Home Based Telemedicine: for CHF or COPD. Second Opinion for General Practitioner:

Transcription

1 TELEMACO PROJECT: TELEMEDICINE FOR THE SMALL TOWN HALLS IN LOMBARDIA S.Scalvini, ^P. Zanaboni, P. Bernocchi, *C. Tridico, + G. Borghi, ^C. Masella Telemedicine Service, IRCCS-Fondazione Salvatore Maugeri, Lumezzane (BS), Italy; ^Dep. of Management, Economics and Industrial Engineering, Politecnico di Milano, Italy; + Cefriel, Milano, Italy; *Lombardy Region - Health Care Directorate, t Milano, Italy Luxemburg, 6-8 April 2011

2 Introduction The Telemaco project is integrated in a context of Measures es to support the small ds districts cs of Lombardia a Region, to opposite the depopulation phenomenon and the abandonment of territory. The Telemaco project was born in order to realize a telematic network for the General Practitioners in some territory in Lombardia region with small village with 2000 people maximum and to give them the possibility, 24 hours a day, of monitoring the chronic diseases of their patients using some mobile devices.

3 Districts included in the project

4 Services Home Based Telemedicine: for CHF or COPD patients after hospital discharge with a nurse tutor and a 24-h Service Second Opinion for General Practitioner: Cardiology, Dermatology,Diabetology and Pneumology Images teleconsulting: teleconsultation on digital images between rural hospitals and high specialised hospitals for traumatic brain injury and stroke.

5 Method For each program, a detailed clinical protocol has been approved by all clinical participants. An experimental reimbursement has been also introduced d to support the economic sustainability and the routine clinical l practice.

6 The specific objectives for the implemented telemedicine services are: 1. To improve clinical effectiveness and quality of life; 2. To reduce unnecessary hospital admissions; 3. To improve accessibility to secondary care in rural areas; 4. To verify the users satisfaction; tif and 5. To promote telemedicine networks involving governments, local healthcare providers, specialised hospitals, small and rural hospitals, GPs and external Service Centres.

7 Hospitals General Practitioners Pti Patient t at th home Service Centre Nurse triage Specialists

8 Telematic support Telemonitoring (scheduled call for collection of clinical data and biological signals, i.e. ECG, blood pressure) Telemonitoring (unscheduled calls for evaluation of symptoms and/or ECG) Tl Teleconsulting lti (each calls requiring a second opinion by a specialist) CLINICAL HEALTH RECORD ECG TRACING

9 Atrial fibrillation One lead ECG recording Complete A-V Block

10 Oxygen saturation for COPD patients for 24 h

11 Home based Telemedicine: flow-chart Specialist Patients Telework Service Centre Nursing triage

12 Home based Telecardiology in chronic heart failure AO Bolognini Seriate AO Spedali Civili Brescia AO Chiari AO Lecco AO Pavia AO Valtellina Valchiavenna ASL Vallecamonica AO Macchi Varese TOTAL Started from 19/07/ /02/ /01/ /01/ /05/ /04/ /03/2007 / 16/11/2007 Patients enrolled

13 Home based Telepneumology in COPD patients Started from: Enrolled patients AO Bolognini Seriate Fondazione Salvatore Maugeri Lumezzane AO Chiari AO Pavia AO Valtellina Valchiavenna ASL Vallecamonica AO Macchi Varese TOTAL 19/07/ /02/ /01/ /05/ /05/ /02/ /04/

14 Second opinion for GP GP Service Centre Specialists

15 Second opinion for GP: telecardiology The General Practitioners received a portable 12 leads electrocardiographer which can be interfaced with a fixed or a mobile telephone. The ECG trace, recorded d anywhere in the territory, either in emergency or elective circumstances, was transferred, in real time, to the receiving station where the cardiologists (with teleworking procedure) were available for the ECG referral and for an interactive teleconsultation.

16 Second opinion for GP: teledermatology Teledermatology handles pictures taken by digital camera with at least 3 Mpixels resolution boxes

17 Second opinion for GP Cardiological Dermatological Diabetological Pneumological Total

18 Second opinion for Radiological Images The patient arrives at the Emergency Department Radiological images are executed Using a PACS system, the digital radiological images can be transferred on Service Centre The Service Centre actives the workstation where the specialist can display and process the radiological images; after this, in a teleworking model the teleconsulting can be done. The ED doctor of the remote hospital and the radiologist of the principle p hospital can see each other speak together and act in a real time on a common board of diagnostic images each one with own pointer. At the end of the teleconsultation eco tat o the radiologist og send the referral ee to the ED.

19 Teleconsultation lt ti on Digital it Images Started from: Second Opinion ASL Vallecamonica - Poliambulanza Brescia AO Macchi Varese 24/11/ /09/

20 Others Cardiological Second Opinion and teleconference for Echocardiogram Started from: GP Second Opinion ASL Vallecamonica November Pneumological second opinion with spirometry Started from: GP Second Opinion ASL Lecco May

21 Problems reported In general: Provide flexible telemedicine systems that offer , voice, image, fax are preferable; Equipment: must be reliable and tested to ensure high-quality connection in a variety of circumstances. Insufficient i training i for users: Clinical i l training i was inadequate to persuade physicians to use telemedicine in their practice Protocols for telemedicine consultations not clearly established Guidelines: Develop uniform clinical practice guidelines and train providers. Many others..

22 Conclusion TELEMACO provided good evidence of the benefits of specific telemedicine services. After the project ended, regional health authorities decided to support the continuation of those services for rural communities into a large-scale telemedicine program named Nuove Reti Sanitarie (