The Covid-19 emergency and innovative technologies to support public health
In pandemic era’s Trentino, digital solutions are being put into practice that are changing healthcare
The pandemic has now made it clear that digital technologies are able to make our healthcare system more sustainable, effective and resilient. Since the TreC system (Citizen Medical Records) has been active in Trentino, some things for healthcare professionals and patients have become easier and faster. Pediatricians, cardiologists, ophthalmologists, diabetologists and other specialists are solving many of the problems caused by the pandemic thanks to a constantly evolving ecosystem of services that revolves around the platform.
Developed by TrentinoSalute4.0 and active since 2011, TreC enables healthcare professionals to actively monitor patients through a system complete with a chat and medical report upload options, and to visit them remotely by using a dashboard from their hospital PCs. On the other hand, patients are prescribed by the doctor a TreC ecosystem app that, once installed on the mobile phone, allows them to follow the prescribed treatment, to keep in touch and share data and information with the doctor, that then ends up in the digital system of the Trento Province Healthcare System (APSS). Thanks to this digital prescription, healthcare professionals are able to better manage care and improve the quality of life of their patients, especially those suffering from a chronic disease. The fields of application of these digital health technologies can encompass many specialization disciplines and will gradually become a service offered to all health system patients. In recent months, several trials are underway in the Province of Trento to make new digital health technologies available, such as virtual visits, an easy-to-use tool that is highly appreciated by patients, especially now that access to health facilities has become harder. Starting last year, thanks to the collaboration of medical specialists and pediatricians, a number of so-called PoCs have been launched. They are the Proof of Concept, in practice, the field trials of a project or method, which serve to prove if it works and is sustainable.
TreC_Pediatria, TreC_Cardiologia, TreC_Oculistica and TreC_Diabete are some of the experiments carried out in Trentino, in addition to those in health prevention and the upcoming oncology and Labor and Delivery ones. The doctors who participated prescribed treatment, provided follow-up care, managed appointments and carried out virtual visits with their patients directly from their clinic’s PCs.
How does this innovation happen and how does it work that does not only concern technology, but also the organization of the provincial health system? It is run according to a shared governance model for the development of digital health that the Province of Trento, thanks to TrentinoSalute4.0. The competence center, made up of APSS, PAT and FBK created in 2016 is pushing for the results of the research to be validated, made safe and available as soon as possible as services to citizens. For TS4.0 this model represents the most powerful engine for developing and building knowledge and skills in the healthcare sector.
What prompted Trentino to develop innovative technologies in support of the healthcare system? First of all, maintaining continuity of care and avoiding the gathering of patients in the clinics; more actively involving citizens and healthcare professionals in the construction of services, validating new technologies and functions, and promoting a new organizational model. The basic idea is that each PoC launched in the provincial territory is based on three reference pillars: data security (information, SPID, Cloud), integration with APSS services and flexibility, so as to be able to export and adapt solutions in other regions as well.
In addition to the shared creation of health services, which is expressed through workshops with citizens and health professionals and the synergy between all skills, the final goal is to build a national community that will share good practices. The characteristics of the technology and the governance model for development and its constant evolution allow an effective and immediate reuse on a national scale also in other public and private contexts.
The TreC platform in recent months has thus been selected and adopted also by other Italian regions: the Province of Trento has signed agreements with the Emilia Romagna and Umbria Regions, the San Giovanni Calibita Fatebenefratelli Isola Tiberina Hospital (Rome), the IRCCS Romagna Scientific Institute for the Study and Treatment of Tumors (Forlì), the Mauriziano Hospital and ASL 3 (Turin), the Bologna Healthcare System and the ULSS7 “Pedemontana” healthcare system of the Veneto Region. Actual contacts and interest in reusing our platform have then given way to agreements with the Friuli Venezia-Giulia Region, with Alessandria, Novara and Cuneo (Piedmont), the Sicily Region and the Giglio Hospital – Cefalù (Sicily).
The Trentino experience on citizens’ medical records is becoming the core of a community of public administrations and private health structures that have decided to adopt TreC to tackle the challenges of telemedicine together and to review the way in which services can be provided to citizens.
What purpose does this Community serve?
The emerging community, supported by the TS4.0 competence center, adopts the model defined by AgID (the Agency for digital Italy) for the deployment of technology solutions called Open Community PA. It will offer support to all participating healthcare systems with the management of the evolution of the technology platform and with the sharing of the organizational models adopted to make sure that the best services possible be provided to citizens.
How does TreC work?
The TreC ecosystem of digital health applications and services connects Autonomous Province of Trento residents to the healthcare system and to health professionals. TreC offers a set of online tools, accessible via app or web portal, which allow users to access the FSE (Electronic Health Records) and consult online reports, manage their health status duary and share it with healthcare professionals, to see drug prescriptions and specialist referrals. During the past year, the TreC_FSE app (active since 2018) has been added new features that allow, for example, to make payments for healthcare services (thanks to the integration with SPID and PagoPA), to delegate access to one’s TreC to other people, to change the general practitioner, to access the app with biometric data (fingerprint or face recognition), to view the results of Covid-19 tests and certificates of completed isolation period, to view the “green certificate” and, for some specialist and pediatrics services provided by the Healthcare System, to carry out virtual visits as well. Bringing these innovations into production, researching and experimenting is what TrentinoSalute4.0 is aiming for in the coming years. TreC represents the starting point to better understand how health services should evolve. Citizens themselves have asked to reverse the paradigm: patients do not look for an outpatient clinics any longer, the health service, instead, reaches patients and responds to the needs of the community. And usage data shows it: in Trentino, TreC has now become a habit for over 150,000 people (over 38,000 people access via the TreC_FSE app). Medical records, since 2007, are available on the patients’ personal computers, laptops or mobile phones and no longer take up space in their homes. They no longer need to carry paper medical records. Now it’s all in the patients’ pockets, wherever they happen to be. That’s convenient! Of course, but this has come after a lot of work and a big effert.
2020 certainly represented a critical year for the TrentinoSalute4.0 competence center. Not only because it coincided with the pandemic, which has in fact made telemedicine an area and a model in healthcare that is now vital, but it has made it possible to identify new healthcare models on which to start experimentation and the development of research that can quickly translate into tools to support the health facilities, doctors, health professions, all personnel working in this sector. The efficiency of healthcare services will now be played out in health districts that need to be strengthened based on the health needs of residents. Issues such as digital health and telemedicine should be addressed today in order not to find ourselves tomorrow without fair and available care for all.
As for future developments, after having created a first level (online access to APSS services), and a second level for TreC (remote care of chronic patients, telemedicine), now TS4.0 is building the third level which concerns the integration of artificial intelligence solutions into the TreC platform, through personal assistants who deliver digital therapeutics services. Digital therapies are non-pharmacological therapies that use approaches and behavioral theories for prevention and treatment as though they were “active principles” (like those of drugs, but digital ones). We are already working on a digital therapeutics project which consists of providing psychoeducational support to promote the mental well-being of pregnant women.
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