[Telemonitoring of cardiovascular diseases in Germany. Standing position and perspectives].
The changes in the demographic structure, the increasing multimorbidity in connection with a rise in the number of chronic illnesses and the absence of an effective coordination of the different levels of healthcare services with its discontinuous processes and redundancies will lead to intolerable economic burdens in the German health-care system, affecting medical, health-political and economic dimensions alike. This is the significance in terms of content and strategy of "health telematics" as an application of modern telecommunication and information technologies in the health-care system, and of "E-Health" as a specification of all services, quality improvements and rationalization effects, which are achievable by digitizing data collection as well as communication processes. Not only do digitizing and electronic transmission offer a better, faster and safer way of communication, but by possibilities of combining data they also allow the rationalization and quality-improving introduction of new methods of diagnosis, therapy and aftercare. The latest developments and appropriate logistic premises nowadays offer a realistic basis for implementing telemonitoring as a central service and information tool as well as an instrument controlling the information and data flow between patient, hospital and medical practitioner. Considering the enormous significance of cardiovascular diseases, focusing on corresponding cardiologic disease patterns seems almost self-evident. Notwithstanding remarkable medical progress during the past few years, cardiovascular diseases are still the number one cause of death in industrialized countries. In the cardiologic sector, telemedical systems are most commonly used with patients suffering from coronary heart diseases, e.g., for the detection of unclear dysrhythmia, as well as with patients suffering from chronic heart failure. Seen from a medical point of view, it is paramount to judge the clinical situation without delay as well as to take necessary therapeutic measures timely and to control their efficiency over a long period of time.Consequently, telemedical projects include the establishment of a nonstop monitoring of patients with increased or high risk of cardiovascular incidents, starting with the hospitalization, postoperative/post in-house health care and up to home care. This kind of monitoring needs to be adjustable to the respective situation modularly in order to guarantee a smooth possibility of surveillance both in the stationary and the ambulant sector, which, in addition, has to be individually adjustable to the demand of required monitoring functions (heart rate, blood pressure, S-T segments, oxygen satiation, weight, breathing rate, and temperature) and the intensity of the monitoring (event recording, "on-demand" vs. continuous monitoring). Certainly rich in meaning for the future is the integrated telemedicine care of a "primary" cardiac patient with his relevant comorbidities: diabetes and coagulation monitoring, respectively.
Helms
Thomas M
TM
Deutsche Stiftung für Chronisch Herzkranke, Fürth, Germany. helms@stiftung-telemedizin.de
Zugck
Christian
C
Pelleter
Jörg
J
Ronneberger
Dierk L
DL
Korb
Harald
H
D002309:Cardiology / Q000458:organization & administration*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000517:prevention & control; D020000:Decision Support Systems, Clinical / Q000639:trends*; D003695:Delivery of Health Care / Q000639:trends*; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D003936:Diagnosis, Computer-Assisted / Q000639:trends*; D005544:Forecasting; D005858:Germany; D006801:Humans; D017146:Models, Organizational; D019114:Remote Consultation / Q000639:trends*