HEALTH SYSTEMS AND POLICY ANALYSIS POLICY BRIEF 13 How can telehealth help in the provision of integrated care? Karl A. Stroetmann, Lutz Kubitschke Simon Robinson, Veli Stroetmann Kevin Cullen, David McDaid Keywords: © World Health Organization 2010 and World Health Organization, on behalf of the European Observatory TELEMEDICINE on Health Systems and Policies 2010 COMPUTER COMMUNICATION NETWORKS – utilization Address requests about publications of the WHO DELIVERY OF HEALTH CARE, Regional Office for Europe to: INTEGRATED – trends Publications HEALTH POLICY WHO Regional Office for Europe COST –BENEFIT ANALYSIS Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). All rights reserved. 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How can telehealth help in the provision of integrated care? Contents Page Key messages Executive summary Policy brief Editors Health policy context and current use 1 WHO Regional Office for of telehealth Europe and European What do we know about the benefits 8 Observatory on Health and effectiveness of telehealth? Systems and Policies Policy options to help foster use of 12 Editor telehealth as a support to integrated Govin Permanand care systems Associate Editors Identifying alternative ways of 18 Enis Barı̧s bringing about change Josep Figueras Summary and outlook 23 John Lavis David McDaid Elias Mossialos References 24 Managing Editors Jonathan North Kate Willows Frantzen Authors Karl A. Stroetmann, Lutz Kubitschke, Simon The authors and editors are Robinson and Veli Stroetmann empirica grateful to the reviewers Communication and Technology Research, Bonn, who commented on this Germany publication and contributed Kevin Cullen Work Research Centre, Dublin, their expertise. Ireland David McDaid LSE Health & Social Care and European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, United Kingdom ISSN 1997-8073 How can telehealth help in the provision of integrated care? Key messages • Demographic change, rising incidence of chronic disease and unmet needs for more personalised care are trends that demand a new, integrated approach to health and social care. Professionals must work across sectors as a team with common goals and resources to deliver a coordinated response to each individual's care requirements. Advanced information and communications technology (ICT) provides a major new opportunity to realise care integration, superseding today's chain of disjoint responses to discrete threats to health. • Telehealth, the provision of care at a distance, is a key component in future integrated care. Today's segregated telehealth applications still require linking into more comprehensive eHealth strategies, in which clinical pathways and service delivery processes are fully coordinated and patient data safely shared. An increasingly solid evidence base is emerging indicating that telehealth can be used effectively to respond to the growing call for improved care, in particular for those with chronic conditions. Mainstreaming remains a challenge; market forces alone are likely to remain insufficient. • Making the case for investment in telehealth applications requires better marshalling of existing evidence, not only to show that telehealth works, but also to show where – in what organisational context – it will work. Evidence from large-scale pilots and the few mainstream implementations requires careful synthesis, taking particular account not only of clinical dimensions but also of indicators relating to successful deployment in normal care: change management, human resources, organisational interfaces, financing requirements, technology integration and ethics for everyday practice. • Financial flows in health systems must be critically assessed for their ability to act as incentives or disincentives for telehealth provision, acknowledging that the “business case” for telehealth is often very different for different players. Medico-legal and regulatory regimes can also pose critical barriers to the exploitation of telehealth. The various regimes should be compared to identify best practice and opportunities for regulatory and legislative reform, so as to facilitate better integrated care through the use of telehealth. • The use of telehealth, as a tool to help support better integrated care, can be helped through initiatives that bring policy responsibilities together. This could include setting up financial and organisational vehicles (joint budgets, joint ventures) to support partnership across sectors. Policy brief • To bring about change, mechanisms should be put in place to foster dialogue, thereby instilling a sense of partnership in reform and reducing resistance to change. Process innovation driven by clear health policy priorities should precede telehealth design – technology on its own cannot be expected to deliver. Change management must fully engage all involved participants. Full attention to ethical issues should be mandatory and the usability and interoperability of today's ICT systems can, and should be, much improved. How can telehealth help in the provision of integrated care? Executive summary The quest for more integrated care is not itself new, but new opportunities for effective realisation have emerged quite recently. In particular, the appropriate application of advanced ICT can make a major contribution towards achieving this goal. Telehealth, the provision of care at a distance, is certain to be a key component in future ICT infrastructure for integrated care. It has already raised high hopes among policy makers with reagrd to its potential for delivering solutions for growing capacity problems. For integrated care, today's segregated telehealth applications still require linking into more comprehensive eHealth strategies, in which clinical pathways and service delivery processes are fully coordinated and patient data safely shared. Although few instances of routine application have yet emerged in Europe or elsewhere – in contrast with an enormous breadth of research activities – an increasingly solid evidence base is emerging indicating that telehealth can be used effectively to help support better integrated care, in particular for those with long-term chronic conditions. Policy options Generating and using evidence of the benefits and cost –effectiveness of telehealth Making the case for investment in telehealth applications, as one aspect of the ICT infrastructure, requires better marshalling of existing evidence, not only to show that telehealth works, but also to show where – in what organisational context – it will work. Evidence from large-scale pilots – and from such mainstream implementations as there are – requires careful synthesis, taking particular account not only of clinical dimensions but also of indicators relating to successful deployment in normal care: change management, human resources, organisational interfaces, financing requirements, technology integration and ethics for everyday practice. A comprehensive approach to its socioeconomic impact is of particular importance in further telehealth evaluation; the human and infrastructure costs accruing to health, as well as to social care systems and other services, should be taken into account. Modelling can be used to assess the long-term benefits and costs, and help identify the level of effectiveness a telehealth investment has to achieve to be considered worthwhile. Policy brief Analysing governance frameworks and institutional arrangements to facilitate the implementation of efficient