Telehealth in care increases the flexibility of facilities in North Rhine-Westphalia
Clinical, scientific and business insights
Telemedicine in care settings has become increasingly important in recent years. The use of telemedicine in care has enormous potential in the face of demographic change, the increasing shortage of skilled workers and the growing number of people in need of care. Digital consultations, remote monitoring and telemedicine emergency care can reduce the burden on nursing staff and improve medical care for residents. But how can telemedicine be integrated into care facilities? What are the benefits and challenges associated with its use? This article reviews current developments, presents practical examples and discusses how telemedicine can help make care in care facilities more efficient and future-proof.
We spoke to three experts to explore the opportunities and challenges of telemedicine in the care sector. Arno Brauckmann is Head of Nursing at the EvA Gemünd Foundation and has been working in nursing and geriatric care for 40 years. In recent years, he has become increasingly involved in promoting digitalisation in the care sector. The AIDA research project has enabled him to introduce telemedicine at the EvA Gemünd Foundation on a regular basis. Prof. Dr. Dr. Czaplik is the managing partner of Docs in Clouds GmbH in Aachen. The company has expertise in three areas: Telemedicine in nursing and medical care, medical engineering services and the development of medical technology innovations in the context of research projects. Among other things, Mr Czaplik was involved in a research project aimed at testing a telemedicine system for inpatient care in order to improve medical care for residents. Susanne Rademacher is a project manager at the Innovation Centre for Digital Medicine at RWTH Aachen University Hospital. She conducts research at the interface between care and innovative technologies, with a particular focus on telemedicine solutions. Building on her training as a nurse, she completed a degree in European Public Health and Health Policy, Innovation and Management at the University of Maastricht.
What excites you about telemedicine solutions?
Arno Brauckmann: In my opinion, telemedicine solutions have great potential for the future. With the increasing shortage of doctors and nurses, telemedicine offers a great deal of security in terms of care.
Prof. Michael Czaplik: I am excited about telemedicine because it improves the quality of care while being economical – through efficient use of resources and improved patient management. It makes healthcare more equitable, as high quality medical expertise is not limited to urban areas. In particular, the intelligent combination of telemonitoring and teleconsultation increases patient safety, enables early detection of complications and thus contributes to better and sustainable care. As an entrepreneur, I see the huge potential for scaling: many solutions are software-based and can be rolled out flexibly.
Susanne Rademacher: What really excites me about telemedicine is its ability to improve care in acute situations – especially when the required medical contact is not physically present. Telemedicine helps to provide expertise in real time, especially at times when access to medical professionals is difficult, such as nights and weekends. What I find particularly exciting is how these technologies can not only improve care in the short term, but also help to improve the quality of care in the long term through sustainable, interdisciplinary networks. Not only will patients receive better care through quick and easy consultation, but collaboration across the healthcare network will also be enhanced.
What telehealth applications are you using, developing or researching in your organisation?
Arno Brauckmann: The EvA Foundation has already been involved in the development of telemedicine solutions in old people’s homes through the AIDA research project. We are currently using the mobile telemedicine unit for additional tele-visits with participating general practitioners, in addition to the planned home visits. In addition to digital recording of vital signs, a single-channel ECG, digital remote monitoring and wound visits with image and sound are being used.
Prof. Michael Czaplik: At Docs in Clouds, we develop and operate telemedicine systems that go far beyond simple video consultations. They combine hardware, software and medical technology to enable true remote medical diagnosis and delegation. The key is the non-physician specialist who implements the physician’s instructions, with a clear division of responsibility: the specialist performs the procedure, the physician makes the decision. A key element is forensic documentation that integrates all findings, measurements and actions into the digital patient record. The biggest challenge is often not the technology, but the organisational implementation. Success factors include targeted training, change management and close support for all those involved in the introduction of these innovative solutions.
Susanne Rademacher: In our project, we have created an intersectoral cooperation network in the Aachen region, which makes it possible to provide acute care for residents in need of inpatient care in an efficient and needs-based manner. What is particularly important to me is the combination of telemedicine with an outreach service – this cooperation ensures that residents can be cared for quickly and without unnecessary transport. This benefits not only the residents, but also the doctors, who receive fast, qualified support without having to be physically present. Another highlight is that by involving the nursing staff as users, we have not only increased the acceptance of telemedicine solutions, but also improved the collaboration between nursing, medical treatment and the needs of the residents being cared for. The professional exchange through teleconsultations promotes continuous training, which strengthens the overall collaboration.
How can care providers make good use of telemedicine to increase benefits for care recipients?
Arno Brauckmann: In the AIDA research project, we have already shown that the use of additional telehealth visits reduced hospital admissions by almost 36%. Telemedicine can also be a valuable tool in the care of people with dementia. In the future, it would be very helpful if the medical emergency service could be linked to telemedicine. A local service in NRW would be sufficient.
Prof. Michael Czaplik: Care providers can use telemedicine to improve care for their clients and to work more efficiently with general practitioners. GPs who are already involved in the care of patients can make regular virtual home visits through routine tele-visits. This enables closer care without the need for doctors to be physically present – a key benefit given the increasing shortage of GPs and the long distances in rural areas. Tele-visits can also be arranged in urgent situations. This allows a doctor to quickly decide whether an acute deterioration requires the intervention of an emergency doctor or transport to hospital – or whether alternative measures are sufficient. This reduces unnecessary hospital stays, ensures faster and more targeted care, and reduces the burden on caregivers and emergency services.
Susanne Rademacher: Telemedicine can be an incredible support for caregivers, especially in acute situations where health changes are not emergencies, but a medical assessment is needed quickly. Caregivers can use teleconsultation to get immediate medical expertise without taking residents out of their familiar surroundings. I see this as a great benefit: people in need of care do not have to go to hospital unnecessarily, and care staff are relieved of the burden of making difficult decisions without support. This technology not only reduces the workload for care staff, but also ensures that the benefits are immediately visible to everyone involved – care staff, doctors and residents. It is incredibly motivating to see how access to immediate medical advice not only reduces the burden on care staff, but also allows them to benefit from ongoing professional exchange.
What are the risks of using telehealth in care?
Arno Brauckmann: As in the whole field of medicine, care in the delivery of care is important. This does not stop at telemedicine, of course. Telemedicine significantly increases data security. Orders and diagnoses are made in writing and are verifiable.
Prof. Michael Czaplik: When using telemedicine, there are some significant risks that need to be considered. Firstly, compliance with medical device legislation. Telemedicine diagnostics can only be used with approved medical devices. For example, assessing a skin change using a mobile phone camera is problematic unless a certified dermatoscope is used. Improper use of unapproved technology can have legal and liability consequences. Secondly, the reduction of physical home visits for reasons of convenience. Televisits are a valuable addition, but must not lead to necessary physical home visits being omitted simply because virtual visits are easier to carry out. Doctors need to consider on an individual basis when a physical visit is necessary. Thirdly, misjudgement due to lack of measurement data. Video telephony alone can lead to misjudgements if no additional medical measurements are taken. Safe telemedicine diagnosis requires suitable medical equipment to objectively record vital parameters such as blood pressure, oxygen saturation or heart rate. These risks can be minimised through clear guidelines, the use of certified technology and good training for all parties involved. Telemedicine works best as a targeted adjunct, not as a substitute for direct medical contact where medically necessary.
Susanne Rademacher: Of course, there are challenges to implementing telemedicine that we cannot ignore. One of the biggest challenges is integrating the technology into the highly structured and often hectic day-to-day care routine. The technology must be designed to support the work of caregivers without making it unnecessarily difficult. An intuitive user interface that fits seamlessly into existing workflows is critical. Secure handling of sensitive health data is also critical. Another risk is that the positive effects of telemedicine are not immediately visible. It can take time to see measurable results, so it is important to have realistic expectations about the change process. The true benefits of telemedicine are gradual and require continuous adjustments and improvements. We have also found that a long-term change process is needed to fully engage all stakeholders, from nurses to doctors. At the same time, other factors such as technology acceptance, technical infrastructure and gradual integration into existing workflows need to be recognised as potential challenges. It is therefore important to ensure acceptance through ongoing training and support, while optimising the infrastructure for smooth implementation.
How will telehealth in care affect the labour market?
Arno Brauckmann: Facilities that are not closed to digital opportunities and use telemedicine, for example, can be very interesting for potential applicants. I believe that the use of digital opportunities will make institutions more attractive.
Prof. Michael Czaplik: Telemedicine will significantly change the labour market in the healthcare sector, offering both opportunities and challenges. First, it will make medical and nursing work more flexible. Medical services can increasingly be provided from the home office, whether through teleconsultation or remote monitoring of patient data. A new field of activity is also emerging in nursing – “telecare”. Experienced caregivers can remotely assist less experienced colleagues with care-related issues, which is particularly beneficial in rural areas where there is a shortage of skilled workers. Second, it makes the nursing profession more attractive. Telemedicine gives nurses a wider range of activities and more responsibility, for example by allowing them to take over activities delegated by local doctors. This leads to greater appreciation and can help address the shortage of skilled workers. Third, new job profiles and skill requirements are emerging. Telemedicine requires new skills, from the safe use of digital technologies to interdisciplinary collaboration over digital channels. This creates new roles, such as specialised telecare workers or telehealth coordinators to manage the use of such solutions. And fourth, there is a decentralisation of medical care. Medical expertise can be provided regardless of location, opening up new working models not only in rural areas but also internationally. Specialists in structurally weak regions could be relieved by telemedicine consultations taking place across regions or even globally.
Susanne Rademacher: I believe that telemedicine will change the job market in the healthcare sector. It opens up new job opportunities, both on the technology side and for medical professionals. We are already seeing an increasing demand for professionals with skills in areas such as e-health, medical informatics and telemedicine management. Especially in rural or underserved areas, telemedicine will play an important role in attracting and retaining specialists in the long term. The ability to treat patients remotely means that specialists can cover a wider geographical area, improving care in structurally weak regions. I find it particularly exciting that specialists can work together in an interdisciplinary network, so that the exchange and continuous training of those involved will naturally also have a positive effect on the attractiveness of jobs. Telemedicine therefore not only creates new opportunities, but also improves the quality of work and increases the satisfaction of specialists, which makes a huge difference in practice.
What skills do carers need to use telehealth applications effectively?
Arno Brauckmann: Nurses need to be trained in the use of telemedicine and have the necessary professional skills. Personal communication skills with different doctors are also important. An interest in digital technology is helpful, but not essential.
Prof. Michael Czaplik: For nurses to use telehealth applications effectively, they need a combination of technical, communication and medical skills. On the one hand, there is technical competence. Nurses need to be confident in the use of telemedicine systems – from using video platforms to handling medical devices and digital documentation. Knowledge of privacy and IT security is also essential. Clinical expertise is also required. Often acting as an extension of the physician in the field, nurses must be able to gather relevant evidence, implement telemedicine instructions correctly, and identify changes in the patient’s condition at an early stage. On the other hand, communication skills are required. Telemedicine requires accurate and professional communication – both with doctors and with patients and their families. Nurses must be able to communicate findings clearly and carry out medical instructions accurately. Critical thinking and empowerment are also required. Often working independently in the field, nurses must be able to assess situations with confidence: When is a telemedicine consultation sufficient? When is a physical visit to the doctor or emergency care required? Finally, flexibility and openness to digital processes are essential. Finally, flexibility and openness to digital processes are essential. The success of telemedicine depends heavily on how well it is integrated into everyday life. Caregivers should be open to digital innovation and willing to learn about new technologies and work processes. In addition, training and standardised processes are important to ensure the safe and efficient use of telemedicine applications in nursing practice.
Susanne Rademacher: For me, it is particularly important that telemedicine is seen as a support rather than an additional burden in the daily lives of caregivers. Of course, caregivers need to have basic digital skills, but the technology needs to be so simple and easy to use that it does not require lengthy training. The aim is to use simple but effective applications to provide immediate medical support and the best possible care for residents. Interdisciplinary communication is also important – nurses need to be able to work effectively with doctors and other healthcare providers. But the application should be so intuitive that caregivers can easily integrate these technologies into their daily work without any additional burden. The beauty of telehealth is that it not only improves patient care, but also enables continuous learning through regular professional interaction, which benefits everyone in the long run. Through this continuous interaction, nurses improve their skills and knowledge, which in turn improves the quality of care.
More information on telehealth in care
The ATLAS contains more articles and scientific summaries on the use of telehealth in care. For example, read how telehealth is supporting care in nursing homes and hospices, and how digital wound management is easing the burden on healthcare professionals.
You can also read our Bug of the Month interviews on exciting topics.
