E-health networked services:
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Transcript of E-health networked services:
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E-health networked services: E-health networked services:
empowering elderly and chronic patients, empowering elderly and chronic patients, increasing output of the health and social care increasing output of the health and social care
system and improving productivitysystem and improving productivity
Th. Vontetsianos, MD, PhDTh. Vontetsianos, MD, PhD Consultant Pulmonary PhysicianConsultant Pulmonary Physician
Head, e-health UnitHead, e-health Unit
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The care provision changesThe care provision changes• Ageing of the population• Increased demand for continuity of care
and home care• Increased mobility of the population• Wellness pathways• Evidence based medicine• Managed care• Health control from a distance• Emphasis on the existence of an active
continuously updated EHR• Increased role of genomics and bio-
informatics
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The problem….The problem….
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The costThe cost
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The costThe costWHO WHO 19811981
TodayToday
The aged and chronic patients represent the 1% of all the patients who consume
the 30% of the insurance expenses
The aged and chronic patients represent the 1% of all the patients who consume
the 30% of the insurance expenses
Beyond Beyond 20202020
It is estimated that these patients will absorb the 60-
80% of all the insurance expenses
It is estimated that these patients will absorb the 60-
80% of all the insurance expenses
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Quality changesQuality changes
• Today’s elderly are more educated and more demanding for better quality of care, more social life, more autonomy, and more protection by the community
• There are no clear boundaries between elderly and disabled
• There are no clear boundaries among personal, informal, formal and social health care
• Shortage of informal care givers • Shortages in health care personnel • Specialization and sub-specialization of personnel
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The technologyThe technologyA philosophic point of viewA philosophic point of view
• Technology is the second defense line of the human, after religion, against his existence anxiety Chr. Malevitsis
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The technology developmentsThe technology developments
• Smart wearable sensors measuring physiological parameters, personal and safety data
• Wireless telecommunication
• High bandwidth Internet
• Smart and networked homes
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E-health status in EuropeE-health status in Europe
• e-Health is still an evolving concept
• Citizen-centric model is not a reality as yet– Limited number of citizen-targeted applications
• Benefits have not been proven– cost-effectiveness, quality improvement
• Security – Privacy – Confidentiality– main concerns
• Organisations towards e-Health era– need for new knowledge and skills
– workflow-compatible applications
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E-health status in Europe (II)E-health status in Europe (II)
• Lack of business & reimbursement models– Impact both supply & demand side
• Industry: limited innovation
• e-Health is not yet part of national priorities– Initiative from national policy makers will be limited
(in most countries)
• Standards, cross-country harmonisation need to be promoted
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e-Health hindering factorse-Health hindering factors
• Legal and ethical (outdated or variable legislation, different perceptions)
• Cultural (organisational, IT related) • Managerial (strategy, harmonisation) • Financing (funding, reimbursement)• Human attitudes• Established workflows
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What we’ve been doingWhat we’ve been doing
Provision of e-health home-based rehabilitation, follow up and home hospitalisation services in patients with advanced stages of chronic diseases
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Hospital
The e-health unit was established in 1999, as a horizontal research and therapeutic unit, for the implementation of various telemedicine applications, especially focused in home tele-health
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The ‘‘Sotiria’’The ‘‘Sotiria’’ Hospital Hospital home care teamhome care team
• Physicians• Nurses• Physiotherapists• Clinical psychologists• Social workers• Dieticians• Pharmacists• The patients themselves and
their relatives
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The patientsThe patients
• Chronic patients suffering mainly of COPD of advanced stages with a history of multiple hospital admissions in the past
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Elements of the e-health systemElements of the e-health system
• EElectroniclectronic HHealthealth R Record ecord for for each patient based on each patient based on especially designed multimedia especially designed multimedia
s/w systems/w system (Frontis) (Frontis)
Compilation of medical Compilation of medical devices integrated into each devices integrated into each patients’ s EHRpatients’ s EHR
Digital camera for live, Digital camera for live, interactive communicationinteractive communication
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Phases of Home integrated carePhases of Home integrated care
• Initial phase
Home hospitalization
Home base rehabilitation –
regular follow up
Main (chronic) phase:
Outpatient rehabilitation program
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Initial phaseInitial phase
• It aims to create patients’ EHR and to train both patients and their relatives for the optimal, holistic rehabilitative treatment of their disease and to prepare them for the innovative services of the program
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Main - HomeMain - Home care phasecare phase
It is performed by nurse home visits on a scheduled or on emergency basis
• Regular follow up - home based rehabilitation
• Home hospitalization of the patients
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Nurse’s equipmentNurse’s equipment
• Laptop with Frontis system and patient’s EHR
• Peripheral medical devices for patient examination at home
• Digital video-camera
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Schematic View of ServicesSchematic View of Services
Patient Site Telemedicine Unit
Ambulance
Doctor
Nurse
Relatives
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Tasks of Scheduled Home VisitsTasks of Scheduled Home Visits
• Checking of vital signs and physical condition• Control of pharmaceutical therapy • Consultation for the correct use of medical devices• Checking of exercise training program and
nutrition • Reinforcement of patient’s and relatives training • Detection of primary signs of disease exacerbation• Treatment of other health related special problems
of each patient.
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Tasks of Emergency Home VisitsTasks of Emergency Home Visits
Monitoring of patient’s vital signsLive communication with the Telemedicine Unit Patients’ s home treatment (in cases of mild exacerbations) or instruction for patients’ s admission to the hospital
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A home VisitA home Visit
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• Application of the therapeutic plan
• Performance of medical examinations
•Optionally, real time connection with e-health Unit
Home Visit FunctionsHome Visit Functions
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Home Visit FunctionsHome Visit Functions
• Use of patient’s TV set, via an ISDN line (128kbps)
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ResultsResults
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Significant decrease of patients’ Significant decrease of patients’ hospitalizationhospitalization
376
315
64
156
86
0
50
100
150
200
250
300
350
2 years before theintervention
2 years after theintervention
Number of hospitalizations (per year)
Number of inhospital days (per year)
Number of Emergency andScenduled visits (per year)
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Patient’s disease knowledge and Patient’s disease knowledge and self managementself management
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Initial assessment After the initial phase(3 weeks)
After 12 months
+++
++
+
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Significant cost savingsSignificant cost savings
0,00 €
1.000,00 €
2.000,00 €
3.000,00 €
4.000,00 €
5.000,00 €
6.000,00 €
7.000,00 €
Hospital days Emergency room andother visits
12 months before
12 months after
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What we have learnedWhat we have learned• Significance of the team work• Skills of health care professionals in team
and net-working• Service personalization (from medical and
technological point of view –flexibility)
• Accessibility “a single point of entry and access to continued and coordinated care among care levels”
• Greater emphasis on prevention (at all levels)
•Training health-care professionals
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What we have learned IIWhat we have learned II
• Patients’ acceptance• Sustainability and affordability of the services• Significance of political, social, ethical,
organizational, managerial, civil values “e-health services provision is more an organization reform than a simple issue of technology adoption”
• Cost savings
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The next stepThe next step
• The development of a home and community based care delivery network of sustainable connections among all levels of care providers, patients, insurance organizations and community for integrated,patient-centered services
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UN Ageing ConferenceUN Ageing Conference International Plan of Action
• Promote strong partnerships between all levels of government, civil society, private sector, the elderly themselves and their care givers
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WHO guide linesWHO guide lines
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Diagram, modified from Caro's Model, showing Future Health Systems under the co-influence of major
transformational forces.
The Spanish The Spanish predictionprediction
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The Home Telehealth Delivery Network
The Canadian The Canadian proposalproposal
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Insurance organization
Tertiary Hospitals
Primary careResearch / University
Telecom organizations
Local authoritiesPrivate sector
Ministry of Health / RNHS
Home and community based Home and community based health care delivery Networkhealth care delivery Network
Patients and
relatives
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Expected improvementsExpected improvements• Co-ordination and optimization of the personal health
management and care provided by the informal givers, formal providers and community structures
• Elimination of multiple overlapping activities• Reduction of the management burden• Transfer of expertise from academic centers to the
point of care (empowerment of care providers and patients)
• Optimal surveillance within the system • Clinical information sharing between care providers
regardless of geographic or organizational boundaries
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Expected resultsExpected results• Delivery of the right patient care, at the
right place by the right care provider• Provision of more timely, accessible and
convenient care• Increased focus towards health promotion
and prevention• Reductions in emergency room visits, re-
admission rates, length-of-stay and the use of other community services
• Increased productivity• Significant direct and social cost savings
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Current technologiesCurrent technologies
SensorsSensors 3G GSM and high 3G GSM and high bandwidth bandwidth InternetInternet
WEB
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”Sotiria” Hospitale-health services
WEB
Emerging home and community based care Emerging home and community based care NetworkNetwork in Greece in Greece
Athens Medical schoolDept. of intensive care
Municipality of Athens
Public employees insurance organization
Primary care doctors’ association
Hellenic MobileTelecom Organization
’’NGO child’s smile’’ for children with cancer
Hellenic
Telecom Organization
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• Medical Exams include:
Lab results, Video, Image.
• Schedule Organizer for professionals
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• Patients’ Medical Records include:
History, allergies & lifestyle.
• Internet links and Services included
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• Communication Tools include:
Video-Conference, Chat, File Transfer, Forum and E-mail utilities
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The Agenda for the Decade
Ministry of Health and Social Solidarity, Executive Secretariat
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INFRASTUCTURES FOR SERVICE QUALITY AND PATIENT SAFETY
THE NATION’S HEALTH INFORMATION SYSTEM (NHIS)
THE NHS OBSERVATORY
OPEN HEALTH FORUM
NATIONAL CENTER FOR QUALITY OF HEALTH SERVICES
CENTER FOR INFORMATION MANAGEMENT AND TECHNICAL SUPPORT
INSTITUTE FOR HUMAN RESOURCE DEVELOPMENT
Ministry of Health and Social Solidarity, Executive Secretariat
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Europe elderly care Europe elderly care provisionprovision
Europe elderly e-care Europe elderly e-care provisionprovision
Strategic partnerships
Technology and care providers
Organizational-cultural changes
Traditional infrastructures
Standardization-Interoperability
Heterogeneity
Non coordinated services
Networked services
towards
ConclusionsConclusions
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I am 74 years old and for a long time I’ve been suffering from bronchitis, heart failure, diabetes and arthritis. I used to visit a lot of specialists and sub-specialists, take a lot of medication and worst of all I was taken to the ER very often and admitted to the hospital when my diseases got worse. For the past two years though, ever since entering the home care program, instead of my searching through the system for good care and specialists … the specialist and good health care came to me. This significantly improved my personal quality of life and that of my family. I am very grateful that we don’t spend our time running around from hospital to hospital any more. St. Papaioanou
A patient’s opinionA patient’s opinion