KHZG - Kardiologie Remote Medicine

LOT-0001
KHZG - Cardiology Remote Medicine.
Description of procurement:

The overall system aims to improve the care of heart failure patients in post-hospital care by means of data-driven management and to establish 24/7 care by means of telemedical procedures. Components for this are already available and in use. These are to be completed to form the overall system outlined below.
Chronic heart failure is one of the most common chronic diseases in Germany; it is still one of the most common diagnoses in hospitalized and deceased patients. The number of unreported cases of chronic heart failure is high, around 40-50%. Patients with chronic heart failure have a poor prognosis, despite good drug therapy; Approximately 15-25% die within 5 years of hospitalization. The care of patients with such a complex clinical picture is thus a prime example of how structured, transsectoral and patient-centered monitoring with interface-defined action triggers could significantly improve the course and thus the prognosis and outcome.
In order to cooperatively optimize the entire process of diagnosing and treating patients with heart failure in line with demand, a much closer integration and coordination between primary care physicians, cardiology specialists in private practice and also inpatient and cross-departmental care is required compared to the status quo. In order to ensure this, the different levels of care have corresponding responsibilities:
- General practitioner level of care: Searching for chronic heart or kidney failure and, if necessary, accompanying patients who are stable.
- Outpatient specialist care: Verification of the respective diagnosis, differential diagnostic clarification if necessary and initiation of the appropriate general and diagnosis-specific drug treatment.
- Inpatient interdisciplinary specialist care level: Implementation of centre-specific diagnostic and/or therapeutic services and implementation and paving the way for transsectoral care in the transition to the outpatient sector.
The new form of care, remote medicine, for people with chronic heart failure (HF) addresses precisely these central challenges by facilitating and improving transsectoral and interdisciplinary patient-centered communication with the help of a patient- and physician-managed digital case file in addition to the electronic patient record (ePA). Networked and digitally supported care will strengthen the implementation of guideline-based therapies across all sectors involved and across the board, thus preventing comorbidities and sequelae in this high-risk group earlier and more effectively. The aim is to identify high-risk patients at an early stage (secondary prevention) and, in the case of those who are already ill, to reduce consequential damage and complications (tertiary prevention) through an interdisciplinary, transsectoral and patient-oriented care pathway.
New developments and guidelines have led to the predominantly comparable strategies being recommended as basic therapy for patients with chronic heart failure, such as the control of cardiovascular risk factors and the use of inhibitors of the renin-angiotensin-aldosterone system and the sodium-glucose transporter (SGLT-2 inhibitor). At the same time, there are a whole series of prognosis-relevant therapy decisions that have to be made in a clinically interdisciplinary manner and for which there are no clear recommendations that have been proven by clinical scientific evidence, including e.g. Adaptations of anticoagulation strategies, special therapy of cardiac arrhythmias, adjustments of medications for impaired renal function (secondary hyperparathyroidism, renal anemia), etc. These diverse interdisciplinary challenges and the "medical need" are ensured within the framework of remote medicine in an interdisciplinary, evidence-based and digitally supported manner across all levels of care involved.
The comprehensive, interdisciplinary and transsectoral design of care with the help of digital applications ("tools"), such as the EHR and shared case files, offers a significant opportunity to improve secondary and tertiary prevention of chronic non-communicable diseases (NCDs). Remote medicine-based care concepts are an integral part of the guideline on chronic heart failure in the 2021 update of the European Society of Cardiology (ESC), which has also been adopted nationally by the German Society of Cardiology (DGK) without any changes. Appropriate interdisciplinary and transsectoral communication structures will be established and, in the event of specific questions or problems, telemedical support for patients will be offered in the form of regular monitoring and counselling.
The case file used in the context of Remote Medicine will be based on the applications HealthShare Patient Index and HealthShare Unified Care Record from InterSystems GmbH, which have already been implemented at the UKA.
This project will enable and improve telemedical support for patients with heart failure in transsectoral care.
Details can be found in the Appendix Terms of Reference.