Telemedicin har sedan länge använts i Holland. Nu studeras hur det kan implementeras i Sverige.

1.
KSYOS TeleMedisch Centrum, Prof Bavincklaan 2 – 4, 1183AT Amstelveen, The Netherlands
tel: +31 (0) 20 600 00 60, fax: +31 (0) 20 203 11 21, www.KSYOS.org
1
KSYOS
TeleMedical
Centre
KSYOS
TeleMedical
Centre
is
a
health
institution,
solely
delivering
health
care
with
the
means
of
eHealth.
In
The
Netherlands,
KSYOS
is
active
all
over
the
country
and
with
over
5.000
general
practitioners
(60%
of
all
GP's)
and
2.500
medical
specialists
and
paramedics
contracted
servicing
over
150.000
patients
in
2014.
KSYOS
has
become
one
of
the
major
health
institutions
in
the
country
in
terms
of
health
workers
contracted.
KSYOS’
mission.
KSYOS'
mission
is
to
contribute
to
increased
efficiency
in
healthcare
delivery
using
innovative
techniques,
changed
working
roles,
prevention
and
education.
KYSOS
brings
high
quality
hospital
based
knowledge
to
local
communities.
This
increases
the
quality
of
care
for
the
patient
and
reduces
the
waiting
and
travelling
time
for
the
patient.
KSYOS
Services.
KSYOS
develops,
investigates
and
implements
TeleMedicine
services
that
enable
health
workers
to
deliver
care
close
to
the
patient
in
a
quick
and
efficient
way
with
the
means
of
IT
(Internet).
KSYOS
started
with
TeleConsultation
in
2005,
followed
by
TeleDiagnostics
in
2008
en
TeleMonitoring
in
2012.
As
a
health
institution,
KSYOS
has
the
treatment
relation
with
the
patient
together
with
her
contracted
health
workers
and
is
paid
for
het
health
services
by
insurance
companies
and
care
groups.
KSYOS
TeleDiagnostics.
With
TeleDiagnostics,
patients
are
screened
by
paramedics
such
as
optometrists
and
laboratory
assistants
for
retinopathy,
heart
function
or
long
function
as
a
part
of
integrated
care
models
under
the
direction
of
the
GP
and
under
random
and
anonymous
supervision
of
the
medical
specialist
in
the
region.
KSYOS
performs
retina
screenings
for
half
of
the
diabetic
population
in
The
Netherlands
screened
in
primary
care.
KSYOS
TeleConsultation
With
TeleDermatology
Consultation,
the
general
practitioner
(GP)
uploads
pictures
of
the
skin
into
the
transmural
KSYOS
Electronic
Health
Record
(EHR)
and
adds
medical
information.
The
dermatologist
to
whom
the
GP
would
normally
refer
the
patient
physically
and
who
also
works
with
KSYOS
reviews
the
pictures
remotely,
makes
a
diagnosis
and
gives
a
therapeutic
advice
to
the
GP.
This
is
also
available
in
TeleCardiology,
TeleNephrology,
TeleENT,
TelePulmonology
and
TeleOphtalmology.
In
TeleConsultation,
both
medical
specialists
and
GP's
are
involved.
KSYOS
is
responsible
for:
-­‐
Organisation,
medical
content,
stakeholders
-­‐
Internet
based
EHR,
capturing
devices
-­‐
Support,
helpdesk,
education
and
training
-­‐
Medical
liability,
privacy
and
security
-­‐
Billing,
administration
and
contracting
-­‐
Quality
assurance

2.
KSYOS TeleMedisch Centrum, Prof Bavincklaan 2 – 4, 1183AT Amstelveen, The Netherlands
tel: +31 (0) 20 600 00 60, fax: +31 (0) 20 203 11 21, www.KSYOS.org
2
KSYOS
TeleMonitoring.
With
Telemonitoring,
patients
are
monitored
in
blended
care
models
by
paramedics,
psychologists
and/or
medical
staff
for
somatic
disorders
(diabetes
mellitus)
and
mental
disorders
(eMental
health).
Improving
quality
of
care.
TeleDermatology
is
a
fine
example
of
how
TeleMedicine
improves
care.
The
GP
receives
an
answer
from
the
dermatologist
within
4.7
working
hours
meanly
(median
2
hours)
instead
of
weeks
to
months
waiting
time
in
case
of
a
physical
referral.
This
leads
to
immediate
proper
care
to
the
patient
and
reduction
of
insecurity
for
this
patient.
The
same
holds
true
for
other
TeleMedicine
services.
Improve
prevention
or
health
promotion
Apart
from
preventing
patients
to
unnecessarily
visit
a
hospital
TeleDermatology
has
a
significant
learning
effect
on
the
GP
due
to
the
immediate
answers
received.
This
leads
to
better
care
by
the
GP
over
time.
After
5
years
of
active
TeleDermatology,
the
GP
performs
60%
less
TeleConsultations
as
compared
to
the
first
year,
all
due
to
the
learning
effect.
Even
more,
this
GP
refers
30%
less
patients
physically
to
the
hospital
as
compared
to
colleagues
who
have
never
done
TeleDermatology,
also
due
to
the
learning
effect.
Increased
efficiency
or
cost-­‐
effectiveness.
By
avoiding
immediate
referrals,
TeleDermatology
has
a
cost
saving
effect
of
18%.
However,
the
savings
due
to
prevented
referrals
to
secondary
care
by
the
learning
effect
over
the
years
vary
between
40
-­‐
60%.
The
same
holds
true
for
TeleCardiology
and
TelePulmonology.
Another
outstanding
example
is
the
screening
of
diabetic
patients
with
KSYOS
TeleFundusScreening
combined
with
TeleOphtalmology.
Patients
are
screened
by
local
opticians
under
the
remote
supervision
of
a
local
ophthalmologist
leading
to
a
96%
reduction
of
hospital
visits
for
retina
screening.
The
fastest
growing
TeleMedicine
service
is
KSYOS
eMental
Health.
This
service
has
been
adapted
by
over
1.000
GP's
in
one
year
with
a
total
catchment
area
of
2.500.000
inhabitants.
Short
term
efficiency
increase
TeleDermatology
-­‐
74%
reduction
in
physical
referrals
-­‐
response
time
4.6
hours
instead
of
6
–
8
week
-­‐
learning
effect
in
91%
of
the
TeleConsultation
-­‐
20
–
40%
reduction
in
costs
-­‐
Quality
assurance
0,00
10,00
20,00
30,00
40,00
50,00
60,00
With TD
Without TD
Annual
number
of
physical
referrals
per
general
practitioner
with
or
without
TeleDermatology
(TD)
experience