1) The document discusses the need for increased patient participation and a virtual health practice model to deal with challenges of an aging population, consumer driven models, and economic constraints. 2) It proposes a virtual health practice strategy that promotes consistent use of technology across the care cycle to increase patient contact, reduce face-to-face visits, and maximize health outcomes in a sustainable way. 3) The key features of virtual health practice are that it is personalized, predictive, preventive, participatory, and relies on disruptive innovations using big data and multiple ICT tools in a systemic approach.

1. S3.3
Patient participation
and Virtual health
practice
Barcelona , May 22th, 2014
1
Joan Escarrabill MD PhD
Chronic Care Program– Barcelona Esquerra.
Hospital Clínic (Barcelona)
Master Plan for Respiratory Diseases (PDMAR) & Home
Respiratory Therapies Observatory (ObsTRD). FORES.
Ministry of Health (Catalonia)

2. 2
The doctor’s visit (1663)
Jan Steen (1626-1679)
The doctor (1891)
Sir Samuel Luke Fildes (1842-1927)
A Fortunate Man (1997)
John Berger (1926- )
Episodic office-based model

3. Health care in digital age
3
Cycle
 Ageing and chronic diseases
 Consumer driven models
 Economic constraints

4. 4
Nothing is so dear and
precious as time
F. Rabelais (1494-1553)
Time

5. 5
 Health indicators
 Recovery Time
 Maintenance of health
NEJM 2010;363:2477-81
Care cycle

6. 6
Better value through population
and personalised medicine.
J A Muir Gray. Lancet 2013;382:200-1
Effectivity
Quality
Safety
Value
Presonalised
Population
medicine
Customize evidence
 Biomarkers
 Personal values
 Clinical situation
 Context
Responsibilities to the
population to be served
 Avoid inequalities
 Distribution of resources

7. Health care in digital age
7
Cycle
 Ageing and chronic diseases
 Consumer driven models
 Economic constraints
Without ICT, this is impossible
With science and paternalism, is not feasible to deal
with ageing, chronic diseases and budget constraints

8. 8
The need to be knowledgeable about and understand these
choices and engage in a shared decision-making process
http://thehill.com/blogs/congress-blog/healthcare/198595-
a-better-healthcare-system-requires-active-participation-by

9. 9
Shared Decision Making
• Patients have to be informed
• Patients have to spend some time to consider their goals
and concerns.
• Interaction with their health care providers

10. 10

11. 11
The challenge of health system is to increase
value of care for patient in sustainable way
Virtual health practice
• The transformation of the health system is not possible if it
is based almost exclusively on face-to-face visits.
• We define "virtual health practice" as the strategy of
promoting the consistent use of technology across all points
of care cycle in order to increase contact with the patient,
reducing face-to-face visits, to get the maximum value in
terms of health and wellbeing.

12. Virtual Health Practice:
Key features
Disruption
P4
Big Data
Systemic
approach
ICT
12
Changes in Business Model
Personalized
Predictive
Preventive
Participatory

13. 13
Need of disruptive innovations
to care for patients with
chronic diseases
Increase the total number of contacts
and reducing face to face visits
Need to respond to the needs
of the population (not just
those of patients who "knock
on the door")
To develop scalable projects, not just
pilot studies
Need to promote an intensive
and simultaneous use of
multiple ICT’s tools
ICT is not the driver of change, it’s just
a lever.
Why we need Virtual Health Practice?

14. 14
 Artificial Intelligence in Medical Decision Support.
 Artificial organs.
 Augmented Reality .
 Augmenting Human Capabilities.
 Curated Online Information.
 Customized Mobile Apps
 Digestible Sensors
 Gamification Based Wellness
 Humanoid Robots
 Personalized Genomics and Optogenetics
 Semantic Health Records

15. 15
1
2 Waiting Rooms Will Be Phased Out
3
4
www.wolterskluwerhealth.com/

16. 16
The immediate future of health care should be based on the
coexistence of the face-to-face visits & virtual practice and
synchronous & asynchronous

17. 17

18. 18
1
2
3
4
• E-visits are designed to handle common,
nonemergency conditions
• What happens when you need to do
a physical exam?
•CDC and Prevention says any condition that
could lead to an antibiotic warrants an in-
person exam
• Telehealth services could lead to
more health-care spending

19. 19

20. 20

21. Conclusions
• The main objective of health care is to increase the
value for the patient. Information and participation are
key elements.
• Information and communications technologies (ICT)
have a central role to play in transforming our health
care system.
• ICT is a lever not the main issue.
• The main purpose is to define a package of care, as
personal as possible, adapted to local circumstances
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