How eHealth can help us to be healthier and wealthier! EUSBSR Forum 2016 – Tuesday, 8 November 2016 Professor Dr. Roland Trill Director Institute of eHealth and Management in Health Care Flensburg University of Applied Sciences

? The turning point is now – at the latest! Quality of Care Quality of Life Hospital Specialist Family Doctor Patient 2030 Rural Areas Efficiency Demography Demands Cost Pressure Productivity ? eServices Healh Literacy eHealth Literacy

Specialist Hospital or Telemedicine Center eHealth can save lifes ! patient with stroke in ambulance car in case of heart attack a direct communication from ambulance car take place making CT-Scan send CT-Scan interpret CT-Scan and give recommendations for treatment Specialist Hospital or Telemedicine Center Regional Hospital

eHealth can offer comparable services all over, also in the rural areas

Health Literacy – Definition eHealth can enhance the health behaviour, avoid illnesses and/or postpone illnesses to higher age Health Literacy – Definition The WHO defines Health Literacy as the totality of all cognitive and social skills which motivates people and enables them to adopt a health-promoting lifestyle. Health Literacy is seen as the key for health-promoting behaviour. (http://www.who.int/healthpromotion/conferences/7gchp/track2/en/)

Opportunities from an improved Health Literacy Risk-conscious health behaviour. Increased use of prevention and screening measures. Improved treatment adherence and compliance. Improved self-management of risk factors / diseases. Decreased hospitalization. Improved physical and mental health. Decrease of early death risk. Decrease in treatment and health care costs. According to estimates by the WHO the share of health expenditures due to insufficient Health Literacy is 3%-5%. (http://www.aok-bv.de/imperia/md/aokbv/gesundheit/gesundheitskompetenz/gesundheitskompetenz_infoblatt_15_07_gruen.pdf)

European Commission

The new Health Care System Hospital Specialist Family Doctor Patient 2030 Hospital Teleconsulting Specialist Family Doctor Teleconsulting/Telemonitoring and Mobile Services Intermediates Patient 4.0 / Citizen BSR-Strategy!

Recommendations Develop the new health care system step by step – avoid time lasting discussions and particular interests (make consensum over all political parties) Implement a digital infrastructure. Set incentives for professionals for the use of digital services. Implement Electronic Health Records. Forster mobile services. Improve Health and eHealth Literacy. Foster companies with innovative digital services. Use experiences from other BSR countries. Join networks.

Thank you!

Additional informations – on demand

Standardised Health Literacy Score (European Health Literacy Survey 2011)

Europeans becoming enthusiastic users of online health informations. www.ec.europa.eu/digital-agenda (28.11.2014)

Questions for discussion Evidence of telemonitoring for chronical illnesses, e.g. heart failure. Who could be placed as intermediates in the rural areas? What‘s about the elderly in the digital health care system? Are business models ahead to make digital health also attractive for companies?

By using eHealth (digital services) we could (from a patients‘ view) Save lifes. Offer comparable services all over, also in the rural areas. Support chronically ill patients in organizing their lifes, offering save surroundings, helping increase quality of life. Enhance the health behaviour, avoid illnesses and/or postpone illnesses to later ages .

Reasons and motivation for using the internet Basically learning something about my disease Searching for physicians, hospitals or other institutions I am searching for experiences from similar patients being in a similar situation like me Buying medication or health products online For information about healthy life, prevention, precaution, vaccination In case of Complaints (minor emergencies) For a second opinion about a diagnosis/ operation Before or after a visit to the doctor (or other treatments) Change of constitution (deterioration, improvement) Need help with a certain everyday problem Questions about reimbursement by health insurances or subsidies Change in the previous therapy ( by the physician or other) Gründe und Motivation für die Internetnutzung Grundlegend etwas über meine Erkrankung lernen Ärzte, Kliniken oder andere Einrichtungen suchen Ich suche Erfahrungen von ähnlichen Patienten in ähnlicher Situation wie ich Medikamente oder Gesundheitsprodukte online kaufen Um Informationen zu gesundem Leben, Prävention, Vorsorge, Impfungen,.. Bei Beschwerden (kleineren Notfällen) Eine Zweitmeinung zu einer Diagnose oder einer Behandlung/ Operation Vor oder nach einem Arztbesuch (oder anderen Behandlungsterminen) Bei einer Veränderung (Verschlechterung/ Verbesserung) innerhalb meiner Erkrankung Hilfe zu einem bestimmten Alltagsproblem als Mensch mit einer bestimmten Erkrankung Bei Fragen der Kostenerstattung durch die Krankenkassen, Zuschüsse, etc. Bei der Veränderung der bisher üblichen Therapie (durch den Arzt oder andere) (E--‐Patienten Studie 2014 in Deutschland)

c) Support chronically ill patients Data-exchange via mail or phone Telemedicine – an example Telemedicine Center Patient with heart failure at home Family Doctor Ambulance car Scale - Blood pressure device - ECG wearable

Market development The digital health care market will increase from 80 billion $ (2015) to 2000 billion $ until 2020. Yearly average of 21%. Highest increase on mobile services = 41% per year! (Roland Berger 2016)

The patients are ready … 92% of respondents expect health information seeking online as part of the health care system in 10 years. 78% of Germans would like to book appointments with health professionals online. 29% of Germans use health apps on their smartphones. Approx. 65% of Germans would appreciate a greater openness of their GPs towards digital media.

Satisfaction with the information found in the internet European Commission (2014)

Effects Now I am able to understand my disease much better (f. e. what is important; what is important to consider,…) I am able to be confident in making a decision for or against a certain therapy/ change of therapy. I am able to handle better my disease in my everyday life. I live healthier now or rather do something for my health. I am able to deal better with my disease, bothmentally and emotionally The information on the internet were impractical to implement in practice. The information on the internet were not helpful for me and rather confusing. Auswirkungen Ich kann jetzt besser meine Krankheit verstehen (z.B. auch was wichtig ist, worauf ich achten muss etc.) Ich kann selbstbewusster Entscheidungen für oder gegen eine bestimmte Therapie oder Therapieänderung treffen. Ich kann besser mit meiner Erkrankung in meinem praktischen Alltag umgehen. Ich lebe jetzt gesünder bzw. tue etwas für meine Gesundheit. Ich kann psychisch und emotional besser mit meiner Erkrankung umgehen. Die Informationen im Internet waren für mich in der Praxis nicht umsetzbar. Die Informationen im Internet waren für mich nicht hilfreich und eher verwirrend. (E--‐Patienten Studie 2014 in Deutschland)

Impact on treatment adherence Now I am able to understand better what is important for my recovery and rehab (f. e. after surgery or specific treatment) Now I am able to understand and follow better the instructions and recommendations of my physician. Now I am able to better deal with my medication and the correct way to take the medicine. Auswirkungen auf die Therapietreue Ich kann jetzt besser verstehen, was für meine Heilung und Reha wichtig ist (z.B. nach einer OP oder bestimmten Behandlung) Ich kann jetzt die Anweisungen und Empfehlungen von meinem Arzt besser verstehen und befolgen. Ich kann jetzt mit meinen Medikamenten und der richtigen Einnahme besser umgehen. (E--‐Patienten Studie 2014 in Deutschland)

Albert Schweitzer (w. y.) “Each patient carries his or her own doctor with him/her. The patient just don‘t know it yet and visits us. The most important is to give this own inner doctor the chance to be active.” Albert Schweitzer (w. y.) Jeder Patient trägt seinen eigenen Arzt in sich. Der Patient weiß das noch nicht und kommt zu uns. Das Beste und Wichtigste ist, diesem inneren Arzt im Patienten die Chance zu geben, aktiv zu werden.

Teleconsulting Example: Teledermatology Cisco

Where are we heading – wealthier and healthier in the decades to come, or just the opposite? We are heading towards great challenges - it is time to act now! If not, the goal to become wealthier and healthier will not be reached. If we start to accept the challenges and agree on the goals, our opportunities are obvious: better health for everyone in the BSR.

Example: Teleconsultation D2P Example: Health App