Remote Treatment: Clear the Way for Telemedicine

Telemedicine as part of eHealth

Telemedicine is not the only area in the healthcare system that makes use of modern information and communication technologies: this innovation represents just one of many application areas of an entire electronic health services (eHealth) unit.

What is eHealth?

According to the definition of the World Health Organization (WHO), eHealth includes the use of modern information and communication technologies (ICTs) for the health sector. The eHealth unit works with partners at global, regional and country levels to promote and strengthen the use of ICTs in health development – from local application to global governance. The eHealth unit is based in the Service Delivery and Safety Division of the Health Systems and Innovation Cluster.

What does eHealth include?

Until the year 2000, the term eHealth mainly referred to the digitization of classic processes in the health sector (e.g. the digital patient file). However, with the rapid development of modern information and communication technologies, such as the mobile Internet, the importance of eHealth applications has become increasingly general and has meanwhile developed into a generic term for numerous areas. ‍ Areas of application in practice
include

• telemedicine
• Electronic Health Card
• digital patient record
• eDoctor’s letter with electronic signature
• e-prescription
• Computer-based disease and knowledge management
• m-health: health apps for smartphones (e.g. for prevention or diagnostics)
• mail-order pharmacies

‍ Areas of application in practice include

• Information: Provision of information for doctors and patients (e.g. via internet portals)
• Communication: facilitated electronic exchange of information
• Interaction: direct communication (e.g. via email or Skype) -> telemedicine
• Transaction: Data exchange between participants, eg between a health insurance company and a doctor’s office; Electronic mapping and processing of medical services (e.g. electronic health card, electronic prescription)
• Integration: long-term central storage of data (e.g. digital medical records)

Importance of telemedicine

An important area of ​​application for eHealth is, among other things, telemedicine. This makes it possible for medical measures for health care to take place despite the physical and temporal distance. These medical measures include diagnostics, therapy, rehabilitative treatments, or medical emergency services. In addition to these functional barriers, telemedicine can also help to bridge emotional barriers – for example, shame about personal issues (like sexual dysfunction) or simply the lack of drive to see a doctor. Medical decision-making advice – i.e. the interdisciplinary exchange of medical expertise – also falls under the measures that can be facilitated by telemedicine. Examples of this are so-called teletumor conferences between outpatient oncologists and specialists in related disciplines. In telemedicine, the medium is audiovisual communication and information technology – for example, video conferences.

Telemedicine in social use – What does telemedicine bring you?

Telemedicine offers the patient the opportunity to receive medical advice and care despite the physical and temporal distance. This can be useful if, for example, you are on vacation, not mobile (don’t have a car, can’t get out of bed), or live very far from the nearest doctor. Telemedical services can also be used flexibly in terms of time – for example after work or at the weekend. Telemedicine also simplifies doctor consultations with shame-related medical problems, such as erectile dysfunction, hair loss, or contraception.
‍ Telemedicine
offers various measures that you can use from home:

• Online video consultation hours: Here you can get in touch with your doctor via video. You can explain your symptoms and, for example, show the doctor your hair loss. You can then discuss the diagnosis and therapy measures with your doctor in a video consultation.
• Telediagnostics: You can send your examination data to a specialist doctor who is geographically distant. The doctor can then make the appropriate diagnosis and arrange the appropriate therapy.
• Telemonitoring: Your current state of health is monitored with the help of ICTs over a geographical distance (e.g. an ECG app on the Apple Watch helps to monitor the heart rhythm and identify disturbances)
• Teleradiology: A spatially distant radiologist can examine your radiological image material. As a result, a radiologist would no longer have to be on-site to be able to carry out image-supported examinations.
• Teletherapy: You can have therapy sessions from anywhere. The therapist can initiate therapy measures remotely.

development of telemedicine

Telemedicine applications have been around for over 140 years. Over the time span to date, these applications have continued to evolve and have become increasingly complex. What telemedicine will bring in the future is still in the stars – but constant further development of eHealth and digital health applications is certain.

As you can see: In the last few years, a lot has happened in favor of telemedicine development in the UK. That’s a good thing, because telemedicine is becoming more and more relevant for the UK population. The reasons for this are demographic change and the increasing prevalence of chronic diseases. Added to this is the increase in costs in the health care system and thus the demand for economical alternatives. The sub-optimal infrastructure in rural regions – for example in the new federal states – is an important reason for the expansion of telemedicine.

Telemedicine stakeholders

As one can easily see, telemedicine is of great value to patients and offers them numerous benefits. That’s why many ask themselves the question: “Why is it all taking so long?” – the answer is this: Patients are just one of many stakeholders that are part of the market for telemedicine applications. This market is very complex, with the actors involved influencing it to varying degrees or being influenced by the market and other actors. The most relevant interest groups are:

As you can see: The market for telemedicine applications is connected to a large number of different interest groups. These interest groups differ in their influence, their goals, and their relevance within the value chain. A large part of the various interest groups cooperate with each other and with telemedicine and thus promote the development of telemedicine applications. Despite this collaboration, barriers remain that need to be addressed by stakeholders. Examples of these barriers are questions about data protection, fees, the legal basis or the benefits of telemedicine. Probably the most powerful player influencing the development of telemedicine is politics.

Opportunities and limits of telemedicine

The fact that the development of telemedicine in the UK is progressing slowly is not unjustified. Telemedicine makes a valuable contribution to solving demographic challenges in healthcare and can sustainably improve medical care for citizens. However, telemedicine also has numerous limitations and is therefore often criticized.

Chances :

• The medical infrastructure is decentralized, doctors can work more flexibly.
• The shortage of doctors in rural areas is compensated.
• Spatial and temporal distances to the doctor (e.g. when you are away) are overcome, and the visit to the doctor for people who are not mobile is less time-consuming.
• Appointments can be made faster, especially with specialists.
• The overcrowded practices are relieved, and the risk of infection in the waiting room is minimized.
• Patients’ barriers to consulting a doctor about shameful topics are falling.
• Patients at risk can be identified more easily and encouraged to take precautions (e.g. prostate screening for all male patients over 45).
• Communication between doctors is improved (and thus the quality of medical care).
• Data values ​​can be queried in a standardized way, elementary quality standards can be guaranteed.

Limits :

• The exclusive online treatment of unknown patients is always inferior to direct doctor-patient contact.
• The risk of misdiagnosis increases.
• A prerequisite for qualitative treatment is a very good internet connection, which is particularly problematic in rural areas.
• A certain basic knowledge of modern technologies such as the Internet is a prerequisite for use.
• Technology dependency in healthcare is increasing.
• There are no clear legal framework conditions, especially with regard to data protection and data security.

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Telemedicine under discussion

In principle, telemedicine offers promising opportunities to improve the healthcare system in the UK in the long term – at least as long as the telemedicine applications are carried out within an appropriate framework. Accordingly, the development of telemedicine applications is supported by most interest groups. At the same time, however, the limits and risks of telemedicine are constantly being discussed.

Such pluralism towards modern information and communication technologies (ICTs) in the health sector is nothing new. In the debate about the E-Health Act, fears were the main focus and the view of what could be improved by ICTs in the future was clearly neglected. The lack of incentives and the unnecessary sanctions and bureaucracy also had a negative impact on the opinions of interest groups.

Many concerns are also expressed in the discussion surrounding telemedicine. A term that is used very often is technology dependency. However, this fear ignores the fact that technology is already indispensable in many cases in medicine: For example, most junior cardiologists depend on an ultrasound device in order to be able to make a diagnosis. Accordingly, it is not so much the dependence on technology as such that should be discussed, but rather how to deal with it. The handling or implementation of the technical challenges that are the basis for telemedicine applications is also limited. Because modern information and communication technologies could be too complicated and overwhelm them, especially for older patients or doctors. Improve medical care in rural areas and facilitate access to doctors and specialists – hardly anyone disputes that. Tangible evidence of this is provided, for example, by the result of a pilot project for integrated stroke care “TEMPiS” in the region of southeast Bavaria. In this project, the telemedical connection of regional hospitals to national stroke centers led to an increased chance of survival and a low risk of disability in stroke patients from rural areas. It should also not be underestimated that telemedicine makes it much easier for those affected to consult a doctor with shy topics and thus makes diagnosis and treatment possible for people with emotional barriers. Despite such achievements through telemedicine, there are repeated warnings that telemedicine is not a complete solution for medical care, even in rural and underserved regions. Because – and this is supported by all concerned –a long-distance conversation cannot replace the traditional visit to the doctor, but only supplement it. Accordingly, telemedicine is only seen as an opportunity if it is coupled with a personal visit to the doctor (survey, coloquio GmbH, July 2017, n=349 physicians).

These and many other topics, such as the possible relocation of the workforce abroad, are discussed again and again and will probably not be clarified in the next few years. Unfortunately, such discussions are barriers to the implementation of unrestricted telemedicine in the UK. In order to remove these barriers, it would be important to create incentives for all interest groups and to make the medical and economic benefits of telemedicine clearly recognizable. This would presumably optimize acceptance and thus cooperation between medical service providers.

Telemedicine in the UK and EU: what is the state of play?

eHealth and telemedicine in the UK and EU: what is the state of play?
‍ E
-health and telemedicine were long foreign words in the UK and their development seemed to have come to a standstill. This standstill ended with the entry into force of the E-Health Act, the easing of the ban on remote treatment, the Digital Care Act, and some initiatives in the digitization of the healthcare system.

The law for secure digital communication and applications in healthcare (eHealth law), which came into force at the beginning of 2016, aims to establish information and communication technologies in everyday medical life. This is intended to improve the cost-effectiveness and quality of care in the health sector. Important components of the implementation of a nationwide digitally networked healthcare system in the UK are the telematics infrastructure, the electronic health card, and the digital patient file. These innovations are the basis for the secure exchange of medical information.

Telemedicine is also an important part of eHealth, but its development has long been slowed down by the ban on remote treatment. This ban prohibited the doctor from treating or remotely diagnosing a patient who had never been examined in person. Fortunately, the 121st German Doctors’ Day lifted the ban on remote treatment only, removing a barrier to telemedicine. Doctors are now allowed to advise and treat patients in individual cases without personal initial contact via telephone or the Internet – but with restrictions:

• Exclusive online consultation and treatment are only permitted if this is medically justifiable.
• Appropriate diligence must be guaranteed with regard to the assessment, counseling, treatment, documentation, and patient information about the special features of online counseling and treatment.

Another milestone in the development of telemedicine is the “Act for Better Care through Digitization and Innovation” (Digital Care Act, DVG)., which was passed by the German Bundestag in 2019. This law gives the insured a regulated right to the prescription of telemedical health applications – for example, apps on prescription – as well as their reimbursement by the statutory health insurance companies. The prerequisite for reimbursement is that the telemedical health application produces positive care effects and meets the test criteria of the Federal Institute for Drugs and Medical Devices. As a result of this law, the insured are offered a significantly broader range of services. In addition, healthcare providers are encouraged to further develop their digital offerings and to invest in the innovative power of the healthcare system.

These legal changes have significantly advanced telemedicine opportunities in the UK. The German government, in cooperation with health insurance companies, medical organizations, innovation fund projects, and the IT and pharmaceutical industry, is increasingly trying to improve electronic health services. Despite these efforts, the UK is still in its infancy compared to other European countries:

• In Estonia, most medical care is paperless.
• In Sweden, the implementation of eHealth is state-funded – the focus here is on telemedicine and IT consulting.
• In Denmark, investments are being made consistently in the digital support of healthcare provision.
• Remote treatments and prescriptions are legal in the UK.
• In Austria, patients have direct access to their own data with the electronic health record.

Telemedicine: Where is the journey heading in the coming years?

One thing is certain: telemedicine is on the rise in the UK. It’s high time, too, since other European countries are already far ahead of the UK in the implementation of telemedicine applications. The UK is therefore under pressure to face up to international competition and to advance telemedicine development. The relaxation of the ban on remote treatment was already a step in the right direction.

In order to break down further implementation barriers, what is probably the most powerful player in the telemedicine value chain has to step in: politicians. This has already removed some bureaucratic hurdles and will continue to do so in the future: The Federal Ministry of Health is planning to launch the e-prescription in 2021. Despite this progress, problems remain: One example is the urgently needed clear and simplified regulations on data protection and data security in telemedicine. The telematics infrastructure must also be expanded so that the development of telemedicine can continue – for example, improved technical and semantic interfaces for communication between stakeholders should be created. In addition to the inadequate framework conditions, conflicts between the interest groups among themselves and with telemedicine are hampering the market entry of telemedicine providers. One example is the pronounced skepticism about online treatment as a substitute for direct doctor-patient contact, which emanates from both doctors and patients. However, medical guidelines developed by medical societies are intended to counteract this skepticism.

As high as the hurdles may seem now if some of the implementation barriers are overcome, the future of telemedicine in the UK has a bright future. Because the telemedicine market is a dynamic and innovative area with high growth potential and is urgently needed in the UK to tackle the current challenges in the healthcare system.

Telemedicine – social conclusion

The reactions of various surveys show that a large part of society supports the development of telemedicine applications. If you take a closer look at the geographical distribution of medical care, it is no wonder: In the rural regions of the UK, which are not in the catchment area of ​​large cities, the infrastructure is usually less well-developed and there are not enough doctors – specialists are particularly popular scarce in these remote regions. Telemedicine will play a very important role in serving these rural areas and has the potential to significantly improve medical care for the population living there. In addition, the demographic change in the UK, the increasing prevalence of chronic diseases, and the population’s need for more options and flexibility in everyday life – including in healthcare – alternative treatment options. As you can see: the demand for modern, telemedical applications is there and will probably continue to increase in the coming years. However, in order to meet this demand and to integrate timely telemedicine into the basic care of the German population, the appropriate framework conditions still have to be created and important questions clarified. telemedicine applications exist and are likely to continue to increase in the years to come. However, in order to meet this demand and to integrate timely telemedicine into the basic care of the German population, the appropriate framework conditions still have to be created and important questions clarified. telemedicine applications exist and are likely to continue to increase in the years to come. However, in order to meet this demand and to integrate timely telemedicine into the basic care of the German population, the appropriate framework conditions still have to be created and important questions clarified.

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