An integrated approach to health and social care services

In broad terms, 'Integrated eCare' consists of getting actors from healthcare and social care services to collaborate on multiple levels - from private doctors to public hospitals and from home carers to emergency centres for the elderly. They need to be structured efficiently, be aware of their specific roles in the value chain, and, most significantly, be able to effectively share information between them.

'Healthcare and social care services are often delivered independently today. This leads to inefficiencies, duplication of resources, and potentially to reduced quality of care,' explains Ingo Meyer, a research consultant at Empirica in Germany. 'Older people are particularly affected by this situation, since they often need both types of services, such as support with daily living activities and chronic disease management.'

Empirica coordinated a consortium of 11 partner organisations from five European countries in the project, 'Common platform services for ageing well in Europe'(COMMONWELL), a more than three-year initiative to develop and deploy integrated care models and supporting technology. The project, co-funded by EUR 2.68 million from the European Commission, proved so successful that the systems and services it developed are still being used at COMMONWELL's four pilot sites, and plans are underway to extend the integrated care model to other areas.

'The idea of integration between healthcare and social care goes back a couple of decades, but it is really gaining momentum now, in part because people are demanding more services and providers are realising that so much time and effort is being wasted because tasks are being performed in parallel by different providers - so the same things get done twice or other things get lost in translation, so to speak,' Mr Meyer says.

He points to the example of someone being discharged from hospital but the hospital failing to inform their home care provider that their bandages need to be changed the next day or a certain medication given at a certain time - oversights that can affect the patient's health and waste health and care providers' time, money and resources.

At the heart of COMMONWELL's solution are systems and technologies to greatly improve and manage information exchange between organisations. The model encompasses everything from establishing a protocol for email exchanges between hospitals and home care providers to sharing the output of home monitoring systems and linking it with patients' medical and social care data.

To address the technological challenges of getting different ICT systems to communicate, the consortium developed a modular software architecture that provides standard open integration points for collaborating systems to access and share information. Taking advantage of service-oriented approaches to systems design, the COMMONWELL architecture manages real-time and batched event and health data acquired from widely available modules - such as telemonitoring platforms in people's homes. The information is then made accessible to different actors over a series of COMMONWELL web services.

Protecting patient privacy

Crucially, the system is designed to isolate safety critical and non-safety critical elements, and protect patient data in line with data protection laws.

'Patient data is highly sensitive, and rules on who can see it and what can be done with it vary from country to country,' Mr Meyer notes. 'So for each of the pilot sites in Germany, Spain, the Netherlands and the United Kingdom we had to begin with a legal analysis and figure out ways to adapt the system and the sorts of data we could use and share accordingly.'

He points to the example of providing social carers with vital signs data from telemonitoring systems. In most countries only the patient's doctor, nurse or hospital is allowed to access this information. However, a workaround was found so that the system could automatically check the data to determine if the person's blood pressure or blood sugar, for example, is within the recommended parameters set by their doctor and let the social carer know that the patient's vital signs are ok. If something changes, the system can inform the carer immediately that for example their heart rate is too high, but without giving them access to the sensitive raw data from the monitoring system.

At pilot sites in Milton Keynes in the United Kingdom and Eindhoven in the Netherlands, the system was deployed to support health and social care providers treating people with 'Chronic obstructive pulmonary disease'(COPD) and 'Chronic heart failure'(CHF). The architecture and subsystems were primarily aimed at improving communication and collaboration between different providers, and in turn helping to reduce anxiety and improve health outcomes for people with chronic conditions and patients requiring support immediately after leaving hospital.

Coupled with telemonitoring solutions, the COMMONWELL system was used with hundreds of older people at both sites. Besides showing the potential to reduce so-called 'revolving door' hospital admissions, where a patient is discharged only to return to hospital a few weeks later, the better coordination and communication enabled by the COMMONWELL system resulted in a notable improvement in patients' sense of security, support, mental health and general wellbeing.

In Bielefeld, Germany, the COMMONWELL partners worked with Johanneswerk which provides social care services to around 550 people in the city. The organisation's nurses have to deal with about 100 to 150 hospital admissions and discharges per year, most of them to one specific hospital. Previously they used paper forms to provide patient data to the hospital - a time-consuming procedure. With the COMMONWELL system now in use, the information is digitised and shared automatically, reducing the complexity of hospital admissions so patients can get treatment faster and costs are lowered for providers.

And in Spain, COMMONWELL technology was deployed with ASSDA, the Andalusian government's social services provider, which currently operates one of the largest social care call centre in Europe with over 175,000 clients across the Andalusia region.

'ASSDA call centre operators would often have to deal with emergency situations, but in order to dispatch an ambulance to a caller's home, for example, they would have to hang up on the caller and relay their information by phone to the emergency services. This took time, and created a lot of anxiety for the caller as they had to wait for the ambulance service to call them back,' Mr Meyer says.

With the COMMONWELL solution in place, ASSDA operators are now able to send caller data, such as name, address and health condition, to the emergency services at the click of a button, saving potentially vital minutes for the patient, and reducing the workload on both ASSDA operators and emergency service dispatchers.

To operate continuously and sustainably over an extended period of time, the business model must be right - so COMMONWELL services underwent a rigorous cost-benefit analysis. In general, the system led to faster handling of emergency calls, more efficient patient admission, and more targeted service response. When calculating the socio-economic return of the system, the project found that there was a positive return that paid for the investment within around two years of starting the pilot.

The COMMONWELL system continues to be used at all four pilot sites, while a parallel project called 'ICT-enabled service integration for independent living' (INDEPENDENT) has sought to extend the integration model to include not just public and private health and social care providers but also volunteer organisations and informal carers. Empirica is also in the process of publishing a book, 'Beyond Silos -Achieving Effective Integrated E-Care Beyond the Silos', on the organisation's experiences in both projects and elsewhere in Europe that will address the challenges of establishing integrated eCare services and offer potential solutions.

In addition, a follow-up initiative, SMARTCARE, will involve several of the COMMONWELL partners and dozens of municipalities across Europe which are keen to adopt models of integrated care.

'Integrated care has been talked about for years, but it seems that with initiatives such as these, people are realising that it is time to take action and do it,' Mr Meyer says.

COMMONWELL received complementary funding under the European Union's Competitiveness and Innovation Framework Programme (CIP), under its ICT Policy Support Programme (ICTPSP).

Link to project on CORDIS:

- CIP on Europa
- COMMONWELL project factsheet on CORDIS

Link to project's website:

- 'Common platform services for ageing well in Europe' project website

Other links:

- European Commission's Digital Agenda website