e_Disease Management. A system for the management of the chronic conditions

1. e_Disease Management. A system for the management of the chronicconditions Sergio Guillén, Maria Teresa Meneu, RiccardoSerafin, Maria Teresa Arredondo, Elena Castellano, 2010

2. Introduction • With 50–80% of all global health spendingrelated to chronic diseases, health systems that maintaincurrent disease management practices cannot afford to continue caring for the escalating numbers of people with chronic diseases • DM models of care may be a systematic approach to coordinating health care interventions across levels

3. Introduction • DM • supports the physical practitioner/patient relationship and plan of care • emphasizes prevention of exacerbations and complications through the use of evidence-based practice guidelines • evaluates clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health • e-DM - supported by the intervention of Information and Telecommunication Technology

4. Methods • HeartCycle • e-DM solution to serve both Heart Failure (HF) and Coronary Heart Disease • integrating care at home with professional care in the hospital • multi-parametric monitoring of vital signs, analysing the data and providing automated decision support, to derive therapy recommendations

5. Methods

6. Methods • Scenarios • Rehabilitation - recover body functions compromised by the disease • Maintenance - keep patients within certain ranges to reduce or avoid medium-long term negative consequences • Preventing Deterioration - avoid or reduce the severity of a new crisis, which will provoke short term damage

7. Results • User requirements • Patient - maintaining their quality of life and making their life easier reducing their feeling of being ill • Professionals - know much information about their patients and focus their attention in those patients in need for more support • Organizations - a sustainable way to better manage the increasing number of chronic patients with an optimal usage of the resources and the different care levels.

8. Results • System Architecture • Medical Response Centre • Self-Care Management Unit • DM Planner & Assessment • Education & Social connection • Logistic & Maintenance

9. Results

10. Results • Implementation • SCMU - wireless monitoring devices, mobile PC • MRC - J5EE web application accessed by the professional, also holds patient’s current care plan • DMPA – another supporting web application with graphical editors to create complex evaluation rules • E&SC - in-house content management system which provides access to certified medical knowledge customized on the bases of the medical profile

11. Conclusion