E-health unit

Why was this example implemented?

The E-health unit was established in March 1999, as a horizontal research and therapeutic unit, for the implementation of emerging ICTs in everyday clinical practice, as an initiative to modernise the previously offered rehabilitation services for chronic patients. The programme addresses the gaps in post- discharge and continuity of long-term care at the interface between hospital and home care and is particularly relevant, due to the lack of a unified and comprehensive primary health and social care system in Greece. It aims to maintain older patients with multiple morbidities at home by effective IT supervision and monitoring, to avoid crises, reduce hospital visits and admissions, and to provide support and educate family carers. The programme involves no extra costs for the users and targets older people of low education and income. The E-health unit is especially focused on:

• Home and community integrated care
• Home based rehabilitation
• Home based monitoring and support
• Early discharge and home-hospitalisation
• Personalized and mobile care
• Chronic Disease Management Technology represents the necessary enabling factor to achieve all of the above goals.

Description

The E-health unit has been inspired and promoted by the Medical Director, a consultant chest physician employed by the hospital. It provides patient–centred services, supported by ICT solutions customised to each patient’s needs in order to empower the patient and bridge the gaps between services at all stages of the care delivery system. The unit is jointly funded by EU research programmes and the hospital budget. The Unit has created a specially trained multi-disciplinary rehabilitation and home care team of physicians and other health allied personnel (nurses, physiotherapists, social workers, sociologist, clinical psychologists, dieticians, pharmacists). Personnel and management support is also provided by different departments of 'Sotiria' Hospital, the University and public sectors. EU funding covers the purchase and running cost of any extra technological applications and innovations that transform normal care delivery The technologies in use for realising the programme’s goals include the central Unit infrastructure in “Sotiria” Hospital. There is also cooperation with other peripheral sub-systems that may be placed in patients’ houses, peripheral health centres, nursing homes and workplaces, or support home nurse visits. Various systems provide:

• Two-way real-time interactive video and voice to allow the patient to electronically meet face to face with a nurse or doctor on a scheduled or on emergency basis for interview and physical examination, and on-line (web based) social contact and patient education;
• Real-time transmission of patients’ vital signs (ECG, electronic stethoscope, spirometry, oximetry, blood glucose, weight, blood pressure), which are automatically collected and logged into the patient’s Medical Health Record, located in the central database of the Unit; 
• Continuous monitoring of bio-signals through the use of innovative, non-invasive wearable systems that allow transmission of ECG, heart and respiratory rate, oxygen saturation, activity and body position;
• Home hospitalisation and early hospital discharge;
• Home visits by nurses equipped with diagnostic and therapeutic devices similar to Hospital Emergency Departments and instructions by physicians in charge and e-health Centres. 

Through these services, holistic care delivery around individual care plans, as well as interventions by multiple collaborating professionals at the right time and place, become feasible in a well-orchestrated and cost effective way.

What are/were the effects?

Improvement in the patients’ conditions

• Better quality of life: >28%, measured by special questionnaires (SF36 and Saint George)
• Reduction of re-admission rates and length-of-stay >60%
• Reduction in clinics and emergency room visits >40%
• Significant behaviour changes and treatment compliance
• Significantly increased autonomy, satisfaction and acceptance: estimated by specially designed subjective questionnaires 

Health and social care system decongestion 

• Unblocking of hospital beds
• Documentation of costs and avoidance of duplication among multiple points and levels of care delivery that patients are very frequently subjected to 

Significant cost reduction

• Direct costs (a reduction of >60% for each patient treated in the programme instead of being hospitalised)
• Indirect and social costs, which although very important, have not been precisely measured yet 

All of the above evaluations have been made during clinical trials (pre and post, and randomised control studies), with the use of common EU level clinical protocols.

Mobilisation of all relevant stakeholders

• Creation of a critical mass of multiagency working to help influence decisions 

Awards

• The E-health unit has received a special award from the European Commission for its innovative use of ICT to fight the exclusion of socially disadvantaged and fragile groups of patients that it serves. "Sotiria" Hospital E-health unit was one of five short-listed entries that impressed the judging panel in the 2008 European e-Inclusion Awards, in the "inclusive public services" category. 
• The unit has been accredited with the "Best Practices" label of the eu.practice portal, and as a good e-health organisation.
• The unit was selected by the Greek Ministry of Health to represent the country in the e-health 2005 conference, Tromso, Norway, the top EU event in the field.

What are the strengths and limitations?

Strengths

• This practice has been tested and running for over 10 years and has overcome the main barriers or gaps in the programme’s LTC provision. It has attracted multinational interest, having established a common language of communication and having already created an international network of affiliated institutes. 

Weaknesses

• Education in new technology is needed, but primarily a holistic system change in the attitude of professionals (policy makers, managers, care providers) from reactive to proactive, as well as firm support from government and administrative bodies through secure funding. 

Opportunities

• The current economic crisis may act as an opportunity to demonstrate that home care is cost-effective, through the transfer of hospital costs to provision of integrated care at home. This involves integrating the experience, skills, and diligence of a wide spectrum of disease and care management professionals, who will always be essential to the success of any project involving IT (Coughlin et al., 2006). 

Threats

• The possibility of total suspension in development may postpone the adoption of the practice at a national level. 
• The need for chronic care management processes to be customisable, rather than being shaped around a particular technology, means that individual care plans must precede the choice of the right technological support, a process that needs integrated care solutions that are currently scarce.

Credits

Links to other INTERLINKS practice examples

• AMICA – Telemonitoring system for COPD patients
• Coordinating Care for Older People (COPA): Team work integrating health and social care professionals in community care

External Links and References

• Sotiria tele-care EU 
• Sotiria tele-care GR 
• e-inclusion awards
• Coughlin, J./Pope, J./Leedle, B. (2006) 'Old Age, New Technology, and Future Innovations in Disease Management and Home Health Care' in: Home Health Care Management Practice, Vol.18: 196-207.