Stroetmann Karl A, Stroetmann Veli N, Westerteicher Chris
Empirica Institute for Communications and Technology Research, Bonn, Germany.
Stud Health Technol Inform. 2003;97:131-41.
All industrial societies are ageing. This has profound socio-economic and health sector implications. Innovative services based on Information Society Technologies (IST), like telehomecare are regarded as promising avenues to follow both to allow (national) health systems to cope with these challenges and to improve the quality of life of chronically ill and frail older citizens. The aim of the TEN-HMS project is to convincingly prove that telemonitoring of congestive heart failure (CHF) patients at home can improve medical outcome for these patients as well as their quality of life and the efficiency of healthcare delivery processes. But this will not (yet) be enough for the sustained success of such a service. Unless it takes into account the interests of the various players in the health care arena and a long-term Business Case can be proven, it will be very difficult to integrate such services into routine health care delivery processes. Before developing concrete delivery models for such a telemonitoring service, the "players" directly involved in such a service need to be identified--customers/patients, health services providers, IT services suppliers, and public/private insurance funds as payers--and their assessment perspectives considered. Then four concrete telemonitoring delivery models and their probability of success are discussed. Our analysis suggests that telemonitoring will presently only be successful if the service delivery model applied reflects national health system idiosyncrasies, takes into account established organisational boundaries and adapts to patient quality of life and health professional preferences. In the longer term, the new paradigm of seamless, patient-centred care will, however, require new, more efficient service delivery models integrating all aspects of the health services value chain.
所有工业社会都在老龄化。这具有深刻的社会经济和卫生部门影响。基于信息社会技术（IST）的创新服务，如远程家庭护理，被视为有望遵循的途径，既能让（国家）卫生系统应对这些挑战，又能提高慢性病患者和体弱老年公民的生活质量。TEN-HMS项目的目标是令人信服地证明，在家中对充血性心力衰竭（CHF）患者进行远程监测可以改善这些患者的医疗结果、生活质量以及医疗服务提供过程的效率。但对于这样一项服务的持续成功而言，这（目前）还不够。除非考虑到医疗保健领域各参与者的利益并能证明有长期的商业案例，否则将此类服务整合到常规医疗服务提供过程中将非常困难。在为这种远程监测服务开发具体的提供模式之前，需要确定直接参与此类服务的“参与者”——客户/患者、卫生服务提供者、IT服务供应商以及作为付款人的公共/私人保险基金——并考虑他们的评估视角。然后讨论了四种具体的远程监测提供模式及其成功的可能性。我们的分析表明，目前只有应用的服务提供模式反映国家卫生系统的特点、考虑既定的组织界限并适应患者生活质量和卫生专业人员的偏好，远程监测才会成功。从长远来看，无缝的、以患者为中心的护理新范式将需要整合卫生服务价值链所有方面的新的、更高效的服务提供模式。
