Technology & procurement The Slovenian experience

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Melvyn Malone
5 years ago
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1 Technology & procurement The Slovenian experience Drago Rudel, MKS Ljubljana (subcontractor to SB-SG and RAV-KOR)

Patient s home Telehealth Centre 1 PATIENT

2 CHF service in SB-SG public hospital (target 200, curr. 92, rural area, pop , CHF, 800 in DB) Ongoing Health Coaching Patient s home Telehealth Centre 1 PATIENT TELEMONITORING DEVICES GATEWAY SERVER GENERAL PRACTITIONER DIABETOLOGISTS AT HOSPITAL OR LOCAL HEALTH DISTRICT 5 7 OTHER INVOLVED HEALTHCARE PROFESSIONALS 6 REGIONAL CENTRE S OPERATOR FAMILY DATA TRANSMISSION DATA ACCESS OPTIONAL CONTACT (DIRECT/INDIRECT)

Diabetes service at SB-SG (Target 400, curr.

) Patient s home Telehealth Centre 1 SERVER

GENERAL PRACTITIONER 5 DIABETOLOGISTS AT HOSPITAL

HEALTHCARE PROFESSIONALS REGIONAL CENTRE S

3 Diabetes service at SB-SG (Target 400, curr. 200, rural area, pop , DM pat. ) Patient s home Telehealth Centre 1 SERVER PATIENT TELEMONITORING DEVICE GATEWAY GENERAL PRACTITIONER 5 DIABETOLOGISTS AT HOSPITAL OR LOCAL HEALTH DISTRICT 7 6 OTHER INVOLVED HEALTHCARE PROFESSIONALS REGIONAL CENTRE S OPERATOR FAMILY 3 DATA TRANSMISSION DATA ACCESS OPTIONAL CONTACT (DIRECT/INDIRECT)

4 Terminal devices used in U4H PCS Device Type 210 Blood Pressure Meter Cignus TD Senior Line TM-TD3128 RR 210 Pulse Oxymeter Nonin Onyx II Weight Scale I.E.M Librograph 410 Glucometer Cignus Profiline TM-TD4279 BT 1 Ear Thermometer TD Thermometer 1 Asthma Monitor Vitalograph asma-1 (PEF/FEV)

5 Background No service at the SB-SG before U4H Subcontractor s experience in telecare (MKS) Clinicians decided to monitor CHF and DM patients Visits to telemedicine service providers in Italy and Austria (Renewing Health Televita,Trieste; Klagenfurt hospital) Decision -not to go for any development in the data transer chain An experienced telemed technology provider approached (HIS) A need for a design of our own portal to handle data was recognised in advance developed by the subcontractor MKS All the decision proven to be good!

6 Towards obtaining the technology (1/2) Financial limitations of the Slovenian U4H partners - agreement on value for money made before joining the U4H proposal Aware of potential huge delay if entering a public procurement Searching for alternative solutions on the national level considering different scenarios An alternative legal way choosen: a consortium formed to introduce telemedicine services beyond the duration of the U4H Study of possible financial arrangements with the potential solution provider (HIS)

7 Towards obtaining the technology (2/2) Tests of the technical solution before any agreement made with the potential provider (demo suitcase) All technology components provided by a single supplier (HIS) major potential incompatibility avoided Minor adjustment to the technology solution implemented within the test period Agreement with the solution provider to enable the solution adjustments e.g. data FWD to our own hospital server Mostly all things turned positively: financial and technological

8 Telemedicine service implementation at SB-SG SB-SG decided to go for new services delivered outside the hospital although having no experience SB-SG was found organsationally not ready for the new service Key people for CHF and DM involved determined to introduce new service to support the patients, although above standard emergency service had been in place Strong support from the hospital general manager Interna IT and technical sector not used to service external partners poor responsiveness (server, gateways, VPN, )

9 Gaitways Smart Phones Smart phone selection dilema and phone availability on a long term (several phone models in the scheme) Smart phone settings adjustment (too many apps on the phone simplification needed Locking of the settings and some functions needed (not integrated in OS) Smart phones not designed ergonomically for use by senior people many false commands when handling the phone

10 Challenge - Connectivity Data transfer costs choose an adequate package (smart phone used by patients also for other purposes 150 monthly bill for 1 patient) Upgrades to mobile OS needed that comes out costly Sometimes poor coverage with the mobile signal Patients want roaming when going to holidays to continue providing data

11 Measuring devices user perspective Differences between their own and the U4H measuring equipment : The measured values not always identical (glucometers - hypoglicemia), blood pressure meters with higher values Reliability of the measuring devices 10% drop-out with weight scales Frequent difficulties experienced with reliability with oxymeters

12 Recommendations 1. Select and exerienced technology provider the key solution elements should be ready, not in the development phase 2. Avoid open public procurement where the lowest price is the only criterion - select technology partners in an alternative legal process 3. A local technology support service to the sevice provider is crucial the technology could easylly be compromised or blaimed to cover a lack of readiness to fight obstacles 4. Thing about post-project period ethical issues open is the service is removed

13 CHF patient s daily results

14 DM patient s weekly results

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