Integrated support for dealing with chronically ill patients
Ole Martin [email protected]
SINTEF Telecom and Informatics
Contents
Today’s and future problems Today’s healthcare system Change of paradigm The chronic care model Experiences from limited trials
The Clinic hospital trial The Karolinska trial
Today’s technology Future technology Conclusion
Today’s situation
The management of chronic conditions is one of the greatest challenges facing health care systems throughout the world
Chronic conditions are responsible for 60% of the global disease burden
Chronic conditions will increase and will be responsible for 80% of the disease burden within 15 years
Chronic conditions are responsible for 70% of the worlds deaths
Deaths from persistent health problems comes after years of disability, reduced productivity, and inefficient health care utilization
Today’s situation II
Chronic conditions are so prevalent, so poorly managed that they negatively impact health, social, and economical foundations
Dramatic decreases in communicable diseases have highligthed the mismatch between health problems and health care
For the near future, medication or medical interventions will not cure most prevalent health problems such as diabetes, asthma, heart disease, and depression
Today’s organisation of healthcare
Health care is organised around an acute, episodic model of care that no longer meets the needs of most patients
The system is focused on documenting the past, instead of preparing the future
Hospital experts, general practitioners and the municipal care services communicate at a low level
The reimbursement system is built up to support pro-action
Long term treatment and care plans does not exist No treatment goal is normally identified
Local caregiver (patient or patient relative) is not educated at a acceptable level
Today’s technology
Separated Electronic Patient Record systems Call centre Patient Administration Mobile Phone Specialised monitoring equipment Wired sensors
Still possible to change paradigm
Leaders actions regarding financing, resource allocation, and health care planning could significantly diminish the negative effects
Care for chronic conditions must be integrated to ensure shared information across settings and providers, and across time
Education is important for both the professionals and the local caregiver
Change the patients role from passive recipient of care to an active knowledged expert – the care and treatment of chronic ill patients happened in their homes, not in the hospital or in the general practitioners office
ClinicalInformation
Systems
Community resources & policiesDelivery system designDecision supportSelf-management support
Health System
Functional & Clinical Outcomes
PatientPracticeTeam
ProductiveInteractions
Hospital expertEmergency responsible
Special Nurse
Hospital team
General practitioner
Mobile care nurse
Planning, Treatment, Evaluation and Monitoring team
Patient
Relatives
Mobileteam
Requirements for having success applying the model
Effective collaboration across organisational level and between professions
Knowledge transfer Change of thinking Supporting technology
Experiences from limited trials
Clinic Hospital (Barcelona) Obstructive lung disease patients Economy: 40% reduction in costs Focus: Teaching and availability Outcome:
Reduced time at hospital Reduced fallback Effective use of resources Increase patient satisfaction
Experiences from limited trials II
Karolinska Hospital (Stockholm) Children early discharge Economy: 45% reduction in costs Focus: Close follow up, monitoring, planning Outcome:
Reduced time at hospital Reduced fallback Effective use of resources Increased patient satisfaction
The TelemediCare Project
Example of IST project with objectives that covers some
features in the new paradigm
TelemediCare Objectives
The TelemediCare project will improve the quality of home based care and medical treatment, through the development of a new generation of open platform telemedicine solutions.
The design objective is to make the system both safe, secure, and easy to use.
System Description
Medical Net Instruments local communication technology (bluetooth) advanced and reliable micro sensors
Local Patient Computer (Single Patient View) analyses and stores the data. intelligent software will trigger medical supervision,
treatment or care. bedside record trends and monitoring
Health Care Control Centre (Multi Patient View) all data from the LPC available through data base
synchronising video conferencing web-interface for access from other locations integration with patient record systems care and treatment planning
In Field / At Home
User InterfaceAnd
Processing
Blood Pressure
Temperature
ECG/ Heart Rate
Oxy meter/pulseControl Center
(Multi Monitor Solution)
Patient RecordSystem
MedicalDevices
Respiratory rate
In Hospital, Patient Hotels and Geriatric Villages
Blood Pressure
Temperature
ECG/ Heart Rate
Oxy meter/pulse
MedicalDevices
Respiratory rate
Portable PC / PDA
Patient RecordSystem
Stationary PC
Processing
The Chronic Project
Example of IST project with objectives that covers some
features in the new paradigm
The Chronic Project
Objective: The CHRONIC project will develop a new
European model for the care of chronic patients, based on an integrated IT environment, to provide effective and efficient health care services in the new millennium
The CHRONIC project is going to provide patients with a user friendly, high quality, personalised, single entry point to health related contents, information and services, taking advantage of the Information Society tools and infrastructure.
The Chronic Project Solution
The Care Management Centre, an atomized communications solution that integrates into a comprehensive hard and software package the management and follow up of the patients under the scheme, allowing automated call answer and forwarding, bi-directional communications, integration of Hospital and home care through clinical history look up.
The home hub is the second part of the CHRONIC solution, and is a novel and central piece of it. Through the home hub the user can attach any monitoring and communications device to the CHRONIC system.
HospitalHospital
PrimaryHealth Care
Centre
PrimaryHealth Care
Centre
Informalcarers
Informalcarers
Home careHome care
Emergencyservices
Emergencyservices
Second levelhospital
Second levelhospital
Non healthrelatedservices
Non healthrelated
services
CHRONICCARE
MANAGEMENTCENTRE
CHRONICCARE
MANAGEMENTCENTRE
•Triage•Information•Education
•Triage•Information•Education
Interactivedigital TV
Telephone
PC / Internet
Home hub
Chronicpatient
sensors
Chronic project
Central Information Space
Mobile team
Hospital Experts
General Practitioner
Control Centre
Health autorities
Emergency Unit
Local Patient Computer
Future Solution
Future technology I
The Local caregiver Wireless connection Bedside Record Wireless sensors Collaboration solution (synchronous /asynchronous) Continuous learning Plans Trends Alarms Contact information Evaluation
Future technology II
The Mobile Unit Wireless connection Patient Record Patient administration Wireless sensors Patient Planning Collaboration solution (synchronous /asynchronous) Continuous learning Task list
Future technology III
The Control Centre Wireless connection Bedside Record Patient Administration Resource Planning Patient Planning Call Centre Wireless sensors Collaboration solution (synchronous /asynchronous) Continuous learning Plans Trends Alarms Contact information Evaluation
Future technology IV
The General Practitioner Wireless connection Patient Record Patient administration Wireless sensors Patient Planning Collaboration solution (synchronous /asynchronous) Continuous learning Examination agent Proactive support management
Future technology V
The Hospital Expert Wireless connection Patient Record Patient administration Wireless sensors Patient Planning Collaboration solution (synchronous /asynchronous) Continuous learning Learning material management support Data analysing interface Supporting knowledge based system
Future technology VI
The Emergency reception Wireless connection Patient Record Patient administration Wireless sensors Patient Planning Collaboration solution (synchronous /asynchronous) Continuous learning Screening support
Future technology VII
The Hospital Administration Collaboration solution (synchronous /asynchronous) Continuous learning Financial outcome Epidemiological outcome
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