Purpose-fit technical infrastructure
SmartCare’s main aim is to implement and validate ICT based support for integrated healthcare, social care and self-care (informal care), for different health / living conditions, along integrated care pathways for improved health and wellness. This integrated care is to occur mainly outside the hospital, in the home or community of the care recipient (CR). Many stakeholders are to be served by the integrated service model: healthcare providers, social care providers, informal care providers, third sector care providers, and the care recipients / patients. Each of the stakeholders has a different perspective, and needs access to services and information at different levels of detail and points on the pathways. It is hoped that an integrated platform and service model will allow for appropriate access by each stakeholder, as well as provide an integrated view of the CR's needs in the clinical and social realms.
The care pathways developed in the first work packages provide the starting point for the development of the technical specification, as ICT components support the care pathway workflows and use cases.
Technical specifications were produced as an overlay to the original pathway, listing IT infrastructure components (such as LAN, wireless networks, databases), IT systems (such as electronic health records, telehealth devices), and functionalities needed for each step.
Defining the SmartCare System
The SmartCare project developed two care pathways that used similar functional blocks:
- enrolment and consent
- integrated care plan
- on-site provision of care
- remote provision of care through telemonitoring or telecare
- documentation of care
- assessment and re-assessment of care needs
- exit from the service.
Each of the deployment sites used different IT to support the functional blocks for the care pathways.
These functional descriptions are shown in the table below along with input, output, users, system interfaces, possible communication methods and standards, and possible messaging methods and standards.
Functional blocks | Inputs | Outputs | Users | Sytem Interfaces | Possible Communication Methods/Standards | Possible Messaging Standards |
Enrolment and Consent | CR Demo-graphics, Discharge plan, Request / Referral by community resources | Discharge summary and recommendation for care | HCP, SCP, CR, I/FC | Healthcare Record System; GP Record System | Database based, electronic message based (e-mail, text message, phone call, fax) | IHE ITI BPCC, PDQ; national standards as promulgated by deployment sites; epSOS recommended standards |
Care Plan | CR Information, Discharge summary, possible care protocols | Integrated protocol / plan for CR | HCP, SCP, TCP, I/FC, CR | Healthcare Record, GP Record System; Community health and social care record | Database based; electronic message based (e-mail, text message, phone call, fax); wireless or wired, a configured device, PC based or mobile handset; interface to hub could be a specific application or web-based; TCP/IP; web-based protocols | HL7 CDA R2; IHE ITI XCA, XDM, XDE, XDS, XDS-SD, PDQ, PDQv3, PIX, PIXv3; IHE PCC MS, XPHR, CM |
On site provision of care | CR information, care requested / needed, scheduling of care | Care provided, modification to care plan | HCP, SCP, TCP, I/FC, CR | Caseload Management and Appointment scheduling; Community health and social care record | Electronic message based (email, text message, phone call, fax); wireless or wired, a configured device, PC based or mobile handset; interface to hub could be a specific application or web-based; TCP/IP; web-based protocols | HL7 CDA R2; IHE ITI XCA, XDM, XDE, XDS, XDS-SD, PDQ, PDQv3, PIX, PIXv3; IHE PCC MS, XPHR, CM |
Remote provision of care and support | Vital parameter monitoring, telecare / smart home monitoring, educational material / content, scheduling of care, directory of services | Vital parameter measurement, telecare / smart home measurements and alarms, educational / training information / content, alerting of out of range parameters, virtual coaching (audio / video teleconferencing), service information | HCP, SCP, TCP, I/FC, CR | Telehealth / telecare system sensors, aggregator (hub – which could be paper record; wireless or wired, a configured device, PC based or mobile handset; interface to hub could be a specific application or web-based), call centre, service directory database | Electronic message based (email, text message, phone call, fax); wireless (Bluetooth, ZigBee, WiFi, GSM (2G/3G/4G)), wired (PSTN, ISDN); TCP/IP; web-based protocols | IEEE 11073 PHD data standards, HL7 CDA R2; Continua certification; IHE PCD DEC, RTM, ACM; IEEE802.15.4 (ZigBee) |
Documentation of care | Care provided, modification to care plan, vital parameter measurement, smart home measurements, educational / training information / content, alerting of out of range parameters, virtual coaching (audio / video teleconferencing) | Document / message / proof of care provided, modification to care plan, vital parameter measurement, smart home measurements educational / training information / content, alerting of out of range parameters, virtual coaching (audio / video teleconferencing) | HCP, SCP, TCP, I/FC, CR | Telehealth / telecare system, call centre, community health and social care record; paper based; wireless or wired, a configured device, PC based or mobile handset; interface to hub could be a specific application or web-based | Database based; electronic message based (e-mail, text message, phone call, fax); wireless or wired, a configured device, PC based or mobile handset; interface to hub could be a specific application or web-based; TCP/IP; web-based protocols | HL7 CDA R2; IHE ITI XCA, XDM, XDE, XDS, XDS-SD, PDQ, PDQv3, PIX, PIXv3; IHE PCC MS, XPHR, CM |
Assessment and reassessment of care | Care plan, care provided by all means (on-site and remotely), CR progression through plan | Modification to care plan, emergent care escalation request, recommendation for SmartCare service exit | HCP, SCP | Community health and social care record; health record; GP record system | Database based; electronic message based (e-mail, text message, phone call, fax); wireless or wired, a configured device, PC based or mobile handset; interface to hub could be a specific application or web-based; TCP/IP; web-based protocols | HL7 CDA R2; IHE ITI XCA, XDM, XDE, XDS, XDS-SD, PDQ, PDQv3, PIX, PIXv3; IHE PCC MS, XPHR, CM |
Exit from SmartCare service | Care summary | Healthcare Record system, GP record system, Social care record system | HL7 CDA R2; IHE ITI XCA, XDM, XDE, XDS, XDS-SD, PDQ, PDQv3, PIX, PIXv3; IHE PCC MS, XPHR, CM |