Our main aim was to develop an end-to-end digital integrated care delivery solution for multimorbidity in the context of chronic disease management. The C3-Cloud integrated care approach offers ICT tools for optimized multimorbidity care pathways and organizational models. The C3-Cloud ICT components have been showcased as high technology readiness successes at EU’s Innovation radar (
https://www.innoradar.eu/resultbykeyword/c3-cloud(öffnet in neuem Fenster)).
The project’s achievements are summarised as follows:
1. The project management and communications structures have been developed to oversee activities, monitor risks and issues; and assure quality. Dissemination of results through various channels, such as website, social media, conferences, workshops and publications.
2. Exploitation plans for the project results have led to a final business plan and the incorporation of a community interest company, namely C3-Cloud Partnership Ltd.
3. The design of the technical architecture of C3-Cloud has been completed with co-production between technical and clinical teams throughout software development, testing and deployment phases.
4. Patient pathway and organisational model development and change management for using the tools developed in C3-Cloud have been extensively analysed and guidance developed for new patient pathways and corresponding personalized care plans.
5. The Interoperability Middleware consists of 3 components. The Technical Interoperability Suite enables seamless data exchange between the local care systems and the C3-Cloud components, while the Semantic Interoperability Suite addresses the challenge of heterogeneous clinical data representation formats. Finally, the Security and Privacy Suite enables authentication and authorization of care team members and ensures encrypted and auditable data.
6. The Patient Empowerment Platform (PEP) has been developed for use by patients and their informal caregivers, with messaging and self-management training materials access for increasing patient adherence to care plans.
7. NICE clinical guidelines for the 4 diseases and multimorbidity have been studied. 43 logical flowcharts have been developed that model the clinical recommendations from the guideline text documents to develop 31 CDS services. A drug-drug interaction service has been developed based on the NICE British National Formulary (BNF) database to support care plan development.
8. The Coordinated Care and Cure Delivery Platform (C3DP) has been developed as a web application to allow collaborative creation and execution of personalised care plans for multimorbid patients by a multidisciplinary care team.
9. All the technical components have been successfully integrated and the C3-Cloud system has been successfully deployed at the 3 pilot sites in Spain, Sweden and UK.
10. Protocols have been developed for the 4 layers of evaluation in the project (e.g. component and application test plans, usability evaluation, etc.). Ethics applications have been obtained successfully for the technology trial of the C3-Cloud system at the pilot sites.
11. The study has run for 6 months and the data gathered has helped to inform C3-Cloud system’s acceptance and perform impact assessment in the context of scaling up of the solution.
