1. Nuvola IT – Home Doctor
Telecom Italia’s integrated multi-channel Telemedicine service
2013
2. 2
E-Health Solutions
Context
Telemedicina may be considered when clinical data (body weight,
body temperature, blood pressure, heart rate, breathing, blood oxygen
levels, blood sugar, ECG plots, fixed and moving diagnostic images,
blood, urine e tissue analysis results, etc.) is available in digital
format.
nefrologia, gerontologia, oncologia, neurologia, ginecologia, ortopedia,
opth. The most common illnesses well-suited to treatment using
telematic methods are in the area of cardiology and pulmonology and
diabetes; as technology evolves dermatology, nephrology, gerontology,
oncology, neurology, ginecology, orthopedics, and opthalmology are
following.
Telemedicina is tightly coupled with ICT technology and it’s boundaries expand with the technological
evolution of clinical engineering.
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E-Health Solutions
Home Doctor: service models enabled.
The Home Doctor solution for Telemonitoring enables 3 service models.
Autonomous in-home Telemonitoring
For Patients with a good level of autonomy and independence, with
chronic illness which need to be monitored for potentially long
periods, according to the prescribed care plan.
Caregiver-aided in-home Telemonitoring
Aimed at decongesting in-hospital activities for patients requiring
periodic check-ups or contingent diagnostic needs. To be used in
the context of local clinics or general practices.
Surgery Telemonitoring
Indicated when hospital access is difficult (for distance, overloading
conditions, etc.) and initial monitoring could be provided locally. Also
for enabling screening campaign for specific targets (i.e. children
monitoring for diabetes)
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E-Health Solutions
Home Doctor: the proposal
Multi-benefit: savings and rationalization for healthcare organizations, prevention diffusion, increased
well-being for patients.
Savings
For hospitals, possibility of anticpated patient discharge.
A hospitalized patient costs between 500 and 700 Euro; a patient in
telemonitoring costs 2 Euro (plus the fixed costs of the healthcare
organization)
Rationalization
For Regions and Local Heathcare Organizations, possibility to rationalize
territorial services, increasing ADI (today only 4% of chronic patients are
served)
To cope with the closing of small hospitals, guaranteeing the management of
the major chronic illnesses in the local area.
To extend healthcare services to disadvantaged areas or specific categories
(e.g. prison populations, foreign offices of multinational organizations etc.)
To limit improper Emergency Room access and re-admittance of chronic
patients.
Prevention
For hospitals and local care (clinics, single GPs or GP groups), possibilty to
conduct screening campaigns for chronic illness (hypertension, diabetes,
asthma, etc.), oriented at prevention.
Well-being
For chronic patients, greater comfort and tranquillity (knowing you are
continuosly monitored)
For the population, service safeguards (in the face of smaller hospital
closings)
Indirect benefits: fewer lines, less travel, less time wasted
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E-Health Solutions
Home Doctor: strengths
Telecom Italia’s solution stands out for its completeness, robustness and ease of use
Home Doctor is a solution entirely “home made”:
• Prototype devised and tested by TILab Innovation
• Commercial platform developed, validated and installed in Data Center TI by TILab Engineering
Employs Telecom Italia’s core technology:
• For data connectivity (mobile GPRS/EDGE/UMTS/HSxPA, fixed ADSL and Wi-Fi, satellite)
• For Disaster Recovery and Business Continuity
• To respect the existing regulations related to Privacy and the handling of sensitive information
Completely independent from the Telbios solution
May be integrated with other Telecom Italia solutions on a project basis:
• Customer Care solutions (HCC or solutions from other companies in the TI group: TeleContact,
Advalso, ecc.)
• SD and HD videoconferencing (for teleassistence)
• Localization solutions (ad es. geofencing to check the whereabouts of the elderly)
• Solutions for electronic patient files (standard HL7)
• Digital signature (for ECG reporting) etc.
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E-Health Solutions
Home Doctor: composition of the offering
The basic offering uses all of Telecom Italia’s core services (connectivity, IT services, Privacy Management,
etc.) and may be enhanced with optional services for the complete care of elderly, chronic or post-
discharge patients.
For autonomous patients
For patients who are less
autonomous, with disabilities
or lacking familiarity with the
basic technology (the elderly)
For clinics in remote areas,
screening campaigns,
ambulances, etc.
Hosted Contact
Center Services
To complete the offer with services to assit
with the patient assignment, training and
Customer Care, including specialized
(healthcare)
Electronic
Patient Files
To make the patient’s biometric parameters
available in the major applications for
electronic patient files from our partners,
available also on mobile devices (iPad,
iPhone, tablet PC, smartphone)
Fixed,Movile,SatelliteConnectivity
DataCenterITServices
(disasterrecovery,businesscontinuity)
SecurityePrivacyManagement
Home Doctor
basic
FeebasedConsumption
based
PROJECTBASEDPROJECTBASED
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E-Health Solutions
Application platform designed, engineered and developed by Telecom Italia
Indipendence from device vendors
Multiple device support: measurement richness
Wireless comunication with medical devices (bluetooth)
Mobile Gateway (full wireless)
Fixed Gateway (data conettivity: ADSL, Satellite, Mobile KEY)
Security Policy in Telecom Italia IDC
Possible commercialization through MEPA
Distinctive factors of the solution
Home Doctor in Cloud: functional architecture (2/2)
9. 9
E-Health Solutions
Adapter
XML/HL7
Home Doctor: logical architecture
Electronic
Patient Records
(*)
External
Systems
3° Party
Platforms
Home Doctor
Device
Gateway
Gateway
Service
Data Layer
Component Decomposition
Appointment
Management
Alert &
Reminder
Help & Info
Schedule
Management
Medications
Managemet
Measures
Management
Measure
Reporting
with Digital
Sign.
Configuration
Meaure
Thresholds
Patient
Management
User
Management
Reporting
Dashboard
Statistics and
search
Portale
Video
Communication
Privacy&Security
Adapter
Service
SMS Gateway
(*)Integrations:
•Tabula Clinica
DSGroup,
•wHospital Lutech,
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E-Health Solutions
Electronic Patient File Integration with Partner DS-Group (Tabula Clinica)
Electronic Patient File Integration with Partner Lutech (wHospital)
Host Contact Center services from Telecom Italia
Statistics and searches
Help & Info
Optional services
Home Doctor: Functionalities
Medical devices and illnesses handled
Diabetes e
hypertension
Broncopathies Heart diseases
Anticoagulation
therapy
Glucosimeter X
Spirometer X
Blood pressure
monitor
X X X
Body weight scale X X
ECG X
Pulse oximeter X
INR monitor X
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E-Health Solutions
Bilancia
bluetooth Peso in kilograms [kg]
IEM Gmbh
Libr-O-graph
CARD GUARD (Obsoleto)
PMP4 – SelfCheck Weight
Scale
Sfigmomanometro
bluetooth
Pressione Diastolica ( “Minima") [mmHg]
Pressione Sistolica ( "Massima") [mmHg]
Pulsazioni al minuto [bpm]
IEM Gmbh
Stabil-O-Graph
CARD GUARD (Obsoleto)
PMP4 – BP Pro
Ossimetro
bluetooth
Percentuale di O2 [%]
Pulsazioni al minuto[bpm]
MIR
Spirobank II /MIROxy
(obsoleto)
NONIN
9560
Spirometro
bluetooth
Test di funzione e capacità polmonare
FVC [l], FEV1 [l], FEV1% [%], PEF [l / min], FEF
25% -75% [l / min]
MIR
Spirobank II Cod. 910575
Sprirometro +
Ossimetro Bluetooth
Test di funzione e capacità polmonare (val.
teorici&mis.)
FVC [l], FEV1 [l], FEV1% [%], PEF [l / min], FEF
25% -75% [l / min]; Percentuale di O2
Max/Min/Med [%]
Pulsazioni al minuto Max/Min/Med [bpm]
MIR
Spirobank II Cod. 910570
Device Misure Prodotto Note
Medical devices integrated in Home Doctor (1/3)
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E-Health Solutions
Coagulometro
(con adapter “IR-
bluetooth”)
Tempo di Protrombina espresso come:
INR (International Normalized Ratio), valore
protombina [sec], % protombina [%]
ROCHE Coagucheck
Elettrocardiografo
bluetooth
ECG a 12 derivazioni, secondo lo stanard to 1064-
Standard Communication Protocol - Computer
Assisted Electrocardiography (.scp)
Cardiette
Microtel
Cardiette
Cardioline AR1200 ADV
IR/RS232
Elettrocardiografo
bluetooth DICOM
ECG a 12 derivazioni, secondo lo
standard Unipro e conversione in
DICOM
Mortara Rangoni
ELI 10 09/2011
Glucometro
bluetooth Glicemia Pre/Post-Prandiale [mg/dl]
Bodytel
Glucotel
09/2011 per gtw Symbian,
12/2011 per Nexus
Android 2.3
Termometro
bluetooth
Temperatura corporea esterna (da
orecchio e fronte)
TAIDOC
FORA IR21b 12/2011
ECG 1 derivazione
ECG 1 derivazione (Aritmia),
Frequenza cardiaca, Frequenza
respiratoria, Variabilità e Affidabilità
Freq. Cardiaca, Rilevazione
movimento
STM
Body Guardian (v2
non certificato)
08/2011: gestione misura
ECG con gtw Android
10/2011: gestione
completa di tutte le
misure con gtw Android
Integrati nel corso del 2011
Device Misure Prodotto Note
Device Misure Prodotto Note
Medical devices integrated in Home Doctor (2/3)
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E-Health Solutions
Device Misure Prodotto Note
Massa Grassa e
Peso bluetooth
Peso
Massa Grassa
ForaCare W100b
Glucometro Glicemia pre-post prandiale
Entra Health System /USA San
Diegio
MyGlucoHealth
ECG 12/8
ECG 8/12 derivazioni con 3 elettrodi
in formato prorietario e poi
trasformato in scp, Frequenza
cardiaca.
Aerotel
HeartView Bt
Black-box M2M Supporta: ECG 8/12, e altri device
con BT e RS232
Aerotel ConnectCell Receiver
(CCR),
BT e GPRS connectivity
Glucosimeter +
Blood Pressure
Monitor
bluetooth
Glycemia Pre/Post-Prandial [mg/dl]
Diastolic Pressure( “Minimum")
[mmHg]
Sistolic Pressure ( "Maximum")
[mmHg]
Beats per minute [bpm]
Foracare
2in1D40b, bluetooth
connectivity, voice
2in1D40G M2M, gprs
connectivity, voice
D40b integrato
Spirometer
+ Oximeter
Test of pulmonary function &
capacity(theoritical value & meas.)
FVC [l], FEV1 [l], FEV1% [%], PEF [l
/ min], FEF 25% -75% [l / min];
Percentage O2 Max/Min/Med [%]
Beats per minute Max/Min/Med
[bpm]
Activity and Motion Detection
MIR
Spirotel M2M e BT (gprs e
Bluetooth connectivity)
In fase di integrazione (2012)
Medical devices integrated in Home Doctor (3/3)
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E-Health Solutions
Invio real-time delle
misure alla Cartella
Ospedaliera
wH Suite Service Bus
wHospital
Modulo importazione
parametri vitali da
MDH
Modulo
visualizzazione
parametri vitali HL7
Engine
Electronic Patient File Integration (1/2)
Home Doctor
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E-Health Solutions
Non esclusive license agreement, for n° 16 contemporary active users, on the software application Nuvola
It Home Doctor, installed in Telecom Italia Data Centers;
N° 2 SIM M2M for access to the mobile network associated with a user profile, allowing only data
trasmission over GPRS/EDGE/UMTS/HSxPA networks) with fees and traffic included;
N° 1 SIM Voice for Help Desk access with Mobile Voice TIM Flex fees included;
N° 3 Cellular telephones with operating system Symbian version 9;
Electromedical devices: N. 2 ECG recorders, N. 2 Body weight scales, N. 2 Blood pressure/glucose monitors,
N. 2 Oxy/Spirometers, N. 1 Coagulometer IR-BT Adapter;
Consumable materials used with the Electromedical Devices;
Client Training with a duration of 1.5 days;
Platforma setup and configuration;
Basic Services: transport, delivery, installation;
Operations Help Desk for technical problems.
Nuvola It Home Doctor Basic – MEPA Offering
MEPA Quote: Annual Fee (UT + Fees IVA excluded) € 19.920,00
Nuvola It Home Doctor Basic - Telemonitoring at-home with Tutor
Provides continuous remote monitoring of patients’ biometric parameters recorded/detected using
electromedical devices by a healthcare worker visiting the patient at home. The parameter results are sent via
mobile phone to Telecom Italia’s telemonitoring platform, Nuvola It Home Doctor, situated in a Telecom Italia
Internet Data Center.
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E-Health Solutions
The mobile gateway application
MEDICAL DEVICES
Bluetooth
An analogous software application is available for the PC (OS Windows)
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E-Health Solutions
Digital Signature on Results Report using Smart Card
• The digital signature on results report feature is available using Telecom Italia’s Kit Firma Sicura, available for Win32 and IE7.x,
and digital signature client CompEd Digital Sign 3.1.
• The signature function is activated during the uploading of the results report in .pdf format to the platform (A). The browser
activates the plug-in that initiates the digital signature process with the PIN request (B) and setting of the date and time of the
signature (C).
Option to apply Digital
Signature to the report
A
Insert PIN della Smart-
Card
B
Conferm date/time of the digital
signature
C
• The signed results report is available in .p7m format for consultation by downloading the file with the signature icon
Download digitally signed
PDF file
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E-Health Solutions
TI, in collaboration with its subsidiary TIM Brasil, conducted a Home Doctor trial in the favelas of Rio de Janeiro with the
objective to export excellence in healthcare inovation on an international basis.
Brazil Project –Rio de Janeiro Trial
The project involved 3 clinics located in 3 favelas of Rio de Janeiro and 1 hospital (Miguel
Couto) in its Cardiology department (ECG reporting) for approximately 6 months
starting in October 2009, using the Home Doctor Telemedicine platform with the following
operational model:
TRIAL TMED BRASILE
TELE-SCREENING
TELEMONITORAGGIO
CON TUTOR
The patient goes to the clinic where a
set of vital parameters are taken and
following hospital consultation, a
response is provided to the patient
The hospital identifies a patient to
include in the telemonitoring
program provided at the
decentralized clinic
User base: circa 25,000 patients. Healthcare personnel involved: 14 doctors and 26 nurses.
In 2011 it is expected an extension of the service to approx. 40 clinics connected with 4 hospitals in the Rio Metro area.
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E-Health Solutions
Home Doctor: awards
Home Doctor ahs received important recognitions, raising the interest of GSMA
The trial at AO Molinette di Torino awarded for “The use of
innovative technology…that simplifies the patient’s access to
services through the already familiar device, the cellular phone.
The project is therefore orientated at overcoming the digital
divide”.
Winning solution at the poster session “Telemedicine: the right
care in the right place at the right time” during the Final Event of
European Health Optimum Project, held in Verona, Italy, 3-4 June
2009.
'Imprese per l'innovazione' Award from Confindustria and 'Premio dei premi' from the Italian Presidenza
del Consiglio. Recognition: “for the application’s social relevance and the broadness of integration at a
service level as well as in terms of technological convergence”.
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E-Health Solutions
The trial with AO Molinette di Torino
The trial.
The telemonitoring service has been tested for over than 1,5 year in Molinette Hospital in
Turin, on 20 elder patients (average age > 85 years) in de-hospitalisation model. A
comparison has been made with a sample of patients treated in traditional way.
Major outcomes.
Cost savings. On 18 patients:
• Reduction in medical examinations, with an extimated savings of almost 2000,00 Euro
• Reduction in new hospitalizations, with an extimated savings of almost 18.000,00 Euro
Medical examination reduction in the tele-monitored patient group (253 versus 392)
Considerable reduction of new hospitalizations after three months from the
dismission
Significant improvement of the mood tone only in tele-monitored patients (evaluated
using Geriatric Depression Scale-GDS)
Significant reduction of the stress level for tele-monitored patients’ parents and
caregivers (evaluated using Relatives' Stress Scale-RSS)
Source: L‘Ospedalizzazione A Domicilio e la Telemedicina (Dr. Nicoletta Aimonino Ricauda, Dr Claudio Zanon – AO Molinette)
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E-Health Solutions
Home Doctor: deployment in Regione Piemonte
The first Italian region to go beyond the trial phase offering a wide reaching service, involving all the ASL of the
region.
Based upon the results of the trial with the hospital AO Molinette, at year end 2010 the Govenor of Regione
Piemonte signed an important contract with Telecom Italia, providing for the extension of the
Ospedalizzazione Domiciliare (Home hospitalization) service to 5.000 patients in 3 years.
AO Molinette will act as a center of excellence for the extension of the operational model trialed to other
major cities in the Region. The objective being then to gradually extend the service to all of the regional ASL.
