Integrated support for dealing with chronically ill patients Ole Martin Winnem 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

Clinical Information Systems Community resources & policies Delivery system design Decision support Self-management support Health System Functional & Clinical Outcomes Patient Practice Team Productive Interactions

Hospital expert Emergency responsible Special Nurse Hospital team General practitioner Mobile care nurse Planning, Treatment, Evaluation and Monitoring team Patient Relatives Mobile team

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 Interface And Processing Blood Pressure Temperature ECG/ Heart Rate Oxy meter/pulse Control Center (Multi Monitor Solution) Patient Record System Medical Devices Respiratory rate

In Hospital, Patient Hotels and Geriatric Villages Blood Pressure Temperature ECG/ Heart Rate Oxy meter/pulse Medical Devices Respiratory rate Portable PC / PDA Patient Record System 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.

Chronic project

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