Eating Disorders, Social Media & Digital Technology Workshop - Lincoln University - December 6th 2015

1. Behavior change to develop a consistent approach
against eating disorder needs a strong patient’s
empowerment
Andrea Migliavacca, Renata Guarneri, Marco Decandia, Luca Piras
December 7th, 2015

2. Lombardia Informatica’s mission is to innovate services and increase the
Regional System’s productivity through Information Technology, in order
to improve Citizen’s quality of life and Lombard companies’
competitiveness.
100% owned by Regional Government.
Responsible for the soundness and the effectiveness of the whole
Regional Information System.
Cannot compete with Private Companies in Italy, but can be involved in
Projects abroad
LISPA
2

3. Since 1999 Lombardy Region
developed SISS – eHealth
Regional System.
SISS first goal was create a
Regional infrastructure to
connect and guarantee an
information exchange between
all the health care operators
and citizen.
Extranet SISS
Application
Server
PDL
SISS
PDL
SISS
PDL
SISS
HospitalGPPharmacy
LISPA
Citizens
Electronic Health Record – Citizen in the center
3

4. • 9.900.000 Citizens (roughly 99% of total)
• 150.000 Health & Social Care Operators
• 7.800 General Practitioners (98%)
• 2.600 Pharmacies (100%)
• 35 Public Hospitals (100%)
• 15 Local Healthcare Units (100%)
• Private Healthcare Service Suppliers
(98%)
• Nursing home (100%)
• Facilities for people with disabilities
(100%)
Some figures
4
• 6 millions active EHR (Electronic Health
Records)
• 17,5 millions ECDs
• 93 million prescriptions
• 4,3 millions online consultations of
medical reports by citizens
• 3,5 millions bookings

5. 5
Vision
CITIZEN-CENTRIC  Information sharing: SISS
is an instrument of dialog between medical operators
and citizens.
TERRITORIALISATION OF ASSISTANCE
(Dehospitalization, associative primary care,
clinical pathways, domiciliary assistance, ...)
 Extended support of care in the Region territory:
new organization for chronic disease care
REDUCED RESOURCES  Integrated governance
for resource optimisation: correlation between
clinical/ epidemiological data and administrative
data.
Howtoachivethat?

6. Electronic Health Record for citizens
6
Extranet SISS
Application
Server
PDL
SISS
PDL
SISS
PDL
SISS
HospitalGPPharmacy
LISPA
Citizens
EHR
The citizen clinical
history is shared between
all the health care operators
and providers in charged to
care the citizen
Physician second opinion is
available. It is possible an
immediate clinical
document sharing
In the Personal Page the
citizen could exchange
clinical documents,
relevant biometric
measurement with his or
her GP
The documents update is in
real time.
All the clinical documents
are immediately available

7. Electronic Health Record for citizens
7
Personal
Page
-
Personal
documents
Personal
Page
-
Personal clinical
History
Personal
Page
-
Data monitoring
Reports (Labs,
Radiology, Discharge
letters,
Ambulatory visit and
procedures, first aid)
provided and digital
signed by public and
private hospitals
Chronic
disease
patients
documents
ePrescription
eDispensation
Patient
Summary
Personal
Page
-
Personal
documents
EHR
Booking and
payment
Administrative
services

8. 8
SISS ongoing evolution
• Inclusion of vital signs
• Calendar management
• Privacy management
• Hospitalization clinical dossier on line
• Services during Home Visits:
 Electronic Prescriptions
 Sick-leave certificates
 Consultancy/radiology service booking
• DICOM image exchange for fast
consultancy and reduction of physical
transfers

9. 9
Why is so important an Empowerment strategy?
CITIZEN-CENTRIC  Information
sharing: SISS is an instrument of dialog
between medical operators and citizens.
TERRITORIALISATION OF
ASSISTANCE (Dehospitalization,
associative primary care, clinical
pathways, domiciliary assistance,
...)  Extended support of care in the
Region territory: new organization for
chronic disease care
REDUCED RESOURCES  Integrated
governance for resource optimisation:
correlation between clinical/
epidemiological data and administrative
data.
Need a citizen interested and with all tools
to have a correct relation with the
healthcare providers
Need to involve all the care giver (social
and parental resources)
Activation of all the resources present on
the field and optimization

10. 10
What empowerment is?
Active
Citizen
Engagement
Knowledge
CollaborationCommitment
Tolerance of
Uncertainty
Education
Information
Motivation
Communication
Notification
Information sharing
Second opinion
Training
Activities scheduler
MeansFunctionalities

11. 11
What citizen expects?
PALANTE Project results
Good level of activation
 EU citizens/patients:
 Are already largely activated
(levels 2 & 3)
 Have no prejudices to eHealth
 Expect eHealth being useful and
ease to use

12. Extranet SISS
Application
Server
PDL
SISS
PDL
SISS
PDL
SISS
HospitalGPPharmacy
LISPA
Citizens
Not only access to Electronic
Clinical Documents and services.
But also
• Citizen empowerment platform
• Interaction with platforms and
devices through the “Personal
Page”
Citizen in the center
12
Behaviour
change
platforms
Fitness
platforms
Life Style
analysis
platforms
Wearable
data
collectors
and data
analysis
platforms

13. 13
Empowerment and Behaviour Change Platform a good
synergy
Empowerment
Focus
• Citizen actives and responsible for
his health
Tools
• Information
• Education
• …
Limits
• Quite mono directional activity
• Create awerness but need support
for day by day life
Behaviour Change Platform
Focus
• Real and virtual environment to
activate a behaviour change
Tools
• Game
• Training
• Social
• …
Limits
• Involve active people
• Need motivation

14. 14
Integration with a behaviour change platform: the Pegaso
project experience
A mobile, social and networked gaming
platform to engage young people to stimulate
healthier choices to prevent obesity.
1) Individual & Environmental Monitoring, through a
high level-monitoring platform including wearable
sensors and mobile phone as well as multimedia
diaries for the acquisition of physical, behavioral and
emotional attitude of adolescent.
2) Feedback System provides feedback in terms of
“health status” changes, required actions to
undertake etc. This function will also propose
personalized healthy modification of the lifestyle thus
promoting active involvement in behavior change.
3) Social connectivity and engagement, social
network where users can share experiences with a
community of peers concerning e.g. physical activity,
food consumptions and everyday habits through
different gaming strategies.

15. 15
Behaviour Change Platform
Pegaso Experience
• Develop
Awareness
• Affective learning
• Create motivation
• Enable Behaviour
Change

16. Extranet SISS
Application
Server
PDL
SISS
PDL
SISS
PDL
SISS
HospitalGPPharmacy
LISPA
Citizens
The connection between BCP and EHR (Personal page)
Biological data
Physiological data
Physical activity data
Nutritional data
GP
Teen agers
Personal Health Folder
16

17. 17
Actual and future challeges
External platform could be able to
identify potential health risk
situation
eHealth system are from technical
point of view able to transmit data,
information, alert to the GP or
other specific actor
Constrains:
• Ethical and Privacy
• Legal
• Social acceptance
• …
?
Behaviour
changer
platforms
Fitness
platforms
Life Style
analysis
platforms
Wearable
data
collectors
and data
analysis
platforms

18. 18
Thank you
For any question
andrea.migliavacca@cnt.lispa.it