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Feedback from UK Policy Experts on the Timis Study Visit Events > Feedback from UK Policy Experts on the Timis Study Visit
22/07/11
Two representative External Experts from the UK (South East Region) recently attended the PEOPLE Programme Study Visit in Timisoara, Romania on 28-29 June 2011.

The Study Visit provided an opportunity for our Romanian Partners to showcase emerging results arising from their work on sub-objectives as well as to visit some new facilities where the work had been carried out.

Summary feedback reports from the UK External Experts can be read below.

Notes from PEOPLE Study Visit held in Timisaura, Romania 28-29 June 2011

By Bruce Don, 01/07/2011

The event was attended by delegates from 5 of the 7 countries / regions represented in the PEOPLE Programme. A diverse programme of presentations and visits were organised, with an emphasis on e-health and the use of ICT to enable social objectives.

The presentations by Syonic (a medium-sized Romanian-based IT company) of their e-health records (ICMed) implementation in Romania provided an opportunity to compare and contrast with the approach taken across the UK, especially NPfIT. Whilst aiming, broadly, at similar objectives (integrated e-records, online booking, e-lab reporting, smart cards for authentication, registers for patients with long-term conditions), the approaches to development and implementation are very different. In contrast with NPfIT, the ICMed programmes is:

- Supported by a single supplier

- Based on a developmental and evolving product

- Designed bottom-up, not a “top-down” national solution

- Driven by commercial imperatives (insurance payments), not political goals

- Funded through modest budgets (largely income generated by early adopters), and service costs to users are equally modest (e.g. only 30 euros / month for a general practice to use the system and services).

In Timis county, for example, ICMed is used by more than 50% of GPs, and many specialists, covering some 60% of the population. The Personal Health Record is a service offered to ordinary citizens on a commercial basis (access costs around 10 Euros per year), but only approximately 300 people currently use this service. This finding strongly parallels experience with the UK's Summary Care Record (SCR), where only a very small proportion of the population have, so far, opted to view their SCR on HealthSpace (which is free). A recent review found that just 752 patients out of more than 1.2m who have a SCR have opted to access it.

The level of system/service development and its future potential is impressive. For example, a smartphone application has been developed allowing access to the e-record anytime, anywhere. Therefore, a key lesson for the UK, as it contemplates ICT after the demise of NPfIT, is that small-scale, local innovation must not be stifled.

A discussion on the shifting role of general practitioners from that of treatment providers to that of guiding patients towards healthy living raised several cultural and technical issues. As more long-term conditions can be monitored remotely (telecare / telehealth), a new set of functions are required to act as broker between patient and clinician, to analyse and interpret the mass of information potentially available. The most appropriate model(s) for skill-mix and organisation of this brokering function is an issue also emerging from the UK's Whole system Demonstrator (WSD) programme, and will need to be considered if integrated telecare / telehealth are to be rolled out at scale.

A small scale project in Romania was described, which examined the use of telehealth (in this case video-conferencing using Skype) for patients with aphasia following stroke. The trial aimed to examine whether on-line patient consultations were an effective form of therapy. The lead researcher considered that they were. As no data were presented, nor was it clear whether there was a control group, and what specific outcomes were assessed, it was not possible to evaluate these findings. Clearly, if other countries / regions are to learn from studies such as these, trials should be designed and conducted with a degree of scientific rigour.

Tim Teen is a small local project which aims to “incubate” young people with a talent for and ambition to succeed within ICT, through practical project-based work. The commitment and positive outcomes were evident. Clearly such initiatives, with a mix of public, academic and industry inputs, can act as a catalyst for technological entrepreneurs of the future.

Notes from PEOPLE Study Visit held in Timisoara, Romania 28-29 June 2011

By Carl Petrokofsky, 21 July 2011

Timisoara has been participating in two of the People projects: - Sub-objective 2, E-health and independence and Sub-objective 4, Social Enterprise and e-inclusion. I have supported the E-health and independence project for sometime in my position as public health advisor concerned with promoting health and wellbeing in Older People in the South East region of England.

Romanian colleagues gave a number of short presentations about aspects of the projects including:

Developing an Integrated Medical IT Infrastructure:

A series of papers examining the development of an integrated IT infrastructure, IC-MED. The system has the potential to link GPs, hospitals, and laboratories in aid of seamless patient care saving time and reducing errors. A personal electronic health card has supported patient empowerment, by making it easier to access health facilities or having prescriptions filled... The work has been led locally by Syonic SRL, a research and high tech company based in Timisoara. The product is working and is being rolled out; although only a few hundred have currently patients have signed up to access their own records.

There is a challenge now to extend take-up. There is a basic system which has been put in place nationally to support more administrative arrangements, but which doesn't have the capacity to do the clinical support work which the IC-MED infrastructure can provide. Future challenges remain to link up the work between the public and private systems. The developers are convinced that the project will go a long ways to supporting the EU Patient Empowerment directive by supporting access to information; supporting health literacy and patient rights; and access to service providers.

Evaluation of Children's Health:

Worker mobility is an important issue in Romania where significant numbers of the population are currently working abroad in other EU countries. This has resulted in the temporary breakup of families with either one or both parents working abroad. It is estimated that 15% of children in Romania have at least one parent working abroad for significant periods (informally called ‘Euro-orphans'). This project examined the impact on health and wellbeing of the children who are left behind and if use of simple ICT could help keep families better connected whilst parents were abroad. The study focused on nearly 1,000 high school children. The study examined both the ability of the children to access and use ICT and at school performance, social interaction and psychological wellbeing.

The results of the study showed that there were generally no significant differences in the behaviour and well being (e.g. school performance) of the ‘Euro-orphans' and the control group of adolescents. However there was a significant increase in psychological vulnerability of those left behind with a higher incidence of depression and anxiety. However, the good news from the study was that these feelings could be ameliorated by use of ICT which supported ongoing and regular contact with parents working abroad. By communicating more frequently with their parents they were able to perceive more emotional support and care. Although the children were skilful enough to use both the computers and mobile phones – their parents preferred to rely on the mobile phone as they didn't necessarily have the computer skills!

Use of Telecare to undertake long distance assessment of patients:

Currently there is only one specialist stroke unit in the whole of Romania. Thus, getting access to specialist skills in the stroke unit are at a premium. A project was described which used remote telecare to determine whether assessments could be made centrally by specialists of patients with stroke at a remote location. A key component of the study was the need to ‘translate' and test a standard assessment tool developed elsewhere into Romanian and determine whether it was able to pick up the subtleties of Romanian language. The initial phase of the study has proved successful as clinicians at a central location were able to use the remote information and make accurate diagnoses. At this stage no financial benefits had been recorded, but further implementation would probably bring costs to make the scheme viable.

There were then a series of presentation about the work of the social enterprise and e-inclusion programmes, including the ‘Tim Teen IT Summer School' and the ‘Blogging School'. The Tim Teen school was designed to help the teenagers develop technical skills as well as project management, team working, and social entrepreneurship skills., The design and application of these skills in the development of business cases , in an environment which also stressed creativity and ‘fun' - were all important elements of the project.

The rest of the Study Tour involved visits to:

- a placement centre for children with disabilities

- the Tim Teen IT Summer School, and

- the Public Centre for Alzheimer's Care

The visits reinforced both some of the progress and some of the challenges facing Romania. The visit to the Tim Teen IT Summer School especially showed how projects that had been described were operating in practice.

In conclusion, below are my reflections both on the visits and projects described:

Some of what we heard had to be taken on trust. It was sometimes difficult to assess the robustness of some of the claims made by the studies as clear objectives; evaluative design; and outcomes were not necessarily clearly described (although there were notable exceptions to this). As a result it is difficult to assess whether such pilot projects have the robustness to warrant recommending further large scale roll-out. It was also difficult to judge whether the context for the projects were so culturally or geographically specific that one would want to recommend further roll-out in the wider local geographic area, much less across national boundaries.

Having said that, the projects undoubtedly generated enthusiasm, support and interest and could prove to be real pathfinders locally on how to proceed – with the proviso that next steps needed to be set up so they could be rigorously evaluated with clear health (or other) benefits and financial costs illustrated.

Some of the projects would have benefited from making links with local and wider academic researchers. For the IC-MED project in particular, there is a potentially extremely rich source of data which could be used for future epidemiological and other healthcare studies and it seems that future links – perhaps on a cross-European basis would be worthy of future exploration

The site visits were notable for several reasons:

Placement Centre for Children with Disabilities: we visited a new wing of this Children's centre. . The inside was a pleasant environment and the children (we saw) seemed occupied and engaged with staff on a series of activities (and this was in the late afternoon for our visit). Given the past history which Romanian orphanages have in the wider public imagination this was reassuring. I should say that the children that we saw were all mobile and physically active – and, in the UK context would be more like a home for children in care rather than one for children with (physical) disabilities.

Tim Teen IT Summer School: the young adults we met were just a joy to be with. Enthusiastic, articulate (in English as well as Romanian), confident. They described the projects they had been developing and were very aware of both the IT and technical as well as the social element of the team-working which the project had engendered. To this extent the Summer School seemed an absolute success. In terms of future policy – the real challenge will be how such an ‘incubator' can be used to reach a much wider number of high school students in future. The dozen or so teenagers we met had been chosen partly because they possessed some of the skills they were able to display so confidently when we met them. The challenge must be to how to mainstream in some way such an undoubtedly successful programme.

Alzheimer's Care: This was a modern, new wing of a larger establishment. . My view was the Care centre demonstrated a caring regime in transition: - it didn't quite know if it was trying to be a clinical or more of a residential type care facility. The rooms and environment were clean and attractive: - unlike all too many care homes for patients with Alzheimer's there wasn't any smell of urine anywhere – indicating, at the very least good basic care. However, the facility was still somewhat institutional in feel and could benefit from addressing a few basic design issues (eg, there was a potential ‘trip hazard' when entering all the clients' rooms; the gym seemed to have equipment designed more for fit and active 20 year olds than for the care residents. ). The People Programme might wish to consider how to encourage shared learning across borders in a systematic fashion to promote the best in building design and use backed up by a focus on outcomes.

Finally, a general observation and policy recommendation for the People Programme is that overall there has been little work which has been undertaken to see how technology could be used and adapted on a population basis to improve public health and wellbeing. Such projects could help improve the health literacy of the population and promote informed choice for healthy lifestyles and behaviours and begin to make a significant impact on the health and wellbeing of say a regional population.

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