CORēHealth: operating center of telemedicine for chronic conditions and clinical networks

CORēHealth is a transformative solution that leverages digital innovation to revolutionize remote healthcare delivery and empower patients to actively participate in their care journey. Developed as a result of the POR Puglia 2014-2020: HLCM and TALIsMAn projects, CORēHealth addresses the challenges posed by the COVID-19 emergency and aims to transform the Apulian Oncological Network into a digitally-enabled ecosystem.

Tactical Objectives

The CORēHealth DT solution aims to achieve the following tactical objectives:

• Enhance patient engagement and involvement in their own healthcare.
• Improve communication and collaboration between patients, doctors, medical teams, and caregivers.
• Optimize care delivery and reduce unnecessary hospital visits.
• Develop digital skills among healthcare professionals.
• Enable seamless data exchange and integration with existing healthcare systems.

Methods

CORēHealth incorporates several technologies to support its functionalities and achieve its objectives. The key technologies utilized in the solution are as follows:

• Web-cloud platform with HL7-FHIR interoperability: CORēHealth leverages a web-based cloud platform that ensures secure storage, accessibility, and interoperability of health data using the HL7-FHIR (Health Level Seven - Fast Healthcare Interoperability Resources) standard. This enables seamless exchange of health information between different systems and applications.

• Televisit, Teleconsultation, Telemonitoring, Telecooperation, and Teleconferencing: The solution integrates various telehealth technologies, allowing healthcare providers to conduct remote visits, consultations, monitoring, and cooperative activities. This includes video conferencing, real-time monitoring of vital signs, and remote collaboration among medical teams.

• Device traceability system: CORēHealth incorporates a device traceability system that enables the integration and interoperability of medical devices used for real-time detection and monitoring of vital parameters. This ensures accurate data collection and timely alerts for healthcare interventions.

• Clinical repository: The solution includes a clinical repository that serves as a centralized database for storing and managing patient health records, treatment plans, and other relevant clinical information. This repository facilitates easy access and retrieval of patient data by authorized healthcare professionals.

• Patient Synoptic: CORēHealth employs a patient synoptic tool that provides a comprehensive overview of the patient's medical history, treatment plans, and care instructions. This tool helps patients understand and actively participate in their care process.

• Central Alarms: The solution incorporates a central alarm system that automatically generates alerts and notifications based on predefined parameters. This enables timely response and intervention in case of critical health events or deviations from the expected parameters.

• Mobile App for the Citizens (Android and iOS): CORēHealth offers a mobile application for patients, available on both Android and iOS platforms. The app allows patients to access their medical history, treatment plans, and communicate with their healthcare providers through video calls and chat. It also facilitates the recording of vital parameters and the management of clinical diaries.

• Integration with the Regional Health Information System, Electronic Health Record, etc.: CORēHealth integrates with existing regional health information systems and electronic health record systems to ensure seamless data exchange and interoperability. This enables healthcare providers to access comprehensive patient information and deliver coordinated care.

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Functional requirements

To deploy or customize CORēHealth, the following resources in terms of competencies, costs, and time are generally required:

1. Competencies:

   • Technical expertise: skilled professionals with knowledge in healthcare IT systems, web/cloud platforms, interoperability standards (such as HL7-FHIR), and mobile application development.
   • Domain knowledge: healthcare professionals and administrators familiar with integrated care pathways, medical device integration, telemedicine, and patient management processes.
   • Project management: competent project managers to oversee the implementation, customization, and deployment of CORēHealth, ensuring effective coordination and timely delivery.

2. Costs (Total Cost of Ownership):

   • Acquisition costs: expenses associated with procuring the necessary hardware, software licenses, and infrastructure components to support the implementation of CORēHealth.
   • Customization costs: costs involved in tailoring the solution to meet specific organizational requirements, such as configuring workflows, integrating with existing systems, and adapting the user interface.
   • Deployment costs: expenses related to deploying the solution, including installation, setup, network configuration, and data migration.
   • Operation and management costs: ongoing costs associated with maintaining and supporting the solution, including infrastructure maintenance, system updates, technical support, and staff training.
   • Upgrades: costs involved in upgrading the solution to newer versions or incorporating additional features and functionalities as per evolving needs and technological advancements.
   • Support services: costs associated with obtaining technical support and assistance from the solution provider or dedicated support teams.
   • Training: expenses related to training healthcare professionals and administrative staff on the usage and functionalities of CORēHealth.

3. Time:

   • Customization time: the duration required to tailor the solution to meet specific organizational needs, including configuring workflows, integrating with existing systems, and adapting the user interface.
   • Deployment time: the time taken to install, set up, and configure the solution within the organization's infrastructure, including network and security configurations.
   • Data migration time: if applicable, the time required to migrate existing patient data from legacy systems to CORēHealth.
   • Training time: the duration needed to provide comprehensive training to healthcare professionals and administrative staff on how to effectively use CORēHealth.
   • Change management time: the time allocated for managing the change process within the organization, addressing resistance, and ensuring smooth adoption of the solution.

The specific competencies, costs, and time required for deploying or customizing CORēHealth may vary depending on the size and complexity of the organization, the level of customization desired, and the availability of internal resources. It is recommended to conduct a detailed assessment and engage relevant stakeholders to determine the exact resource requirements for a successful implementation.

Dependencies and constraints

• Organizational culture: implementation of CORēHealth may face challenges related to conflicting organizational cultures within healthcare institutions. Addressing these cultural barriers and promoting a culture of digital transformation and collaboration is crucial for successful adoption.

• Regulatory compliance: the solution must adhere to relevant regulations and standards governing the storage, transmission, and security of patient data, such as data protection and privacy laws. Compliance with regulatory requirements should be ensured to protect patient privacy and maintain data integrity.

• Skill development and expertise: adequate training and skill development programs should be implemented to equip healthcare professionals and administrative staff with the necessary knowledge and expertise to effectively utilize CORēHealth. This will promote smooth adoption and maximize the benefits of the solution.

• Data governance: effective data governance practices must be established to ensure the quality, accuracy, and reliability of the data used within the solution. This includes data standardization, data validation, and adherence to data governance frameworks.

• Software dependencies: CORēHealth may have dependencies on other software systems or components, which may require acquiring specific licenses or complying with licensing agreements. It is essential to identify and address these dependencies to ensure the smooth functioning of the solution.

• Limited data quality: insufficient or low-quality data can hinder the effectiveness of CORēHealth. Efforts should be made to improve data quality and ensure data completeness, accuracy, and relevance to maximize the potential benefits of the solution.

• Change management: the implementation of CORēHealth may require significant changes in workflows, processes, and organizational structures. Proper change management strategies should be employed to mitigate resistance to change and ensure smooth transition and acceptance among stakeholders.

• Cost considerations: the functional requirements of CORēHealth, such as customization, deployment, and ownership costs, should be considered and reported. These costs may include acquisition and procurement expenses, licenses, hardware, operation and management costs, upgrades, support services, training, software scaling, and change management.

Identifying and addressing these dependencies and constraints is essential for the successful implementation and reusability of the CORēHealth solution within the public sector.

Results and impact assessment

The tangible results obtained from the implementation of the solution are the following:

• increased patient satisfaction and engagement in healthcare decision-making.
• reduction in unnecessary hospital visits and optimized care delivery.
• improved communication and collaboration among healthcare stakeholders.
• enhanced digital skills and professional development among healthcare professionals.
• seamless data exchange and integration with existing healthcare systems, leading to improved continuity of care.

The trial phase of CORēHealth, which ended in December 2021, focused on 4 regional pilot projects: Oncology Department of the San Paolo Hospital in Bari (about Breast cancer), Thalassemia Center in Brindisi (about Thalassemia), Putignano District (about Diabetes and Hypertension) and Local Health Authority of Taranto (rural medicine).

As of January 2022, training of “COrO” and Breast Unit providers, enrollment of approximately 23,000 cancer patients (about breast), and initiation of a change management and digital literacy process involving both the care team and patients has begun. Another key element of CORēHealth is the systematic approach in Continuing Training and Digital Competence Consolidation to enable informed access of all the actors involved to new digital technologies. For this, AReSS has initiated a virtuous path of training, change management and digital literacy for all users (medical and administrative teams) and patients.

Among the results to be achieved in the near future:

• Extension of the Telemedicine service to all chronic diseases in the Apulia Region
• Apulian Oncological Network: training and enrollment started (about 200,000 oncological patients in Apulia)
• Rare Diseases: pilot project launched with the Rare Disease Center - Thalassemia of ASL Brindisi (around 23,000 rare disease patients in Puglia)
• Chronic: the pilot project of Putignano district of Local Health Authority of Bari, about Diabetes/Hypertension District started (about 1.7 ml of chronic patients in Apulia)

CORēHealth overturns the traditional patient care pathways, bringing, for the first time, digital innovation directly into their hands (App Mobile) enabling them to have their own medical history, their care plan and maintain a constant, regulated dialogue with their doctor, medical team and care giver, as well as being able to take the most appropriate measurements for the management of pathology/ies. Doctors can manage the clinical history of their patients in an integrated environment, optimizing care time, reducing inappropriate access to hospital facilities, developing their professional skills, including digital skills, according to a multidisciplinary approach to care taking with a single common point of access, reducing the distance between hospital and territory, and moving the care activities of chronically ill patients to an environment as close as possible to the patient's home.

The Apulia Region (during the Presentation at the Permanent Conference for relations between the State, the regions and the autonomous provinces, last 2 March) was identified by the Minister for Technological Innovation and Digital Transition to develop, together with the Lombardy region (Flag Regions), the applications for the provision of Telemedicine services nationwide under M6C1 of the italian National Recovery and Resilience Plan, (NRRP). In November 2022 the Apulia Region received the "Innovation in Digital Health" award, organized by AGENAS, the National Agency for Regional Health Services, and Sics, publisher of the journals Quotidiano Sanità and Popular Science, for the regional telemedicine platform CORēHealth. CORēHealth was also included among the best practices of the AGENAS’s PON GOV chronicity (2014-2020) as a simultaneous investment to improve the use of and access to ICT Technologies and strengthen the institutional capacity of public authorities. In January 2023 CORēHealth won the "Regional Digital Agenda" award established by the Milan Polytechnic and on 23 March 2023 it won the "Best Practice Award - Innovation Flow in Healthcare" of Regions4PerMed in Brussels.