Summary of the good practice:
Summary of the Good Practice
The practice, performed by University Hospital Olomouc with regional activity, introduces specific remote monitoring of patients with Congestive heart failure, structural damage of myocardium and left chamber dysfunction through the deployment of telehealth services and enhances relevant medical protocols. This new practice is to detect as many patients with the given diagnoses as possible, deploy telehealth services for monitoring and improved treatment of these patients.
The telehealth service consists of telemonitoring with clinical protocol that is in line with the protocol used in a large EU project Unite4Health (www.united4health.eu) that focused on assessing the impact of innovative healthcare services in real conditions in 14 regions of Europe. The practice adapted this generic protocol for the target group of patients (with advanced CHF) and for the regional conditions.
The practice enabled screening of common population in the Region with the disease; it provides tools for remote control of patients with advanced heart failure (NYHA class III-IV, it means patients that are markedly or severely limited during physical activity) on standard medical therapy (ESC guidelines), before and after heart transplantation. Further it covers population of patients with hemodynamic support (ventricular assist device – VAD) before orthotropic heart transplantation (OTS) or in long-term regimen. Until the service was introduced, there has not been method that would enable to collect relevant information about critical parameters development besides keeping the patient in hospital.
The practice requires only minimum organisational changes in the hospital; it’s essential parts are under control of clinical staff (cardiologists and nurses) who make use of data (including weight, blood pressure, SpO2) received from patients at home. The ICT system used for the practice has also several features that enable bidirectional communication between the medical personnel and patient; including distant ordering of medicaments, which party fills the gap of non-existent e-prescription service in the country. Other features increase technical reliability of distant communication between patient ?s smartphone (gateway) and healthcare personnel (nurse, cardiologist with access to telehealth portal).
There is clear relationship between initial disease detection in population – screening, followed by specific individualized therapy and management of the target group of ill in higher age and therefore the practice has positive impact to health conditions of targeted population. It is also expected that morbidity, mortality, and quality of life of the targeted patients with observed diagnoses will be improved. Inputs in international medical (cardiology) societies will also further improve position and prestige of EU medical expertise. As the issue of sustainability of the service is essential, the Good Practice management systematically negotiate with medical societies and national healthcare authorities to achieve reimbursement on national level and to upgrade standardized treatment protocols.
New jobs associated with telemonitoring services were created. New force is needed mostly for technical and management oriented tasks. With growing penetration of telemonitoring into the target population it is clear that especially an increase in newly detected patients with heart failure will require more medical personnel. However, the load of staff associated with inclusion a patient into the service is not significant. The practice demonstrated increase of the quality of care.
Essential elements of the practice can transferred as a whole to other regions in the CR or abroad. The practice is suitable for hospitals/centres treating advanced CHF.
Challenge addressed by the good practice
Training of medical personnel, preparation of the infrastructure, such as the ICT system and its features reflecting needs, pathways for patients including education, methodology for stratification of patients (selection for the service), financing – investment and operation, strategy for negotiation of sustainability (ongoing with stakeholders in the CR in 2016).
Key innovative elements of the good practice
Patients with CHF can be discharged from the hospital and more regular information about their vital sings in available to the medical staffs that care. If a decision is to be made the patients is called to come to the hospital as the practice introduces only informative elements and therefore medical protocols are not compromised. The practice enables to reduce routine status checks for which the patients must have stayed in or frequently to come to the hospital. Patients stay in the services for period of time as necessary (e.g. 1 month) and then the equipment can be transferred to another patient.
Full Scirocco information on the good practice
Publications and reports on the good practice
Contact point: Zdenek Gütter, PhD ; Milos Taborsky, M.D., Ph.D, FESC, MBA (head of I. Internal Clinic); Gutter@ntmc.cz