The newly coined term “telemedicine” describes the provision of clinical health care at a distance, using modern information and communication technology. In other words, it addresses the application of telematics in the health care industry, or “health telematics.” Although overlaps between the two terms are highly debated, they are closely related to “e-health,” which refers to the use of electronic media in the field of clinical healthcare.
Health telematics have developed into an important catalyst for the European clinical health care industry – though telemedicine is actually not a new concept for treating patients. As early as 1905, the father of the modern ECG, Willem Einthoven, transmitted heartbeats by telephone. And since 1931, doctors in the municipal hospital of Cuxhaven have been providing medical advice services to patients at sea as part of a program called Telemedical Marine Assistance Service (TMAS). Domestic medical distress systems have been in use in Germany since the early 1970s, and the list of historical applications could be lengthened at will. So why has telemedicine been so slow to have the anticipated impact on the clinical health care system in Germany?
Most health experts agree on one thing: More widespread use of telemedicine would produce substantial social and economic benefits. Despite this, many telemedicine services and projects are still not a standard feature of modern medicine. Frequently, they are just pilot projects that are discontinued once the funding dries up. Germany has spent many years trying to come to terms with self-administering doctors, insurance companies and other key players with respect to the telematics infrastructure. The introduction of electronic patient cards has been postponed several times now and the arguments about costs have, until now, stalled all hope of a general introduction of telemedicine services. In other countries they have already made more progress. For example, in Denmark, there is a central health portal which can be used to record or call up medical information on every individual patient. This has already made centralized electronic patient records – and thus the basis for other telemedicine services – a reality for the Danish. And in Germany? There are still not even any billing codes for outpatients receiving telemedicine services and there are an unfathomable number of projects and initiatives underway.
Despite adversity, fortunately some projects have now made the leap from the pilot stage to routine operation. For example, there are a number of regional teleradiology alliances, making it possible to transfer image data between hospitals and local radiologists. This is also safeguarding the role of smaller medical units in the long term. Another example is the practice of neurological teleconsultation – already established in many areas. This allows stroke units to deliver expertise through videoconference-based diagnostics for the regional care of stroke patients.
Everyone involved in the health care industry is totally aware of the fact that in an aging society, telemedicine holds huge economic potential. Caring for the growing number of chronic patients and housebound patients with multimorbid conditions is a challenge that cannot be solved adequately without using health telematics. Given the predicted dearth of rural doctors’ practices, it will also be impossible to provide sufficient care to patients in rural areas without telemedicine.
Medical technology companies have already started rising to the challenge and offering a number of solutions. Their focus lies in ambient assisted living (AAL). AAL refers to the use of technologies and applications to provide everyday help to the elderly or sick patients, and thus allow them to remain integrated in the home environment. This includes solutions like telemedicine supervision systems, which monitor health by regularly measuring vital signs such as heart rate, blood pressure and hydration levels. Values are then analyzed centrally. In combination with the right treatment management systems, this telemonitoring of vital signs can be supplemented with dialog systems to capture further health parameters by conversing with the patients and issuing new instructions.
The market for such applications is clearly so promising that companies from outside the industry are prepared to invest major sums of money in research and development just to gain a foothold. It is not exactly a secret that Apple would like its HealthKit app to lay the standards for the integration of a variety of different sensors, as is already the case with the measurement of parameters in the fitness and health market. The aim is for Apple’s cloud technology to make it possible to store and manage health parameters centrally.
We can still hope that this will not all result in a multitude of incompatible standalone solutions. Fortunately, genuine attempts are being made to establish standards. But for systems to be integrated properly, and for health data to be used on a continual basis, it will be even more important to set up a central electronic patient record system – a kind of electronic health database, with similar access for doctors and patients. Until now, attempts to set up some sort of central system have been unsuccessful in Germany. Apparently, the main stumbling block has been problems with data protection. Given the fact that we now carry out the majority of our banking transactions online and it has evidently been possible to solve data protection issues in that area, it is difficult to understand why this should be the case. The urgently needed new patient care methods, made possible by rapid developments in telemedicine technology, are already established in other European countries, so it is only a matter of time until this happens in Germany.
Prof. Dr. Hans-Heino Ehricke is director of the Steinbeis Transfer Center for Image Processing and Information Technology in Medicine at the Stralsund University of Applied Sciences. Aside from the development of image processing applications, the center plans and operates telemedicine networks, such as a teleradiology network in the state of Mecklenburg-Western Pomerania.
Professor Dr. Hans-Heino Ehricke
Steinbeis Transfer Center Image Processing and Information Technology in Medicine (Stralsund)