A citizen telemonitoring strategy as envisaged for Central Greece Presentation: Eleftheria Vellidou, VIDAVO SA George E. Dafoulas 1, George Gorgogetas 2, Kalliopi Liatou 2, Kostas Karampoulas 2, George Vallas 3, Pantelis Angelidis 4 1.Faculty of Medicine-University of Thessaly, Greece 2.e-trikala SA, Municipality of Trikala, Greece 3.Cities Net SA, Digital Municipal Community of Central Greece 4.Faculty of Engineering Informatics and Telecommunications- University of Western Macedonia, Greece
Table of Content RENEWING HEALTH in a nutshell Objectives Consortium Clusters Renewing Health in Central Greece 2
Large demographic changes are underway in the EU the size of the EU population will fall from 376 million in 2000 to 364 million in 2050. Big declines will take place in Italy, Spain and Germany whereas increases are projected in France, Ireland, Luxembourg and the UK; the number of young persons (aged between 0 and 14) will fall from 69 million in 2000 to 58 million in 2050 the working-age population (aged between 15 and 64) will fall by some 20%, from 246 million in 2000 to 203 million in 2050 the numbers of elderly persons (aged 65 and over) will rise significantly from 61 million in 2000 to 103 million in 2050. within the 60+ age group, there will also be significant growth in the number of "very old", i.e. people aged 80 years and over. Whereas the very old constitute 3% of the European population today, 11 of the former EU-15 Member States will have at least 10% of their population aged 80 or over by 2050. Eurostat
As the population ages, healthcare will focus increasingly on the management of long-term conditions Perhaps the greatest challenge to face health systems in the twenty-first century will be to develop effective responses to the growing burden of chronic diseases. Today, chronic diseases such as cardiovascular disease (primarily heart disease and stroke) and diabetes are among the most prevalent, costly, and preventable of all health problems. European Observatory on Health Systems and Policies WHO European Centre for Health Policy
Challenges for EU Health Systems Pressure on healthcare systems Citizens expectations for high-quality care Demographic changes: more people will require prolonged care Increased prevalence of chronic diseases: substantial part of the overall healthcare costs Staff shortages Reactive model of healthcare delivery: after appearance of symptoms Rising healthcare costs: faster than the economic growth itself How to offer high-quality & affordable care?
e-health services and chronic diseases management: Needs and trends Emphasis on: Remote monitoring and care continuity of care/health services outside hospitals Efficient disease management -monitor patients over extensive periods of time (at home) -avoid costly treatments - reducing healthcare costs Prevention and Prediction of diseases Enhanced Quality of Life Individual citizen with stronger role in healthcare process
home-based telemedicine: patient at his/her residence, with direct communication with his/her doctor
Telehealth Challenges Telehealth services face important challenges regarding: a clear definition of telemedicine services legal framework and liability issues harmonization of diagnosis related groups that can be treated by telemedicine accreditation of health professionals who provide telemedicine applications ιnteroperability issues cost effectiveness reimbursement for telemedicine services Telemedicine for the benefit of patients, healthcare systems and society COM(2008)689 Final Novembre 2008 8
RENEWING HEALTH An EU initiative to adress the telehealth challenges RENEWING HEALTH is the second Pilot Type A ehealth project funded under the new European Union ICT-PSP (Information and Communications Technologies Policy Support Programme) Project start date: 1 st of February 2010 Project duration: 32 months Total budget: 14.000.000 Euros EU contribution: 7.000.000 Euros 2O pilot sites, grouped in 7 clusters and distributed over 9 EU regions The largest RCT in the telehealth field 9
Size 20 partners + 5 Competence Centres 7.900 patients in the Intervention Group 72 person-years of work Multicultural character Partners come from 11 different EU countries nicely covering Northern, Central and Southern Europe Evaluation methodology RENEWING HEALTH in a nutshell Randomised Controlled Trials MAST (outcome of Methotelemed study ) 10
Population covered Region RENEWING HEALTH in a nutshell Population Regione del Veneto 4.800.000 Region Syddanmark 1.200.000 Norrbotten County 250.000 North Norway 462.000 Catalunya 7.000.000 South Karelia 135.000 Thessaly & Central Greece 1.500.000 Land Kärnten 560.000 Land Berlin 4.900.000 Total 20.807.000 11
Objectives Clinical objectives 12 improving the quality of life of chronic patients who, for just the three chronic diseases addressed in the Project, account for well over 15% of the EU adult population by removing anxiety about health conditions reducing the need for the patient to use emergency services and/or hospital stays avoiding and/or slowing down the worsening of their disease and the insurgence of complications providing clinical evidence that, at least for certain chronic diseases, a telemedicine-based delivery network can supply healthcare services at least of the same clinical quality and reliability as those supplied through a traditional healthcare delivery network
Objectives Patient/user perspective objectives 13 providing coherent clinical services through ICT that take into proper consideration patients and professional users needs, capabilities, risks and benefits implementing solutions that support the empowerment of the patients and increase patients satisfaction demonstrating that the implementation of telemedicine services improves the professional satisfaction of the involved healthcare professionals. measuring patients, relatives, informal caregivers and healthcare professionals satisfaction (through questionnaires)
Economic objectives Objectives containing the cost of care for chronic patients to maintain the health system sustainable in spite of the demographic changes reducing the reliance of chronic patients on the expensive care facilities and replacing them with more affordable homecare 14
Objectives Organisational objectives 15 cutting across the traditional fences among different levels of care creating an organisational model for telemedicine services that ensures a safe, clear and efficient pathway for patients in their journey through the healthcare system promoting active participation of the patients in the organisational model measuring the organisational impact of telemedicine in both a qualitative and quantitative manner
Consortium It comprises all the relevant stakeholders Regional Health Authorities Regional Healthcare Providers Competence Centres in Telemedicine Patient and professional (through their associations) Industrial companies (through their associations) 16
Consortium Regione del Veneto Region Syddanmark Norrbottens Läns Landsting (County Council of Norrbotten) Lulea Tekniska Universitet - Centre for Distance-spanning Healthcare Helse Nord RHF - Northern Norway Regional Health Authority Universitetssykehuset Nord-Norge HF (Norwegian Centre for Integrated Care and Telemedicine) Ministerio de Salut - Generalitat de Catalunya Agència d'avaluació de Tecnologia i Recerca Mèdiques (Catalan Agency for Health Technology Assessment and Research) Etelä-Karjalan sosiaali- ja terveydenhuollon kuntayhtymä (South Karelia Social and Health Care District) Anaptyxiaki Diadimotiki Eteria Psifiakes Polis Kentrikis Elladas AE OTA (Intermunicipal Development Company Digital Cities of Central Greece S.A.) Anaptyxiaki Etaireia Dimou Trikkaion Anaptyxiaki Anonymi Etaireia OTA (e-trikala AE) Italy Denmark Sweden Sweden Norway Norway Spain Spain Finland Greece Greece 17
Consortium Municipality of Trikala Diikisi 5th Ygionomikis Periferias D.Y.P.E. Thessalias kai Stereas Ellados (Regional Health Authority of Sterea & Thessaly) European Patient s Forum European Health Telematics Association Continua Health Alliance Private Stichting Fundació TicSalut Krankenanstalten Betriebsgesellschft Land Kärnten Pflegewerk Managementgesellschaft Greece Greece Luxembourg Belgium Belgium Spain Austria Austria Germany 18
Why clusters 19 The concept of clusters has been introduced for: grouping existing telemedicine services, although using heterogeneous technological platforms, according to their aim, timing and duration of the intervention increasing the statistical power of the trials by aggregating data from the various pilots of a same cluster promoting close collaboration and sharing of experience among teams which have never worked together before RENEWING HEALTH Meet the need to produce solid outcome for decision making for the main existing telehealth types of services per pathology
Cluster table 20
Draft clinical protocols per cluster The current draft protocols have been completed and will be used for the applications to the local ethics committees and for trial registration according to the requirements of the International Committee of Medical Journal Editors (ICJME). RCT The proposed economic analysis is at the moment too broad and will be completed in the final protocols. 'usual care' has been been described in detail in order to obtain an understandable comparison between the intervention and the control groups. In some protocols, the eligibility criteria are too selective for a pragmatic trial, and will be modified in the final protocols. All clusters have agreed on a small set common primary outcomes. Patient Perceptive 21
1.The Municipality of Trikala Partners of Renewing Health in Greece located in central Greece, has designed a long-term strategic plan for the transformation of the local society, based on the opportunities created by the information society era. To this end, several e-services are planned and are being implemented in the area of e-government, e-health, e-education, etc. Part of this strategic plan is the establishment of a telehealth center offering advance health and social care services to the citizens with Chronic Diseases. The infrastructure and services were launched in 2007 and was partly funded by the 3th Community Framework Support (CSF).
Partners of Renewing Health in Greece 2.Municipal enterprise e-trikala SA A municipal enteprise, e-trikala SA, operates the telehealth services of the Municipality of Trikala.
Partners of Renewing Health in Greece 11 Municipalities of Central Greece, representing more than 1.000.000 citizens, have recently joint forces together in order to establish a telehealth service for patients with chronic diseases. Digital Cities SA, a company owned by the 11 Municipalities of the Digital Community of Central Greece runs the telehealth services under a framework agreement with the respective Municipalities.
Partners of Renewing Health in Greece 4.The 5th Regional Health Authority (5th RHA), a beneficiary of the project, will ensure proper monitoring of the patients by specialists and it will provide support to the everyday clinical effort. In addition, the 5th RHA's HIS is under completion (Nov 2009-12 Hospitals + 1 University Hospital + 33 Health Centres) which will provide the means and infrastructure for putting innovative services to the task, performed by IT aware specialists.
The telehealth platform in Central Greece
The Telehealth Services of the Region of Central Greece in the Renewing Health Project The telehealth services to be included in the context of the RENEWING HEALTH project will focus on the major chronic diseases and specifically on Chronic Heart Failure, Chronic Obstructive Pulmonary disease (COPD) and Diabetes type 2.
Health Technology Assesment
Pathologies and patient basis of Renewing Health in Greece Pathology Diabetes COPD CHF Intervention group (number) Patient basis 100 Control Group (number) 80 Intervention group (number) 100 Control Group (number) 80 Intervention group (number) 100 Control Group (number) 80 Total 540
Thank you for your attention! www.renewinghealth.eu 31