telecare and unlimited care

Telecare in Chinese Taipei- Policy and Prospect

Sue-Wen Teng,Director-General,

Bureau of Nursing and Health Care , Department of Health

2009.10.14

2009 APEC Workshop for Innovation in Telecare

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Outline

Profile of Chinese Taipei

Background

The Policy and Strategies of Telecare in Chinese Taipei

Telecare Service Model

Innovations, Impacts and Challenges


3

Profile of Chinese Taipei

TainanTainan

TaichungTaichung

KaohsiungKaohsiung

TaipeiTaipei

HualienHualien

Area: 36,189 sq. km

Flat / mountains: 3 / 7

Population (Feb. 2009):

23.0 million.


4

Background

Technology．Humanity．Care


5Sources:1. UN Statistics Division , World Population Prospects：The 2000Revision , February 2001.

2. CEPD, Projection of the population in Chinese Taipei: year 2002 to 2051, July 2002.

Along with the decreased birth rate and prolonged life expectancy, the increasing of elderly population is the natural trend of the world.

Growth Trend of Aging Population

Total population of over 65 y/o was 5 billion in year 2000 and will increase to 10 billion in year 2030


0

5

10

15

20

25

30

35

40

1950 1970 1990 2010 2030 2050year

Chinese Taipei

Singapore

Japan

UKUSA

Italy%

China

Ag

ed a

bo

ve 6

5 y/

0,

%

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Why Focus on Long Term Care (LTC)?

Source: Prof. Joan Escarrabill MD, Health Studies Institute, Barcelona


Increasing Dependency Ratio Results in the Shortage of Care Staff

• Shrinking of the family unit• Dramatic growth of world's elderly population

The ratio=people over 65 : people under 65

2000 2030

Europe 1 : 5 1 : 3

Asia 1 : 16 1 : 7

Percentage of people of 65 and over dependency ratio

South America

North America

Africa

Europe

Russia

Asia

Oceania 10.116.3

5.812.0

12.520.9

14.723.4

9.916.5

5.812.4

2000

2030 3.24.5

9.2

13.0

UK

Manpower alone is not enough for health care!

Increasing of elderly peopleReducing of Young people


8

Aging in place

Enhance quality of care and

quality of life

Improve system efficiency

Objectives of Long Term Care (LTC)


9

Health Services in Chinese Taipei National health insurance

launched in Mar.1995 with >99% coverage

Visit hosp.: 15/person/year (vs. 4 in USA)

Expenditure on health*: U.S.$ 982 / Per Capita (vs. 6,714 in USA)

Physicians and surgeons*:15.65 per 10,000 population

Healthcare facilities Hospitals: 530 / 79,235 acute care beds

Clinics: 19,370

Nr home: 321 / 22,733 bed

Elderly care facilities: 1,074/ 65,358 bed

Home care facilities: 466

*Source:OECD Health Data 2008, June 08.*dentists and traditional medicine service providers not included

Reference: MOI weekly surveillance, 2009/03/13 http://www.moi.gov.tw/stat/news_content.aspx?sn=2197&page=2


10


Strengths for ICT

Web users*

Individual: 70.95% (>55y/o--20.06%)

Wireless user: 20.89%

Households: 75.46% (ADSL: 72.99%)

Mobile phone subscribers (2009) : 92%

Networked Readiness Index by the World Economic Forum (2008~09): 13th/134

2007 Digital Opportunity Index (DOI): 7/181

2008 IT Competitiveness Ranking by t h e Economist Intelligence Unit (2008/9): 2/66

Reference: * WTNIC, 2009/2/17, http://www.twnic.net.tw/NEWS4/85.doc

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Strengths for Health Service

Health care system infrastructure:

13th/55 (World Competitiveness Yearbook, 2007)

Worldwide Health Rankings:

2th/27 (The Economist Intelligence Unit, 2000)


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Why Telecare?

Relatively good preparedness in ICT (Information & Communication Technology)

Aging of population

Proact rather than react to LTC demands

Move toward shared care and integrated services

Improve accessibility and cost-effecctiveness of health services

Extend services based on existing LTC info network


13

The Policy and Strategies of Telecarein Chinese Taipei

ContinuumComprehensiveAging in place


14

Development of Policy in Telecare

Six emerging industries in Chinese Taipei Biotechnology, Green energy, Health care, Intensive

Agriculture, Tourism, and Cultural Creativity

Department of Health (DOH) Platinum Program of Health Care Upgrade

InitiativeIntelligent Medical Services Telecare

Ministry of Economic Affairs (MOEA)U-Care flagship projects for elderly care Innovative healthcare service projects Innovative technological healthcare service

project


15

Service Scope of Health Care Industry

Expansion of Industry Territory

En

han

cem

ent

of

Co

re T

ech

no

log

ies

Intelligent Taiwan medical services

Biotechnology and pharmaceutical industries

Internationalized medical services

Wellness and health promotionservices

Long-term care systemCurrent medical service system

Source: * DOH Platinum Program of Health Care Upgrade Initiative


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Intelligent Medical Services Flagship Program

HospitalRFID Project

EMR and PACSValue-added Application of

Health Database

NHI IC Card Upgrade Project

Telecare

IT-based Intelligent Care Model to Enhance the Quality and Efficiency of Medical Care

Intelligent Medical Services

Source: * DOH Platinum Program of Health Care Upgrade Initiative

Combine health care and ICT to develop community, home and institutional care service models.


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Sectors and Goal for telecare

DeviceDeviceInfo-

exchange standard

Info-exchange standard

information exchange platform

information exchange platform

trans-department and trans-specialty

trans-department and trans-specialty

Clientparticipant

Clientparticipant

ICT Medical service

Develop telecare service networkPromote telecare device industries

Promote population health behavior change


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2007

Prospective and Time-table of Ministriesto Promote Telecare

2006

2008

2012

2011

2009

2010

Develop the elderly care service, medical device, medicine, and health food to provide dignity, comfortable, instant and convenient life quality for people

year

Telecare service promoting project

Telecare Service Improvement and Quality

Enhancement Project

2013

U-Care flagship projects

Innovative healthcare service projects

Innovative technological healthcare service project

Cross ministry & department

meeting

Cross ministry & department

meeting

Telecare pilot project

DOH MOEA

•Establish the sustainable business model•Take the leading position to promote telecare services in Asia


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Total budget: US$ 20million Industry: US$ 12 million

Government: US$ 8 million

Integration of 7 portable medical devices for physiological monitoring at home/in the community

Development of service models (home, community, and institution) and 41 telecare services

Development of standardized system interoperability testing process

Improvement of participants’health behavior self-care monitoring, Knowledge/behavior of med safety,

Hospitalization rate


20

Roadmap for Telecare

2012

2016

Growth of Telecare service network & industry•Build the national Telecare service network to support the comprehensive care services•Develop technological healthcare industrial value chain and promote industry development

2009

•Encourage the cross-industrial collaboration targeting specific population to develop the innovative service model•Promote the open source Telecare info exchange standards•Develop the trainings and mechanisms for digital healthcare services manpower cultivation•Develop the chronic care network &Develop multifaceted services and the innovative model

Replication of Telecare model and ICT infrastructure

Development of Telehcare model and pilot study•Develop the cost-effectiveness evaluation mechanism•Build up the universal info platform and promote the info infrastructure•Develop innovative community, home, and institution services model •Elderly care needs oriented


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Major Elements ofTelecare Development

Function of telecareWhere is the clients? What do they want?How to satisfy the clients’expectation?

Integration of telecare devicesSelection of Telecare devices to provide the

appropriate service function

Process design Integration of multi-industrial design process

Evaluation:

quality control, cost analysis, outcome evaluation


23

Project Organization Structure

SECOMTMUH

Hsiao Chung Cheng Hospital

Gien Ann Nursing HomeCan-full Nursing HomeAnn Tai Nursing Home

ITRICHT

WanfangHospital

Telecare Pilot Project

Principle Investigator Co-Principle Investigator

Community Telecare

Home Telecare

InstituteTelcare

Project Management Office

TelecareInformation

platform

Consultant Group

ITRILTCPA

TelecareService Center

WanfangHospital


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CommunityCare

NHII Information Platform

Institutional CareHome Care

Telecare Service Center(TSC)

Emergency care centerEmergency care center

Telecare Information Platform (TIP)

LTC managementcenter

LTC managementcenter

0800-008-850

members


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Inclusion Criteria & Core Services of Telecare

Tele-consultation

Tele-visiting for family members

Tele-physiological monitoring

e-learning

Medication safety services

Client health management


Living resources referral

Tele-health education

Emergency management

Community health station- physiological

monitoring- on-site consultation- Tele-education- Tele-consultation

Dispensary and medication safety

Location monitoring

Living resources referral

ContentContent

Moderate to high-grade disability

Without psych Dx

Low to moderate-grade disability

Caregivers for people with chronic disease

Low-grade disability Living alone

Dx with HT, mild dementia, DM

ClientsClients

InstitutionHomeCommunity


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Telecare Information Platform (TIP)

LTC PHR service

Service registration

Service portal

Info exchange interface、video transmission interface

Info security, service diary, system monitoring


Call CenterGovernmentagencies

Care service resources

Info exchange standards

LTC info network

NHIP info exchange platform

LTC related info platform

Com. e-counter

SECOM/TMUH

Home e-counter

WFMC

Institute e-counter

HCC Hosp.

Service Oriented Architecture (SOA)

AC

(HCA,MOICA)

Living support

Med institute

Care institute

服務儲存庫(UDDI)

e-learningTele-education

LTC management center

Individuals


The Flow Chart of Telecare Services Operation

Evaluation and improvement

Third stepService utilization statistics

Second step Services provided

First StepClient assessment & management

Fourth step


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Personal Health Record (PHR)

Discharge preparation

center

LTC management

center

TIP

PHR Member profile LTC PHR index

Discharge processDischarge process

LTC infonetwork

Get discharge info

Institutional Care

Home Care

•Get member profile•Get discharge info

•Maintenance of LTC PHR

•Notification of service transferred

PHR review

•Maintenance of LTC EHR•Notification of service transferred

Service model transferredService model transferred


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Evaluation

81.9%

9.3%

2.81%

2.12%

0.31%

1.18‰

after

53.8%

38.2%

4.29%

6.11%

0.39%

1.85 ‰

before

Test score ≦17False knowledge &

behavior of drug safety

C

O

M

Compared w/ pt at the

home care center of

Wanfang Hosp

Hospitalization rateH

O

M

E ER admission rate

I

N

S

T 21% decreasedRe-hospitalization rate

Weekly monitoring of BP

and glucoseSelf-care monitoring

InterpretationIndex

36% decreasedInstitution infection rate

Duration: 2008/01/01~2008/12/31


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Innovations, Impactsand Challenges


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Innovations and Impacts of Pilot Telecare Project

Social Aspect

Increase the variety and choices of LTC services Advocate individual’s health promotion to enhance

health care quality Create the new benefits of shared healthcare resources Support “aging in place”

Economic Aspect

Promote telecare information exchange standards and service guidelines that accelerate the development of healthcare/medical devices/IT industry

Develop the telecare operational model to promote service sustainability

InternationalAspect

Build up the international channel to enhance experiences sharing

Follow HL7/CDA 2.0 to support international information exchange


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Challenges for Telecare Promotion

ReplicationReplication

IntegrationIntegration

Law & Regulation

Law & Regulation

System & Device

System & Device

Service Model

Service Model

TrainingTraining

Planning Evaluation

Standardization Commonality Interface design User friendly humanity

Resource Profession System Service

Behavior change SOP Quality contrl

Business model sustainability Financial analysis Standard module


33

Thanks for Your

Attention !

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Telecare, Unlimited Care

telecare and unlimited care

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