pHea

lth20

09

Osl

o 24

-26

June

200

9

Systems Integration

Innovative Integrated Care Services supported by Open ICT Platforms

Josep Roca (Hospital Clinic)

Marius Mikalsen (SINTEF)

pHea

lth20

09

Osl

o 24

-26

June

200

9

Systems Integration

- Setting the Scene – The Catalonian experience(Josep Roca, Hospital Clínic)

- Standardization and security in pHealth Systems(Milan Petkovic, Philips Research Europe)

- IBM + Google: a collaboration to empower the patients(Stefan Ohlsson, IBM Nordic)

- The future of senior care(Aase Karl Haugeto, The Norwegian Technology Advisory Board)

pHea

lth20

09

Osl

o 24

-26

June

200

9

Integrated Care Services for Chronic Patients: Time for Deployment

From HealthCare to Health PromotionThe practical experience in Catalonia

Josep RocaHospital Clinic.IDIBAPS.University of Barcelona

pHea

lth20

09

Osl

o 24

-26

June

200

9

Agenda

Integrated Care

Public Health & Social Support

Basic & Clinical Research

Conclusions

Catalonianhealthcare

system

pHea

lth20

09

Osl

o 24

-26

June

200

9

Catalonia

Barcelona

7.5 million habitants

pHea

lth20

09

Osl

o 24

-26

June

200

9

• Geographical organization(city councils & consortia)

The adaptation of the Catalonian Healthcare System to the new scenario generated by Chronic Disorders is a

political mandate Health Plan 2007-2015

• Strong interactions among Healthcare, Social Support and Public Health

• Cooperation & competition among providers

pHea

lth20

09

Osl

o 24

-26

June

200

9

Agenda

Integrated Care

pHea

lth20

09

Osl

o 24

-26

June

200

9

NESSI General Assembly 2007 – Working Sessions

The “ paradox “ of successful Health Care Systems: The lack of adherence and outcomes measurementThe patient does not play ( yet !) an active role

Process

The only part that is measured

Care provision of episodes

Long term patient compliance/Outcomes

pHea

lth20

09

Osl

o 24

-26

June

200

9

Shared care across the system

Patient

Consultant

Relatives & care givers

PrimaryCareTeam

Mobile teams

Emergencyteam Case

Manager

Home

Primary Care

Hospital

pHea

lth20

09

Osl

o 24

-26

June

200

9

Information technologies supporting- enhanced citizens life style - well standardized care paths

resulting in integrated care strategies for chronic patients

Modulation of disease progressEfficient patient management

pHea

lth20

09

Osl

o 24

-26

June

200

9

Patient Supportcenter

prov

ider

sne

twor

k

Services

• Triage• Self-management• Remote monitoring

• Target groups• Management by programs• Well standardized interventions• Patient-centered care

pHea

lth20

09

Osl

o 24

-26

June

200

9

A frame for a Program

Patients

- Patients get access to an authorized center- Patients are assessed for entry into a program- Patients are monitored and followed up through

mobile technology and internet.

Professionals

InteroperabilityIntegrated Health Networks

Bio-connectivity

pHea

lth20

09

Osl

o 24

-26

June

200

9

Strategies for adoption

1 Emphasis on organizational changes

2 Interoperability & scalability

3 Iteration among pilots & pre-deployment &deployment experiences

pHea

lth20

09

Osl

o 24

-26

June

200

9Previous developments & current challenges

• Facing co-morbidity & individual risk factors• Articulation of healthcare & community services & public health• Organizational and educational issues• Modularity, scalability and interoperability of the ICT platform• Identification of business models ensuring service sustainability

2000

2006

2008

2004

2002

Nexes

pHea

lth20

09

Osl

o 24

-26

June

200

9

NEXESSpain , Norway and Greece

• Deployment and validation of 4 integrated care services

• Addressed to patients with highly prevalent chronic disorders

- Enhanced care for frail patients

- Home hospitalization & early discharge

- Remote support to diagnosis and therapy in primary care and patient’s home

- Self-management and muscle training

pHea

lth20

09

Osl

o 24

-26

June

200

9

INTEROPERABILITY AMONG PROVIDERS• Level A - Barcelona – Esquerra• Level B - Spain and Europe

Patient summary record and electronic prescription

EAPs ICSEAPsCAPSEEAP GesclínicEAP Les HortesEAPsVallplasaHospital ClínicHospital SagratCorClínica PlatóCAP II Manso (ICS)CAP II Numància(ICS)

EAPsICSEAPsCAPSEEAP GesclínicEAP Les HortesEAPsVallplasaHospital ClínicHospital SagratCorClínica PlatóCAP II Manso (ICS)CAP II Numància(ICS)

EAPsICSEAPsCAPSEEAP GesclínicEAP Les HortesEAPsVallplasaHospital ClínicHospital SagratCorClínica PlatóCAP II Manso (ICS)CAP II Numància(ICS) 3D

3G

3A

2A2C

4A

2D

2E4B

5C4C

3E

5D

3C

3B

2B

5A5B

5E

3D3G

3A

2A2C

4A

2D

2E4B

5C4C

3E

5D

3C

3B

2B

5A5B

5E

• 540.000 habitantes

• 18 ABS y 2 CAPs II (5 empresas distintas)

• 4 Hospitales

• 1 Centro Sociosanitario principal y otros de menor dimensión

• 3 Proveedores de Salud Mental

• Servicio de Emergencias Médicas de Cataluña

BARCELONA ESQUERRA

pHea

lth20

09

Osl

o 24

-26

June

200

9 Co-morbidities & use of resourcesDisease phenotypes

Need for stratification by patient’s risk profile

pHea

lth20

09

Osl

o 24

-26

June

200

9

Agenda

Public Health & Social Support

pHea

lth20

09

Osl

o 24

-26

June

200

9

Integrationof PublicHealth

IMCA-II project

DG- SANCO

4 extensive field studies in elderly and 8 feasibilitystudies

WIRELESS MOBILE SYSTEM

Fieldwork at home

Improvementon data quality

Data on lineready foranalysis

Easy follow-up

& management

Optimization ofstudy designs

Link health care

& epidemiology

pHea

lth20

09

Osl

o 24

-26

June

200

9

Agenda

Basic & Clinical Research

pHea

lth20

09

Osl

o 24

-26

June

200

9

Research“Filling the

gap”

BioBridge

Basicscience

Clinicalresearch

Deliveryof care

FP6-2005- 037939

pHea

lth20

09

Osl

o 24

-26

June

200

9

A new paradigm in Biomedical Research: “from bedside to bench and back to bedside “

modified from Jain, J .Current Opin Mol Ther 2002

pHea

lth20

09

Osl

o 24

-26

June

200

9

Agenda

Conclusions

pHea

lth20

09

Osl

o 24

-26

June

200

9

pHea

lth20

09

Osl

o 24

-26

June

200

9

Linkcare vision

ChronicCare Services

ElectronicHealth

Records

• Web-based application addressed to management of chronic patients

• Platform supporting extensive use of services: modular, scalableand robust

• Potential for integration with a diversity of HIS and mobile systems

• Facilitating organizational interoperabiliy

• Integration of stand-alone systems

• Prepared to support knowledge management applications