Integrated support for dealing with chronically ill patients

Ole Martin WinnemOle.M.Winnem@sintef.no

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

Conclusion

Major changes must be done to make the care and treatment more efficient

Several promising trials Technology plays a role as facilitator Technology is only one small part of what

should be improved