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Brief description of demo projects

 

Pre-visit is an important link that complements the family physician's work process and enables for a comprehensive primary care level service.  It begins with the patient describing the problem for which the most appropriate course of treatment is found. The service is available 24/7 and is based on a triage module: self-diagnostics, a symptom questionnaire and a workflow management module that helps find a solution to the problem quickly and determine the urgency of the service to be provided. The solution allows to make reservations for different services according to the complexity of the problem and the category of the triage and to conduct consultations via chat and video call.

This tool reduces the number of physical contacts by addressing some issues through patient instructions and enables the use of a variety of communication channels. Triage reduces staff time and empowers them and patients with quality structured information.

We are creating a digital solution for effective communication between patients and primary health centres for care planning, monitoring and supporting. The main goal of the solution is not only to prevent exacerbations and complications of chronic diseases but also to prevent diseases in case of patients with health risks. The pilot solution will be based on evidence-based health technologies and will use decision support opportunities from the treatment instructions.

A primary care centre will prepare a care plan for the patient using a motivating interview. The care plan will include specific goals and activities to follow. The role of a family physician and his/her team is to empower their patients to take an active role in managing their health and involving other health centre specialists according to the needs (physiotherapist, clinical psychologist, mental health nurse, midwife).

The methodology of the care plan has been developed in the framework of a risk patient care management project. In this project, a distant service model will be developed for primary care centres, and the research partner will measure its impact. The involved technology partner will create a telemedicine solution that is an add-on to the existing solution. It is a secure communication and collaboration tool for family physicians and patients including features to keep and raise patient’s motivation to take care of his/her health.

DocuMental telemedicine service model is intended for anyone with a mental disorder or who is suspected to have a mental disorder. The model offers an opportunity to modernize the treatment of mental disorders for all professionals providing mental health services (psychiatrist, family physician, general practitioner, nurse, mental health nurse, psychologist, etc.) The solution enables to integrate the treatment at different levels and institutions of care.

The service model helps improve the patient treatment and the quality of service before the consultation (self-assessment, self-help, e-triage etc.), during and between doctor’s consultations. DocuMental platform can be used for both – during in-person consultations and e-consultations, and the level of documentation remains the same.

DocuMental service model includes various telemedicine aspects enabling remote reception in the form of video consultation and asynchronous communication (messaging, advice), decision support for the healthcare professionals, and patient-implemented solutions (self-monitoring, scales, health scoring).

The aim of the project is to improve the availability of mental health support services, increase the quality of care, provide and improve the continuity of treatment.

The goal of the project “Hospital at Home” (HaH) is to develop a hospital teleservice model suitable for the needs and conditions of Estonia. HaH could be an option in a crisis (such as a pandemic) but can also be used daily to provide hospital level care for people with chronic illnesses, while giving them an option that is more flexible and patient-centered. HaH is hospital level care by a visiting nurse and medical specialist for a condition that usually would require hospitalization and inpatient care. The patient can be referred to HaH by their general practitioner or the on-call doctor at the emergency department, depending on where the patient decides to turn to first. Referral to the service is only possible once the patient has been examined by a doctor and first-line treatment has been prescribed. Should the patient's health deteriorate whilst in HaH, they can be quickly admitted to the inpatient hospital.

In Estonia, more than 42,000 people suffer from psoriasis. Psoriasis is a chronic relapsing skin disease and has many comorbidities. Although the patient cannot be cured from psoriasis, on-going and personalized treatment approach can significantly increase the quality of life of such patient. Thus, decreasing periods of skin inflammation and early detection and treatment of related diseases important. The project will create new service model that will provide the patient with access to care in case the symptoms worsen, and will be able to share disease-specific risk data and medical photos of the skin from distance. Doctors can evaluate treatment progress; compare risk scores and photos of the skin. The project implements a care pathway approach, including remote monitoring and enabling doctors to decide whether treatment regimen should be changed, a face-to-face appointment or a referral to another specialist is needed. The approach will help to prevent exacerbations of psoriasis and enable early detection and effective treatment of co-morbidities. The implementation of the new model is enabled by Dermtest medical photo management software.

The goal of the project is to introduce multiparametric telemonitoring of patients with severe heart failure. Telemonitoring takes place in cooperation with the heart failure outpatient clinic of the North Estonia Medical Centre and Cardioly LLC.

Our emerging service model will make the treatment process more dynamic - allowing timely treatment decisions and improving access to healthcare - and logistically more efficient - making healthcare consumption more convenient. Telemonitoring will likely increase the consistency of treatment process, thereby improving its quality.

Eligible patients will receive a home monitoring system and training to use it. During regular self-monitoring, biometric parameters are obtained and transmitted to the cloud environment. Based on the received data, it is possible to analyse the current state of health of the patients and make treatment decisions. The overall purpose of the project is to improve patients' quality of life and survival.

Telemedicine service “ER outside the ER” is a collaboration model that enables cancer patients to report treatment-related side effects to their care team.

Timely knowledge about the patient’s side effects allows for early intervention and treatment by the patient’s care team. Therefore, serious, potentially life-threatening side effects and need for hospitalization can be reduced. Platform also collects structured patient-reported outcome data, which can be used to change future treatment strategies (in both cancer clinics and primary care).

The purpose of the telemedicine service is to:

  1. maintain/improve patient’s quality of life during treatment.
  2. reduce the number of unnecessary ER visits by cancer patients.
  3. ensure early intervention in case of complications.
  4.  improve adherence, which is a prerequisite for an improved treatment outcome overall.
  5.  increase collaboration between general practitioners and the cancer clinic.
  6. use patient-reported data in treatment-related decision-making.
  7.  conduct active patient counselling, which can reduce treatment-related anxiety and increase the patient’s sense of safety.

Patient and the care team are connected through a digital health platform. The pilot entails up to 250 breast and colorectal cancer patients receiving systematic treatment.  

There are an average of 80,000 new cardiovascular cases with 8,000 deaths per year (50% of all deaths) in Estonia.

Under 10% of eligible patients attend cardiac rehabilitation programs (Western European countries average 20…45%).

Tartu University Hospital is piloting a care pathway integration platform to streamline the care process, optimize critical care team resources and reduce variation and cost.

The goal is to design and implement care pathways for cardiac rehab patients, assigning tasks to appropriate team members, based on roles, skills, and risk to get real-time visibility of progress. This allows us to prioritize, redirect, and escalate activities to deliver better care.

 

Efficiency is achieved by EHR integration, automatically executing tasks, interacting with patients and caregivers, and algorithmically coordinating care, based on disease, risk and compliance.

Remote monitoring of patients with chronic obstructive pulmonary disease

The project involves remote monitoring of patients with chronic obstructive pulmonary disease (COPD). It includes patients with severe and very severe COPD struggling with daily respiratory symptoms, low exercise capacity and a significant risk of exacerbations. Each exacerbation is associated with worsening of symptoms, further decline in patient's quality of life, an increased risk of death, and high costs to the health care system.

The aim is to control exacerbations faster, reduce hospitalizations, and maintain and improve patients’ quality of life. For this, a multidisciplinary team dedicated to COPD patients will be formed and the MyCOPD application will be adapted to Estonian conditions. The application allows the team to remotely assess patients’ condition, and patients have a tool to support treatment adherence and disease awareness. In addition, the remote service model includes remote visits of various specialists for patient counselling, treatment and rehabilitation. After the one-year pilot period, data analysis, interpretation of results, cost comparison will be carried out.

Suicide is the number two cause of death among 15-29-year-olds worldwide while only 2% of the health budget is spent on mental health, which indicates a global crisis of mental health inactivity (World Economic Forum 2020 (GAMIAN Europe)).

The aim of the “Help Me” project is to detect the mental health problems of students at an early stage and to provide help as a remote service.

The focuses of the project: 1) the implementation of the mental health assessment tool developed by DocuMental among the target group, the aim of which is to collect data on the student's emotional and psychosocial health, assess the data, and organize further help, if necessary; 2) launching online consultations (video bridge, chat) to advise the students; 3) development of an authentication application that is universal and interfaceable with all information systems providing health care services; 4) increasing the competence of school nurses in identifying mental health problems, providing first aid and referral.

As a result of project implementation:

- improved access to mental health care for students;

- increased mental health awareness and ability to help oneself among students;

- remote consultation of mental health nurses reduce the burden on psychiatrists and clinical psychologists;

- an opportunity is created to refer students whose problem needs specialist help, based on objective data.