CASA
Regions for Smart Living
Local Dissemination Event – Flanders
Fabian Dominguez
Lead Partner
17th June 2014, Brussels
EPSCO Council meeting
• EPSCO Council meeting on 19th June 2014 in Luxemburg
• Adoption of the Social Protection Committee (SPC) key messages:
• EU citizens of 65 year of age will have less than 50% of remaining life span free
of conditions that can impede normal day-to-day activities
• Risk of LTC increases as of the age of 80. Same goes for multimorbidity
Impact on quality of life ageing population and impact on government spendings
• LTC: 3 major challenges:
• Increasing demand. Next 50 years: +80y people that will require care will triple
• Decrease of number of working people > threat to LTC providers
• Increasing demand will affect the quality of care
EPSCO Council meeting
• Member states will have to evolve from a reactive to a proactive policy:
• Increase the autonomy of their citizens to decrease the demand for care
• Increase efficiency in home and residential care
This can be achieved by support via technical and technological systems:
• Use the full potential of these innovations to keep elderly people longer at
home in a comfortable and safe way
• Necessity of full integration of health and care
• Reponsability for this lies with member states (MS)
• EU can support MS in their policy via stimulating of testing of new solutions; research
and innovation support;… E.g. of EU-tool: EIP AHA
• MS – responsible for LTC – with support of the EU need to learn from each other
CASA
• CASA (Consortium for Assistive Solutions Adoption) is funded under the 4th call of
the INTERREG IVC programme, approved in January 2012 (end Dec. 2014)
• INTERREG IVC Programme is part of the European Territorial Cooperation Objective of
the Structural Fund policies 2007-2013
• Overall objective of the INTERREG IVC Programme is to improve the effectiveness of
regional policies and instruments financing interregional projects to build on the
exchange of experiences among partners
• Regional initiative project under Priority 1: “Innovation and the knowledge
economy”, sub-theme: “the information society”
• Total budget = €2.635.999,32 and co-financed by a grant of €2.002.154,39 ERDF
CASA
• The CASA partners are intending to work under the umbrella of the CORAL forum
(Community Of Regions for Ambient Assisted Living):
currently an informal community group with the aim to feed back good practices
from the study visits
exchange of experiences to influence future Ambient Assisted Living (AAL)
policies at European level
www.casa-europe.eu
CASA
1. Context
• Ambient Assisted Living (AAL) is a complex field across Europe
- More structured approach to accelerate the uptake and roll-out new
technologies
- In parallel to development and review of policies
• 14 participating regions joined forces to find solutions and allow best
practices sharing in the field of AAL:
CASA partnership = to respond to regions and governmental pressure
faced with increasing pressure on health and social care
- Demographic change
- Ageing population
CASA
2. Partners
14 partners:
• Flemish Government – Lead Partner (BE)
• Province of Noord-Brabant (NL)
• Kent County Council (UK)
• South East Technologies Alliance (UK)
• Veneto Region (IT)
• Friuli-Venezia Giulia (IT)
• Scotland (UK)
• Southern Denmark (DK)
• Region Wielkopolska (PL)
• Catalonia (ES)
• Timis County (RO)
• Andalucia (ES)
• East-Sweden (SE)
• Region Halland (SE)
CASA
3. CASA: what?
• Respond to increasing pressure on health and social care resulting from demographic
change and an ageing population
• Use of new technologies:
- Improve the comfort of citizens in managing their conditions
- Reduce the economic and social burden on governmental care budget
• Attempt for implementation policies moving away from traditional mono-domain
policy to work horizontally along the supply chain and across different departments
and ministries
CASA
4. CASA: deliverables
• Events and seminars to provide opportunities for demonstrating and sharing good
practices amongst the partnership:
10 study visits
speaker @ conferences (e.g. Open Days 2012)
Transfer Task Force
regional SWOT analysis
Best Practice Guide
2 Knowledge Transfer Conferences
13 local dissemination events
regional implementation plans
final ministerial conference in Brussel
28 staff secondments
CASA
• Intention: formalize and ‘legalise’ the inter-regional CASA network for long term
sustainability and open it to a wider European platform
a. Study visits (2 days):
• Noord-Brabant: 'Social interaction’ – (following AAL forum in Eindhoven)
• Cataluñia: ‘Healthy lifestyle and rehabilitation ICT’
• Kent: ‘Monitoring, safety and self management’
• Wielkopolska: ‘Informal care’ (http://www.youtube.com/watch?v=AmCN3MT_qT0)
CASA
• South Denmark: ‘Telemedecine evaluation model’
• Andalucia: ‘Large scale deployment’
• Veneto: ‘Chronic diseases' (http://www.youtube.com/watch?v=uOv2V91xm5M)
• Flanders: ‘Mobility and liveability/integrated regional policy business and knowledge
development’ (http://www.youtube.com/watch?v=4v7aD_jynLQ)
• Scotland: ‘Telehealth and Telecare’ (http://www.youtube.com/watch?v=TQER0aW2UzU)
• Sweden: ‘User driven innovation through public/private partnership’
b. Communication
• 1 joint web site
• 1 policy forum
• Brochure
• DVD
• E-newsletters
• Press releases
• Speaking opportunities and CASA stand at 15 conferences related to Ambient Assisted
Living: AAL forum (Eindhoven); EIP AHA: The Opportunity for regions (minister
Vandeurzen – Open Days);…
• 1 ministerial conference in Brussels (final conference) – October 2014
CASA
c. Secondments
• “mini study visit” – tailor-made to specific requests of experts
• At least 28 secondments (2 per partner)
To Flanders
• Polish secondment: 24th – 27th March 2014 – 4 experts
• Kent County Council: 7th – 9th May 2014 – 9 experts
• Scotland: 12th – 14th May 2014 – 2 experts
Some impressions…
CASA
d. Final conference
• 7th October 2014 – Brussels > week of Open Days 2014
• Joint final event of 2 INTERREG IVC-projects: CASA and INNOVAge (Improvement of the
effectiveness of regional development policies in eco-independent living for the elderly)
• Working title of final conference:
“Creating unity out of diversity: sustaining lessons learnt in Active Ageing”
CASA
Thank you
Fabian Dominguez
Social Affairs and Public Health attaché
Permanent Representation of Belgium to the European Union
P.A.: Ministry of Welfare, Public Health and Family Affairs
Staff of the Secretary-General
Koning Albert II-laan 35, bus 30
BE-1030 Brussels
Alison Davis
Director Integrated Care, North Kent
17th June 14
Integrated Health & Social Care: service
transformation supported by technology
• Brief Introduction to the complexities of the Health and Social Care system in Kent
• History of use of telehealth/telecare ,whole system demonstrator and what we learned
• Current agenda including pioneer programme and Better Care Fund (BCF)
• North Kent approach to the Integration of Health and Social Care
Content
Kent & Medway Location Sea on 3 sides,
London suburbs
Mixture of Affluent, Rural and very deprived areas across the County.
Health and social care structure
8 CCGs, 1 county council, 12 borough councils, 1 unitary authority, 4 acute hospital trusts
Demographics • Total Population: 1.7m
• Mixture of Affluent, Rural and very deprived areas
across the County.
• Better health outcomes when compared to
England
• Variation at local level with Dartford, Dover, Swale
and Thanet have higher all cause mortality rates.
• Increasing elderly population
• Age 65+ predicted to grow by 9.7% between 2012
and 2016
• 17.3% of the population are aged 65+
• Within the target population, individuals report
having an average of 1.6 of the three target
conditions of HF, COPD, Diabetes
Advanced Assistive Technology in Kent 2004 The Kent Telecare Pilot 1100 users of enhanced Telecare Packages
93% felt more independent
93% also felt safer in their own homes
Reduction in residential placements
2005 The Kent Telehealth Pilot One of the first in the UK to formally evaluate AAT and the benefits to the Health economy
Reduction in A&E Attendances
Reduction in unplanned Admissions
£1800 average saving per patient over 6 months
2008 -2011 WSD (Telecare & Telehealth) Largest Randomised Control Trial in the World 6000 participants
December 11 20% reduction unplanned admissions 15% reduction in A&E attendances 14% reduction in bed days 45% reduction in mortality rates.
June 12
Telehealth reduces Hospital Admissions but unlikely to have a significant effect on costs.
Feb 13
Telehealth did not improve quality of life
Telecare has no significant impact on the use of other NHS or social care services
• A better quality of care, lower mortality rates and
reduced unplanned hospital admissions are possible
• Patients on the whole like this type of intervention and
age is no barrier
• Deploying appropriate technology at the appropriate time
to the appropriate patient
• Eligibility criteria and critical mass-technology alone does
not bring the change – you need service transformation
• Clinicians key to implementation and success
• Education and training – skilled competent workforce
• Need to Identify an appropriate procurement model to
realise cost benefits
What did we learn?
• NHS - over 1 million patient contacts every 36 hours
• Increase in Long Term Condition – 1:3 people with a Long Term Condition
• In England over 15 m people have a long term condition with numbers set to increase in the next 5 to 10 years, especially co-morbidity
• People with long term conditions use 72% of inpatient beds, 68% of out-patient appointments and 55% of GP appointments
• Treatment and care of those with LTCs account for 70% of the total health and social care spend in England, or almost £7 in every £10 spent
• Deliver more for less – increasing demand and financial challenge
The Challenge
I want……. …less time in hospital
…independence
…empowerment
…own bed
…prevention of exacerbation
…in control
…freedom
…more time
…understand
own condition
…fewer trips to
see specialist
North Kent Vision
“Transformation of the Health & social care system so that
it works better for people, with a focus on promoting
independence and self care, delivering the right care, right
time, right place, providing seamless, integrated care for
people, particularly those with complex needs”
• Better access
• Increased independence
• More control
• Improved care at home
• Live and die safely at home
• Shared care plans
“A single pooled budget for health and social care services
to work more closely together in local areas, based on a
plan agreed between the NHS and local authorities”
6 National conditions
• Plans to be jointly agreed
• Protection for social care services (not spending)
• 7 day services in health and social care
• Better data sharing between health and social care based on the NHS number
• Assure joint approach to assessments and care planning, where funding is used for integrated packages of care there will be an accountable professional
• Agreement on the consequential impact of changes in the acute sector
Better Care Fund (BCF)
The Integrated Care & Support Pioneer Programme
• 14 areas selected to lead on health
and social care integration.
• Support from the Department of
Health and 40 national partners.
• Responsibility to “barrier bust”.
• Underpinned by the Better Care
Fund.
Integrated Transformation Components
Non Acute bed Provision: Consultant and GP support; Integrated Care Centres; Extra Care; Rehab Units; Community Hospital beds; Private Residential and Nursing bed provision
Crisis Response Services: Access to Shared Anticipatory Care Plans by the ambulance service, enhanced rapid response ,enablement services and voluntary sector based crisis response services.
Integrated Care Home support: Integrated teams including Consultant and GP support; Use of technology to Care Homes / Extra Care Housing providers.
Integrated Equipment , DFGs, capital adaptations & assistive technologies at the front end of all the services video conferencing with clinicians and development of new pathways.
Improved data sharing Promotion of the NHS umber, better health information, use of the health & social care information centre, patients accessing own health records. GPs linked to hospital data.
Operating model: Integrated skill mix, assessors accessing integrated care direct: i.e. nurses accessing social care and case managers nursing care, skills for mental health, dementia/LD a
Integrated Primary Care Teams 24/7 access to multi-disciplinary teams coordinated by the GP, inc mental health/dementia; risk stratifying patients; access to one shared care plan for patient and professionals
Integrated Access: Integrated Locality Referral Unit; 7 days a week direct access and 24/7 crisis response ; Access to one shared care plan on an integrated platform.
Integrated Discharge Teams: Across acute & community; 7 days a week working including Rapid Response; Enablement” Going Home Teams”
“I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.”
The Future of Health & Social Care
By 2015
• Integrated health and social care teams working 7 days, 24/7 in your
local community.
• Your GP as the coordinator of your care, bridging the gap between
your GP, social care, community health services and your hospital.
Supported by the community and voluntary sector.
• You will have access to a shared care plan so you and everyone
around you know about your care and support.
• Access services through a local referral unit with access to crisis
teams and rapid response .
By 2016:
• Hospitals without walls.
• One team, one estate working towards one budget.
• The continued focus on enablement, admission avoidance and crisis
intervention.
New Model of Delivery
Primary
Prevention
Acute
Care
Inte
gra
ted
Dis
ch
arg
e T
eam
In
teg
rate
d P
rim
ary
Care
Team
Telehealth/ Care/ Medicine
Shared care plans
Psychological Liaison
Discharge Nurses
Case Management
Discharge Planning Teams
Pharmacy
Specialist Services – for example
Diabetologist & Respiratory
Consultant
Impact/RR
Falls
OT/ Physio
Specialist
Nurses
Geriatricians
Mental Health
Enablement
Twilight
Ambulance
10K Population
GP
District
Nurses
30K Population
Dementia
Adult Mental
Health
Health Visiting
Case Management
Community Pharmacy
Single Point of
Access
LRU + LRMS
Measuring Success
• Patient outcome and experience measures
(national voices “I” statements)
• Whole system impact – reduction in
emergency admissions and social care
placements
• Financial sustainability
• Individual project performance indicators
• New integrated models of commissioning
and procurement.
Any Questions?
Telehealth and Telecare:
Integrated Delivery In Scotland
17 June 2014 Alistair Hodgson
34 JIT is a strategic improvement partnership between the Scottish Government, NHS Scotland, CoSLA, the Third
Sector, the Independent Sector and the Housing Sector
Overview of Presentation • Set out the Scottish Context – some facts and
figures
• Provide some background context to the
Telecare Development Programme
• Describe the current Policy Drivers and
ambitions for Scotland’s health and care
services
The JIT and SCTT: An Effective Collaboration
The Joint Improvement Team (JIT) is a unique strategic improvement partnership between the Scottish Government, NHS Scotland, Convention of Scottish Local Authorities, the Third Sector, the Independent Sector and the Housing Sector
The Scottish Centre for Telehealth & Telecare (SCTT) was established to support and guide the development of telehealth and telecare throughout Scotland.
37
> “Telehealth” - provision of health services at a distance using a range of digital and mobile technologies. This includes the capture and relay of physiological measurements from the home/community for clinical review and early intervention and “teleconsultations” where technology such as email, telephone, telemetry, video conferencing, digital imaging, web and digital television are used to support consultations between professional to professional, clinicians and patients, or between groups of clinicians.
> “Telecare” is the provision of care services at a distance using a range of analogue, digital and mobile technologies. These range from simple personal alarms, devices and sensors in the home, through to more complex technologies such as those which monitor daily activity patterns, home care activity, enable ‘safer walking’ in the community for people with cognitive impairments/physical frailties, detect falls and epilepsy seizures, facilitate medication prompting, and provide enhanced environmental safety.
> “Telehealthcare” is used as an overarching term to describe both telehealth and telecare together.
Facts and Figures • Population: 5.3 million and projected to rise to 5.8 million in next 20 years
• The 2011 Census was the first time that the number of people aged over 65 years was greater than the number aged 15 and under.
• Between 2012 and 2037, the number of people over state pension age is projected to increase by 27 per cent.
• Over next 20 years number of people over 75 will increase by 60%. More people living with complex long term conditions.
• Numbers of people with dementia will double by 2035.
• A girl born today has a one in three chance of reaching 100 and boys have a one in four chance
• Scotland getting healthier but gap widening between better well off and less well off
50
100
150
200
250
300
2012 2017 2022 2027 2031 2037
Ind
exed
po
pu
lati
on
ch
ange
(2
01
2=1
00
)
Scotland's projected population by age group: 2012-2037 (indexed to 2012)
85+
75-84
65-74
0-14
15-34
35-54
55-64
Source: General Register Office Scotland; chart by Peter Knight JIT
Long Term Conditions
Ageing population
Health Inequalities
Workforce Challenges
Affordability
Sustainability
System Drivers
Overall aim of Telecare
Development Programme….
• To help more people to live at
home for longer, with safety,
security, and quality, through the
use of Telecare equipment
Scottish Government’s
Strategic Objectives - 2007
Wealthier & Fairer
Healthier
Safer & Stronger
Smarter
Greener
Increase wealth, fair shares
Sustain and improve – especially disadvantaged communities, local and faster access
Local communities; strong, safer and better
Expand opportunities
Improve natural and built environmental and sustainable use
Joining it all together Phase 1 (2006-9): Raise
awareness/develop local & national expertise
Phase 2 (2010-12): Joint strategic drive, strengthen underpinning infrastructure & expand/integrate national programmes (90% roll-out/10% innovation) = Robust Platform
Phase 3 (2013-15): Health & Social Care integration. Increase scale of development to inform national expansion. Increase innovation/data integration & analysis. £10m Scottish Assisted Living Demonstrator announced March 2011.
Expansion
Innovation
Policy Context - 2014
Health and Social Care provision
• 32 Local Authorities , social care, education, housing, transport etc. • 14 NHS Boards – acute, hospital, community, primary care And by April 2015 •32 New Health and Social Care Partnerships for social care , community, primary care and some hospital services NHS Boards and Local Authorities still providing range of services
National Policy Drivers
• Overarching strategic objectives: wealthier & fairer, healthier, smarter, safer & stronger and greener (see www.scotlandperforms.com)
• Public Service Reform
• Public Bodies (Joint Working) (Scotland ) Bill 2013
• Reshaping Care for Older People
• National Telehealth and Telecare Delivery Plan for Scotland to 2015
A Scottish Approach
to Public Service Reform: Ambitions • a decisive shift towards prevention: we must prioritise
expenditure on public services which prevent negative outcome and preventing problems arising or dealing with them early on.
• greater integration of public services at a local level driven by better partnership, collaboration and effective local delivery bringing public, third and private sector partners together with communities to integrate service provision deliver shared outcomes that really matter to people.
• greater investment in the people who deliver services through enhanced workforce development and effective leadership
• a sharp focus on improving performance, through greater transparency, innovation and use of digital technology.
Setting the Context for Health & Care in
Scotland – The Quality Strategy • Safe - There will be no avoidable injury or harm to people from
healthcare they receive, and an appropriate, clean and safe environment
will be provided for the delivery of healthcare services at all times.
• Person-Centred - Mutually beneficial partnerships between patients,
their families and those delivering healthcare services which respect
individual needs and values and which demonstrates compassion,
continuity, clear communication and shared decision-making.
• Effective - The most appropriate treatments, interventions, support and
services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
And our 2020 Vision…
By 2020 everyone is able to live longer healthier lives at home, or in a
homely setting and, that we will have a healthcare system where:
• We have integrated health and social care
• There is a focus on prevention, anticipation and supported self-
management
• Hospital treatment is required, and cannot be provided in a community
setting, day case treatment will be the norm
• Whatever the setting, care will be provided to the highest standards of
quality and safety, with the person at the centre of all decisions
• There will be a focus on ensuring that people get back into their home or
community environment as soon as appropriate, with minimal risk of re-
admission
The Public Bodies (Joint
working) (Scotland) Bill (2013)
“Improve the wellbeing of recipients....” • Is integrated from the point of view of recipients
• Takes account of the particular needs of different recipients
• Takes account of particular needs of recipients in different parts of the areas in which the services is being provided
• Is planned and is led locally in a way which is engaged with the community and local professionals
• Best anticipates needs and prevents them arising, and
• Makes the best use of the available facilities, people and other resources”
Reshaping Care: A Programme for Change 2011-2021’ – Integration in Action
10 year whole system transformation programme that seeks not only to shift the location of care (from institution to community) but also to transform the culture and philosophy of care from reactive services provided to people towards preventative, anticipatory and coordinated care and support at home delivered with people
£300 million Change Fund 2011/12 – 2014/15
£120 million Integrated Care Fund for 2015
0
50000
100000
150000
200000
250000
2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
N o
f A
dm
issi
on
s p
er
year
Emergency Admissions in Scotland
65+ Real data
65+ Prediction if solely due to demographic change.Based on changes from 2007/08 demographic
75+ Real data
75+ Prediction if solely due to demographic change.Based on changes from 2007/08 demographic
Trend in emergency admissions (Index) by length of stay (LOS),
aged 75+
90.0
100.0
110.0
120.0
130.0
140.0
150.0
160.0
2005/6 2006/7 2007/8 2008/9 2009/10 2010/11
Ind
ex
(y
e M
arc
h 0
6=
10
0) 0 days
1 day
2 days or
more
All LOS
Source data ISD
Chart PK JIT
Local Authority Commissioned Services:
Telecare and Home Care
58
December 2012:
National Delivery Plan
Significant role of Telehealth and Telecare in the reform of health, care, housing and wellbeing in Scotland
59
4 Objectives
> Telehealth and telecare will enable choice and control in health,
care and wellbeing services for an additional 300,000 people
> People who use our health and care services, and the staff
working within them, will proactively demand the use of
Telehealth and Telecare as positive options
> There is a flourishing Innovation Centre where academics,
care professionals, service providers and industry innovate to
meet future challenges and provide benefits for Scotland’s
health, wellbeing and wealth.
> Scotland has an international reputation as a centre for the
research, development, prototyping and delivering of innovative
Telehealth and Telecare services and products at scale.
60
Example – Telecare for People with Dementia: Evaluation of Renfrewshire Project
• Renfrewshire Council’s Telecare
Service has data on 325 people with
dementia using telecare to enable them
to stay safely at home. • Most relevant are door contacts and
Responder Service. • Provide evidence on cost-effectiveness
of using telecare in people with
dementia. • Quantitative using assessed savings
from avoided admissions. • Qualitative from interviews
Findings • From 2007 to 2012, avoided 114 hospital (35% of 325) and
88 care home admissions (27% of 325)
• Mean length of stay: 19.5 days in hospital and 606 days in a care home
• Mean cost: £336 per hospital day (or £6,522 per admission), £577 per week in a care home (£49,998 per admission)
• Annual cost of telecare less user fee: £1,330
• Annual cost of social care for clients: £12,570
• Net savings: £2.8 million over 5 years (about £8,650 per client) 61
Findings • Safe – for users and staff
• Effective – equipment and Responder service
• Accessibility – improve by earlier referral before dementia sever, better links to NHS (e.g. discharge planning) and housing providers
• Acceptability – high for clients, carers, families and police
• Satisfaction – rated by users and carers as ‘very’ or ‘satisfied’
• High quality cost-effective telecare service for people with dementia 62
Key Messages • Shared learning is vital – Telehealthcare Learning Network
• Political support plays a big part
• Continuity of policy – shared ambitions across portfolios
• Recognition of local priority – national government can set the ambition, but local areas drive change
– However, must continually support and challenge
– Dialogue must be encouraged and maintained; delivery cannot exist in isolation from policy
• See slide from 2011!
What have we learnt? • This is about complex change management and takes time,
effort & resources
• Technology can play a significant part in remodelling our health & care services
• Incremental implementation – establish key priorities, have robust monitoring in place and review as progress
• It can be hugely personalised and empowering for the service user and their carer, but it is not suitable for everyone
• Needs effective leadership nationally & locally - champions
• Build on what you have and keep going!
For more info: @jitscotland and @SCTT_NHS_24
www.jitscotland.org.uk and www.sctt.nhs.scot.uk
www.livingitup.org.uk
CASA Seminar - Flanders 17 June 2014
Scaling-up? From pilot to routine care …
68
Scaling up innovation in healthcare
Marc Lange, EHTEL Secretary General
CASA Seminar - Flanders 17 June 2014
Competence Centre
Health Care Authorities
Industry
Health Care Delivery
Citizens/Patient Representative
InnovationAgency
Insurers
Social Care
Dissemination Organisation
European Health TELematics
A cross-(any)border and multidisciplinary
collaboration forum
CASA Seminar - Flanders 17 June 2014
Sustainable and large scale eHealth deployment
requires engagement and synergies
70
Innovation in healthcare:
CASA Seminar - Flanders 17 June 2014 71
Patient’s home Hospital or primary care or eHealth centre
SERVER
PATIENT
REGIONAL CENTRE’S OPERATOR
TELEMONITORING DEVICES
GENERAL PRACTITIONER
CARDIOLOGIST AT HOSPITAL OR LOCAL HEALTH DISTRICT
OTHER INVOLVED HEALTHCARE PROFESSIONALS
GATEWAY & APP
eHealth actions in DAE
KA 13 Undertake pilot actions to equip Europeans
with secure online access to their medical
health data by 2015 and to achieve by 2020
widespread deployment of telemedicine
services;
EMPOWERING
17 June 2014 CASA Seminar - Flanders 72
European Innovation Partnership on Active & Healthy Ageing
health & quality of
life of European citizens
growth & expansion
of EU industry
sustainable&
efficient care
systems
+2 HLY by 2020 Triple win for Europe
Improving prescriptions and adherence to treatment
Better management of health: preventing falls
Preventing functional decline & frailty
Integrated care for chronic conditions, inc. telecare
ICT solutions for independent living & active ageing
Age-friendly cities and environments
Specific Actions
crosscutting, connecting & engaging stakeholders across sectors, from private & public sector
Pillar I
Prevention
screening early
diagnosis
Pillar II
Care & cure
Pillar III
Independent living &
active ageing
17 June 2014 CASA Seminar - Flanders 73
Identify the problem
Recognize the need for change
Explore
Search for a solution
Build
Create, test and assess potential
impact
Apply, scale-up and monitor
Real-life solution
CASA Seminar - Flanders 17 June 2014
74
Innovation and Service Redesign
Testing of Service Routine Care Service
Small Scale Deployment
Large Scale Deployment
Hospital Group
Department
Department
HealthCare System
Piloted Service
Lessons learned from
deployment inside an
organisation Local champions
Limited constraints
(e.g. at legal level)
Cost and benefit analysis
…
Lessons learned from
deployment across organisations
(for servicing the healthcare system) Institutional endorsement
Legal constraints (if it is a D2P relationship)
Need for robust methods
Socio-economic analysis
…
From pilot to routine care
17 June 2014 CASA Seminar - Flanders 75
Tools and methods are needed to deploy telehealth services
Impact assessment framework
The results and lessons learned from Renewing Health
The approach of United4Health
Guidelines for large-scale deployment
The Momentum blueprint
Cost and benefit analysis toolkit
Innovation governance
… 17 June 2014 CASA Seminar - Flanders
76
17 June 2014
A European Telemedicine Deployment Blueprint
CASA Seminar - Flanders 77
Strategy
& Management
Legal,
Regulatory &
Security
Organisation &
Change Mgmt.
Technical
&
Market relations
Four domains for deployment guidelines
17 June 2014 CASA Seminar - Flanders 78
Critical Success Factors for Deployment Strategy
CASA Seminar - Flanders 17 June 2014
1. Check that there is cultural readiness towards
telemedicine and the need to change the way to
care.
2. Ensure leadership through a champion.
3. Create a community consensus on the
compelling need to address
4. Put together the resources needed for
deployment.
Strategy
& Management
Legal,
Regulatory &
Security
Organisation &
Change Mgmt.
Technical
&
Market relations
79
Critical Success Factors for Organisational Change
CASA Seminar - Flanders 17 June 2014
5. Address the needs of the primary client(s).
6. Involve health care professionals and decision-
makers.
7. Prepare and implement a financial plan.
8. Prepare and implement a change management plan.
9. Put the patient at the centre
of the service.
Strategy
& Management
Legal,
Regulatory &
Security
Organisation &
Change Mgmt.
Technical
&
Market relations
80
Strategy
& Management
Legal,
Regulatory &
Security
Organisation &
Change Mgmt.
Technical
&
Market relations
Critical Success Factors for Legal, Regulatory and Security Compliance
CASA Seminar - Flanders 17 June 2014
10. Establish the conditions under which the service
is legal.
11. Seek for advice from legal, ethical, privacy and
security experts.
12. Seek for relevant legal and security operational
guidelines to help setting the service up
13. Ensure that telemedicine doers and users have
“privacy awareness”.
81
Strategy
& Management
Legal,
Regulatory &
Security
Organisation &
Change Mgmt.
Technical
&
Market relations
Critical Success Factors for Technology Decisions and Procurement
CASA Seminar - Flanders 17 June 2014
14. Ensure that the IT and eHealth infrastructures
needed are in place.
15. Ensure that the technology is user-friendly.
16. Put in place the technology and processes
required to monitor the service.
17. Maintain good procurement practices.
18. Guarantee that the technology has
the potential for scale-up
(i.e., “think big”).
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The challenge for scaling-up innovative services in healthcare
This is about moving
From building tools and infrastructure
to developing service, redesigning care pathways
From collecting data
to integrating data into care processes
New Technology
+ Old System
= New Old System
CASA Seminar - Flanders 17 June 2014
83
Any questions?
More at www.telemedicine-momentum.eu
CASA Seminar - Flanders 17 June 2014 84
Marc Lange
Secretary general
EHTEL Association 49/51, rue de Trèves
B-1040 Brussels Belgium
Tel: +32 (0)2 230 15 34
Fax: +32 (0)2 230 84 40
Mobile: +32 (0)475 27 71 45
www.ehtel.eu
TELEMONITORING
&
NIHDI
ALPHONSE THIJS
( NATIONAL INSTITUTE FOR HEALTH AND DISABILITY INSURANCE)
HISTORY
31th July 2009: call-up for telemonitoring
projects via website www.riziv.be
Budget: 500.000,00€
Results: 22 proposals
- 6 approved by the jury
- 16 not approved by the jury
NOT APPROVED BY THE JURY
Diabetes
Multiple Sclerosis
Chronical obesity
Blood preassure
Heart failure
…
APPROVED BY THE JURY
Service Cardiologie – Clinique Saint Jean de Bruxelles: Heart Failure
OLV-Ziekenhuis – Cardiovasculair Centrum - Aalst: Telemonitoring of NYHA III-IV: patients with heart failures
Virga Jesse Ziekenhuis – Hasselt (AZ Groeninge – Kortrijk): Heart failure
Wit-Gele Kruis Oost-Vlaanderen: bloodpressure measuring by telemonitoring off high-risk patients with hypertension
Asbl PSD (Permanence soins à domicile) Bouge + Le Service Aide et Soins à domicile Namur Asbl: dementia
CHU Sart-Tilman Liège – UZ Brussel: COPD - BPCO
ROLL OUT PROJECT
Signature of the convention
Realization project
Follow up meetings as mentioned in the
convention+ annual reporting: factual situation
Closure: final report ( June 2013 – December
2013)
CONCLUSIONS
need for more research :
According to EBM-guidelines
According to (legal) regulations
Renumerations
How to implement
Privacy-reglementations
Organisation
Communication/information
Telephone, …..
Tele-conferences
?
?
QUESTIONS?
Thank you!
Telemonitoring : personal experience
The past: Tema HF 1
Dendale et al. Eur J Heart Fail. 2012 Mar;14(3):333-40
Telemonitoring in heart failure
The present : Tema HF 2
Telemonitoring in heart failure
The future:
Incorporation of smart algorithms (Censtat)
Health economic analysis (RIZIV)
Telerehabilitation in heart disease
The past: TeleRehab 1
I Frederix et al. J Telemed Telecare. 2011;17(5):231-4
Telerehabilitation
The present: TeleRehab 2
Frederix et al :Eur J Prev Cardiol 2013
Telerehabilitation
The near future: TeleRehab 3
Telerehabilitation
2015 (?): MobileHeart
EU funded (?) International
Multidisciplinary State of the art
Incasa : integrated care to stimulate adherence
INCASA
Online
platform
Integrated Care to Stimulate Adherence
Patient
Hospital GP
• Medication • Vaccination • Intake
Informed consent
• Point of care testing • Bloodpressure • Weight – BMI • HbA1c • Lipids • Questionnaires
• Connection to eHealth box and Vitalink • Health management
• Education • Supportive actions • Promotional messaging • Tailored screens
• Connection towards online patient platform • Encrypted data storage (intra muros)
Barriers to implementation
- Low quality of providers - Lack of business case for “service providers” - Lack of reimbursement - Patient and GP acceptance - Liability, confidentiality Totally new health care organisation and financing
-Patient empowerment/increased self care -Tsunami of data -Integration in Electronic Patient Files -Constantly changing technology -Elderly population -Hospital-centric or patient-centric (or GP-centric)? -Multimorbidity
Restart meeting at
15h45
Reflectie en interactie
• Doel:
– Ideeën genereren over toekomst zorg op afstand
• Wat leeft er in Vlaanderen? Beleid afstemmen?
• Uitkomst:
– Regional Implementation Plan voor CASA
• Vlaams overheid
– Relevante ideeën laten doorstromen naar federale collega’s
Opdracht 1
• Goede ervaringen met zorg op afstand:
– Vertel elkaar een verhaal over zorg op afstand
• Eigen ervaringen
• Inspiratie uit de voorbeelden
• Gedeelde elementen noteren op flipover
• Tijd: 30 minuten
Opdracht 2
• Zorg op afstand in de toekomst
– Dromen over een ideale wereld waarin zorg op afstand de standaard is. Er is geen fout antwoord.
– Twee groepen: telecare en telehealth (zie definities)
– Zoek de gedeelde elementen.
• Noteer de 5 belangrijkste elementen op 1 blad
• Tijd: 40 minuten
Opdracht 3
• Prioriteiten kiezen (20 minuten):
– 5 belangrijkste elementen voorstellen en blad ophangen
– 3 elementen kiezen die voor jou prioritair zijn: stickers
Bedankt Thank you
