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E-health networked services:

E-health networked services: empowering elderly and chronic patients, increasing output of the health and social care system and improving productivity. Th. Vontetsianos, MD, PhD Consultant Pulmonary Physician Head, e-health Unit. The care provision changes.

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E-health networked services:

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  1. E-health networked services: empowering elderly and chronic patients, increasing output of the health and social care system and improving productivity Th. Vontetsianos, MD, PhD Consultant Pulmonary Physician Head, e-health Unit

  2. The 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

  3. The problem….

  4. The cost

  5. The cost Today WHO 1981 The aged and chronic patients represent the 1% of all the patients who consume the 30% of the insurance expenses Beyond 2020 It is estimated that these patients will absorb the 60-80% of all the insurance expenses

  6. Quality 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

  7. The technologyA philosophic point of view • Technology is the second defense line of the human, after religion, against his existence anxiety Chr. Malevitsis

  8. The technology developments • Smart wearable sensors measuring physiological parameters, personal and safety data • Wireless telecommunication • High bandwidth Internet • Smart and networked homes

  9. E-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 • Organisationstowards e-Health era • need for new knowledge and skills • workflow-compatible applications

  10. 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

  11. e-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

  12. What 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

  13. 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

  14. The ‘‘Sotiria’’Hospital home care team • Physicians • Nurses • Physiotherapists • Clinical psychologists • Social workers • Dieticians • Pharmacists • The patients themselves and their relatives

  15. The patients • Chronic patients suffering mainly of COPD of advanced stages with a history of multiple hospital admissions in the past

  16. Elements of the e-health system • ElectronicHealth Record for each patient based on especially designed multimedia s/w system(Frontis) Compilation of medical devices integrated into each patients’ s EHR Digital camera for live, interactive communication

  17. Phases of Home integrated care Outpatient rehabilitation program • Initial phase Main (chronic) phase: Home base rehabilitation – regular follow up Home hospitalization

  18. Initial 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

  19. Main - Homecare 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

  20. Nurse’s equipment • Laptop withFrontis system and patient’s EHR • Peripheral medical devices for patient examination at home • Digital video-camera

  21. Patient Site Telemedicine Unit Ambulance Doctor Nurse Relatives Schematic View of Services

  22. Tasks 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.

  23. Tasks of Emergency Home Visits • Monitoring of patient’s vital signs • Live communication with the Telemedicine Unit • Patients’ s home treatment (in cases of mild exacerbations) or instruction for patients’ s admission to the hospital

  24. A home Visit

  25. Home Visit Functions • Application of the therapeutic plan • Performance of medical examinations • Optionally, real time connection with e-health Unit

  26. Home Visit Functions • Use of patient’s TV set, via an ISDN line (128kbps)

  27. Results

  28. Significant decrease of patients’ hospitalization

  29. Patient’s disease knowledge and self management

  30. Significant cost savings

  31. What 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

  32. What 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

  33. The 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

  34. UN Ageing ConferenceInternational Plan of Action • Promote strong partnerships between all levels of government, civil society, private sector, the elderly themselves and their care givers

  35. WHO guide lines

  36. The Spanish prediction Diagram, modified from Caro's Model, showing Future Health Systems under the co-influence of major transformational forces.

  37. The Canadian proposal The Home Telehealth Delivery Network

  38. Home and community based health care delivery Network Ministry of Health / RNHS Insurance organization Tertiary Hospitals Primary care Research / University Patients and relatives Local authorities Private sector Telecom organizations

  39. Expected 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

  40. Expected 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

  41. Current technologies WEB Sensors 3G GSM and high bandwidth Internet

  42. ”Sotiria” Hospital e-health services Public employees insurance organization Athens Medical school Dept. of intensive care WEB Hellenic Telecom Organization ’’NGO child’s smile’’ for children with cancer Hellenic Mobile Telecom Organization Primary care doctors’ association Municipality of Athens Emerging home and community based care Network in Greece

  43. OTE Vortal 1/3 • Medical Exams include: Lab results, Video, Image. • Schedule Organizer for professionals

  44. OTE Vortal 2/3 • Patients’ Medical Records include: History, allergies & lifestyle. • Internet links and Services included

  45. OTE Vortal 3/3 • Communication Tools include: Video-Conference, Chat, File Transfer, Forum and E-mail utilities

  46. The Agenda for the Decade Health Service Quality, Safety and the National Information System Ministry of Health and Social Solidarity, Executive Secretariat

  47. INFRASTUCTURES FOR SERVICE QUALITY AND PATIENT SAFETY THE NATION’S HEALTH INFORMATION SYSTEM (NHIS) THE NHSOBSERVATORY 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

  48. Conclusions Networked services Non coordinated services Heterogeneity Standardization-Interoperability Organizational-cultural changes Traditional infrastructures Technology and care providers Strategic partnerships Europe elderly care provision Europe elderly e-care provision towards

  49. A patient’s opinion 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

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