Simonetta Scalvini, MDHead of Telemedicine UnitIRCCS Salvatore Maugeri FoundationLumezzane (BS) - Italy

OPEN DAYS - Bruxelles, 9th October 2008

Realized Benefits from Regional Telemedicine Services

Who we are

Salvatore Maugeri Foundation

(FSM; www.fsm.it ) is an IRCCS (Institute for Research and Care) in the field of Rehabilitation; FSM was born in 1965 in Pavia and after that 18 centers were born spread all over Italy. In Lombardy Region there are the most number of hospitals.The activity of the Telemedicine Department in FSM started on 1998 with Health Telematic Network (HTN) to monitor chronic heart diseases; in the next years we succeeded in building services in the field of Home Telenursing, Teleconsulting between GPs and Specialists and Service Center for hospitals.

Who we are

Health Telematic Network (HTN, S.r.l) is a Telemedicine Services Centre started as an Ltd. Company in December 1998 becoming a joint-stock Company in May 2001 with the entry of the investment capital

The Service utilizes the scientific-organizational competences of Salvatore Maugeri Foundation and the technological-operative competences of HTN that supplies telemedicine services to medical structures, general practitioners, specialists and patients for 24/24 hours 365 days

The Service Centre is characterized by:

• an advanced technological web-based platform, continuously upgraded operations 24/24 hours all year round

• a high skilled team

• an intensive use of telework

• a network of Hospitals, Universities, General Practitioners, Specialists and Nurses able to offer effective and efficient telemedicine services on a solid scientific basis by teleconsultation second opinion, triage and telematic instrumental services report (on line, store and forward)

NURSE TUTOR

GP

Cardiology

PneumologyRadiology

Psycology Rheumatology

Diabetology

Neurology

Geriatry

Psycologist

Nutritionist

Training Ventilation therapy Therapy

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1-Telecardiology community: a new approach to take care of cardiac patients. Cardiologia 1999; 44 (10): 921-24

2- Appropriatezza dell’invio in Pronto Soccorso mediante un servizio di telecardiologia sul territorio. Italian Heart Journal Suppl 2000; 1 (7): 905-909

3- Potenziale riduzione dei costi per il Servizio Sanitario Nazionale mediante un servizio di telecardiologia dedicato ai medici di medicina generale.. Italian Heart Journal 2001; 2 (10): 1091-1097

4- Chest pain prehospital assessment with a telecardiology service. Journal of Telemedicine and Telecare 2002; 8: 231-236

5- Incidence of Atrial Fibrillation in an Italian population followed by their GPs through a telecardiology service.International Journal of Cardiology 2005; 98: 215-220

A Giordano et al. IJC 2008, in press

• 230 CHF patients followed for 365 days using telephonic follow-up and ECG monitoring

• 230 patients in the control group.

• average age 57±10 y; FE 27±6 %; VO2 13.3 ml/kg/min

• In the “Telemedicine Group” we observed a reduction in:

- hospitalizations (around 44%)

- destabilizations (around 50%)

- costs (around 24%)

Multicenter randomised trial on home based telemanagement to prevent hospital

readmission of patients with chronic heart failure

Randomised trial on Telemedicine to save health care requests for patients with severe chronic respiratory failure M Vitacca et al. , European Respiratory Journal 2008 , in press

0 100 200 300 400

Giorni liberi da ospedalizzazione

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telemedicina

controllo-censored

telemedicina-censored

Survival Functions

HospitalizationHospitalization

Mortality [TM (18%) vs control (23%)] andNumber of ER admissions were not statistically different groups.

TM vs control group showed reduction in: o hospitalisations (-36%, p<0.02)o GP urgent calls (-65%, p<0.002)o home relapses (-71%, p<0.0001)with a higher probability to be free from first: hospitalisation (p<0.015), ER admission (p<0.002), GP urgent call (p< 0.015), home relapse (p<0.015) Calls from patient to TM staff: 3625 times Reasons: clinical instability or therapy modification. Resolution: 63% by nurses alone. Patient and caregiver’s satisfaction: very high in > 92%. Average overall direct cost per each TM: reduction of 33% with respect to usual care.

240 CRF patients were randomisedMain Diagnosis: COPD (46%) and neuromuscular (23%) diseases, more than 70% with HMV.Groups: no differences in age, diagnosis, mechanical ventilation use or in overall functional status in TM and control group

• Honorable mention “Europe Awards in e-Health”European Commission 2003 Brussels “The contribution of ICT to eHealth” Telemedicine and Homecare eHealth Applications

ww.e-europeawards.orgww.e-europeawards.org

• “eEurope Awards in eHealth” “Good Practices for Developing a Country’s

eHealth Action Plan”

• Runner-up in Health Care Provider category. The 2003 ATSP telehealth awards

The Seventh Annual ATSP International Conference September 16-18, 2003

www.atsp.org/about/telehealth_awards.asp

Awards

Main Projects with Lombardy Region

2002-2005 SUMMA: financed by the Italian Health Ministry (Research

Project ex art.12 lett.b D. Lgs. n°502/92) and coordinated by the Lombardy Region/CEFRIEL

2003-2006 CRITERIA: financed by the Italian Health Ministry (Decree

of the General Director- Lombardy Region Health D.G. n.15882 on 29 September 2003) and coordinated by the Lombardy Region - Health and Family General Directorates/CEFRIEL

2005-2007 ICP: “Programma di riorganizzazione e riqualificazione

dell’assistenza sanitaria nella città di Milano”- authorization Lombardy Region n. VII/18228 19.07.2004

2006-ongoing TELEMACO: financed by the Italian Health Ministry

(Decree n° 882 on 30.1.2006) and coordinated by the Lombardy Region.

2006-ongoing Nuove Reti Sanitarie: authorization DGR n.VIII/2471

11.05.2006

Unified Second Opinion for General Practitioners

Grant: Ministero della Salute (Programma di ricerca ex art.12, lett.b) D.Lgs. n°502/92

Coordinator: Regione Lombardia D.G. Sanità – ProgrammazioneDicembre 2003

SUMMASUMMA

THE SUMMA PROJECT: A FEASIBILITY STUDY ON

TELEMEDICINE IN SELECTED ITALIAN AREAS

Simonetta Scalvini et al.

Telemedicine & E-Health, 2008 in press

Services between specialists and GPs

Second opinion

CARDIOLOGY

DERMATOLOGY

PNEUMOLOGY

DIABETOLOGY

RHEUMATOLOGY

SERVICE CENTRE

ACTIVATION OF THE SERVICE

ACTIVATION OF ELECTRONIC PERSONAL HEALTH RECORD

COLLECTION/TRASMISSIONBIOMEDICAL DATA

SPECIALISTS

CONSULTING

COLLECTION/TRASMISSION OF DATA TO THE SERVICE

CENTRE

Home care for Chronic Heart Failure

in Lombardy Region

200620042003

CRITERIA - closed3 Facilities (2 IRCCS (S. Maugeri, Cardiologico Monzino), 1 AO Busto Arsizio) - N°269 Patients

PIANO URBANO - closed3 Facilities in Milan (AO Niguarda, AO Sacco, AO San Carlo) - N°275 Patients

TELEMACO - on going 5 Facilities belonging Districts in Little Towns -N°84 Patients enrolled within 31 March 08

2008

NRS – Nuove Reti Sanitarie - PTS – on going 31 Active health facilities in Lombardy Region-N° 827 Patients enrolled of whom 357 closed on 31 Sept 08

CRITERI ACRITERI ACRITERI A Confronti fra Reti Integrate Confronti fra Reti Integrate TEcnologiche per gestire al domicilio TEcnologiche per gestire al domicilio pazienti post acuti e cronici – RIcerca pazienti post acuti e cronici – RIcerca

ApplicataApplicata

Objective: cost-efficacy evaluation of two differnt models of cardiac patients homecare

• Programma di Ospedalizzazione Domiciliare Riabilitativa (200 post-cardiac surgery patients)

• Programma di Telesorveglianza Sanitaria Domiciliare (300 CHF patients, NYHA III-IV)

D.G.R. 11.05.2006 n° VIII/2471

Programma di Ospedalizzazione Domiciliare Riabilitativa

(Home Rehabilitation using Telemedicine)

o The program takes into consideration a period of 28 days as maximum

o The estimated HOMECARE daily cost for patient is 123,00 €

o The actual daily fee provided by the Lombardy Region (DRG n°37597 del 24.07.98) for Rehabilitation is 470,00 €

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NRS - NRS - New health care New health care networksnetworks

Technological Networks for home care management of post acute and chronic patients comparison – with experimental reimbursement.

Rehabilitation post cardio surgery Involved Patients on 06.02.2008: 227 Involved Hospitals: 4

Home care Telesurvey for chronic heart failure patients Involved Patients on 06.02.2008: 526 Involved Hospitals : 28

www.cefriel.it/NRS

Determinazioni in ordine alla gestione del servizio socio-sanitario Determinazioni in ordine alla gestione del servizio socio-sanitario regionale per l’esercizio 2006regionale per l’esercizio 2006

““Percorso di Telesorveglianza Sanitaria Domiciliare Percorso di Telesorveglianza Sanitaria Domiciliare per pazienti con scompenso cardiaco cronico per pazienti con scompenso cardiaco cronico

medio-grave”medio-grave”

36 Health Facilities Certified for New Models of 36 Health Facilities Certified for New Models of Management of Cardiologic DiseasesManagement of Cardiologic Diseases

€ € 660,00/patient/six months660,00/patient/six months

D.G.R. 11.05.2006 n° VIII/2471

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TELEMACOTelemedicine for small Municipalities

2005

www.telemaco.regione.lombardia.it

• Improve services for citizens located in remote areas

• Reduce the “distance” between citizen and HC services

• Assure continuity and quality of care• Define indicators for evaluation

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TELEMACO Health Care Services

Home care Telesurvey for CHF or COPD patients

Teleconsultation on CAT and video between Hospital for Stroke and trauma

Second opinion for GPs (cardio, pneumo,

dermato and diabetology)

Cardiologic Emergency (technological support)

CHF - Chronic Heart Failure COPD - Chronic Obstructive Pulmonary DiseaseGP – General Practitioners CAT - Computerized axial tomography

Telecardiology in Italy: Benefits from a telemedicine network connecting chronic patients, General

Practitioners and Health Provider Organisations.

The economic impact of extending telecardiology across the whole Lombardy Region, steadily over about six years up to 2012, is material. Much of the investment needed in information and communication technology, electrocardiogram equipment and service infrastructure has already been set in place by Health Telematic Network. The total net benefits are considerable, with an estimated annual benefit cost ratio of more than 3.3:1 by 2012

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present value of cumulative costs present value of cumulative benefits

Our understanding of market: the future

Projects

Remb. Operations

R&D

Projects

Remb.Operations

R&D

Projects

Remb.

Operations

R&D

now

2/3 yy 3/5 yy

Cash flows from Projects still

finance a large amount of operating activities.

Probably, it will take 5 years to reverse this structure. Mostly, it

depends on the speed of expansion of

reimbursment, in terms of number of services and

number of types of services.

What we actually offer:

a strategic development department a professional consultancy department an informatic department developing telemedicine services and

biological signals processing dedicated software a scientific research department the management

Perspective objectives:

to evaluate new outcomes to share the Italian experience with other European realities

(meeting/ working groups) to update our knowledge in particular field (i.e cardiology) opening

to new strategies of intervention

Aims & Objectives

Conclusions