telemonitoring – AQuAS Blog

Integrated care in Europe: Change management? The ACT@Scale experience

28 Feb

The ACT@Scale project responds to the need for a deeper look into the results and conclusions that came out of the previous project, Advancing Care Coordination and Telehealth Deployment (2013-2015) and it follows the strategic lines proposed by the European Association on Active and Healthy Ageing (EIP on AHA).

This new project, ACT@Scale, began in March 2016 within the framework of the Horizon 2020 programme which was financed by the European Union. The aim is on transforming health processes and the provision of services related to integrated care and telemonitoring.

How have we done all this?

Different regions in Europe, the industry and innovative academic institutions have worked in collaboration over these past few years. The Agency for Health Quality and Assessment of Catalonia (AQuAS) has been one of the partners in this consortium leading the work-package Change Management, Stakeholder Management and Staff Engagement.

With 15 partners, in association, from 8 countries of the European Union and with the coordination of Phillips Healthcare we have worked collaboratively in order to consolidate and scale up the best practices identified in integrated care and telemonitoring so that they can be transferred to other European regions.

The Basque Country, The Netherlands, Scotland, Germany and Catalonia have contributed with a total of 15 programmes of integrated care, both innovative and of reference, regarding best practices in health. In particular, Catalonia has participated with five reference programmes of good practices in integrated care: Programme of Chronic Care, of the Badalona Serveis Assistencials; Nursing Homes, of MUTUAM; Frail Care for Older People, of the Parc Sanitari Pere Virgili; Complex Case Management, of the Hospital Clínic de Barcelona and the Promotion of Physical Activity, also of the Hospital Clínic de Barcelona.

ACT@Scale has developed a framework of assessment based on experience, practice and evidence using the Donabedian theoretical framework. To assess the implementation of the programmes, a collaborative methodology (Plan-Do-Study-Act) has been used. Thus, in order to assess processes of implementation and scalability, research has been done within four work packages:

Service Selection, led by Kronikgune
Business Models, led by the University of Groningen
Citizen Empowerment, led by NIRE
Change and Stakeholder Management, led by AQuAS

What have we learnt in relation to Change Management, Stakeholder and Staff Engagement?

In relation to Stakeholder Management, the leaders of the programmes that completed the questionnaires agreed that participative and co-creation strategies need to be introduced to improve the quality of integrated care and to reduce the resistance of stakeholders to change, where all identified stakeholders feel part of the process.
In terms of Change Management, regarding leadership, new communication strategies need to be incorporated which should be based on a collaborative methodology so as to detect and prioritise needs, implement them and monitor and assess them within the processes of change initiated.
In terms of Staff Engagement, we can confirm that the implementation of programmes of integrated care is a dynamic process in which potential risks need to be identified and therefore, assessment and redesign need to be ongoing..

Integrated care contributes to the creation of new health scenarios, some in a state of change and others as yet unknown. These new scenarios should make us think about defining new professional profiles, new areas of expertise and identify new actors and “actresses”.

Post written by Núria Rodríguez-Valiente.

La Meva Salut (My Health) and eConsulta (eConsultation): deploying the model of remote care in Catalonia

18 May

The management of information is key to the health system from the perspective of a greater integration between patients and professionals of different levels. Shared information, transparency, evaluation and the readjustment of healthcare processes need to be primary lines of action so as to situate the patient at the centre of the different interactions with professionals of different fields.

The expansion of information technologies has created new opportunities which enable people to participate actively in the monitoring of care processes offering a unique opportunity to facilitate communication and improve a patient’s commitment. The new model of care which the Health Plan Catalonia 2016-2020 proposes is aimed at putting more focus on patients and to that effect, tools have been developed that improve the relationship between citizens and the health system making it all easier.

In Catalonia, we have a personal health folder available since 2009, Cat@Salut La Meva Salut (LMS), accessed by using a digital certificate or using a user name and password which are provided by a citizen’s primary healthcare reference centre.

You can read this article published in the magazine Annals de Medicina.

La Meva Salut is a personal digital space for consultation and interaction, which puts relevant health information generated by public healthcare centres in Catalonia at the disposal of citizens, in a safe and confidential way. This information includes such things as the current medication plan, vaccines administered, diagnoses, clinical information, results of tests and complementary examinations

When considering La Meva Salut, we can say that it is a strategic project which promotes the participation and co-responsibility of citizens in prevention and the care of their health, fostering awareness and knowledge related to their pathologies and making it possible for them to participate in the clinical process of care.

La Meva Salut offers cross-cutting and strategic services of the Catalan Department of Health and it also allows different health providers to incorporate more personalised services according to the more specific needs of patients in each entity, which are standardised in La Meva Salut.

In this way, La Meva Salut offers a unique gateway to the virtual health system allowing citizens, who identify themselves only once, to use services of different centres in an integrated and personalised way. Some of these services already in use, are, among others: changing primary care doctors, requesting appointments to see a primary care doctor and for international vaccination services, service of patient communities (allows groups of patients to be created for sharing opinions and dealing with different pathologies with the help of an administrator that is usually a health professional), and the monitoring of patients with chronic pathologies.

This article has recently been published in the magazine New Perspectives in Medical Records.

The most noteworthy cross-cutting services that the Department of Health has made available are:
• Consultation of waiting lists for surgery
• Consultation of pending appointments and tests of any health provider in an integrated way
• Obtainment of organ donor’s card
• Consultation of the Advance Directives document
• Inclusion by the patient of clinical variables in their clinical history
• Secure mail service, eConsulta

The goals of La Meva Salut and the eConsulta service are in line with the Non-Face-to-Face Model of Care of the Catalan Health Department, which aims to guarantee, improve and facilitate the access to the Catalan Health System and to offer options for non-face-to-face care by providing added comfort both to professionals and citizens in the process of care.

Data for access to La Meva Salut

eConsulta is an asynchronous and bidirectional remote communications tool between a citizen and health professional that complements face-to-face care. The access by citizens is only possible via La Meva Salut, in a safe environment which guarantees confidentiality in communication. Citizens are authenticated each time they enter and the professional can only consult or respond from their work station; in this way, the information is stored in the repositories of the Health Dept. incorporating them into the electronic clinical history of each citizen.

This is a new channel of agile communication to resolve a citizen’s consultations in a virtual manner. Either the professional or the patient can begin a dialogue. The access of citizens to the health system is thus made easier and a solution is provided to a part of healthcare needs without needing to programme face-to-face visits, with the corresponding saving of paperwork and time this means for citizens and professionals.

Data used in eConsultation in Primary Care in Catalonia*

What do these two tools, La Meva Consulta and eConsulta, offer the professional?

We can answer this question briefly and clearly:

These tools represent a new model in the relationship with citizens where they are invited to participate in the care process and, moreover, have the possibility of adding information (via La Meva Salut)
The new channel of communication generated by these tools allows notifications and documents to be sent in a safe way and, ultimately, to establish a non-face-to-face type of relationship with patients. In models such as Kaiser Permanente in the United States, the number of face-to-face visits has been reduced considerably
Tele• Substitution of face-to-face visits with virtual visits such as the updating of the online medication plan, results of normal tests and the monitoring of some types of pathologies

As happens with any change, the inclusion of technologies in processes requires users to adapt to new uses despite these having clear benefits.

This new way of interaction between patients and the health system has come to stay as happened in other sectors, such as in banking, for example, where processes have been changed significantly.

On the other hand, technologies increase the levels of security of access to information, enabling alerts of pathological results to be generated, providing support tools to clinical decision making, improving the self-management of agendas with the use of eConsulta, substituting low added value tasks with others that require a clinical interpretation and dedication to patients that need more time and knowledge.

The challenge in Catalonia is the deployment of a new model of care that promotes the use of online services, with the objective – once implemented – of fundamentally changing the care process in health centres by empowering patients and achieving a safer medical practice.

With careful development and the joint effort of professionals and citizens, each one in their role, these services can be incorporated successfully into the organisation of healthcare.

Post written by Òscar Solans (@osolans), functionally in charge of eSalut (eHealth) in the Catalan Health Department.