Updated: Feb 1, 97
IREP

Project Code:   A2018 Project value:   3478 KECU EC contribution:   1600 KECU No of partners:   15 No of countries:   5 Duration:   30 months

Contact: Ing. Sergio Copelli TSD Tecnologie e Sistemi Datamont SRL Via Taramelli 26 I-20124 Milano, Italy Tel.: +39-2-62.70.80.54 Fax: +39-2-62.70.46.72

Overview

Purpose and objectives

Rehabilitation Medicine is a very new and unexplored experience in Europe. The field, instead of being perceived as a new beginning for the rehabilitation patient, is associated mostly as the last, desperate and rather conclusive step of patient's medical experience. Due to the combined disorganisation, unemployment and lack of communication among rehabilitators that characterise most European regions, patients do not reach their full therapeutic and restorative capabilities. This does not only confine the broader quality of life aspects for the patient but it creates a heavier burden on the society that has to support the quasi-rehabilitated patients in the ranks of unemployed and disabled citizens.

The aim of the IREP Consortium in addressing this area of work is to build a common European conceptual frame-work and to prototype effective and viable IT infrastructures and tools to support the rehabilitation of people with different types of physical handicaps.

The main outcomes of the project:

• Information Bases of available rehabilitation protocols and procedures to support the exchange of information and the harmonisation of practices through different European countries,
• Front Ends to access pre-existing relevant Services and Data Banks in this area.
• a Workstation environment for rehabilitation specialists and operators,
• a Workstation environment to support rehabilitation at home,
• Test Beds experimenting the system.

The technological scope of the project was very large because Rehabilitation is fairly new as an independent discipline and therefore it exhibits a large number of needs which must be addressed in a unified way: at one end the requirement of moving the rehabilitation process from the hospital to home in order to favour the integration of the handicapped inside his/her family and social context. At other end, the requirement, from the community of R&D specialists, for a high level of inter working between different Centres in different Countries for the definition of widely-accepted new rehabilitation protocols, for the harmonisation of existing ones and for sharing know-how and experiences.

The scientific baseline of IREP was an innovative approach to rehabilitation based on:

• a trans-disciplinary view of Rehabilitation considered as a global discipline which involves the cooperation of different medical disciplines like cardiology, cardiosurgery, neurology, orthopaedics, plastic surgery, urology, psychology, etc.
• a view of rehabilitation not as single step in the patient's care process, but as a continuous procedure which starts at the moment when an injury or disease is detected.
• need for levels of functionalities and services to be efficiently used by a wide range of operators, from single patients to care operators and rehabilitation specialists.

Significant categories of users have been identified: Patients, Families, Medical Teams, Volunteer Associations, Rehabilitation Specialists, IT Industry, Local Authorities and Social Services, Health care Planners, International Organisations (WHO, Rehabilitation International, etc.). For each category of users, the main requirements have also been set.

As a conclusion the general architecture of the IREP Information System has been defined. At the end of this step, the activity of prototyping and testing in a real site has been started. Due to the limited amount of time and resources, the Consortium decided to perform a limited experiment, with respect to the functionalities provided and the categories of users targeted.

IREP 1 was targeting the category of Medical Experts, that perform R&D in the Rehabilitation field. A sample of this category is represented in the Project. They provided a test site for the prototype and a general scientific validation to the overall approach. The first test site was at Ospedale Bambin Gesu' (Rome) in the domain of cardiac rehabilitation. This included a Base of harmonised protocols represented in a standard (to IREP) and homogeneous way. This protocol Base allowed the selection, customisation and tuning of the treatment for a specific patient with respect to a specific organisational environment and other parameters related to the specific case.

In parallel to this technological activity, a stream of medical activity contributing to populate the Information Base through the collection, harmonisation and validation of rehabilitation protocols currently in use in Europe was done. This stream of activity also played an important role for the creation of the consensus in the community of scientific experts.

The activity done in the phase 1 of the project was crucial for establishing the general framework and for testing through concrete experiments in real life environments the actual feasibility of the project goals.

The phase 2 of IREP extended the experience and the achievements of IREP 1 to implement a complete prototype of the IREP Information System: a full functional version was produced and a broader population of users addressed.

The categories of users addressed in this phase were:

• the patients, with particular emphasis on the rehabilitation at home and in open-care environments;
• Health care planners and administrators and administrators;
• Rehabilitation operators.

Two main technological streams were addressed:

• Telecommunication services for rehabilitation,
• Workstations for rehabilitation.

Telecommunication services for rehabilitation include:

• Communication between rehabilitation Centres
• Communication between the patient at home and rehabilitation centres
• Inter working between the IREP Information System and the external context: hospital information systems, general management information systems.
• Link to Data Banks in the rehabilitation domain.

Workstations for rehabilitation included a wide range of IT facilities:

• On one side the workstation for the medical experts must provide facilities to manage multimedia information, including animation and sounds to describe rehabilitation protocols. It must also provide "groupware" facilities to manage and control the cooperation of medical teams when planning and performing the intervention on specific patients. It must also support authoring facilities to produce specific rehabilitation interventions to be deliver for execution either to rehabilitation centres or to the patients.
• On the other side a workstation for home care must provide, at reasonable costs, sophisticated user interfaces and facilities for executing rehabilitation exercises and for assessing their progress and their results.

This stream of activity requires strong investments and high technological competence, therefore it appeared to be mandatory to strengthen the contacts with related projects in AIM and in other CEC programmes in order to take advantage of the results achieved in these domains.

Results

Prototyping and testing in a real site. The test site was organised at the South & East Belfast Community Unit.

This first prototype of the IREP software makes contribution on three levels of rehabilitation: the clinical, the R&D and the administrative management levels. This prototype acquires and exploits a Base of harmonised protocols represented in an homogeneous way.

IREP has defined a model to describe in a formalised way the set of activities related to a certain pathology. The description is carried out on the basis of a meta model of generalised protocol which allows for each phase the definition of protocols and activities.

With respect to the management of the information concerning the patient, according to the IREP process model, through a number of logical steps taking into account the patient data, the organisation context and other aspects relevant for the medical decision, a customised version of a generalised pathology protocol can be prepared for the planning of the care on a specific patient which is affected by that pathology.

From that moment on, the complex logical structure of diagnostic and therapeutic activities defined for the pathology becomes the guide for the planning and for the execution of care activities on the patient providing also the basic structure to collect a number of synthetic information related to the patient and to the activities performed.

The environments in which the IREP system can be run may vary from simple cases in which a small number of physicians and rehabilitation specialists work on a limited number of patients affected by an homogeneous set of pathologies, to cases in which the health organisation is much more complex and the pathologies treated are spread over a wide spectrum.

As the targeted IREP services users include all categories of health operators, patients, researchers, administrators and other interested parties (from the phase of prevention to the phase of social integration), all other projects that aim at the same user population can be serviced by IREP process model and/or its network. IREP data base is structured in such a manner that allows continuos additions and expansions.

From the medical point of view IREP system can collect from the field of rehabilitation structured data and classifications, even semantic material which later can serve as a basis for the creation of an harmonising and even standardising process (rehabilitation procedures, e.g.).

IREP introduction in the Rehabilitation field is expected to reinforce systematisation in the working habits of rehabilitation workers and medical operators in general. The system introduces a methodological approach in health services delivery as well in file management and progress reporting; related changes are expected to be seen in the behaviour of health professionals that use the system.

For experts in the field of rehabilitation, the IREP data system rationalises their work. It is a tool for producing individual expert protocols and for combining the rehabilitation team's different protocols in a uniform protocol including the time-schedules. For the client the IREP software offers the advantage of receiving the printed plan of the rehabilitation process and its updated version easily available at any time along with the process.

For administrative purposes it is possible to plan the resources needed (specialists and equipment) better than earlier. Also the possibility to receive statistical data about the rehabilitation procedures can be useful for long-term planning of the employer and of governmental authorities.

IREP aims to build co-operation between providers of IT solutions so that a population needing rehabilitation interventions, rehabilitation operators and planners will benefit sooner from better services based on IT technology.

As a general objective, the exploitation of the results of IREP will allow the industrial participants:

• to consolidate their position in the market of IT solutions for health-care
• to attack the new market of IT solutions for rehabilitation
• last but not least, the internal use of the technology and experience acquired as a result of the work.

List of Deliverables

Year 1