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Adaptación de los profesionales sanitarios a las nuevas tecnologías 1 Tecnologías de la...
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H ospital de la Santa C reu iSantPau Adaptación de los profesionales sanitarios a las nuevas tecnologías 1 Tecnologías de la información, nuevos escenarios para la innovación Josep M. Picas Donosti, 18 de noviembre de 2010
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Tecnologías de la información, nuevos escenarios para la innovaciónJosep M. Picas
Donosti, 18 de noviembre de 2010
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Success Depends on Innovation and Innovation Depends on Information
Technology
Adam KolawaThe next leap in Productivity
2009, John Wiley & Sons
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Significant and sustainable improvements in the quality and efficiency of health and
social care can be obtained trough the procurement of R&D services that can
lead to solutions and technologies that do not yet exist and that will outperform the
solutions available on market
Accelerating the Development of the eHealth Market in EuropeeHealth Taskforce report 2007
European CommissionInformation Society and Media
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Health 2.0
It’s Up To You
Pieter Vos
Council for Public Health and Health Care
The Netherlands
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Healthcare providers, insurers and the government should make greater use of the social media in order to provide
information in a suitably transparent manner ……..
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9Encourage the use of Personal Health Records for the
purposes of self-management.
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Evolución de los sistemas de información:
• Plataformas IT
• Sensores
• Redes
• Super-computación / Cloud computing
• Internet-TV
http://discover.sonystyle.com/internettv/#/home
• La evolución de los programas informáticos
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Telenotícies TV3, 2 Octubre 2010
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HOSPITAL
A.P. H.CENTRO
ASISTENCIAPRIMARIA
ProcedimientosQuirúrgicos
Críticos
Urgencias
Procedimientos diagnósticos
PATIENT CENTERED“MEDICAL HOME”
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HOSPITAL
A.P. H.CENTRO
ASISTENCIAPRIMARIA
ProcedimientosQuirúrgicos
Críticos
Urgencias
Procedimientos diagnósticos
PATIENT CENTERED“MEDICAL HOME”
63.788 M€
1.421 € h/a
Fuente: National Health System of Spain, 2010. MSPS
Gasto Sanitario Publico en España
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HOSPITAL
A.P. H.CENTRO
ASISTENCIAPRIMARIA
ProcedimientosQuirúrgicos
Críticos
Urgencias
Procedimientos diagnósticos
PATIENT CENTERED“MEDICAL HOME”
63.788 M€
1.421 € h/a
Fuente: Nationall Health System of Spain, 2010. MSPS
Gasto Sanitario Publico en España
34.446 M€
54,0 %
10.015 M€
15,7 %
12.630 M€
19,8 %Farmacia
Procesos clínicos compartidos
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Accountable care organizations: A new idea for managing MedicareThe goal of ACOs is to encourage physicians and hospitals to integrate care by holding them jointly responsible for Medicare
quality and costs.By Jane Cys, amednews correspondent. Posted Aug. 31, 2009
Dartmouth Institute for Health Policy and Clinical Practice and the Engelberg Center for Health Care Reform at Brookings Institution
The ACO also would need a designated administrator and a formal organization that could serve as a point of contact, work with
payers, monitor performance and collect any shared savings. The physicians, hospital and other ACO members would need to agree
on how to divide any earned bonuses.
ACO: Accountable Care Organizations
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ACO: Accountable Care Organizations
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Medicina Personalizada
Genómica
Gestión de enfermedades crónicas
T. I. C.
Empowerment
Hospital + Big Farma Liderazgo
clínico
ACO
Gestión Poblacional
Health Literacy + Pacientes Expertos
Proyectos de Comunicación Audiovisual:
- Internet, TV
- Health2.0
- m-health
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Knowledge Center
as a driver of innovation at Sant Pau University Hospital
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Center of Biotechnological Knowledge and Industrialists Demonstrator for Innovation in Public Health
Sant Pau - Knowledge Center (SP-KC)
Funded: 1.3 M Euros:
NATIONAL PLAN OF SCIENTIFIC RESEARCH, DEVELOPMENT AND TECHNOLOGICAL INNOVATION (2008-2011)
• Platform of Innovation - Mission
• To improve patient care by facilitating collaboration among patients, scientists, engineers/technologists and clinicians
• To catalyze the discovery, development and implementation of innovative technologies
• Emphasizing minimally invasive approaches, e-health and primary care
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• The need and the opportunity – Sant Pau’s Knowledge Centre (SP-KC)
► A ‘Multi-tasking Simulation Environment’
> an area that could simulate one or more real-world health-related settings, allowing rigorous testing and rapid improvement of eHealth innovations before they are introduced into real environments
> equipped with high-capacity graphic workstations with supercomputing and server capabilities, data gathering equipment (cameras, video network processors, etc.), high-quality printing devices, complete hardware for the simulation of various modular environments, testing and observation rooms, and work stations.
► A ‘Demonstrator Area’
> Space for the demonstration of the products generated in the laboratory itself or transferred to industry or other researchers who wish to convene its products and its customers / audiences in an environment of health validation
‘e-Health
• Laboratory
• Demonstrator
Simulation
• Citizens
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e-dis. Disphagia Tele-Rehabilitation
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Background
► Prevalence of oropharyngeal functional disphagia is very high in patients with neurological disease:
• > 30% of patients having had a CVA.
• Parkinson’s disease: 52-82%.
• It is first symptom for 60% of patients with ALS.
• It affects 40% of patients with myasthenia gravis, up to 44% of patients with MS.
• Alzheimer’s disease: 84% of pts.
• More than 60% of elderly institutionalized pts.
Buchholz DW: Dysphagia associated with neurological disorders. Acta Otorhinolaryngol Belg 1994; 48(2):143–55.
Clavé P. et al. Approaching oropharyngeal dysphagia. Rev Esp Enf Digest 2004; 96 (2): 119-31.
e-dis. Disphagia Tele-Rehabilitation
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► The most common consequences are:
Malnutrition, with a high prevalence in these patients.
Tracheobronchial aspiration, which is the main cause of mortality.
► Oropharyngeal dysphagia in long-term care: misperception of treatment efficacy. Campbell-Taylor I. J Am Med Dir Assoc. 2008;9(7):523-31.
► Martin B et al. The association of swallowing dysfunction and aspiration pneumonia. Dysphagia 1994; 9(1):1–6.
► Smith Hammond CA, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia; ACCP evidence-based clinicalpr actice guidelines. Chest 2006;129:154S–168S.
Background
e-dis. Disphagia Tele-Rehabilitation
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► The system e-dis is a telemedicine application that aims to replace a part of the treatment of oropharyngeal dysphagia through the use of ICTs.
e-dis. Disphagia Tele-Rehabilitation
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Why exercise with?
It exits evidence that swallow musculature increase strength/tone with non-swallow exercises and increased strength/tone translates into improved function.
• Clark H: Therapeutic exercise in dysphagia management: philosophies, practices, and challenges. Perspectives on swallowing and swallowing disorders. Newsletter for the Dysphagia Special Interest Division of the American Speech-Language-Hearing Association 14(2):24–27, 2005
• Logemann J: The role of exercise programs for dysphagia patients. Dysphagia 20(2):139–140, 2005.
• Robbins J et al. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53(9):1483-9.
• Burkhead LM et al. Strength-Training Exercise in Dysphagia Rehabilitation: Principles,Procedures, and Directions for Future Research. Dysphagia 2007; 22: 251–65.
e-dis. Disphagia Tele-Rehabilitation
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How e-dis works?
Patients watch a video where the doctor performs the exercises and gives specific instructions for proper performance.
e-dis. Disphagia Tele-Rehabilitation
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e-dis. Disphagia Tele-Rehabilitation
How e-dis works?
Patients tape videos making exercises and send them through e-dis system
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e-dis. Disphagia Tele-Rehabilitation
How e-dis works?
Therapist watch the patient’s videos and send feedback to them
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e-dis. Disphagia Tele-Rehabilitation
Pilot Study Results: General health perception
Your health today
The best imaginable
state of health
The worst imaginable
state of health
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e-dis. Disphagia Tele-Rehabilitation
Presential
► Videofluoroscopy: 381,25 €
► Dysphagia clinical evaluation and treatment: 146,80€ x pt
► Transportation if needed x 15 days.
Distance treatment► Videofluoroscopy: 381,25 €
► Dysphagia clinical evaluation and treatment:
> 19,57€ (2 inhospital visits).
> 1 therapist / 2 pts: 63,61€
> Total cost: 83,18€ x pt
> Transportation if needed x 2 days.
► Computer: 304,99€
► Modem + internet connection: 30€/month
How much costs a dysphagic pt?
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Patient
Therapist
Projects in development & assessment
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Projects in development & assessment
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Last challenge: e-blood Living Lab
Simulator for theoretical assessments.
Blood Bank
Blood Donor
Patient
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ConclusionR2R methodology for e-Innovation
Market
Multidisciplinary Research
Medical / Business / Technology
Health System and authorities
Users of Services
Hospital
Primary Care
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En resumen:
• Necesidad de dar respuesta a una demanda creciente y exigente, caracterizada por el cambio de modelo epidemiológico (enfermedad crónica), en un entorno de graves dificultades en el financiamiento sanitario
• Cambio real ( virtual...) en el modelo de financiación
• Las dificultades de una correcta aplicación de las herramientas tecnológicas
Para acabar: dos reflexiones (una de ellas muy amarga)
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47La Vanguardia, 16 d’octubre de 2010
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48
http://www.lavanguardia.es/politica/noticias/20101003/54014268215/la-republica-de-las-aceitunas
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49
Ho
spita
l de
la S
an
ta C
reu
i S
an
t P
au
Ad
ap
taci
ón
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los
pro
fesi
on
ale
s sa
nita
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a la
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ue
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tecn
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gía
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50
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