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Germany seeks telehealth solutions in Canada

By Andy Shaw

Demographic differences more than daunting distances are what’s driving remote healthcare in Germany. In Canada, the 1,000 kilometre or more distance between an injured or ill patient in an Inuit community in the sub-Arctic wilds of Northern Ontario, and specialist help in Toronto is no doubt what pushed Ontario to build the world’s largest telemedicine network.

Yet in Germany, a much more compact country with nearly three times our population and consequently with far less need to make seven-league video conferencing and other digital leaps as we do, there is a burgeoning telemedicine industry, which Canadian caregivers, patients, and entrepreneurs could well profit from. 

That came clear recently during a visit to Canada made by several innovative German telemedicine companies and their supporting agencies. 

“Even though we don’t have the same distances to cover, we have very much the same problem as you do. We have trouble attracting doctors to serve in our rural areas,” explains Ywes Israel, the managing director of Germany’s National Association for eHealth and Telemedicine - NEST, for short, based in the German capital of Berlin.

“Most of our young people, for both professional and personal reasons, gravitate towards our major cities, leaving behind an aging population that requires more care as they age, but have fewer and fewer caregivers close at hand to look after them.”

Like Canada, the hope that Israel and his fellow NEST innovators have is that telemedicine will support the caregivers in rural regions, and even encourage more doctors to practice there.

They found encouragement from no less than Ontario’s province-girding Ontario Telemedicine Network (OTN).

“From the point of view of both our patients and our caregivers, our satisfaction rates run almost embarrassingly high, usually over 95%, and we consistently lead satisfaction surveys done for all other healthcare sectors in Ontario,” OTN vice president Ron Riesenbach told the German visitors at a breakfast briefing arranged for them in a downtown Toronto hotel.

“We’ve also tracked travel savings from not having to fly patients into places like Toronto. Last year, we saved the healthcare system about $15 million dollars in travel costs and expect it to rise to $20 million dollars this year. Also, we know that more doctors are now setting up practices in some of our remote locations, because they know they can have specialist help at their beck and call via OTN.”

“We’ve learned a lot already about telemedicine in Canada,” said Markus Schroeder, CEO of Tembit Software GmbH, a maker of remote patient monitoring software, based in Berlin. 

Schroeder and his fellow travellers to Canada found other OTN statistics cited by VP Riesenbach similarly impressive and encouraging, including OTN’s: connections to all of Ontario’s 175 hospitals, 2,000 videoconferencing outlets, 3,000 clinical users, and last year some 100,000 remote clinical consultations along with 20,000 administrative and educational sessions conducted over the network.

Building a similar network in Germany is problematic, says Israel. “We have very strong physician and pharmaceutical lobbies in Germany that, at least at the outset, might oppose it. Also, like Canada, our healthcare is controlled to a great extent by our individual states, the equivalent to your provinces.

“We are really in a land of small kingdoms in healthcare, each with its own king. What’s more there’s no overriding federal agency, such as your Canada Health Infoway, providing financial and other support for network development. So we have to work harder at convincing hospitals and other partners to finance pilots we undertake.”

And yet medical device development, including telemedicine technologies, are thriving in Germany. In the Berlin area alone, some 250 companies fall into that bracket. And despite a recession that hit Germany particularly hard, the sector continued to grow right through it. And now, buoyed by a resurgent German economy, the sky seems to be the limit. 

“It’s a very fruitful environment now in Germany for medical technology,” Dr. Tilo Mandry PhD, the senior manager for healthcare at Germany Trade & Investment, told the breakfast briefing. “Generally we expect growth of the German economy to be 3.4% this year, the highest in the European Union (EU) and our unemployment is at its lowest since 1987. Also, we have an aging population that makes Germany even more attractive for those serving that market. At an estimated 23 billion euros (over $30 billion Canadian), it is the largest healthcare market in the EU.”

Speaking to the interests of Canadian medical device exporters to Germany, Dr. Mandry, a former pharmaceutical industry lawyer, added: “It’s a relatively easy market to enter. We do have one or two big companies like Bayer, but the great majority are small to medium sized. Nor do we have large chains like Walgreens like they do in the United States. So it’s no big battle to get your products listed with distributors.”

As an added incentive, to help overcome high wage costs for a very skilled workforce in the medical device field, Mandry pointed out that Germany has recently reduced its high business taxes to around the lowest in Europe.

Nonetheless, there are strong incentives for German telemed makers to come to Canada. Take Ywes Israel’s own company, TimeKontor AG, based in Berlin, for example.

TimeKontor is working with one of Germany’s largest health insurance companies on an internet-based, smoking cessation program, with an eye to exporting it with an English-only name: Smoke, Quit, Win! – or SQUIN for short.

“We developed it, in part, with the prestigious Brandenburg Research Institute and it takes you through several levels of smoking reduction and then through three levels of actual cessation. It’s on the internet, so you can take it with you wherever you go and it makes you part of a therapy group, as well,” explains Herr Israel. “We would be interested in sharing this application with Canada, especially if there is a smoking cessation problem in any of its remote territories. We would also be open to Canadian firms or organizations bringing their experiences to our network in Germany.”

A German experience that Canadian telemedicine care-givers might well want to share is the remote monitoring, indeed, even remote diagnosing projects that Herr Schroeder and his Tembit firm have undertaken. Schroeder, who is also a NEST board member, founded his company with a partner 18 years ago. Today some 33 Tembit employees produce customized ISO 9000 certified financial services, marketing, and healthcare quality management, tracking, and record keeping software.

“Our expertise lies really in coding systems that we used initially for tracking things like contributions to bio-banks. But now we’ve evolved and focus mainly on development of patient record-keeping for chronic diseases,” says Schroeder. “And we’ve worked hard at developing interfaces with other software such as the clinical pathways software used in Germany and with portable devices such as smartphones. We naturally have been working in German at first, but we expect certification for our English version by the end of the year.”

In the meantime, Tembit has launched a universally accessible record-keeping project for one of the most devastating chronic diseases, multiple sclerosis (MS).  

“It’s a sad fact that MS patients are often struck by relapses. If they are travelling or otherwise away from home, they must often go to a strange hospital that has no access to their medical records. So in co-operation with another German company, we developed a completely secure USB stick complete with its own browser that the MS patient can give to the attending doctor. So no matter where in the world the patient is, the patient can give the doctor both access to his or her records, but also, from a privacy point of view, by virtue of handing over the stick also giving informed consent to access the complete record.”

In addition, Tembit makes monitoring software packages for homecare including one that comes bundled with a new device that performs overnight blood cleansing via the stomach membrane – used by dialysis patients not at the hospital where dialysis is traditionally done – but at home.

Perhaps just as remarkably, Dr. Ronald Weiss, a lecturer at the University of Applied Sciences for Social Pedagogy in Berlin, has developed a new remote monitoring diagnostic tool – for one of the world’s most misdiagnosed afflictions: attention deficit hyperactivity disorder (ADHD) in children.

“We’ve done studies in Germany and I know in the rest of the world on just how much medication is being given inappropriately to children, often just to keep them quiet, and who often do not have the disease,” says Herr Weiss. “Of course, it’s also a very difficult disease to diagnose in the first place.”

But in one telling pilot, a school child who had been accurately diagnosed with ADHD and one who was clearly not afflicted at all were both wired up with a remote monitoring belt and wristband and monitored around the clock for two weeks.

“We were measuring and collecting data on their body functions and vital signs such as body temperature, blood pressure, skin conductivity, muscle tone, and muscle contractions,” explains Weiss. “And we found at school, for instance, when the teacher told her students to do something, you could see big and consistent differences in these measurements between the ADHD and the normal child.”

This promise of solving one of the world’s most perplexing diagnostic challenges, is one that Weiss, NEST, and indeed Germany would like to explore to their mutual benefit with Canadian counterparts. 

At the wrap-up Question-and-Answer to the breakfast briefing, a Toronto attendee, Veronika Litinski, hung out another carrot for German telemed developers to bring their innovations to this side of the Atlantic. Said Litinsky, who co-ordinates the venture services programs delivered to entrepreneurs, investors and high-growth companies at Ontario’s MaRS medical innovation centre, “One of the advantages we have in Ontario is that there are a number of system integrators that can put your products into a pilot for Canadian testing without the same difficulty you may be finding in Germany. Also we have a centre for innovation and complex care co-funded by hospitals and a provincial government that is also very approachable for such joint projects.”

A common breeding ground, in other words, for both the long and the short and the best of telemedicine.

Posted October 21, 2010