Digital health Telemedicine house call

Some patients find it difficult to regularly attend their family doctor’s practice for essential monitoring or follow-up treatment. In such cases, telemedicine house calls, which are currently available in some regions of Germany, can provide the perfect solution.

Instead of a doctor, a specially trained healthcare assistant calls to the patient’s home at a pre-arranged time. The assistant can perform tasks such as taking the patient’s blood pressure or blood sugar level, administering injections or caring for wounds.

The healthcare assistant is equipped for the telemedicine house call with special measuring devices, such as a mobile ECG device. Using digital technology, they can measure the patient’s health data and send this data to the doctor’s practice.

Doctors are always responsible for diagnosis and for choice of treatment. If necessary, the patient’s doctor can join by video call. This enables personal contact with patients despite physical distance.

Telemedicine house calls also allow doctors to closely supervise the care of their patients in the following situations:

• if patients have limited mobility
• in rural areas where few doctors are available
• in the case of chronic conditions that require regular monitoring

Telemedicine house calls can save doctors time. However, telemedicine house calls are currently only available in some federal states and regions of Germany.

How does a telemedicine house call differ from a video consultation?

With a telemedicine house call, video contact with the doctor responsible for treating the patient is only established if necessary. The healthcare assistant who is on location at the patient’s home has the equipment required and establishes the video connection.

In a video consultation, the patient has direct contact with the doctor. Patients require their own technical equipment and must use it themselves.

Telemedicine house calls are a valuable solution for people who struggle to get to a medical practice. This particularly applies to people who:

• are confined to bed or have limited mobility
• have chronic conditions that require regular monitoring
• live in rural regions where there are too few medical practices

How do patients benefit from telemedicine house calls?

• Patients do not have to travel to the practice and wait to be seen.
• Hospital stays can be avoided in certain cases.
• The progression of chronic conditions can be regularly monitored.
• If a patient’s health deteriorates, examinations and treatments can be initiated quickly.
• Patients experience personalized care and a personal approach.
• Contact can be made with the doctor treating the patient if necessary.
• Patients are still cared for by their usual medical practice.
• Patients don’t require any technology or technical knowledge.

After a stay in hospital, telemedicine house calls can help people transition back into their home environment while continuing to receive constant medical care.

Telemedicine house calls are initiated by the doctor responsible for patient’s treatment. They commission non-physician practice assistants (NäPa) to visit patients at home or in a nursing home. The assistants can perform various tasks, including:

• taking a blood sample
• measuring blood pressure
• measuring blood glucose levels
• performing an electrocardiogram (ECG)
• checking lung function
• measuring body temperature
• determining body weight
• wound care
• administering injections
• conducting a dementia test
• assessing the patient’s capacity for self-care
• documenting the course of treatment
• passing on the data collected
• setting up a video connection to the doctor’s practice

The healthcare assistant carries special equipment with them to perform these tasks. This equipment includes, for example, medical monitors (e.g. to measure blood sugar and blood pressure).

A tablet PC is normally used to record patient data and send it to the practice. At the doctor’s practice, this data and the measures taken are entered in the patient record and evaluated. The healthcare assistant and the responsible doctors also discuss the examination results and treatment with one another in person.

When is video contact established with the doctor’s practice?

If treatment is urgently required or any pressing questions arise during the house call, the visiting healthcare assistant can use their tablet PC to establish video contact with the doctor responsible for the patient’s treatment. The doctor is available to the assistant making the house call at all times. Video contact may be necessary, for example, if the patient is feeling unwell of if their condition has deteriorated.

During the video call, the doctor can get an overview of the situation, give the visiting healthcare assistant instructions and see that these are carried out correctly. Patients can also ask questions, so that they maintain their personal relationship with their doctor.

Doctors must only task specially trained healthcare assistants to conduct the house calls. These are known as non-physician practice assistants (“NäPa” for short in German).

Trained health workers and nurses and physician assistants with three years’ professional experience can undergo further training to become non-physician practice assistants. Healthcare assistants can also perform house calls following further training as a care assistant in primary care (VERAH) or a supporting physician assistant (EVA).

These specially trained healthcare assistants must only provide treatment under the direction of the doctor responsible and must document all measures taken. The data collected must be in the possession of the doctor’s practice by the next working day at the latest.

The relevant doctor is responsible for the telemedicine house call and for any measures taken during the house call. They make decisions about diagnosis and treatment.

How secure is data protection with telemedicine house calls?

During a telemedicine house call, data is transferred using digital media. Rigorous security standards apply – only special video services approved and certified by the National Association of Statutory Health Insurance Providers (Kassenärztliche Bundesvereinigung) are to be used.