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1 EHRA Summit 2010 E-health and Personalized Health Care European Hearth House, Monday Telemonitoring i in arrhythmias and CRM devices: Finland Pekka Raatikainen, MD, PhD Heart Center Tampere University Hospital
2 Goals of telemonitoring Alleviate the burden of caregivers Optimize patient safety and care Reduce health care cost
3 Telemonitoring of CRM systems Biotronic: HomeMonitoring Boston Scientific: Latitude Medtronic: CareLink Network St Jude Medical: Merlin.net
4 AUTOMATIC FOLLOW-UP Pekka Raatikainen, MD, PhD
5 CONTINUAL MONITORING FOR DEVICE AND PATIENT RELATED PROBLEMS
6 Travel burden Distance 700 km Travel time 8 h 45 min (80 km/h) m t 1400 km About Oulu
7 Patient travel burden Travel distance 130±96 (range 3-350) km traveling with a car, train or taxi In 9 occasions the patient had to be on sick leave because of the FU visit Almost 40% of the patients (n=15) were accompanied by another person Raatikainen et al. Europace 2008:10:1145
8 Time burden to the patients Mean ± SD Median Baseline 9 mo FU* Unscheduled visit Travel time to clinic** (min) Test trans 3 mo FU 6 mo FU Unscheduled FU transmission time (min) 391±282 (range ) min 6.9 ± 4.0 (range 2-18) min Raatikainen et al. Europace 2008:10:1145
9 Unscheduled visits 18 patient-initiated transmissions during a follow up of 9 months All of these were resolved remotely without need for in-office evaluation! reassurance of fthe patient t changes in medication etc. Raatikainen et al. Europace 2008:10:1145
10 Cost of ICD F-U according to the generally applied follow-up scheme and the study protocol during the 9 months study period. Number of visits Generally applied F-U scheme Study protocol Savings In-office visits* Remote data transmission** 0 82 Direct cost In-office visit (210 per visit) Remote monitoring (55 per visit) Patient fee (22 per in-office visit) Indirect cost Traveling (77.68 per in-office visit) 12739, , ,76 Accommodation (20.18 / night) Sickness allowance (44 / day) visits) Total costs Annual saving 708 / patient t Total costs per patient , ,32 Raatikainen et al. Europace 2008:10:1145
11 Oulu University Hospital district 1. Lapland 2. Western Lapland 3. Northern Ostrobothnia 4. Kainuu 5. Middle Ostrobothnia OUH + 4 satellite centers
12 Enhanced monitoring Atrial and ventricular arrhythmias Heart rate variability Mean heart rate Mean heart rate at rest %CRT Activity it / 24h Thoracic Fluid (intrathoracic impedance) Hemodynamics (intracardiac impedance)
13 Telemonitoring in arrhythmias Holter analysis via the Internet brings services closer to patients t and their local l clinics i reliable diagnosis irrespective of place and time Low investment Remote Analysis (RA) equips its customers with the registration devices and charges them on a per report-basis No special expertise is required from an attending doctor and administrating nurses
14 Devices and Internet portal are very easy to operate Pekka Raatikainen, MD, PhD
15 Remote Holter analysis Providence of Western Finland 34 centers Providence of Northern Finland 7 centers The recordings are analyzed by 6 experienced electrophysiologist Providence of Oulu 7 centers Providence of EasternFinland 19 centers Providence of Southern Finland: 33 centers
16 Remote Holter analysis Pekka Raatikainen, MD, PhD
17 Customer satisfaction 1. Expertise of the specialists 2. Easy-to-use and reliable service 3. Good availability of service 4. Fast and knowledgeable customer support 5. Prompt delivery of specialist statements
18
19 Remote analysis Pekka Raatikainen, MD, PhD
20 Remote cardiac consultation Information 1. History & problem 2. Clinical findings 3. ECG 30 min
21 SecGo VPN Pirkanmaa Hospital District Network FIREWALL Server Medical Data Internet Home Office SecGo VPN-gateway Secgo VPN client Operator ADSL-Router Autentication: Smart Card + password Encrypted Data Unencrypted Data Timo Asumaniemi
22 Remote ECG analysis Pekka Raatikainen, MD, PhD
23 Scientific documentation Pekka Raatikainen, MD, PhD
24 Questions related to telemonitoring Regulatory and legal issues Technical issues analog phone lines several Internet sites Alleviate the burden of caregivers Reduce health care cost reimbursement Optimize patient safety and care
25 Telecardiology in the future ECG CONSULTATION SERVICE SUPPORT FOR HOME CARE SUPPORT FOR SELF CARE Chronic heart Post cardiac Transmission Arrhythmia failure surgery or from implanted follow-up & heart attack devices diagnosis Acute & urgent cases Risk individuals Non-urgent cases Diagnostic problems
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