ICT CIP – Competitive and Innovation Programme

UNIversal solutions in TElemedicine Deployment for European HEALTHcare

(Grant Agreement No 325215)

Document D4.3 Annex4

UPAB meeting
Brussels, 6thJuly 2015

Version 1

United4Health User Policy Advisory Board meeting:

“Respiratory conditions: Key messages”

Report from meeting

Monday, 6th July, 2015

Rue de Trèves 49-51, B-1040 Brussels, Belgium

This board meeting was hosted thanks to EHTEL and to the European Respiratory Society offices in Brussels, Belgium.

Work Package:WP4

Version & Date:v1 / 6thJuly 2015

Distribution Status:Confidential

Authors:Julie Bjerregaerd (EWMA),
Jo Taylor (University of York Health Sciences),
Marc Lange (EHTEL)

Filename:D4.3 Annex 5 United4Health UPAB Respiratory conditions and telehealth

The information in this document is provided as is and no guarantee or warranty is given that the information is fit for any particular purpose. The user thereof uses the information at its sole risk and liability.

/ D4.3 Annex 4UPAB meeting
Brussels, 6th July 2015

Table of Contents

Table of Contents

1.Overview

2.Detailed notes

2.1An introduction to the United4Health project

2.2An introduction to the United4Health dissemination framework (Session 1)

2.3An introduction to COPD and eHealth (Session 1)

2.4Evidence-gathering about deployment on chronic obstructive pulmonary condition (COPD) sites (Session 2)

2.4.1General observations resulting from all the presentations

2.4.2Process-based findings resulting from all the presentations

2.5What does deployment in the respiratory conditions field mean for telehealth doers/managers and for healthcare professionals (Session 3)

2.6Sharing discussions on deployment findings in the respiratory conditions field for telehealth doers/managers and for healthcare professionals (Session 4)

2.6.1From a decision-makers’ viewpoint

2.6.2From a health and care professionals’ viewpoint

2.6.3Previous discussions on policy messages related to business modelling

2.7Plans for the United4Health final conference and next steps (Session 5)

2.7.1United4Health final conference

2.7.2Next U4H UPAB meeting and next steps

3.Discussions following the site presentations

3.1Example pilot 1: Evidence regarding COPD in Wales (Sara Hicks)

3.1.1Example pilot 2: Evidence regarding COPD in Galicia (Susana Fernandez Nocelo)

3.2Example pilot 3: Evidence regarding COPD in Scotland (Morag Hearty)

3.3Example pilot 4: Evidence regarding COPD in Norway (Wenche Tangene)

3.4Evidence from telehealth sites related to respiratory conditions in South Yorkshire, UK (Jo Taylor)

Appendix A: Break-out session on policy messages from a health and care professionals’ viewpoint

Appendix B: Agenda

Appendix C: Attendees and apologies

1.Overview

The meeting was divided into five sessions during which presentations were made on:

  • An introduction to the United4Health dissemination framework (Session 1).
  • Evidence-gathering about deployment on chronic obstructive pulmonary condition (COPD) sites (Session 2).
  • What does deployment in the respiratory conditions field mean for telehealth doers/managers and for healthcare professionals (Session 3).
  • Sharing discussions on deployment findings in the respiratory conditions field for telehealth doers/managers and for healthcare professionals (Session 4).
  • Plans for the United4Health final conference and next steps (Session 5).

See Appendix B for the meeting agenda.

It is planned that the presenters’ PowerPoints are to be placed on the United4Health website in a newly-created area related to the United4Health user policy advisory board

The five main action points arising from the meeting were that all board members should:

  • Note that the next United4Health user policy advisory board meeting will be held in September, 2015 on the topic of “Diabetes: policy messages”. A doodle will be sent out to determine suitable dates.
    To be included in the meeting will be:
    1) A dedicated session on dissemination/the project’s dissemination framework for clinicians at the start of the September 2015 meeting.
    2) Feedback on status with regard to United4Health user policy advisory board (UPAB) local site visits.
  • Complete a doodle for your preferred September 2015 board meeting attendance date (this doodle will follow on 16 July 2015).
  • lnform the UPAB management team if you are aware of similar useful documentation on COPD and eHealth to that which was provided by ECC and EFA (see item 3 below).
  • Send your suggestions modifications to the attached notes byFriday14 August 2015 at the latest to .
  • “Save the dates” of Tuesday/Wednesday 1/2 December 2015 (for the United4Health final conference) in your diaries:

In terms of the board management team, it will:

  • Run a doodle for the preferred September 2015 board meeting (this doodle will follow on 16 July 2015).
  • Organise the September 2015 board meeting and its content. Circulate the materials needed around the first working week in September 2015.
  • Summarise briefly the main findings of the PowerPoints presented at the board meeting on 6 July 2015.
  • Provide a “to do” list of actions in September 2015 of those activities that the board needs to undertake to reach the goal of its final deliverable (D4.3) by end November 2015.

This board meeting benefitted from there being ten different associations present, including two specifically from the field of respiratory conditions: the European COPD Coalition (ECC) and the European Federation of Allergy and Airways Diseases Patients' Associations (EFA). Attendees came from other associations representing payers, providers, (health and care) professionals and patients/older adults. On this occasion, new participants attended from the European Association of Paritarian Associations (AIEP) and the European Union of Medical Specialists (UEMS). See Appendix C for the actual list of attendees.

2.Detailed notes

2.1An introduction to the United4Health project

The board members were re-introduced briefly to the United4Health project, and the role of the board.

2.2An introduction to the United4Health dissemination framework (Session 1)

Julie Bjerregaerd of the European Wound Management Association (EWMA) introduced briefly some recent work done by the association for United4Health to create a new deliverable entitled D2.4: Dissemination framework targeting healthcare professionals. It describes EWMA's experiences in introducing eHealth to healthcare professionals in the wound management field and its potential linkages with a number of the chronic conditions that the United4Health project is exploring. EWMA has had some success in encouraging increased interest in the ways in which care and treatment of patients with chronic wounds can be enhanced using technologies. See as examples, the content of EWMA’s May 2015 eHealth symposium and a specially-written report on eHealth, eHealth in Wound Care, produced in the context of United4Health.

There was sufficient interest in this report-back by Julie Bjerregaerd that it was decided to focus on dissemination issues during a dedicated session at the start of the next board meeting.

In United4Health, EWMA is involved in facilitating local site visits that focus on the involvement of healthcare professionals who are new to eHealth use. An update on status will also be included in the September 2015 meeting.

ACTION: Include on the agenda of the September 2015 U4H UPAB meeting.

1)A dedicated session on dissemination at the start of the meeting.

2)Feedback on U4H UPAB status with regard to local site visits.

2.3An introduction to COPD and eHealth (Session 1)

A spontaneous discussion arose with regard to the use of various technologies in treating COPD. Attendees alerted other board members to two useful sets of documentation:

1) The European COPD Coalition webpage on COPD and eHealth, and – in particular a collection of (17) references on the use of telemonitoring with COPD patients.

2) Although not specific to eHealth, the Survey Report 2014, produced by the European Federation of Allergy and Airways Diseases Patients Associations (EFA) Harmonizing Prevention and Other Measures for COPD Patients Across Europe provides a current overview of the situation in 17 European member states (as well as in Norway and Serbia).

ACTION: Inform the UPAB management team if you are aware of similar useful documentation on eHealth/telehealth findings in the field of COPD/respiratory conditions.

2.4Evidence-gathering about deployment on chronic obstructive pulmonary condition (COPD) sites (Session 2)

This session consisted of six presentations. They were the findings on COPD from four United4Health local pilot sites (Galicia, Norway, Scotland, and Wales). In addition, the experiences of the Maccabi Health Services Multidisciplinary Medical Call center (MOMA) were presented. Last but not least, the outcomes of the 2014 Mainstreaming Assisted Living Technologies (MALT) study (which focused partly on COPD), undertaken in South Yorkshire, England, were discussed in some detail.

Since it is intended to upload the PowerPoint presentations on the United4Health website, rather than repeating the content of the presentations here. See, however, ANNEX 1 for highlights of the discussions, and questions posed to presenters, following the presentations.

Each of the presentations – with the exception of the MALT study presentation – focused on a number of standard key issues: context; experiences; barriers (solutions); enablers; lessons learned; and main conclusions (often referring to more high-level policy messages).

There was especial interest in the tools and techniques presented by Jo TAYLOR of the MALT study. It emphasised grassroots-based co-design work that uses qualitative methods, involving all stakeholders, and was able to produce concrete and helpful tips for stakeholders on change management/technology introduction.

See especially the project video (vimeo) on Overcoming barriers, Reducing uncertainty, and the 20-page project final report. See also various tools on e.g., business modelling and financial modelling; four short films that are particularly useful for healthcare professionals; quick guides to implementing telehealth; and a set of factsheets called “mythbusters”.

2.4.1General observations resulting from all the presentations

A brief discussion took place on three issues related to the various COPD pilot site presentations: commonalities and differences, organisational challenges, and different payer models.

  • Commonalities and differences: Common elements and the differences among the sites seem to be:

-Commonalities: All sites have difficulties with the technologies, and there is a preference for simpler technologies.

-Differences: It seems to be easier to shift from a project phase to large-scale depending on the different payer organisations. It was queried:
Could these difficulties be resolved via having sound business plans in place?

  • Organisational challenges: It appears to be a challenge to have separate organisational levels for hospital and community care, and separate budgets for regions and municipalities. A particular observation was about the facilitation of positive experiences whenever a single payer/provider was involved. The situation seemed easiest in Galicia, where there is only one payer/organisation that provides both community and hospital care.
  • Payer models: It would be interesting to explore further how to address the barriers implicit in the different payer models throughout Europe regarding eHealth implementation.

Comparative work still needs to be done to examine whether there are specific commonalities among the four United4Health sites (e.g., geographic isolation; lack of [broadband] technology infrastructure; stage of patient recruitment e.g., on hospital discharge), and similarities among the enablers, solutions found and lessons learned.

2.4.2Process-based findings resulting from all the presentations

With regard to the United4Health project in general, it was found to be particularly useful to consider:

  • Standardised approaches: Have a number of sites present their experiences on introducing telehealth to support a single (health) condition (in this case, COPD), using a coherent, standardised approach/set of PowerPoints that focused on lessons learned.
  • Preparation for the evaluation of the pilot sites’ experiences: Help in preparing the MOMA evaluation team, and informing its members with background knowledge, for the upcoming local site visits e.g., to Scotland on 8-10 July 2015.
  • Mutual learning among sites: Consider whether, e.g., during forthcoming project assemblies, that various groups of United4Health sites should share and exchange their concrete mutual experiences (“lessons learned”).

ACTIONS:

1)Undertake a brief assessment during summer 2015 of the similar messages between barriers, enablers and lessons learned among the four sites (from the PowerPoints presented).

2)At project level e.g., in project assemblies, propose the sharing of mutual site experiences.

2.5What does deployment in the respiratory conditions field mean for telehealth doers/managers and for healthcare professionals (Session 3)

Two separate break-out sessions were organised. Attendees participated in one of two break-out sessions. Having listened to the lessons learned presented in the morning plenary session, participants were asked to consider the question of what the “deployment lessons learned” meant for:

(a) telehealth “doers” or managers or decision-makers, and

(b) telehealth-related health and care professionals from different professional backgrounds (including, for example, doctors and nurses), particularly from the perspective of policy-level messages.

As far as possible, the user representatives (e.g., representatives of older people’s platforms and patients’/condition platforms) were asked to distribute themselves among the two break-out groups.

Detailed discussions are reproduced only in Appendix A for the health and care professionals’ break-out. Rather, the two facilitators reported on the key messages in the board meeting’s final plenary session (see immediately below).

2.6Sharing discussions on deployment findings in the respiratory conditions field for telehealth doers/managers and for healthcare professionals (Session 4)

The DRAFT key messages derived from the two break-out sessions follow. Although numbered, they are not necessarily listed in order of priority. Further refinement of these key messages will take place during summer and autumn 2015.

2.6.1From a decision-makers’ viewpoint

1. The rising importance of policy (understood as “a vision of the future”) in decision-making for deploying telehealth.

2. What needs to be considered in practice under “patient centeredness”?

3. The infrastructure challenge when deploying telehealth on a large scale.

4. How far is deploying telehealth about managing change in people and organisations’ mindsets?

5. Possible business models for running telehealth (including how to deal with the“patients’ contribution”).

2.6.2From a health and care professionals’ viewpoint

1. The need for health information and communication technology (ICT) literacy.

2. The need to support the development of new professions required to operate telehealth.

3. The impact of telehealth on nursing empowerment.

4. The impact of telehealth on existing organisational models of healthcare, with the rising importance of the community care and the need for care coordination (“integrated care”).

5. The need to invest financial resources in service innovation in healthcare.

2.6.3Previous discussions on policy messages related to business modelling

During the previous UPAB meeting held on 6 April 2015 (on cardiac conditions), and earlier (more general) set of policy messages were related to needs for:

1. Mainstreaming and scaling-up.

2. The macro (or systems) level.

3. Cultural readiness.

4. A focus on local settings.

5. A focus on older people’s concerns.

6. A focus on patients, and patient stratification.

7. Appropriate technology.

8. (Organisational and training) tools that can be helpful in bridging gaps on service re-design (e.g., the business model canvas).

2.7Plans for the United4Health final conference and next steps (Session 5)

Two specific items were discussed: the United4Health final conference and next steps for the United4Health user policy advisory board (U4H UPAB).

2.7.1United4Health final conference

On Tuesday/Wednesday, 1st/2nd December 2015, the United4Health final conference will be held in Brussels, Belgium (partly in the European Parliament) around the topic of : Our Daily Digital Health ... is everyone ready? U4H UPAB board members are asked to “save this date”. More specific information about the board members’ role at this event will follow in autumn 2015.

2.7.2Next U4H UPAB meeting and next steps

The United4Health project is due to finish on 31st December 2015.

As a result, the next several meetings of the board – which will take place in September 2015 and November 2015 – will be particularly important in terms of helping to define, and refine, the main policy messages resulting from the project.

The next U4H UPAB meeting will be held in September 2015 on the topic of “Diabetes: policy messages”. A doodle will be undertaken to determine preferred dates.

The next stage of the board’s work is likely to involve more at-a-distance and interactive feedback e.g., through structured discussions or surveys.

The next United4Health project assembly will be held in Prague in the Czech Republic on October 5th and 6th, 2015 with a local site visit on the following day. Its content will be especially important for the United4Health project team as a whole.

ACTIONS:

Concluding discussions implied that:

  • A doodle will be undertaken to determine preferred dates for the next (September, 2015) user policy advisory board meeting on the topic of “Diabetes: policy messages”.
  • Save the dates of Tuesday/Wednesday 1st/2nd December 2015 (the United4Health final conference) in diaries:

3.Discussions following the site presentations

Note: These notes reflect the clarifications and the content of the discussions following these presentations, and NOT the content of the actual PowerPoints.

3.1Example pilot 1: Evidence regarding COPD in Wales (Sara Hicks)

  • Technology: Technological infrastructure is a major problem. Sometimes the technology did not work as expected. There has been a need to use the available infrastructure in the best way possible. Wales has been forced to use a telephone-based system, as a WiFi-based system was not possible. Therefore, the system is more of a “one-way system” than a “two-way system” (which Wales is working to resolve).
  • Challenges: Challenges included building healthcare professionals’ buy-in. The need for training has been “massive”.
  • Difficulties: Various difficulties have involved:

-Post-discharge: Involvement of community specialist clinicians has been difficult.

-Complete change in [their] way of working with COPD patients.

-Discharge pathway has needed to be standardised.

  • Enablers: Change management is a critical enabler (especially in terms of coordination among four district hospitals).
  • Telehealth changes for patients: Major changes for patients after the use of telehealth have involved:

-Discharge: Follow up after 24 hours. Beforehand, patients waited 4-6 weeks for a check-up to be made by a district nurse.

-Patients do not always want to be subject to a daily follow-up. Instead, they are offered to be in contact with a district nurse, especially over the first two weeks following discharge.

  • Positive patient feedback: Why has there been positive patient feedback on telehealth use in COPD?

-Telehealth has meant that the patients keep them looking after themselves. They maintain the good habits developed.