Medical Device Daily Contributing Writer

BARCELONA, Spain — At the World Healthcare Congress Europe, held here at the end of March, the chief executive for the UK's National Health Service (NHS) neatly described a significant problem that he shares with colleagues from the 26 other member states of the European Union. And he then presented a solution.

"On any day, one-fourth of hospital beds are filled with patients with more than one chronic condition, and most could be better served in their community," said David Nicholson, who went on to show how England's Connecting for Health program is an IT-centered strategy that enables delivery of healthcare services for the chronically ill at the community level.

Jennifer Dixon, director of health policy at the King's Fund, set off a buzz among the 500 conference participants with her presentation of an interactive tool used by NHS primary care trusts to target in real-time patients requiring an intervention for chronic disease prevention.

And the creation of a 100-bed virtual ward for chronic disease management at the UK's Croyden Primary Care Trust was promoted by Capgemini (Paris) as a model for community-based treatment. Patients are identified using the Combined Predictive Model from the King's Fund and assigned to a virtual ward team that meets daily.

Patients are cared for in their own homes. Specialists, including pharmacists, social workers and physiotherapists, are called upon to respond to what are often multiple-morbidity conditions.

The enthusiasm for the pioneering British model, though, gave way at the conference as delegates returned to the sobering workshops on topics such as healthcare financing, data security, patient safety concerns and the fragmented state of IT systems that impede, rather than encourage, such programs, which while aligned with their ambitions, are for the moment far beyond their grasp.

As in the U.S., almost 80% of European healthcare spending is consumed by care for patients with one or more of the "dirty five" chronic conditions: congestive heart disease, congestive heart failure, diabetes, asthma and chronic obstructive pulmonary disease.

Several European pilot programs have reported benefits identical with the American experience, most critically savings of 30% to 40% when care is moved to a home setting or a community clinic.

Where the NHS program builds upon capabilities emerging with the IT "spine" developed by Connecting for Health and sophisticated online tools, other countries have taken a lower-tech approach to chronic disease management.

Rather than reinventing the wheel, the Netherlands created the Maastricht Chronic Care Model "by nicely paralleling the Kaiser Permanente (Oakland, California) model," according to Cor Spreeuwenberg, dean of health sciences at the University of Maastricht in the Netherlands.

"All aspects are integrated," he said. "Outreach from hospital to community, active planning and management, promotion of self-responsibility and self-care, shared care between professionals and with patients and their families."

Spreeuwenberg added: "We've seen improved clinical outcomes overall, brought down overall costs, and have more satisfied patients."

The results are mainly attributable to nurses, he said. "The nurses are much better suited to dealing with high-risk patients than the GPs." But, he added, "We need more powerful systems for self-management."

Dr. Orlaith O'Reilly, director of public health for the Republic of Ireland's Health Service Executive (HSE), described results from a seven-month pilot conducted in the southeastern region that concluded in December.

Described as a "highly scalable system linking expert systems with remote monitoring," the Irish program, more simply put, connected nurses with patients over the telephone.

To reach her goal of a "third-generation disease management" model based on the possibilities of the 21st century, rather than being linked to the episodic acute-care model of the last century, will require "convincing decision makers of the need to change," O'Reilly said.

A survey of the European clinicians and public health administrators at the conference in Barcelona revealed unanimous support for empowering patients and supporting self-care with 100% of participants ranking such a strategic shift as important or very important.

"The many European e-health programs now under way are going to put an infrastructure in place to monitor effectiveness and patient use of medical systems," said Gunther Illert, head of the Central European Life Sciences group for Capgemini. "This is necessarily going to lead us to patient-focused care."

He added: "The focus on the patient is helping people awaken to the insight that we need to change," but more infrastructure is required to provide accurate information and incentives for the regulators and providers to take things further.

"Where is the burning platform that will push us there?" he asked, adding: "It is not a natural market."

Another survey at the conference showed that more than half of participants believe the biggest barrier to implementing a scalable disease management program in their country is, flatly, payment or financing.

Another one-fourth said healthcare professionals are the problem, though the survey did not explore if this was due to resistance to change, or a shortage of professionals.

"The evidence abounds and demonstrations are clear," for home care of chronic diseases, according to G rard Comyn, head of information and communications technology for health for the European Commission. "We expect a lot from IT for home care, with mobile health systems, wearable health monitors and ambient intelligence for the home setting."

Moving forward, he said, the obstacles to plugged-in home care using these sophisticated medical devices are less technological and more a demonstrable value-added business case realigning reimbursement models to reflect the shift in care from medical centers, and contending with legal barriers, especially where the care is to be offered by the national system.

In many cases, he said, "we simply cannot do what is blocked by a legal framework."