At the 11th TTRN 2023 Conference, held at a confluence of esteemed institutions from the US and Denmark - UC Davis Health, UC Berkeley, CITRIS and the Banatao Institute, Cleveland Clinic, ISfTeH, Odense University Hospital, Svendborg Hospital, Department of Psychology and Behavioral Sciences at Aarhus University, Aalborg University, Cardiology Ward Vendsyssel Hospital, Zealand University Hospital, and ICDK Silicon Valley - gathered to discuss and pave the way forward for transatlantic telehealth research solutions. The takeaways were enlightening, as healthcare everywhere deals with the same looming problem.

Traditionally, populations evolve in a pyramid-type constitution, as seen in the above figure on the left. It is a sustainable development, where the base-to-mid part of the pyramid takes care of the top lighter part of the pyramid. It is a strong structure, and it works. When the top part of the pyramid becomes heavier and heavier, we see an emerging unsustainable situation. Estimates today say that by 2034, the US 65+ aged adults will, for the first time in history, outnumber the younger 18- aged population. This is a burning platform. And when human hands can no longer carry the burden, we must look to non-human hands for help – which is where health tech and telehealth come into play.

And while telehealth may seem like a near future discussion, we are in many ways talking about the present – "new mouse traps" are not a requisite for immediate success. To make a lasting impact right now, we already have many of the necessary tools, for as Dr. Vimal Mishra, Head of Digital Care at UC Davis Health, pointed out, 20-30% of all care can be serviced at home with our current technology.

Innovation without change is just research

Dr. Martin Vesterby of Health Tech Hub Copenhagen

This does not change the fact that the want and need for innovation is present throughout the ecosystems, and many actors and stakeholders keep thinking up new and better ways of doing healthcare; nevertheless, as Dr. Martin Vesterby made a strong point for, actual change — systemic, widespread adoption of these innovations — is the true test. And the current systems need to improve.

This sentiment emphasizes that while identifying and integrating telehealth is vital, its success depends on the broader ecosystem and infrastructure, from problem knowers, innovators, regulators, adapters to, ultimately, user acceptance. Each step must show a clear and vetted path to lifting the future of health care where it must be, and only a united ecosystem is a viable path forth.

... making sure innovative tech gets through the system is one part of the solution; the other part is to train staff to properly use it...

Dr. Allison Sekuler, President & Chief Scientist, CABHI and Baycrest Academy for Research and Education at Baycrest Centre for Geriatric Care

Dr. Peter Yellowlees, Emeritus Professor of Psychiatry at UC Davis and CEO of Asynchealth Inc., emphasized the multifaceted related benefits of telehealth that we also need to include in the debate. Beyond its potential to enhance patient care and decentralize healthcare responsibilities, Dr. Yellowlees highlighted telehealth's role in sustaining a skilled workforce. This is particularly crucial in counteracting the workforce exodus observed throughout the Western world. Data shows that well-implemented telehealth tools significantly increase satisfaction in the workforce, he said. Moreover, by providing care where it's needed most - right at home - telehealth will help reduce the ecological footprint of the current healthcare logistical/infrastructure systems, thus adding to a greener, and more sustainable future. It's essential to understand that the influence of telehealth extends beyond merely treating the sick. Dr. Yellowlees asserts that a fundamental shift in our healthcare perspective is necessary. In his words, "... we must reassess established norms and reshape the conventional medical model."

The TTRN conference appeared to resonate with the idea that health tech and telehealth are emerging as beacons of hope. Their convergence foretells a healthcare future where patients experience comprehensive, individualized, and easily accessible treatment. While this direction offers much potential, it’s essential to tread with sensitivity, ensuring that the innovations are designed for user ease and that there’s adequate education and support amongst healthcare workers to navigate this digital healthcare frontier efficiently.

Surprisingly, despite the advantages of telehealth, the TTRN conference shed light on the fact that there’s a wide disparity in its adoption from hospital to hospital and nation to nation. For example, while some Californian hospitals report around 20% of doctor-to-patient communications through video, Denmark lags at just 1%. And the sentiments were unanimously that even 20% is far from where we should be. And please note Denmark is one of the world’s most digitalized countries - a leader in the EU. Most transactions are cashless, and almost all interaction with the authorities takes place online. Yet, the data shows learning is needed when we address implementing these digital tools, such as health care video-conferences over tele-conferences.

Professor Kristian Kidholm of Health Care Innovation at CIMT Denmark pointed out that many cutting-edge ideas typically begin in the US. That the US has an admirable entrepreneurial way of making these ideas come to light. Select US hospitals are, in particular, good at implementing smart solutions that allow for even acute patient care at home. Denmark has much to learn from this, he stresses.

We must speed up implementation of innovative telehealth solutions, but it is not only about implementation…

Professor Birthe Dinesen, Head of Laboratory of Welfare Technologies - Aalborg University, Denmark

As the 21st century progresses, collaboration between nations and healthcare systems will be the lighthouse guiding the healthcare ship through turbulent waters. Nations must share insights, adapt best practices, and build robust frameworks to ensure that telehealth doesn't remain a buzzword but evolves into the default healthcare model. The future is not about whether telehealth will be an integral part of healthcare; it's about how seamlessly we integrate it into the fabric of evolving healthcare systems that challenge the business as usual.

At Innovation Centre Denmark, we aim to connect thought leaders, innovators, hospitals, and universities, fostering an environment where the finest ideas emerge. The term "integration" propels a comprehensive approach, encompassing the entire value chain from inception to realization. Silicon Valley and the Bay Area stand out for their capacity to transcend traditional boundaries, continuously seeking improved methods to achieve lasting and meaningful change. Health tech and telehealth are not only process/workflow optimization or a way of care that pushes the frontier on cost efficiency and accessibility; it is also on urgent care, chronic disease management, cognitive health monitoring, medication management, integration with EHR, social engagement, clinical intelligence, rehabilitation, interdisciplinary care… and predictive analysis keeping the individual healthy, for longer.

… and this leads us to this final quote from the TTRN 2023 conference:

Prevention is the key to solving the hospital problem

Dr Rebecca Boxer, M.D. M.S. UC Davis Health, Division Chief Geriatrics, Hospice and Palliative Medicine.

The abstracts from the TTRN conference are now published through the Journal of the International Society for Telemedicine and eHealth, and can be downloaded here.