Project Context and objectives

HEALTH OPTIMUM is a Telemedicine project co-funded by the European Community.
In most European countries, healthcare is fundamentally public funded and mostly public provided. Healthcare spending represents a major component of state budgets and currently it ranges between 5 and 10% of GDP in the EU Member States.
Today, EU Member States are engaged in an effort to contain the soaring costs of healthcare and, whenever possible, reduce them.
Measures put in place so far in order to contain such costs vary from the introduction of compulsory contribution by citizens towards the costs of the healthcare they receive to a progressive reduction of the service offered under the universal public health scheme.
All these instruments however are little more than stopgap measures to delay a degradation of the healthcare finances which is a direct consequence of a number of variables that no national or regional government controls: explosion of medical knowledge with the continuous introduction of new diagnostic
procedures and disease treatments, ageing of the population and increasing conscience of the right to high quality healthcare among European citizens.
To reverse the stream, more far-reaching reforms of the healthcare delivery systems must be considered. These have to critically examine the delivery system as it is today the result of over a century of organisational stratification and see what todays ICT can do to rationalise the delivery system in ways which were still unthinkable just a few years ago.
The HEALTH OPTIMUM project has validated a comprehensive suite of telemedicine services able to improve the perceived quality of the healthcare services provided and, at the same time, to reduce the costs related to their production and delivery. The Project has also evaluated the users’ acceptance of the services and validated a business model on which the HEALTH OPTIMUM Initial Market Deployment phase is based.

Services to be offered

The services tested and deployed are:

• Neurosurgical Tele-counselling and Tele-laboratory service in homecare;
• Tele-laboratory service in Haematology;
• Tele-counselling, Tele-laboratory and Shared medical record service for Radiology (service available for Uppsala);
• Tele-counselling for Haematology, Oncology and Nephrology;
• Tele-counselling, Electronic referral and Tele-laboratory for Neurophysiology (service available for Uppsala);
• Tele-referral for Cardiology;
• Tele-referral for endocrinology;
• Tele-counselling and Shared medical record for Plastic Surgery (service available for Uppsala);
• Tele-dialysis;
• Tele-thrombolysis;
• Tele-alcohol Rehabilitation;
• Tele-counselling, Electronic referral, Shared medical record for Dermatology (service available for Uppsala);
• Tele-counselling, Tele-laboratory and Shared medical record for Discharge teleconference(service available for Uppsala);
• Tele-counselling and Shared medical record for Oral and Maxillofacial Surgery (service available for Uppsala);
• Tele-coronary Arteriography.

The technology solutions used are different, depending on the specific telemedicine application, but they all meet the interoperability requirements complying with IHE guidelines.
The requirement of application interoperability was fundamental, together with the technological management of the patient documentation produced within the project. The project has carried out a trial of an Electronic Health Record (EHR) technical framework in which all data converge to make easier the exchange of information on advanced consultancy, and to help the search for surgery rooms and bed availability.

Areas of deployment

The “market validation phase” officially began in May 2004 and ended in January 2006. In this phase the countries participating were: Italy (Regione Veneto), Spain (Aragon) and Denmark (Funen). The phase tested some telemedicine services trying to assess them in a first operational field.
In the present phase, called “Initial Deployment”, the existing services and new ones will be deployed in five countries: Italy (Regione Veneto, as coordinator); Spain (Aragón); Denmark (Syddanmark); Sweden (Uppsala); Romania (Timis).

Impact

In Italy, the project representatives for Neurosurgical Tele-counselling and Tele-laboratory have worked first on the functional and technical architecture assessment. For Neurosurgical Tele-counselling they defined the reorganisation of the workflow using a telemedicine approach. A scientific work group defined the basic clinical data set necessary for counselling between peripheral hospitals and the main neurosurgical centre. In the Deployment phase the redefinition of processes and the application of Telemedicine services will be extended to the whole Region

In Spain, in the Deployment phase Tele-counselling will be applied to the following specialties: Oncology, Nephrology, Radiology, Ophthalmology, Haematology, Emergencies or Neurology, already trialled during the Market Validation phase.

In Denmark (Syddanmark) it has also been decided to adopt in the Deployment phase of the Project some of the HEALTH OPTIMUM services that were market validated in the other countries, in addition to those already validated in Funen. The two market validated services, Tele-cardiology and
Tele-endocrinology, will be deployed

Sweden (Uppsala) aims to extend and develop the following clinical areas, all belonging to the Plastic Surgery field: Wound Treatment, Burn Treatment and Breast Reconstruction. The most natural market is represented by the counties closest to Uppsala Hub structure today has agreements in place with all of them and this opens an easy way for the deployment of the HEALTH OPTIMUM services in the whole area covered by these four counties.

In the earlier stages of the Initial Deployment phase, Romania (Timis) will focus on implementing the Tele-counselling for Neurosurgery and Radiology. These are totally new services for Romania and represent a major challenge. In further stages of the Initial Deployment phase, Tele-counselling in Neurosurgery could be extended applying it both to other hospitals in the Timis County and to other clinical specialities.

The results achieved so fare are:

• decreasing mortality and morbidity by reducing transfer time and by improving the appropriateness of patient transfer;
• avoiding unnecessary transfer and reducing risks for patients requiring surgical intervention or sophisticated monitoring;
• improving the ability to rapidly diagnose serious injury for patients without transferring them to another hospital centre;
• rationalising the use of human and technological resources;
• establishing uniform levels of trauma care through the use of standardised protocols;
• guaranteeing equality of treatment to all citizens victim of a trauma, irrespective of where they live;
• improving communication between Primary and Secondary Care;
• releasing financial resources

Future perspectives

The expected outcome of this phase of HEALTH OPTIMUM Project is an operational system which is up and running in all the Regions and which is financially self-standing because it pays for itself through the savings that it releases in the routine delivery of healthcare.
Thanks to HEALTH OPTIMUM, Doctors are saving time, Public Healthcare Systems are saving money and patients are receiving better coordinated and better quality care.
By proving the benefits of telemedicine solutions and deploying them in pioneering trials the HEALTH OPTIMUM project has acted as a catalyst for the rollout of services to meet the challenges that public healthcare system are facing: the ageing population will increase demand for healthcare in the future meanwhile lower tax revenues due to a relative decline of the number of young people joining the workforce leads to budget cuts.

Duration of the Project

The project will last two years, from June 2007 to May 2009.

Funding source

Public funding EU, Public funding national, Public funding regional, Private sector

Project size

More than €10,000,000
Yearly cost: €5,000,000-10,000,000

Links

• Website
• eTEN portal
• ePractice portal

Themes

• Telemedicine
• e-health
• ict

Contacts: