Good telemedicine practice under the microscope

Télémédecine | 21 Jun 2010
ASIP Santé and the French trade union group for the electric, electronic and communications industry (FIEEC) are conducting a study that aims to determine the key success factors for the deployment of telemedicine applications. The goal is to implement these in France.

Doctors looking at a radioThe e-health sector has great potential, and presents both social and economic dimensions. Socially, the key is to guarantee fair access to healthcare in a context characterized by an ageing population and a decline in medical demography in certain parts of France, while the economic issues include stimulating innovation and creating jobs and growth.
These issues are clearly recognized, but there is a marked contrast between the various European countries in terms of the work they are doing1. Unlike the trends observed in Northern Europe, where Denmark, Finland and Sweden have gone from pioneers to world leaders in a decade2, France has not managed to industrialize its e-health sector.
The reports published recently by the French government3 and the French Ministry of Health and Sports4 confirmed the need to go beyond an experimental approach to telemedicine and telehealth to create the conditions for an operational deployment of their applications.

Towards an "industrialization" of practices in France.

Since the vote on the law on hospital reform and on patients, healthcare and the regions, the legal framework has been consolidated. A decree is due to be issued, which will specify how telemedicine5 activities will be defined, under what conditions they will be implemented, and how they will be financed (text yet to be finalized).
A reference framework has thus been drawn up, incorporating:
  • Professional conduct (patient consent, medical confidentiality, and joint liability for requested and requesting doctors, etc);
  • The establishment of cooperation agreements between healthcare professionals, such as cooperation structures between institutions (regional hospital communities – CHTs and health cooperation groupings  – GCS); 
  • Monitoring the protocols and recommendations defined by the French national authority for health (HAS) and the professional bodies in order to guarantee the quality and safety of healthcare.

In addition, the priorities for developing telemedecine and telehealth appear better shared at national level:
  • Intensifying the monitoring of patients with chronic diseases (the list of 30 long-term illnesses known as the ALD 30);
  • Opening up health institutions to outside scrutiny;
  • Developing alternatives that reduce the length of hospital stays and facilitate outpatient and home hospital treatment, and home support.
Finally, ASIP Santé has the task of defining technical reference standards that contribute to the interoperability, security and usage of telehealth telemedicine systems.

Identifying the success factors 

Having both noticed the fragmentation in the sector and the lack of interoperability between applications, FIEEC and ASIP Santé decided to conduct a study aimed at identifying good deployment practices at international level.
Around a hundred reports and articles were analyzed in order to obtain information about the main experiments conducted in seven European countries (Germany, the United Kingdom, the Netherlands, Denmark, Sweden, Finland and Norway), and in Canada and the United States.
Several key elements were closely analyzed: the role of public policy and the governance and organizational structures of the healthcare system, the duration and scale of the projects conducted (local, regional or national), the industrialization factors for telemedicine and telehealth applications, and the conditions for their adoption by healthcare stakeholders (communication, training, etc).
In the end, ten or so applications were selected on the basis of their results and exemplary nature.
The second phase of the study is underway, and involves making around ten on-site visits in Europe. The idea is to meet the industrial, technical and medical teams responsible for the experiments, as well as representatives of healthcare professionals and patients.
When organizing these visits, ASIP Santé and FIEEC have focused on five priority areas6: home support, teleradiology, telecardiology, the treatment of strokes, and cooperation between hospitals.
Once the study is complete, recommendations will be made to healthcare professionals and industry representatives, based on the good practices observed (usage, implementation, technical choices, support, etc), with the aim of facilitating and accelerating the deployment of solutions.
The French trade union group for the electric, electronic and communications industry (FIEEC) is an alliance of 26 trade unions in the energy, automation, electricity, electronics, digital and consumer goods sectors.
These different sectors comprise over 2,000 businesses (86% of which are small and medium-sized enterprises), employ almost 400,000 people and produce a turnover in excess of 82 billion euros.
The areas covered by the FIEEC's remit are: legal, technical and environmental expertise; occupational training; and administrative and customs regulations.
The FIEEC maintains a dialogue with national and European authorities to make them aware of the challenges faced by industry and to express the common positions taken by the industries it represents.

1 Accelerating the Development of the eHealth Market in Europe, eHealth Taskforce report 2007, European Commission
2 Explaining international IT application leadership, Daniel Castro, Innovation Technology & Information Foundation (September 2009)
3 Une stratégie industrielle pour les marchés du futur (An industrial strategy for the markets of the future): Report on government proposals drawn up under the presidency of Pierre Gattaz (June 2008)
4 La place de la Télémédecine dans l’organisation des soins (The role of telemedicine in the organization of healthcare): Mission report by Pierre Simon and Dominique Acker, general councillors for French healthcare institutions (November 2008); La Télésanté, un nouvel atout au service de notre bien-être (Telehealth: a new way of safeguarding our wellbeing): Report by Pierre Lasbordes, deputy for l’Essonne (October 2009)
5 The law recognizes four types of telemedical act: medical teleconsultation, teleexpertise, telemonitoring and teleassistance.
6 These priority areas also appear in the report by deputy Pierre Lasbordes, submitted to the French Ministry of Health in December 2009: La télésanté, un nouvel atout au service de notre bien-être (Telehealth: a new way of safeguarding our wellbeing).