Please activate JavaScript!
Please install Adobe Flash Player, click here for download

EH 1_2015

Continued from page 1 Chilled to the bone! EUROPEAN HOSPITAL  Vol 24 Issue 1/15 2 NEWS & MANAGEMENT Report: Sascha Keutel Asked what technical and staff are needed by a cardiology depart- ment to introduce a home monitor- ing system, he explained that the technical prerequisites are given in every German hospital. These obvi- ously include internet access and an acceptable bandwidth. However, he points out that the personnel infra- structure and workflow need more thorough consideration. ‘Who han- dles which data and how these data are then processed further must be clearly defined. In Leipzig, we have a specially trained staff-member who checks the data concerning their further processing and then forwards them to the respective staff. ‘Basically, you can say that the overall infrastructure in the hospital is significantly relieved by our cardi- ology Home Monitoring System and the treatment quality has improved significantly.’ ‘Studies have shown a very posi- tive effect on peoples‘ health through home monitoring. Our IN-TIME- study, for example, has shown a significant reduction in the over- all mortality of cardiac degenera- tion patients through implant-based remote aftercare. ‘We analysed whether the rate of cardiovascular mortality is reduced to the same extent as the overall mortality rate. It is indeed! One cru- cial driver of the reduction of the overall mortality rate is the reduction of the cardiovascular mortality rate. ‘There’s certainly also a psycho- logical component. For the most part the patients accept home moni- toring well. Only a few patients rejected our offer due to possible technology-based doubts they might have had. Most patients are happy that they now only have to plug in the CardioMessenger – an auto- matic transmitter similar to a mobile phone – into the power outlet. From this point on, transmission happens automatically. The patient thus has the certainty that the system imme- diately registers technical or medical abnormalities.’ Unsuitable patients ‘I cannot think of any condition at all under which home monitoring should not be used with a patient: there are no measurable risks. The system consumes only a little power, which does not influence the life- cycle of the implants at all. The patient also gets additional infor- mation from another partner in his existing health-network. This allows for significantly higher quality treat- ment at no additional cost. Cardiologist involvement ‘We’ve planned for interconnected- ness with resident colleagues and have already implemented a sys- tem with some offices and have intensive exchange. We forward all relevant messages to these col- leagues. However, the responsibility of informing the patients remains with us. For example, whenever we think a measure such as a change of the medicinal treatment is necessary, we consult with our colleagues and jointly develop a solution. Health insurance ‘We are currently negotiating with the health sector payers. They want to see data proving an improvement of quality before they take over financial responsibility. These data are now given. We made consider- able input in setting up a high den- sity of studies about home monitor- ing with the company Biotronik, in financing and processing it without asking too much from the health sector. Now I have an urgent request to all payers involved: Take a look at these data, take an acceptable posi- tion, and take responsibility for your patients. Turn the quality-improve- ment for the patients into financially relevant services!’ Documentation hopes ‘It’s not an inconsiderable task to successfully manage the connection of all data in a hospital. It would be an optimal approach and an efficient treatment-path if the data showing a decline in the patient’s health would automatically be transmitted through PACS or KIS into the medical record. This would ensure a direct connec- tion, comprehensive documentation and follow-up treatment. ‘This connection is planned – but it has not yet been opti- mally implemented in all areas because it’s very complicated. ‘No aspect of this, however, affects data security: all data are stored on a multiple-security platform allow- ing us encrypted access at any time, from any computer all over the world. It’s a matter of course that only authorised people have access to these data. The system is well protected!’ Communication and upkeep expenditure ‘The costs are currently carried by the manufacturers. The patient does not bear any additional cost. In addi- tion, in case of downtimes, the data are of course not lost. We cooper- ate with cellular network provid- ers who guarantee high network reliability. The transmission rate for Home Monitoring lies above 90%; this is very high. Future prospects Just like telemedical applications, these systems will play a vital role in disease management in the future. An ever-increasing amount of data regarding frequently occurring ill- nesses will be transmitted through automatic data systems. In the future, there will even be bio-monitors that will be adapted to the individual patient’s needs; also, in the mid-term, implants for which sensors are acti- vated will be available. A dysrhyth- mia patient can then have an ECG- monitor activated; a diabetic with dysrhythmia will have an insulin or glucose sensor implanted and the ECG-monitor will also be activated for this patient. ‘This is how cardiology will look, in the future.’ Home monitoring in fast action France electroEvery year, worldwide, over a million patients have a pacemaker or defibrillator implanted. Home moni- toring systems can significantly improve the safety and quality of life for these patients, says Professor Gerhard Hindricks, head physician in the rhythmology department at Leipzig’s Heart Centre. Report: Jane MacDougall The idea of a ‘dossier médical person- nalisé’ (DMP, or electronic health record) for every French citizen was first inaugurated in 2004. Now, over 10 years and €500 million later, we can look at the pros and cons encountered during this still incom- plete journey and consider if similar projects would be a useful addition to healthcare administration in other European countries, or not. The main DMP aim was that all doctors involved in a patient’s treat- ment would have immediate access to a complete medical record, to avoid repetition of investigations/ prescriptions or risk from overlooked illnesses etc., which can occur when relying on an oral medical history. Also wanted: Faster exchange of secure information between the vari- ous healthcare structures involved in a case e.g. an in-patient having exams in different locations. Another long- term aim was to use the information collected for epidemiological and eco-epidemiological syndromic sur- veillance to help in the early detec- tion of health problems, as has been the case in the USA from 2013-2014. A brief history As early as the 1960s, when the potential power of computing first became apparent, the idea was pos- tulated to digitise medical records as a means to help in population healthcare. However, it was not until 2004 that the French health minister, Philippe Douste-Blazy, launched the DMP as a fully-fledged two-year pro- ject to ensure the transfer of medi- cal information between healthcare providers, which he declared would result in €3.5 million annually saved from wasted examinations, prescrip- tions etc. Nonetheless, the experiment, which had included, private doctors, hospitals, healthcare networks, and allowed them access to computerised medical notes, was legally terminated by the end of 2006. In the audit of Geneva, a sealed room where the pressure can be increase as high as 2.5 times normal atmospheric pressure. Most large hospitals have such chambers, Cauchy said, typically for treating patients with difficult wounds. He also points out that portable, inflatable chambers are routinely carried as essential equipment for the base camp of climbing expedi- tions to treat or prevent acute alti- tude illness. Using a mechanical pump, atmos- pheric pressure is increased inside the chamber to increase the victim’s arterial oxygen pressure, thereby reproducing the effects of a low-alti- tude evacuation when a real descent is not possible. Patients enrolled in the study will be hospitalised in Chamonix for up to eight days to undergo specific therapies developed by Cauchy at IFREMMONT. Each day the patient will be transported to Geneva, an hour away, for a treatment session in a large-scale, 16-person hyper- baric chamber where atmospheric pressure is increased to 1.5 bars. Oxygen levels will also be boost- ed during the hyperbaric session, Cauchy explained, to increase the oxygen transport capacity of the plasma to counteract ischemia in tissue. Frostbite patients also suf- fer from painful wounds and, as with other patients being treated in the hyperbaric chamber, the ther- apy sessions are also expected to improve wound healing. The cross-border cooperation for the GELOX study is supported by funding of €421,000, half of which is provided by the European Regional Development Fund with the remaining financing raised joint- ly by French and Swiss regional authorities. Cardiology and internal medicine specialist Gerhard Hindricks is a medical graduate of the Westfälische Wilhelms- University Münster, Germany. Today he co-directs the Cardiology and Angiology Department at the Heart Centre, University of Leipzig, where he has also been Professor of Medicine since 2005. The expert has contributed to more than 150 publications. Biotronik’s CardioMessenger: Over the telephone line the device sends the patient data to the attending physician. Photo:BIOTRONIKGmbHuKGPR

Pages Overview