Telemedicina si e-Sanatate

CURS 1 - Prof. dr. ing. Hariton Costin

Telemedicina si e-Sanatate (e-Health): definitii,

problematica, starea actuala a sistemelor de
telemedicina, e-sanatate si telemonitorizare

1
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

I. DEFINITII
• Telemedicine Definition 1
• Telemedicine involves the use of modern information technology, especially
• two-way interactive audio/video communications, computers, and telemetry,
• to deliver health services to remote patients and to facilitate information
• exchange between primary care physicians and specialists at some distances
• from each other

• Telemedicine Definition 2
• Telemedicine is health care carried out at a distance

• Telemedicine Definition 3
Telemedicine—the use of advanced telecommunications technologies to
• exchange health information and provide healthcare services across geographic,
• time, social and cultural barriers

• Telemedicine Definition 4
• The World Health Organization (WHO) makes a distinction between telemedicine
• and telehealth: telehealth is understood to mean the integration of
• telecommunications systems into the practice of protecting and promoting health,
• while telemedicine is the incorporation of these systems into curative medicine

2
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

e-Sanatate (e-Health):

• The term encompass a range of services that are at the edge of

medicine/healthcare and information technology:
• Electronic Health Records: enable easy communication of patient data between
different healthcare professionals (GPs, specialists, care team, pharmacy)
• Telemedicine: includes all types of physical and psychological measurements
that do not require a patient to travel to a specialist. Patients need to travel less to
a specialist or conversely the specialist has a larger catchment area.
• Consumer Health Informatics (or citizen-oriented information provision): both
healthy individuals and patients want to be informed on medical topics.
• Health knowledge management (or specialist-oriented information provision):
e.g. in an overview of latest medical journals or best practice guidelines.
Examples: physician resources such as Medscape and MDLinx.
• Virtual healthcare teams: consist of healthcare professionals who collaborate
and share information on patients through digital equipment (for transmural care).

3
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin
• mHealth or m-Health: includes the use of mobile devices in
collecting aggregate and patient level health data, providing
healthcare information to practitioners, researchers, and patients,
real-time monitoring of patient vitals, and direct provision of care (via
mobile telemedicine)

• pHealth or p-Health: “personal health”, collection of H&S tools for

(tele)monitoring of health status of a subject

• Medical research uses eHealth Grids that provide powerful

computing and data management capabilities to handle large
amounts of heterogeneous data

• Healthcare Information Systems: patient data management, work

schedule management and other administrative tasks surrounding
health. These tasks are part of eHealth and interface with most
eHealth implementations due to the complex relationship between
administration and healthcare at Health Care Providers.

4
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin
II. PROBLEMATICA
• EC health new policies
There are several growing challenges to the health of the population which require a
new strategic approach by the EC.

(1) Demographic changes including population ageing are changing disease patterns
and putting pressure on the sustainability of EU health systems. Supporting healthy
ageing means both promoting health throughout the lifespan, aiming to prevent
health problems and disabilities from an early age, and tackling inequities in health
linked to social, economic and environmental factors.
(2) Pandemics, major physical and biological incidents and bioterrorism pose
potential major threats to health. Climate change is causing new
communicable disease patterns. It is a core part of the Community's role in health to
coordinate and respond rapidly to health threats globally and to enhance the EC's
and third countries' capacities to do so. This relates to the Commission's overall
strategic objective of Security.
(3) Recent years have seen a great evolution in healthcare systems in part as a result of
the rapid development of new technologies which are revolutionising the way to
promote health and predict, prevent and treat illness. These include information and
communication technologies (ICT), innovation in genomics, biotechnology and
nanotechnology. This links to the Commission's overall strategic objective of
Prosperity.

5
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin
http://ec.europa.eu/information_society/activities/health/policy/telemedicine/inde
x_en.htm
• “COMUNICARE A COMISIEI CĂTRE PARLAMENTUL EUROPEAN,
CONSILIU, COMITETUL ECONOMIC ȘI SOCIAL EUROPEAN ȘI
COMITETUL REGIUNILOR
privind telemedicina și beneficiile sale pentru pacienți, pentru sistemele
de sănătate și pentru societate” (Bruxelles, 4.11.2008 COM(2008)689 ):
• Telemedicine can improve access to specialised care in areas suffering from a
shortage of expertise, or in areas where access to healthcare is difficult.
Telemonitoring can improve the quality of life of chronically ill patients and
reduce hospital stays. Services such as teleradiology and teleconsultation can
help to shorten waiting lists, optimise the use of resources and enable
productivity gains.
• Telemedicine can also make a significant contribution to the EU economy
• The use of telemedicine services is still limited, and the market remains highly
fragmented. Although Member States have expressed their commitment to
wider deployment of telemedicine, most telemedicine initiatives are small-scale
projects that are not integrated into healthcare systems.

6
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

• Actions to be taken by Member States, the

Commission and the broader stakeholders' community
are focused in particular on:
1. building confidence in and acceptance of telemedicine
services ;
2. bringing legal clarity ;
3. solving technical issues and facilitating market
development.
• In its Health Strategy [1] and eHealth Action Plan [2],
the European Commission has further committed itself
to supporting dynamic health systems and the
beneficial use of new technologies.
[1] COM(2007) 630 final, 23.10.2007
[2] COM(2004) 356 final, 30.4.2004

7
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

• ICT sunt o prioritate tematica a PC7/FP7 al U.E.: “sisteme informatice în

servicii publice”, dar si a PNCDI II al Romaniei (2007-2013)

• E.C.: telemedicine encompasses a wide variety of services: teleradiology,

telepathology, teledermatology, teleconsultation, telemonitoring, telesurgery
and teleophthalmology.
• Other potential services include call centres/online information centres for
patients, remote consultation/e-visits or videoconferences between health
professionals.
• Health information portals (http://www.ehealthnews.eu ,
http://www.ehealthserver.com ), electronic health record systems [1],
electronic transmission of prescriptions or referrals (e-prescription, e-
referrals) are not regarded as telemedicine services for the purpose of this
Communication.

Telemonitoring and teleradiology services are especially outlined as

together they encompass most of the challenges that are relevant to the
implementation of telemedicine services in general.

[1] The issue of electronic health records has been addressed in a recent
Commission Recommendation: C(2008) 3282 final, 2.07.2008
8
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

• Telemonitoring is a telemedicine service aimed at

monitoring the health status of patients at a distance. Data
can be collected either automatically through personal
health monitoring devices or through active patient
collaboration .
• Telemonitoring is very useful in the case of chronic illnesses
(e.g. diabetes, chronic heart failure, COPD – chronic
obstructive pulmonary disease). Many of the patients - who
are often elderly people - need regular monitoring because
of the prolonged duration of their disease, the nature of their
health condition and the drugs that they are using.
• Telemonitoring supports patients and health professionals.
• It also results in less frequent visits to healthcare facilities,
with increasing the quality of life for patients and reducing
medical costs.

9
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

• Telemonitoring has specific characteristics:

• It can contribute to re-organisation and re-deployment of
healthcare resources, for instance by reducing hospital
visits, thus contributing to the greater efficiency of
healthcare systems.
• It has proven to increase quality of care for patients, in
particular chronically ill patients. In the context of an
ageing population and an increasing burden of chronic
diseases, the benefits and its wider deployment can be
crucial.
• It requires a coherent approach and partnership
involving patients, health professionals, healthcare
providers, payers and the industry, to ensure
sustainability of the services.
10
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

• Teleradiology has specific features:

• It is currently the telemedicine service in the most

advanced stage of deployment.
• It is usually carried out as an outsourced service, on a
commercial contract basis.
• The service can be offered in a national or cross-border
mode involving other EU countries or third countries.
• The most important challenges for teleradiology are to
ensure benefits of patient care and overall patient safety.
• Telemedicine does not in any way reduce the quality of
radiology services provided to the citizen.

11
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

• The aim is to support Members States in achieving

large-scale and beneficial deployment of telemedicine
services, by focusing on three strategic sets of actions:
• building confidence in and acceptance of telemedicine
services ;
• bringing legal clarity ;
• solving technical issues: broadband access and full
connectivity is a prerequisite for the deployment of
telemedicine; interoperability and standardisation in
telemonitoring ;
• facilitating market development.

• These different sets of actions are partially interlinked.

12
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

• Actions at the level of Member States:

- Member States are urged to assess their needs and
priorities in telemedicine by the end of 2009. These
priorities should form part of the national health strategies
to be presented and discussed at the 2010 eHealth
Ministerial Conference.
- By the end of 2011, Member States should have
assessed and adapted their national regulations enabling
wider access to telemedicine services. Issues such as
accreditation, liability (responsabilitate), reimbursement
(decontarea), privacy and data protection should be
addressed.
• Member States' actions to be supported at EU level
• Actions to be undertaken by the Commission

13
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

III. STAREA ACTUALA

• România
• Bucureşti, Iaşi, Timişoara: Firma Romsoft SRL din Iaşi a realizat încă din
2002, prin finanţare în PC5 al U.E. (Proiectul MEDCARE;
www.euroines.com ; TELEMON (UMF-Bioinginerie:
www.bioinginerie.ro/telemon); TELMES (INSCC Buc.) s.a.;
• Europa: proiectele (în PC5 şi PC6): EPI-MEDICS (pentru detectarea
sindromurilor cardiologice), E-REMEDY (telemedicină pentru reabilitarea
la domiciliu, folosind Internet), HEALTHMATE şi HEALTHSERVICE24
(sisteme mobile de teleconsultare bazate pe calculatoare PDA), INCA
(asistarea inteligentă a diabeticilor), TELECARE (telemonitorizare
folosind senzori de semnale vitale, cu ajutorul telefoniei mobile);
• Germania, UK, Spania, Scandinavia (Norvegia), Italia s.a.

• SUA: Code Blue - Universitatea Harvard - este un proiect de referinţă

14
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin
• Necesitatea e-sanatatii si telemonitorizarii:
• număr mare de pacienţi bolnavi cronic sau cu risc medical crescut (în
U.E. şi S.U.A. peste 20% dintre cetăţeni suferă de o boală
cardiovasculară şi cca. 45% dintre decese se datorează acestor boli);
>20% dintre adulti – diabet sau prediabet (!!);

• supraveghere postoperatorie;

• îmbătrânirii populaţiei (persoane în vârstă şi eventual singure – cca.

72% dintre persoanele peste 70 de ani trăiesc singure dar 90% dintre
ele doresc să fie independente, deci necesită (tele)supraveghere la
domiciliu);

• accesul la îngrijirea sănătăţii pentru persoanele din locuri izolate sau

defavorizate socio-economic;

• reinserţie profesionala şi incluziune sociala a unor categorii de

cetăţeni.
15
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin
Proiecte punctuale
1. HEALTHSERVICE 24 (HS24) project:
- The system allows healthcare professionals to follow-up patients remotely, while the patients are free
to continue their daily activities
- In UK the annual cost for mobile patient management is just 10,000 euros, << conventional medicine
- The HS24 platform is based on advanced concepts and technologies: Body Area Networks (BAN),
2.5/3G wireless broadband communications (GPRS/UMTS) and wearable medical devices. Users
are equipped with sensors interconnected under a BAN, and managed by a PDA or mobile
telephone. The collected data is transmitted continuously via a wireless UMTS or GPRS service to a
medical centre or directly to medical professionals.
- Medisch Spectrum Twente in Enschede, Netherlands, focus on high risk pregnancies. Hospital
Clinic Provincial de Barcelona, Spain, focus on chronic obstructive pulmonary disease (COPD)
patients. LITO Polyclinic, Paralimini, Cyprus, focus on cardiac patients.

2. CardioSmart project (Spain/Sevilla): heart rate and other cardiac parameters; “…equipping a patient
with the system costs around 20 euros per day. That compares, for example, to keeping a patient in
a hospital, which in Spain costs around 180 euros per day on average.”

3. Health Early Alarm Recognition and Telemonitoring System, http://heartsproject.datamat.it/

4. http://e-care-ist.net/ (Italy, Greece, the UK, Germany and Cyprus ), IST programme of E.C.:
monitoring of diabetes and cardiovascular diseases

16
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin
5. The Wearable Health Care System (WEALTHY) ; http://wealthy-ist.com/
Smart clothes incorporate functional fibres, allowing researchers to develop
many useful sensors for a wide variety of applications. (turnover: > 1 billion
euros in 2008). Beneficiaries: soldiers under extreme conditions in the field,
athletes, personnel in high-risk jobs (firefighting), or the sick and vulnerable,
people undergoing physical therapy and rehabilitation, people who drive long
distances. Sleep apneas, where people stop breathing in their sleep.

6. THE HUB (http://interactive-wear.de/): a 'wearable electronics' jacket wired for

both sound and mobile telephony capable of withstanding the most radical
environment.

7. The HEARTS system (http://heartsproject.datamat.it/hearts): offers

continuous monitoring and has decision support capabilities; the patient-
centric approach involves improved automatic diagnosis based on disease
knowledge. Was tested and results validated at Policlinico A. Gemelli hospital
in Rome.

17
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

8. CARME (Catalan Remote Management Evaluation) study, conducted by Philips Healthcare and the
Catalonian Health Service (ICS) show significant benefits in the management of certain chronic
diseases, thanks to telemedicine (The II-nd Spanish Congress of Chronically Ill Patients Care,
Santiago de Compostela, February 25 – 26, 2010).
• The study evaluated the Philips' Motiva telemedicine system in patients with severe heart failure (HF),
who were monitored at home from the hospital.
• Dr. Mar Domingo: "the study's preliminary results shows up the advantages of this telemedicine
systems and the benefits that they provide to the patient as well as to the clinical staff, as a tighter
control of the disease from both sides, which enables acting faster in case that any anomaly would
happen. Patients themselves have perceived an improvement on their quality of life and have shown a
very high satisfaction and confidence on the system and the information it provided to them.
• Improvement of the quality of life and reduction of hospitalizations
Patients who participated on the study (97 patients with severe heart failure were enrolled and 68 of
them completed the 12 months period of the study) showed an improvement in their perception of their
quality of life, according to the questionnaire EuroQoL. At the beginning of the study, more than half of
the patients (55, 88%) stated that their quality of life was medium or low. Six months later, this number
had decreased to 29%, while at the end of the study it was reduced to 22%.
• The patients who set their quality of life index as middle-high grew from a 43, 6% at the beginning of
the study to a 78% at the end of it, among whom, a 28% stated that their quality of life was almost
excellent.
• The hospitalizations due to HF were reduced 68% during the one-year period of the study. Also, the
patients positively improved their attitudes, except for the ones related to physical exercise and diet.
This way, the patients experienced an improvement in their changes of attitude towards the illness,
which at the same time was associated to an improvement in their perception of quality of life vs.
baseline.
• The study's favorable results open the door to the use of MOTIVA and telemedicine solutions for
chronically ill patients in primary care settings. MOTIVA offers to patients the benefits of better disease
self-management and a higher knowledge and empowerment about it.
• For healthcare professionals MOTIVA and telemedicine solutions provide the chance for a tighter
patient monitoring, enabling the early detection of any type of descompensation that may be detected, 18
which makes easier its correction and prevent HF related events.
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin

Concluzii partiale …

• eHealth is a dynamic legal environment

• eHealth derives its competences from
competences of other policies
• eHealth is a tool, a solution, a system, a
product, a service
• eHealth is already covered by EC law

19
 Telemedicina si e-Sanatate
CURS 1 - Prof. dr. ing. Hariton Costin
Bibliografie

• H. Costin (editor), „Advancements of Medical Bioengineering and Informatics”, Editura U.M.F. “Gr. T. Popa” Iasi, 2009, ISSN
2066-7590
• Cr. Rotariu, H. Costin, „Electronică Medicală. O abordare practica”, Editura U.M.F. “Gr. T. Popa” Iaşi, 2009, ISBN 978-606-
544-010-4
• http://ec.europa.eu/information_society/activities/health/policy/telemedicine/index_en.htm
• Metin Akay, Andy Marsh (eds.), “Information Technologies in Medicine”, 2001, John Wiley & Sons, Inc., ISBNs: 0-471-38863-7
(Paper); 0-471-21669-0 (Electronic)
• A. W. Darkins, Margaret Ann Cary, “Telemedicine and Telehealth - Principles, Policies, Performance, and Pitfalls”, Springer
Publ. Company, 2000
• E.C./FP6, HealthService24, Continuous Mobile Services for Healthcare, eTEN-C517352, Final Report, 2006
(www.healthservice24.com)
• E.C., The European eHealth policy and deployment situation by the end of 2006, http://www.ehealth-era.org (2007)
• http://www.ehealthnews.eu , http://www.ehealthserver.com
• “p-Health” conferences sites
• http://www.library.nhs.uk/ (National Electronic Library for Health - UK)
• http://www.eih-eu.org/ (European Institute of Health)
• http://www.hl7.org/ (Health Level 7)
• http://www.eurorec.org/ (European Institute for Health Records)
• www.ehealthweek2010.org/ , www.worldofhealthit.org/ (eHealth Week conference, Barcelona)
• http://www.webmd.com/ , www.skolar.com , www.freebooks4doctors.com/ , www.mcw.edu/display/docid48990.htm (e-learning)
• http://www.ehtel.org/ (European Health Telematics Association)
• http://www.ehto.org/ (European Health Telematics Observatory)
• www.calliope-network.eu/ (interoperability and standardization in eHealth)
• CodeBlue - Wireless Sensor Networks for Medical Care - ttp://www.eecs.harvard.edu/~mdw/proj/codeblue/
• Cocoon: http://www.cocoon-health.com/
• EPI-MEDICS: http://epi-medics.univ-lyon1.fr/statico/epimedica.htm
• HealthAgents: http://www.healthagents.net/
• SemanticHealth: http://www.semantichealth.org/
• ARTEMIS: ,http://www.srdc.metu.edu.tr/webpage/projects/artemis/publications.html 20