Progress is happening, but unfortunately whenever we look around the world and people talk about integrated care, they can’t always point to best practice,” said Hassan Chaudhury, opening the session ‘Best Practice in Integrated Care – What does success look like?’ at the HIMSS22 European Conference on Wednesday (15 June)
The speakers were: Hassan Chaudhury, global digital health specialist, Healthcare UK, UK Department for International Trade, HIMSS Global Innovation Committee; Dr Carlos Ferrando, head of surgical and trauma intensive care unit, department of anesthesiology, Hospital Clinic Barcelona, Spain; Juha Jolkkonen, director of social services and healthcare division, City of Helsinki, Finland; Prof Nick Guldemond, professor healthcare and public health, Leiden University Medical Centre, The Netherlands.
An example of what successful integration could look like at a local level was presented by Dr Carlos Ferrando of Hospital Clinic Barcelona. He described how the ‘Zero Project’ aimed to use technology to achieve zero preventable deaths and zero preventable adverse events for surgical patients at the hospital, which carries out around 30,000 surgeries a year.
In Barcelona, he said hospitals do not currently share health data with each other or with primary care, making integrated care a huge challenge.
“Our idea was to start inside the hospital. We wanted to make a continuum of critical care possible – which means we needed technology, we needed data and we needed human resources,” Dr Ferrando said.
The Zero Project aimed to monitor patients on the hospital floor to find out whether they had adverse events and what was happening when they went to the surgery room.
“We needed to measure what was happening and create a clinical pathway to improve the outcomes of these surgical patients,” explained Dr Ferrando.
To achieve this, they looked for technological solutions that were wearable, wireless, and individualised to each patient.
“We started spending a lot of money on technology to give us all this data, automate processes and avoid human mistakes,” continued Dr Ferrando. “We worked with a data engineer to create a data centre system which is able to generate alarms and tell us what is happening so we can improve patient treatment and improve the clinical pathway. Now we’re working on the next step – to share the data with our primary care colleagues.”
Preliminary results after one year of the project show a decrease in patient mortality, decrease in hospital length of stay, decrease in intensive care unit (ICU) length of stay, increase in years of patient life gain, and decrease in surgical complications.
“This way we can decrease the number of days a surgical patient is in the hospital and reduce the healthcare cost without increasing patient risk,” concludes Dr Ferrando, “This is the way I see integrated care working inside a hospital.”
Breaking the siloes
Juha Jolkkonen, director of social services and healthcare division, City of Helsinki, gave an example of how integrated care could work on a city-wide level. In Helsinki and several other Finnish cities, citizens have access to the Maisa app, which is based on Epic’s MyChart.
“Most people can find their information and contact through this with all their publicly funded social and health services,” said Jolkkonen. “This is one example of integration in practice.”
Jolkkonen said it was important for patients to be able to access to all social and health services as easily as possible.
Helsinki’s University hospitals use a common patient and client data system based on Epic, which has been expanded to cover all social and health services including specialised healthcare, primary healthcare and social services. This covers around 1.7 million citizens.
“We shouldn’t be in siloes when it comes to answering a solution to your problem,” he said. “Good coordination is good for equality. It’s good for the customer experience. You can find many different benefits from integration.”
Jolkkonen added that when funding comes from the same source it can provide an incentive for innovation.
“Around 15-25% of people – depending on how you measure it – use most of the health services and expenditure, so it’s wise to have services that are unified and integrated to provide them the best possible options in different situations.”
According to Jolkkonen, multi-disciplinary teams with a team leader are the key to integration.
“We still rely too much on doctors. We need to use different types of professionals and expertise more often – this is also integration,” he argued. “We need cross-sectoral, we need integrated service systems, we need to have services with different kinds of models, for instance centres for elderly people where you can find many different services from the same contact.”
The human factor
Prof Nick Guldemond, of the Leiden University Medical Centre in The Netherlands, has been researching the success of integrated and value-based care approaches in various countries, with sobering conclusions.
“There is really no country that is successful in implementing these approaches in a cost-effective way. Although we see some examples at a local level, it’s still fragmented,” he said.
According to Prof Guldemond, even countries with solid infrastructures and well-trained health professionals such as The Netherlands, are failing to upscale good examples of integrated care.
“This points to that you can have everything in place, but still not be able to realise better care with better outcomes in a more sustainable way,” he said.
So, what is the solution? Prof Guldemond believes success will only be achieved through total system change.
“All the ideas that data or technology will revolutionise integrated care are not so much true – what we know from implementation successes are that they are very limited,” he said. “The human factor and redesign of services within the system are the keys to driving integrated care. Technology is just an enabler. Rather than pushing solutions, it’s about how can we establish and realise integrate care together.”