Challenges and opportunities for telehealth in the management of chronic obstructive pulmonary disease: a qualitative case study in Greece.

BACKGROUND: Telehealth (TH) was introduced as a promising tool to support integrated care for the management of chronic obstructive pulmonary disease (COPD). It aims at improving self-management and providing remote support for continuous disease management. However, it is often not clear how TH-supported services fit into existing pathways for COPD management. The objective of this study is to uncover where TH can successfully contribute to providing care for COPD patients exemplified in a Greek care pathway. The secondary objective is to identify what conditions need to be considered for successful implementation of TH services. METHODS: Building on a single case study, we used a two-phase approach to identify areas in a Greek COPD care pathway where care services that are recommended in clinical guidelines are currently not implemented (challenges) and areas that are not explicitly recommended in the guidelines but that would benefit from TH services (opportunities). In phase I, we used the care delivery value chain framework to identify the divergence between the clinical guidelines and the actual practice captured by a survey with COPD healthcare professionals. In phase II, we conducted in-depth interviews with the same healthcare professionals based on the discovered divergences. The responses were analyzed with respect to identified opportunities for TH and care pathway challenges. RESULTS: Our results reveal insights in two areas. First, several areas with challenges were identified: patient education, self-management, medication adherence, physical activity, and comorbidity management. TH opportunities were perceived as offering better bi-directional communication and a tool for reassuring patients. Second, considering the identified challenges and opportunities together with other case context details a set of conditions was extracted that should be fulfilled to implement TH successfully. CONCLUSIONS: The results of this case study provide detailed insights into a care pathway for COPD in Greece. Addressing the identified challenges and opportunities in this pathway is crucial for adopting and implementing service innovations. Therefore, this study contributes to a better understanding of requirements for the successful implementation of integrated TH services in the field of COPD management. Consequently, it may encourage healthcare professionals to implement TH-supported services as part of routine COPD management.

A systematic map and in-depth review of European telehealth interventions efficacy for chronic obstructive pulmonary disease.

BACKGROUND: Evidence to support the implementation of telehealth (TH) interventions in the management of chronic obstructive pulmonary disease (COPD) varies throughout Europe. Despite more than ten years of TH research in COPD management, it is still not possible to define which TH interventions are beneficial to which patient group. Therefore, informing policymakers on TH implementation is complicated. We aimed to examine the provision and efficacy of TH for COPD management to guide future decision-making. METHODS: A mapping study of twelve systematic reviews of TH interventions for COPD management was conducted. This was followed by an in-depth review of fourteen clinical trials performed in Europe extracted from the systematic reviews. Efficacy outcomes for COPD management were synthesized. RESULTS: The mapping study revealed that systematic reviews with a meta-analysis often report positive clinical outcomes. Despite this, we identified a lack of pragmatic trial design affecting the synthesis of reported outcomes. The in-depth review visualized outcomes for three TH categories, which revealed a plethora of heterogeneous outcomes. Suggestions for reporting within these three outcomes are synthesized as targets for future empirical research reporting. CONCLUSION: The present study indicates the need for more standardized and updated systematic reviews. Policymakers should advocate for improved TH trial designs, focusing on the entire intervention's adoption process evaluation. One of the policymakers' priorities should be the harmonization of the outcome sets, which would be considered suitable for deciding about subsequent reimbursement. We propose possible outcome sets in three TH categories which could be used for discussion with stakeholders.

Supporting integrated care with a flexible data management framework built upon Linked Data, HL7 FHIR and ontologies.

In this paper we present the methodology and decisions behind an implementation of a telehealth data management framework, aiming to support integrated care services for chronic and multimorbid patients. The framework leverages an OWL ontology, built upon HL7 FHIR resources, to provide storage and representation of semantically enriched EHR data following Linked Data principles. This is presented along with the realization of the persistent storage solution and communication web services that allow the management of EHR data, ensuring the validity and integrity of the exchanged patient data as self-describing ontology instances. The framework concentrates on flexibility and reusability, which is addressed by regarding the aforementioned ontology as a single point of change. This solution has been implemented in the scope of the EU project WELCOME for managing data in a telemonitoring system for patients with COPD and co-morbidities and was also successfully deployed for the INLIFE EU project with minimal effort. The results of the two applications suggest it can be adopted and properly adapted in a series of integrated care scenarios with minimal effort.

Learning Healthcare Systems: Scaling-Up Integrated Care Programs.

Current healthcare systems are struggling with rising costs and unbalanced quality of care. Integrated care (IC) is a worldwide trend in healthcare reforms designed to tackle these problems. ACT@Scale is a partnership of leading European regions, industry and academia which aims to identify, transfer and scale-up existing integrated healthcare practices. In this context, participating programs are applying iterative process improvement cycles using collaborative methodologies. The vision of learning health systems (LHS) is similar to IC, but it focuses on IT means as a change enabler for rapid and continuous knowledge integration into better outcomes. In this paper, we present the ACT@Scale program as an example of an LHS that monitors integrated care performance and effects of process improvement cycles.

Integrated Care and Connected Health Approaches Leveraging Personalised Health through Big Data Analytics.

Integrated care and connected health are two fast evolving concepts that have the potential to leverage personalised health. From the one side, the restructuring of care models and implementation of new systems and integrated care programs providing coaching and advanced intervention possibilities, enable medical decision support and personalized healthcare services. From the other side, the connected health ecosystem builds the means to follow and support citizens via personal health systems in their everyday activities and, thus, give rise to an unprecedented wealth of data. These approaches are leading to the deluge of complex data, as well as in new types of interactions with and among users of the healthcare ecosystem. The main challenges refer to the data layer, the information layer, and the output of information processing and analytics. In all the above mentioned layers, the primary concern is the quality both in data and information, thus, increasing the need for filtering mechanisms. Especially in the data layer, the big biodata management and analytics ecosystem is evolving, telemonitoring is a step forward for data quality leverage, with numerous challenges still left to address, partly due to the large number of micro-nano sensors and technologies available today, as well as the heterogeneity in the users' background and data sources. This leads to new R&D pathways as it concerns biomedical information processing and management, as well as to the design of new intelligent decision support systems (DSS) and interventions for patients. In this paper, we illustrate these issues through exemplar research targeting chronic patients, illustrating the current status and trends in PHS within the integrated care and connected care world.

Novel Heidelberg retina tomograph-based morphological parameters derived from optic disc cupping surface processing.

PURPOSE: To explore new features of the optic nerve head morphology using the Heidelberg retina tomograph (HRT) and to assess their discriminating power between glaucomatous patients and normal subjects. METHODS: HRT reports, exported as TIFF images, from 97 normal subjects and 97 primary open-angle glaucoma (POAG) patients were used. For each image the contour of the dominant region of the optic disc cupping surface (dROCS) was transformed into a data series by calculating the distance of each contour pixel from the centroid. The length of contour (LC) and SD of contour (SDC) along with the dROCS area divided by the disc area (DA) HRT parameter were examined as novel parameters. RESULTS: The means of LC and SDC, after adjustment for cup area (CA) and DA HRT parameters, and dROCS/DA, after adjustment for CA, presented statistically significant differences (ANCOVA, P < 0.001) between the two groups. Using LC and SDC together in discriminant analysis with leave-one-out cross-validation, 75.3% of cases were correctly classified. Using dROCS/DA together with SDC, the correct classification percentage was 80.6%. The area under the ROC curve was 0.782 for LC, 0.725 for SDC, 0.861 for dROCS/DA, and 0.879 for the linear discrimination function that combines dROCS/DA and SDC. CONCLUSIONS: These findings suggest that LC, SDC, and dROCS/DA can be exploited to the discrimination between glaucomatous and normal subjects. LC and SDC seem to arise from the difference in the shape of the contour of dROCS between the groups, suggesting bigger deviations and irregularities in the POAG group.