NEXES - Living Healthily at Home

Acronym of the case:

NEXES

Web address of the case:

http://www.hospitalclinic.org

Country of the case:

Greece , Norway , Spain

City/region:

Catalonia (Barcelona), Central Norway (Trondheim), Attica (Athens)

Posting Date:

3 June 2008

Last Edited Date:

07 January 2010

Author:

Josep Roca (Hospital Clinic)

diagnostic | continuity | chronic

Type of initiative

Project or service

Case Abstract

NEXES grew from the need to unfold pilot experiences for integrated and innovative healthcare services. It is aimed at citizens at risk and with chronic illnesses. The main objective of the project is to evaluate the potential of generalising these services in the healthcare system. The project fits with the European dynamic of adapting regional healthcare services to the challenges posed by demographic and lifestyle changes and the increased prevalence of chronic illnesses. ICT play a fundamental support role in the new healthcare model. The project plans the controlled deployment and evaluation of four types of innovative services: Wellbeing and physical training; Care for fragile patients; Home hospitalisation and early discharge, and Diagnostic and treatment support.

Description of the case

Domain

eHealth

Topic

Decision support systems | Health risk management | Regional/national Health Information Networks

Sector

Healthcare | Social Services

Date

May 2008 to April 2011

Date operational

January 2010

Target Users

Health professionals

Target Users Description

Public and private healthcare/ social care providers implementing integrated models for service delivery. This modality of services is to provide better outcomes to patients with chronic conditions or to citizens at risk (primary prevention model). Doubts remain on how to address organisational factors so that full deployment can be carried out successfully. The project phase of NEXES will explore these barriers through a range of randomised clinical trials summing up more than 5000 patients.

Scope

Regional (sub-national)

Status

Research

Language(s)

Greek | Norwegian | Spanish

Other

Catalan

Policy Context and Legal Framework

The services foreseen in the project operate under the legislation of each of the member states. Diversity of these frameworks will be explored during the project phase. Some grey areas regarding shared responsibility among professionals will also be studied.

NEXES will be developed at a European level in 3 areas (central Norway, Athens and Catalonia). In Catalonia, the project management monitoring (NEXES- Living Healthily at Home) will be done by a commission appointed by the Health Department of the Catalan Autonomous Government.

One of the important objectives of the project is to identify leadership qualities in Catalonia in order to stimulate territorial expansion of innovative integrated care services as validation results continue to be generated. We hope to establish collaborations with other Spanish autonomous governments. At a European level, the Linkcare Alliance will also stimulate these types of dynamics.

Project Size and Implementation

Type of initiative

Inclusive services of general interest

Overall Implementation approach

Partnerships between administration and/or private sector and/or non-profit sector

Technology choice

Proprietary technology | Standards-based technology | Open source software

Funding source

Public funding EU | Public funding regional

Project size

Implementation: €500-999,000

Yearly cost:

€49-299,000

Implementation and Management Approach

The delivery model assumes that integrated care provides a more efficient approach due to four reasons:
- The normalisation of the interventions as opposed to traditional care (where at each contact it is decided what comes next) facilitates a new organisational frame. The set of interventions are geared towards specific health and/or social goals, generally more specific than those adopted in traditional care (i.e. improving patient self-management of the disease versus improved clinical outcomes)
- The redefinition of the roles of professionals: given the precise definition of patient trajectories, checkpoints can be incorporated and, accordingly, delegate in nurses or other professionals, regular follow-up activities.
- Generation of opportunities for a more proactive allocation of scarce resources. It is possible to anticipate the resources that will be needed to attend the majority of the patients (80%) and, as a result, also foresee the needed free time for those requiring traditional approaches
- The model results in higher needs of coordination and information sharing among professionals, not only belonging to different specialties, but also across different teams and providers. This is where the ICT solutions enter the picture. Its value lies on their capabilities of enabling these interactions to take place.

Technology solution

Technologically, the Linkcare platform (Linkcare eTEN 517435) sets the reference architecture. Modularity, flexibility and scalability are based on Service Oriented Architectures (SOA) using the IBM UML 2.0 Profile for Software Services.

Briefly, the platform consists of a web-based application addressed to management of chronic patients and elderly, facilitating organizational interoperability following a distributed model.

The following services are available at the moment:
- Health portal,
- Call centre service,
- Professional mobile access,
- Patient wireless monitoring service,
- Collaborative work service,
- Security modules
- Interoperability module with hospital information systems and shared electronic patient records.

In the future, it will incorporate knowledge management applications and it is foreseen its evolution towards an IMS platform.

Impact, innovation and results

Impact

Innovation relies on the interplay of three factors:
- adoption of an integrative approach including profound organizational changes,
- facing the co-morbidity challenge,
- use of ICT as modular and scalable tools supporting interoperability among actors.

The main programs of the project are:
- Wellness-rehab: Early diagnosis, promotion of healthy life-styles and patient self-management. Physical activity and cognitive aspects being main components;
- Enhanced Care Support of unplanned hospitalizations;
- Home hospitalization of patients with exacerbations;
- Support: Transient remote support to diagnosis and/or treatment

Track record of sharing

Health authorities in the different sites are already present in the project Consortium thus ensuring positive commitment beyond the pure project life. Thus, in Catalonia, the involvement of the Department of Health illustrates a willingness to go even further: Around Nexes, the commission for innovation of the Department of Health is working to take the service model to primary care practices.

Lessons learnt

Lesson 1 - Evolution from pilots to services for the programes considered in the project.

Lesson 2 - Controlled deployment, integration and validation of services

Lesson 3 - Identification of strategies suitable for the success of extensive and sustainable deployment of services

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