For the past decade health care across Europe has been dominated by concerns about cost containment and efficiency resulting in increasing emphasis on cost-effectiveness of care. Among other things this has stimulated a shift away from centralised and institutional care towards care in the community.
The growing importance of primary care (i.e. non- hospital care which is provided locally, not only by general practitioners but also by other health and social care professionals) highlights the need for a change to care which is effective and acceptable to patients and their careers.
This new scenario presents different organisational and delivery challenges for the provision of health and social care services.
To address these issues EPIC give an integrated primary care solutions that seeks:
- to pilot integrated telematics based local health care systems;
- to develop and evaluate a prototype for integrated care across the different health care sectors involve.
The early work of the project has been to specify the consolidated requirements for an integrated care information system, from the different European sites, with particular application to the elderly, in terms of service users and service providers. Input from users has been collected through a framework of interviews, workshops and questionnaires in three different sites. Results have been compared individualising commonalties and differences between them.
Detailed education and training needs have been identified on the basis of the service requirements and the different categories of staff on:
- the perceived uses and values of the proposed system,
- the use of equipment,
- application software
Work on standards will proceed by adopting relevant existing clinical and technical standards. The availability of medical standards in the field of integrated care is limited. EPIC will concert with CEN/TC251 to identify emerging and planned standardisation work of relevance to EPIC and where no such developments are taking place, internal conventions will be agreed to meet the needs of the EPIC application. While some of these conventions, will remain internal, those which are considered to be essential to the future dissemination of EPIC will be developed with the goal of subsequent presentation to the standardisation bodies. In addition, throughout the evolution of EPIC, a glossary of terms requiring a precise definition is being created. This will be an important contribution to the integrated health care environment in European, to assure uniform understanding of terms relevant to integrated care.
In technical standards the integration of the different Health Care realities (including Home Care and Mobile Systems) in a complete Telemedicine systems means the integration of many different technological realities. The project will adopt a standardised open system approach where standards will be identified, mainly those dealing with communication. Particular service requirements' standards that deal with devices directly attached to patients will be specified.
The methodology to be applied during the development of the system will be described.
The work on EPIC systems aspects began with an analysis of the technology solutions available in various shared care scenarios with particular interest in systems applying generally applicable models.
The consolidated requirements are being formalised into a structured system specification and expressed in terms of the data elements and required functionality. Functionality will be categorised into data handling, user interface, communications and home based which will be refined with further input from relevant users.
Object-oriented design techniques will be applied for particular requirements where appropriate. The design will aim to specify a system that maintains a generic view of shared care while still addressing the needs of the pilot group.
An application framework will be designed where the different system components, their functionality and interaction will be identified and specified.
A security framework with data security, confidentiality and integrity issues will also be addressed as well as contingency planning.
During the architecture definition a site specific analysis will be conducted in the pilot site. Software development will apply proven techniques and will aim to minimise the risks involved by applying industry standard software tools and hardware components.
A risk assessment analysis will be performed, when required, preceding the building of new hardware and risky software components.
An ancillary demonstrator will, making use of existing systems and components, be configured and applied to an antenatal client group. Previous work in this area will be 'pulled through' from the project "Telemedicine" (AIM Exploratory Action A1024) to facilitate the demonstrator.
Prior to release the pilot system to the pilot site, some rigorous internal testing will be conducted.
This process will involve the design and use of test cases and the monitoring of system performance and suitability.
The system will be evaluated over a six-month period, based on clearly defined evaluation criteria from a technical, organisational, clinical, social, ethical and economic perspective. Technical aspects to be analysed will include system performance, security, user-friendliness, reliability and safety.
The fundamental aim of the clinical evaluation will be identify whether the technology leads to improved health status of clients. The economic appraisal will attempt to identify direct and indirect cost and some benefits to both users and consumers.
Key outcome indicators, related to the quality of health and social care, will be identified and included in EPIC.
This will enable the quality of care to be compared between regions and good practices to be recognised and disseminated.
The measurement of outcomes requires the use of standard assessment schedules. A prime goal within EPIC is to agree a common approach to multidisciplinary assessment across the EPIC sites, which may then be presented as a potential European standard.
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