Other EU and non EU cases of ICTenabled Integrated Care and Independent Living

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1 SIMPHS3 Case Studies Integrated Care Other EU and non EU cases of ICTenabled Integrated Care and Independent Living Elena Villalba Mora, PhD Fundación para la Investigación Biomédica Hospital Universitario de Getafe Validation Workshop Brussels, 19 th May 2015 Disclaimer: The views expressed are those of the presenter and may not in any circumstances be regarded as stating an official position of the European Commission. Neither the European Commission nor any person acting on behalf of the Commission is responsible for the use which might be made of this presentation. 22 May

2 Cases Renewing Health (Austria) 2. Diabmemory (Austria) 3. Veterans Health Administration (USA) 4. MOMA-Maccabi Healthcare Services (Israel) 5. Commonwell (Germany) May

3 Cases Renewing Health (Austria) 2. Diabmemory (Austria) 3. Veterans Health Administration (USA) 4. MOMA-Maccabi Healthcare Services (Israel) 5. Integrated care for older in. and out-patients at University Hospital of Getafe (Spain) 22 May

4 Data Collection Customized on-line questionnaires (20) ALL CASES Face-to-face interviews (16) + informal talks during visits (5) AUSTRIA (2), SPAIN, USA Phone interviews (4) ISRAEL CASE STUDY ANALYSIS Documentation + Input from case managers ALL CASES 22 May

5 Case 1: RenewingHealth (Carinthia) 22 May

6 Renewing Health Feb 12-Dec EU CIP PSP Pilot project for the scaling-up and validation of ICT-based telemonitoring of chronic patients. Part of a EU consortium involving 9 countries. TARGET Diabetes and COPD patients AIMS 1. Self-management of diseases by patients. 2. Promotion of compliance to DMP. 3. Early detection of signs of worsening. 4. Build a permanent infrastructure and an integrated treatment. 22 May

7 Renewing Health Strategy RCT with193 diabetic patients and 65 COPD patients: results not conclusive 22 May

8 Case 2: DIABMEMORY 22 May

9 DIABMEMORY Since April 2010 Proof-of-concept of a mhealth-based telemonitoring system. Part of a wider programme: Gesundheitsdialogue TARGET Type I and II Diabetes Mellitus patients AIMS 1. Continuous assessment of patients relevant parameters. 2. Remote management of patients by GPs. 3. Clinical and motivational feedback for patients 22 May

10 DIABMEMORY Strategy Weekly evaluation by GP in charge. Reliable and continuous information supply from the Health Data Center. Therapy Refinement Motivational Messages, Reminders and Clinical Feedback Closed Loop Approach 22 May

11 Case 3: Veterans Health Administration 22 May

12 VHA Since 1990s Complete reform of the health system aiming to promote operational and budgetary efficiency. The reform impacted the system in all senses: Organisational, Financial, Operational, Functional, etc. TARGET The whole VHA healthcare system: 9M veterans / year. AIMS 1. Improvement of medical and care services for veterans. 2. Shortening of waiting times. Coordinated delivery of care. Efficient allocation of resources and efforts. 3. Change in users perception of the system. 4. Transition to a community-centred system May

13 VHA Strategy VISNs KIZER S REFORM Decentralisation Creation of Veterans Integrated Service Networks (VISNs) Reorganisation of care around patients Transition to ambulatory care Collaboration of professionals for a shared goal Excellence INTEGRATION Top-Down: Funds, Protocols, Guidelines, Recommendations, Vision. Bottom-up: Local and Particular Requirement Horizontal: Cooperation among professional groups at the same level: Teleconferences, meetings, congresses. 22 May

14 Case 4: MOMA-Maccabi Healthcare Services 22 May

15 MOMA-Maccabi Since 2012 MOMA is a high quality Call Center for the 24/7 assistance of chronic patients. It aims to be a point of contact for counselling, information and education of patients and interaction with multidisciplinary team and GPs. TARGET Both age-related (Diabetes, frailty, COPD, CHF) and non-age related (stoma, chronic wounds, oncology) chronic patients. AIMS 1. Continuous assessment of patients relevant parameters. 2. Remote management of patients by GPs. 3. Clinical and motivational feedback for patients May

16 MOMA-Maccabi Strategy Since 80s, Maccabi has adopted a technological strategy and created an EMR 1. In 2008, Macabbi and Gertner Institute carried out a pilot involving COPD patients being remote-monitored: Own funds Good results 2012 Maccabi offers MOMA as part of its services End 2014, no complex patients are using active devices 22 May

17 Case 5: Integrated Care for older patients University Hospital of Getafe 22 May

18 Geriatrics at HUG Since The Geriatrics Service at the University Hospital of Getafe has implemented an Integrated Care model for in- and out-patients to improve and guarantee continuous, progressive and coordinated attention. TARGET Elderly patients at high risk of functional decline, institutionalisation and hospitalisation AIMS 1. Transition from a comorbidity-based evaluation of patients to a functionality-based standpoint. 2. Reduction of length of stay and rehospitalisation events. 3. Enhancement of care in the Community. 4. Telemonitoring of HF patients after discharge ( ). 22 May

19 Discharge Plans Prevention Geriatrics at HUG Strategy Nursing Homes 1. Primary care Emergency Room Acute Care Unit CCU HUG s INTEGRATED CARE PROGRAM Day Hospital Falls and Fractures Clinic INTEGRATION CARE CONTINUUM 22 May

20 Lessons learnt after the analysis of all cases 22 May

21 LL: Integration (I) None of the five cases has devised complete integration only on the areas that demanded a clear change within their systems (organisation structures, information pathways, DMP, barriers.) A deep and multidimensional analysis must be performed prior to implementation to state clear and definite goals, the strategies to follow and the achievable degree of integration, in terms of resources, capacity, readiness, scope, barriers etc. 22 May

22 LL: Integration(II) Big systems and robust organisations can reach deeper internal integration but their complexity and opacity can hinder the integration of other stakeholders. Small systems find it harder to spread their integrating actions. They must devise partnership with private technological companies or the pursuit of additional budgetary sources to succeed. 22 May

23 LL: Integration(III) Every healthcare manager aiming to change the system will always find barriers for complete integration. They must refine their initial ideas (e.g. position of patients within the system, educational or incentive programs for some actors, enforceability of the initiative, etc. ) to minimize the constraints of these problems and reduce their impact in the pathways for integration 22 May

24 LL: Role of ICT (I) ICTs have been used as an adjoining tool DMP have been slightly modified in the 5 cases. New care services have not substituted existing pathways. They have been offered as complement or alternative Existing DMP New DMP Legal Environment ICT Existing DMP Patient must choose They must find their own best option Cultural issues? 22 May

25 LL: Role of ICT (II) The implementation of ICTs must be build over some common rules to ease the scalability and spread of integration. Common Language HL7 Understanding Interoperability Shared Format Communication Protocols Communication Pathways HIS Cooperation Same Information EMR 22 May

26 LL: Funding(I) 3 DIFFERENT GROUPS 1. Big leading organisations launched the initiatives with their own assets. They have succeeded and established solid infrastructures and operations thanks to their economic power. 2. Small leading organisations that have launched initiatives with their own assets. Implementation is local and scalability is impossible without any further funding source. 3. Medium sized organisations that have implemented their initiatives thanks to European co-funding. 22 May

27 LL: Funding(II) Idea and Planning Implementation Establishment CURRENT FINANCING DESIRABLE FINANCING Funds must be available after the implementation of the integrated care models to guarantee reinforcement and to promote the establishment of new solutions in regular care. European co-financing should be extended beyond until the implementation of ICTs is proved to be efficient. (See Renewing Health case) 22 May

28 LL: Transferability(I) Appropriateness Of Target Breeding Ground WHERE? WHAT? Replicability Analysis of Transferability Cultural and Political Readiness HOW? WHO? Leadership 22 May

29 LL: Transferability(II) LL: Example Other Austrian Insurance Companies WHERE? WHAT? Models for Telemonitoring Solutions DIABMEMORY and RENEWING HEALTH Policy Alignment and Cultural Readiness. Interoperability? Patient Readiness? HOW? WHO? Austrian Federal Ministry of Health Funding? 22 May

30 LL: Transferability(III) FACTORS THAT EASE TRANSFERABILITY Existence of interoperable Health Information Systems Dissemination of success factors, good practices and proof of efficiency may encourage other systems to replicate initiatives and health policy makers to facilitate the application Collaboration between leading organisations and those aiming to join the initiative or implement some similar approach Availability of resources and the power and freedom of organisations are crucial for the expansion of ehealth systems 22 May

31 Conclusions Europe is not ready to expand ehealth solutions as a general solution in regular clinical practice. Financial Barriers CONSTRAINTS Legal Framework Barriers POLICY MAKERS Patients and Professionals HEALTHCARE MANAGERS 22 May

32 There is a need for a change but cost-efficiency and cost-reduction must be proved to change the mind of policy makers and funding actors. A cultural change must be devised to change the perception of healthcare professionals and patients. They must feel ehealth as the best solution to achieve complete success. THANKS FOR YOUR ATTENTION! 22 May