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Presentation of the PICASO Project at WHINN Conference, October 2016

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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

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Presentation of the PICASO Project at WHINN Conference, October 2016

  1. 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. 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. 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. 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. 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. 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. 7. PICASO - A Personalised, Integrated Care ApproachPICASO - A Personalised, Integrated Care Approach Short overview of the PICASO project
  8. 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. 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. 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. 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. 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. 13. 5th October 2016 WHINN 2016 - Odense, Denmark - Integrating Health and Social Care 13 Examples – Workflows in Outpatient ClinicsExamples – Workflows in Outpatient Clinics
  14. 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. 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. 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. 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. 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. 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. 20. Trials and Reference Implementation of the PICASO ComponentsTrials and Reference Implementation of the PICASO Components
  21. 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. 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. 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. 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. 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. 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. 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.

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