2. Outline
• Project objective
• Expected outcomes
• Scaling-up process
• Organizational model
• Technology
• Lessons learned
3. Exploit and further deploy innovative telehealth
services across different European regions.
Services are designed to give patients a central
role in the management of congestive heart
failure, fine-tuning the choice and dosage of
medications, promoting compliance to treatment,
and helping professionals to detect early signs
of worsening.
PROJECT OBJECTIVE
4. Improve quality of life of patients and their informal
caregivers.
Patient satisfaction for using integrated telehealth
services.
Increased productivity of the healthcare professionals
by involvement of patients and their informal caregivers
in the chronic condition management.
Use by healthcare providers of familiar, everyday
technologies to improve access to person-centred care.
Definition of cost-effective and sustainable
interventions.
Identify potential barriers and facilitators to adoption,
which will help to design successful implementation
strategies.
EXPECTED OUTCOMES
6. Scaling-up process in the Basque Country
Decision
makers
involvement
Analisys of
telemedicine
& telecare
pilots
Team: PC +
Hospital, Call
Centers+
ManagersDesign the
clinical
pathway
(who, when,
where)
Logistics,
funding and
ICT
infrastructure
Dissemination
Plan
7. 1
Set up the first working team
constituted by (1= pioneer):
Clinicians from the organizations involved
(clinical practice guidelines and pathway
definition)
Managers (pathway definition and roles
redistribution)
IT technicians and developers
Project manager (leadership and strategic
guidelines)
Decision makers involvement
Pathway reproduction and
customization in other
organizations (2 and 3= followers)
Scaling-up process in the Basque Country
2
3
9. Telecare Call Centre: administrative data management,
alarm validation and filtering.
Health Counseling Call Centre: coordination and
management of healthcare resources (alarm management),
follow-up calls to patients.
Hospital (cardiologist, nursing): recruitment of patients
and patient´s follow-up while he/she is unstable.
Primary Care (GPs, nursing): proactive disease
management when patient is stable, patient and informal
caregiver empowerment.
ORGANISATIONAL MODEL
“integrated care model where each actor performs the
task more suited to their position in the value chain”
12. Objectives
Contract complete telemonitoring and telecare
service (installation and maintenance of
devices, technical support and user training).
Mobile and non-mobile solutions available.
Use the existing corporative technological
platforms.
Avoid healthcare professionals to use different
platforms, relevant telemonitoring information is
visualized in the Electronic Health Record.
TECHNOLOGY
13. 1. Gateway device
2. TM devices:
• BP monitor
• Pulsioximeter
• Weight scale
3. Panic button
Telemonitoring
platform
Client
Relationship
Management
Electronic
Health Record
(for both primary
and secondary
care)
HOME TELECARE CENTRE HEALTH SYSTEM
TELEMONITORING INFORMATION FLOW
TECHNOLOGICAL INFRASTRUCTURE
Patient
Caregiver
Telecare Centre´s
operators
eHealth Centre´s nursing
Cardiologists
Hospital nurses
GPs
GP practice nurses
COMMUNICATION AND COORDINATION
14. LESSONS LEARNED: intervention perspective (1)
• Need of existing resource re-organization and
definition of new roles.
• Integration of telemonitoring service into the routine
practice.
• Complete telehealth service has to be provided (device
installation, technical support, maintenance and user
training).
• Alarm filtering and validation, ensuring that healthcare
professionals only attend to health-related alerts.
15. LESSONS LEARNED: intervention perspective (2)
• Technology facilitates both coordinated management of
all processes and communication between professionals.
• The technological platforms used by professionals have
to be user-friendly.
• Provide evidence-based and technical support to
healthcare professionals.
• Healthcare professionals access to telemonitoring
information via the Electronic Health Record.
18. LESSONS LEARNED: implementation perspective
• CONTEXT: alignment with corporative strategy, commitment
and support of managers
• INTERVENTION: evidence based, adaptable, flexible and
sustainable
• COMMUNICATION:
Presentation of the project by both managers and clinicians
Share mid-term results: early wins
Collect feedback from front-line professionals
• LEADERSHIP: shared leadership (managerial, clinical and
methodological)
• ACTORS:
Interdisciplinary working group (manageriual and clinical competences)
Field trial coordinator role
19. Thanks for your attention!
http://www.united4health.eu/
afullaondo@kronikgune.org
Hinweis der Redaktion
First of all, thanks to the organizers for giving me the opportunity to present here the experience of the Basque Country in scaling-up telemedicine solutions. The challenge of implementing telemedicine services for patients with congestive heart failure started one year and a half ago, when United4Health project funded by the EU was launched.
In this presentation I will talk about the project objectives and outcomes, how the scaling-up process happened in the Basque Country, the organizational model defined and how this model is supported by the technology, and finally the lessons learned during this adventure.
The main goal of the U4H project is to deploy innovative telehealth services across European regions; services that give patients a central role in the management of their disease and help healthcare professionals to detect early symptoms of worsening.
Starting from this principal goal several outcomes are expected:
Improve quality of life of both patients and caregivers.
High patient satisfaction for using integrated teleheath services.
Increase productivity of professionals by enhancing patient´s and caregivers´ empowerment.
Boost the use by healthcare professionals of familiar, everyday technologies to improve access to centered care.
Ensure the cost-effectiveness and sustainability of the interventions.
Identify potential barriers and facilitators of the implementation process.
The big question is how to extend and scale-up the service.
The process we followed in the Basque Country started with a deep analysis of existing telehealth and telecare pilots in our system, in order to understand their strengths and weaknesses, and the potential improvement areas. During this analysis we concluded who the key actors were, who have to participate in the intervention.
So we put together all these actors, healthcare and social care professionals, and created a working team. The members of this team come from the organizations involved in the project: GP and nurses from primary care, cardiologist and nurses from hospitals, managers from Primary care and hospitals, nurses from the health counselling call centre and the director of the telecare centre. This group worked together during several months and defined the clinical pathway, who has to do what, when and where.
Once the organizational model was defined the logistics and the ICT infrastructure were set up and the funding was negotiated and then distributed accordingly.
The implementation of the service was properly disseminated in different settings and finally the involvement, and consequently the support, of decision makers was achieved.
The big question is how to extend and scale-up the service.
The organizational model defined has as slogan “in the integrated care model each actor performs the task more suited to their position in the value chain”, which can be understood as cost-effectiveness.
In the Basque Country this is turned into this:
Telecare call centre is in charge of administrative data management, alarm validation and filtering.
Nurses from the health counseling call centre coordinate and manage healthcare resources, what we call “alarm management”, and also make follow-up calls to patients.
Healthcare professionals from the hospital are responsible for recruiting patients and monitor their health status while patients are unstable.
Healthcare professionals from Primary Care (GPs and nurses) are responsible for both proactive disease management when the patient is stable and patient empowerment.
In this scheme how alarm management looks like is shown.
The patient transmits routinely his parameters. When the parameters are out of range an alarm is activated. Operators of the telecare centre first verify the alarm by a phone call to the patient. If the patient needs technical support or any social care, the operator triggers the corresponding resource. When the alarm is health related, nurses of the health counselling call centre are notified.
Depending on the severity of the situation, nurses then either solve the alarm on their own, refer to the GP or the specialist, or activate Emergency Department. If the patient is referred to the GP´s office, the GP can resolve patient´s health problem by himself, ask for support to the specialist or refer to the specialist.
With respect to the technology used we had very clear in mind that our health system was not interestd in buying its own telemonitoring and telecare devices, the main objective was to contract the complete service, including installation and maintenance of devices, technical support and user training. The devices offered to users are mobile or non-mobile solutions, depending on the frequency with which the patient will be away from home for holidays
Another premise that we established from the beginning of the project is that we were going to promote the use of the existing corporative technological platforms. In practice we have avoided healthcare professionals to use different platforms to the electronic health record, where all relevant telemonitoring information is visualized, and also the CRM.
In this slide the scheme of the technological infrastructure is shown.
Telemonitoring and telecare devices are installed at patients´home. The data (blood pressure, oxygen saturation, weight and questionnaire on health status) is transmitted manually or via bluetooth to the gateway and then sent to the server which belongs to the service provider. Once the telemontoring information coming from patient´s home is validated is sent to the CRM where the management of processes is coordinated. Nurses of the eHealth centre are responsible for handling the CRM while other professionals consult telemonitoring information via electronic health record.
As I mentioned before, our strategic criteria was based on the use of our own systems in order to reduce the number of interactions between professionals and distinct applications and interfaces. To reach this goal the integration between platforms has been a great challenge and a huge effort has been made
Need of existing resource re-organization and definition of new roles; prioritize task shifting over the introduction of new staff
The organizational model of the telemonitoring service has to be well adapted to the routine practice, integration of the new telehealth functions in clinicians´ daily agenda is essential.
Complete telehealth service has to be provided (device installation, technical support, maintenance and user training).
Need of both administrative management and guarantee of good quality of telemonitored data (alarm filtering and validation) ensuring that healthcare professionals only attend to health-related alerts.
1.Technology is crucial to facilitate both coordinated management of all processes and communication between healthcare professionals
2. The technological platforms used by professionals have to be user-friendly in order to ease their handling and avoid rejection from users.
3. Provide evidence-based and technical support to healthcare professionals to increase their confidence with respect to the service delivery.
4. Healthcare professionals do not have to deal with different technological platforms; they need to access telemonitoring information via the Electronic Health Record, which is their daily work tool.
