workshop 10 "Addressing demographic change:
a socio-economic challenge and opportunity for Europe“
Presentation of the Telemaco case in Lombardy
Gabriella Borghi
Brussels, 16 June 2011
Project
TELEMedicina Ai piccoli COmuni lombardi – Telemedicine for small municipalities
Innovative models of care supported by telemedicine
TELEMACO is defined in the context of the Regional Law n°11/2004 “Measures to
support the small municipalities of the Lombardy”, addressed to contrast the
phenomena of depopulation and desertion of the territory (art.1), that interest many
of the municipalities (up to 2000 inhabitants) in situation of socio economic and
infrastructural difficulty.
Objectives
– To develop the use of telemedicine and ICT to assure continuity and quality of
care and to make more efficient, appropriate and accessible the innovative
services
– To test and evaluate the results of different research projects in remote areas
– To involve health professionals, local communities, research institutes and
private ICT industries
www.telemaco.regione.lombardia.it
16 June 2011
DIREZIONE GENERALE SANITA’
2
Involved Areas in Lombardy
ASL
• 8 Local Health
Authorities(ASL)
• 19 Districts
• 9 Health
Corporations
Bergamo
Brescia
Varese
Brescia
• Distretto Alto e
Medio Lario
Lecco
• Distretto Bellano,
sub area Valsassina
Pavia
• Distretto Oltrepo
Varese
Hospital
16 June 2011
TELEMACO
• Distretto Alta Valle
Seriana e Val di
Scalve
• Distretto Garda
• Distretto Oglio
Ovest
• Distretto Monte
Orfano
• Distretto Bassa
Bresciana Occident.
• Distretto Valle
Sabbia
• Distretto Valle
Trompia
Como
Sondrio
Pavia
Areas
Vallecamonica
Sebino
•
•
•
•
•
•
•
•
•
Distretto Bormio
Distretto Chiavenna
Distretto Tirano
Distretto Arcisate
Distretto Azzate
Distretto Cittiglio
Distretto Luino
Distretto Varese
Distretto
Vallecamonica
Sebino
3
Telemedicine for small Municipalities
FUNDING
Total cost
€ 3.436.064,84
MINSA
MIT
LOMB
RTI (Temporary Grouping of Companies)
€ 1.600.000,00
€ 450.000,00
€ 1.386.084,84
European call for
tender
• Improve services for citizens located in
remote areas
• Reduce the “distance” between citizen
and HealthCare services
• Assure continuity and quality of care
• Define indicators for evaluation
16 June 2011
DIREZIONE GENERALE SANITA’
TELEMACO
Start 10.04. 2006
End
10.09. 2010
4
Health Care Services
Home care
Telesurveillance for
CHF patients
Teleconsultation
on CT and video
between Hospital
for stroke and trauma
Involved:
8 Local Health Authorities
9 Public & Private Health Corporations
19 Social - Health Districts
More than 200 Municipalities
About 400.000 inhabitants
Specialist opinion for
GP (cardio pneumo,
dermo and diabetic)
Home care Telesurveillance
for COPD patients
CHF - Chronic Heart Failure
COPD - Chronic Obstructive Pulmonary Disease
GP – General Practitioner
CT - Computerized Tomography
16 June 2011
Services
Closed at
9.9.2010
Home care
Telesurveillance
for CHF patients
N° patients
166
Home care
Telesurveillance
for COPD patients
N° patients
474
2nd opinion for GP
Teleconsults
5.350
Teleconsultation
on CT and video
Teleconsults
105
DIREZIONE GENERALE SANITA’
5
Training and Assessment
Training Model: Training on the field, workshops, technical training
Assessment Model
Based on minimum data
set and questionares
Clinical
Indicators
Organizational
Economic
Based on customer
satisfaction
Based on amount of
activities tracked by the
project database
stakeholders
Assessment
services output
16 June 2011
DIREZIONE GENERALE SANITA’
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Benefits
Telesurveillance Services - Customer satisfaction
Maximum rate 5
Assessment Areas
Service overall evaluation
Technology evaluation
Perceived impact of the service
PTS
mean ± SD
COPD
mean ± SD
4.9 ± 0.4
4.8 ± 0.3
4.2 ± 0.5
4.7 ± 0.7
4.8 ± 0.3
3.9 ± 0.6
PTS - Home care Telesurveillance for CHF patients
COPD - Home care Telesurveillance for COPD patients
16 June 2011
DIREZIONE GENERALE SANITA’
7
Benefits
2nd opinion for GP - cardio - Sample of service cost
Every teleconsultation leads to a saving of about 13 €, due
to a reduction in the number of in hospital visits and
hospitalizations
Balance
16 June 2011
Teleconsultation
+ € 86.940,00
Specialist Visit
- € 121.430,10
Hospitalisation
- € 28.350,00
Total Cost saving
- € 62.840,00
DIREZIONE GENERALE SANITA’
8
From Projects to Services
From TELEMACO to NUOVE RETI SANITARIE – Regione Lombardia with d.g.r. n.
IX/409 dated 05.08.2010 confirms the deployment of TELEMACO services through
Nuove Reti Sanitarie to ensure the continuity of care in remote areas.
REGIONAL DEPLOYEMENT
EXTERNAL
FUNDING
RESEARCH
PROJECTS
GOVERNANCE AND
MONITORING
REGIONAL
FUNDING
TELEMACO
REGIONAL PROJECT
EXPERIMENTAL
REIMBURSEMENT
16 June 2011
DIREZIONE GENERALE SANITA’
NRS
SERVICES
9
Funding Models
Telemaco
Telemedicine for small municipalities
• Regional authorization for
healthcare providers (Hospital)
• European Call for tender
Start
• RTI (Temporary Grouping
of Business) winner for the
Manage
call
ment
Funding
Activities
• Pubblic and Private
Hospital Authorized
• Regional experimental reimbursement
and management
• National and Regional
Funding for RTI
• RTI must
• Define and structure and implement
the services
• Assure management, training and
assessment of the project
16 June 2011
NRS - Nuove Reti Sanitarie
New healthcare networks
•Hospital must:
•respect quality criteria (including technical and
organizational requirements and data security)
•involve patients, General Practitioners and Service
Centres
•Assure the collection of clinical and organizational
data
DIREZIONE GENERALE SANITA’
Start
Manage
ment
Funding
Activities
10
Strenghtness Evaluation
These services provide additional benefits
to the care system thanks to:
Improved continuity of
care between hospital
and territory
Cost reductions in
accordance with the
imposed financial
limitations
High level of acceptance and
compliance of the enrolled patients.
Moreover, it has emerged a correct functioning of an organizational model based on
an integrated network of participants. In addition to the patients and their caregivers,
authorities, healthcare providers and Service Centres successfully participated to the
provision of the service.
Considering the Digital Agenda “Key Action 13: Undertake pilot actions to equip
Europeans with secure online access to their medical health data by 2015 and to
achieve by 2020 widespread deployment of telemedicine services”, Telemaco and
Nuove Reti Sanitarie have relevant points of reference with the goal of testing
telemedicine services on large regional territory.
16 June 2011
DIREZIONE GENERALE SANITA’
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