The “ABILITA” project for virtual consultation and remote cooperation

25 July 2023 By Marzia Lucianer

In use in Trentino’s nursing homes, the system provides a telecooperation service between ABILITA’s medical and hospital health teams and physical therapists, through a certified platform integrated with province-wide health databases that allows secure sharing of documents needed for patient assessment.

(edited by Francesca Perini – TS4.0, and Daniela Bonaldi – PAT Health Department)

Let’s contextualize the “ABILITA” project: what is the rationale and needs that led to its development?

The project, promoted by TrentinoSalute4.0, responds to the need for healthcare professionals to be able to consult, in a structured and secure way and via a tool integrated with healthcare databases , through teleconsultation or telecooperation, optimizing patient care and available clinical resources. In some contexts, such as in RSAs (assisted living residences), the request that came to TS4.0 was to structure a telecooperation service between physicians and other health professionals, specifically RSA physical therapists with the patient present during the virtual visit, that will enable RSA guests to have an accurate clinical diagnosis without the need to leave the facility, avoiding the implications that this entails in the case of fragile and difficult to transport patients.

The first area in which the solution was introduced in 2022 was telecooperation between the ABILITA physicians and physical therapists group, the service offered by the Trento Province Healthcare System for Aid Information and Evaluation at the “Villa Rosa” Rehabilitation Hospital in Pergine Valsugana (TN), and the APSS (Trento province Healthcare System) physical therapists. Upon request, the Villa Rosa service is also available to carry out remote prescriptions in cooperation with physical therapists working at nursing homes across the province. At present, about 40 remote visits per month are carried out with RSAs, but these numbers are constantly on the rise.

For a more accurate assessment of the cases being examined, ABILITA’s team of healthcare professionals often needs to evaluate other sources of information, such as photos and floor plans of the home, seeing the patient’s movements on video (how he or she climbs and descends stairs), etc. Therefore, the project intended to officially structure the telecooperation service with a platform linked to the corporate repository, so as to digitize the service in all its phases, and to allow complex assessment documents and information to be shared securely and efficiently.

How was the project developed? What structures and institutions are involved?

ABILITA is among the strategic objectives of the Autonomous Province of Trento (PAT) and is in line with national guideline documents on telemedicine and in advance of the interventions envisaged by the PNRR (Mission 6 Health), which promote the use of remote consultation, medical-health remote consultation, and remote cooperation, benefiting especially the most peripheral areas that often do not have specialists on the ground.

To develop the service, in addition to the ABILITA team, the APSS Technology Department also took part in the working group, which, thanks to the coordination of TrentinoSalute4.0 project managers, in 2021 and 2022 carried out the needs analysis through interviews with physicians and physical therapists, identified the requirements and implemented the organizational change.A digital tool was then created based on HealthMeeting Ⓡ (HM), a platform for customizable clinical collaboration equipped with “class 1” medical device certification, and accessible with credentials from a web portal, either from a laptop or tablet. Remote access allows physical therapists to physically move to different locations, depending on the patient’s needs.

A web platform, therefore, that allows professionals to collaborate remotely. How does it work and what benefits does it offer specifically?

The process of telecooperation works like this: when the RSA physical therapist finds the need to have or change an aid for one of his or her patients (e.g., wheelchair, prosthetic limb, etc.), but the patient is unable or has difficulty moving from the facility where he or she resides, he or she uses the HealthMeeting Ⓡ platform to send the digital request to ABILITA. He or she fills in the patient’s medical record and adds other information that might be helpful in the assessment (e.g., a video showing the patient walking, a photo of the aids he or she is already using, etc.). The ABILITA team receives the documentation, evaluates the request (checking the patient’s aid payment exemption eligibility), and schedules the video conference. On the scheduled day, the ABILITA team, consisting of the hospital physician and physical therapist, remotely connects through the HM Ⓡ platform with the RSA physical therapist and the patient.During the video call, the team can request to be shown the patient’s abilities and mobility, or other information useful for case assessment. When the assessment has benn completed, ABILITA selects the most suitable aid and checks its availability in the central warehouse.

Through the platform, ABILITA’s medical and health care team is also able to see clinical information, view visits and reports on the Hospital Information System, create and digitally sign the prescriptive certificate (digital signature will be activated soon), which will be sent digitally to the relevant office (prescription dematerialization is also underway).The requested aid is then delivered to the nursing home, which must then enter the date of receipt into the HM Ⓡ platform and, if necessary, provide feedback on testing. If no problems with the aid are notified within 20 days, the platform automatically closes the request with positive testing. A report is also created for internal use with all the information shared digitally, while the prescriptive certificate can be saved on both the Healthcare System’s repository and the patient’s medical record, and will be visible to the patient and proxy caregivers on the platform and the TreC+ app. Upon request, the system also allows the family to be involved in the aid assessment process: caregivers or family members of the RSA guest can in fact participate remotely in the video call.

What are the benefits?

The remote cooperation organizational model with nursing homes lays the foundation for optimization of resources, time and money, and space. The hospital, RSA and patients can benefit from time and money savings by no longer having to be physically present at the hospital except when strictly necessary (about 600 patients in a year). This means that in many cases it will no longer be necessary to have to request the already saturated “Transportation service for the sick”, which can instead be used for other people who need the in-person evaluation instead. Finally, the health system will be able to optimize the use of outpatient clinics, which will be less crowded.

And for health providers?

The IT tool provides a single platform for collaboration and support for the management of remote multidisciplinary meetings aimed at discussing clinical cases. It also allows for direct consultation of the citizen’s medical records, automatic completion of documents and, in a second version under development, provides for the dematerialization of the red prescription and referral forms, halving the time and resources involved. A simple and ubiquitous tool across the province territory that enables different specialists to collaborate and consult remotely, through the sharing of documents, reports and images, in a secure and efficient way.

What are the benefits for patients and citizens?

Patients who need a prosthetic prescription, particularly those with civil disabilities, are also often those who have the most difficulty traveling to the hospital for in-person visits. Thanks to this platform, not only is the privacy of sensitive data protected in compliance with the GDPR, but also the assessment process becomes easier since the patient can be assessed remotely, without the need to travel, improving the quality of care he or she receives, and facilitating access to aids to loan.

Finally, for the patients’ family members and caregivers, the platform, on the one hand, allows those with delegated authority to see and download through TreC+ (Cartella Clinica del Cittadino) the aid prescription report (which is saved on the Electronic Health Records). On the other hand, it offers the possibility to participate remotely in the meeting for the evaluation of the aid. A need that has become even more pressing with infectious disease prevention and control measures in the context of the Covid19 emergency.

How is the trial of the ABILITA service going?

Since the service started with the first ten RSAs, more than 40 requests have been made using the new platform.

The experience gained in the first few months also revealed some critical issues (but these have already been resolved in the latest version of the platform). They can be traced back to the need for a more flexible modification of the prescribing certificate for specific patient cases, the level of digital literacy of the practitioners involved, and the need for an investment of resources to support the scalability of the solution in the transition phase from one tool and organizational model to another. At the same time, the model made it possible to confirm the potential and effectiveness of a platform integrated with business systems, which allows for the dematerialization of all documents and the automation of many processes that were previously carried out manually and/or in paper form (e.g., automatic positive aid testing).

What are the possible future developments?

The flexibility of the tool also allows it to be used in other contexts of remote cooperation and teleconsultation between different healthcare providers. In the first half of 2023, a more agile version of the platform was developed on an experimental basis, which still allows file sharing, connection to the corporate IT system, and both synchronous and asynchronous teleconsultation. Health workers in peripheral emergency rooms in the Province of Trento will be able to use the synchronous teleconsultation with the psychiatrist on call in the emergency room of the central hospital. In addition, the platform has been made available to the first 12 general practitioners for teleconsultation with physicians specializing in three specialties (cardiology, dermatology, and pneumology), and then at a later stage the tool will be extended to all physicians in the Trento Province.

The organizational model needed to use the platform for consultation between specialists and multidisciplinary consultations is being defined, and in the context of Telestroke, with the support of certified special cameras, which will be deployed in 2023.

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