It is a story that comes from afar, and that wants to go far. It is the COReHealth project of the Puglia Region: a regional telemedicine operating center for chronic conditions and clinical networks managed by AReSS, the Regional Agency for Health and Social. Today the platform connects the Breast Units of the San Paolo Hospital in Bari and that of the Polyclinic, plus the Oncological Orientation Center of the two hospitals, for an audience of nearly 23,000 women diagnosed with breast cancer. But the goal is even higher: to include in the project also other chronic diseases – thalassemia and diabetes – and to add other oncological pathways, related for example to lung, prostate, colorectal and uterus cancer. Thanks to funds from the PNRR.
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How the project was born
“The idea of using the various digital features to improve assistance and bring health to the home of citizens was born at least six years ago, on the initiative of the regional government”, he explains Giovanni Gorgoni, General Manager of the Apulian Agency. At the basis of the project, continues Gorgoni, a little luck but above all the political will to work on telemedicine, and consequently also the funding to realize a good idea. Of course, the journey is long and it is not over yet. In 2017, explains the director of AReSS, the Puglia Region had decided to use European funds to create a technological platform that combined patient profiling tools and IOT (Internet of Things) technologies to manage complex patients. A co-financing of about 9 million euros for a project called HLCM, for the planning and management of health components: 4 million allocated between the Region and European funds, 5 million from private partners. But to really reach citizens and change the approach to care, information technology was not enough. Something more was needed.
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Thus, thanks to a call by the then MIUR, a partnership is built between 16 public and private entities which leads to the birth of Talisman. A change of pace compared to the old system, because we work on taking care of chronic or complex patients on the basis of PDTAs, in a continuous interrelation between professionals. “The project takes off – recalls Gorgoni – but in the meantime the pandemic also arrives, and we have the opportunity to experience the advantages of telemedicine precisely in a critical area such as that of Covid-19”.
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July 2021: the first test of the platform
The leap in quality therefore arrives in July 2020. Thanks also to the Relaunch Decree of the Conte Government, the regional council approves the establishment of the Regional Telemedicine Operations Center, COReHealth, in fact. “The first test dates back to the following year. In July 2021 we tested the power plant on three very different clinical scenarios: a Breast Unit, a thalassemia center and a territorial center for hypertension and diabetes, three very different types of pathology. The value of the solution – underlines the AReSS president – is in fact that of being versatile, not vertical but suitable for different conditions “. The test is a success, the system is officially presented last October.
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Telemedicine in action
Today’s reality is therefore that of a Central that provides the care team (doctors and nurses) with a cloud platform for the telematic management of their patients, offering, among the main services, personalized monitoring paths (telemonitoring), remote assistance, television, teleconsultation and health telecooperation, digitalized services for taking charge, personalization and management of patient care plans, logistic / warehouse management of medical device kits. The goal is to support patients in the self-management of their chronic disease, thus reducing hospitalizations and visits to clinics.
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The app and the multi-performance kit
There are two different paths depending on the severity of the patient, Gorgoni continues. For less severe cases there is an app that allows remote monitoring, with a self-assessment questionnaire of some parameters and the sending of values such as temperature and pressure. The multi-performance kit, always connected to the app, is instead used for more complex cases. It consists of a tablet, a scale, the impedance meter, the bluetooth sphygmomanometer, a small device for making ECG and holter, a bluetooth glucometer and the tensor tip, a sophisticated instrument designed with Israeli technology that monitors up to 16 hemodynamic parameters (hematocrit , red blood cells, pressure, saturation, etc.).
The next steps
Then with the PNRR will come, hopefully, the funds to implement the help desk, the production of news to be published in the app, to manage the training of patients and clinicians. This last aspect is not negligible. And not so much from a technological point of view, but from a procedural point of view. “We need to understand one important thing: telemedicine does not necessarily take away the doctor’s work, quite the contrary. In addition to the daily routine, the staff of a hospital ward who undertake to follow patients remotely must also add the control-room activity: did patient X enter the blood pressure values this morning? Did patient Y report her temperature correctly? Patient Z parameters are not good, need to be addressed. In short, the television does not necessarily replace the one in the clinic, on the contrary, in many cases it is in addition to the traditional visit. For the doctor it may be a burden, but for the patient it means better management ”, concludes Gorgoni. The advantage of COReHealth and telemedicine in general is all here.