S3.3 Patient participation

and Virtual health practice

Barcelona , May 22th, 2014

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Joan Escarrabill MD PhDChronic Care Program– Barcelona Esquerra. Hospital Clínic (Barcelona)

Master Plan for Respiratory Diseases (PDMAR) & Home Respiratory Therapies Observatory (ObsTRD). FORES. Ministry of Health (Catalonia)

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The doctor’s visit (1663)Jan Steen (1626-1679)

The doctor (1891)Sir Samuel Luke Fildes (1842-1927)

A Fortunate Man (1997)John Berger (1926- )

Episodic office-based model

Health care in digital age

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Tim

eCycle Population

Ageing and chronic diseases Consumer driven models Economic constraints

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Nothing is so dear and precious as time F. Rabelais (1494-1553)

Time

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Care cycle

Health indicators Recovery Time Maintenance of health

NEJM 2010;363:2477-81

Care cycle

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Better value through population and personalised medicine.

J A Muir Gray. Lancet 2013;382:200-1

Effectivity

Quality

Safety

Value

Presonalised

Population

medicine

Customize evidence Biomarkers Personal values Clinical situation Context

Responsibilities to the population to be served Avoid inequalities Distribution of resources

Health care in digital age

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Tim

e

Cycle Population

Ageing and chronic diseases Consumer driven models Economic constraints

Without ICT, this is impossible

With science and paternalism, is not feasible to deal with ageing, chronic diseases and budget constraints

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The need to be knowledgeable about and understand these choices and engage in a shared decision-making process

http://thehill.com/blogs/congress-blog/healthcare/198595-a-better-healthcare-system-requires-active-participation-by

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Shared Decision Making• Patients have to be informed• Patients have to spend some time to consider their goals

and concerns.• Interaction with their health care providers

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The challenge of health system is to increase value of care for patient in sustainable way

Virtual health practice• The transformation of the health system is not possible if it

is based almost exclusively on face-to-face visits.

• We define "virtual health practice" as the strategy of promoting the consistent use of technology across all points of care cycle in order to increase contact with the patient, reducing face-to-face visits, to get the maximum value in terms of health and wellbeing.

Virtual Health Practice: Key features

Disruption

P4

Big DataSystemic approach

ICT

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Changes in Business Model

PersonalizedPredictivePreventiveParticipatory

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Need of disruptive innovations to care for patients with

chronic diseases

Increase the total number of contacts and reducing face to face visits

Need to respond to the needs of the population (not just

those of patients who "knock on the door")

To develop scalable projects, not just pilot studies

Need to promote an intensive and simultaneous use of

multiple ICT’s tools

ICT is not the driver of change, it’s just a lever.

Why we need Virtual Health Practice?

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Artificial Intelligence in Medical Decision Support.

Artificial organs.

Augmented Reality .

Augmenting Human Capabilities.

Curated Online Information.

Customized Mobile Apps

Digestible Sensors

Gamification Based Wellness

Humanoid Robots

Personalized Genomics and Optogenetics

Semantic Health Records

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2 Waiting Rooms Will Be Phased Out

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4www.wolterskluwerhealth.com/

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The immediate future of health care should be based on the coexistence of the face-to-face visits & virtual practice and

synchronous & asynchronous

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• E-visits are designed to handle common, nonemergency conditions

• What happens when you need to do a physical exam?

•CDC and Prevention says any condition that could lead to an antibiotic warrants an in-person exam

• Telehealth services could lead to more health-care spending

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Conclusions

• The main objective of health care is to increase the value for the patient. Information and participation are key elements.

• Information and communications technologies (ICT) have a central role to play in transforming our health care system.

• ICT is a lever not the main issue.

• The main purpose is to define a package of care, as personal as possible, adapted to local circumstances

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