News in Telemedicine: March 2018

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ISfTeH International Conference provides intriguing glimpses of inclusive virtual hospitals and greater emphasis on home based healthcare.

This month I traveled to Helsinki to attend and present some of our research at the ISfTeH International Conference in tandem with the Finnish National Conference on Telemedicine and eHealth.

Aside from attempting to stay warm as the cruise conference venue broke through ice on its way from Helsinki to Stockholm — not kidding — I had fascinating discussions with colleagues from around the world presenting their research, programs and thoughts on Telemedicine and eHealth. Here were some highlights I took back to chew on.

Rural Telemedicine
Finland has a public system set up with larger hospital districts supplying specialty care to satellite primary care centers. The country is sparsely populated and varies greatly in population density. Because much of the population may not be near a higher level of care, there was an initial focus in using Telemedicine in these areas, whether acute care delivery, radiology readings, and provider to provider consults.

Centralized vs. Satellite Care
One speaker related that a proposed part of the future healthcare plan was to funnel patients to a higher level of care, rather than first treating at a smaller clinic. There is a more complicated discussion on the political climate in Finland that would affect this possibly next year.

Initially, I thought this would decrease geographic access to services, but expected tech innovations would address those concerns. Some of these tech innovations going forward include:

Virtual Hospital 2.0
A joint project with university hospitals to create a virtual hospital that covers all Finns. A presentation from Helsinki University Hospital (Väätäinen, Saku et al) ran a dynamic predictive modeling to compare current practice with VH 2.0 for health care visits, treatment, calls, e-visits, e-messages and traveling. The model predicted savings of 42 million euros annually that likely improves the equality of citizens by monitoring quality of life, symptoms and chronic disease. Of course, implementation and adoption are a different story, however potentially covering the entire population speaks to increasing access, not decreasing.

AI/Data Science
Finland has kept and continued to ramp up electronic records and databanks for decades and is using it to improve their epidemiological studies and research capabilities. There is high participation from their population and a general trust in biomedical research. They are using the data to improve patient engagement, reduce costs and stage earlier interventions. A notable first study was able to predict sepsis in very low birth weight infants in the NICU 24 hours earlier than regular clinical methods.

Home Based Healthcare
The entire Nordics are leading toward setting up the home as the center of health care with cooperative interaction between hospitals, communities, private sector, startups, research and even insurance companies. With a smaller population and mutual aid between the numerous players in the health care continuum, it is likely we will be learning how this works in an equitable form from this part of the world before we see it here.

Research
A literature search run by a US-based RN of all RN articles related to Telemedicine resulted in it heavily weighted toward review articles. She suggested continuing research should focus elsewhere. The ACEP Telemedicine section is doing a similar project, and I can attest that MD/DO articles are also similarly skewed. She, and many others, also stressed keeping RNs and other care providers as part of the Telemedicine discussion.

There were many other interesting TM use cases including:
– A comprehensive program in India in a private hospital network.
– Machine learning CVD risk assessment tool from Hong Kong.
– The security of food and nutrition for mothers and babies in the Amazon.
– Developing TM education curriculum in the Nordics.
– VH 2.0 portion on emergency care to help send patients to correct service center.

Dr. Arild Faxwang from Norway stated ‘knowledge is both evidence based and experience based.’

Despite having different health systems, insurance, government regulation and data, many of us have the same challenges when trying to implement and improve our enmeshment between healthcare and technology. Learning from each other is a productive and engaging process as Telemedicine continues to grow.

ABOUT THE AUTHOR

Dr. Aditi Joshi is an Emergency Medicine Physician who has worked in Telemedicine for over five years, beginning at a startup and moving onto an academic institution. She is the current Medical Director of JeffConnect, part of Thomas Jefferson University Hospital's Telehealth program. She is particularly interested in the issues of patient access and engagement, provider education and fostering international collaboration.

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