A Telehealth Nation WHITE PAPER CONNECTED HEALTH Telehealth

Home , Esbjerg Municipality, Rigshospitalet

INNOVATING BETTER LIFE

CONNECTED HEALTH Denmark - a telehealth nation WHITE PAPER CONNECTED HEALTH Telehealth

About this white paper This white paper presents the Danish approach to national implementation of telehealth and a broad range of ground-breaking solutions that contribute to making the Danish healthcare system more efficient and improve patient safety and treatment quality. It is part of a series of white papers that show how Danish solutions can contribute to increase efficiency in healthcare while empowering patients and staff.

Danish healthcare innovation is not exclusive for the Danes: many years of global presence show that our healthcare products and solutions create value internationally. Danish ideas and products are used every day in ambulances, medical clinics, hospitals, and nursing homes across the world.

We hope to inspire you and would like to invite you to Denmark to learn more about the Danish healthcare system.

Photo credits Foreword: Flemming Leitorp (Minister for Health Ellen Trane Nørby), Nadia Fryd (Minister for Public Sector Innovation Sophie Løhde), Region of Southern Denmark (Chairman of the Regional Council Stephanie Lose) Page 10: Lene Pedersen FOTO AV Aalborg Universitetshospital Page 12: Lene Pedersen FOTO AV Aalborg Universitetshospital Page 14: Ard Jongsma/Still Words Page 15: Medic OUH I/S Page 16-17: Claus Sjödin/CSPress.dk Page 18: Rigshospitalet Page 19: Rigshospitalet - permission is granted strictly for this white paper Page 20: Tonny Foghmar, Kommunikation Aarhus Universitetshospital Page 21: Getty Images/monkeybusinessimages Page 22-24: The Centre for Telepsychiatry in the Region of Southern Denmark Page 27: Esbjerg Municipality Page 28: Systematic Page 29: Medtronic

Editor in Chief Healthcare DENMARK, Hans Erik Henriksen, [email protected]

Steering Committee Danish Agency for Digitisation, Mette Myrhøj Jensen, [email protected] Danish Ministry of Health, Mathias Christiansen, [email protected] Danish Regions, Sine Mainz, [email protected] MedCom, Lars Hulbæk, [email protected] Mental Health Services in the Region of Southern Denmark, Anders Meinert, [email protected] Rigshospitalet, Peter Aagaard Nielsen, [email protected] Systematic, Henrik Jespersen, [email protected] TeleCare North, Tina Archard Heide, [email protected]

Contributors Aarhus University Hospital, Olav Bjørn Petersen, [email protected] Bispebjerg Hospital, Finn Gottrup, [email protected] Centre for Telepsychiatry, Marie Paldam Folker, [email protected] Esbjerg Municipality, Britt Saarup Kronbøge, [email protected] Health Innovation Centre of Southern Denmark, Søren Aggestrup, [email protected] MedCom, Dorthe Skou Lassen, [email protected] Odense University Hospital, Lea Bohn, [email protected] OpenTeleHealth, Henrik Ibsen, [email protected] Rigshospitalet, Peter Aagaard Nielsen, [email protected] Systematic, Jens Peder Rasmussen, [email protected] TeleCare North, Tina Archard Heide, [email protected]

Healthcare DENMARK’s partners :

Telehealth white paper version 1, March 2018

2 INNOVATING BETTER LIFE

Executive Summary

Like many other countries, Denmark has an age- Research shows that patients with severe COPD expe- ing population and a growing number of chronic rienced improved quality of life, and the number and patients. More and more people are in need of length of hospitalisations were reduced by 11% and 20% healthcare, which places an increasing strain on respectively. public finances. Building on the positive results for COPD patients, the offer Telehealth solutions may help the healthcare system to of home monitoring will now be expanded to include heart meet this challenge in a way that also improves the quality failure patients as well. of care. The Virtual Hospital Telehealth is not just about technology; it requires organi- The virtual hospital concept allows patients to receive treat- sational change. It may act as a catalyst for new routines ment at home and enjoy the same quality of care as they and workflows, which put the patient at the centre of treat- would in hospital. ment. Instead of admitting the patient to the system, the system is deployed to the patient. It saves them the trouble of going to the hospital for control visits or treatment sessions, and frees up hospital re- In general, patients are assigned a more active role in their sources at the same time. own treatment: They learn more about their condition, improve their self-care skills and are able to influence their Bispebjerg Hospital in Copenhagen has implemented a own health situation. At the same time, telehealth solu- telehealth service for wound patients that has increased tions reduce the number and length of hospitalisations, efficiency and patient satisfaction. Specialised municipal enhancing the financial viability of the healthcare system. home nurses are responsible for the treatment, which is coordinated by a wound healing centre at the hospital. The Denmark has been working strategically with telehealth for results of the project have inspired a nationwide telehealth years. At the core of these efforts are a number of small- solution for the treatment of wounds. and large-scale telehealth projects carried out across the Danish healthcare sector. At Rigshospitalet in Copenhagen, the Chemo at Home project uses a redesigned workflow to offer patients high- The most successful concepts are selected for further er-quality treatment without increasing expenditure. trials and development, preparing them for national dissemination. At Aarhus University Hospital, the Department of Obstet- rics and Gynaecology has implemented a telehealth solu- TeleCare North tion allowing women with pregnancy complications to be The TeleCare North project has implemented home mon- monitored at home. The number of outpatient visits has itoring to support patients suffering from COPD (chronic been reduced, staff spend 75% less time on patient mon- obstructive pulmonary disease). itoring, and the number of inpatient days for women with pregnancy complications has been reduced by 44%. The project has established new cross-sector roles and procedures to support the regionwide implementation of Odense University Hospital has implemented a telehealth home monitoring. This has paved the way for a new inte- service offering home support to families with preterm ba- grated care model, which allows the concept to be expand- bies. Instead of starting their new family life with a lengthy ed to other patient groups. stay in unfamiliar hospital surroundings, the solution allows families to be discharged as soon as the baby is in no Since 2013, approximately 1,400 COPD patients in the clinical danger. North Denmark Region have accepted the offer of home monitoring.

3 CONNECTED HEALTH Telehealth

Executive Summary (continued)

Telepsychiatry Compliance and prevention For patients with a mental disorder, timely access to mental Telehealth has the potential to inspire and motivate citizens health services is often of vital importance. Telepsychiatry to engage in their own health in a new way. It may increase can provide them with faster and more flexible access to their awareness of risk factors and facilitate close coope mental healthcare services, as well as the opportunity to be ration between patients, providers and professionals of the more directly engaged in their own treatment. healthcare system.

The Region of Southern Denmark has established a Centre At the Municipality of Esbjerg, telehealth is used to pro- for Telepsychiatry to empower patients and improve out- mote population health. Telehealth and preventive servic- comes and service delivery through the use of telehealth. es have been designed to motivate chronic patients to adopt a healthy lifestyle and improve their compliance The Internet Psychiatric Clinic gives citizens with mild with treatment. to moderate depression or anxiety fast access to evidence-based treatment and guidance, without the need At the Municipality of Holstebro, a study has documented for a referral from their GP. Based on the positive results, how a telehealth solution supporting home blood pressure it has been decided to implement the solution in all five measurement has reduced the reporting bias normally as- Danish regions. sociated with the detection of hypertension. The study not only revealed that many patients were being treated on the The Centre for Telepsychiatry has also implemented home- basis of an inaccurate diagnosis. It also identified a number based video consultations, providing easier access to psy- of citizens with undiagnosed hypertension. chiatric care. Home-based video consultations also support joint decision making between patients, mental healthcare Odense University Hospital is collaborating with the nation- providers and other healthcare professionals. al health authorities on a project that will make screening for colorectal cancer more efficient. Since 2014, all Danish A national infrastructure for telehealth data citizens between the ages of 50 and 74 have been offered Denmark’s implementation of large-scale telehealth solu- screening for colorectal cancer – either a colonoscopy, tions between 2011 and 2015 has revealed that telehealth which is a highly accurate, but invasive procedure, or a stool requires a new approach to data and data sharing. test, which is non-invasive, but much less accurate. A new “camera pill” technology allows colonoscopy diagnostics This has led to new initiatives and a sustained focus on to be carried out in the patient’s own home, significantly standardisation and further development of the Danish reducing the risk and discomfort associated with conven- healthcare system’s IT infrastructure in order to support tional screening methods. telehealth on a national level. Some of Denmark’s most promising and successful tele- Denmark was the first country in the world to adopt the health concepts are described in further detail in the fol- Continua Health Alliance standard as the national standard lowing pages – along with the potential or documented for telehealth devices. It is now the backbone of a robust gains for the patients as well as the healthcare system as framework for implementing telehealth nationwide. a whole.

4 INNOVATING BETTER LIFE

8 TeleCare North 3 Executive – home monitoring on Index summary 6 Foreword a grand scale

10 Improving 12 Proving quality of the case life for COPD for heart patients patients

16 Home-based wound treatment increases 14 The Virtual efficiency and patient Hospital satisfaction

18 Chemo at Home 20 Home monitoring – the hospital in a of women with preg- backpack nancy complications

21 Neonatal home care – telehealth support for 22 Telepsychiatry premature babies and – improving access to their families mental health treatment

23 The 24 Psychiatric 25 A national Internet home-based outpa- infrastructure Psychiatric tient care through for telehealth Clinic video-conferencing data

26 Compliance 27 Using telehealth and prevention solutions to improve population health

28 Telehealth facilitates 29 Innovative video early detection of hyper- capsule allows cancer tension diagnostics at home

30 Denmark 31 About

44.551 – a telehealth Healthcare nation DENMARK

5 CONNECTED HEALTH Telehealth © Flemming Leitorp

“Through hands-on experience from large-scale projects and day-to-day operations, we have learned that telehealth is smarter healthcare: Instead of sending the patient to the system, we deploy the system to the patient, benefitting everyone involved.”

Ellen Trane Nørby Minister for Health

Foreword

Through years of innovation and co- of telehealth and cross-sector collaboration. the ability to influence their own condition, operation, Denmark has created a We do this not only to balance budgets now while clinical staff can focus more on other modern healthcare system that and in the future, but first and foremost to patients needing intense, on-site care. Fur- keeps the patient in focus. We be- ensure that we continue to deliver high-qual- thermore, telehealth helps reduce the num- lieve that healthcare should be uni- ity and patient-centred healthcare. Health- ber and length of hospitalisations, while versally available and based on the needs care should be convenient, cohesive and increasing patients’ quality of life and the of the patient, not the needs of the system. citizen focused. financial viability of our healthcare system at the same time. However, an ageing population and a gro- ”Denmark is already a wing number of chronic patients mean that frontrunner in providing Telehealth supports existing workflows and more people are going to need healthcare in treatments that are being carried out with a the future, which will put increased pressure cost-efficient, citizen-centred high level of expertise. The new technological on public finances. Adopting new techno- healthcare of the highest opportunities can connect different parts of logies can help us overcome this challenge the healthcare system in smarter and more and create a better and smarter healthcare quality.” efficient workflows. Therefore, telehealth is system. considered an area with considerable poten- Through hands-on experience from large- tial by clinical staff, healthcare experts and When the challenge is to deliver high-quality scale projects and day-to-day operations, welfare technology companies. care to more people with the same resources we have learned that telehealth is smarter available, telehealth is one of the solutions. healthcare: Instead of sending the patient to Denmark is already a frontrunner in provi- Therefore, we are working hard to create and the system, we deploy the system to the pa- ding cost-efficient, citizen-centred health- adopt new innovative solutions throughout tient, benefitting everyone involved. Patients care of the highest quality. And we are just the Danish healthcare system. One way of learn more about their condition, increase getting started: By adopting and expanding doing this is through national dissemination their self-care skills and may even acquire the use of telehealth and other technologies,

6 7 Stephanie Lose

Chairman of Danish Regions INNOVATING BETTERINNOVATING LIFE

Sophie Løhde -

Minister for Public Sector Innovation Minister for Public Sector Innovation

© Nadia Fryd Stephanie Lose Chairman of Danish Regions Sophie Løhde Minister for Public Sector Innovation Ellen Trane Nørby Ellen Trane Minister for Health sing field. We hope this white paper will provide readers paper will provide hope this white We with inspiration and knowledge about Den mark’s experience so far within this promi- of citizens and society alike. we aim to keep Denmark at the forefront of aim to keep we the benefit – to technological development CONNECTED HEALTH Telehealth

General Practitioner Hospital COPD Patient Family Members Municipality

Patient centered telehealth The Telecare North project puts the patient in the center of attention from the GP, the hospital, the municipality, and family members. The telehealth project facilitates the collection and sharing of information in order to improve both patient insight and compliance as well as efficient and timely interaction by clinicians and relatives.

TeleCare North – home monitoring on a grand scale

TeleCare North is one of three and respond proactively to disease deterio- “One of the major benefits of TeleCare North large-scale telehealth projects in ration or other changes in the patient’s con- is that it allows us to perform healthcare Denmark. The aim is to transfer dition. tasks at the most efficient cost level. For in- telehealth concepts from small stance, a GP or a municipal nurse now per- pilot projects to solutions covering ”One of the major benefits forms tasks that previously required an out- an entire region, subsequently making the of TeleCare North is that patient visit or hospitalisation,” explains Tina case for national implementation. Heide, Project Executive for TeleCare North. it allows us to perform In 2011, Denmark launched three large-scale healthcare tasks at the More than technology… telehealth projects, each with the aim of im- Home monitoring is not just about new tech- plementing telehealth solutions for all rele- most efficient cost level. nology. It is also about using technology to vant chronic patients in a particular region. For instance, a GP or a reinvent processes of long-distance services that allow data to “follow” the patient and Among them is the TeleCare North project in municipal nurse now per- be shared among the different operators, the North Denmark Region – a collaborative forms tasks that previously sectors and professionals involved in the effort between the regional authority, its hos- patient’s care and treatment. pitals, GPs and 11 municipalities. required an outpatient visit or hospitalisation.” This perspective has been a key element in The main focus of the project is home moni- Denmark’s approach to home monitoring toring. The concept includes tools such as video and other telehealth concepts: It is focused consultations, home training and solutions on the optimal use of healthcare resources The general idea of home monitoring is to that enable patients to access patient net- and based on a close and well-functioning measure indicators such as blood pressure works or other sources of knowledge about collaboration between regional authorities, or pulse rate in the patient’s own home. The their condition. It may also be supplemented hospitals, municipalities and GPs. patient is provided with the necessary equip- with questionnaires, where the patient re- ment to perform the tests, while healthcare sponds to health-related questions through TeleCare North has established and defined professionals can monitor the patient’s data an easy-to-use telehealth app. new cross-sector roles, procedures and pro-

8 INNOVATING BETTER LIFE

General Practitioner Municipality Hospital Motivation to participate Medical referral Patient training Monitoring Gold D patients Contact to Gold D patients Monitoring special care needs Contact special care needs Rehabilitation Yearly COPD control

An Integrated Care model for telehealth The Telecare North project required a new way of organizing referral of patients to telehealth and determining the cooperation between clinical professionals in hospitals, primary care and municipalities. Therefore, an Integrated Care model to document this new kind of workflow was developed.

cesses to support the region-wide implemen- The scalability is supported by an interorga- tation of home monitoring. This has, in turn, nisational service centre concept to deliver resulted in a new integrated care model – a the logistics, education and maintenance platform that will enable other telehealth initi- solutions that are necessary to operate large- atives in the region or nationwide. scale telehealth services.

The integrated care model has been tried and tested with COPD (chronic obstructive pulmonary disease) patients and heart failure patients, and North Denmark Region is now ready to adapt it to fit the needs of other pa- Hjørring Frederiks- havn tient groups. Læsø Brønderslev

Jammerbugt

A concept ready for scaling Thisted Aalborg

Vest- Rebild Implementation of home monitoring requires himmerland Morsø a well-functioning IT infrastructure, tele- Mariagerfjord health equipment and solutions designed to meet the needs of patients and healthcare The Telecare North participants professionals. • 1256 Patients In the TeleCare North project, the technical • The Danish Lung Association solution is based on a flexible open-source • The municipalities in North Jutland telehealth platform. This makes it possible to • The GPs in North Jutland expand the home monitoring concept to oth- • The North Denmark Region er patient groups and to integrate new devic- • The 4 hospitals in North Jutland es and technologies. • Aalborg University

9 CONNECTED HEALTH Telehealth

Improving quality of life for COPD patients

The TeleCare North project has Twice a week, the patient tests blood pres- For patients with severe COPD, telehealth provided home monitoring for sure, pulse rate, saturation and weight with has increased rehabilitation activities by 9%. COPD patients in the North Den- equipment connected via Bluetooth to a This is important, because exercise helps mark Region. They now experience tablet and a user-friendly telehealth app. patients maintain their functional ability, im- fewer and shorter hospitalisations The patient also responds to health-rela- proves their independence, and reduces the as well as improved quality of life. ted questions about breathing difficulties need for healthcare services. and coughing. The results are immediately COPD (chronic obstructive pulmonary transmitted through mobile broadband, and ”The group of patients with disease) is a disease that develops over healthcare professionals may take action at severe COPD experienced im- time, slowly reducing the patient’s ability to any given time if necessary. engage in everyday activities. As the disease proved quality of life, and the progresses, breathing and moving around Empowering patients number and length of hospi- will require more effort, leading to social iso- Home monitoring gives patients a more ac- lation and reduced quality of life. tive role in their own treatment. The majority talisations were reduced by of patients experience improvements with 11% and 20% respectively.” Telehealth solutions make it possible to track regard to disease control, confidence and the development of the disease more closely self-management. For instance, they are The offer of telehealth home monitoring to and establish early interventions. Evidence able to respond to early signs of deteriora- COPD patients in the North Denmark Region shows that treatment involving telehealth tion and prevent hospitalisation in favour of is based on solid randomised clinicial trials also increases COPD patients’ confidence personalised self-management plans from results from four PhD studies conducted in and knowledge about their disease. their own GP. collaboration with TeleCare North. Since 2013, approximately 1,400 COPD patients in the North Denmark Region have Due to increased knowledge about their own When evaluating the effects of telemedicine, accepted the offer of telehealth home moni- illness, they also feel better equipped for the health economics plays a key role. In the toring. dialogue with healthcare professionals. TeleCare North project, the health economic

10 INNOVATING BETTER LIFE

Joined service Private vendor Public vendor Technical preparation of Telekit Logistics Support Server and software operation Software support Train the trainer Solution owner Contact/supplier management Devices for the TeleKit

The telehealth support centre The Telecare North project revealed the need to establish a telehealth support centre where public and private organizations can work together with the purpose to establish the logistics support, which is needed to implement telehealth on large-scale.

impact is measured in QALYs (quality-adjust- ed life years), an overall indicator of the value of health outcomes based on length of life Empowering patients and quality of life. • Most patients (61.7%) experienced improved con- The results show that the group of patients trol of their disease by using the system. with severe COPD experienced improved qual- • Most patients (71.7%) experienced improved secu- ity of life, and the number and length of hos- rity by using the system. pitalisations were reduced by 11% and 20% • Half of the patients (50%) experienced increased respectively. awareness of their COPD symptoms and respond- ed proactively. • The majority of patients (96%) found the system “easy” or “very easy” to use. • 27% of patients experienced more freedom. • Patients with severe COPD experienced enhanced quality of life.

These findings are not affected by the patient’s level of health literacy or socio-economic affiliation.

Source: Research findings on patient-related effects and health literacy.

11 CONNECTED HEALTH Telehealth

Proving the case for heart patients

Heart patients will be the next called up-titration process, where the hospi- sponsibility for following up on the patient’s patient group to benefit from tal’s heart failure clinic educates the patient data is transferred from the hospital to the telehealth home monitoring in and initiates treatment. municipal level, which is also responsible for the North Denmark Region. The rehabilitation and prevention efforts. project, TeleCare North Heart In addition to ensuring the correct medica- Failure, is based on the existing tele- tion, the solution provides patients with skills ”In addition to ensuring the health platform and includes the Integra- and insight into their own disease as well as correct medication, the solu- ted Care model and the interorganisa- the tools to cope with it. It is complemented tional service centre concept. by outpatient controls and questionnaires fo- tion provides patients with cusing on early signs of deterioration. skills and insight into their Building on the positive results from the COPD project, the North Denmark Region has The patient is provided with the equipment own disease as well as the decided to focus on heart failure patients necessary for self-monitoring, including a tools to cope with it. It is as the next chronic patient group to benefit pulse rate and blood pressure gauge, weigh- from telehealth home monitoring. ing scales and a tablet equipped with the complemented by outpatient telehealth app. controls and questionnaires Whereas patients with COPD have typically lived with their condition for several years The patient’s self-monitoring is followed focusing on early signs of before they are offered a home monitoring closely at the hospital, where staff responds deterioration.” solution, heart failure patients are introdu- to any signs of deterioration, ensuring rapid ced to telehealth immediately after they are adjustment of medication. diagnosed. A step towards national implementation After completing the up-titration process at Heart failure may have severe consequences How it works the heart failure clinic, the self-monitoring for a person’s general well-being and quali- The first steps are taken as part of the so- continues in the patient’s own home. The re- ty of life. But without a telehealth solution,

12 INNOVATING BETTER LIFE

General Pracititioner Hospital

al it P p G s

o H

Municipality Patient and relatives

ity l t a n p i e i c t

P u M

Patient centered co-operation The TeleCare North Heart Failure project facilitates a transparent and patient centered co-operation between hospital, municipality, GP, the patients and their relatives, which supports patient self-monitoring and compliance.

heart patients would not have regular con- toring for heart patients. The expected result of working age, the research also focuses on tact with the healthcare system after the is that telehealth home monitoring leads to the possible impact of the patient’s labour up-titration process. fewer hospitalisations for this patient group. market participation and/or dependence on sickness benefits. Evidence shows that patients tend to lose The purpose of the study is to determine focus on their symptoms 12-18 months af- whether telehealth support for patients with Finally, the research will assess whether mu- ter the up-titration process, and many expe- heart failure is suitable for national implemen- nicipalities are able to support patients in rience deterioration and/or rehospitalisation. tation. As patients with heart failure are often maintaining their ability to cope through home monitoring. The number of heart patient admissions in Denmark has doubled in 15 years, and a large number of patients suffer from both COPD and heart failure.

Therefore, the heart failure project also aims to establish a model for home monitoring of patients with more than one diagnosis.

Proving the case through research The framework is provided by the project Tele- Care North Heart Failure, an RCT (randomized controlled trial) study running until the end of 2018. The study, which is carried out in collaboration with Aalborg University, seeks to TeleCare North equipment for assess the effect of telehealth home moni- patient self monitoring.

13 CONNECTED HEALTH Telehealth

A nurse at a hospital telehealth center instructs a telehealth patient on how to use a device.

The Virtual Hospital

A virtual hospital concept uses Unburdening patients – and hospitals telehealth solutions to reduce the The virtual hospital concept saves patients the need for hospitalisation. It impro- trouble of going to the hospital for control vis- ves patient satisfaction as well as its or treatment sessions, potentially improv- cost efficiency. ing their chances of living a normal life.

Telehealth solutions based on video consul- At the same time, it relieves the strain on tations, apps for mobile devices, home mon- hospital resources by reducing the length itoring, and mobile treatment now make it and number of hospital stays. This allows possible to treat patients at home. hospitals to focus on admitted patients and deliver high-quality healthcare services to all Odense University Hospital has implemented citizens. It also ensures a better transition a solution that enables patients to be “hos- from the hospital to the municipal care sys- pitalised at home”: They can receive treat- tem, which is responsible for ongoing reha- ment at home and enjoy the same quality of bilitation. care as they would in hospital. They are, in a sense, admitted to a virtual hospital. The following cases describe how Danish hospitals have implemented virtual hospital “Shorter periods of hospitalisation is a stra- solutions in the areas of wound treatment, tegic goal for Odense University Hospital. chemotherapy, pregnancy complications and Telehealth enables patients to be discharged neonatal care. earlier by being “hospitalised at home”. It improves the quality and efficiency of treatment and offers more empowerment and quality of life for patients,” says Peder Jest, CMO at Odense University Hospital.

14 INNOVATING BETTER LIFE

The New Odense University Hospital

“Shorter periods of hospitalisation is a strategic goal for Odense University Hospital. Telehealth enables patients to be discharged earlier by being “hospitalised at home”. It improves the quality and efficiency of treatment and offers more empowerment and quality of life for patients,” says Peder Jest, CMO at Odense University Hospital.

Peder Jest CMO at Odense University Hospital

15 CONNECTED HEALTH Telehealth

Home-based wound treatment increases efficiency and patient satisfaction

At Bispebjerg Hospital, a telehealth every two weeks to guarantee an optimal The telehealth project has significantly re- service for wound patients has in- treatment plan. duced the average referral-to-treatment time creased efficiency and patient sat- from the primary healthcare sector to the isfaction. Specialised home nurses A specialised education programme hospital. are responsible for the treatment, To ensure that nurses have the required which is coordinated by a wound healing wound management and therapeutic skills, Based on its work with wound treatment, centre at the hospital. The project has paved they must first pass a multidisciplinary Bispebjerg Hospital plans to expand the use the way for a nationwide telehealth solution course, led by medical doctors, experienced of telehealth. for the treatment of wounds. nurses and podiatrists. Nationwide implementation An estimated 50,000-60,000 people in Den- “Patients and wound care These positive results have paved the way mark have chronic, non-healing wounds, typ- nurses report high levels of for a national telehealth concept for wound ically due to diabetes, decreased function of treatment from 2012-2015. the venous or the arterial system or unac- satisfaction with telehealth ceptable external pressure on exposed skin solutions: Patients feel more The national implementation includes the areas. option for municipal nurses to photograph involved and do not have to wounds with their mobile phones and upload These types of wounds heal very slowly, with travel as much. Nurses feel the images to a web-based electronic patient the added risk of severe complications, lead- record. A specialist may then prescribe new ing to amputation in worst cases. Because that their skills have improved treatment or medication as necessary. the patient’s underlying condition may not and that they can provide disappear, the wounds often need several Patients and wound care nurses report high treatments before healing. a better service for their levels of satisfaction with telehealth solu- patients.” tions: Patients feel more involved and do not To improve the quality of treatment, the Co- have to travel as much. Nurses feel that their penhagen Wound Healing Center (CWHC) at The course authorises nurses to refer pa- skills have improved and that they can pro- Bispebjerg Hospital offers a telehealth ser- tients to telehealth treatment without con- vide a better service for their patients. vice where municipal home care nurses can sulting a GP. All nurses are offered an annual treat patients at home, in nursing clinics, re- follow-up course at the CWHC to make sure Furthermore, the referral-to-treatment time habilitation centres and retirement homes. they are up to date on wound treatment and from the primary healthcare sector to the Nurses specialised in wound care are respon- patient care. hospital has decreased considerably. sible for updating the wound chart at least

16 INNOVATING BETTER LIFE

“Telehealth allows municipal nurses to photograph wounds with their mobile phones and upload the images to a web-based electronic patient record. A specialist may then prescribe new treatment or medication as necessary.“

17 CONNECTED HEALTH Telehealth

When a patient receives treatment at home, he or she will be able to contact the service team at the hospital 24/7/365.

Chemo at Home – the hospital in a backpack

A portable digital pump, a redesig- nous antibiotics. The chemotherapy or an- The clinic is also available for calls 24/7. ned workflow and a service design tibiotics are provided in a backpack, with a approach are at the core of Rigs- programmable pump connected to an intra- The “Chemo at Home” concept makes it hospitalet’s award-winning “Che- venous catheter. possible for patients to receive higher-quality mo at Home” concept. For patients treatment at the same (or at a lower) cost. diagnosed with acute leukaemia, it has re- “The “Chemo at Home” It has reduced the average number of inpa- duced the average number of hospital days concept makes it possible tient days from 30 to 10, freeing up beds for for inpatients from 30 to 10. elderly cancer patients who are more in need for patients to receive higher- of hospital care. Even with a critical diagnosis, patients want quality treatment at the same to keep their everyday routines, spend time Chemotherapy at home was implemented with their families and friends and maintain (or at a lower) cost.” in Denmark’s four other regions in 2016 in some control over their lives. close cooperation with Rigshospitalet, which The pump controls the infusions and the provides implementation service and sup- To meet these needs, Rigshospitalet in the treatment is selected by the nurse from a port. Capital Region of Denmark has introduced table of presets. Patients are trained on re- the “Chemo at Home” concept. It offers pa- start procedures and how to keep the cath- “Chemo at Home” received the “European tients with acute leukaemia the opportunity eter free from bacteria. The pump is locked Public Sector Best Practitioner Award” from to receive most of their treatment at home, so that patients cannot accidentally reset the European Institute of Public Administra- without the presence of clinical staff. To qual- anything. tion (EIPA) in 2015, the Danish “Golden Scal- ify, patients must meet a set of compliance pel Healthcare Award” for best national clini- criteria and more than 90% do. The patient visits the hospital every two or cal initiative from the weekly medical journal three days to get a check-up, pick up a new Dagens Medicin in 2016, and the “Implemen- An award-winning concept supply of medicine and receive transfusions tation and Impact Award” from the Interna- The concept is available for intensive chemo- if necessary. They usually return home within tional Confederation of Nurses in 2017. therapy as well as treatment with intrave- two hours.

18 INNOVATING BETTER LIFE

Chemo at Home

CONCEPT • A portable digital pump, a redesigned workflow and a service design approach (COMBINATORIAL INNOVATION) including co-designing and testing with patients. • Treatment with intensive chemotherapy at home without any clinical staff present. • Hospital check-up every two or three days. • 24/7/365 service team available at the hospital.

IMPACT • Substantial increase in patients’ quality of life. • Average reduction in days as inpatient from 30 to 10.

IMPLEMENTATION • Developed and tested at Rigshospitalet during 2014. • Implemented at Rigshospitalet during 2015, including the use of antibiotics in five other clinics.

FURTHER POTENTIAL • Scaled to the other five Danish clinics of haematology during 2016. • Scaling the use of intravenous treatment with antibiotics at home for other patient groups.

19 CONNECTED HEALTH Telehealth

Home monitoring of women with pregnancy complications

Pregnancy complications usually University Hospital has now tested and im- staff spends 75% less time on patient moni- call for hospitalisation. But Aarhus plemented a telehealth solution allowing toring, and the number of inpatient days for University Hospital now offers home women with pregnancy complications to be women with pregnancy complications has monitoring as an alternative for monitored in their own home. been reduced by 44%. women who experience health problems during pregnancy. An open-source platform The project at Aarhus University Hospital It is built on a user-friendly open-source plat- has led to an agreement between Danish When women experience complications du- form, developed in collaboration between pa- Regions and the Government to implement ring pregnancy, hospitalisation is usually the tients and professionals with a participatory home monitoring of women with pregnancy standard response. design approach. The underlying methods complications on a national level by 2020. have been developed in close cooperation be- Complications like premature rupture of tween public healthcare providers, research membranes (“waters breaking” before the institutions and private telehealth enterprises. baby has reached full term) or pre-eclamp- sia (a condition characterised by high blood During implementation of the new methods, pressure and the risk of damage to organs) hospitalised pregnant women requested to require close monitoring to ensure the use the system for self-monitoring during well-being of mother and baby. their stay at the hospital, highlighting the potential of redesigning and optimising work- While home monitoring solutions for measu- flows in a hospital context. ring physical parameters and detecting early warning signs have been available for years, Transferring a selected group of pregnant the monitoring of biochemical parameters women from hospitalisation to home mon- has only been possible at hospitals. itoring has led to substantial benefits for patients and hospital staff, without lowering To improve this situation, the Department satisfaction levels or quality of care. The num- of Obstetrics and Gynaecology at Aarhus ber of outpatient visits has been reduced,

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Neonatal home care – telehealth support for premature babies and their families

Odense University Hospital has in- lies to be discharged as soon as the baby is the baby is healthy and growing as it should. troduced a telehealth service that in no clinical danger. And as an extra precaution, a doctor at the relocates neonatal care from the hospital checks the child every two weeks. hospital to the family’s own home. The hospital provides the family with a tablet, a customised scale for weighing the infant The solution is integrated with the electronic Preterm birth is often associated with hos- and a measuring tape to monitor the growth medical record, which makes it easy for hospi- pitalisation at a neonatal unit. In the Danish of the baby’s head. tal staff to review information, reply to messa- healthcare system, the general practice is to ges and store everything in the patient records. keep mother and baby at the hospital until “The family has video Since the neonatal telehealth service was im- the original due date in order to monitor their consultations with a hospital plemented in November 2015, it has been condition and ensure their well-being. used by more than 200 families, saving nurse twice a week to ensure them from unnecessary days in the hospital But this has a number of practical implica- that the baby is healthy and and giving each family a better start in their tions for the family. They have to wait longer new family life and freeing up beds for other before they begin a normal family life at growing as it should.” patients. home, they often struggle to get enough rest and it is more difficult to begin breastfeeding At home, the family receives support from The Hans Christian Andersen Children’s Hos- in a “foreign” hospital environment. the hospital through an app that contains pital at OUH considers the telehealth solution information about prenatal care, instruction a big success and is now looking to expand To give families more freedom and flexibility, videos and the option of sending text mes- the solution to include other paediatric pa- several Danish hospitals have tested soluti- sages and pictures of the baby to hospital tient groups. The objective is to give more ons that enable neonatal care in the family’s staff. The app also provides the family with children the possibility to stay in familiar sur- own home. a nourishment schedule provided by health roundings while receiving treatment and care professionals. from specialists. Early discharge Odense University Hospital (OUH) has imple- The family has video consultations with a mented a telehealth service that allows fami- hospital nurse twice a week to ensure that

21 CONNECTED HEALTH Telehealth

The Centre for Telepsychiatry in the Region of Southern Denmark operates the Internet Psychiatry Clinic and supports implementation, research and development of new tele psychiatry services.

Telepsychiatry – improving access to mental health treatment

Digital technologies such as vid- defined as the application of telemedicine to service delivery through the use of digital eoconferencing, mobile apps and the field of psychiatry. This typically involves technologies. interactive software can provide mental healthcare services delivered with tel- faster, easier and more cost-effec- ecommunication technology. tive access to psychiatric help. In general, telepsychiatry allows for a more For patients with a mental disorder, timely efficient use of the psychiatrist’s time. It is access to mental health services is of vital especially relevant in specialised fields where Anxiety and depression on the rise importance to help prevent their symptoms there is a shortage of psychiatrists, such as Anxiety is the most widespread men- increasing and their condition worsening. child and adolescent psychiatry, or in rural or tal disorder in Denmark. 136,000 underserved areas. patients are registered with anxiety Limited resources and a lack of integration disorder, and 17,000 new cases are between different operators and services To explore the potential of telepsychiatry, the added every year. make it a challenge to meet all patient needs Region of Southern Denmark has established within the existing framework for mental the Centre for Telepsychiatry – a research Depression poses a similar challenge. healthcare. and development centre devoted to develop- International studies indicate that de- ing, researching and implementing innovative pression affects 11% of the popula- In this context, telepsychiatry has the poten- digital solutions that are safe and clinically tion in Europe with a trend towards tial to provide patients with faster and more effective. becoming the most serious mental flexible access to mental healthcare servic- disease for society by 2030. es, as well as the opportunity for them to be The centre collaborates with patients, men- more directly engaged in their own treatment. tal healthcare professionals, researchers In an international context, telepsychiatry is and IT developers to improve outcomes and

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The Internet Psychiatric Clinic

The Region of Southern Denmark The clinic’s self-help treatment programme The clinic is operated by the Region of South- offers online psychological therapy includes questionnaires about symptoms, ern Denmark’s Centre for Telepsychiatry. The to citizens with mild to moderate short educational videos and cognitive be- centre is carrying out randomised trials to depression and anxiety. They have havioural therapy, in which patients practice investigate clinical outcomes, cost effective- fast access to evidence-based skills that will help them cope with their con- ness, patient satisfaction and the usability of treatment without the need for a doctor’s dition. The treatment includes a video-based internet-based therapy for depression and referral. assessment interview and a video-based end- anxiety disorders. of-treatment interview after 10-12 weeks of In the Region of Southern Denmark, patients online treatment. “It does not keep me from working while I am suffering from mental illnesses such as mild in treatment – and it gives me more energy depression or anxiety receive internet-based Self-referral 24/7 to do my own treatment exercises at home. psychological therapy at home. While assessment interviews and thera- On days when I do not feel well and find it pist support are only available during office difficult to leave home, I can still do my ex- This service is provided by the Internet hours, patients who experience symptoms ercises at home and be compliant with my Psychiatric Clinic. Originally launched as a of anxiety or depression may seek treatment treatment,” one patient explains. demonstration project in the National Ac- themselves through the clinic’s website at tion Plan for Dissemination of Telemedicine any time, day or night. Towards national implementation 2012-2015, the online clinic now operates In the period 2018-2020, internet-based as part of the Mental Health Services in the The clinic’s services are offered to adults therapy for depression and anxiety will be Region of Southern Denmark. (18 years and over) with a primary diagnosis made available nationwide to citizens across of mild to moderate depression or anxiety, the five Danish regions. The Internet Psychi- The clinic gives citizens fast access to evi- no record of substance abuse and no bi- atry Clinic will treat approximately 1,400 pa- dence-based treatment and guidance, with- polar or psychotic disorders. They need to tients per year. out the need for a referral from their GP. understand and write Danish, and have ac- A growing number of patients contact the cess to a computer and broadband internet clinic themselves, often on the recommen- connection. dation of friends or relatives.

23 CONNECTED HEALTH Telehealth

Centre for Telepsychiatry in Region of Southern Denmark.

Psychiatric home-based outpatient care through videoconferencing

Home-based video consultations tween patient and provider for treatment and e-learning modules that support the use of make it easier for patients to follow-up. video consultations by clinicians and patients. gain access to psychiatric care. Videoconferencing also supports The use of video consultations includes It has also chaired a clinical work group joint decision making between scheduled and urgent outpatient visits, medi- tasked with developing practice guidelines for patients, mental healthcare providers and cation management, psychotherapy and oth- video-based mental healthcare covering, reg- other healthcare professionals. er forms of therapeutic and supportive con- ulatory, technical and administrative issues. sultations. Since 2013, remote videoconferencing between clinicians and patients has been pilo- The video consultation service is based on a • Since 2013, remote video consulta- ted in the Mental Health Services in the bring-your-own-device model where patients tion between clinician and patient Region of Southern Denmark. From 2015, use their own tablets or desktop computers. has been piloted in the Mental videoconferencing has been implemented at Videoconference software and support are Health Services in the Region of scale in the hospital, with reimbursement for managed by the IT department of the Mental Southern Denmark. the service equalling that of in-person con- Health Services. • From 2015, videoconferencing has sultation. been implemented at scale in the A tool for healthcare professionals hospital with reimbursement for ser- For many of the patients, leaving one’s In addition to patient-professional consulta- vice equaling in-person consultation. home for treatment requires some effort in tions, videoconferences are also used by psy- • 486 video consultations were per- itself, and the option of videoconferencing chiatrists and other healthcare professionals formed during the first year. In 2017, makes a big difference. (GPs and municipal healthcare providers) for the number increased to 1,816 and joint decision making. a further increase in the number of Every department in the region’s mental video consultations is expected in health service has videoconferencing equip- The Centre for Telepsychiatry has developed the coming years. ment and offers video consultations be- a suite of educational resources including

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The national telehealth infrastructure enables sharing of telehealth data between hospitals, GPs and municipalities. Secure access to data and data sharing relies on the National Service Plat- form, which is already being used to facilitate sharing of e-health and EHR data in Denmark.

A national infrastructure for telehealth data

Denmark’s nationwide implemen- In 2012, Denmark was the first country in the Denmark has also established a national tele- tation of telehealth relies on a well- world to adopt the Continua Health Alliance health database, which is accessible to hos- developed infrastructure based on standard as the national standard for tele- pitals, GPs and municipalities – and is com- international standards that facili- health devices. patible with electronic health records (EHRs). tate data sharing and integration across the healthcare system. Since then, Denmark has implemented a The large-scale implementation of home national architecture for data sharing. This monitoring presented a good opportunity to Denmark’s implementation of large-scale is based on the international Health Level 7 put the national telehealth architecture to telehealth solutions between 2011 and 2015 (HL7) standards for transfer of clinical and the test. Based on three years of data, test revealed that telehealth requires a new ap- administrative data between software applica- runs have resulted in TRL +7 score on the proach to data and data sharing. tions used by different healthcare providers. Technology Readiness Level scale (a nine-level maturity indicator developed by NASA). Firstly, it relies on a new type of data gathe- Denmark’s large-scale telehealth projects red from questionnaires and devices used by have made it clear that the terminology and A national public governance organisation, patients, often at home. Secondly, it requires description of data in relation to telehealth which collaborates with private enterprises, that data are shared between hospitals, device readings are very important for clinical has created a national infrastructure, includ- municipal healthcare providers, GPs and professionals working with telehealth data. ing common standards for telehealth data, other healthcare professionals. This, in turn, in just five years. Denmark now has a robust raises new concerns about data security. This type of information is standardized by framework to implement telehealth nation- using the HL7 Personal Health Monitoring wide. This infrastructure will be further test- This calls for common standards and proce- Report standard (HL7 PHMR), which reports ed and improved during the coming years. dures for handling large amounts of data as data about the health status of a patient well as a shared terminology that ensures measured by clinical devices such as weigh- that clinical staff can access, interpret and ing scales, blood pressure monitors, glucom- share data from different telehealth devices. eters, pulse oximeters, etc.

25 CONNECTED HEALTH Telehealth

Compliance and prevention

For the past 10-15 years, Danish This is not just a matter of providing patients patients with one or more chronic illnesses, healthcare policies have given in- with basic health information. Citizens need telehealth technology may make their every- creasing priority to prevention and information that is immediately relevant, day lives easier because monitoring, treat- public health efforts. In the future, empowering and tailored to their individual ment and rehabilitation does not involve fre- telehealth solutions may play an needs, giving them the tools to engage in quent outpatient visits. important role in promoting healthier life- their own health management. styles, diagnosing diseases earlier and en- Integrating telehealth solutions into popula- suring compliance with treatment. “Telehealth engages citizens tion health management programmes may in their own health in a also reduce the amount of costly interven- Since Denmark’s public administration re- tions, emergency department visits, hospi- form in 2007, a new focus on population different way than traditional talisations, imaging tests and surgery, with health and prevention has played an increas- healthcare services. It obvious benefits to the healthcare system as ingly important role in national and local a whole. health policies. increases their awareness of risk factors and facilitates In some fields, the application of telehealth In the future, telehealth solutions will make a solutions as part of public health pro- valuable contribution to these efforts. close co-operation with grammes has significantly improved clinical providers and professionals outcomes and management of health. Telehealth engages citizens in their own health in a different way than traditional within the healthcare system.” healthcare services. It increases their awareness of risk factors and facilitates close co- Telehealth will be an important instrument operation with providers and professionals in ensuring patients’ compliance with their within the healthcare system. treatment or rehabilitation programmes. For

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Using telehealth solutions to improve population health

In the Municipality of Esbjerg, a combined telehealth and prevention platform motivates chronic patients to comply with treatment and consider healthy lifestyles.

Esbjerg Municipality in the Region of Southern Denmark has taken a new approach to population health. With a health management platform combining telehealth and preventive services, it seeks to motivate chronic patients to adopt a healthy lifestyle, and improve their compliance with treatment.

Healthy citizens may access the platform through a website where they monitor their health situation and lifestyle. At-risk or chronic patients connect directly to healthcare professionals in the municipality for support, follow-up and feedback.

Using their own devices, such as smartphones, tablets or desktop computers, these patients connect to a telehealth service to monitor their condition at home or seek preventive services if needed.

The interface also provides information and advice related to their individual health issues, in the form of short video guides or written information.

A tool for inspiration, motivation and understanding Experience shows that the interface helps citizens visual- ise what is otherwise “invisible” and makes it easier for them to address their health issues. The use of a mobile device means that they always “bring” their data to any given location, and the connection between data and lifestyle makes it easier for them to act towards better compliance.

The platform has been launched with the intention of helping people to understand and manage their own health situation. It is designed to inspire them to set and achieve individual goals with regard to their health, and motivate them to comply with treatment.

“Addressing the health status of our citizens in a way that motivates them to adopt a healthy lifestyle is our primary concern. A healthy lifestyle and compliance with treatment help prevent new diseases and ensure faster rehabilitation for our patients,” says Arne Nikolaisen, Healthcare Executive at Esbjerg Municipality.

27 CONNECTED HEALTH Telehealth

Telehealth facilitates early detection of hypertension

Telehealth solutions may facilitate with some well-known problems relating to normally high HBP measurements and a quar- the early diagnosis of hyperten- reporting bias: Blood pressure levels can be ter were reported to have either white-coat sion. A clinical study in the Muni- affected by the measuring process in itself, hypertension or masked hypertension. cipality of Holstebro documents the surroundings and the awkwardness of that home measuring supported the situation etc. Therefore, the “office blood It also showed that electronic transfer of by telehealth technology may help elimi- pressure” measurement (taken in a clinical home measurements to the GP’s electronic nate reporting bias. setting) is sometimes different to the “natu- record system improved the quality of clinical ral” blood pressure level. This has given rise documentation as well as the efficiency of Hypertension, or high blood pressure, is a to concepts like “masked hypertension” and monitoring and follow-ups by healthcare pro- global public health concern. Sometimes de- “white-coat hypertension”, describing condi- fessionals. scribed as “the silent killer”, it is known to tions where office blood pressure levels are trigger heart conditions, strokes and kidney lower or higher than home measurements. It is the first large-scale project to completely failure, and is a major cause of premature eliminate the risk of reporting bias by using mortality and disability. All participants, and not just those with high telehealth technology to disseminate blood office blood pressure, were asked to do their pressure data. The World Health Organization (WHO) has set own HBP measurements. The data from the a goal to reduce hypertension by 25% by the home measurements were automatically The results clearly document the potential for year 2025. transmitted to their personal health record using telehealth to identify patients with un- and were made accessible to healthcare pro- diagnosed hypertension at an early stage, as In the Municipality of Holstebro in the Cen- fessionals through the electronic clinical re- well as patients that are treated based on an tral Denmark Region, a clinical cross-sector cord systems. inaccurate diagnosis. study examined home blood pressure (HBP) measurements, transmitted using telehealth The project revealed that 35% of the partici- equipment, as a tool for early detection of hy- pants had untreated or insufficiently treated pertension and elimination of reporting bias. hypertension. One third of the participants The detection of hypertension is associated aged 55-64 years were reported to have ab-

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A video capsule is used to diag- nose patients in their own home. It collects images of the colon, which are later analyzed at a diagnostics center.

Innovative video capsule allows cancer diagnostics at home

A new technology, supported by nal health authorities are testing a third al- discomfort to the patient. If tests reveal that a telehealth solution, may signifi- ternative, a “camera-pill” technology. The the video technology is as reliable and cost- cantly improve Denmark’s screen- patient swallows a video capsule, which re- effective as expected, it has the potential ing programme for colon cancer. A cords its passage through the digestive sy- to significantly increase participation in the “camera pill” allows patients to be stem. This can be done in the patient’s own screening programme – improving clinical diagnosed at home without the risks and home because the service is supported by a outcomes and survival rates. discomforts of a colonoscopy. The project telehealth solution to control recordings and has shown remarkable results. transfer images to a diagnostics centre. A comparative pilot study from 2016, involving 250 citizens from the national screening Since 2014, all Danish citizens between the “The patient swallows a programme, showed remarkable results. The age of 50 and 74 have the option of partici- video capsule, which records video capsule detected twice as many abnor- pating in a screening programme for colorec- malities as a colonoscopy, showed no signs tal cancer. So far, patients have had the choice its passage through the of technical difficulties or instabilities – and between a colonoscopy, which is a highly accu- digestive system. This can caused much less patient discomfort. rate, but invasive procedure; and a stool test, which is non-invasive, but much less accurate. be done in the patient’s own A larger clinical project with 3,000 partici- home because the service pants will aim to validate these results. The latter often results in false-positive results, which means that these patients have is supported by a telehealth Other hospitals are now implementing the vid- to undergo a colonoscopy anyway. solution to control recordings eo capsule solution based on Odense Universi- ty Hospital’s experience. This has made many people reluctant to and transfer images to a participate in the screening. To improve the diagnostics centre.” At the same time, Danish health authorities participation level and accuracy of the pro- are taking the initial steps towards defining gramme, Odense University Hospital in the The procedure provides the same information the conditions for future implementation in Region of Southern Denmark and natio- as a colonoscopy, but with much lower risk and the national screening service.

29 CONNECTED HEALTH Telehealth

Denmark – a telehealth nation

As the cases in this white paper show, Den- Telehealth is not just about implementing new technolo- mark is using telehealth successfully across gies. Preparing the organisation is equally important, and sectors and geographical boundaries for the telehealth implementation often acts as a catalyst for benefit of patients and professionals. changing routines and workflows. This is vital to realising the benefits of telehealth for the patient. In the Chemo at The success of these efforts can be attributed to diffe Home project, a redesigned workflow gave patients high- rent factors in the Danish approach to the use of tele- er quality treatment without increased expenditure and health: reduced the average number of inpatient days, freeing up beds and staff resources. Denmark has been working strategically with telehealth for years, for example through the National Action Plan Furthermore, telehealth gives patients access to their own for Dissemination of telemedicine during 2012-2015, and electronic healthcare data, which are available through the national strategies for the digitization of the Danish telehealth solutions and the national infrastructure. This healthcare sector. empowers patients, making it easier for them to gain insight into their condition and play a more proactive role Small- and large-scale telehealth projects are being car- in their own healthcare. In TeleCare North, COPD patients’ ried out across the Danish healthcare sector. This pro- ability to respond to early signs of deterioration has in- vides the basis for trials, development and innovation in creased their confidence and level of self-management. different fields of healthcare, which in turn lay the foun- dation for national dissemination of the most successful Denmark will continue to prioritise the use of telehealth concepts. solutions in the future, with the ambition that even more patient groups and healthcare professionals should ben- Denmark is a global frontrunner when it comes to the efit from telehealth. use of telehealth across sectors. Healthcare professionals in hospitals, municipalities and general practitioners If you want more information on telehealth in Denmark collaborate to provide cohesive treatment for the benefit or the next generation of telehealth innovation, feel free of patients throughout the country. The TeleCare North to contact Healthcare DENMARK. If you want to visit project and the concept of Home-based ulcer treatment Denmark and examine the innovative telehealth solutions are examples of this. presented in this white paper, you can request a delega- tion visit through the Healthcare DENMARK website.

The telemedical map – telehealth projects in Denmark

The purpose of the telemedical map is to contribute to a common overview of the telemedical initiatives in Denmark and to provide a basis for knowledge sharing

44.551 and cooperation across regions and sectors. The map provides easy access to knowledge about telemedical experienc- es within the Danish healthcare system.

The telemedical map is aimed at both Municipality decision makers, project managers and Hospital General Practitioner clinicians.

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About Healthcare DENMARK

Healthcare DENMARK is the international gateway to Danish health- HRH Crown Princess Mary of Denmark care expertise and innovation. Our patron of Healthcare DENMARK aim as a non-profit public-private partnership is to internationally meetings, and arranging access to otherwise benchmark Danish best practices within off-limits areas and people within both the healthcare. public and private sectors, as well as assist you with local accommodation and transportation. The goal of Health- care DENMARK is not Healthcare DENMARK has a national and po- to sell or promote litical mandate to provide this service to pol- any specific prod- iticians, relevant top and management level ucts or solutions, but professionals, and journalists working with to communicate the healthcare. strongholds of Dan- ish healthcare. We Backing this public-private initiative is a part- do this by attracting ner group of both public and private key ac- health politicians, de- tors within Danish healthcare, including the Hans Erik Henriksen cision-makers, and Ministry of Health, the Ministry of Foreign Chief Executive Officer journalists to experi- Affairs of Denmark, the Ministry of Industry, ence Danish health- Business & Financial Affairs, Danish Regions, care solutions in practice and meet the Region of Southern Denmark, the Confedera- people behind. Our network is an extensive tion of Danish Industry, the Confederation of pool of public sector, private companies, and Danish Enterprise, Falck, KMD, Systematic, other actors in the area of healthcare – all OpenTeleHealth, Intelligent Systems, Public dedicated to providing excellent and efficient Intelligence, and Vendlet. healthcare as well as sharing best practices across borders and professions. Her Royal Highness Mary, Crown Princess of Denmark is patron of Healthcare DENMARK. ’’In Denmark our focus on putting the patient first – combined with efforts to improve effi- Visit www.healthcaredenmark.dk to learn more ciency and quality – has resulted in a wide ar- about some of the world’s best and most in- ray of innovative solutions. I sincerely believe novative healthcare Danish solutions and expertise can have a providers and com- positive impact on global health.” - Her Royal panies or to request Stay updated with Highness Crown Princess Mary of Denmark meetings with the our newsletter Visit our website stakeholders who healthcaredenmark.dk If you would like to learn more about our are future-proofing and sign up! world-renowned healthcare, we can assist you healthcare sectors with tailoring a visiting program, setting up around the world.

31 Healthcare DENMARK CONNECTED HEALTH Forskerparken 10H Phone: +45 23 84 00 56 INNOVATING BETTER LIFE Telehealth DK-5230 Odense M [email protected]