The Faculty of Social Sciences, Centre for Social Informatics at Ljubljana University and NHS Liverpool Clinical Commissioning Group (LCCG) organised reciprocal study visits during December 2019 as part of the InnovaTion in Health And Care for All (ITHACA) project. Both partners, along with their regional stakeholders, have expertise in the use of telehealth to provide patients with remote monitoring of vital signs along with information, education and support that can help them to self-care and to self-manage their disease/condition. However, the way that they have recruited patients and how the service is provided differs. In Liverpool City Region, primary care practitioners identify patients for the service and a community-based provider delivers the technology-enabled support. By contrast, in Slovenia, there is a hospital-driven telehealth supported service for patients discharged from hospital. These variations on a common base make each region’s good practices particularly ripe for transfer to the other and both regions plan to introduce new service models drawing on each others experience in the implementation phase of the ITHACA project.
In this context, the two study visits provided an opportunity to enrich each partner’s ITHACA action plan and their implementation, to engage, inform and inspire stakeholders (including decision makers, health practitioners, technology providers and evaluators) and to reinforce bi-lateral collaboration supportive of ongoing mentoring and advice. Both study visits comprised presentations, site visits and extensive opportunities for interactive dialogue and discussion enabling the visiting delegates to seek out the information most valuable to them.
The first study visit was held in Liverpool on 11 December. The visiting Slovenian delegation comprised 8 external experts from University Medical Centre Ljubljana, Telekom Slovenije, MKS Electronic Systems d. o. o. and Social Protection Institute of the Republic of Slovenia along with 3 members of the ITHACA project team from the Faculty of Social Sciences, Centre for Social informatics). The one-day event began by setting the context for LCCG’s digital health and care strategic framework and its technology supported health service. This included an introduction to Liverpool’s new Digital Health Strategy, a review of impact and evaluation of the telehealth service and detailed insights into the commissioning of remote technology supported health and care services. Incorporating a site visit to Liverpool’s telehealth hub, session 2 provided detail about the establishment, operation and future development plans of the Merseycare run telehealth service for Liverpool and other parts of the city region. Liverpool’s approach to commissioning, delivery and evaluation of home-based telecare service, fall detection and wider innovations for social care in Liverpool were presented and discussed during the remainder of the event.
The second study visit took place a few days later, on 16 December, in Ljubljana.The visit of a nine-member delegation from Liverpool City Region, including representatives from LCCG, Merseycare and the Clatterbridge Cancer Centre NHS Trust, took place on 16 December 2019. The event was organized together with the University Medical Centre in Ljubljana. After the introductory speeches, the context of long-term care and e-health in Slovenia was presented, namely Aleš Kenda from the Ministry of Labour, Family, Social Affairs and Equal Opportunities presented the Strategy of Active Aging (with focus on telemedicine), Vesna Dolničar from Faculty of Social Sciences, Centre for Social Informatics presented challenges in the field of long-term care, and Hajdi Kosednar from the National Institute of Public Health gave information on national overview of e-health and telemedicine in Slovenia. In the second part, the presentations focused more on smart technologies in the field of health and social care, with Peter Pustatičnik (Telekom Slovenije) presenting the SMART Integrated Health and Care System and Gregor Poglajen (University Medical Centre Ljubljana) telemedicine services for patients with chronic heart failure. Vesna Dolničar presented the results of three projects, financed by Slovenian Research Agency: "Smart ICT solutions for active and healthy aging: Integrating informal e-care services in Slovenia", »Factors impacting intention to use smart technology enabled care services among family carers of older people in the context of long-distance care«, and "Understanding and analysing needs of end-users for developing e-services of integrated social and health care in an aging society", focusing on the role of utility and acceptability of telemedicine and telecare in users. The third set of presentations consisted of representatives of Slovenj Gradec General Hospital (Maja Pušnik Vrčkovnik) and MKS Electronic Systems d. o. o. (Drago Rudel) who presented the results of good practice CEZAR. Participants also visited the telemedicine centre at the University Medical Centre in Ljubljana.
Key practical learning from the study visit exchange for the Liverpool ITHACA partner and its other stakeholders that will support the action plan implementation of a hospital-led telehealth service for patients with cancer undergoing immunotherapy and chemotherapy included: (a) reinforcing the importance of hospital-based clinical buy-in to the service; (b) the significant advantage for successful implementation of “champions” supportive of the service amongst clinical staff; (c) the benefits for successful recruitment of patients to telehealth services arising from established and trusted relationships between clinicians and patients; (d) ensuring that service pathways and data monitoring are as seamless and straightforward as possible; (e) the added value and importance for service improvement and future commissioning of tailored and robust process and impact evaluation.
Liverpool has one of the largest scaled deployments of technology supported care within a European city. In contrast, Slovenia is still at a very early stage of development of ICT solutions for dependent people living at home. For the Slovenian ITHACA partner and its stakeholders the study visit gave valuable insight into how it can achieve its future ambition for widely scaled services on a regional level, which supports around 1000 patients at any one time. In particular, the study visit has provided insight, evidence and tips about how to organise the work required, how to engage end-users and how to better target the clients that need certain services, as well as how to persuade policy makers to adopt an agenda that will lead to e-health and e-care technologies at home. For the ITHACA partner, knowledge on evaluation methods and instruments in order to provide support for evidence-based evaluation methodologies and reporting was especially beneficial.
These two events also gave a valuable opportunity for local team building. Partners and stakeholders who will be responsible for delivering their respective ITHACA Action Plans got to know each other better, learnt about colleagues’ expertise and clarified in more detail what their respective roles in delivering their ITHACA action plan will be. Moreover, the intensive trans-national collaboration and the constructive mutual working atmosphere throughout the events has created an informal networking resource for further knowledge sharing, mentoring and peer-to-peer collaboration that can help in the next phase when setting up new services and delivering the ITHACA action plan.
In addition to disseminating knowledge and connecting stakeholders on the national level, ITHACA project achieved practical implications as well. University of Ljubljana took an active role to support drafting the tender for long-term care pilot testing, stressing the importance of development of ICT solutions in community care. The proposed e-care and e-health services were a result of interregional learning from ITHACA partners. The findings from pilot sites will be the starting point for the final design of system solution in the field of long-term care in Slovenia. By including and testing proposed solutions in pilot activities and by hopefully proving their value, we strongly increase the likelihood of the inclusion of those same activities to the final legislation. In the long term, this means better and more affordable access to quality e-care and e-health services for end-users and represents a major step forward in the field of e-care technologies for active and healthy aging in Slovenia.
Innovative approaches have also gained media attention, reporting the event among others RTV Slovenija, Večer, 24ur.com, Delo and Siol.net.