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Title and Description
Medgate – Teleconsultation for patients
Reviewed/ candidate case
Quality reviewed case
Short description
Since its foundation in 1999, Medgate has become the leading Swiss centre for telecounselling (doctor to doctor) and teleconsultation (patient to doctor). More conventional centres only provide information to the patient. In contrast, Medgate can in 57% of all patient contacts successfully treat the patient and prescribe medicine via a mail-order pharmacy. A team of 90 physicians and medical assistants handles 2,000 patient contacts daily and takes care of around 2.8 million insured persons via telephone, internet and biometric monitoring.
Objectives and purpose
As a specialist in 'distance medicine’, Medgate aims to provide a patient-oriented service and a forward-looking corporate development strategy. The Teleconsultation Centre provides Demand Management services (24/7 medical advice, drug information, etc.). The Medgate Clinical Centre offers services in disease management (treatment programmes for chronic illnesses), telemedical consultations with clinical experts, and participates in research and development activities.
Detailed description
In 1999, when Medgate was founded, several services offered by insurances and/or the Swiss Federal Office of Public Health were only available during office hours mostly personally in one of their rather few offices. Citizens demand services like medical advice, second opinion, drug information, and care provider lists when in need or when at home. Therefore Medgates’ business idea was to offer these citizens services via a 24/7 telephone hotline at the same or less costs but with increased accessibility. Based on these services, Medgate has continuously extended its service offer in both quantitative and qualitative terms. The most important extension of Medgate’s concept was to introduce teleconsultation. Triage centres like NHSDirect offer information on self-care or access to conventional healthcare. Teleconsultation is a substitute for physical consultation with a doctor. For example, a young woman with dysuria can be treated via telephone consultation. The telemedical working diagnosis involves using a knowledge management system for urinary tract infection. Therapy in this case involves electronically prescribing antibiotics delivered by a mail-order pharmacy within 6 hours. The treatment is followed up by a call after 24 hours and again after 5 days. In cases of skin irritation patients can send in a photo taken with their mobile phone. In 57% of all patient contacts this teleconsulation is able to successfully treat the patient and close the case.
To allow for these complex and various treatments via teleconsultation a number of measures needs to be in place. So for example, several Swiss cantonal health authorities approved Medgate as a doctor-led telemedical institution based on detailed structural requirements. This then also authorized Medgate to charge for telemedical services. A specific indemnity insurance allows Medgate to take the risks incurred in every medical treatment. Staff qualification and medical competence is another important issue. The 65 physicians and 25 medical assistants proved Swiss or comparable national exams with a minimum of 2 years practical experience. This is complemented by a basic telemedical training of 1.5 months culminating in theory and practical exams and annual refresher exams. Quality is improved by regular case discussions. A further asset is Medgate’s close cooperation with a group of 25 external medical specialists. On the technical side, process and knowledge management systems support staff in their therapy. Electronic medical records document results and an electronic prescription system checks for interaction and forwards prescriptions digitally to a mail-order pharmacy.
Further services provided by Medgate include: * Case Management: early recognition of inability to work. * Disease Management: treatment programmes for chronic illnesses, e.g. Chronic Obstructive Pulmonary Disease (COPD) and arterial hypertension. * Second Medical Opinion: telemedical consultation from experts.
The combination of medical, IT and economic competence allowed Medgate to become the leading Swiss Centre for Telemedicine handling a daily call volume of up to 2,000 calls and taking care of around 2.8 million insured persons.
Funding
In February 2006, the leading Swiss telecommunications company Swisscom acquired a 40% stake in Medgate Holding AG. Underlying Swisscom’s investment is the initiative to develop and promote comprehensive telemedical patient care in Switzerland. Medgate Holding AG includes Medgate AG (services for patients, physicians and health insurance providers), Medcontrol AG (services for pharmaceutical companies), and Sirius Technologies AG (software development and distribution of telemedical systems).
Interoperability and standards
Medgate is a HON certified website (http://www.hon.ch/). The initiative is supported by the Swiss Society of Telemedicine and the International Society of Telemedicine and Health.
Timescale
Start of planning
1999
1st milestone
Implementation of Medical Call Centre in Basel with, as a first service: telephone consultation.
2nd milestone
Scaling up the telephone consultation service to more than 200 teleconsultations a day and implementing quality standards. Start with additional basic telemedical services: Internet consultation, video consultation and telebiomonitoring.
3rd milestone
Further scaling to more than 1,500 teleconsultations a day (through telephone, Internet, video, and telebiomonitoring). Increasing effectiveness and quality of teleconsultation (standards of process and good practice, prescribing of drugs after teleconsultation, and diagnosis of pictures taken by patients via mobile phone, etc.).
Start of routine operation
2000
Evaluation
In the past
Ongoing
Characteristic of the application
Country
Switzerland
Part in the healthcare chain
Diagnosis
Therapy
Follow-up / long-term care
Home-monitoring
Professional education and training
Level of Implementation
Country-wide
Technology
Customised solution
Details on Technology
Various information and communication technologies are used for medical consultations: Internet, telephone, expert systems, fax, and image transfer. Patient-record software, home-monitoring devices and specialised software are also used.
Results
Outcomes
Up to 2,000 teleconsultations a day by telephone, Internet, videoconferencing, and involving biodata monitoring. There have been over a million teleconsultations since the launch of the service in October 2000.
Triage results: - 55% of patients receive telecare treatment only, with no need to visit a doctor. This reduces healthcare costs by up to 21%. - 35% of patients are referred for a subsequent appointment with a doctor. - 10% of patients are urgent cases requiring an immediate appointment with a doctor.
Reasons why patients contact Medgate: - 75% need medical triage for acute symptoms. - 25% are looking for general medical advice.
Most calls received are in the area of paediatrics and infectology.
Wider impact
A recent Swiss survey showed that up to 60% of Swiss doctors would be willing to use telemedicine. It is hoped that a service like Medgate can provide a good practice example for how other telemedicine services throughout the European Union might operate.
Success factors
The combination of medical, economic and technical aspects was a key success factor. On the business side incentives for all stakeholder played a major role from the very beginning. One of the incentives for insurance companies was the cost neutral or cost saving service offer in combination with increased accessibility. Medgate could demonstrate cost savings of 10-30 percent. Further to this Medgate redesigned the reimbursement system. While it was initially paid by number of teleconsultations x price it is know paid by a fixed price. On the medical side, physicians need short & short-term answers on why to do telemedicine. The answer to this highly depends on the type of telemedicine service offered (tele-biomonitoring is not the same as tele-consultation).
To prove safety, quality and value benefits of telemedicine Medgate set itself quality indicators and introduced a yearly test for doctors. This was especially important because at the beginning a telemedicine service needs to be much better than conventional treatment to convince politicians and potential customers.
Failure factors
1. The biggest problems are open legal issues.
2. In the view of many physicians and patient a doctor has to see his patient physically. In Medgate’s understanding it is more relevant having access to all information. Overcoming the prejudice – I have to see my patient – is a major and ongoing challenge as long as telemedicine service are not yet routinely used. Normally, when once used, the telemedicine service overcomes these prejudices.
3. At the beginning, not the best doctors are interested in providing telemedicine service. After a while and with continuing operation it was possible to attracted some really good MDs
4. Doing telemedicine is very different from normal practice and Medgate learned that they needed to train their physician specifically for that way of therapy.
References
References and dissemination
The company website http://www.medgate.ch/ refers to articles authored by staff members. http://www.swisscom.com/GHQ/content?lang=en http://www.medcontrol.ch http://www.sirius.ch/EN/ http://www.medgate.ch/eprise/main/F_Medgate/F_Products/P_ProductOverview?SubArea=Tab1 http://www.epractice.eu/cases/2754
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