Presentation of PICASO in the session on integrating health and social care by Jesper Thestrup from partners In-JeT ApS WHINN: Week of Health and INNovation, October 2016

1. ICT Support for Integrating all Aspects of CareICT Support for Integrating all Aspects of Care
in Diverse Cultural Settingsin Diverse Cultural Settings
Innovative Solutions for
Integrating Health and Social Care
Jesper Thestrup, In-JeT ApS (stand 1421)

2. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 2
Overview of PresentationOverview of Presentation
• Introduction
• The PICASO project - A Personalised, Integrated Care Approach
– Funded by the EU, 8m€, 3 years, 9 partners, 7 countries
– Three major innovations in ICT supported integrated care / continuum of care
• Automated and integrated workflows across sectors
• Secure data exchange between actors
• Handling of care plans for multimorbidity
• Trials and reference implementation
– Two trials in Rheumatic Arthritis and Parkinson’s Disease with CVD as co-
morbidity
– Diverse set of formal carers and organisation involved (Co-morbidities)
– DIverse cultural backgrounds (Northern and Southern Europe)
– Example: Using the PICASO platform for Remote Cardiac Examination
• Questions, conclusions and outlook

3. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 3
Introduction: The Patient JourneyIntroduction: The Patient Journey
Age Event Monitoring/Therapy PICASO Component
45 Hypertension Blood pressure, risk score
for complication
Telehealth, BPM, data mining
Intelligent personalised feedback
55 Type II Diabetes Blood glucose (spot),
lifestyle advice
Telehealth, data mining
Intelligent personalised feedback
65 Rheumatoid Arthritis Temperature, agility Personalised rehabilitation service
execution, decision support
67 Hearth Failure Balancing, exercise, gait Telehealth weight, BPM, Kinetics
70 Early Dementia Medication monitor
Environmental sensors
Reminder services, social well being
Integrated care plan execution
72 Insulin dependent Continuous BG, urine and
ketone monitoring
Multimorbidity analysis, goal
optimiser
74 Valve disease Medication, risks factors Integrated care, decision support
75 Peripheral vascular
(leg ulcer)
Leg elevation monitoring,
image monitoring
Telehealth, telecare
Integrated care, decision support
76 Incontinence Incontinence monitor Telecare, intervention alert
78 Fall Fall sensors, fall alert Telecare, intervention alert
80 Vision Movement, fall alert, agility Telecare, intervention alert
82 Death
Source: Russell Jones, MD, Chorleywood Health Clinic, mod. IN-JET

4. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 4
Prevalence of Multimorbidity in Age Groups (UK n=99,997)Prevalence of Multimorbidity in Age Groups (UK n=99,997)
C Salisbury, L Johnson: Epidemiology and impact of multimorbidity in primary care, Br J Gen Pract 2011;
DOI: 10.3399/bjgp11X548929.

5. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 5
Deficits in Communication and Information Transfer BetweenDeficits in Communication and Information Transfer Between
Hospital-Based and Primary Care Physicians in relation to dischargeHospital-Based and Primary Care Physicians in relation to discharge
• Overall, direct communication between hospital physicians and primary
care physicians occurred infrequently (3%-20%).
• The availability of a discharge summary at the first post-discharge visit was
low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the
quality of care in approximately 25% of follow-up visits and contributing to
primary care physician dissatisfaction
• Discharge summaries often lacked important information such as
diagnostic test results (missing from 33%-63%), treatment or hospital
course (7%-22%), discharge medications (2%-40%), test results pending at
discharge (65%), patient or family counselling (90%-92%), and follow-up
plans (2%-43%)
Source: Sunil Kripalani, MD, AMA. 2007;297(8):831-841. doi:10.1001/jama.297.8.831

6. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 6
Why is There Such a Lack of Information Flowing AcrossWhy is There Such a Lack of Information Flowing Across
Boundaries?Boundaries?
Materials & Substances
Sub-assemblies
Assembly
Car
Manufacturing Industry
Hospital
Clinics
General Practice
Municipal and Social Care
Healthcare Industry

7. PICASO - A Personalised, Integrated Care ApproachPICASO - A Personalised, Integrated Care Approach
Short overview of the
PICASO project

8. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 8
PICASO Project OverviewPICASO Project Overview
• PHC 25 – 2015: Advanced ICT systems and
services for Integrated Care
• Re-design health and care systems by
developing integrated care models that are
shifting from a reactive approach to
proactive and patient-centred care
Technology Partners Clinical Partners

9. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 9
Continuum of Care – Roads to Better and Cheaper HealthcareContinuum of Care – Roads to Better and Cheaper Healthcare
1. Allow more cost-effective care management through automated and
efficient workflows
2. Improve cooperation and exchange of knowledge between professional
caregivers in health, rehabilitation and social care domains
3. Actively include patients and their relatives in the integrated care settings
thus supporting patient empowerment and self-care;
4. Reinforce medical knowledge and create new care models for
management and treatment of patients with multi-morbidity conditions;

10. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 10
Decoupling of Information and Care SpacesDecoupling of Information and Care Spaces

11. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 11
Care Management Through Automated WorkflowsCare Management Through Automated Workflows
• Moving care plans across organisations - narratives
• Moving patient data across organisations - tokenized
• Moving patients across organisations – Assisted Living support
• Making sure that no one feels stigmatized – ethical issues
• Making sure that no one is left behind – compliance issues
• Making sure that no one is excluded – organisational integrity

12. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 12
Moving Care Plans Across Organisations – NarrativesMoving Care Plans Across Organisations – Narratives
• The aim of ‘narratology’ can be defined as that of producing an in-depth
description of the ‘syntactic/semantic structures’ of the narratives. The
narratologist is in charge of dissecting narratives into their component
parts in order to establish their functions, their purposes and the
relationships among them.

13. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 13
Examples – Workflows in Outpatient ClinicsExamples – Workflows in Outpatient Clinics

14. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 14
Steps for Constructing Care PlansSteps for Constructing Care Plans
Narrative
Care plan (pathway) described in plain text
Care Plan
Standard care plans to be customised to individual
patients by physicians and others authorised
to set up care plans
Template
Standard care plan for various disease management
actions specific to organisation/physician with open data
fields for specific service details
Service Library
Standard services to be included in templates and used
for automatic service execution including in clouds and
in patient’s homes

15. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 15
Visualisation of Integrated Care Plans and Work FlowsVisualisation of Integrated Care Plans and Work Flows
MAQUET INSIGHT Clinical Logistics
IBM Case Management

16. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 16
Cooperation and Exchange of Knowledge Between CaregiversCooperation and Exchange of Knowledge Between Caregivers
Distributed Physical
Care Spaces
Integration Information Space

17. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 17
PICASO Integrated Data Exchange EcosystemPICASO Integrated Data Exchange Ecosystem
Sentinel Agents
PICASO Public Cloud
Distributed Physical
Care Spaces
Integration Information Space
Meta Data!

18. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 18
Visualisation of and Search for Data StructuresVisualisation of and Search for Data Structures
• Web-based interactive Data Resource
Browser
– The user retrieves data by querying the Shared
Memory Manager for instances of connectors
relevant to a certain patient or a certain carer.
– The query provides a visual image of which
data are found and that the user can retrieve.
– The relationship between the kind of data
available and the data owner can be presented
• Security and Privacy Management Subset
– Requestor must have patient credentials
before anything is shown
– Requestor must be authenticated before
owner will be displayed – request can be send
– Patient and owner (and 3rd party) must agree
before data can be send to requestor

19. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 19
Moving Patient Data Across Organisations – TokenizedMoving Patient Data Across Organisations – Tokenized
Distributed Physical
Care Spaces
Integration Information Space

20. Trials and Reference Implementation of the PICASO ComponentsTrials and Reference Implementation of the PICASO Components

21. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 21
Overview of PICASO Trials (Planned for Jan 2017 to Dec 2019)Overview of PICASO Trials (Planned for Jan 2017 to Dec 2019)
Two trials chosen for cultural diversity for organisation of health and social care:
• Trial 1: Rheumatologic Arthritis (RA) and CVD in Düsseldorf
– Northern European Institutional social care
• Focus on transition of workflow and patient data between formal carers
– Bismarck healthcare financing system
• Focus on the involvement of insurance companies
• Trial 2: Parkinson Disease (PD) and CVD in Rome
– The Mediterranean Family Centred Healthcare
• Focus on transition of workflow and patient data between formal and informal carers
– Beveridge healthcare financing system
• Focus on the cost effectiveness of organisations

22. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 22
Trial 1: Rheumatoid Arthritis (RA) and Co-morbidityTrial 1: Rheumatoid Arthritis (RA) and Co-morbidity
Cardio Vascular Disease (CVD)Cardio Vascular Disease (CVD)
• Performed by the Policlinic of Rheumatology and Hiller Research Unit Rheumatology at the
Heinrich-Heine-University (HHUD) / University Hospital of Düsseldorf.
• The trial will perform cross-sector workflows involving rheumatologists in the outpatient clinic,
physicians and scientists from the Centre for Health and Society, and physiotherapists at the
Heinrich-Heine-University Düsseldorf.
• 30 patients that meet the inclusion criteria will be enrolled in the pilot
– 15 patients and their treating physician will start directly with preliminary devices installed, another 15
patients and their treating physician will start after the deployment of the updated platform
• Primary endpoints are:
– User acceptance, adaptability and usability factors (patients and physicians perspective)
– Secure and accurate handling of data and data sharing in PICASO
– Improved outcome (e.g. health and quality of life)
– Active participation by patients and their informal carers in the care process and management
– Reduced number and length of admissions to hospital
• Secondary endpoints are:
– Increased medical knowledge on the provision and better management of integrated care for patients
with multiple co-morbidities
– More efficient, dynamic and personalised care
– More efficient sharing of relevant data and care plans between the involved physicians and other
stakeholders as social carers.

23. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 23
Trial 2: Parkinson’s Disease (PD) and Co-morbidityTrial 2: Parkinson’s Disease (PD) and Co-morbidity
Cardio Vascular Disease (CVD)Cardio Vascular Disease (CVD)
• Performed by The University Hospital of Tor Vergata in Rome
• The trial will deploy PICASO platform to a subset of the patients as well as their treating
physicians, licensed and unlicensed care providers, and in particular their families.
– The goals are to empower the patient’s family in their role as primary care givers, to support and
improve the social aspects of patient – family interactions.
• 30 patients that meet the inclusion criteria (>65 years of age with CVD and Parkinson’s) will be
enrolled in the pilot.
– Ten patients will be selected to test PICASO and twenty will be part of a control group.
• Primary endpoints are:
– Inform unclear/equivocal treatment decisions
– Determine the efficacy of therapy and supporting appropriate adjustments
– Support the appropriate adjustment of drug therapy for patients who have been previously misdiagnosed or over-
treated
– Promote medication adherence (compliance) and lifestyle changes and to make patients more aware of their condition
– Evaluate control of clinical parameters in patients discharged home from hospital with newly commenced or altered
therapy.
• Secondary endpoints are:
– Usability (both valued by patients and doctors
– Integration in the management of care
– Improved participation of patients and their informal carers.

24. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 24
Narrative for Remote Monitoring of CVDNarrative for Remote Monitoring of CVD
1. Assign patient to regular physical trainingsessions
2. Deploy remote ECG equipment in patients’ care spaces
3. Train patient to perform standard exersises
4. Send reminder to the patient the day before
5. Start sessions at the scheduled time
6. Check that patients are on-line
7. If yes, to to 9
8. If not, go back to 6
9. Monitor patients’ exercises and results
10. If OK, continue to 12
11. If not, call patient via video and instruct for changes
12. Session ends
13. Store results in EPR

25. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 25
LinkWatchLinkWatch©©
MEGA BioLinkMEGA BioLink©©
Remote ECG Monitoring in Real-timeRemote ECG Monitoring in Real-time
• 1 or 3 channel ECG with Bluetooth
• Real-time transmission of data to command
centre
• Simultaneously monitoring of up to 8 patients
• Including 3D activity data and breathing
• Store in HIS in EDF format
• Optional Blood Pressure, Weight, SpO2 etc.
http://www.linkwatch.se & http://www.megaemg.com/products
PICASO components and reference implementations will be used in the trials
Example from Cardiac Remote Monitoring e.g. during physical training.

26. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 26
ECG Event Viewer (EDF format)ECG Event Viewer (EDF format)
http://www.megaemg.com

27. Please see us here: www.picaso-project.eu
All rights reserved. All copyright for this presentation are owned in full by the PICASO Project.
Permission is granted to print material published in this presentation for personal use only. Its
use for any other purpose, and in particular its commercial use or distribution, is strictly
forbidden in the absence of prior written approval.
PICASO has received funding from the European Union’s Horizon 2020 research and
innovation programme under grant agreement No 689209.
Possible inaccuracies of information are under the responsibility of the project. This
presentation reflects solely the views of its authors. The European Commission is not liable for
any use that may be made of the information contained therein.