Best Practice Issue

November | 2011
Connected Healthcare
Best Practice Issue
© Deutsche Telekom
Lower costs, higher quality –
How connected technology
supports healthcare
2
Contents
3 The Cost Issue
Interview.
Dr. Axel
Wehmeier,
head of Deutsche Telekom’s Healthcare business
Krankenhaus – Behandlungskosten
sparen,
Behandlungszeit
gewinnen.
Ob Notfallaufnahme, stationäre Behandlung oder Langzeittherapie – im internen Klinikbetrieb und in der sektorübergreifenden integrierten Patientenversorgung spielt die zuverlässige Verfügbarkeit von Daten eine entscheidende Rolle für alle Prozesse rund um den Patienten.
segment, explains how costs can be cut without sacrificing quality.
Zu Hause betreu
Telemedizinische Infr
Gleichzeitig werden Z
6 Connected Healthcare
Overview. Increasingly complex processes can no longer be managed without a
smart healthcare network.
8 Round the Clock
Alle Daten auf dem Schirm
In der Notaufnahme sind die Ärzte dank
elektronischer Gesundheitskarte sofort über
die medizinische Vorgeschichte informiert.
Wichtige Daten können sie sich zum Beispiel
auf Tablet-PCs anzeigen lassen. Bei der
Aufnahme erhält der Patient außerdem
ein Funkarmband, das sicherstellt, dass zum
Beispiel Blutkonserven nicht versehentlich
verwechselt werden.
Zeitersparnis durch Telekonferenz
Virtuelle Besprechung mit Kollegen:
Eine sichere Unified- & Collaborative-
Mobile Visite ohne Aktenberg
Patienten verfügen am Bett über ein Terminal,
mit dem sie fernsehen, im Internet surfen oder
Patienten dürfen schneller nach Hause
Nach der Entlassung werden die Vitaldaten
von Herz- und Diabetespatienten im
Communications-Plattform
(UCC) ermögihr Essen auswählen. Kommt
Arzt, fungiert
Rahmen
einer intensivierten Nachbetreuung
Secure
and convenient.
Germany’s
firstder area-wide
telemedicine
network has been
licht Fachkonferenzen der Ärzte in einem
das Terminal als Bildschirm für die mobile
telemedizinisch überwacht. Dadurch
Virtual Private Network (VPN). So können
Visite: Arzt und Patient betrachten gemeinsam
verläuft der Übergang in die ambulante
eventuelle
Befunde
und
Therapien
unabhängig
patientenspezifische
Laborwerte
oder
RöntVersorgung
reibungsloser,
und
launched
in the state of Brandenburg.
Now, patients
receive constant attention.
Probleme werden frühzeitig erkannt.
vom Aufenthaltsort der Ärzte gemeinsam
genbilder und besprechen die Befunde.
am Bildschirm besprochen werden.
9 Data Protection
Hochsicherer Datenverkehr
Internet einfach nutzen
Viele Menschen wollen ihr
Telefone ohne viel technis
bedienen. Das mobile Ser
tert Internet-Neulingen un
stieg ins World Wide Web.
nutzen sie verschiedene D
richten, Medikamentenbe
oder Videotelefonie.
Krankenkassen:
Ob es um Finanzdaten geht, um Verwaltungsprozesse oder um digitale Patientenakten – die medizinischen Daten aus
eHealth-Prozessen
werden stets bei den
Leistungserbringern
oder in besonders
gesicherten Rechenzentren
gespeiNew rights for patients.
Wolfgang
Zöller,
German
Government
Commissioner
chert. Die sichere Datenspeicherung bildet das Herz aller modernen ICT-Infrastrukturen im Gesundheitswesen.
for Patients’ Interests, on security and transparency in data protection.
Neue Kommunikationskan
ten, Leistungserbringern u
und sicheren Netzwerken b
10 Connected Hospital Doctors
Always ready to hand. More and more hospitals are using mobile systems.
Quick access to data takes the strain off doctors and improves
care quality.
Sicher unterwegs
11 No More Boredom
Gesund leben von klein auf
Kinder zu gesundem Leben anzuhalten
ist eine besondere Herausforderung. Der
virtuelle Personal Trainer einer OnlinePlattform motiviert und coacht Kinder und
Jugendliche, um Bewegungsmängeln,
Haltungsschäden und Gewichtsproblemen
effektiv vorzubeugen.
Viele Senioren sind bis ins hohe Alter aktiv.
Doch wenn sie allein unterwegs sind,
be- steht die Gefahr, dass sie durch einen
Unfall oder gesundheitliche Probleme in
Not geraten. Moderne Handys können per
Knopfdruck Kontakt zu einer Leitstelle
eines Wohlfahrtsverbandes herstellen.
Gemeinsam entscheiden Patient und
Leitstelle, ob Verwandte, Freunde oder
ein Arzt benachrichtigt werden.
Multimedia. With a bedside terminal, patients can watch TV, surf the Internet, or
order meals – at no extra cost to the clinic.
Vernetztes Gesundheitswesen
12 Cutting Costs
Egal ob Patienten mit handfesten Erkrankungen oder mit diffusen
Beschwerden zum Arzt kommen,
ob sieaÄrzte
nur gelegentlich
aufsuchen
Make
success
of outsourcing.
A hospital in Berne, Switzerland, shows how to
oder immer wieder: Bei der medizinischen Versorgung geht es um einen
outsource
processes
and
reduce
costs
without compromising on quality.
schnellen Zugriff auf Daten. Intelligente Gesundheitsnetze stellen dies
sicher. Sie unterstützen den Patienten. Aber sie sind auch unverzichtbar
für das Überleben unserer Versorgungssysteme. Sei es bei der Patientenbetreuung, bei der Leistungserfassung oder bei der Ressourcensteuerung:
Ohne ein schlaues Medizinnetz können die zunehmend komplexen
Versorgungsprozesse heute nicht mehr bewältigt werden.
13 Instantly Informed
Waiting is worthwhile. A hospital in Linz, Austria, has an online portal to help
kidney patients who are waiting for a donor organ.
14 Live Independently for Longer
Modern living. Assistance systems enable senior citizens and people with illnesses
to continue living in their own homes for as long as possible.
15 Help at the Touch of a Button
IMPRINT
Publisher
Deutsche Telekom
Harald Lindlar
Friedrich-Ebert-Allee 140
53113 Bonn
Germany
E-mail: [email protected]
Editorial and Layout
PR-Partner Köln
Agentur für Kommunikation GmbH
Breite Strasse 161–167
50667 Cologne
Germany
www.prp-koeln.de
Best Practice Issue | November 2011
It couldn’t be easier. Smart technology like the ServicePortal or Emporia Elegance
cellphone enable swift and uncomplicated assistance – at home or out and about.
16 Mobile Health Manager
One app, four devices. With the VitaDock app and modules, an iPhone, iPad, or
iPod touch becomes an integrated healthcare manager.
17 ECGs Made Easy
A life-saver. By using the mobile event recorder Clue Medical, patients can take an
ECG at home and provide their physicians with more comprehensive data.
18 New Opportunities
User-friendly. Health insurers are using new online portals to encourage their
customers to think about health matters – and making cost savings in the process.
Kontrollierte Vorso
Via Bluetooth sendet ein Br
Joggern und anderen Sport
die Daten anschließend an
Beispiel von der Krankenka
Portal übernimmt die Ausw
die individuellen Trainingsp
zu erreichen.
Interview
Rubrik
3
Intelligent
networking –
instead of shredding
Dr. Axel Wehmeier, head of Deutsche Telekom’s Healthcare business segment, on doctors’ iPads, telemedicine, the
Electronic Health Card, products for the secondary health market, and opportunities abroad.
Dr. Wehmeier, Telekom’s Healthcare business segment has been in
existence for a year. What balance
do you draw from the first twelve
months?
We have set many things in motion,
for instance the telemedicine project
in the Lausitz region, an iPad for
hospital doctors, and a tenant
service portal for self-determined
living in T-City Friedrichshafen. And
Medisana blood glucose monitors
and thermometers have brought us
to wider public attention as a health-
care company. Healthcare products
moving into Telekom shops – who
would have thought it?
tients or care services can exchange
information with each other digitally
with a high level of security.
So, gazing into your crystal ball,
where does Telekom want to be in
five years’ time as far as healthcare
is concerned?
That is easy to answer: we want to
be the central partner for the entire
healthcare system, bringing all
participants together. We will have
reached our objective when doctors,
health insurers, hospitals and pa-
You mentioned Medisana monitoring devices. Are you planning to
launch any further secondarymarket products?
The market for these products is still
in its infancy and there is plenty of
room for growth, and for imagination.
In addition to blood pressure, weight,
blood sugar and temperature, many
other physical indices such as pulse
or daily stress levels need to be kept
under control. Customers will soon
see a whole series of fresh product
ideas in this area.
Are people prepared to pay for
such products?
According to all the surveys, yes.
Even the travel-mad, car-crazy
Germans would rather economize
on holidays or cars than on health.
And many people are keen to do
more for their health. On the one
hand, due to lack of exercise and
Best Practice Issue | November 2011
4
Interview
unhealthy eating, we will see an
increase in chronic illnesses such
as diabetes. On the other, a counter
trend is already emerging, of people
wanting to manage their own health
and being willing to pay for doing so.
What wiser investment is there than
investment in one’s own health?
© Deutsche Telekom
Does Telekom also plan to develop
care products?
In future we will offer a range of solutions that make life easier and safer
for seniors, including telephones
with an emergency service function
and touch screens they can use
for easy ordering of medication or
“meals on wheels”, or for sending
e-mails or making video calls. Keeping in touch with their grandchildren
ranks just below good health in
people’s wish list for their old age. In
addition, in collaboration with partners such as the University of Göttingen, for example in Liebenau, we
are developing technologies such as
fall monitoring that are geared to the
needs of older people.
Best Practice Issue | November 2011
Telekom is also involved in Germany’s largest telemedicine network
for high-risk cardiac patients. Is
this the hoped-for breakthrough for
telemedicine in Germany?
Other projects have already made
that claim. I am economical with
superlatives. But of course we
hope so. Of the many steps along
the way to making telemedicine
part of regular healthcare provision, this has undoubtedly been of
major significance, because we are
bringing telemonitoring to an entire
region. In addition, we have a major
health insurer, AOK Nordost, on
board. What we need now is a valid
evaluation that only a project on this
scale can produce. Some advantages are well known – avoidance of
duplicated tests and of unnecessary
visits to doctors, patients feeling
more secure and possibly even improving their prognosis. Regardless
of that, I am convinced that without
telemedicine our healthcare system
is basically no longer financially
sustainable.
In future
we will offer
a range of
solutions that
make life easier
and safer for
seniors
So it probably won’t stop at
cardiac patients …
No, telemedicine can also help
with the care of diabetics, pregnant
women at risk, stroke patients or
people with chronic wounds.
Many people are frightened of
electronic health data and uneasy
about the “transparent patient.”
However, digitalization of healthcare
will not lead to worse, but to better
data protection. After all, at present
some medical reports are sent
by post or fax without any special
protection of data. In future, the
patient will play an increasing role in
deciding which persons should have
access to which data. The new Electronic Health Card will give patients
greater autonomy in this respect.
Incidentally, Federal Commissioner
Peter Schaar has praised the data
protection afforded by the Electronic
Health Card.
It’s good that Mr. Schaar trusts
the card. But do you believe that
customers trust Telekom to protect
their data?
Precisely because of the scandals,
hardly any other company is now so
data protection aware. Telekom is
the first Dax-listed enterprise to have
embedded data protection at board
level. We have learned our lesson.
We are now turning protection and
security of customer data into a competitive advantage, and are making
good headway with that. Germany
has strict data protection laws that
apply especially to our data centers.
We only tackle health projects at all
if the data protection agency agrees.
This close cooperation creates a
very high level of security. There is
no such thing as one hundred per
cent security – just look at the
hackers worldwide.
Interview
5
Back to the fiercely debated
Electronic Health Card. Where
does Deutsche Telekom stand
on this issue?
We want the cards to go online
quickly. Only intelligent networking will enable patients, doctors
and health insurers to make full
use of the card’s benefits, such as
the speedy transfer of emergency
data to a hospital in an emergency,
electronic exchange of medical
reports, and online updating of
insured persons’ key data, rather
than feeding millions of cards into
the shredder every year.
How quickly could the online
connection be achieved?
Our industry estimates that with a
tight schedule it could be implemented in one to two years, provided that industry standards that
are now on the market are adopted.
And if it takes five years, will
you pull out of telematics? You
wouldn’t be the first to do so.
Health is our most precious asset.
So if healthcare decisions take
longer, it is with some justification.
That is why the health sector is not
for those who are looking for quick
results. Nonetheless, I fully understand those companies that have
become less willing to invest.
And Telekom?
Telekom would also like to see
speedier progress with developing
telematics, but is fundamentally
committed to the subject. The overwhelming majority of Germans want
the card and its useful functions.
What is more, a networked card will
help to keep our healthcare affordable. We really cannot afford to do
without the Electronic Health Card.
Hospitals want to save money and
be more efficient, too. What does
Telekom recommend?
Essentially, that they look at what
they must do themselves, and transfer to service providers anything
that does not form part of their core
business and that service providers
can produce at lower cost.
Which of your customers is taking
advantage of this offer?
The Inselspital – Berne University
Hospital – in Switzerland, for example. We organize almost the entire
IT there.
What else can hospitals do apart
from traditional outsourcing?
They can give doctors access to the
information they need for treating
patients at any time and anywhere
in the hospital. The Evangelisches
Waldkrankenhaus hospital in BerlinSpandau has tested a special iPad
for physicians. The doctors there
were delighted with it because
for the first time they had speedy
access to digital patient data in their
everyday working lives. They can
read data, copy findings, or load
X-ray images. The iPad speeds up
the work process, so doctors have
more time for their patients. In other
words, with a single intelligently connected device hospitals can not only
reduce their costs but also improve
their service. Telekom will offer iPad
solutions for doctors, too.
Do you already have customers?
After showing the tablet computer
for doctors at trade fairs, we have
received enquiries from various
hospitals. I am sure that we will soon
be able to say specifically where
pilot projects will be run.
Many health insurers are Telekom
customers. Experts believe that
only 50 health insurance schemes
will be left before long. Is that your
view?
We naturally keep an eye on market
movements and we offer support
to health insurers as they brace
for competition, for instance by
outsourcing or by cooperating with
other health insurers.
Health insurers are also adopting
bright ideas to encourage customer
loyalty. We developed an online por-
tal for Barmer GEK which members
can use to swap ideas with experts
and other users in forums, have
fitness programs drawn up, browse
a medication database, or watch
health videos. In order to tailor the
portal to members’ needs, the company took into account suggestions
from 5,000 insured individuals. That
was an enormous effort, but it will
pay off because the website offers
a good service to members and
attracts new customers.
Will Telekom offer its products
internationally?
Many countries have growing health
markets and are good places to
market German health technology.
Right now we see a great need for
hospital information systems in Eastern Europe, for example in Poland,
where hospitals are required to comply with EU standards by 2015. But
there is a great need for modern,
intelligent, networked technology
in other countries such as Hungary,
Croatia and Russia, too.
Best Practice Issue | November 2011
6
Connected Healthcare
Best Practice Thema | November 2011
Connected Healthcare
7
Best Practice Thema | November 2011
8
Telemedicine
ECGs at
home
© Deutsche Telekom
Germany’s first area-wide telemedicine network has been launched in the federal state of
Brandenburg. Now, round-the-clock care enables
high-risk patients to enjoy an easier life.
J
there will be around 20,000 doctors
too few in the future. Even now,
a general practitioner in sparsely
populated areas has to look after
more than twice as many people as
a colleague in the city.
Better medical care
In the federal states of eastern
Germany, this is not a new problem.
Efforts to find new care models have
been ongoing for years. Telemedicine could be the way to a solution.
Anita Tack, Health Minister of the
federal state of Brandenburg, thinks
that telemedicine offers great opportunities to improve medical provision. “First and foremost, general
practitioner services to patients in
rural regions could benefit from the
use of telemedicine procedures,”
she said.
The Health Minister moved a
step closer to her goal in October
2011, when Germany’s first areawide telemedicine network went
online in Brandenburg. In future,
telemedicine centers at the Carl
© Deutsche Telekom
ochem Gerdesmann, 65, is doubly fortunate. Despite a serious
heart attack eight years ago,
he still works as a developer. He
builds equipment for telemonitoring
patients with chronic heart disease,
thereby helping others as well as
himself.
Gerdesmann is one of two
to three million people in Germany who suffer from chronic
heart disease. In 2010, this chronic
condition was the second most
common reason for hospitalization
in Germany and the third most common cause of death. Sufferers in
rural regions were especially badly
affected, since emergency services
travel greater distances to reach
them than in urban areas. More­
over, medical care provision is set to
deteriorate further. By 2015, around
50 percent of medical practitioners
in rural regions will retire. At the
same time the number of people
aged 60 or more will increase by 25
percent. According to the Association of Towns and Local Authorities,
Patients use the Physiogate (above) and the ECG
monitor (right) to record their vital signs at home.
Best Practice Issue | November 2011
Thiem Hospital in Cottbus and the
Municipal Hospital in Brandenburg/
Havel will provide round-the-clock
care to around 500 high-risk patients with chronic heart disease.
For patients like Jochem Gerdesmann that means less risk and a
better quality of life. Previously, he
frequently had to go to hospital or
to a doctor for routine checks. Now,
he takes key medical measurements
such as weight, blood pressure and
ECG himself on a daily basis. “That
makes me independent of hospital
doctors. I can take the readings
anywhere, even on a camp site,” he
explained.
Secure data network
Patients benefiting from telemedicine use their measuring devices
to send the data automatically by
Bluetooth to a base station. From
there it is forwarded via a secure
virtual private network (VPN) directly
to the electronic patient record kept
by one of the two telemedicine centers. A team of doctors monitors and
analyzes the data and if there are
signs of a critical condition informs
the patients, their general practitioners or cardiologists, or in an extreme
case the emergency doctor. Doctors
in private practice also have access
to their patients’ vital data, which
they can discuss with the patient at
their next appointment.
Prior research at the hospital in
Brandenburg showed that continuous telemonitoring of patients could
reduce hospital admissions by up
to 11 percent and days of treatment
by up to 23 percent. Previously, the
use of telemedicine was hindered
by the fact that the services did not
qualify as part of standard medical
care. Now, Brandenburg has an integrated care contract to enable this.
Telemedicine saves time and costs
The technology and data protection
are regarded as fully developed. Not
least, surveys confirm the economic
efficiency of telemedicine. It helps to
avoid duplicated tests and reduces
administrative work, while patients
benefit by saving time and money
spent on visits to doctors. They can
measure their vital signs even when
on holiday and continue to receive
medical attention. That is why Heidrun Grünewald, chief executive of
the Carl Thiem Hospital, is already
thinking ahead. “At the moment we
are only monitoring patients with
chronic heart disease, but tomorrow
pregnant women at risk, diabetics,
stroke patients and high-maintenance patients could be integrated
into the system. We are preparing
for that,” she said.
Data protection
9
Ensuring patients’ security:
the Electronic Health
Card and Bill of Patients’ Rights
Wolfgang Zöller, German Government
© Buttler-Design
© Wolfgang Zöller
Commissioner for Patients’ Interests, on
security and transparency in data protection.
I
see establishing transparency in
healthcare as one of my major
tasks. Consumers can only take
responsibility for their own health
if they have sufficient access to
comprehensive, easily understandable information about the benefits,
prices and quality of the plethora of
treatment options, medical drugs
and aids. Most recently, we made
the German Independent Patient
Advice Service (UPD) part of standard medical care. If citizens have
access to independent information
they are better able to function as
equal partners in healthcare. I also
welcome the UPD’s new function as
a seismograph. In future, it will report
to me on complaints it has received.
This creates the conditions for taking
the necessary action either directly
with those involved or by changes
in the law. Along with the Health
Minister and the Justice Minister, I am
currently engaged in drafting a Bill of
Patients’ Rights. The first draft will be
ready within a few weeks. It will have
quite a lot to say about transparency in particular. The planned Bill
of Patients’ Rights will lay down
patients’ rights more transparently
and do away with existing enforcement deficits.
At the same time, healthcare
will be safer for patients as risk
and error avoidance systems and
improved complaint management in
hospitals help to optimize treatment
procedures in increasingly complex
medical processes. Encouraging an
error avoidance culture will never
completely eliminate mistakes in
treatment, however. In such cases,
the bill provides for reliable support
for patients by their health insurers.
In addition, the rights of patients and
of people in need of care vis-à-vis
their health and care insurers will be
strengthened.
Another important point as
regards transparency and patients’
rights is the launch of the Electronic
Health Card. It is important to state
that all involved agreed that the Electronic Health Card should provide
a considerably higher level of data
protection than the previous health
card. That is because my work as
Patients’ Commissioner has taught
me that along with the quality of
medical treatment, patients see data
protection and informational selfdetermination as a very high priority.
The goal is to create a telematics
infrastructure that improves healthcare communications. The Electronic
Health Card will underpin patients’
rights, because at its heart is patients’ unlimited right to self-determination. True, the storage of medical
data is still in the preparatory phase,
but it is already certain that patients
will be able to specify themselves
whether, and which, data is to be
stored on their card. The plan is
to set up patient terminals where
patients can inspect the data on their
cards. Only administrative data will
be stored compulsorily on the card.
Data protection is top priority.
Best Practice Thema | November 2011
10
Hospitals
Connected at last
© Deutsche Telekom
© Deutsche Telekom
Networked communications are moving into healthcare. More and more hospitals are testing mobile systems at work.
Quick access to patient data takes the strain off doctors and improves the quality of healthcare provision.
With the help of the Checkpad MED, Dr. Sabine Presser and Prof. Dr. Jan Langrehr are better able to explain diagnoses and therapy to patients.
W
hen senior physician Dr.
Sabine Presser first appeared on her ward round
with an iPad, her patients were
amazed. “They thought it was my
own computer,” she said, “but when
I showed them their X-ray images on
the monitor, they were delighted. I
can use the findings and images to
explain their diagnosis and therapy
to them better.” Dr. Presser is one of
a team of doctors at the Evangelisches Waldkrankenhaus in BerlinSpandau that is testing the use of
iPads in everyday hospital work. She
and nine colleagues carry the tablet
computer, which weighs in at just
730 grams, around with them constantly. It enables them to access
medical reports or histories, laboratory findings or surgery reports,
care or administrative documents
within a few seconds anywhere on
the hospital site. Checkpad MED,
an iPad application, displays data
Best Practice Issue | November 2011
as image, film, sound or text files.
When doctors log on to their IPads
at the start of their shift, they get a
quick, up-to-date overview of new
admissions and new test results.
Checkpad MED saves time
Prof. Dr. Jan Langrehr, chief physician at the Clinic for General, Vascular and Visceral Surgery in Spandau,
can no longer imagine work without
the Checkpad MED. It saves him
valuable time. “Formerly, when I
came out of the operating theatre
there was a heap of files waiting
for me on my desk. I had to check
through and sign off findings and
see what was happening to which
patient. Sometimes I had insufficient
information to make a decision,” he
explained. Then he had to consult
colleagues, make inquiries, chase
results, or in case of doubt order a
further examination, which costs
time and money. In contrast, with
the iPad and the Checkmad MED
application he has an instant overview of all information on screen.
Saving time is crucial for doctors,
and not only for medical reasons.
A survey by the Marburger Bund
medical association found that
hospital doctors work around 55
hours a week. There is a shortage of
personnel in German hospitals, with
an average of 1.5 physicians’ posts
vacant in every department. Carsten
Schaulinski, chief executive of the
Waldkrankenhaus, is familiar with
the problem. “We have been thinking for a long time how to relieve the
strain on our doctors and modify
processes,” he said.
Lean management
At a time of increasingly tight
budgets, rising demands and
tougher competition, hospitals have
little room for maneuver. That is
why the Waldkrankenhaus relies on
lean business management. “Our
aim is optimal coordination of all
value-creating activities,” Schaulinski explained. Checkpad MED,
he said, was a building block for
implementing this principle in everyday hospital routine. “Information
goes directly to doctors. That saves
time and money, and increases job
satisfaction,” he explained. The
Checkpad MED retrieves data from
hospital information systems or from
radiology, laboratory or surgery subsystems and archives. Information is
transmitted via a wireless LAN or by
broadband via UMTS. Data is always
encrypted and transmitted via a
protected tunnel separate from the
public Internet. In addition, all users
have to identify themselves each
time prior to accessing the system.
Otherwise the gates remain closed.
Hospitals
11
© Deutsche Telekom
Bedside
multimedia
Patients
© Deutsche Telekom
stay an average of 7.9 days in
hospital, according to the German Federal Statis­
tical Office. Since treatment only accounts for a
fraction of that time, patients have to find ways
to pass the rest with TV, the telephone, a book
or a magazine. Videos? Internet? Professional
sports? Forget about it – even though they would
score points with patients. Less than 20 percent
of hospital patients would rate their stays as “very
good”, according to the “Hospital Environment on
the Brink” study from consultancy Ernst & Young.
“Hospitals prefer to apply their tight budgets
to medical equipment, which makes sense from
a medical viewpoint,” says Timo Baumann, T-Systems hospital expert. But the hospital managers
polled by Ernst & Young put “increasing patient
comfort” at the top of their lists – even above any
medical investments. “They ultimately balk at the
costs since it‘s hard for them to understand what
competitive advantage it gives their hospital,” says
Baumann. One alternative is offering multimedia
services without an accompanying investment.
“We equip rooms and beds with the necessary
technology. Hospital operators don‘t have to pay
anything up front. Instead, patients pay us directly
for the services using payment cards.”
Plug in and surf
Almost every German hospital bed has a telephone and cable jack. These standard outlets
allow T-Systems to install a touch-screen monitor
and connect it with an entertainment network.
Patients can phone using IP telephony, watch TV
and use the integrated video conference system.
“Patients can also surf the Internet and page
through their favorite newspapers and magazines on PagePlace, an online newsagent,” says
Timo Baumann. The system makes professional
German soccer games as well as the newest Hollywood blockbusters available at the bedside.
Visual support for doctor‘s visits
The system isn‘t just good against boredom. It can
also help doctors discuss a patient‘s condition
with them by showing x-rays and laboratory tests.
Patients can even keep track of their appointments for treatment. And if all that information
and entertainment makes a patient hungry, they
can just pause the TV and use the touch-screen to
order lunch.
Connected on every floor
Telekom is establishing an electronic
exchange in the T-City Friedrichshafen
to ensure family doctors are connected to their clinical peers. Doctors
at Friedrichshafen hospital and their
colleagues from a local care center as
well as family doctors all have access
to patient information stored in a
variety of locations, systems and organizations. If patients agree with this
use of their data, each doctor involved
in their care can read and share the
documents. This gives the medical
professionals a more complete view
of the patient‘s hospital and treatment
history and helps avoid redundant
exams. Telekom partners Cisco and
Tiani Spirit are relying on the Medical
Data Exchange Solution (MDES) as
well as the open IHE standard for the
information exchange.
Best Practice Issue | November 2011
© argironeta – Fotolia.com
Most hospital beds are spartan
affairs – but things could be different.
A bedside terminal allows patients to
watch TV, surf the Internet and order
food – all without increasing costs
for hospitals.
12
International
Learning to outsource
The Berne University Hospital now relies on specialized external Information and Communications Technology (ICT)
service providers for most of its IT, freeing up valuable IT manager resources.
Doctors, nurses and care personnel at the Berne University Hospital can focus completely on their work. T-Systems takes care of the IT.
A
bout a third of German
hospitals aren‘t profitable,
according to marketing and
management consulting firm Pierre
Audoin Consultants (PAC). Costs
are exploding, there‘s a lack of qualified employees and competition for
patients is increasing. The situation
is no different in Switzerland.
So hospitals are optimizing their
processes and sometimes turning
to outsourcing. Hospitals now rely
on specialized service providers
for everything from laboratories to
cafeterias. But one area has been
widely ignored – in Germany only
about 94 percent of hospitals manage their own IT, according to the
German IT Association [Gesellschaft
für Informationstechnologie].
Outsource or in-house?
IT is getting more and more complex – operating systems, standards,
Best Practice Issue | November 2011
interfaces and hardware change
continuously. “As a company whose
expertise lies elsewhere, keeping
up is nearly impossible,” says Martin
Gray, CIO of the Berne University
Hospital. The hospital has now
outsourced most of its Information
and Communication Technology infrastructure. “The maintenance and
operation of various technologies
and solutions is getting increasingly
complex. This can cause personnel
shortages. The IT experts a hospital
of our size requires are tough to find
on the market,” says Graf.
With about 50,000 in-patient
and 260,000 out-patient visits a year,
the Swiss general hospital is a medical science center. Its cardiology,
neurology and oncology departments have a good reputation.
“Our 1,200 doctors and
scientists need to concentrate fully
on their work. Our IT department
focuses on providing them with
the best-possible applications for
their medical efforts,” continues
Graf. T-Systems has taken over the
complex technical infrastructure
activities – from desktop systems to
running servers and databases in
the datacenter. Experts monitor the
availability of the Berne University
Hospital‘s approx. 300 IT systems
which cover everything from a
hospital information system to
laboratories and even SAP. “An
individual hospital can‘t compete
with a specialized service provider
either financially or technologically.
They can create economies of scale
that we can‘t,” says Graf.
Outsourced IT simplifies a lot
of thing for the hospital: a complex
SAP architecture automates almost
most hospital administration processes. All key hospital systems are
also connected either via cable or
through a wireless network. During
patient visits, doctors can download
x-rays to their mobile devices. The
temperature of the medicine storage refrigerator can even be taken
wirelessly. Wheelchairs can be
located throughout the campus and
care personnel place patient meal
orders with their handheld devices.
The order is sent immediately to the
cafeteria.
Saving with better service
With the support of T-Systems‘ IT
infrastructure, Graf and his team
are concentrating their expertise in
further developing medical and administration applications at the Bern
University Hospital. “Together with
doctors and the hospital‘s administration, we‘re improving patient care
and reaching our cost-cutting goals
at the same time,” says Graf.
International
13
Online portal for
improved dialysis
© trismile – iStock.com
Doctors’ visits, kidney-replacement therapy through dialysis, waiting for a donor organ – just another day for a kidney
patient. The Elisabethinen Hospital in Linz, Austria offers patients support with an online portal.
Dialysis can successfully perform kidney-replacement therapy until a donor organ can be found.
C
hronic renal failure – 67-year-old Franz
T.‘s lab results were clear. The former
locksmith is suffering from what has
become a widespread disease. Some estimates
claim kidney function is reduced in as many as
one-in-ten adults. About 70,000 Germans require
regular kidney-replacement treatment, according to the German Society of Nephrology. The
Austrian Dialysis and Transplant Registry counts
about 4,200 dialysis patients who receive care
at nearly 80 dialysis centers in the small Alpine
nation – and nearly the same number have undergone successful kidney transplants.
Treatment support from the Net
Franz T. has received treatment from a specialized clinic in Linz since his diagnosis. Doctors at
the Elisabethinen Hospital are using drugs and
hormone treatments in an attempt to improve
the pensioner‘s health – the hospital treats about
1,500 renal patients each year. They‘re continuously monitoring his blood values, blood pressure
and hormone levels.
A nephrology Internet portal, developed
jointly by the hospital and T-Systems, supports
patients like Franz T. as well as medical personnel in such things as treatment planning. Current
lab results and appointments can be transferred
automatically to the portal from the Elisabethinen
Hospital‘s clinical information system. The system
uses text messaging and e-mail to let Franz T.
know any time new data has been added. He can
log in at home any time he wants to review his
appointments or check a doctor‘s prognosis. All
data is encrypted.
The transport portal can help doctors should
kidney-replacement therapy become necessary.
Hospitals and neurologists record the frequency
and type of dialysis and examination results on
the portal though only attending physicians have
access to the prognoses via an encrypted connection.
The information helps transplant centers
decide if a patient can receive a donor organ
from the current supply. “When it comes to kidney
transplants, there are as many as a hundred differ-
ent variables with different expiration dates,” says
Prof. Dr. Rainer Oberhauer from the Elisabethinen
Hospital. Since patients must usually wait three
years for a donor kidney, doctors have to continuously examine the patients.
A traffic light as decision maker
The kidney transplant portal bundles all the criteria into a simple traffic light system. If everything is
pointing toward a transplant, the light is green. If
an additional exam is necessary, it turns red. The
portal‘s monitoring function e-mails administrators and doctors two months in advance. Doctors
can click on the traffic light to access checklists
and review details.
For now, Franz T. can go without dialysis or a
donor organ. His kidney function has stabilized
thanks to customized treatment. He‘s already
come to terms with the regular exams required by
his disease and the nephrology portal helps him
keep all his appointments at the Elisabethinen
Hospital.
Best Practice Issue | November 2011
14
Ambient Assistant Living
Living independently as you grow older
© jo unruh – iStock.com
Intelligent support systems
help aging and ill people live
at home for as long as possible
G
ermany‘s population is one of the oldest
in the world. According to the German
Federal Statistical Office, every fifth
German is over 65, the equivalent of 17 million
people. The reason: the birth rate has been falling
for years while life expectancy increases. But as
the population gets older, its care needs also
increase. Most people don‘t want to move to a
care home.
The goal is increasingly
to integrate technology
into existing social environments such as families,
neighborhoods and retirement villages.
Desire to live independently
Eight out of ten people over 45 want to live at
home as long as possible, according to a study
by the F.A.Z. Institute. Among 70-year-olds, the
figure climbs to 90 percent. Telekom is working
with partners on solutions to help older people
live an independent life for as long as possible.
“Technology alone isn‘t enough to pull off an
Ambient Assisted Living (AAL) business model,”
explains Irene Maucher, T-Systems health expert.
“The goal is increasingly to integrate technology
into existing social environments such as families,
neighborhoods and retirement villages.”
Irene Maucher, T-Systems health expert
Best Practice Issue | November 2011
The pilot Safety at Home and Away project
was launched in January 2010 in MeckenbeurenLiebenau near Lake Constance. The project
partners, including the University of Göttingen,
the Liebenau Foundation and T-Systems, are
developing various technologies to enable
people with physical or mental disabilities to live
independently. The developers have equipped a
test apartment with sensors that recognize when
people are in danger. If someone wakes up in the
middle of the night to go to the bathroom, the sensor notes the movement. If they don’t return within
a certain period, the system sounds a warning
and then sends out an alarm. Users themselves
can determine who the system should notify in an
emergency – a neighbor, relative or care service.
Experience has shown that users feel too
confined if the system will only allow them to leave
the bedroom for preset periods. T-Systems is
now working on a new solution that takes users’
individual habits into account.
Fingertip services
Yet another project is underway in T-City, the joint
workshop of the future for Deutsche Telekom and
the city of Friedrichshafen. T-City and Fränkel AG
have been testing a service portal since early
2011 (see page 15). An easy-to-use touchscreen
provides access to certain services for residents
in 19 apartments. “The terminal is really easy to
use,” says user Heinrich Dageförde. “A few movements are enough to customize the screen for my
needs. It’s much simpler for me than the Internet.”
Ambient Assistant Living
15
Keep it simple
Telekom’s Mobile ServicePortal
simplifies access to the World
Wide Web for both Internet neophytes and seniors.
© emporia Telecom
The number of older Internet users is growing:
a poll by Institut Aris for the BITKOM Federal
Association for Information Technology, Telecommunications and New Media showed
that about a quarter of all people over the
age of 65 use the Internet. Seniors generally
don’t care how the technology works, they
just want a computer that’s easy to use and
with a low learning curve. Telekom’s Mobile
ServicePortal is just what they’re looking for. A
simply structured interface provides intuitive
access to local and national services. Users
themselves decide what services they want
in their personal portal. And to make sure
users can surf comfortably away from home,
Telekom also offers the service for Android
tablet computers.
Safety on-the-go
Help at the touch of a button
Brigitte H. knows that if she pushes the button, the
employees at the center can tell from the phone
number who is calling. The system will also show
that she suffers from diabetes and requires regular insulin injections. Using the stored data as well
as information from Brigitte H. about her current
health, she and the center can decide together
how best to proceed, whether it’s notifying paramedics or just getting in touch with her daughter.
“The Mobile ServiceCall helps older people meet
their mobility and safety needs while reassuring
relatives that they’ll know quickly if something is
wrong,” says Nils Lipprandt, T-Systems healthcare
expert. Deutsche Telekom hopes to introduce the
service market-wide in 2012.
With its big keys the ServicePortal is well laid-out
as well as easy an comfortable to you.
The services include news, weather reports, public transport information, energy-use
data and online ordering for medications or
a pizza from the neighborhood. If desired, an
e-learning system can also be integrated for
a step-by-step demonstration of the Internet’s
opportunities. The portal also makes it easy
to send and receive e-mails as well as video
conference with friends and relatives.
© emporia Telecom
B
rigitte H. is in great shape and is always
active. She doesn’t let her diabetes slow
her down: the single retiree still enjoys
traveling and exercises regularly. And it’s the
times she’s on her own that she begins to worry
– what would happen if she hurt herself during
her morning Nordic walking sessions? Who
would intervene if she became hypoglycemic?
Telekom is dialing up an answer. The Information
and Communication Technology service provider
has joined with mobile phone maker emporia Telecom and various charities to develop the Mobile
ServiceCall [Mobilen ServiceRuf] for just these
kinds of situations.
The service is based around a cellular phone
with a simple display, large buttons and sound
that is customized for the needs of seniors. The
emporia phone was also given a contemporary
look – most senior phones have had limited
success because of their unattractive designs.
The back of the phone also has an easy-to-find
panic button. Pushing the button doesn’t connect
the user to the local fire or police department,
but rather a charity’s around-the-clock assistance
center. Users can maintain a personal profile at
the center that includes their telephone number
and address as well as medical info, the number
of their family physician and contact information
for relatives.
© Deutsche Telekom
The Mobile ServiceCall allows older people to get qualified help when
away from home.
Best Practice Issue | November 2011
Mobile health
16
The iPhone as health manager
© PREVIEW Event & Communication
VitaDock devices allow patients to check, save and monitor
blood sugar, temperature, weight, blood pressure and pulse
with their iPhone, iPad and iPod Touch.
Data saved automatically
The CardioDock blood pressure
module allows people with
high blood pressure to
monitor their stats at
home to reduce the
number of doctor
visits. CardioDock
takes five measurements quickly after
it’s launched and
then calculates an
average to eliminate
Zeroing in on your target
weight: TargetScale’s light
rings show users how close they
are to their desired weight.
Best Practice Issue | November 2011
natural swings during individual readings. In addition to CardioDock, GlucoDock allows
diabetes patients to check their blood sugar
quickly and comfortably with their iPhone – the
results are available just five seconds after a reading. The app also eliminates the cumbersome
hand-written collection of blood sugar levels since
all data is automatically recorded in a digital diary.
TargetScale transforms iPhones and their
relatives into weight-management devices. The
app notices every time the user steps on a scale
and uses rings of light to illustrate how near they
are to their target weight. The closer the rings are
to the middle, the closer they are. The Balancetest
function also shows if users are standing evenly
on both feet. Targetscale then also determines
a user’s body fat, muscle mass, water retention
and bone mass as well as their Body Mass Index
(BMI). When in athlete mode, active athletes can
check their fitness level.
With ThermoDock, iPhones become an infrared thermometer. Users can quickly determine the
exact temperature of surfaces and liquids without
coming into contact with them. The infrared technology makes measuring temperatures hygienic and simple.
Body temperature can
also be determined within
seconds and the module
with the Livemode setting can
quickly measure how hot baby food and
other items are.
iPhones become health managers
Users have to install the VitaDock app to measure
their vital signs. It can be downloaded for free
from Apple’s App Store. It makes iPhones and
other Apple products into health management devices. The app saves all readings in a
databank, freeing patients from taking notes.
It can also display data collected over longer
periods as a graph or list to improve monitoring
and analysis. Comments can even be attached
to individual readings – and no one can view any
of the information without a user’s permission.
Attach a VitaDock to a smartphone and it’s ready
to measure vital signs. GlucoDock, Thermo-Dock
and TargetScale are compatible with the latest
iPhone, iPad and iPod touch models. CardioDock
is only compatible with iPhones and iPod touches.
CardioDock can
measure blood pressure at home.
© Medisana AG
© Medisana AG
M
obile phones will play a growing role in
medical care in the future, according to
a poll from research institute 2guidance.
The study showed that 67 percent of healthcare
companies expect a majority of doctors to use
apps for transferring and saving patient information by 2015. The apps will make it easier to treat
primarily lifestyle diseases such as diabetes, obesity, blood pressure and asthma. “Mobile healthcare solutions can slow the dramatic healthcare
cost increases by allowing chronically ill patients
to take their own vital signs at home,” says Dr. Pablo Mentzinis from the BITKOM Federal Association for Information Technology, Telecommunications and New Media. This is where manufacturer
Medisana’s VitaDock devices can help.
Mobile health
C
© q-snap – Fotolia.com
ardiovascular disease remains the
most common cause of death in
Germany. In 2010, about 41 percent
of all deaths were caused by heart attacks or
other circulatory system illnesses. Although
patients should seek medical advice rather
than ignore changes in their heartbeats, a
racing heart, arrhythmia or other change
often disappears by the time a patient finally
makes it to the doctor hours or days later.
Electrocardiograms (ECGs) are then of little
help. “Many people are also very excited
when they see a doctor,” explains cardiologist and professor Dr. Johannes Kastner
from Vienna’s AKH General Hospital. “Stress
levels are correspondingly high, which naturally has an effect on vital signs and cardio
vascular risk indicators.”
Clue Medical’s mobile measuring
device allows cardiac patients and athletes
to regularly monitor their cardiac function
at home, at work, while traveling or even
during training. The device is jointly offered
by Lavandoo Mobile Solutions GmbH, a
telemedicine solution specialist, and Deutsche Telekom.
Users can use Clue Medical to record a two-minute, single-channel ECG
every morning and evening, when necessary. They simply hang Clue Medical
around their neck like a bag and it measures heart function using integrated
metal electrodes – the device eliminates the use of cumbersome adhesive
electrodes. It weighs just 70 grams, has only one button for use and saves
up to 30 readings. The user then sends the results via infrared or Bluetooth
to their cellular phone or computer, which can display the results as a graph
in a variety of forms such as a standard PDF. The data can also be sent over
the Internet or cellular phone to the Clue Medical service center where the
password-protected information can be stored and managed anonymously.
Users as well as attending physicians and relatives can access the results
© Lavandoo Mobile Solutions
© Lavandoo Mobile Solutions
Mobile
ECGs
Heart patients and athletes can use
Clue Medical’s device to keep an eye
on the function of their hearts and
stress levels.
© iStock.com – 1193495
17
Measurements are displayed graphically on mobile phones and computers.
at any time – as long as the patient has
provided authorization by giving them
the user name and password. If desired,
the service center can also automatically
forward the data to a doctor or relatives
using e-mail or text messaging. It even
includes a comprehensive statistical function for analyzing several readings as well
as highlighting trends.
Clue Medical uses the ECGs to
calculate heart rate, heart rate variability
(HRV) and other parameters. The data
can be evaluated to determine a user’s
cardiac condition and stress level and
to diagnose certain risk factors that can
point to excessive stress, burn-out, fear,
depression, as-yet undiscovered cardiac
diseases or the threat of death through a
sudden heart attack in athletes. “Serial or
regular collection of cardiac information
allows us to not get just a still picture but
a comprehensive idea of a patient’s state
of health,” explains Kastner, who has
used Clue Medical at the AKH hospital in
Vienna since 1998 and even loans it to patients when needed. “This gives us
an opportunity to catch diseases early.”
Safe data management
All personal patient information is sent anonymously to a
central server and stored anonymously with a device number.
Patients have exclusive access to their information since they
are the only ones who know their user names and passwords.
Doctors and relatives can only gain access to the information
and analyses when a patient authorizes them by sharing their
login information.
Best Practice Issue | November 2011
18
Health insurers
Working your way to
© Cat London – iStock.com
Workplace healthcare increases employees’ sense of
well being and simultaneously saves costs …
L
ong periods of sitting, stress and irregular meals – these days a day‘s work for
many is anything but healthy. The results
are often exhaustion and a lack of energy and
motivation or even sick days because of physical
and psychological diseases. It comes at a great
cost to companies too – a study by strategy
consultant Booz & Company on behalf of the
Felix Burda Foundation discovered that sick days
cost German companies €1,199 per employee
in 2009 alone. Sick employees that come to work
anyway can be even more costly because it leads
to decreased quality, accidents, chronic illnesses
or even burn-out. According to Booz & Company,
this so-called “presenteeism” wracked up another
€2,399 per person in 2009 – a whopping €129
billion combined for German companies.
Best Practice Issue | November 2011
But only a few companies in Germany have
instituted workplace healthcare management.
For most, the direct advantages of preventative
measures are had to quantify and most companies either know nothing or very little about
the legal, political and financial conditions for
workplace healthcare management. Deutsche
Telekom is already ahead of the pack. It has
made its employees‘ health a fixed component
of its internal service culture and was recognized
by Handelsblatt, EUPD Research and TÜV SÜD
Life Services with the 2010 Workplace Health
Award. “Comprehensive workplace healthcare
isn‘t just a basic human resources principle, it‘s
also a pillar for maintaining corporate value,” says
Thomas Sattelberger, Management Board Member for Human Resources. And Dr. Anne-Katrin
Krempien, Telekom‘s chief physician, adds: “It‘s
up to managers to set a good example and take
on responsibility for the health of their employees.
The goal is to create a lasting motivation for the
workforce to take on the responsibility for their
own health to increase both their ability to work
and their quality of life.”
Fit@Telekom
In addition to regular check-ups, vaccinations
and assistance for psychosomatic issues, Fit@
Telekom is now available as an internal healthcare portal. The portal follows the motto, “Being
Healthy is Fun” and offers plenty of functions and
information about exercise, nutrition and good
health. Employees can complete a fitness check
to learn gain a better look at threats to their health.
Health insurers
19
health and fitness
… for the company. Healthcare portals can also
help spark interest in the topic.
German government
rewards healthcare
policies
© Bundesinnungskrankenkasse Gesundheit
The German government bolstered workplace healthcare as part of the annual 2009
tax law, which went into effect January 1,
2009. An addition to paragraph 3 No. 34
of the Income Tax Law (Einkommensteuer­
gesetz) made payments of up to €500 per
employee per year for promoting general
health and workplace healthcare exempt
from tax and social contributions.
Health insurance companies can
win new customers and improve
service with informative and
user-friendly online portals.
The site also offers motor and memory exercises,
interviews with experts, reading tips on health,
movement and nutrition as well as links to various
Wikis and blogs. “Fit@Telekom should do more
than just inform – employees should be motivated
to speak with their co-workers about health and
network throughout the company,” explains
Nicole Schmidt, T-Systems Market Manager for
Health. “Recipes for low-calorie meals are currently very popular with our female visitors.” Fit@
Telekom can also be very easily adapted for other
companies. “We‘re happy to bring the expertise
we acquired with the development of our own
portal to our customers,” says Schmidt. “Together
with our clients, we can customize the content
specially for the needs of each user.”
Connected healthcare expert
One example is the Barmer GEK member portal
that Telekom hosts in its data center and developed together with the health insurer. The pages
are divided into two areas – the classic “Services”
pages offer users basic information such as applications, forms and contacts. But Barmer GEK has
also created a “Knowledge & Dialogue” section
to offer a communication platform. Members can
post in the forums to share with experts and other
users, get help creating a fitness program or flip
through a media database. A library also offers
a place to research diagnoses and therapies.
Users can even subscribe to newsletters and RSS
feeds or watch health-related videos. Barmer
GEK took a unique approach to customizing the
portal to its members‘ needs: they relied on the
suggestions of the members themselves. About
5,000 insurance customers played an active role
in the creation of the pages and offered ideas and
requests for the portal.
The effort paid off. The Interactive Media
Council in New York awarded Barmer GEK and
Telekom the Interactive Media Award in April
2011 for the portal. The prize was initiated by
the non-profit Interactive Media Council Inc. and
recognizes the highest standards in Internet
design and development. “The award is a nice
accolade for our efforts and motivates us to
continue to improve what we offer our customers,” says Heiner Beckmann, Marketing head for
Barmer GEK. “Our goal is to offer our members a
comprehensive service and quickly answer their
enquiries completely.”
Best Practice Issue | November 2011
Your Mobile Health Check.
Innovative
Health Products
for Your iPhone.
Available in
ops
Telekom Sh
and Online
in Germany