What is the problem and why it is important?
Healthcare systems in Europe face the combined challenge of limited resources and an increasing demand spurred by rising cases of chronic conditions. The situation is intensified in depopulated areas, where the proportion of elderly people is higher (anticipating the situation in urban areas in 20 years’ time) and the distances to access healthcare are longer.
This situation creates a pressing need for a fundamental rethink of the way health services and systems are organized.
Reorganizing rehabilitation services has been identified as an urgent need, due to the significant implications they have in people’s lives (including the painful consequences of traveling from remote areas for every session) and the burden they place on the healthcare system.
How can it be solved?
ROSIA wants to pave the way for an extensive deployment of the self-care model for long-term conditions and disabilities by first focusing on rehabilitation. Supported self-care and self-management is a key component of rehabilitation. It enables patients to be as independent as they possibly can using their personal assets and capabilities. The public healthcare system should be aiming for patient-centred services to foster these qualities.
Redesigning rehabilitation services to better conform to patients’ realities, needs and expectations is the most efficient way to warrant their ability to benefit from those services, regardless of where they live, and to improve, not only their health, but also their experience of the healthcare system.
ROSIA works towards making self-managed care through telerehabilitation possible with:
- Systems that provide support during the complete rehabilitation process (evaluation, exercise assignment, rehabilitation follow-ups), but also include motivation and coaching features. At present, solutions providing such functionalities could be labelled as disruptive technologies, as they are just appearing on the market, supported by high-tech.
- Data driven intervention to make digital support personalized and meaningful to the patient.
A TAILORED INTEGRATED CARE PATHWAY
- Supporting the patient in the rehabilitation process, with a comprehensive approach based on a holistic vision of the patient’s health status which is shared with a coordinated care team to provide the most appropriate care by the right care professional at the right time.
- Extending the care team to an enlarged community, including the family, informal carers, municipality service providers, third sector and voluntary organisations, and other relevant local entities.
What are the challenges?
A preliminary look at the demand side shows that telerehabilitation is a mature concept largely deployed in very sparsely populated countries, like Australia, but it is currently understood mostly as teleconsultation. There is no public healthcare system that deploys self-management rehabilitation in a large scale.
The supply side, on the other hand, is already using a full range of new technologies to propose solutions catering to self-managed rehabilitation. There is, actually, a vast offer of research and pilots results already available. However, not so many seem to have found their way to the market (with the exception of a few that focus on post-stroke rehabilitation). The main hurdle for full scale deployment is that, because they tend to work as pathology “silos” and stand-alone solutions, the eventual healthcare provider ready to purchase these solutions is faced with an endless list of non-interoperable, separated, telerehabilitation “platforms”, rather than an integrated and flexible telerehabilitation suite of digital health and support services, one that could actually match the vast variety of its patients’ needs and set the ground for continuous technological updates.
The current health and care system lacks the appropriate organisation and care workflow to optimise use of resources to cover all of the population’s needs.
Rehabilitation is frequently associated with permanent changes in lifestyle, like in COPD or neurological conditions, and individuals will therefore need: strong motivation and meaningful empowerment, including improved health and digital literacy; support of local and digital communities, alternative group rehabilitation activities, peer networks; and support for carers.
How wil ROSIA solve these challenges?
1. Make disruptive technological solutions in self-managed care available for the telerehabilitation market , addressing current and future public healthcare needs in this field
2. Enable data driven interventions tailored to the patient’s needs and context
3. Implement a flexible model of personalized integrated care pathways and procedures to support the patient in self-managed care, and redesign the rehabilitation services to include an effective tele-care and proximity element, better fitted to 21st century patients, shifting away from the strictly-in-person care models.
4. Strengthen the role of the community to support the multidimensional needs of the individual. The community will contribute to the well-being and also provide social networks, motivation, peer support, complementary rehabilitation treatments and encourage adoption of healthier lifestyles.
5. To empower patients and/or families to become as self-reliant as possible in matters related to healthcare, supported by all the necessary educational, motivational, and technological resources.
6. To validate and generate evidence of value of each of the components of the telerehabilitation model, from clinical outcomes, to financials, including patient experiences, and workforce satisfaction perspectives.
7. To create an open platform, designed and configured to deliver the features and functionality described in the above objectives, and that includes a governance model.
8. To generate a business model which guarantees the long-term sustainability of ROSIA’s care model both for the public buyer and for the provider.
9. To improve the overall experience of the patient and to protect their dignity.
How will we make it happen?
The complexity of ROSIA’s model goes far beyond the design of supporting ICTs. The ROSIA model merges ICT technologies with the research findings related to telerehabilitation and the development of personalized care pathways, to deliver an integrated and flexible telerehabilitation suite of digital health and care services, which as yet is not available for commercial deployment.
Close collaboration between public health and care systems, experts and the industry is essential, to tackle this challenge and in order to create commercial solutions sustainable in the long-term.
The methodological approach to create the ROSIA model includes three phases.
DESIGN of ROSIA’s model through co-creation:
Design of ROSIA’s model is based on an iterative work of co-creation, including all stakeholders:
- Experts from the different fields of knowledge: data-based ICT systems, integrated care models, value-based health care schemes, behavioural change, project coordination, innovation procurement.
- Clinicians from several areas of rehabilitation expertise.
- Public healthcare systems from three different countries, representing the European diversity.
- Six communities, representing a range of isolated areas, each with different features. These communities will include the local ecosystems of patients, social care, primary care, municipalities and other local entities.
This will be enriched with the market development activities including supply and demand:
- Engaging ICT developers, R&D service providers, tele- rehabilitation related industry to create telerehabilitation related industry and local services.
- Raising awareness among the demand side outside the buyers’ group on the benefits and feasibility of tele-rehabilitation and supported self-management.
VALIDATION of the proposed solutions will:
- Take place in six municipalities, two in each procuring country.
- Validate the applicability of the solution to the seven chosen pathologies.
- Generate evidence on the benefits of the solution based on a value based evaluation framework.
ASSESSMENT of the model will include clinical effectiveness; value based economic analysis, personal experience of participants, and practical analysis of the viability of the proposed solution through business modelling.
How will ROSIA make a difference?
ROSIA will design, validate and assess a state-of-the-art model to address a common need: self-management of telerehabilitation, supported by community integrated care.
To do so:
– We will unlock the market to existing disruptive SMEs.
– We will pull existing research solutions out from the lab.
– We will get ready for scale-up.
– We will generate evidence on results and guidelines, to improve and motivate participation in a PCP