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Cisco TelePresence allows doctors to conduct virtual consultations

Two hundred Swiss pharmacies offering telemedicine facilities, as part of a pilot

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The Swiss healthcare system is facing a crisis. Fifty-seven percent of its general practitioners are over the age of 55, and new doctors coming up through the system are increasingly choosing to go into specialist roles, so there are not enough new GPs to compensate for the number of retirements that will take place over the next ten years.

GP practices in Switzerland are currently trying to fill their vacancies with foreign doctors from France, Germany and Italy, but this is not a long-term strategy, and over time the supply of qualified GPs will continue to dwindle. The healthcare industry has therefore decided to pilot a new approach, called netCare, which enables the provision of telemedicine services in pharmacies.

netCare is the result of a collaboration between pharmaSuisse (Switzerland's association of pharmacists), Medgate (Switzerland's centre for telemedicine), and the medical and accident insurer Helsana. With the help of Cisco and communications provider Swisscom, they have equipped 200 pharmacies in Switzerland with Cisco TelePresence video communication systems.

At the Cisco Live conference in London this week, Cisco's general manager for Switzerland Eric Waltert explained that pharmacists in his country are educated to the same level as GPs, but they are not allowed to sell certain medications without prescription.

Using the new TelePresence systems – which consist of a Cisco EX90 system equipped with a microphone, a camera and a 24-inch full-HD display – patients can receive an initial consultation (triage) with a physician over a video link at a pharmacy.

When a patient enters the pharmacy, they are first assessed by the pharmacist using one of 20 “algorithms” developed by Medgate. These algorithms are effectively flow charts for different medical conditions – such as back pain, conjunctivitis, or a bladder infection – providing a very structured process for diagnosing the problem.

The patient then goes into a video consultation with one of 70 Medgate doctors. In order to safeguard patient privacy, medical examinations take place in a separate consultation room, and Cisco's TelePresence system offers secure data transmission.

Medgate has more than 12 years of experience providing healthcare advice over the phone, but the telepresence systems mean that it can now scale up its service to a higher level of interaction.

The physician and patient can now see and hear each other as if they were sitting in the same room. For the patient, the experience is like visiting the physician in-person, and for the physician it is easy to make a visual assessment of the patient's problems.

“It is an advantage to have more visualisation of the patient, and it is even more important for the patient to see the doctor,” said Cédric Berset, director of marketing at Medgate. “We hope that the video will give us the possibility to also step into fields where we are limited at the moment with telephone.”

The TelePresence system can be expanded by incorporating additional components if necessary. For instance, diagnostic devices and an additional monitor can be connected to measure a patient's heart rate, blood pressure and temperature. The system also supports multiple languages.

Once a full diagnosis has been made, the doctor faxes the prescription directly to the pharmacy, and the medication issued there and then.

Berset said that around 500 patients have used netCare since in launched in April 2012. The majority of patients have been between the ages of 25 and 45, although there is a wide spread, and the split between women and men has been fairly even.

“The pharmacies have to learn how to sell the new service, they have to adapt,” said Berset. “Some are early adapters, so they do this quite well already, but still need to learn what the offering is about and understand that they now offer now a doctor within their pharmacy.”

Helsana is currently the only health insurer taking part in the pilot, but Waltert said that other insurers are keen to get on board, because it is a very cost-effective for their customers to get an initial assessment, instead of having to go into a doctors.

“This gives an indication of how collaboration technology can help solve real challenges out there,” concluded Waltert. “In this case it's a healthcare challenge on a government scale, but the same thing can be applied within corporations.”



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