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Piemonte healthcare initiatives: role of ICT and

possible sustainable actions

Antonio Sciarappa

(ISMB-Istituto Superiore Mario Boella)

Contents

• Needs and trends for Europe Health SystemsGeneral e-Health needs

• Challanges for Piemonte Healthcare

• Projects

– Chronic diseases • Home care solution

• Tele-rehabilitation solution (classification and tracking of the movements) for

– Post Trauma Rehabilitation

– Parkinson disease

– Predictive Medicine • Lifestyle (risk factors: diet, movement, stress)

• Biomarker investigation (hardware and software genoma analysis)

– Assistive Technologies • Monitoring of aged people

• Robot service

• Alzheimer disease monitoring

• General sustainable architecture

• eHealth for sustainability

– eHealth: efficiency & productivity

– eHealth: from ‘hospital-based’ to ‘patient-centred’ care”

– eHealth: from "late disease" to "early health"

• Market impact

– Living Labs goals

– Pre-Commercial Procurement

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Needs and Trends for Europe Health Systems

Pressure on healthcare systems:

– Citizens’ expectations for high-quality care

– Demographic changes

– Increased prevalence of chronic diseases

– Increased mobility of citizens and patients

– Staff shortages, unequal territorial distribution

– Reactive model of healthcare delivery

– Rising healthcare costs

How to offer high quality services ?

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Challenges for Piemonte Health Care

• Increase in regional citizens expectations;

• Reduction of public health care expenditure;

• Patient mobility: tourists, immigrants and long term resitents;

• Lack of health professionals (mainly nurses….);

• Reduce hospitalisation and improve disease management (ageing population)

• Increase links and interaction between patients and health professionals, facilitating more active participation of patients in care processes

• Improvement of quality of life for patients suffering form chronic conditions

• Provide a convincing business case to be presented to National, Regional and Local Health Authorities and to stimulate them to speed up the deployment of patient-centered eHealth service solution

.

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Piemonte vision : ICT to support a paradigm shift

From ‘curative care’ to ‘preventive care’

From ‘hospital-based’ to ‘patient-centred’

By using ICT to enable collaborative, personalised care empowering

By aiming at sustainability of healthcare systems reengineering

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Projects

– Chronic diseases

• Home care solution (PHS 4*4)

• Tele-rehabilitation solution (classification and tracking of the movements) for

– Post Trauma Rehabilitation (Clabs Salute)

– Parkinson disease

– Predictive Medicine

• Lifestyle (risk factors: diet, movement, stress)

• Biomarker investigation (hardware and software genoma analysis)

– Assistive Technologies

• Monitoring of aged people (DREAM)

• Robot service (KSERA)

• Alzheimer disease monitoring (Clabs Salute)

ISMB PHS 4*4 monitoring solution (I)

Personal Health Systems (PHS) assist in the provision of continuous, quality

controlled, and personalised health services to empowered individuals

regardless of location. It consist of:

• Diseases monitoring (audio, video ,data, usable interface..)

• Telediagnosis

• IoT platform

• Intelligent processing of the acquired information

• Active feedback based on such new insights, either from health professionals or

directly from the devices to the individuals

Web

Service center

…at home

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Solution based on:

• Zigbee / Bluetooth Low Energy

Sensors

3 axis accelerometer

3 axis gyroscope

sensor for monitoring muscle

activity

• Gateway:

COTS smartphone

sitting lying standing walking

ISMB PHS telerehabilitation – Solution (II)

• Movement analysis (walking…)

• Remote monitoring

• Bio feedback

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Predictive Medicine: Point of Care (running project)

• Predictive medicine offers the possibility of detecting many common diseases that have a genetic basis.

• Advances in genomics and molecular biology reveal a large number of possible new, genome-related, molecular markers for the presence of disease, susceptibility o disease, or differential response to treatment.

• These markers support new genomics-based diagnostic tests for identifying and/or confirming disease, assessing an individual’s risk of disease, identifying patients who will benefit from particular interventions.

Hospital platform

PoC Lab on chip

Fornitura patient premises

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mobile Lifestyle solution (running project)

Majority of the health risks and diseases in the

modern world are related to lifestyles, e.g.,

overweight, unhealthy diet, physical inactivity, sleep

deprivation, and stress.

The project considers three main risk factors such as:

– Obesity; The primary cause of obesity is an

energy intake consistently greater than the

energy used in everyday life.

– Stress is a state of anxiety, frustration and

other unpleasant feelings caused by an

individual’s response to a specific situation

– Inactivity; regular exercise assists in

controlling other risk factors such as blood

pressure, obesity, and stress.

Goal: to generate an aggregate indicator of daily

lifestyle

Indoor base station

indoor-outdoor solution Service Center

Safety indoor-outdoor monitoring (aged people)

Personal parameters skin temperature, heart beat rate,

mobility

Environmental parameters temperature, light

System parameters removal from wrist, fault,

radio coverage, battery level

Emergency Button

KSERA: service robot for ageing people

GOAL To develop a Knowledgeable Service Robot for Aging (KSERA)

that will serve several related purposes for elderly people in general

and those with pulmonary disease in particular.

Specifically KSERA provides

• a mobile assistant to follow and monitor the health and behavior

of a senior,

• useful communication (video, internet) services including

needed alerts to caregivers and emergency personnel,

• a robot integrated with smart household technology to monitor the

environment and advise the senior or caregivers of anomalous or

dangerous situations.

KSERA aims at an adaptive technical aid that will provide needed

and useful services in a pleasant, easy‐to‐use format via a robot that

also acts as a companion and assistant

KSERA

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Prototyped solutions for “ Wandering” and “at home” monitoring

“SONO QUI ”: ("Here, I am")

Personal Localization Web Based System: Place

identification by GoogleMaps website

interface based on “ parents images”

Exit Detection: Enabling this functionality, when

the patient goes out from the house, (acoustic

Buzzer Alarm or SMS to caregivers.)

Alzheimer - Dementia diseases

Goal:

To favour the stay at home and monitoring of people

suffering from severe forms of Dementia and Alzheimer’s

disease, thanks to mobile internet services

Zigbee,

bluetooth (BLE)

Internet of

Things

Middleware

Control Unit

Near Real time data communication

Publish/subscribe paradigm

Personal/home Gateway

IoT server

Other Applications: Biodiagnosis,

Dementia diseases

• Model to support concretely sustainability

• Overcoming fragmentation, modular solution, based on Future

Internet services

• Cooperation with patient organisations, hospitals, academia

• Cooperation with SME, Large industries

GENERAL ARCHITECTURE

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eHealth: from ‘hospital-based’ to ‘patient-centred’ care

Improving quality of healthcare through more personalised, continuous, efficient and responsive services.

– Improving access to healthcare for patients living in underserved areas, and to a lesser extent, for socio-economically disadvantaged patients.

– Higher involvement of patients in the disease management process and hence more awareness of the importance to adhere.

– Helping patients and health professionals stay more regularly in touch, which is a fundamental condition for maintaining trust.

– Improving quality of healthcare through more personalised, continuous, efficient and responsive services.

– Improving access to healthcare for patients living in underserved areas, and to a lesser extent, for socio-economically disadvantaged patients.

– Fostering patient adherence because of the higher involvement of patients in the disease management process and hence more awareness of the importance to adhere.

– Helping patients and health professionals stay more regularly in touch, which is a fundamental condition for maintaining trust.

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ICT has shown impact on sustainability but this impact needs to scale:

– patients need to take more active role in health & care and use ICT in their

health/wellness management (changing consumer behavior pattern)

– stronger focus but health delivery system on prevention and early diagnosis

Solutions presented are direct to support new options dor diseases

management in terms of:

– Quality/efficacy of healthcare services (improve home services, support for

informal and volunteers caregivers )

– Management of Lifestyle

– Physical and social environment (for ageing population)

– Genetic profile and monitoring genetic changes

eHealth: from "late disease" to "early health"

Factors determining a health status of an individual & population:

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eHealth: Living Labs and Pre Commercial Procurement (I)

• two additional instruments have been recently added to in support to RDI (Research, Development and innovation) : Living Labs and Pre-Commercial Procurement (PCP).

• Their common trait is the ambition to improve the traditional RDI process that moves

– from the laboratory to the prototyping phase,

– from the testing phase to product or service engineering

Definition of Living Lab

the Living Lab approach refers to a set of (quantitative and qualitative) methodologies and tools for the co-creation and validation of innovation together with (and by) the end users in real-world environments.

Compared to traditional testbeds, where users are not necessarily involved and the laboratory setting is controlled, Living Labs place

people at the centre of the innovation process

Living Lab may represent a valid instrument to support territorial development policies.

“Innovation tools and market in the public sector”

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Definition of Pre-Commercial Procurement (PCP): PCP is a special tendering instrument that is only accessible to public administration and that derogates (attenuates) the most binding provisions of the general procurement law, by virtue of the following characteristics:

– PCP is restricted to RDI services, i.e. not usable to purchase goods or services that are already commercialised as is. Eligible activities can range, just to make a few examples, from problem-driven research to the design of viable solutions and applications, from development and/or refinement of prototypes to the installation of a limited number of them in the form of test series, etc.;

– PCP must award a plurality of bidders, as its aim is not of purchasing the single ‘best solution’ to a given problem, but promoting collaborative RDI to solve specific needs of the procuring organisation, and consequently testing the validity of alternative prototypes in accordance with some predefined requirements and quality standards;

– PCP has to share RDI risks and benefits between each bidder and the procurer. This means that the public purchaser will pay a lower amount than the market price for the RDI services, the results of which, however will not be restricted to its exclusive usage (exploitation), as it happens in conventional calls for tender. Conversely, the bidding enterprise will be part financed in its effort to develop and validate new and innovative solutions, but in case these become successful, the resulting IPR will have to be shared with the procuring agency itself;

eHealth: Living Labs and Pre Commercial Procurement (II)

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• PCP is a special tendering instrument that is only accessible to public administration for procurement actions.

• It follows a staged operational procedure, designed to gradually lead the public purchaser to select the most appropriate pre-commercial solutions. This can be approximately described as follows:

eHealth: Living Labs and Pre Commercial Procurement (III)

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Thank you for your kind attention!

sciarappa@ismb.it