\u201cTelehealth was a technology we\u2019d been planning to implement for a couple of years. But then almost overnight everything changed \u2013 it became a must-have platform the hospital needed today.\u201d<\/p>\n
Francesca De Giorgi, CIO of Italian research hospital IRCCS Carlo Besta, reflects on the recent challenges her team faced when social distancing measures imposed by the Italian government sparked an immediate need for digital transformation.<\/p>\n
\u201cMany of our patients have chronic conditions that require frequent check-ins with our clinicians,\u201d explains Francesca. \u201cBut the lockdown restricted their ability to travel, so suddenly our clinicians were receiving unregulated phone calls and emails from worried patients.\u201d<\/p>\n
Francesca and her team had to move fast to implement a virtual consultation system to help bridge the gap and ensure that patients with chronic neurological diseases could still follow up with their clinicians in a private and secure way, without leaving their homes \u2013 all in a matter of weeks.<\/p>\n
\u201cWe started implementing a new solution with two guiding principles: it had to be simple, and it had to be fast,\u201d she recalls.<\/p>\n
\u201cThat\u2019s how the telehealth infrastructure we now have in place came about, and we need integrated implementation of technology and processes support tailored interaction.\u201d<\/p>\n
Founded in 1918, IRCCS Carlo Besta is a world-leading healthcare provider and research center, providing both high-quality patient care and advanced medical research for neurological diseases and conditions such as Alzheimer\u2019s, Parkinson\u2019s, ALS, Ataxias, Multiple Sclerosis, Neuromuscular disorders, Epilepsy, Cerebrovascular diseases, Pain, Brain Tumors and Rare Neurological Diseases.<\/p>\n
Fabrizio Tagliavini, Scientific Director of the Carlo Besta Institutes, based in Milan, explains that its reputation goes far beyond the city\u2019s borders, with 60% of its patients coming from other regions across Italy and even from abroad . For that reason, the hospital had already begun the groundwork for a telehealth infrastructure in 2017, funded by the Italian Ministry of Health, although ongoing discussions around privacy and regulations had prevented the project moving forward.<\/p>\n
That is, until restrictions imposed by the government in the middle of February 2020 began limiting how clinicians and patients could interact. Now Francesca and her team needed to kickstart the project fast.<\/p>\n
\u201cThe pandemic was a sudden push to rethink how we communicate and manage our chronic patients,\u201d says Davide Pareyson, Director of the Functional Department of Neurodegenerative and Neurological Rare Diseases. \u201cMany of our patients already had consultations in place for March, April and May,\u201d he adds. \u201cSo, we had an urgent need to guarantee a continuity of care for these patients.\u201d<\/p>\n
We needed a new solution that would allow patient interaction to continue, without compromising their healthcare.<\/p><\/blockquote>\n
\u201cThat solution was a Microsoft Teams collaboration suite.\u201d<\/p>\n
Embracing a digital solution<\/strong><\/h2>\n
With over 100 different outpatient clinics for a variety of neurological disorders and no existing telehealth infrastructure in place, four departments were selected to pilot the new system: Parkinson\u2019s Disease, Multiple Sclerosis, Child Neurology and Rare Diseases.<\/p>\n
\u201cClinicians in these areas had showed a lot of interest in telehealth and how it could help them manage and treat patients,\u201d explains Francesca. \u201cIt was important they were enthusiastic as we would need their help to quickly stress-test and improve the system.\u201d<\/p>\n
Using Microsoft Teams, clinicians in these departments can now offer chronic patients a video consultation to safely continue their treatment plan, with help from support staff to ensure each patient has the technology needed to take part.<\/p>\n
\u201cThey send patients a checklist through Microsoft Forms before their consultation to help everything run smoothly,\u201d Francesca says. \u201cAnd with the integrated EMR, their records are attached to the booking and made available to the clinician during the call \u2013 helping us guarantee privacy and security.\u201d<\/p>\n
The hospital\u2019s booking system was also integrated into Microsoft Teams and Office 365, allowing patients to follow-up their appointments with ease and receive any correspondence electronically. Working with their booking provider, Francesca was also able to develop an API to translate any previous patient records and appointments to Microsoft Bookings.<\/p>\n
\u201cIt is a complete system that covers each patient\u2019s visit from end-to-end,\u201d says Francesca.<\/p>\n
The benefits for patients<\/strong><\/h2>\n
For chronic patients, these virtual consultations have helped restore some order, allowing clinicians to regularly monitor how their patients are managing their condition, and even reproducing a large part of the neurological physical examination.<\/p>\n
\u201cWe can use these consultations to see how their condition has developed, such as asking them to walk on their heels or toes to assess balance and coordination,\u201d says Davide. \u201cAnd we can still have a discussion at the end about their results, prescriptions and next visit.\u201d<\/p>\n
\u201cA lot depends on the patients\u2019 internet connection and the quality of the call,\u201d he adds. \u201cBut we\u2019re already seeing lots of benefits to this approach.\u201d<\/p>\n
Another of these benefits for patients has been economic, something Francesca would like to see more of as her team continues to develop this solution.<\/p>\n
\u201cBefore the lockdown, patients could spend over \u20ac600 travelling to us for , calculating overall costs of travel for the patient and an accompanying person and the loss of a working day for both of them treatment,\u201d she explains. \u201cIf we can get a clearer framework from the ministry on the specific tariffs and regulations, we can help offer patients better access to the healthcare they need.\u201d<\/p>\n
And the feedback from patients has been positive. \u201cWe have only recently sent feedback questionnaires through Microsoft Forms,\u201d says Davide. \u201cBut so far we\u2019re delighted that many patients are very happy and satisfied with this new approach.\u201d<\/p>\n
A successful test for the future<\/strong><\/h2>\n
For IRCCS Carlo Besta, this has not just been a response to a pandemic, but a roadmap for future clinical research.<\/p>\n
\u201cThere is no division between our clinical work and research, as both are based around the interactions we have with the patients,\u201d explains Fabrizio. \u201cThey are at the center of our activities, which we\u2019re hoping this new system will help us explore more in the future.<\/p>\n
\u201cWe\u2019re already training many other departments to use the system,\u201d he adds. \u201cAnd to explore more than just patient examinations. We also want to look at how telehealth solutions can impact rehabilitation and neuropsychological testing, and how we can use this approach to research different disorders and compare clinical scales.\u201d<\/p>\n
So while IRCCS Carlo Besta continues its fight to provide vital services to its vulnerable patients, there may be a glimmer of hope that in the future those patients might benefit from an even more efficient and cost-effective, digitally-driven service.<\/p>\n
At the same time, we hope that Tele-health will become a routine model and a recognized framework to provide care in the national context.<\/p>\n