telecare and unlimited care
DESCRIPTION
Sue-Wen Teng, Director-General, Bureau of Nursing and Health Care , Department of Health 2009 APEC Workshop for Innovation in Telecare 2009.10.14 Outline 2009 APEC Workshop for Innovation in Telecare 2 3 KaohsiungKaohsiung TaichungTaichung TainanTainan HualienHualien TaipeiTaipei TechnologyHumanityCare 2009 APEC Workshop for Innovation in Telecare 4TRANSCRIPT
Telecare in Chinese Taipei- Policy and Prospect
Sue-Wen Teng,Director-General,
Bureau of Nursing and Health Care , Department of Health
2009.10.14
2009 APEC Workshop for Innovation in Telecare
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Outline
Profile of Chinese Taipei
Background
The Policy and Strategies of Telecare in Chinese Taipei
Telecare Service Model
Innovations, Impacts and Challenges
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Profile of Chinese Taipei
TainanTainan
TaichungTaichung
KaohsiungKaohsiung
TaipeiTaipei
HualienHualien
Area: 36,189 sq. km
Flat / mountains: 3 / 7
Population (Feb. 2009):
23.0 million.
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Background
Technology.Humanity.Care
2009 APEC Workshop for Innovation in Telecare
5Sources:1. UN Statistics Division , World Population Prospects:The 2000Revision , February 2001.
2. CEPD, Projection of the population in Chinese Taipei: year 2002 to 2051, July 2002.
Along with the decreased birth rate and prolonged life expectancy, the increasing of elderly population is the natural trend of the world.
Growth Trend of Aging Population
Total population of over 65 y/o was 5 billion in year 2000 and will increase to 10 billion in year 2030
2009 APEC Workshop for Innovation in Telecare
0
5
10
15
20
25
30
35
40
1950 1970 1990 2010 2030 2050year
Chinese Taipei
Singapore
Japan
UKUSA
Italy%
China
Ag
ed a
bo
ve 6
5 y/
0,
%
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Why Focus on Long Term Care (LTC)?
Source: Prof. Joan Escarrabill MD, Health Studies Institute, Barcelona
2009 APEC Workshop for Innovation in Telecare
Increasing Dependency Ratio Results in the Shortage of Care Staff
• Shrinking of the family unit• Dramatic growth of world's elderly population
The ratio=people over 65 : people under 65
2000 2030
Europe 1 : 5 1 : 3
Asia 1 : 16 1 : 7
Percentage of people of 65 and over dependency ratio
South America
North America
Africa
Europe
Russia
Asia
Oceania 10.116.3
5.812.0
12.520.9
14.723.4
9.916.5
5.812.4
2000
2030 3.24.5
9.2
13.0
UK
Manpower alone is not enough for health care!
Increasing of elderly peopleReducing of Young people
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Aging in place
Enhance quality of care and
quality of life
Improve system efficiency
Objectives of Long Term Care (LTC)
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Health Services in Chinese Taipei National health insurance
launched in Mar.1995 with >99% coverage
Visit hosp.: 15/person/year (vs. 4 in USA)
Expenditure on health*: U.S.$ 982 / Per Capita (vs. 6,714 in USA)
Physicians and surgeons*:15.65 per 10,000 population
Healthcare facilities Hospitals: 530 / 79,235 acute care beds
Clinics: 19,370
Nr home: 321 / 22,733 bed
Elderly care facilities: 1,074/ 65,358 bed
Home care facilities: 466
*Source:OECD Health Data 2008, June 08.*dentists and traditional medicine service providers not included
Reference: MOI weekly surveillance, 2009/03/13 http://www.moi.gov.tw/stat/news_content.aspx?sn=2197&page=2
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2009 APEC Workshop for Innovation in Telecare
Strengths for ICT
Web users*
Individual: 70.95% (>55y/o--20.06%)
Wireless user: 20.89%
Households: 75.46% (ADSL: 72.99%)
Mobile phone subscribers (2009) : 92%
Networked Readiness Index by the World Economic Forum (2008~09): 13th/134
2007 Digital Opportunity Index (DOI): 7/181
2008 IT Competitiveness Ranking by t h e Economist Intelligence Unit (2008/9): 2/66
Reference: * WTNIC, 2009/2/17, http://www.twnic.net.tw/NEWS4/85.doc
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Strengths for Health Service
Health care system infrastructure:
13th/55 (World Competitiveness Yearbook, 2007)
Worldwide Health Rankings:
2th/27 (The Economist Intelligence Unit, 2000)
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Why Telecare?
Relatively good preparedness in ICT (Information & Communication Technology)
Aging of population
Proact rather than react to LTC demands
Move toward shared care and integrated services
Improve accessibility and cost-effecctiveness of health services
Extend services based on existing LTC info network
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The Policy and Strategies of Telecarein Chinese Taipei
ContinuumComprehensiveAging in place
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Development of Policy in Telecare
Six emerging industries in Chinese Taipei Biotechnology, Green energy, Health care, Intensive
Agriculture, Tourism, and Cultural Creativity
Department of Health (DOH) Platinum Program of Health Care Upgrade
InitiativeIntelligent Medical Services Telecare
Ministry of Economic Affairs (MOEA)U-Care flagship projects for elderly care Innovative healthcare service projects Innovative technological healthcare service
project
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Service Scope of Health Care Industry
Expansion of Industry Territory
En
han
cem
ent
of
Co
re T
ech
no
log
ies
Intelligent Taiwan medical services
Biotechnology and pharmaceutical industries
Internationalized medical services
Wellness and health promotionservices
Long-term care systemCurrent medical service system
Source: * DOH Platinum Program of Health Care Upgrade Initiative
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Intelligent Medical Services Flagship Program
HospitalRFID Project
EMR and PACSValue-added Application of
Health Database
NHI IC Card Upgrade Project
Telecare
IT-based Intelligent Care Model to Enhance the Quality and Efficiency of Medical Care
Intelligent Medical Services
Source: * DOH Platinum Program of Health Care Upgrade Initiative
Combine health care and ICT to develop community, home and institutional care service models.
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Sectors and Goal for telecare
DeviceDeviceInfo-
exchange standard
Info-exchange standard
information exchange platform
information exchange platform
trans-department and trans-specialty
trans-department and trans-specialty
Clientparticipant
Clientparticipant
ICT Medical service
Develop telecare service networkPromote telecare device industries
Promote population health behavior change
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2007
Prospective and Time-table of Ministriesto Promote Telecare
2006
2008
2012
2011
2009
2010
Develop the elderly care service, medical device, medicine, and health food to provide dignity, comfortable, instant and convenient life quality for people
year
Telecare service promoting project
Telecare Service Improvement and Quality
Enhancement Project
2013
U-Care flagship projects
Innovative healthcare service projects
Innovative technological healthcare service project
Cross ministry & department
meeting
Cross ministry & department
meeting
Telecare pilot project
DOH MOEA
•Establish the sustainable business model•Take the leading position to promote telecare services in Asia
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Total budget: US$ 20million Industry: US$ 12 million
Government: US$ 8 million
Integration of 7 portable medical devices for physiological monitoring at home/in the community
Development of service models (home, community, and institution) and 41 telecare services
Development of standardized system interoperability testing process
Improvement of participants’health behavior self-care monitoring, Knowledge/behavior of med safety,
Hospitalization rate
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Roadmap for Telecare
2012
2016
Growth of Telecare service network & industry•Build the national Telecare service network to support the comprehensive care services•Develop technological healthcare industrial value chain and promote industry development
2009
•Encourage the cross-industrial collaboration targeting specific population to develop the innovative service model•Promote the open source Telecare info exchange standards•Develop the trainings and mechanisms for digital healthcare services manpower cultivation•Develop the chronic care network &Develop multifaceted services and the innovative model
Replication of Telecare model and ICT infrastructure
Development of Telehcare model and pilot study•Develop the cost-effectiveness evaluation mechanism•Build up the universal info platform and promote the info infrastructure•Develop innovative community, home, and institution services model •Elderly care needs oriented
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Telecare Service Model
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Major Elements ofTelecare Development
Function of telecareWhere is the clients? What do they want?How to satisfy the clients’expectation?
Integration of telecare devicesSelection of Telecare devices to provide the
appropriate service function
Process design Integration of multi-industrial design process
Evaluation:
quality control, cost analysis, outcome evaluation
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Project Organization Structure
SECOMTMUH
Hsiao Chung Cheng Hospital
Gien Ann Nursing HomeCan-full Nursing HomeAnn Tai Nursing Home
ITRICHT
WanfangHospital
Telecare Pilot Project
Principle Investigator Co-Principle Investigator
Community Telecare
Home Telecare
InstituteTelcare
Project Management Office
TelecareInformation
platform
Consultant Group
ITRILTCPA
TelecareService Center
WanfangHospital
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Telecare Service Model
CommunityCare
NHII Information Platform
Institutional CareHome Care
Telecare Service Center(TSC)
Emergency care centerEmergency care center
Telecare Information Platform (TIP)
LTC managementcenter
LTC managementcenter
0800-008-850
members
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Inclusion Criteria & Core Services of Telecare
Tele-consultation
Tele-visiting for family members
Tele-physiological monitoring
e-learning
Medication safety services
Client health management
Tele-physiological monitoring
Living resources referral
Tele-health education
Emergency management
Community health station- physiological
monitoring- on-site consultation- Tele-education- Tele-consultation
Dispensary and medication safety
Location monitoring
Living resources referral
ContentContent
Moderate to high-grade disability
Without psych Dx
Low to moderate-grade disability
Caregivers for people with chronic disease
Low-grade disability Living alone
Dx with HT, mild dementia, DM
ClientsClients
InstitutionHomeCommunity
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Telecare Information Platform (TIP)
LTC PHR service
Service registration
Service portal
Info exchange interface、video transmission interface
Info security, service diary, system monitoring
Tele-physiological monitoring
Call CenterGovernmentagencies
Care service resources
Info exchange standards
LTC info network
NHIP info exchange platform
LTC related info platform
Com. e-counter
SECOM/TMUH
Home e-counter
WFMC
Institute e-counter
HCC Hosp.
Service Oriented Architecture (SOA)
AC
(HCA,MOICA)
Living support
Med institute
Care institute
服務儲存庫(UDDI)
e-learningTele-education
LTC management center
Individuals
2009 APEC Workshop for Innovation in Telecare
The Flow Chart of Telecare Services Operation
Evaluation and improvement
Third stepService utilization statistics
Second step Services provided
First StepClient assessment & management
Fourth step
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Personal Health Record (PHR)
Discharge preparation
center
LTC management
center
TIP
PHR Member profile LTC PHR index
Discharge processDischarge process
LTC infonetwork
Get discharge info
Institutional Care
Home Care
•Get member profile•Get discharge info
•Maintenance of LTC PHR
•Notification of service transferred
PHR review
•Maintenance of LTC EHR•Notification of service transferred
Service model transferredService model transferred
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Evaluation
81.9%
9.3%
2.81%
2.12%
0.31%
1.18‰
after
53.8%
38.2%
4.29%
6.11%
0.39%
1.85 ‰
before
Test score ≦17False knowledge &
behavior of drug safety
C
O
M
Compared w/ pt at the
home care center of
Wanfang Hosp
Hospitalization rateH
O
M
E ER admission rate
I
N
S
T 21% decreasedRe-hospitalization rate
Weekly monitoring of BP
and glucoseSelf-care monitoring
InterpretationIndex
36% decreasedInstitution infection rate
Duration: 2008/01/01~2008/12/31
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Innovations, Impactsand Challenges
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Innovations and Impacts of Pilot Telecare Project
Social Aspect
Increase the variety and choices of LTC services Advocate individual’s health promotion to enhance
health care quality Create the new benefits of shared healthcare resources Support “aging in place”
Economic Aspect
Promote telecare information exchange standards and service guidelines that accelerate the development of healthcare/medical devices/IT industry
Develop the telecare operational model to promote service sustainability
InternationalAspect
Build up the international channel to enhance experiences sharing
Follow HL7/CDA 2.0 to support international information exchange
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Challenges for Telecare Promotion
ReplicationReplication
IntegrationIntegration
Law & Regulation
Law & Regulation
System & Device
System & Device
Service Model
Service Model
TrainingTraining
Planning Evaluation
Standardization Commonality Interface design User friendly humanity
Resource Profession System Service
Behavior change SOP Quality contrl
Business model sustainability Financial analysis Standard module
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Thanks for Your
Attention !
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照護上線,健康無限
Telecare, Unlimited Care