"We set out to prove the sustainability of telemedical services from an organisational and economic point of view", stated Health Optimum project co-ordinator Claudio Dario. "In our two years of market validation, we found that telemedicine not only gave advantages from an economic point of view, but was very useful for the needs of patients."
Like good doctors anywhere, the Health Optimum team realised that just treating the symptoms of Europe's health care malaise would not save the patient. All European Union Member States are facing changes that are largely beyond their control - an explosion of medical knowledge accompanied by expensive new diagnostic equipment and procedures, an ageing population and declining work force, and increasing expectations for high-quality health care.
Claudio Dario and his colleagues across Europe realised that these structural problems demanded structural solutions - solutions that telemedicine might be able to help bring about. "The concept of telemedicine is that you can bring the high-level specialisation of a few centres to patients all over the region", stated Claudio Dario.
The team first tested the concept, focusing on a variety of medical specialties, in Denmark, Spain and Italy. In Claudio Dario's region of Veneto, which includes Venice and is home to 4,6 million people, the focus was on head trauma.
Before the project began, Claudio Dario said, most patients with head trauma and possible brain injury were transported by ambulance or helicopter to one of the region's six neurosurgical centres. The centres were overloaded, treatment was often delayed, needless costs were incurred, and, once diagnosed, it turned out that most of the patients had not needed the centre's specialised services.
With the co-operation of the region's physicians and health care administrators, Health Optimum restructured the entire process. First, an IT infrastructure was put in place to support remote but full-service neurosurgical consultation using a hub-and-spoke model. Reorganisation of medical record keeping proved to be a crucial step. An adequate and inclusive system had to be designed to move records, such as computed axial tomography (CAT) images and lab results, smoothly and securely between a specialised centre and the peripheral clinics.
With the infrastructure in place, patients no longer need to be ferried from the accident site to a surgical centre, but can simply be brought to the nearest of 60 emergency rooms in the region, according to Claudio Dario. There, the patient is stabilised and given a CAT (or CT) scan which is immediately sent in digital form to a specialist. The specialist reads the scan and consults with the local health care provider as needed to determine if surgery is needed. Only in that case is the patient transferred to the neurosurgical centre.
"Our analysis showed that up to 80 percent of transportations have been avoided by this system, achieving a high level of savings", stated Claudio Dario. "In addition, by speeding up expert assessment, telemedicine saves lives."
Similar trials in Spain and Denmark demonstrated that telemedicine is not only useful in managing trauma, but provides similar benefits in the management of chronic illnesses, such as endocrine disorders, diabetes, and heart disease. "We have shown that telemedicine is useful and sustainable and that it provides both an economic and a medical value", stated Claudio Dario. "If it did not have value, we would not have been able to convince people to use it."
Since Health Optimum is funded under the European Union's eTEN programme for market validation and initial deployment, moving from demonstration to dissemination is part of its mandate. Accordingly, Health Optimum is now increasing the range of its telemedical services in Italy, Spain and Denmark, and is expanding the project to Romania and Sweden.
Some of the services being rolled out include patient-physician videoconferences, with both having access to the patient's complete record, dermatological, radiological and surgical consultations supported by high-resolution images, and tele-counseling for discharge planning, home care, and alcohol rehabilitation.
With standardised records and protocols in place, Claudio Dario pointed out, they have even been able to provide medical consults from Italy to patients in Romania. Claudio Dario is pleased to have shown that telemedicine can be accepted by doctors, patients and administrators, and that it can help Europe contain rising medical costs. Still, he says, there's more to be considered.
"We now know that we can achieve a high level of savings", stated Claudio Dario. "But we have to consider that medicine is not just an industry. In many cases, the timing and specificity of diagnosis and treatment are vital. Telemedicine can save your life."
More information is available at the Health Optimum project website and in the VMW July 2006 article Health Optimum offers telemedicine solutions to optimise health care. This article has been reprinted from the ICT Results website.