eHealth and telemedicine: current situation and future challenges

Our health systems are facing great challenges. This is due to demographic changes, progress in medicine technology and regional problems in providing healthcare to low density populations. Furthermore, due to the increase of life expectancy and the growing number of elderly people, there is an increasing need for the treatment of chronic diseases. Telemedicine, as it is today, is not only seen as a supplement to the classic health delivery methods but will be integrated into private and public health economy as a main component of modern healthcare. Progress in eHealth and telemedicine is not only driven by health economic factors but in particular by the breathtaking speed of progress in computer sciences and information technologies. The term ‘telemedicine’ has a wide definition and is considered to be the practice of medicine at a distance and corresponds to a wide range of telemedicine applications. Telemedicine interactions are of two types, either taking place in real-time such as in video conferences, or asynchronously such as in storage and forward transmission of data from monitoring of home-based measurements of body weight, blood glucose, blood pressure and other vital signs or physical values. Mobile applications may be either automatic (e.g. passive monitoring of activity using room sensors) or require the patient to take action (e.g. transmitting home-measurement values using conventional telephones or increasingly, and in particular, smart phones). Educational applications depend on web access of personal computers (PCs) or smartphones and are widely applied in medicine for distance learning and information. Such applications will turn out to be particularly useful for primary and secondary prevention of cardiovascular disease. Another important application includes the remote control of devices such as internal cardioverter defibrillators (ICDs) and/or pacemakers. Transmission of data from the device to a central database with the opportunity to survey patient data such as heart rhythm has benefit in increasing patient safety and, hopefully also, comfort. However, the evidence base for the value of eHealth and telemedicine in managing a wide range of cardiovascular diseases is, on the whole, still weak and contradictory. The aims of the first European Conference on eHealth and Telemedicine in Cardiovascular Prevention and Rehabilitation are to provide information about the actual situation and current knowledge, and to promote interaction between those involved in fundamental and applied research, for developers and manufacturers of tools and devices and, in particular, for those taking care of patients with cardiovascular disease or those involved in cardiovascular disease prevention. The first article by Bernhard Wolf and Karolin Herzog explains the technical background and the development of electronic devices to be used in eHealth and telemedicine, using technologies from cancer research including telematic healthcare systems which can, for example, assist patients with cardiovascular disease. The article is an excellent example of the speed and the advanced stage of technical development which has already been achieved. Some of these developments have already been integrated in diagnosis and treatment of patients and further developments will increase the impact of electronics on progress in medicine and patient care. In a second article, Enno Van der Velde and colleagues explain the application of eHealth and telemedicine for remote monitoring of patients with implanted devices. The data are promising and it may be expected that remote monitoring systems will develop into dedicated monitoring and therapy platforms. The authors expect that data retrieved from these systems will form an integral part of the electronic patient record in the future as more and more outpatient clinic care will shift to personalized care provided at a distance, in other words at patients' homes. A third article by Ewa and Ryszard Piotrowicz gives us an insight into the future of cardiac telerehabilitation. Monitoring cardiovascular risk factors seems to be particularly appealing for the use of telemedicine. This includes health applications to improve lifestyle and adherence to pharmacotherapy by surveillance, education, psychological support and interactive motivational tools i.e. to improve physical activity, healthy nutrition and smoking cessation with the final goals of reducing metabolic risk factors and improving cardiovascular health. Telerehabilitation may be a support or, in the case of a lack of adequate cardiac rehabilitation programs, a substitute as a home-based program in particular in areas where cardiac rehabilitation programs are not available for patients within a reasonable distance. This is of particular interest in areas with a low level of development and low population density. This article is complemented by a statement of Paul Dendale who is a Board member of the European Association of Cardiovascular Prevention and Rehabilitation and presents a comprehensive view about potential shortcomings but also great opportunities for telerehabilitation to be applied in the near future. The contribution by Friedrich Köhler and colleagues presents results on feasibility and perception of telemedical care by patients and physicians. This has been studied in the framework of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial with the objective of proving the superiority of remote patient monitoring compared to usual guideline-based care in terms of total mortality, heart failure-hospitalization, quality of life and other markers of cardiovascular health. Two telemedical centers, located in two German regions, provided physician-led medical support for 24 h/day, 7 days a week, according to defined standard operating procedures. Patients were enrolled from 165 practices in cardiology, internal medicine or general medicine, and followed for at least 12 months with several outpatient visits. Results are encouraging, showing the feasibility of telemedical care and positive perception by patients and physicians. eHealth and telemedicine are excellent examples of innovative technology. They will rapidly evolve and become an important component of today's medical care. They have the potential to reduce healthcare costs by reducing the burden of disease, the risk of complications, hospitalizations, recurrent events and premature death and to improve quality of life. eHealth and telemedicine have a particular potential in cardiovascular disease prevention but also in the long-term care management of patients with cardiovascular disease. An important challenge for those involved in these new technologies will be to keep the main focus on patients’ individual needs and not to be overwhelmed by the enormous speed of progress in technology and informatics and to continue to carefully evaluate the evidence behind the practice. The author declares that there is no conflict of interest. The editor of this journal supplement wishes to express his gratitude to all contributing authors and to Julia Lambrecht for her outstanding editorial and administrative support.