Telemedical applications for remote monitoring and follow-up of patients

This summary of knowledge deals with the use of telemedical applications for remote monitoring and follow-up of patients, a type of welfare technology that has been subject to increased attention in recent years. A focus of this summary is how such technologies have been used in the primary healthcare services. Norway has a long history of projects with these technologies in both the specialist and municipal health services, but implementing these solutions have been difficult. In 2020, the covid-pandemic led to an urgent need to offer remote healthcare services, to ensure social distancing, while providing adequate care.

This summary covers telemedical applications within a wide range of municipal health services. Although experimental testing has mainly focused on certain groups with chronic disorders where such follow-up has been considered particularly appropriate, the summary does not target specific user groups. The summary provides insights about recent scientific research as well as ongoing development work, important laws and regulations, official guidelines, and key policy documents, which can be useful for employees in the care services and other stakeholders. 

Key developments

Current telemedical applications in primary healthcare is the product of several political, economic, and technological developments which have also driven the emergence of other kinds of welfare technologies. One such trend is the ongoing reorganization of health services to put the user’s needs at the center. A core value that motivates this shift is the perception that the one who receives the service should take a more active role in managing their own health. Another characteristic is the need to reduce the cost of certain types of health services because increasing demand due to demographic changes, without negatively affecting the quality of service. Follow-ups and remote monitoring are thus promoted as a potentially cost-effective measure, in a time when service-providers are faced with a scarcity of resources. Other fundamental drivers include the wide availability of consumer technologies for telecommunications, as well as broadband coverage in large parts of the country that can handle large data traffic with high quality audio and video. This now enables service delivery in ways that would have been unthinkable without such a digital infrastructure. Users now expect that healthcare services capitalize on the potential in these technologies 

The international scientific literature suggests that successful implementation of telemedical applications is highly context-dependent, and lessons from implementation in one health system, with specific user groups, cannot be straightforwardly transferred and implemented in other contexts to produce the same results.

There are also considerable knowledge gaps about the benefits and cost-effectiveness of such technologies. In Norway, large-scale trials have therefore been initiated to investigate the performance of such solutions on several outcome-measures. This summary of knowledge describes preliminary results from this, and other relevant studies.

Challenges

Despite that telemedical applications may appear very similar to traditional face-to-face consultations between service recipients and healthcare professionals, remote care involves new technology, unfamiliar work practices, organizational change, and novel modes of communication. Creating high-quality services from afar requires considerable investments in technical infrastructure and knowledge-building, both among healthcare professionals and recipients of care.