Denmark's hospitals keep closing, but its residents don't stop getting sick. That's where telemedicine can play a role in maintaining efficient and effective healthcare delivery.
Odense University Hospital is working to build a videoconferencing network on Denmark's existing healthcare IT infrastructure, which includes fully integrated EHR, ePrescribing, RIS and PACS, all on secure Internet protocols.
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The aim of the project is to respond to closing hospitals and declining resources while offering an alternative to the traditional hospital visitation model.
"You have to be in good health to be at a hospital," said Claus Pedersen, Head of the Department for Clinical Innovation at OUH, while speaking at the eHealth Week 2011 and World of Health IT conference in Budapest. "About 10 percent [of patients] get an infection during admission."
Compounding the issue of contracting illness while visiting a hospital is an issue of patient confidence. When patients enter a hospital examination room, they immediately surrender their dignity along with their clothing, Pedersen said. Wearing a johnny gown creates a sense of discomfort that tends to make patients passive and inactive in their care. "Patients lose the chance to decide and demand what kind of care they want for themselves," he said.
Telemedicine gives patients a new care experience, allowing them to receive treatment and consultation from their own home, while wearing their own clothes.
Videoconferencing with patients is a reality at OUH and will be throughout the southern region of Denmark by the end of 2011, Pedersen said. Interpretation of care notes via videoconference is a more cost-effective alternative to a hospital visit, he said, and it's popular with patients and physicians.
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Pedersen said that Denmark will recover its investment in videoconferencing within five years.
In addition to videoconferencing, there are currently three clinic focuses in which OUH is developing telemedicine resources:
1. Home monitoring of COPD patients
COPD sufferers are frequent guests at hospitals, but they don't have to be. Specialized nurses conduct consultations while working with a homecare staff, who can upload patient vital signs directly to the hospital. OUH has already seen positive results, including earlier discharge, patient satisfaction and empowerment, and fewer total COPD admissions.
2. Photographic monitoring of diabetic foot ulcers
Visiting nurses photograph foot ulcers of diabetes sufferers within the patients' homes, while a hospital-based expert reviews the images and provides guidance to the nurse. A general practitioner is informed of the patient's condition throughout the case management.
3. ECG arrhythmia detection for heart patients
Nurses are doing rounds at homes of heart condition patients while using "ePatches" for remote monitoring. Currently in a pilot phase, the project aims for large reductions in costs and time.
Denmark's ambitious healthcare IT projects over the last two decades are fully public-financed, and have cleared the way for these developments in telemedicine. The project is complex nonetheless. Among its challenges, Pedersen listed:
- The appearance of new healthcare organization models
- Creating a market for telemedicine
- Creating a sustainable business model
- Developing clinical evidence of telemedicine's importance
- Understanding citizen demands, behavior and resources for telemedicine
- The possibility of new standards.
Pedersen is optimistic about telemedicine's potential for Denmark as a true alternative to hospital-based care. "At a hospital, what we're doing is probably really stupid, because in reality we're trying to get rid of patients," he said. "We have to get patients in and out as quickly as possible... and there's good reasons for doing that."