Client: Barcelona Hospital Clinic
Objective: Towards more integrated, long-term health care: Could NEXES be a model for Europe?
Team: Cécile Nourigat (France), Nicholas Sandars (United Kingdom) João Alves Soares da Silva (Portugal), Alban van der Straten Waillet (Belgium) and Rikke Wetendorff Nørgaard (Denmark)
Europe’s healthcare systems are facing a crisis. The 65+ population ratio in Europe is predicted to rise by more than 50% by 2050. The prevalence of chronic diseases (such as cardiovascular, chronic obstructive pulmonary disease and diabetes) is also on the increase: they are the most frequent cause of death and/or disability worldwide. Europe’s health systems therefore need to treat patients who live for longer and whose diseases are long term. This will place a tremendous economic burden on governments, private employers and individual consumers. Healthcare professionals will also constantly be overstretched.
A broad consensus of opinion has formed around dealing with this challenge through a so-called ‘Integrated Care’ model. Under the scenario, healthcare providers focus more on patients’ needs than on the resolution of one particular disease, i.e., they move away from episodic treatment towards a longer-term approach. Information and Communications Technologies (ICT) is recognised as a major enabler to practising Integrated Care effectively.
Europe has seen large amounts of research launched to develop and test ICT-enabled Integrated Care models. The EU has been an important source of funding. The research has provided evidence that Integrated Care improves clinical outcomes and cuts costs. Despite this, it seems to be difficult to deploy pilot projects with a proven track-record of success at a more widespread level: across health authorities, regions, countries and across borders.
In this study, we identify the key factors constraining the wider deployment of successful Integrated Care projects and make recommendations for overcoming them. The critical constraint is the large number of different ways in which healthcare is delivered across Europe (fragmentation). The other challenges identified are the inability for technical systems and standard medical procedures to interact with each other across internal and external borders (interoperability); lack of clarity over who pays for what and how (financial); which legal provisions would apply to healthcare administered across different jurisdictions (legal); and a large range of challenges relating to organisational change and change management (organisational).
In our report, we use Nexes – a Barcelona-based project to manage chronic disease using ICT-enabled Integrated Care methods – as a case study to illustrate these challenges and an example of approaches to overcoming them. We found the Nexes system to be more advanced than comparable projects, as individual parts of the integrated model had already been successfully tested at pilot level. Nexes also places strong emphasis on the principles and objectives of integrated care, but uses a deliberate light-touch on processes for achieving them. This makes it particularly appropriate for use in Europe’s fragmented healthcare systems.
The report recommends approaches to resolving each of the five areas of constraint: fragmentation, interoperability, financial, legal and organisational. We highlight the timeframe which combinations of actors within healthcare systems would need to collaborate to achieve success. On interoperability, technical constraints can be reduced by the widespread use of modular, open ICT systems and increased efforts in agreeing European-wide standardised medical definitions (semantics). Legally, medium- to long-term legislative action is needed to ensure the roles and responsibilities of healthcare professionals are re-defined (particularly for nurses), and that patients’ medical data is uniformly protected. Financially, we recommend new business models, such as the foundation of innovative R&D businesses within healthcare structures. Organisationally, we suggest an insistence on agreeing changes by involving actors from across the healthcare disciplines and making use of champions to implement change at local levels.
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