Momentum telemedicine service descriptions

Health Optimum (DK)

Objectives, expected outcomes, main beneficiaries

Health Optimum, which is short for “Delivery OPTIMisation through teleMedicine”, was a project approved by the European Commission in the eTEN programme. The objective of the project was to ensure the healthcare services through virtual medical assistance for a wide range of medical specialties: haematology, nephrology, dermatology, oncology, radiology, endocrinology, cardiology, endocrinology, orthopaedics, plastic surgery, neurosurgery, psychiatry, alcoholism recuperation, home monitoring for old people and general healthcare.

During its market validation phase, Health Optimum has market validated a comprehensive suite of telemedicine services able to improve the perceived quality of the healthcare services provided and, at the same time, to enable a reduction in the costs related to their production and delivery. The project also evaluated the user acceptance of the services and validated a business model on which the Health Optimum Initial Market Deployment phase is based.

The expected outcome of the second phase of the project was an operational system which is up and running in all Danish regions and which is financially self-standing because it pays for itself through the savings that it releases in the routine delivery of healthcare. Thanks to Health Optimum, doctors are saving time, public healthcare systems are saving money and patients are receiving better coordinated and better quality care.

The main beneficiaries are patients, healthcare professionals, healthcare provider organisations, and regional and national health authorities.

Targeted population, number of patients

The service targets people with chronic conditions such as those who receive long-term monitoring or coaching.

People living on a small island can receive specialist treatment through telemedicine. They are patients with diabetes type II, and they would otherwise have to spend hours travelling to receive treatment.

From ten to 20 patients receive the service monthly. The estimated size of the targeted population nationally is from 100,000 to 500,000.

Type of telemedicine service

The service is described as “Consultations – Follow up”. The relationship between the key actors is patient/secondary care.

Set-up that was being replaced

Conventional treatment involves travel by boat to go to the hospital and to see the specialist.

For diabetic patients, the Health Optimum service has meant an increased quality of life as they do not have to spend a day travelling to receive specialist treatment, and therefore they are much more likely to go to the very important three-month check-ups of their chronic condition. Previously, a number of patients did not want to travel and thus their chronic condition was not properly monitored.

Outcomes and results expected after introduction

Approximately 5 percent of the Danish population suffer from diabetes (around 270,000 individuals). The annual increase in the number of diabetes cases is around 7 percent. One Dane dies every second hour, i.e. 12 deaths each day can be related to diabetes. In 15 years’ time, the number of diabetes cases will more than double. While the number of patients is rising, at the same time specialist resources are becoming scarce; it is very important to test new methods for providing diabetes treatment. Patients suffering from diabetes are exposed to some particularly crippling angiopathic complications, such as retinopathy causing blindness, diabetic ischemic foot ulcers leading to amputations, and nephropathy to the level of end-stage renal disease. These patients need to be seen regularly by an endocrinologist who monitors the course of their disease. This type of regular consultation can be particularly inconvenient for people living in remote areas far from the nearest specialist team. On the other hand, modern technology allows healthcare professionals to perform remotely the essential examinations which are required in these cases, and to transmit the information through a network (whether stills or animated images). Examinations for retinopathy will still be conducted in the tertiary hospital, as the equipment necessary for this examination cannot be moved.

In addition, video-conferencing can be applied advantageously to the routine monitoring of patients suffering from diabetes. Patients will have a blood test done at their general practitioner’s and receive the answer through video-conferencing at their local hospital. Before this service was put in place, the patient had to travel to the tertiary hospital to consult a specialist. Even though the consultation itself usually takes less than an hour, the patient’s commuting time back and forth to the hospital was often very significant.

Therefore, as a result of video-conferencing, both the specialist nurse at the local hospital and the patient experience benefits. The patient receives a fine-tuned therapy in a far more effective way than he/she currently does, even with frequent consultations with the specialist. This allows an immediate intervention when the glucose level reaches dangerous thresholds and the metabolic regulation gets out of control. By participating in the consultation, the specialist nurse or the general practitioner on his/her part learns more about the treatment of diabetes and improves over the time his/her problem-solving capability that can occur with poorly controlled diabetes.

The health professionals behind the set-up have collected data over the past six years. It shows that diabetic patients are better monitored than before and that they even might be among the best regulated diabetic patients in Denmark.

Detailed description

In 2005, the Odense University Hospital (Svendborg) took its first baby steps to delivering health care at a distance. Today, every two weeks a specialist nurse travels by boat to the island of Aeroe. Here, she sees diabetes patients at the local hospital. If she needs an expert evaluation, she can contact a specialist doctor through video conferencing.

The feedback can be supplied both synchronously and a-synchronously: this is possible because of shared electronic patient records and shared laboratory results between hospitals and general practitioners. The service is conducted through video-conferencing.

The specialist nurse is present in the same room as the patient at the local hospital. Should the specialist nurse need assistance, she can call up the specialist doctor. The specialist doctor is able to see the patient as well as the shared clinical record. In addition, the specialist nurse is able to transmit live digital images to the specialist – these can be viewed simultaneously. The service requires an Internet connection between the two units as well as a shared clinical record. Should any information be sent to other systems outside the hospital’s clinical record, a standardised MedCom message will be used in order to ensure data security.

Operational status

The service is operational and part of the mainstream health service.