Updated: Feb 1, 97
EPIC

Project Code:   A2007 Project value:   3749 KECU EC contribution:   1880 KECU No of partners:   9 No of countries:   9 Duration:   36 months

Contact: Dr Leslie Boydell, SEBHSS Trust, European Office Knockbracken Healthcare Park Saintfield Road, Belfast Northern Ireland, U.K. Tel.: +44-232-40.22.02 Fax: +44-232-40.21.21

Overview

Purpose and objectives

The first year of the project was devoted to the definition of user requirements, the second to the specification of the system and the third to the development, installation and evaluation of the software in four pilot sites, in four different countries. The role of the pilot sites has been to identify common requirements, and differences, to assist the development of generic solutions. An important consequence of the project has been the formation of a strong cross-site user group of professionals and senior managers from the pilot sites This group has formulated and agreed some of the key concepts underlying EPIC.

The central functions of health and social care professionals are the assessment of individual patients or clients, the identification of their problems and needs, and the planning, delivery and evaluation of care. This approach enables the design of a common, client centred system supporting an integrated health care record around which the system functionality was identified. To complement the work of the EPIC project team in this area experts from 14 different countries were invited to a consensus conference to debate and agree the necessary criteria for a common core assessment for the elderly. These criteria have now been incorporated into the EPIC assessment system (EASY) and are currently being evaluated in the pilot site Implementations.

Another important component of EPIC is the utilisation of technology which can transmit information from the home to professionals at remote locations, such as the health centre or hospital. These home based telecare services bring the appropriate technology and services to anyone who needs assistance related to healthcare and/or social problems at home, in the form of training, information, advice or monitoring. Telemonitoring of alarms, blood pressure and ECG is supported, providing members of the care team with timely information on critical evens arising while the client is at home.

The main component of EPIC is the shared care database in which each community facility, or group of facilities (e.g. local health centre and social services office) is supported by a local area network (LAN). Each of these LANs is connected over a wide area network (WAN) to a central node, enabling update and access of information between the various service points. The EPIC system has been implemented according to an open, client-server model where the client health record is managed in an object oriented manner through specified API functions. The software is layered such that the client application is not affected by how the servers are implemented or which database system they use. Naturally, in any system designed to facilitate the sharing of information, there are important concerns regarding confidentiality and access control mechanisms. The EPIC system meets the confidentiality needs of the client, who should be allowed the choice of who will be granted access to their data, and the participating agencies, conforming to their policies on the sharing of client information. The appropriate confidentiality controls are defined locally in EPIC and community care professionals can grant and revoke access to data that they 'own'.

The lead EPIC pilot site, in Belfast Northern Ireland, employs a LAN at each service point, which are connected via ISDN communication links. Because the system architecture is truly open, enabling free choice of equipment, operating system and database, it can be implemented at any single service point on a standalone PC system. The AIM conference demonstration illustrates such a scenario. Since other service points are accessed transparently, the user does not need to be aware of how many other service points exist, or on which system data is located.

The demonstration application supports the registration of background and current client details, multidisciplinary assessment and co-operative planning and delivery of care.

Throughout Europe there are moves by healthcare authorities to provide more health and social services to people in their own homes, rather than in hospitals, institutions or nursing homes. Elderly people in particular want the choice of being cared for in their own familiar surroundings. The central theme of all Community Care initiatives are that the services should he user centred and needs led.

EPIC provides the tools to develop, on a phased basis, information support systems which facilitate the delivery of integrated Health and Social Services throughout the Community. By delivering application solutions on an open, distributed, client / server platform EPIC enables agencies providing care to attach themselves to the system at the level that is appropriate to their size.

However EPIC is much more than a framework for the multi-agency collection of client data. The emphasis has been to provide a system which will give professional carers quality information, in a format that they can easily utilise and understand, which will help them to look after their clients better

The advantages of home based telecare with regard to safety and security are obvious. EPIC partners are already claiming that at least one life has been saved by early detection of a fire by smoke detectors connected to the system, setting off alarms at the remote control centre. Further improvements in home care will follow once professionals can transmit and receive information whilst in their client's home enabling a faster, more accurate diagnosis and valuable input to their decision management.

Other sites, both affiliated with current project participants and outside of the project, have already expressed interest in using EPIC components. The system developed within the project is the nucleus of a client centred community information system which can usefully be extended in various directions. Already there are plans to develop integrated Mental Health and Ante-Natal applications. Resource management and integration with hospital information systems are also seen as important areas for future development. Many of the project participants are committed to building on the results so far achieved within EPIC, and the commercial partners are confident that they will shortly be marketing a range of community application products which are significantly more advanced than the limited products that are available for enhancing Community Care.

Results

The three main component of EPIC are:

• the architecture, which facilitates the sharing of information between health and social care workers;
• home based telecare, integrating home safety alarms, blood pressure and ECG monitoring;
• a common core assessment for use with elderly in primary care.

The pilot site for the EPIC project are:

• South Belfast, Ireland, that was chosen as main pilot site because of the integrated organisational structure of health and social services.
• Turku in Finland;
• Malaga in Spain;
• Savona in Italy, recruited during the second year of he projects.

At the beginning of the EPIC project here was scepticism about the feasibility of reaching a consensus across diverse organisations on home care and telematics required to support it. By focusing on the client and the needs of the client, the EPIC consortium have been able to reach consensus on several concepts regarding the prevision of home care and consequently the telematic solutions required to support it.

The benefit of addressing the development as a part of an European collaboration has been the diversity of organisations involved, providing creativity and the opportunity to explore new concepts in a relatively non-threatening environment. In addition solutions that have worked in other regions can provide policy-makers with credibility and strength when try to initiate changes within their own organisations.

EPIC provide a focus for organisational thinking and enhance the understanding of the organisations involved in their telematic requirements. The system developed within the project is the nucleus of a client centred community information system.

List of Deliverables

Year 1

• Statement of the needs of the elderly and also of policies, professional processes, a specification of the potential system users and of any other relevant professional and operational issues (3/R/I)
• Documentation describing state of the art existing solutions and recommendations for their possible contribution to EPIC (3/R/R)
• Statements from all sites specifying data sets, definitions, codes, users, guardians and levels of confidentiality (6/R/I)
• An agreed structure and format of the statement of user requirements (10/R/I)
• Documentation describing available and applicable medical related standards (10/R/I)
• Documentation describing available and applicable technical related standards (12/R/I)
• Report describing training and education needs of the target group for the EPIC system
• Detailed Specification of the requirements for an Elderly Integrated Care Information System (12/S/I)

Year 2

• Report on pre-installation analysis (2/R/I)
• Training and Education packages for the EPIC system (3/P,R/I)
• Detailed functional specification of an integrated care application (3/S/I)
• Elderly health care information system technical specification (5/S/I)
• Detailed architectures specification (6/S/I)
• Awareness and training presentations, workshops and information packs (11/O/I)
• Working Prototype of Antenatal monitoring system (11/P/I)
• Working prototype of the elderly health care information system for the pilot site (12/P/I)

Year 3

• Working system installed in main pilot site (2/O/I)
• Report describing Training and Education evaluation for the EPIC system (6/R/I)
• Report documenting performance observations, frequent errors and user remarks relating to the system (6/R/I)
• Report describing the results of the evaluation exercise, summarising the results of the cost benefit analysis exercise and providing a description of the investment appraisal framework
• A report highlighting the strengths and weaknesses of the implemented system. The report will also comment on the implementation procedures and the impact on both staff and clients. The report will contain guidelines to enable other organisations to build upon the work of the Prototype and implement further aspects of Integrated Care (9/R/P)
• Report summarising the conclusions on the validity of the system and detailing recommendations for future developments (12/R/P)

List of Participants

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