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Tele-monitoring of patients with
advanced heart failure
Good Practice:
Telemonitoring of patients with advanced heart
failure (GP1)
Reference Site
Olomouc Region, CZ: University Hospital
Olomouc - Czech National eHealth Center
(NTMC)
Contact information:
Prof. M.D. Milos Taborsky, Ph.D., FESC, MBA
University Hospital Olomouc,
Czech National eHealth Center,
I.P. Pavlova 6, 775 20 Olomouc, Czech Republic
Email: [email protected], [email protected]
or Zdenek Gütter, Ph.D., [email protected]
Short description of your
good practice:
The practice introduces specific remote
monitoring of patients with Congestive heart
failure, structural damage of myocardium and
left chamber dysfunction through the
deployment of telehealth services and enhances
relevant medical protocols. This new practice is
to detect as many patients with the given
diagnoses as possible, deploy telehealth
services for monitoring and improved
treatment of these patients. New protocols will
be standardized, based on evaluation of results
of telemonitoring in initial phase of the
practice.
Start date:
1.2013
Project duration:
unlimited
(planned)
How we did it
The good practice was initiated by experienced
cardiologists who recognized need for
improvement of care for patients, usually
seniors, with structural heart disease.
Political support is sought on several levels,
including regional goverment, national
healthcare management authorities and also
medical societies.
The good practice is financed through projects
undertaken by the NTMC within Structural
funds, national funds and from resources of
project partners. The investment is
approximately 75 000 Euro and still increases
with the number of concurrently monitored
patients, which is under control. Operation cost
is approximately 500 Euro monthly.
The good practice was possible to introduce
with minimum required organizational changes
within the hospital and it also comply with
national healthcare system. It integrates
medical practices and protocols with carefully
selected telehealth services.
Technical solution consisting of telemonitoring
system was installed and monitoring devices
are being distributed to selected patients
according to criteria covering condition of the
patients and economy. Medical procedures
were upgraded so that the clinical part of the
good practice becomes routine.
Our results
Partners in the coalition:
Led by the University Hospital Olomouc and its
Czech National eHealth Centre and the Faculty
of Medicine and Dentistry of Palacky University
Olomouc, the project brings in regional
authorities, patients organisations and
healthcare insurance companies. Other
healthcare providers and selected social
services providers in the region are also brought
in to facilitate broader coverage for the practice.
Coverage: The project aims to cover 15% of the
monitored population in the catchment
territory of the hospital.
The practice enabled screening of common
population with the disease ; it provides tools
for remote control of patients with advanced
heart failure (NYHA class III-IV, it means
patients that are markedly or severely limited
during physical activity) on standard medical
therapy (ESC guidelines), before and after
Success factors
heart transplantation. Further it covers
population of patients with hemodynamic
support (ventricular assist device - VAD) before
orthotopic heart transplantation (OTS) or in long
term regimen. There has not been recognized
practice or protocol that would enable to collect
relevant information about critical parameters
development besides keeping the patient in
hospital.
This good practice can be replicated in other
hospitals providing medical services for
patients with heart failure. Amended medical
protocols are under development in 2013 and it
is planned to have them endorsed later by
medical societies. Then there is need to have
telemonitoring system with devices commonly
available on the marked, which require
investment made by hospitals. That is also why
there are steps made to have the medical
protocols accepted by authorities, with
intention to have reimbursement for these
enhanced services.
There is clear relationship between initial
disease detection in population - screening,
followed by specific individualized therapy and
management of the target group of ill in higher
age and therefore the practice has positive
impact to health conditions
of targeted
population.
It is also expected that morbidity, mortality, and
quality of life of the targeted patients with
observed diagnoses will be improved.
This new practice is associated with higher
deployment of new technologies enabling
provisioning of telehealth services, which have
positive impact to EU industry as major parts of
the telemonitoring system have been supplied
by manufacturers from EU countries.
Inputs in international medical (cardiology)
societies will also further improve position and
prestige of EU medical expertise.
Barriers to innovation
The barriers to extend to all seniors that are
candidates for screening or monitoring are
clearly of economical nature. Barriers on the
side of medical societies are less serious but are
also mapped. That is why Evidence Based
Medicine approach was chosen to provide solid
data that will eliminate uncertainty or doubts of
medical nature.
Transferable elements
The good practice is, thanks to use EBM
methods, highly transferable to other hospitals
in the region, the whole country and, with
possible adjustments to other medical systems,
also to further EU countries. The target
population in the practice in Olomouc region
reflects standard population in EU countries
with medium developed economy, occurrence
of serious chronic diseases and medical risk
stratification of population. University Hospital
Olomouc has close relationships with other
regional hospitals and healthcare providers.
There is long term cooperation with a number
general practitioners GPs and internists in the
region so the good practice will be spread first
to them and then gradually to other locations.
This good practice cannot in its initial phase
avoid classical drawbacks of telemonitoring,
namely required investments and resources to
maintain the service. That is why the good
practice is designed to cover the issues of
sustainability – negotiation with medical
societies and national healthcare authorities to
achieve reimbursement.
New jobs associated with telemonitoring
services were created. New force is needed
mostly for technical and management oriented
tasks.
With
growing
penetration
of
telemonitoring into the target population it is
clear that especially an increase in newly
detected patients with hearth failure will
require more medical personnel. But this is
associated with the increase of the quality of
care.
Operation of the good practice revealed
challenges that are of organizational nature.
There are also aspects related to some more
complex patients, which required selective
approach.
Even though the good practice is in its initial
stage there is positive response from the
patients side. Medical personell experience
somewhat higher load and this will be subject of
negotiation of paymant for the services with
national authorities.
Added value
The practice is innovative, not only in screening
of common population with the disease, but
especially in telemonitoring of patients before
and after heart transplantation, patients with
hemodynamic support before orthotopic heart
transplantation or in long term regimen. This
would not be possible to perform without
having the patients in hospital, which would
require significantly higher expenses.
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Title of the publication
Lesson learnt and
recommendations for others
Key data:
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Title of the publication
The goal of the new practice is firstly, early
detection of maximum possible amount of
patients with heart failure in time before the
functional abnormalities of the heart are more
impaired and quality of life of seniors is
worsened, and secondly, deployment of
telehealth services for optimization and
standardization of new protocols for treatment,
evaluation of results and selection of successful
methods followed by submission of the
conclusions to national and European medical
societies (incl. European Society of Cardiology ESC). At present, there is only Opinion of ESC
for remote monitoring of patients with implants
(Pacemaker/ICD). There is no explicit
Recommendation for serious diagnoses such as
diabetes, hypertension, obesity, COPD, HF and
many others.
Remote monitoring of patients with CHF with
structural heart disease (mainly coronary artery
disease or non-ischemic cardiomyopathy) and
left ventricle (LV) dysfunction (LV ejection
fraction - EF < 0.35) with deployment of
telehealth services has already been proven as
is beneficial in comparison with patients who
undergo current standard healthcare with
pharmacology intervention and clinical follow
up.
Significant part of patients is in senior age and
the disease has frequently impact to demand
for social care.
Palacky University Olomouc with its University
Hospital Olomouc has strong experience in
chronic heart failure management and
possesses medical and technical experts to
perform these daring tasks.
The good practice spans into all three EIP AHA
pillars covering
in Pillar 1 Prevention,
screening & early diagnosis, especially A3:
Prevention, early diagnosis of functional and
cognitive decline, in pillar 2 Care & Cure all 3B
(1 to 3) but especially B1 - B1: Protocols,
education for health workforce (comprehensive
case
management,
multimorbidity,
polypharmacy, frailty and remote monitoring),
in pillar 3 Active ageing
& Independent living especially C2: Extending
active and independent living through Open
and Personalized solutions.
If there are results on the level of Evidence
Based Medicine (EBM), they shall be
incorporated into relevant guidelines, and
should also be part of reimbursement scheme
for each diagnose in Diagnosis Related Group
(DRG) system for classification of hospital cases
used nationally.
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