Project R-14977

Remote monitoring @ home (Research)

Problem statement: The current healthcare systems in the Meuse-Rhine (MR) region are already well established and highly-qualitative, yet fairly polarized when it comes to transmural care. In other words, diseased patients that receive disease follow-up only at discrete moments are prone to frequent (re)hospitalizations creating an overload to the secondary care systems, whilst lacking a clear follow-up within primary care. This indicates 2 major pitfalls in the current systems being (1) the presence of a black box when it comes to the patients' health and wellbeing at home, and (2) the need for a new care path that encloses, delineates and improves transmural care, allowing clearer cooperation and communication between primary and secondary care, incl. in particular cross-border care. As many authorities focus on providing better access to health, including RM and are searching for innovation in healthcare, this project poses as the perfect opportunity to pave the path for the development and implementation of hybrid care paths (HCP). Objective: Our project focuses on the improvement of care of diseased patients via (1) the integration of remote monitoring (RM) using wearable technology to monitor the patients at home and (2) using this data and improving the dataflow, cooperation/communication between primary (GP's, care organizations) & secondary (hospitals) care, cross-border & patients. A major strength of RM@H is that differences & commonalities between all participating regions (Flanders, Wallonia, NL & DE) are taken into account to create a transcending vision on (transmural) care with improved dataflows & communication between primary & secondary care, & patients. Overall, RM@H wants to develop an organizational, technical & legal framework for the deployment of RM within the MR region taking into account the patient. Innovation: RM@H will identify via cross-border collaboration (WP1) the strengths and pitfalls of the current clinical care path of pre-defined patient groups (i.e., pneumology, post-surgical patients, haematology & psychiatric patients) to identify the homo- and heterogeneity (WP1) and formulate a novel theoretical HCP taking into account the expertise of all stakeholders (primary & secondary care, & patient) (WP1). WP3 serves to transform and digitalize the HCP iteratively via feasibility/proof-of-principle trials, incl. the iterative findings in the organizational difficulties of RM (WP2.1), the requirements on dashboarding (WP2.2), the impact of predictive modelling (WP2.3) and the added value of housing conditions (WP2.4). Moreover, in WP4 a legal framework identifying the requirements to process and exchange medical data transmurally, to enable RM using fitness vs medical devices and to use predictive models will be developed to embed them in this and future care paths. Impact: RM@H enables a cross-border improvement in transmural care via the introduction of RM, improved involvement of primary care, transition from sick care to health care (i. e., predictive models), insights in the disease progression at home, respecting local and EU law, and thus overall ameliorating access and care for the patient. If this project would not be granted, several opportunities, as described above, would be missed, as well as the current momentum that is in place to pursue innovative change.

02 September 2024 - 01 September 2027