Aims and scope
The purpose of the Polycare Project was “to develop and test an integrated care model, patient-centred, supported by the use of advanced ICT systems and services that allows the monitoring and care of older chronic patients in acute phases at home”. The project tried to achieve this objective by developing a collaborative website between stakeholders to facilitate the transmission of information, create personalized apps and patient wearables, and develop a decision support system. The project began in January 2016 and ended in December 2018.
The project focused on elderly chronic patients experiencing a flare-up of their illness. These patients need more complex services and some of them need continuous care and monitoring. The increasing elderly population in Spain has led to a surge in the number of patients with these conditions. The provision of healthcare services to these patients is more difficult due to the reduced mobility of elderly people that means higher costs (these patients require more medication and are hospitalized more frequently), especially in areas of high population dispersion. This project aimed to make it possible to receive this care at home to increase patients’ comfort, improving the quality of the service and reducing the cost.
The partnership was part of a European H2020 project with a consortium of eight partners and implemented in Aragón (Spain), Bonn (Germany) and Lille (France). We focus our analysis on the development and implementation of the Polycare innovation in Spain. The reason for creating the partnership was the need for knowledge and experience in different fields (clinical and technological ones), as well as access to enough patients from different regions for the testing and validation of the results.
The innovativeness of the project was the use of advanced ICT systems to enable an integrated patient-centred care model to achieve home health care for elderly chronic patients in acute phases of their illnesses. The partnership developed the software and wearables necessary to monitor patients (e.g. chest bands to monitor respiration, physical activity, body temperature and to make electrocardiograms) and it integrated some existing devices (e.g. to monitor blood pressure and weight). A web-based platform to communicate and share information between healthcare and social care professionals was also developed. This collaborative environment allows the provision of a more patient-centred service. A decision support system based on the use of artificial intelligence was developed to collect all the relevant information (from sensors and wearables and from healthcare and social care professionals) and to provide alerts when health conditions deteriorated or when adverse effects appeared because of drug interaction. An app was developed to be used with a tablet in order to promote healthy habits and educate patients about their illness and treatment through gamification. Gamification tools for the education of patients are not new, but their use in this project helped the healthcare staff to inform and teach the users about the service.
Main collaborative innovation conditions
The ideas in the innovation process emerged due to the interactions between partners with different knowledge and expertise. Requirements for sensors that were not initially considered were solved by communication between healthcare professionals and the technical partners. The same thing happened when problems in the use of the sensors were detected or improvements were needed. Innovations were developed by the technological partners based on the guidelines provided by the healthcare professionals.
The partners discussed the different perceptions of problems and solutions and connected the ideas of different actors (e.g. by organising joint meetings, visits to the healthcare system facilities for the technological partners, and brainstorming sessions, in person and online). The partners actively pursued consensual solutions when conflicts occurred. There were also some activities related to the connecting strategy and process agreements. The coordinator mediated in the conflict to avoid deadlocks and defined rules for decision making and for the distribution of rights to innovations (process agreements). For example, the SALUD retained some rights to further develop the innovation without the involvement of the technological partners.
Great consideration was given to the feasibility of the ideas and those that were not technologically or clinically feasible were discarded. There were different stimuli for each partner to implement the ideas, but this caused no conflicts. Public partners wanted to implement the ideas to improve the quality of their services, while the technological partners wanted to improve their technologies in order to sell their services in the future.
Involving users was essential for the success of the project. Advice provided by healthcare professionals was needed to develop technological tools that met service needs. Moreover, the collaboration of healthcare and social care professionals was needed to involve and monitor patients. The collaboration of patients was necessary to check the effectiveness of the technological solutions and receive feedback to solve possible problems.
Implications and lessons learned
Chronic patients require more complex treatment, especially when they suffer from more than one chronic illness. This frequently occurs in the case of elderly patients. Coordination and collaboration between all the people involved in their care is essential, especially in acute phases. The care and treatment of these patients involves high costs because they require more medication and are hospitalized more frequently. Due to an ageing population, these kinds of patients are increasing in Spain and developed countries in general, and are a major issue in areas with a more dispersed population. The innovation of this project would involve improvements in service quality and patient comfort, at the same time as reducing service cost.
The collaboration process in this project had barriers due to the fact that the motivations of individual partners were not always aligned with the project objective. Some of them are quite common in innovation projects (e.g. intellectual property rights) and others were related to the financial consequences (e.g. financial expectations of the technological partners). However, these barriers did not seem to have a serious effect on the collaboration process. The participation of the coordinator to increase communication, mediate in deadlocks and define rules was necessary to overcome them.
More significant problems arose in the development phases of the innovation processes. Home hospitalization required more security requirements than initially foreseen as the correct monitoring of patients’ biosignals is of utmost importance. The initial overestimation of previous technologies and their possible improvement caused delays in the design and development stage. These delays limited the number of patients involved and reduced the time available for the piloting phase. In addition, patients in the piloting phase were limited in providing feedback due to their health conditions.
The most important lesson learned from this project is that a rigorous analysis of security and a realistic estimation of the time needed to adapt existing technology or develop new tools is necessary when planning eHealth projects to avoid delays during the development stage. Also, issues related to intellectual property rights need to be clarified and regulated upfront to prevent problems between partners. Greater flexibility in the final deadlines would be useful to avoid hurrying in the final stages of the projects, which reduces the capacity of the partnership to test and evaluate the innovation.
To read more about the case study, see D7.1 – Practices of external collaboration for service delivery. Comparative case studies on external collaboration in eHealth partnerships report.
About the Authors
Lourdes Torres, University of Zaragoza
Vicente Pina, University of Zaragoza
Sonia Royo, University of Zaragoza
Jaime Garcia-Rayado, University of Zaragoza