Catalonia: Telemedicine services in routine care

Transcription

1 Catalonia: Telemedicine services in routine care Fundació TICSALUT BRU 6 th December 2012]

2 Overview of reported services: typology Two services over social media (ECOPHI, ENDOBLOC) ECOPHI : Interconsultation among GPs with specialist for all diseases >>Objective :Less referrals ENDOBLOC: Interconsultation among GPs with Diabetes specialists ONE service closed : TELEPRISONS (Teleconsultation) 3 telemedicine services of three types: Telemonitoring >>>ITHACA, (arterial hypertension aiming Thereapeutic adherence) Teleconsultation >>Teleictus (Stroke) Telerehabilitation>> Personal Trainer (Cognitive Rehabilitation) 2012 Survey on 71 Health care providers for 7, inhabitants (Mapa de Tendencias 2012) they declare: 51% make some telediagnostic 36,6% make some teleconsultation 9,8% make some Telemonitoring >>> Serving aprox patients 2012 ( most in teleconsultation) [Brussels ETHEL] 6 th December 2012] 2

3 ITHACA : reported information What was the triggering factor? What were the clinical risks and how they have been addressed? How has the permanent funding issue been resolved? What has been the impact of the tele-service on the organisation (patient flow, staff, work process ) Where there legal and regulatory issues to be addressed, e.g. with respect to the liability of the operators? How is the tele-service integrated into the existing IT system? Is it using an common infrastructure or a specific one dedicated to the service? BRU] 6th Dec

4 ITHACA: Strategy and Management Who has decided to deploy telemedicine? How? Servicio de Innovació: management leadership What stakeholder groups were involved?>clinicians How is the service financed? How were the initial investments funded?>>:novartis (techn.&call center) Who pays? >> NOVARTIS. It replaces the standard service flow Who benefits? >> mainly Secondary care & Primary care How do you assess the effectiveness and outcomes? >> yearly evaluation. Experimental design. Pragmatic controlled trial / Outcome/impact evaluation / Beforeand-after design. [BRU] 6 th Dec. 4

5 ITHACA: Organisation and change management How is management involved in the development? >>Unit director& Hospital CEO and >> in operation? >>NOVARTIS, BSA Hospital CEO, NHS, INDRA How has patient flow been affected? >> reducing visits using IT What were the effects on staff and work processes? No staff reduction & staff new competences Did different departments and organizations have to cooperate? >>Primary & secondary How did that work out? >>At doctor s display appears alarms informing that patient X is enrolled in. This report (pdf) is inserted in the shared EHR How were staff and patients trained? >> at the beginning Did patients roles and behaviors changed? How?>>YES Were patients given an alternative? >> yes Under what terms?>> voluntary basis BRU 6th Dec

6 ITHACA: Legal, regulatory and security issues What is the legal framework for telemedicine?>>same liabilities as in routine care Were changes needed to your data management? >>Yes, external stored monitored data are integrated into BSA HIS platform What are the terms of liability for clinical staff?>>gp Was special training or accreditation required >>YES. At the primary centres Are there guidelines for clinical responsibility? >NO Has the service crossed any jurisdictions? Were there legal issues? >> Backed by our NHS and hospital ethics committee Do patients have to give their informed consent?>yes BRU 6 th Dec

7 ITHACA:Tech. infrastructure and market relations overall infrastructure, legacy systems, level of staff skills?>> new infrastructure ( a server platform) inserted in BSA legacy system. Staff was trained! How have you organised the procurement? >> Invited tender done by NOVARTIS Are there one or several vendors? How did you select? ONE Are telemedicine services integrated with existing IT systems? >>NOT with the EHR How? Integrated in the Badalona SA HIS Did standards and interoperability play a role in choosing vendors and systems? >>YES; Web Server: Apache, Java [Place] [Date] 7

8 Motors for the success Be flexible!!! Rely on innovation champions (mostly clinicians!!) Prototype with user assessment! (user friendly UI) Legal and regulatory>> trust your operators Guarantee permanent funding >> look for interested industry players Infrastructure: with standards, BUT not bothering if it is a specific one dedicated to the service or not! Integrated in Hospital HIS BUT...We still must wait for some years for its integration in regional (NHS)EHR/PHR [BRU] 6 Dec 8