European prototype for integrated care (EPIC)

computer methods and procjrams in biomedicine ELSEVIER

Computer Methods and Programs in Biomedicine 45 (1994) 47 49

European prototype for integrated care (EPIC) L e s l i e B o y d e l l *a, B r e n d a n

McAllister b

"South and East Be(last Community Unit, Be!last, Northern lrehmd, UK ~'lrish Medical Systems, Ireland

Abstract

The EPIC project has devised a means by which care workers can share client information between different professions and different locations through the use of a common domain information model for the client dossier, the client reference dossier and the EPIC message. This approach will be tested by its application to the assessment, planning and delivery of care to individual elderly clients in the community with the intention of extending and applying it to other aspects of the business of the community care service and other client groups in the future. Key words: Primary care: Integration; Elderly

Rapid advances in medical science and technology have lead to an escalation in the cost of health care across Europe. Because of the need to contain costs and to increase the focus on responsiveness to the consumer, European health care policy makers are seeking ways to shift health care from the high technology hospital sector into the community, by investing in an expansion of primary and preventive care. Health and social care in the community tends to be provided from various facilities and by a range of different agencies and professions. To be cost-effective, therefore, primary health care must be integrated. A major factor in the integration of the service is the sharing of information and knowledge relevant to patients or clients and their care between those involved in providing care, those that manage the resources for care and the

* Corresponding author.

patients themselves. Advances in telematics are making a major contribution to the integration of health care. The EPIC project has been devised to support the integration of primary care. Its aim is to develop a prototype information system capable of providing the support necessary to facilitate the delivery of integrated health and social care to vulnerable people in their own home environments, while maintaining optimal quality of life. While this prototype is being developed with a view to its future application to a range of vulnerable client groups in the community, the focus is mainly on the care of the elderly. Within the project, the application of telematics to the integration of antenatal care is also being investigated. There are a number of reasons why the elderly have been selected as the main subject of the EPIC project. One of the most striking demographic changes in recent years has been the in-

0169-2607/94/$07.00 1994 Elsevier Science Ireland Ltd. All rights reserved SSD1 0169-2607(94)01542-N

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L. Boydell, B. McAllister / Comput. Methods Programs Biomed. 45 (1994) 47 49

crease in the elderly population throughout Europe. The World Health Organization has highlighted a number of features with regard to the provision of health and social care to the elderly people in Europe [1]. Service provision tends to be fragmented between providers with separate funding resulting in services that are disjointed; lack of multi-disciplinary assessment often leads to inappropriate placement of elderly people; a wide range of statutory and other organisations are involved in the provision of care, with no single person or organisation accepting full responsibility for ensuring that the full range of services are available for those who need them. It is these observations which underpin the EPIC project. South Belfast was selected as the pilot site for the main part of the EPIC project dealing with the health and social care of the elderly. This is because it is one of the few places in Europe with an integrated organisational infrastructure for health and social care. Supplementary pilot sites have been identified in Malaga, Spain and in Turku, Finland.

Background I Information I

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The project commenced in 1992. The first year was largely devoted to the identification of user requirements. The second and part of the third year is devoted to the development of the system and during 1994 the pilot system will be tested in the three sites.

The technical approach In the initial stages of the project a business analysis of community care was carried out in the three pilot sites. Based on the results of this analysis, an entity-relationship model for community care was developed. This model covered both the assessment of individual patients or clients, the definition of their care needs and the production of a plan of care, the delivery of care and the management of the resources required to provide the service. Focusing on assessment and care planning as the core of the project, a generic domain information model (DIM) was elaborated. This is outlined in Fig. 1. The DIM represents both the client dossier and the client

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Protocol Fig. 1. Basic structure of client dossier.

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L. Boydell, B. McAllister / Comput. Methods Programs Biomed. 45 (1994) 47 49

reference dossier (see below). The basic information generated during the process of assessment and care planning can then be used in the analysis of population health care needs, the measurement of service outcomes and resource management. Because the delivery of care in the community may be provided from separate facilities, the concept of a service point was defined. A service point may be either a facility or a group of services from which the client receives care. Correspondingly, a service period (Fig. 1) is a time span over which services are being provided to the client by a particular community care professional. At each service point where the client attends, a client dossier is held. The client dossier contains the details of the assessment and care plans undertaken at that service point. For each service point a client attends, there will be a separate client dossier. Each service point is linked to a central node, where the client reference dossier is stored. An abstract of the information in each client dossier held at each service point attended by a client is recorded on the client reference dossier. The client reference dossier is regularly updated by the care workers and contains the location of all the client dossiers for each client. The ability of care workers of different professions to update and view the client reference dossier (subject to access control) provides the means by which information held at different facilities and by different professionals in the community is integrated. In order to update the client reference dossier so that it can be understood by other care workers, it is necessary to record not only the information of interest but also the context in which that information has been collected. The use of the generic D I M to represent the client dossier as well as the client reference dossier make this possible. An EPIC message based on the generic D I M has been specified. Objects in the EPIC message may be mandatory or optional and may be unique

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or repetitive. The permitted objects are fully described in a Syntax repository, which is placed at both ends of the transmission path and is used when creating and checking messages. An additional service which is being developed within EPIC is home telecare. This includes the integration of home telealarms and blood pressure monitoring into the EPIC system so that a record of data generated by the home based devices is stored in the client dossier at the service point from which the home telecare service is controlled. This also enables the care worker managing the home telecare service to have access to the appropriate information within the client record when responding to alarm calls. In recognition of the organisational and professional development necessary |\~r the successful implementation of EPIC, the users at the pilot site are working on a c o m m o n approach to assessment of the elderly. To support the sharing of information between professionals a core assessment is being developed and considerable consensus has now been achieved not only across the pilot sites but also with professionals from several centres in other European countries, on the essential domains of assessment. This is expected to avoid some of the duplication of data collection which currently exists and to enable the comparison of the outcomes of health services between different regions.

Acknowledgement EPIC is funded by the A I M p r o g r a m m e of the European Union.

Reference [1] M. Skeet, Small area planning for the elderly. World Health Organisation, Regional Office for Europe. Copenhagen, 1989.