Are your health budgets under pressure?
Do you see growing influx of patients?
Are your doctors and nurses discontent and stressed from high workload over time?
Dignio help Health Providers (Hospitals, Clinics, Home Nursing etc), to achieve better outcome for your patients and reduce their need for traditional face to face consultations and admissions.
Clarification of terms
A doctor’s (or nurses) perform a consultation remotely. It could be through a video connection or ordinary telephone. This model reflects the traditional role of clinician vs patient, where the initiative and control lies with the healthcare professional.
Remote Patient Monitoring
Reading of relevant vital signs (pulse, glucose level, temperature etc) where the results are transferred through internet to healthcare personnel at another location. It allows for patients to stay at home while the relevant measurements can be taken on a regular basis, and clinicians may follow up on any unusual circumstances.
A combination of Telehealth and Remote Patient Monitoring, but strengthened by preventive medicine and more user involvement. In Remote Care, the patient take more control and leaves the clinician to a supportive role – like a “health coach”. End users are helped to reflect on their conditions and learn how they can avoid exacerbations.
The health care challenge
- Essentially – we face an ever increasing healthcare burden from patients with chronic conditions, but todays healthcare does not meet the need of this patient group
- NHS (National Health Services) claim that patients with chronic conditions consume 70% of the healthcare budget – both in primary care and hospital sector – AND it is growing
- The burden is not only to the Healthcare budgets, it is also a burden for the individual patient and for the healthcare professional, who feel constant pressure to deliver more.
- “Increasing” – mainly due to three factors
- Life expectancy – we expect to live longer. Chronic conditions get more complicated as we age and we tend to develop more than one diagnose (comorbidity).
- Unhealthy living – Inactivity and unhealthy diet increase risk of getting chronic conditions in all age groups, or it progresses the disease.
- Demography – number of children grew significantly just after World War 2, and they now pass 70 years of age.
Unmet need - Most people manage their chronic conditions quite well on their own, but 25-30% have complex needs and they need close attention from medical personnel. They are often admitted to hospital, and on discharge they are left on their own in a vulnerable period. GP/Family Doctor is on appointment basis and cannot give the close attention these patients need.
What we do
- We assist Healthcare providers to bring a new service to their patients – Remote Care.
- Remote care combines Remote Patient Monitoring, Telehealth and Preventive Medicine – the patient will experience three improvements in their lives.
- A feeling of safety – experienced healthcare personnel is watching over them and their condition.
- A feeling of control – understand more about their condition and how it affects their body - cause and effect.
- Improved life – coaching and motivation to make small steps towards a healthier living – set and reach small life saving goals.
- The patient will be equipped with a tablet for communicating with the “Remote Care Center” and to access his/her personal health record, and some medical devices to measure vital signs relevant to their diagnose. He/she will also have to answer clinical questions to complement the medical measurements. Everything happens through the “MyDignio” app configured for each patient individually.
- The Remote Care Center communicate with all the patients through the Dignio Prevent SW platform. Nurses with special training on how to provide a high quality remote healthcare service staff the center and they monitor the patients effectively through the software. They follow the Dignio Remote Care Methodology with all the patients through a set of predefined activities.
Remote Care Methodology
One of the major pitfalls of implementing Telehealth or Remote Patient Monitoring is the lack of a well tested methodology. In order to drive a car, society has imposed a minimum of training to get a drivers license. Healthcare personnel are trained to perform face to face consultations, but not remote care.
Dignio has developed and tested a methodology to help patients Manage their Chronic Conditions so that some hospital admissions and doctors appointments can be avoided. The methodology is a synthesis of Preventive Medicine, Nursing Science, Physiotherapy and Nutrition. In contrast to traditional Telehealth, where the clinician is in control, our method enables the patient to take control. The clinician becomes the “health coach”. This is no theory – this is tested and modified in many iterations in a clinical setting with real patients.
From day to day, we recommend to use experienced nurses in the Remote Care Center. The method works best in an integrated health system where the front person can be supported by expertise in various areas:
- Specialists in each of the chronic conditions (Diabetes, Lung Dysfunction/COPD, Heart Conditions and Hypertension)
- Physiotherapist/ Occupational therapist
- Geriatric specialist
Patients exposed to our methodology over time show higher quality of life (QoL) in many respects:
- Feel safe and well taken care of. Remote Care Center will be more active in the start so the patient knows they are “watched over”.
- Becomes an expert on own health condition. Important part of the methodology is to convey knowledge about relevant diagnoses in daily situations, connected to incidents in the patients life. They learn to listen for the right symptoms, and equally important to filter out symptoms that are not associated with their disease.
- Becomes proactive and avoids unnecessary exacerbations. The improved knowledge is directed to practical situations in daily life, so they know the “right thing to do” at important decision points. In our experience, we often see they become more active in their lives.
How we follow patients
- Introduction phase – we get to know the patient and his/her normal levels of vital signs.
- Assessment phase – The remote care center helps the patient to understand his/her own condition.
- Setting goals and setting expectations – setting the first goal and preparing the patient of what lies ahead.
- Coaching phase – Help the patient through both easy and heavy days, keep on educating him/her on own condition and motivate to reach the goal set.
Remote Care Open software platform
We decided to start our own development of a combined Telehealth and Remote Patient Monitoring software in 2011, after thorough research on what the marked could offer held up against what we wanted to offer to our customers, and we haven’t regretted since. The outcome from this decision is:
- Flexible and expandable platform built on Open Software.
- Easy to integrate new medical devices- 10 devices integrated, also outside the domain of vital signs.
- Extremely scalable – Customers may start with 10 patients and end up with 100.000’s and more.
- Adhere to the strongest data-protection regulations. Dignio is in the forefront of securing all sensitive data.
- No need for IT department! – Dignio offer a cloud based service, so there is no IT investments up front!
- Patients and Healthcare Professionals in charge – Our software is developed and extensively tested with both experienced clinicians and end users with no previous digital experience and weak health. We have interviewed and filmed when our software is in use, and improved accordingly.
The software platform consists of two main parts – MyDignio – the patient app, and Dignio Prevent – the back end system and the Clinicians user interface.
- MyDignio – is the end user (patient) app, running on a tablet. Designed to be easy to use, even for people of high age (90+) and no digital experience. It contains the patients own journal, updated by clinicians in the Remote Care Center, all the vital sign measurements and the “daily tasks”. Daily Tasks are the measurements and clinical questions answered, the patient must perform on a daily or regular basis. It also connects with all the medical devices, so that all measurements are automatically uploaded to the cloud when taken. MyDignio also allows the patient to communicate in an easy way with the Remote Care Center.
- Dignio Prevent is the core system, where all data are processed and stored. It’s cloud based which ensure high uptime and a secure environment for your data. All incoming measurements and messages are checked and routed. If there is any indication of an incident, it will be raised as an alert on the dashboard in the Remote Care Center. The clinicians have access to patients history of vital signs, alerts and other communication. From Dignio Prevent the Remote Care Center the clinicians can involve specialists, create reminders, update the patients medical record and manage devices in the patients home if necessary. Alerts and notifications can also be forwarded by the system to involve family or other medical personnel.
Implementation of Remote Care
Success with Remote Care require more than technology and methods. It must be implemented with the customer organization and existing healthcare services in mind. If not handled well, there is a risk to generate resistance among the clinicians or the patients may discard the Dignio solution unless they are properly introduced to it.
Dignio has worked closely with the City of Oslo to implement our solution in four of their primary care districts, and several dozens of other municipalities. During the course of 4 years, we have gained valuable experience about what it takes to implement Remote Care in a successful way.
We possess deep knowledge of the change process and what it takes to run a high quality implementation project. Dignio also have expertise in how to run efficient training programs, and the many other ways we can add value to the implementation process.