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Systems Integration
Innovative Integrated Care Services supported by Open ICT Platforms
Josep Roca (Hospital Clinic)
Marius Mikalsen (SINTEF)
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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)
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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
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Agenda
Integrated Care
Public Health & Social Support
Basic & Clinical Research
Conclusions
Catalonianhealthcare
system
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Catalonia
Barcelona
7.5 million habitants
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• 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
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Agenda
Integrated Care
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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
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Shared care across the system
Patient
Consultant
Relatives & care givers
PrimaryCareTeam
Mobile teams
Emergencyteam Case
Manager
Home
Primary Care
Hospital
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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
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Patient Supportcenter
prov
ider
sne
twor
k
Services
• Triage• Self-management• Remote monitoring
• Target groups• Management by programs• Well standardized interventions• Patient-centered care
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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
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Strategies for adoption
1 Emphasis on organizational changes
2 Interoperability & scalability
3 Iteration among pilots & pre-deployment &deployment experiences
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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
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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
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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
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9 Co-morbidities & use of resourcesDisease phenotypes
Need for stratification by patient’s risk profile
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Agenda
Public Health & Social Support
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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
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Agenda
Basic & Clinical Research
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Research“Filling the
gap”
BioBridge
Basicscience
Clinicalresearch
Deliveryof care
FP6-2005- 037939
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A new paradigm in Biomedical Research: “from bedside to bench and back to bedside “
modified from Jain, J .Current Opin Mol Ther 2002
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Agenda
Conclusions
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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