Portugal is making big leaps in telehealth development with the newly introduced National Strategic Telehealth Plan (PENTS), the first document in the National Health System in Portugal and one of the first of its kind in the world. 

The plan was launched in early November 2019 by the Shared Services of the Portuguese Ministry of Health (SPMS) to advance telehealth, by elaborating on a ­current vision of the field in the country and defining strategic axes for the 2019-2022 term. Other goals will be to characterise valuable and innovative proposals for the sustainable growth of telehealth and offer a roadmap to carry out the plan and its recommended future implementation. 

The new scheme is expected to homogenise telehealth across the country by scaling good examples and maximising its impact, according to Micaela Seeman Monteiro, director of the National TeleHealth Center & NHS’ Contact Center SNS 24, a division of SPMS.

“Many of our telehealth services are local. Sometimes they do not reflect real organisational change and therefore may lack sustainability when champions leave. Only through a national strategy, with a clear overview of the goals to be achieved and supported by policy-makers, managers, professionals, patients and caregivers will it be possible to turn initiatives into an articulated and synergistic system, which is more than the sum of its parts,” she said.

The PENTS will also help to improve infrastructure, interoperability and service availability and support legislation. “The regulatory framework has to become more robust in order to increase trust. The education of healthcare professionals must include digital health. Citizens’ digital health literacy must also increase,” she said.

Patient empowerment through telemonitoring

To that end, the plan has taken the input from 50 institutional stakeholders and experts in health, including patients with the participation of Saúde em Diálogo, a platform that aggregates 52 different patient associations. Patient contribution is crucial to help shape future growth of telehealth, Monteiro explained. 

“The strategy emphasises patient centrality as it focuses on telehealth as an important means for care integration. Patients and informal caregivers play here an important role in co-managing health - particularly in the setting of chronic disease multi-morbidity,” she said. 

Telemonitoring has emerged as an interesting path for patient empowerment in Portugal. The government has recently launched special programs for chronic diseases such as chronic obstructive pulmonary disease (COPD) and chronic heart failure, enabling telemonitoring for 556 patients so far.

The telemonitoring service for COPD patients at Viana do Castelo Hospital in northern Portugal is a case in point. The programme started by telemonitoring 15 patients, a number that has now grown to 80. It has helped to reduce emergency episodes by about 50% and unplanned hospital admissions by 70% among this population, with very high levels of satisfaction reported from both the patients and informal caregivers.

“We live in increasingly aging societies, with a growing burden of chronic multi-morbidity and consequent problems in terms of access and sustainability. Making use of technology has emerged as a natural way to leverage new solutions that best meet society’s needs,” Monteiro said.

An array of digital tools

A whole suite of digital tools is available to the Portuguese to help them manage their health, with relatively high use rates. On the online Citizen Area (RSE Área do Cidadão), users can access their electronic health record (EHR), book an appointment with their primary care physician and check their vaccination card or vital testament. “The platform has now more than 2,250,000 users and every day the number increases by 300 on average, despite the strong authentication process required through the citizen card or the mobile digital key,” Monteiro said. 

One particularly powerful service is e-prescription, which is compulsory within the NHS [national health service] and used by 80% of private healthcare patients. “Virtually every Portuguese has probably already used e-prescription. More than 10.6 million individual patients have received an e-prescription since the service was launched in 2016, most of them by SMS or e-mail,” she said.

Portugal is taking e-prescription one step further, as it will become the first country in the EU to provide the full cross-border services of patient summary and e-prescriptions by the end of November. 

Furthermore, the Contact Center of the NHS, SNS 24, provides an array of clinical and administrative services to citizens, such as teletriage, telecare for the frail elderly, information about health topics, referral for HIV, HCV and HBV point-of-care tests in pharmacies or at home and administrative services. Many of these services are also available online and more than 1.87 million users have already visited the website. Citizens can also download the free mobile app MySNS Carteira, a wallet where they can gather important personal information such as a vaccination card, access data to the NHS, allergy registry or e-prescription. The latter can be exported to any smartphone’s calendar, to remind users when to take their treatment. The service has proved to be quite popular - MySNS Carteira was launched early 2016 and downloaded over 460,000 times since then. 

Teleconsultation as future axis 

In the future, the Carteira will also integrate the video-call app that is being developed for direct teleconsultation with a healthcare professional. Beta-tests are already being run and the service should be available next year.

Real-time teleconsultations have been shown to work well between healthcare providers, for instance between primary care and hospitals. The regular information and communication technology systems already support video-calls, including the sharing of clinical images or lab tests during the sessions. More than 200 healthcare facilities are thereby connected and 21,400 teleconsultations have been held between January and August 2019.

To make sure this service is used further, the government has been injecting financial incentives to promote teleconsultations, which are now reimbursed 10% more than conventional face-to-face consultations.