Telemedicine, or the provision of healthcare services from a distance, can help to improve the life of citizens- both patients and health experts- while also solving some of the challenges that the regional healthcare service is facing. This intervention model, which is based on the use of new technologies and centred on the relationship between the healthcare expert and the individual patients, embodies the vision of a system founded on personalised medicine and technological innovation, so-called digital health. These two aspects are going to be central for healthcare related policymaking both during and after the pandemic, at the European level as well, and for grants such as Eu4Health.
The use of new technologies in this context enables you to increase the efficiency of specific treatment processes, to integrate expertise and to guarantee continuity of care. Meanwhile they also generate a great amount of data on patients (for example in cases where the information and communication technology is linked to individual sensors) that are very helpful to better define the treatment plan based on the degree of complexity and support required. On the other hand the use of telemedicine in addition to the more traditional healthcare provision models enables patients to be more actively engaged in terms of lifestyle management and being able to control their health status and their treatment adherence. The Lazio region has been launching telemedicine projects in different settings for several years.
Two examples of these are the Telemed project and the TeleAdvice system. The former involves the ARES 118 (Regional Healthcare Emergency Authority) and the cardiological network of hemodynamic services for patients with suspected myocardial infarction. The latter is a teleconsultation system connecting all the regional A&E departments and hospitals that provide adult, paediatric, cardiologic, cardiac surgery, stroke, trauma, perinatal and infectious disease emergency services.
Based on the 2019-2021 plan to reorganise, redesign and develop the healthcare service of the Lazio region [1], telemedicine became an essential component of the regional healthcare service. The objective is to apply technological innovation to all the treatment routes in order to promote prompt and appropriate care, facilitate the move to a different support setting and improve the way patients are looked after, particularly those with chronic conditions whose treatment adherence should be monitored with the use of such tools.
The arrival of the Covid-19 pandemic accelerated further the progress of interventions that were already being implemented at the regional level. The use of TeleAdvice proved necessary and very helpful in the current sars-cov-2 emergency context as it connected 51 hospital facilities and 1,671 specialist doctors to the network. The ability to receive teleconsultations on infectious disease cases with the Lazzaro Spallanzani National Institute of Infectious Diseases and the Bambino Gesù Paediatric Hospital was essential for the management and assessment of cases by regional A&E departments. From 20th January- and throughout 2020- the doctors of the Spallanzani Institute conducted 4,783 teleconsultations e the infectious disease specialists indicated it would be appropriate to transfer the patient only in 743 of these cases. Teleconsultations through TeleAdvice were also utilised frequently by the networks of trauma, adult emergency and stroke support services.
In March 2020 [2], the Lazio region created, with the support of the Laziocrea spa (“Lazio creates”) company, the LazioAdvice system and the Lazio Doctor for Covid app. This was achieved by widening the applications of the abovementioned Advice app, a telesurveillance and telemonitoring tool for patients exposed to the risk of infection and for Covid-19 patients, to be used at home or at the relevant healthcare facilities. The regional telesupport platform can be accessed on the Salute Lazio (Lazio Health) portal (www.salutelazio.it). General practitioners, freely chosen paediatricians and doctors who provide continuity of care services, local Covid-19 coordination hubs and telesupport stations access the system to assess the health status of patients based on the relevant local authority. They fill in questionnaires assessing and monitoring the clinical parameters in order to triage patients based on the MEWS- or modified early warning score (i.e. oxygen saturation, breathing rate and diastolic pressure). Patients can also update their own health status by filling in questionnaires and adding clinical parameters by using the Lazio Doctor for Covid app.
The helpline workers of the regional Freephone (800118800) provide another telesupport tool for citizens. In November 2020 a hub was activated near the ARES 118 to guarantee the clinical monitoring of Covid-19 patients, based in their home or in hotel facilities, in close collaboration with the relative local healthcare authority and following shared protocols. When the clinical data that get collected go over certain thresholds, which are elaborated based on international triage systems (MEWS), an alert is sent to the relevant healthcare professionals- who conduct a televisit or, if needed, plan an in-person visit- and emergency services are contacted as well if the case requires it.
Today 124,280 people are registered on the app to get support and the network of professionals that accesses the system comprises of approximately 1,500 healthcare workers involved in primary care services and telemedicine local and regional hubs. 24,628 patients received home-based telesupport from healthcare professionals during 2020 and 18,823 of these were Covid-19 cases. A progressive increase was recorded during the first five months of 2021, which reflects the consolidated implementation of telemedicine services in regional local health authorities.
References
[1] Decreto del Commissario ad acta 25 giugno 2020, n. U00081. Piano di riorganizzazione, riqualificazione e sviluppo del Servizio sanitario regionale 2019-2021.
[2] Ordinanza del Presidente della Regione Lazio 17 marzo 2020 n. Z00009. Ulteriori misure per la prevenzione e gestione dell’emergenza epidemiologica da covid-19. Ordinanza ai sensi dell’art.32, comma 3, della legge 23 dicembre 1978, n.833 in materia di igiene e sanità pubblica.
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