1. Policy recommendations for wider implementation of telemedicine Peeter Ross, MD, PhD e-Health expert, Estonian eHealth Foundation, Estonia

2. Content Overview of current situation in the implementation of telemedicine services eHealth Task Force report Redesigning Health in Europe for 2020 Policy recommendations for deployment of telemedicine services

3. The project consortium Region of Southern Denmark Auvergne, France Catalonia, Spain Estonia Malopolska, Poland Norrbotten, Sweden North Norway Scotland, UK Veneto, Italy

4. New technologies and e-services in healthcare Healthcare is lacking behind of other service industries at least 10 years Healthcare organisation usually is not adopting the free market rules what would promote the use of innovation and disruptive technologies Implementation of e-health services depends in large extent on political decisions. Decisions must be in solid basis

5. Main goal of policy recommendations To improve Patient care Safety Quality Healthcare system efficiency Market development for regional SMEs

6. Difficulties to put telemedicine services into routine operation The reasons are complex Clinical, economical, organizational, technological, legal and safety requirements Political issues are on different levels European National Regional and Local

7. Political levels (1) In EU the healthcare decisions are made according to the principle of subsidiarity Policies concerning provision of healthcare services should always be made at the lowest possible level EU level Legislative documents Recommendations with no legal power

8. Political levels (2) Most recent documents eHealth Task Force report – Redesigning Health in Europe for 2020 Europe 2020 Strategy Digital Agenda for Europe EC Communication on Telemedicine for the Benefit of Patient, Healthcare Systems and Society. EU Directives that have direct influence on telemedicine services

9. Political levels (3) Policy recommendations on national, regional and local level coincide in many aspects In not yet mature and diverse European telemedicine market the differentiation between levels is not reasonable because of variabilities between Member States healthcare administrative structures

10. eHealth Task Force Report. Redesigning health in Europe for 2020

11. Redesigning health in Europe for 2020 – recommendation 1 A new legal basis for health data in Europe Create a legal framework and space to manage the explosion of health data Create the conditions for the integration of user-generated data with official medical data so that care can be more integrated, personalised and useful for patients

12. Redesigning health in Europe for 2020 – recommendation 2 Create a 'beacon group' of Member States and regions committed to open data and eHealth EU facilitates this by creating the central space for national initiatives to flourish and be shared. Successful models developed in different regions or countries can be disseminated A leadership group from regions and countries that have invested in eHealth applications could be pioneers

13. Redesigning health in Europe for 2020 – recommendation 3 Support health literacy Health literacy efforts should begin in school Indeed, citizens can only exercise control over their own data – and subsequently use the data – if it is both in an understandable language and format with user friendly interfaces

14. Redesigning health in Europe for 2020 – recommendation 4 Use the power of data Health institutions must publish the data on their performance and health outcomes. This information should be regularly collected, comparable and publicly available This will support a drive to the top as high performing organisations and individuals can be identified and used as an example to inspire change In health, performance is not just how efficiently the system operates but also the patient experience of the care

15. Redesigning health in Europe for 2020 – recommendation 5 Re-orient EU funding and policies The majority of public funding at EU and national level allocated to eHealth has been invested in centralised, large-scale, top- down solutions These have failed to address and integrate the user experience sufficiently The next phase should see investment in tools that citizens can use to support their wellbeing and manage their lives

16. Regional Telemedicine Forum Policy recommendations.

17. Presents the identified policy recommendations, developed by each RTF partner Includes a brief description of the meaning of the policy Reports a case description, referred to the related policy An example of how the policy was successfully applied by one of the RTF partner and which results are obtained

18. Regional Telemedicine Forum Policy recommendations. Limitations RTF partnership decided to suggest policy recommendations which are each based on a concrete case of problems for the wider implementation of telemedicine services. This can limit the problematics and the field of application Still important beginning to face the problem and to overcome existing barriers.

19. Policy recommendations. Economic area New reimbursement models Integration of evidence based documentation throughout the decision-making Development of evidence, including clinical, organizational and economical aspect and quality of service

20. Policy recommendations. Information technology Development and implementation of an infrastructure for electronic health data sharing Use of ICT based on international standards to create interoperable systems

21. Policy recommendations. Political area. Educational area Political area Create political leadership, including better guidance on what the politicians need to decide on Educational area Postgraduate education Integrate training of usage of telemedicine services in academic area Improve patient empowerment by training patient and caregivers

22. Policy recommendations. Organisation. Legal Organisation Apply a multidisciplinary approach to development of services, including sufficient involvement of clinical expert To link the clinical and economical levels throughout the development of telemedicine Legal Early clarification on legal matters throughout the service development

23. Conclusion Successful implementation of telemedicine demands Actions at regional level by addressing the main beneficiaries and barriers Exchange of good practises Evidence of successful telemedicine to build trust and acceptance Make of use of solutions offered by information technology

24. Thank you! Peeter.Ross@e-tervis.ee