DITIS:

VIRTUAL COLLABORATIVE TEAMS

FOR HOME HEALTHCARE Andreas Pitsillides1, Barbara Pitsillides2, George Samaras1, Eleni Christodoulou1

1University of Cyprus2PASYKAF

http://www.ditis.ucy.ac.cy1

Agenda

The problem and the need - General Scope DITIS history and funding Added value DITIS Architecture Qualitative and Quantitative impact Problems faced Participation and usage of service Lessons learned Accomplishments Enhancements and Future goals

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PASYKAF HOME-CARE Coverage island wide

Cancer centre (located in Nicosia)

Hospice (located in Nicosia)

Government Hospitals located in main cities (oncologist once a week)

Since 1994

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DITIS idea: Support virtual collaborative team through IT

Co-operative model ofthe caring team

•patient and •family

•nurse(s) •general•practitioner

•social •worker

•pain •consultant

•priest

•psychologist

•hospital (records)

•oncologist•physiotherapist

•others that •may join •the team (e.g. •surgeon, radiologist)

•volunteer

•Palliative•care specialist

Short Film

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DITIS - Goal

Improve citizens’ quality of life for both healthcare provider and patient.

Support the healthcare team for a more effective service in the homecare. Continuity of care, everywhere the patient’s is with

the use of a common electronic health record. Access of information from anywhere - anytime Fast and effective decision making from

collaborative healthcare teams that are not in the same physical place (Virtual Teams).

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Supporting Organizations

Initiators / Drivers

Main Supporters

UCY Development of the system software,

UCY has an active policy for spinning off technology, spin-off company - System maintenance, operational support, hosting service

PASYKAF End user, medical know-how provider, mediator

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CYTA Telecom infrastructure provider

Oncology Centre End user

DITIS History

1996 – The initial idea for cancer patients care is presented in a conference 1998 – Work initiated, RPF Grant 2000 – DITIS I deployment starts at PASYKAF 2002 – Goals set for phase II 2003 – Microsoft Research Labs grant

2003 – Larnaca fully supported by DITIS operation

2004 – Successful grant application for DITIS continuation 2004 – All district offices main data entered, users are trained 2005 – Larnaca team starts testing DITIS as true virtual collaborative team 2005 – Direct connect with the Bank Of Cyprus Oncology Center 2006 – DITIS connected with cardio patients of polyclinic LITO

through 2 EU projects

2009 – Cyprus wide use of DITIS PMS system

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DITIS - Funding

Overall Budget > 1.5 Million Euro

RPF Grant 1999-2001 RPF Grant Continuation 2004-05 The Cyprus Development Bank 2001 Microsoft Research Labs Cambridge 2003-04 (First funding

for research project in the area) University of Cyprus (from 1999 till today) PASYKAF – Technical knowledge and pilot run (from 1999

till today) CYTA – infrastructure (from 1999 till today) 2 EU E-Ten projects adopting DITIS technology (2005-2007) Other support

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Added Value

A comprehensive solution that brings state-of-the-art mobile technologies in support for emerging healthcare practices focusing on virtual healthcare team collaboration

Rich functionality, highly adaptable user interface, secure communication, open and highly interoperable system

Enables increased efficiencies that can translate in high quality service and lower costs

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Nurse

Oncologist

Physiotherapist

Social Worker

Cell Phone

Pocket PC

Tablet PC

Desktop PC

Notebook

Internet

DITIS Database

Patients e-Records

Security

Radiologist

Local Area Network 1ADSL Modem ADSL Modem

Local Area Network 2

DITIS Architecture Overview

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Main System Components

A variety of options for system role based access using Desktop (any PC with Windows OS) Mobile Devices

Web-based (any phone with a web browser capability)

Standalone (smart phones such as the SonyEricsson P910, the QTec)

System components are built to support these through tailored secure role-based interfaces

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DITIS Features

1. Comprehensive and Customizable Patient Management System (PMS)

2. Collaboration Engine

3. Communication Engine; includes Messaging and Alert Service

4. Application-specific Auditing

Cancer Cardio

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A rich user interface for desktop component

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Screen Shot

Extensive Reports

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Example printout

Can provide comprehensive reports, including summarisation, but also drill down to detail, e.g. printouts of patient continuations

Mobile Device access

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Access to patient information, including on the spot entry, plus customised team collaboration software

Benefits - Qualitative Impact

For the patient – quality of life Opportunity to stay at home – Resting assured that should a

change in condition occurs, the entire team is virtually there For the healthcare professional – continuity of care

improved communication and collaboration 24/7 access to patient information tools for decision making

For the home care provider organization – evaluation audit and statistics to help with planning, training and research can support lobby for more support

For the healthcare system at large – directions for better healthcare Opportunity to gather vital statistics that help with policy making

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Benefits – Quantitative Impact

Regarding Cancer patients is Cyprus: Paper case study of potential homecare savings

Indicative yearly cost without homecare (hospital based): 1.344.747 Euro

Number of patients: 210 Cost per month per patient in the hospital: 1067 Euro Reasons

Indicative yearly cost with home care (for similar level of care): 124.882 Euro

Number of patients: 210 Number of visits: 4000 Cost per visit: 31.22 Euro

Above estimates exclude medicine expenses

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Quantitative Impact of DITIS Indicative yearly running cost estimates without DITIS:

Total cost per nurse (excluding overhead): 53,570 Euro

Indicative yearly running cost estimates with DITIS (approx. savings: 40%): Total cost per nurse: 35,141 Euro

Cost per nurse (excluding overhead): 32,141 Euro Yearly maintenance, operational support, hosting, Telecom and Internet access cost: 90,000 Euro. For PASYKAF considering 30 professionals the cost per nurse is estimated at 3000 Euro per year

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Quantitative Impact of DITIS

Cost savings are due to reduction of:

healthcare staff unnecessary visits to the head office

preparation work prior and after the visit in the head office

Access and updating patient data

communication/collaboration time among healthcare staff

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Level of system adoption

Patient Management System (PMS) – considered essential adopted by PASYKAF Cyprus wide 6 years after development and 3 years of

paperless operation in Larnaca office achieves paperless operation full functionality is yet to be realised

Mobile access – considered beneficial has been used in many instances when access on the spot was necessary only then has it been considered an essential component by the end-users BUT trust on availability not present at the moment to allow full reliance

Collaboration aspect – has potential potential confirmed by small scale pilot but, to be used organisation-wide

need to have PMS and Mobile access fully adopted and used (by the whole team)

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Participation and usage of the servicePatient Management System (PMS) aspect

PMS system in full use (Larnaca): 2004 PMS system in full use (Cyprus wide): 2009

Patients (seen by nurses) Services (provided by nurses)

2003 2005 2009 (Mar) 2003 2005 2009 (Mar)

September 68 75 133 383

October 78 86 124 404

November 86 93 131 417

December 88 96 126 366

March 447 1541

22Paperless status achieved Cyprus wide now

104 villages

Usage of collaborative aspect of DITIS

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Currently, has not reached its full potential (despite pilot shown potential benefits):

Inhibiting factors in adopting full collaborative model include:

Technology Telecommunication infrastructure; lack of island

wide, predictable connectivity, whenever needed Mobile device technology still immature Mobile device display (perhaps) too small,

especially for admission -- new NetPC devices appealing

Constant need for device (and sometimes program) upgrade - costly

Usage of collaborative aspect of DITIS

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Human factors Training took longer than anticipated Management and staff commitment for uptake

was initially slow

Cost Lack of funding (relied on external research

grants) Can be prohibitive. Need to divert hard earned

money to a system whose benefits cannot be fully quantified upfront, with also some risk with regard to its uptake

Problems faced

By Health Professionals Clinical working process reorganization High user expectation and ‘lack’ of understanding of

complexity of implementation Healthcare team high workload No funding for a dedicated health professional to be

involved fully in its development Health professionals phobia of technology (easing

off)

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Problems faced

By Health Professionals Constant upgrade requiring technology change and

re-training Healthcare team often not able to manage IT

problems Time taken in developing TRUST between the (virtual)

team members as well as team members and technology

Missing Legal framework for ePrescription Missing link to other healthcare systems, e.g.

Oncology centre and government hospitals

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Problems faced

By Management

Management commitment slow -- essential in adopting policy and ‘enforcing’ its use

Never had ‘luxury’ to set up a proper deployment strategy

Patience (!?) --- it took 6 years to adopt PMS by all -- this figure, however, could had been much less

Perseverance (especially during the trial phase)

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Recall Electronic Health Record example from UK – it turns out to be extremely complex

Problems faced

By IT Team

Unreliability of Telecommunications infrastructure (GSM/GPRS)

Constant technology change requiring upgrade of system, re- education of Health Care Professionals, financial input of new hardware

Substantial IT support to medical personnel in different districts

Research funding limitations (small local govt. grants / sponsors)

Research associates high resource investment and constant staff turnover

Commercialization of system

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Concluding remarks

DITIS has changed clinical work processes at PASYKAF more efficient and effective

Improved Quality of life for both patient/family as well as health professional allowing a more flexible workload

Availability of audit not previously available

The implementation would have been easier and more efficient had their been

Continuity and adequate level of funding

Dedicated health professional to advice IT team

Healthcare team had their own IT support within the organisation

User involvement from the very first development stage

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Accomplishments

Adoption by PASYKAF. Paperless operation in Larnaca since 2005 and now Cyprus wide

Used in 2 EU funded e-TEN market validation projects (HealthService24, LinkCare) for cardiac patients

Proposed as the software to be used by Ministry Of Health homecare pilot program Proposed as the software to be used for homecare of patients with acute respiratory failure (Nicosia hospital)Finalist at the 2003 eHealth Ministerial Conference

7th at the WSA competitionThe only non-IST funded project participating in the cluster project MEMOCambridge Microsoft Research Labs grantPublications, book chapters, conference presentations 30

ENHANCEMENTS and FUTURE GOALSIntegrated Homecare Monitoring PlatformMultiple types of Homecare services

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Promising solution This is the reason we continue to work so hard to keep people at home

We KNOW DITIS can make the work more efficient while offering continuity of care to people at home.

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Questions

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Sponsors

Other Sponsors

www.research.org.cy

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NetPC example

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Price from a few hundred Eurofits right in your purse.

Model Features: 8" display with XBRITE-ECO™ LCD technology, 2GB RAM, 60GB HDD, 1.5 lbs., GPS, integrated mobile broadband (3G)

Electronic Health Record UK example

‘Just a few weeks ago, Martin Bellamy, head of the National Health Service (NHS) National Programme for IT (NPfIT), the UK's national electronic health record implementation program, was promising

that by this time next year, EHR systems will be routinely delivered to NHS hospitals.’

Posted by Robert Charette on May 6, 2009 10:30 AM

UK Electronic Health Record Roll-out Causes Pain

"Heartache and hard work." That is how Andrew Way, chief executive of London's Royal Free Hospital, described the hospital staff's experiences with the electronic health record (EHR) system that it received under the UK's £12 billion plus National Health System's (NHS) National Programme for IT.

Posted by Robert Charette on February 15, 2009

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Supplementary slides

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Database

DITIS Modularity

DesktopModule

MobileModule

WebModule

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DITIS Modules

1. Desktop Module Full functionality Multi-modal user-friendly interface User customizability

2. Web-Mobile Module (any browser enabled device) Customized functionality (for organization’s needs) Light interface (capable to load on mobile devices)

3. Standalone Mobile/Smartphone Module Customized functionality (for organization’s needs) User-friendly interface Offline local database

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A rich user interface for desktop component

Screen Shot

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Desktop Module

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Web Module

Nurse

Doctor

Oncologist

Patient

…

Login Page Internet

Nurse Interface

Doctor Interface

Oncologist Interface

Patient Interface

Secure Connection

Sessions

Sessions

Sessions

Sessions

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Web Module

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Standalone Mobile/Smartphone Module

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Alert Service (SMS)

Medicationmanagement

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Mobile Device access

Web Module

Nurse

Doctor

Oncologist

Patient

…

Login Page Internet

Nurse Interface

Doctor Interface

Oncologist Interface

Patient Interface

Secure Connection

Sessions

Sessions

Sessions

Sessions

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DITIS Collaboration

1. Collaboration is achieved using the following components

1. Virtual team management

2. Workflow engine

3. Collaboration engine

4. Messaging service management

5. Alert service

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Workflow Engine

Incorporates organization specific actions into DITIS

Actions are recorded in DITIS through an organization administrator

Automatically executed in some scenarios

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Alert Service

Alerts are sent to both patient and personnel according to the needs of the organization

Three types of alerts so far: Appointment alerts

Notify the personnel and patient for an upcoming appointment Medication alerts

Notify the patient that he must take his medication Diary alerts

Notify professional if a symptom exceeds a predefined threshold

Options for turning the alerts on and off

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