A brand new (tested) approach, a holistic digital strategy to tackle the challenge of chronicity, launched in the Basque Country for providing responsiveness and sustainability to the process of radically changing the current Health Model.

1. Ricardo Devis r-devis@ej-gv.es • @ricardodevis

2. A Responsive Digital Strategy fortackling the challenge of Chronicity

3. 14 Strategic Projects on Chronicity

4. …based on 5 Strategic Policies…

5. …and a Chronicity Web site! cronicidad.euskadi.net

6. But we need a Digital Strategy!

7. For Designing a Strategy we need… A clear Direction A solid Architecture for dealing properly with the relationship between the parts and the whole A Response for everyone of the groups of actors involved in the Health System.

8. Re-health aims Responsiveness and Sustainability

9. Towards a Definition (?!)

10. What direction?

11. The [assumed] e-Health Path

12. The e-Health Simplistic Process

13. e-Addition… Explained! The same aim, but now with a plus: e-lectricity

14. Bridging the gap!

15. Responsive e-Health

16. The e-Health Revised Process

17. A Transitional Path Discourse Half-Duplex Dialogue Dialogue Conversation

18. The Conversational Health System

19. The Pivoting Aim: Chronicity “In the Basque Country, chronic illnesses represent the dominant epidemiological situation of the country. It is estimated that they currently represent 80% of the interactions with the Basque Health System (BHS) and account for more than 77% of health expenditure” Rafael Bengoa

20. Re-Health is… Conversational Responsive Adapted to HC actors Integrated Chronicity-aware Sustainable Supported by realcommunities of practice

21. An integrated architecture An Organically Ordered Web Architecture for HealthCare

22. We need a sense of info-order

23. A well balanced Architecture “Organic Order: … The kind of order that is achieved when there is a perfect balance between the needs of the parts and the needs of the whole” “The principle of organic order: Planning and construction will be guided by a process which allows the whole to emerge gradually from local acts” Christopher Alexander, 1975

24. Different Needs

25. Does the Elastic User exist?

26. A Common Solution?

27. Real (different) Objectives To flirt For kids To Work

28. The Big Picture

29. Architectural Drivers

30. And Inside? The Integration Bus e-HealthIntegration Bus

31. The biggest Chronicity Living Lab

32. Osakidetza orain The Basque Health System’s Web Portal

33. The Integrated Web Initiative

34. Brand New Features

35. Multimode Assistance

36. A Multi-Channel Web Portal www.osakidetza.euskadi.net Integrates all previous portals Virtual Web Assistant Web Appointments Instant Medical Assessment by Phone iPhone, iPad, Android support Integrated with a powerful Patient Relationship Management (PRM) infrastructure 902 20 30 20 Extended tosocial networks

37. …fed with 14 Chronicity Projects

38. Pro-sakidetza An online network of real professional communities of practice

39. Pro by Pros for Pros

40. Unpredictable Master Plans “Master plans have 2 unhealthy characteristics Its existence alienates the users …the members of the community can have little impact on the future shape of their community Because most of the important decisions have already been made …users live in a frozen future, able to affect only relatively trivial details Neither the users nor the key decision makers can visualize the actual implications of the master plan.” Extracted from Christopher Alexander, 1975

41. Master Plans as… skyscrapers! “A modern skyscraper has a fixed inflexible interior, which is secondary to the designed beauty of the exterior. Little attention is paid to the natural light, and often the interiors are constructed as “flexible office space,” which means cubicles. The flexibility is for management to set up offices for the company, not for the inhabitants –the employees- to taylor their own space. When you run out of space in the skyscraper, you build another; you don’t modify the existing one or add to it.” Richard P. Gabriel, 1996

42. Habitability Healthcare professionals are not mere users, but inhabitants of the Health System, and consequently they need a sense of… Ownership Professionals need to feel that they have some authority over what they are responsible for… …and also a sense of ‘elitism’ that hold them together and makes each member of the team feel responsible for the others’ success (Richard P. Gabriel) Professionals know what they need, and despite of the BHS master plans, they’re engaged with their own (usually modest) marginal communities, with their own look & feel and a consensus-based flexible structure. …so they can comfortably inhabit them.

43. A Network of Pro Communities Pro Community #2 Pro Community #4 Agora

44. Our First Pro Community

45. A Pro Social Network

46. Kronikoen sarea A Community of Patients based on emotional elective affinities

47. The Patients’ Associative Platform

48. Identifying Moods as Objectives Patient’s objectives use to be related to their moods and states-of-mind. But it’s not always easy to recognize them! We needed to use Interaction Design techniques for coming out with effective results …that have being successfully validated by Chronic Patients

49. Chronic Patients’ Emotional Cycle

50. …mixing patients and carers!

51. …promotinganEmotionalApproach

52. …tothewayPatientswantto share!

53. Patients… in their own way!

54. Following the Patient’s State of Mind

55. summary Key Ideas: Drivers. Digital Architecture, Re-Health

56. Different Needs, Different Drivers

57. A Response for every BHS’ group

58. Re…Re…Re…Re…Re…Re-Health Re[sponsive]-Health is our way of saying that… We need to react in front of the mere technology sublimation, reformulate our schemes in order to achieve a revolutionary road to an integrated health system, responding to its main actors, and reinserting all their values in it.

59. Responsive e-Health!!!

60. Eskerrik asko Thank you very much… for your attention! Muchísimas Gracias

61. III Spanish conference on chronic care Meet us at Building capacity for progress: the role of clinicians may, 19th/20th 2011 • Donostia – San SebastiánKursaal Congress Center