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Today more than ever the support of telemedicine is decisive if we want to guarantee the sustainability of National Health service. Remote care through the use of information technologies is the answer to the chronic shortage of doctors and nurses in hospitals and in the territory that the pandemic has revealed in all its drama. A striking example is the Dry (the special continuity of the units of care for Covid patients), insufficient everywhere. “Telemedicine is the new horizon of health – he told ilfattoquotidiano.it Massimo magi, secretary of Market of the Italian Federation of Family Physicians (Fimmg) -, essential to promote local medicine by limiting the overload of health establishments ”. The Covid health emergency has given telemedicine a boost, but the projects remain widespread. There Fimmg launched theSm3.0 application for the reservation of visits, medicines and certificates, sending reports and conducting video consultations with the doctor. “We are also preparing an interface for the telemonitoring of clinical data using a multiparametric pulse oximeter, which measures heart and respiratory rate, saturation, temperature, blood glucose and extracts an electrocardiogram,” Magi announced. From telecare to television and teleconsultation. In short, this is where the future of healthcare is at stake and where we must invest. Pending a national reference rate for this type of service, the Conference of the Regions For its part, in a document dated September 10, it was agreed that in the first phase of application the system of remuneration and current rates for the provision of the same services in the traditional way be applied.
The Observatory of Digital Innovation in Health of Politecnico di Milano has selected (and awarded) some virtuous telemedicine projects. Among them, the software Telecovid Zcare of the Asst di Lodi, which since March has allowed home telemonitoring of symptomatic Covid patients to intercept signs of worsening and establish a possible hospitalization. The patient enters clinical data on the web platform (symptoms, heart and respiratory rate, saturation, body temperature and blood pressure), which are processed by an artificial intelligence system and converted into a color code according to severity: white indicates that the framework is stable and there is no need for telematic supervision; green and yellow conditions need to be investigated by phone call from the operating center nurse (who prescribes additional tests: saturation measurement before and after 30 steps; count from 1 to 20 with measurement of respiratory pause; apnea of 10 seconds) and possible home visit; the red that there are more serious changes and the patient must be transferred to the hospital. To date they have been tele-assisted more than 500 patients. Out of a sample of 395 patients, nearly 89 percent were cured at the end of the telemonitoring period, all the others worsened by requiring home help to be activated. I also’Latin ASL has developed a computer system dedicated to those who have already contracted Covid in fragile health conditions (elderly, smokers, hypertensive, cardiac, obese and diabetic). The objective is to intercept situations of clinical worsening early. “Through a device, similar to a mobile phone, the patient is twice a day sends vital signs to the monitoring station, if they are out of control, he is immediately contacted by the nurse, who connects remotely with the specialist if necessary, “explains Salvatore Di Somma, professor of Medicine atSapienza University and territorial manager of emergencies of the ASL of Latina.
L ‘Asl Rome 3 Have proportioned a device that detects the vital parameters of patients with chronic or very disabling diseases. “Values beyond the personal reference threshold trigger an alarm that is sent to the control unit – explains Simona amato, health director -. At that point, the nurse will call the patient and decide whether to activate a video consultation with the doctor. We followed more than 3,700 people and access to hospitals was more adequate ”. The ASL of Verbano Cusio Ossola, in Piedmont, to reduce the comings and goings of dialysis patients in the hospital and not expose them to the risk of contagion, has created a virtual caregiver for home dialysis. “We deliver to the patient a mobile totem with a screen to follow the training and receive psychological support – informs Maurizio Borzumati, the head of Nephrology -. None of the 13 patients at home took Covid, while five percent of the 125 treated at the hospital became ill and some died. “
L ‘Vimercate Assistant, in the province of Monza and Brianza, has devised a predictive model in the field of postoperative complications and chronic diseases based on artificial intelligence algorithms. “It allows doctors to detect early patients at high risk of readmission and predict prevention plans also by resorting to remote assistance “says the company’s information systems director Giovanni Delgrossi. Last spring, in the midst of an emergency, the infrastructure gave a fundamental hand to radiologists, taking care of a hundred chest X-rays a day. “The system indicated the level of severity of the pneumonia in progress help the doctor establish intervention priorities, ”says Delgrossi. A camper as a mobile clinic to ensure continuity of care in the area is the initiative of the cooperative of general practitioners “Cosma”, in the Lecco area. “From Monday to Friday, from 8.30 to 17, every two weeks, each time in a different place, the nurses on board perform electrocardiograms, fundus examinations, spirometries and soon also ultrasounds – he says. Marco Negri, doctor of the cooperative -. The data is uploaded to a platform and sent to Lecco ASST specialists for reporting. We went out in September and delivered 600 services in a month. Chronic patients, ticket-free, who are part of a care plan can access the service ”.
The hospital institution Poliambulanza Foundation of Brescia activated the visit of an online specialist, for now on a solvency basis. To book it, use the Booking App or the mypoli.poliambulanza.it website. It is also in operation at the institute an sms service follow the patient’s path through the emergency room, streamlining the flow of family members to the waiting room. To provide remote assistance to ostomized or incontinent patients, even those in geographic areas without specialized clinics, the hospital uses the Sos application (Smart ostomy bracket).
“Alphabet Sars-Cov2” is the project adopted by the IMaugeri Scientific Clinical Institutes and San Matteo de Pavía Polyclinic: A software based on artificial intelligence mechanisms assesses the degree of severity of the disease and performs a predictive analysis of its evolution, providing the essential elements to decide the healthcare strategy to implement (home care or hospitalization) in the triage phase at the patient’s home, where a chest X-ray is performed with a mobile device. While “Covid-it-net“Is the teleconsultation center created by Bio-Medical Campus of Rome and it is made available free of charge to all hospitals, central and peripheral. “The images are analyzed by artificial intelligence software that classifies the level of severity of pneumonia and one of our specialists reports the data to the requesting doctor. Up to now 4 thousand cases have been evaluated, of which about 600 of external origin ”, underlines Carlo Cosimo Quattrocchi, Head of Radiology.
The Veneto Region since March it has launched a bio-surveillance platform that puts data from the twenty regional laboratories is online in real time where the swabs are tested. “New positive cases are immediately notified to the public health service and the general practitioner for rapid patient care, avoiding the loss of some positives – he explains Lorenzo Gubian, former IT director of the Veneto region health system and recently appointed to head Aria spa -. At the same time, the system, crossing a series of databases, calculates the outbreaks in the workplace, nursing homes, schools, families, neighborhoods and predicts the advance of intensive care ”.
Other initiatives that deserve to be known are the Neuro virtual hospital, a kind of virtual hospital for neurological patients, promoted byIrcss Carlo Besta of Milan. “It is the first system in Italy for diagnosis and treatment via the web and multidisciplinary – he explains Eugenio Parati, Director of the Department of Cerebrovascular Diseases of the Institute -. At the moment, the Civic Hospitals of Brescia, the San Matteo of Pavia and the Asst Nord Milano are participating with us, but from next month the project will be extended to all Italian hospitals ”. The platform, online since June, hosts virtual meetings divided by medical area (oncology, inflammatory diseases, cerebrovascular diseases, post-Covid neurological complications, etc.) in which specialists discuss clinical cases. With extraordinary benefits. Both because the diagnosis and the treatment strategy chosen for the patient are verified and shared by several experts, and because the patient does not have to travel, with the consequent reduction in the flow of people to the hospital. “The goal is to support and train doctors and promote equity in health care so that a patient from Mazara del Vallo can receive the same care as a patient from Milan, “Parati emphasizes, hoping that tomorrow the virtual hospital will also be extended to local medicine to shorten the time for diagnosis and care of the sick.
It also serves to limit interregional health mobility “SmartDoc”, the project of the National Cancer Institute of Milan designed for patients with lung neoplasms (and all those involving the chest) that require first visits or postsurgical follow-ups. “The patient receives by email a link with which he can access the teleconsultation service with the specialist – explains Alessandro Pardolesi, Institute surgeon and creator of SmartDoc -. The screen shares the vision of the radiological images and the digital drawing that the surgeon can make to clarify the type of intervention. Pharmacological reports and prescriptions are sent through WeTransfer. “Long-distance visits, in full operation since July, benefited 44 patients, most of them from the South (67 percent). The system potentially insures 150 to 180 visits per year.
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