The European Market of Telemedicine: where we are

In the last few days the European Union published a study on Telemedicine (link here). The document is very detailed (112 pages) and contains interesting information and a sector wide view, but some aspects create some doubts.

The aim of the study is to examine the telemedicine market in Europe and to understand the factors that determine its development. The analysis maps telemedicine applications and solutions, and applicable technical standards and guidelines; it also describes market dynamics and potential barriers limiting wider deployment and uptake of telemedicine solutions. Finally, the study assesses the cost-effectiveness of larger-scale deployment of telemedicine under current and future market conditions, to provide policy makers with advice and considerations for wider deployment of telemedicine.

To achieve the study aim, both qualitative and quantitative methods of analysis have been applied to primary and secondary data. The former includes a survey and interviews with key stakeholders in the telemedicine market ecosystem. The latter refers to scientific journals and research reports as well as statistical data.

The first doubt arising is about the newness of the document, and then the reliability of some data: the diffusion of electronic prescription among the GPs, for example, is based on information dated 2013!

The study evidences how most telemedicine solutions are deployed at the national or regional level, while only few are in use in multiple MS or outside the EU. This is due to the significant differences in national regulations and social security schemes, which also incentivised EU policy makers to take initiatives to promote interoperability between solutions and facilitate cross-border use.

Another interesting remark is that most of Telemedicine standards and guidelines are defined by international organizations and mainly address technical requirements, being the technology the telemedicine fulcrum. In addition to international bodies, Member States also set their own national standards, especially to provide precise requirements for telemedicine solutions related to a given medical specialty.

The study underlines the market potential of telemedicine, which is demonstrated to be strong and expected to grow at a compound annual growth rate of 14% in the coming years. The well-being market especially, enabled by digital technologies, mainly wearables and mobile applications, is also rapidly growing.

Anyway, many factors slow down the development of Telemedicine in every country of Europe: such as: lack of stakeholder consensus; unfavourable regulations, insufficient investments and inadequate IT infrastructures.

Schermata 2019-02-04 alle 18.17.39
Barriers to eHealth instruments adoption – Source: Melchiorre M.G., Papa R., Rijken M., van Ginneken E., Hujala A., Barbabella F., eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project, 2016

The study encompasses the barriers to tememedicine uptake but, surprisingly, does not examine its economic, organizational and clinic sustainability. What I mean is that the study undervalues the impacts deriving of telemedicine adoption inside the healthcare system.

Telemedicine is generally perceived and judged efficient in terms of costs, as demonstrated in different test reported in the academic literature. The main findings of this analysis suggest that telemedicine is reported to be cost effective in 73.3% of the cases covered by the literature, while negative effects account for 5.6% of the selected studies. The remaining 21.3% of the studies analysed present a neutral effect of the use of telemedicine as a means to save costs.

The revision also identified parameters that have strong impact on the cost effectiveness of telemedicine solutions. They include: distance between patient and nearest healthcare professional; time required per consultation; cost of a doctor visit; QALYs; and mortality rate.

Literature evidences that tele-monitoring solutions resulted the more effective for a wide range of diseases, especially for chronic ones. Anyway, results are based on small pilot projects and not on large-scale adoption. Consequently, the telemedicine cost-effectiveness rapport coming from literature studies should be formulate with caution.

Referring to the cost-effectiveness correlation, the study does not examine how to evaluate the savings that telemedicine can grant. It is a crucial aspect generally afforded in a partial way through controversial criteria, that in many cases require a profound services and assistance model reorganization, in order to become real and tangible.

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