Tecnologías de la información, nuevos escenarios para la innovación

1. Tecnologías de la información, nuevos escenarios para la innovación Josep M. Picas Donosti, 18 de noviembre de 2010

2. Success Depends on Innovation and Innovation Depends on Information Technology Adam Kolawa The next leap in Productivity 2009, John Wiley & Sons

3. Significant and sustainable improvements in the quality and efficiency of health and social care can be obtained trough the procurement of R&D services that can lead to solutions and technologies that do not yet exist and that will outperform the solutions available on market Accelerating the Development of the eHealth Market in Europe eHealth Taskforce report 2007 European Commission Information Society and Media

7. Health 2.0 It’s Up To You Pieter Vos Council for Public Health and Health Care The Netherlands

8. Healthcare providers, insurers and the government should make greater use of the social media in order to provide information in a suitably transparent manner ……..

9. Encourage the use of Personal Health Records for the purposes of self-management.

15. Evolución de los sistemas de información: • Plataformas IT • Sensores • Redes • Super-computación / Cloud computing • Internet-TV • http://discover.sonystyle.com/internettv/#/home • La evolución de los programas informáticos

17. Telenotícies TV3, 2 Octubre 2010

18. A.P. H. CENTRO ASISTENCIA PRIMARIA HOSPITAL Procedimientos Quirúrgicos Procedimientos diagnósticos Críticos Urgencias PATIENT CENTERED “MEDICAL HOME”

19. A.P. H. CENTRO ASISTENCIA PRIMARIA HOSPITAL Procedimientos Quirúrgicos Procedimientos diagnósticos Críticos Urgencias PATIENT CENTERED “MEDICAL HOME” 63.788 M€ 1.421 € h/a Fuente: National Health System of Spain, 2010. MSPS Gasto Sanitario Publico en España

20. A.P. H. CENTRO ASISTENCIA PRIMARIA HOSPITAL Procedimientos Quirúrgicos Procedimientos diagnósticos Críticos Urgencias PATIENT CENTERED “MEDICAL HOME” 63.788 M€ 1.421 € h/a 10.015 M€ 15,7 % Procesos clínicos compartidos 34.446 M€ 54,0 % 12.630 M€ 19,8 % Farmacia Fuente: Nationall Health System of Spain, 2010. MSPS Gasto Sanitario Publico en España

24. ACO: Accountable Care Organizations Accountable care organizations: A new idea for managing Medicare The goal of ACOs is to encourage physicians and hospitals to integrate care by holding them jointly responsible for Medicare quality and costs. By Jane Cys, amednews correspondent. Posted Aug. 31, 2009 The ACO also would need a designated administrator and a formal organization that could serve as a point of contact, work with payers, monitor performance and collect any shared savings. The physicians, hospital and other ACO members would need to agree on how to divide any earned bonuses. Dartmouth Institute for Health Policy and Clinical Practice and the Engelberg Center for Health Care Reform at Brookings Institution

25. ACO: Accountable Care Organizations

27. Medicina Personalizada Hospital + Big Farma Liderazgo clínico Genómica T. I. C. Health Literacy + Pacientes Expertos Proyectos de Comunicación Audiovisual: - Internet, TV - Health2.0 - m-health Gestión de enfermedades crónicas ACO Gestión Poblacional Empowerment

28. Knowledge Center • as a driver of innovation at • Sant Pau University Hospital

29. Platform of Innovation - Mission Sant Pau - Knowledge Center (SP-KC) Center of Biotechnological Knowledge and Industrialists Demonstrator for Innovation in Public Health • To improve patient care by facilitating collaboration among patients, scientists, engineers/technologists and clinicians • To catalyze the discovery, development and implementation of innovative technologies • Emphasizing minimally invasive approaches, e-health and primary care Funded: 1.3 M Euros: NATIONAL PLAN OF SCIENTIFIC RESEARCH, DEVELOPMENT AND TECHNOLOGICAL INNOVATION (2008-2011)

30. Citizens Simulation • ‘e-Health • Laboratory • Demonstrator • The need and the opportunity – Sant Pau’s Knowledge Centre (SP-KC) • A ‘Multi-tasking Simulation Environment’ • an area that could simulate one or more real-world health-related settings, allowing rigorous testing and rapid improvement of eHealth innovations before they are introduced into real environments • equipped with high-capacity graphic workstations with supercomputing and server capabilities, data gathering equipment (cameras, video network processors, etc.), high-quality printing devices, complete hardware for the simulation of various modular environments, testing and observation rooms, and work stations. • A ‘Demonstrator Area’ • Space for the demonstration of the products generated in the laboratory itself or transferred to industry or other researchers who wish to convene its products and its customers / audiences in an environment of health validation

31. e-dis. Disphagia Tele-Rehabilitation

32. e-dis. Disphagia Tele-Rehabilitation Background • Prevalence of oropharyngeal functional disphagia is very high in patients with neurological disease: • > 30% of patients having had a CVA. • Parkinson’s disease: 52-82%. • It is first symptom for 60% of patients with ALS. • It affects 40% of patients with myasthenia gravis, up to 44% of patients with MS. • Alzheimer’s disease: 84% of pts. • More than 60% of elderly institutionalized pts. Buchholz DW: Dysphagia associated with neurological disorders. Acta Otorhinolaryngol Belg 1994; 48(2):143–55. Clavé P. et al. Approaching oropharyngeal dysphagia. Rev Esp Enf Digest 2004; 96 (2): 119-31.

33. e-dis. Disphagia Tele-Rehabilitation Background • The most common consequences are: • Malnutrition, with a high prevalence in these patients. • Tracheobronchial aspiration, which is the main cause of mortality. • Oropharyngeal dysphagia in long-term care: misperception of treatment efficacy. Campbell-Taylor I. J Am Med Dir Assoc. 2008;9(7):523-31. • Martin B et al. The association of swallowing dysfunction and aspiration pneumonia. Dysphagia 1994; 9(1):1–6. • Smith Hammond CA, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia; ACCP evidence-based clinicalpr actice guidelines. Chest 2006;129:154S–168S.

34. e-dis. Disphagia Tele-Rehabilitation • The system e-dis is a telemedicine application that aims to replace a part of the treatment of oropharyngeal dysphagia through the use of ICTs.

35. e-dis. Disphagia Tele-Rehabilitation Why exercise with? • It exits evidence that swallow musculature increase strength/tone with non-swallow exercises and increased strength/tone translates into improved function. • Clark H: Therapeutic exercise in dysphagia management: philosophies, practices, and challenges. Perspectives on swallowing and swallowing disorders. Newsletter for the Dysphagia Special Interest Division of the American Speech-Language-Hearing Association 14(2):24–27, 2005 • Logemann J: The role of exercise programs for dysphagia patients. Dysphagia 20(2):139–140, 2005. • Robbins J et al. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53(9):1483-9. • Burkhead LM et al. Strength-Training Exercise in Dysphagia Rehabilitation: Principles,Procedures, and Directions for Future Research. Dysphagia 2007; 22: 251–65.

36. e-dis. Disphagia Tele-Rehabilitation How e-dis works? Patients watch a video where the doctor performs the exercises and gives specific instructions for proper performance.

37. e-dis. Disphagia Tele-Rehabilitation How e-dis works? Patients tape videos making exercises and send them through e-dis system

38. e-dis. Disphagia Tele-Rehabilitation How e-dis works? Therapist watch the patient’s videos and send feedback to them

39. The best imaginable state of health Your health today The worst imaginable state of health e-dis. Disphagia Tele-Rehabilitation Pilot Study Results: General health perception

40. e-dis. Disphagia Tele-Rehabilitation How much costs a dysphagic pt? Presential Distance treatment • Videofluoroscopy: 381,25 € • Dysphagia clinical evaluation and treatment: • 19,57€ (2 inhospital visits). • 1 therapist / 2 pts: 63,61€ • Total cost: 83,18€ x pt • Transportation if needed x 2 days. • Computer: 304,99€ • Modem + internet connection: 30€/month • Videofluoroscopy: 381,25 € • Dysphagia clinical evaluation and treatment: 146,80€ x pt • Transportation if needed x 15 days.

41. Patient Therapist Projects in development & assessment

42. Projects in development & assessment

43. Simulator for theoretical assessments. Blood Donor Blood Bank Patient Last challenge: e-blood Living Lab

44. Health System and authorities Hospital Users of Services Multidisciplinary Research Medical / Business / Technology Primary Care Market ConclusionR2R methodology for e-Innovation

46. En resumen: • Necesidad de dar respuesta a una demanda creciente y exigente, caracterizada por el cambio de modelo epidemiológico (enfermedad crónica), en un entorno de graves dificultades en el financiamiento sanitario • Cambio real ( virtual...) en el modelo de financiación • Las dificultades de una correcta aplicación de las herramientas tecnológicas Para acabar: dos reflexiones (una de ellas muy amarga)

47. La Vanguardia, 16 d’octubre de 2010

48. http://www.lavanguardia.es/politica/noticias/20101003/54014268215/la-republica-de-las-aceitunashttp://www.lavanguardia.es/politica/noticias/20101003/54014268215/la-republica-de-las-aceitunas

50. Muchas gracias !! jmpicas@santpau.cat