The eCare Network in Bologna

This chapter describes the outcome of the creation of an eCare Network for frail elderly people in 2005. This was developed over the years as a network of citizens, associations, institutions, and professionals, providing a relational and support ecosystem to frail elderly people. The issue of financial sustainability of the health and social welfare system, in the phase of ongoing demographic revolution, has stimulated the creation of a service that aims to encourage the permanence of frail elderly citizens at home to prevent the onset of frailty or dependency and to improve their quality of life by fighting social isolation through the use of appropriate IT technologies. Community-based voluntary associations also play a key role in the eCare Network for the frail elderly. Finally, in addition to a detailed description of the activities that have been put in place, the service outcomes, innovations, and prospects for further development are illustrated.

The Development of BelRAI, a Web Application for Sharing Assessment Data on Frail Older People in Home Care, Nursing Homes, and Hospitals

As the complexity of caregiving rises and surpasses traditional models of care, the need for comprehensive and integrated assessment systems increases. The use of standardised and computerised data—available to those who must make decisions—has become paramount. In Belgium, the BelRAI Web application has been developed to support the use of interRAI assessment instruments in a multidisciplinary way and to exchange client-centred information across care settings. This chapter describes the particularities of BelRAI, the security aspects, the support tools, the gradual process of implementation, the dos and don'ts, the pros and cons, and the challenges for the future. The benefits seem to overrule the drawbacks, but it has also become clear that only a significant expenditure on resources with regard to adequate staffing in healthcare environments, appropriate information technology, and training facilities can contribute to a successful introduction, maintenance, and full exploitation of this innovative health information system.

Telemedically Augmented Palliative Care

Patients with advanced cancer have a substantial symptom burden, which deteriorates their quality of life. Palliative care improves well-being of patients and their family caregivers. Within the scope of a controlled pilot study, a user-friendly telepresence system is developed, which enables patients and family caregivers to send a direct request to a palliative care team. Additionally, a specially tailored database is developed, which contains up to date patient information. Twenty patients with advanced non-small cell lung cancer are consecutively assigned in a control and an intervention group. The intervention group receives the telemedically augmented care, whereas the control group receives standard care. The primary goal of this chapter is to determine the usability and feasibility; the secondary goal is the assessment of the intervention's impact on quality of life and the number of unscheduled hospital admissions. To sum up, telemedically supported ambulatory palliative care may synergistically help to improve safety and quality of life.

Integrating Social and Health Services in Greece

The integration of e-health services in the Greek Healthcare System is expected to be a challenging task. To this end, three EU co-funded projects (ISISEMD, INDEPENDENT, and RENEWING HEALTH) are tested under realistic conditions integrating e-health and e-care services to the existing health services offered to people that suffer from chronic diseases as well as to their formal and informal caregivers. This chapter aims to give an analytic report of those three European programs in terms of service description, implementation, evaluation, and exploitation. The authors introduce the main characteristics of the Greek healthcare system and the risks that it faces in regards to the major reformation and cut offs due to the economic recession. Then they explain how those risks could become opportunities to promote integrated services.

Implementing and Scaling up Integrated Care through Collaboration

Across the developed world, the majority of health and care systems are looking towards the integration of services within and across organisations to deliver efficiencies and enhance effectiveness and, by doing so, deliver service sustainability in an increasingly challenging environment, while a simple aspiration to articulate in reality the delivery of integrated care is proving challenging and in some cases elusive. In 2012, the European Innovation Partnership on Active and Healthy Ageing's B3 Integrated Care Action Group carried out a high-level survey of 27 B3 Action Group members from regions and delivery organisations across Europe to determine their state of readiness for the delivery of integrated care services. This chapter highlights the common bottlenecks and barriers identified, before moving on to explore the key components that support the successful integration of services, including incentives/levers for change and technology-enabled service solutions.

Understanding Integrated Care

This chapter provides a thorough grounding in the meaning and logic of integrated care and the role of ICT. It begins with an overview that describes why integrated care has become a central theme to the reform of health and social care in the face of mounting demographic and economic challenges that require a new way of thinking about how care can be more cost-effectively delivered. Following an in-depth analysis of what is meant by integrated care, including an interpretation of the various definitions and interpretations that have been provided, the chapter moves on to provide an understanding of the challenges faced when implementing integrated care programmes in practice and the key lessons in how systems of integrated care can be built. The role of information, communication, and technology as essential components for the success of integrated care is then considered together with an assessment of the future research agenda.

Integrated eCare in Dementia

This chapter describes the evaluation of the INDEPENDENT project as it was implemented in Ireland. The project in Ireland consisted of the collaboration of the Alzheimer Society of Ireland, a not-for-profit organization providing services for people with dementia and their family carers, and Tunstall Emergency Response (TER), a commercial telecare provider organization. A joint client database was developed that provided information on alerts and events generated by the telecare system to ASI staff. An evaluation was undertaken with family carers, staff, and key stakeholders in ASI and TER. The telecare packages were given a high satisfaction rating by family carers. The Web portal was seen as beneficial by staff, in that it provided close-to-real time access to information on telecare alerts and events that could enhance care planning. However, staff regarded the portal as difficult to navigate and use. Key informants in ASI and TER both viewed the Web portal as enhancing the reputation of their organization.

From Agreement to Realization

Gesundes Kinzigtal is a population-based integrated care approach in Germany that organises care across all health service sectors and indications. This chapter describes the development of an electronic networking system in the project between 2006 and 2013. The IT system that was developed shall supply physicians' offices and other providers such as ambulant nursing care services and hospitals with time saving services providing the complete relevant information of the patient. The status of IT systems in practices at the start of the project and steps to achieve a mutual IT system and intersectoral cooperation are described. Pros and cons for small or large IT companies as partners and patients concerns on data safety and confidentiality are discussed. The chapter closes with an outlook on expanding the project to further healthcare sectors and raises ideas for future studies on self tracking and mobile health data from APPs as well as community resources and voluntary networks to join electronic patient networks.

Making Integrated eCare a Reality in the UK

Integrated health and social care has been a missed goal in the United Kingdom for many years. This chapter examines why this has been the case and what might be done to remedy this. The inception of the welfare state is described in its historical context to provide clues as to why integration has proved difficult, before examining Wistow's forensic analysis of the barriers to integration in light of this, focusing in particular on his emphasis on the difficulty of integrating the diversity of social care with the monolith of healthcare. Rigby's analogy of technological road mapping as a model for integrating care and planning services is explored in detail, before explaining how this method was utilised in the INDEPENDENT project in Hull. The chapter concludes that the analogy of “technological mapping” is a useful guide for directing services and helping to integrate care but that government too has a vital role to play.

Socio-Economic Impact Assessment and Business Models for Integrated eCare

Putting into place ICT-supported, integrated health and social care services means that a multitude of stakeholders are affected by changes to their working process and often to their economic performance. In this chapter, the authors describe their approach to assessing integrated eCare services to enable care integrators in making strategic decisions during development and early operation. The approach is founded on cost-benefit analysis. It stands out from other assessment frameworks in that it 1) allows identifying and addressing stakeholders that lose through the service and thus may become strong veto players, 2) allows monitoring of the actual and prospective service development over time, 3) includes non-financial factors that in many cases have a major impact on the behaviour of a stakeholder, and 4) provides probabilistic methods for achieving rigorous results from data of varying quality. Following an exemplary integration case developed from one of their pilot projects, the steps of the assessment process are described, including an exemplary interpretation of the analytic results and their application in practice. The chapter concludes with an outlook on future work.