Innovative e-health services
Telecom Italia is actively involved, either alone or in partnership with external partners, in devising and developing healthcare services at national, regional and local level. Designed to improve the Italian health service and the quality and effectiveness of healthcare, the services allow doctors, nurses and patients to carry out many activities remotely.
The main electronic healthcare service applications available or being developed include:
- value products and services for general practice, aimed at enabling new primary care models and proactive medical services (e.g. screening campaigns managed by general practitioners);
- legal archiving of digital diagnostic images on the network, with a guarantee of the authenticity and integrity of documents;
- management of both healthcare, administrative and logistical processes and a patient’s healthcare information throughout the period of hospitalisation;
- the management and coordination of operational facilities dedicated to emergencies (118) and continuity of assistance;
- healthcare monitoring (Nuvola IT Home Doctor).
All the solutions comply with the data privacy and transaction security requirements of healthcare processes.
Nuvola IT Home Doctor
This allows patients suffering from chronic illnesses, or in post-hospital care, to monitor their physiological parameters (body weight, blood pressure, heart rate, blood oxygen levels, glycaemia, lung capacity, electrocardiogram, etc.) directly from their own homes or in properly equipped facilities (medical centres, medical practices etc.). The system consists of a technological platform and software configured on the patient’s mobile phone (or alternatively a PC or tablet) and on the healthcare personnel’s PC. Based on the plans established by the doctor, patients receive reminders on their mobile phones regarding the measurements to be taken, they take these measurements using portable electro-medical devices equipped with a bluetooth interface and, using their mobile phone, they send the measurement automatically to the online platform.
The benefits of the service are that it improves the patient’s quality of life while optimising costs for the healthcare organisation. In order to enhance the functionality of the service and increase Telecom Italia’s presence in the social care solutions sector, the following developments are under way:
- adding new devices aimed at increasing the measurements that can be monitored (e.g. physical activity and quality of sleep via wearable devices, blood and urine testing via Point of Care systems);
- the use of internet-connected TVs to improve the usability of healthcare services using various ways of displaying measures and accessing services;
- prevention and wellness services aimed at providing solutions for healthy people to help them maintain, if not improve, their health, particularly in unconventional environments such as schools or workplaces, by means of solutions based on healthcare booths;
- services to support mobility in patients with severe limitations who lose their way very easily and might find themselves in dangerous places, using tracking solutions and mechanisms for family members or service centres to provide assistance;
- video-communication services to support telecare and telerehabilitation activities (e.g. patients can engage in rehabilitation while being monitored by doctors interactively from a remote location);
- services for health and personal well-being, which can be used from a smartphone by means of wearable devices for the monitoring of parameters with the availability of cloud space on which to share information.
The evolution of services is also strengthened by the results achieved through the participation in State-financed projects, such as, for example:
- SSMARTHEALTH 2.0, a project financed by the Ministry of Education, University and Research in which 26 partners take part, which aims to create an innovative technological infrastructure in the cloud computing environment, in which to develop various high added value services and activate new models in the area of health and well-being. In using the clinical competence of La Sapienza University of Rome, Telecom Italia Lab developed the Smart Ageing platform for prevention in adult age conducted on fragile elderly members of the population, at risk of cognitive decline. The platform processes the data and measurements obtained from medical devices, health booths and POCs (Proof of Concepts), questionnaires and cognitive tests acquired by tablets. The doctors draft the prevention programme on the basis of the trends and results of the processing and send patients e-mails with feedback, once a week. The platform is being used for a clinical trial at ITGP2 (Giovanni Paolo II Cancer Institute) in Bari, which ended late 2015.
- MC3CARE, a project financed by the Ministry of Education, University and Research, which aims to develop a technological prototype enabling access to and the use of integrated services connected with citizen health, by means of mobile devices such as smartphones and tablets. Through MobileC3-Care, the citizen is at the heart of an ideal network, interconnected with all the structures forming part of the ecosystem of health, welfare and wellness. The prototype comprises a set of services, including information, tele-medicine (remote monitoring and drug surveillance), wellness, localisation and geofencing, access to digital health systems (FSE, Electronic Health File and CUP, Centralised Booking Centre), agenda and reminds (synchronising events with those coming from integrated systems), personal notebook (with data synchronised with that coming from the integrated systems), discussion forums, privacy management and SSO (Single Sign On). The prototype is currently being validated through interviews with sector stakeholders and a focus group of end users.
This is an experimental motor telerehabilitation service which allows medical personnel remotely to monitor the conditions of patients with orthopaedic or neuromotor problems. The prototype, currently being tested, has been developed for the rehabilitation of knees, although the application can be used for other conditions. The system allows doctors to evaluate compliance with the established programme and the correctness of exercises performed.
Movement data is collected by sensors worn by the patient, which measure acceleration, angular speed and magnetic field along the reference axes. The data is sent by bluetooth to a PC, where an application processes it in real time in order to extract information that can be used to define the movements and store them.
In the field of orthopaedic tele-rehabilitation, activities took place in two main directions: extension to new clinical cases and optimisation of the performance. In the first case, thanks to a new collaboration between JOL WHITE1 and the Viareggio hospital, an activity was launched to establish tele-rehabilitation protocols for functional post-operative recovery in cases of partial or total prosthesis of the knee. With regard to optimising performance, the old sensors are being replaced with new, more efficient ones that are easier to use. This requires integration with the Android app used by the patient when performing the exercises
The service provides remote assistance to elderly people, monitoring them and receiving alarm signals in cases of emergency. The sensors located in dwellings process the data collected, to perform behavioural analyses with a view to improving quality of life. The complete solution includes a reminder service, called RicordaMI, to monitor therapies and ensure their completion. With the involvement of pharmacies in entering dosages and adopting a simple tablet app, the system also is usable by people with mild cognitive impairments.
Tele-monitoring of Parkinson’s disease
As part of the development of a tele-monitoring system for patients affected by Parkinson’s disease, Telecom Italia has filed two patent applications relating to the upper and lower limbs. Furthermore, the option of monitoring new motor tasks was considered and, thanks to a collaboration with the Italian Auxology Institute, an activity was launched to extend its use to the tele-rehabilitation of neurological patients. Finally, based on the data collected during the trials, machine learning techniques were applied to developing a UPDRS2 automatic assessment algorithm to emulate the assessment provided by the neurologist according to this standardised scale.
WebSensor is a prototype for remote monitoring of progress in Parkinson’s disease developed with the support of neurologists. A set of sensors worn on the feet and hands monitors the exercises performed by the patient and sends the data to a platform that processes them and supplies parameters that can be used to assess the status of the disease. The hand sensors, which are often uncomfortable to wear, can be replaced by an appropriate stereoscopic (LeapMotion) camera that frames the hand and automatically extracts the exact position of the fingers in space.
It is a prototype tested on 30 people aged over 65, suffering from slight cognitive function deficits, for their remote rehabilitation. The system provides a kit of interactive games for Android tablets, designed with neurologists to simulate the patient’s various cognitive functions. The games, tested in collaboration with NeuroCare from Cascina (Pisa) communicate with a remote server to send data relating to the patient’s performance and to download their settings. The experiments have allowed the games to be improved, making them more interesting for users and integrating them with other games created by third parties involving the rest of the family, in a kind of game show that encourages their use (GameBus project).
Personalized Playful Spaces is a project funded by EIT ICT Labs3 for the rehabilitation and monitoring of autistic children. Children can interact with a space or sensorised objects that stimulate them when playing and provide the specialist with information on the state of the child. The project is developed in partnership with JOL SCUBE4, which works on sensorised environments, and with the Politecnico University of Milan and SAM Foundation for scientific and medical support.
1 It is one of the eight Joint Open Labs (JOLs) opened by TIM in 5 universities: WHITE stands for Wellbeing and Health Innovative Technologies Lab and it is located at the Sant’Anna school of advanced studies of Pisa.
2 The Unified Parkinson’s Disease Rating Scale is the assessment scale most used in evaluating the prognosis of Parkinson’s disease.
3 European Institute of Innovation and Technology.
4 It is one of the 8 Joint Open Labs (JOLs) opened by TIM in 5 universities; SCUBE (Smart Social Spaces Lab) is based at the Politecnico University of Milan.