opinion on breast biopsies - as they are required to do by law - without having to send the original specimen to a colleague by posting it to him on a glass slide.

All that is required is a digital workstation where the specimens can be photographed with a micro-camera. Digital microscopy takes the process a stage further by replacing the traditional microscope lens with a scanner. Here the quality of the digital tissue sections is so high that there is no longer any need to file the original specimens for future reference.

For a number of years now pathologists have also been actively involved in development aid, and one of the tools they are using is telepathology. The international cancer society UICC has set up a telepathology server for this purpose at the Charité teaching hospital in Berlin.

Hospitals from all over the world can e-mail digital photos of tissue sections to Berlin, where they will be evaluated by experts from the industrialized nations within two days. Several thousand such consultations have already taken place. Thanks to modern technology, highly specialized expert knowledge can now reach the remotest corners of the planet.

TeleHealth 2009

The TeleHealth international Conference and Exhibition taking place at CeBIT 2009 is being extended next year to six days for the first time. From 3 to 8 March 2009 trade show visitors will be able to get a complete overview of the latest telemedical processes and services in Hall 9.

 Alongside the extensive exhibition, Deutsche Messe is also hosting the TeleHealth Conference on 5 and 6 March 2009, with an impressive line-up of guest speakers. Admission to the conference is free of charge to CeBIT ticket-holders.

- Anne-Kathrin Seibt-


10.12.2008 / MaP

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