implications of mobile technology in facilitating integrated care
DESCRIPTION
Implications of Mobile Technology in Facilitating Integrated CareTRANSCRIPT
The implications of mobile technology in facilitating Integrated Care
Albert AlonsoInformation Systems Directorate
Professional Educational Programme 2011
HISI session, Dublin, May 27th 2011
Defining integrated care
“[Integrated care] is a concept bringing together inputs, delivery, management and organisation of services related to diagnosis, treatment, care, rehabilitation and health promotion.”
(Grone & Garcia-Barbero: 2001)
“[Integrated care] is a coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors.”
(Kodner & Spreeuwenberg: 2002)
HISI session, Dublin, May 27th 2011
Why we need integrated care?
Because of our failings in current health and social care systems:– Addressing the changing demand for care– Poor efficiency fragmented approaches (disease versus
patient)– Improving the quality and continuity of care– Recognising that health and social care outcomes are
interdependent– Exclusion of vulnerable groups
(Wait, European Social Network Conference, Edinburgh 2005)
HISI session, Dublin, May 27th 2011
Innovative care for chronic conditions
Links
Positive Policy Environment
Health Care Organisation
Community Prepared
Patients &Families
Community Supporters
Health Care Team
Better Outcomes for Chronic Conditions
Pre
pare
d
I nform
ed Motivated
Links
Positive Policy Environment
Health Care Organisation
Community Prepared
Patients &Families
Community Supporters
Health Care Team
Better Outcomes for Chronic Conditions
Pre
pare
d
I nform
ed Motivated
Innovative care for chronic conditions: building blocks for actions: global report. Epping-Jordan J, editor. 2002. Geneva, Switzerland : Non-communicable Diseases and Mental Health, World Health Organization.
HISI session, Dublin, May 27th 2011
Service model
Traditional care (20%)
Integrated care (80%)
Normalisation
Redefinition of roles
Adapted from Berg M et al. Health Information Management. Integrating information technology in health care work. Routledge 2004.
Allocation of resources
HISI session, Dublin, May 27th 2011
ICT
Service model
Traditional care (20%)
Integrated care (80%)
Normalisation
Redefinition of roles
Adapted from Berg M et al. Health Information Management. Integrating information technology in health care work. Routledge 2004.
Allocation of resources
HISI session, Dublin, May 27th 2011
Redefining roles across the system
HISI session, Dublin, May 27th 2011
Platform and functionalities
HISI session, Dublin, May 27th 2011
Making it work
HISI session, Dublin, May 27th 2011
Discharge
Home Hospitalisation (121)
Exacerbated COPD patients (222)
Discharge
Control group (101)
Visit Outpatient clinic 8 wk after discharge
ER Intervention
Home Intervention < 24hAccessibility
Home hospitalisation programme
HISI session, Dublin, May 27th 2011
Home hospitalisation programme
10% **Emergency room
visits
22%
20% Intervention groupReadmission 28% Control group
- 6.9 ** SGRQ Total
- 2.4
1255€**Savings 2033€
HISI session, Dublin, May 27th 2011
Home hospitalisation programme
HISI session, Dublin, May 27th 2011
Home hospitalisation programme
HISI session, Dublin, May 27th 2011
Home hospitalisation programme
HISI session, Dublin, May 27th 2011
Prevention of exacerbations programme
HISI session, Dublin, May 27th 2011
Prevention of readmissions programme
HISI session, Dublin, May 27th 2011
A new standard?
HISI session, Dublin, May 27th 2011
A new standard?
Yes!“...An integrated care pathway with flexible shared-care arrangements between primary care and hospital, facilitated by information technologies, has an enormous potential to decrease hospital admissions in chronic obstructive pulmonary disease patients.”
HISI session, Dublin, May 27th 2011
A new standard?
But!“... In the integrated care approach, several models are available and we now require comparative studies.”“We must also be aware that from a healthcare provider perspective, furtherstudies of this model must include cost-effectiveness as well as effectiveness in older disabled patients with chronic obstructive pulmonary disease”
HISI session, Dublin, May 27th 2011
What had we learnt (2006)?
• There were better alternatives to the current approach of chronic patient management.
• These alternatives were safe, cheaper and generated better clinical outcomes and professional and patient satisfaction.
• Information technologies facilitated some of the aspects related to their implementation.
• Most of the difficulties concerned the organisation of care delivery and professionals.
• There was a need to change our viewpoint
HISI session, Dublin, May 27th 2011
Changing the viewpoint
Disease Management System
Health Management System
Citizen Management System
HISI session, Dublin, May 27th 2011
Time scale for integrated care at HCB
2000-03 • Embryonic ICT platform• Clinical validation of limited model
2004-06 • Conceptual SOA platform• Market analysis / deployment strategy
2007 • Integrated Care Unit is created
2008-12 • Effective deployment: Facing co-morbidity, articulation health / social care. Sustainable business models.• Reliability of ICT platform
2010 • Creation of the spin-off
2010-13 • Large scale-deployment / regional level
HISI session, Dublin, May 27th 2011
New environments for action
Prevention
Chronic diseases
Dependency
HISI session, Dublin, May 27th 2011
Integrated care at HCB
• Approach by programmes:– Set of normalised actions as well as evaluation tools that target
precise service objectives.– The programme is based on a process model but it is not the
(entire) process.
Patient
Programme “A”
Programme “B”
Programme “C”
Programme “D”
Programme ......
HISI session, Dublin, May 27th 2011
Integrated care at HCB
Caseidentification
Follow-up& event handling
Work plandefinition
Caseevaluation
Discharge
Normalisation of practicesReallocation of roles
ICT application
HISI session, Dublin, May 27th 2011
Integrated care at HCB
Caseidentification
Caseevaluation
Workplandefinition
Follow-upEvent handling
Discharge
HISI session, Dublin, May 27th 2011
IdentificationAssessment Working Plan
Follow-upDischarge
Linkcare® Application
HISI session, Dublin, May 27th 2011
PlannerPre-defined Template
Personalized
Linkcare® Application
HISI session, Dublin, May 27th 2011
Service LibraryAvailable Templates
Personalized
Linkcare® Application
HISI session, Dublin, May 27th 2011
MonitoringEducation
Linkcare® Application
HISI session, Dublin, May 27th 2011
Profile ManagementContact details
AvailabilityLanguage
Agenda Management
Collaborative ToolsCall Centre
Doc. RepositoryPatient’s interactions
Voi- IP Phone
PersonalizationCo-morbidities
Service Optimization
Linkcare® Application
HISI session, Dublin, May 27th 2011
Linkcare® Application
HISI session, Dublin, May 27th 2011
Enhances quality and provides support for interpretation of forced spirometry testing performed by non-specialized actors (Primary Care, Home, Pharmacies, Insurance companies, …)
CSCW tools for remote support: e-SpiroQ
HISI session, Dublin, May 27th 2011
Integrated care at HCB
Summary• HCB’s integrated care programme is a powerful approach to
meet the demand of a variety of health and social care needs• The model and associated technology (Linkcare®) is proving to
meet expectations from both patients and professional• Advanced versions should cover:
– Implementing knowledge intelligent to assist patients and professionals in the optimisation of the mix of services
– Extension of services to cover other conditions and/or different stages of the conditions