Senza categoria 16/09/2020

Health 4.0 – Il Sole 24 Ore DOSSIER

Il Sole 24 Ore, the Italian national daily business newspaper, highlights how a fully automated management of medications and medical devices improves quality of care, patient safety and efficiency within healthcare institutions.
Politecnico of Milano, Pavia Asst and San Martino University Hospital of Genoa shared their success stories in implementing Deenova’s mechatronics solutions.

Read the Original Dossier

Il Sole 24 Ore – 16 Sep. 2020 by Natascia Ronchetti

Health 4.0 – Managing hospitals and local health units through machines and digitalisation by monitoring processes, from production to drug administration. The result? Fewer costs and more efficiency

Medicine 4.0 to cut down on costs and make the whole system more efficient

Telemedicine, electronic health records, conversion of drugs to single dosage forms, not only by leveraging computerisation and automation, but tracking medical and hospital devices as well. The roadmap for the digitalisation of the health system is open; the Covid-19 pandemic has indeed sped up the transition.

During the health emergency, many Regions gave the go-ahead to the provision of services such as teleconsultations. While the number of doctors who customarily use telemedicine, one of the new accomplishments of health 4.0, has doubled – bouncing from 5 to 10%. An unavoidable route but still full of obstacles. «The government has indeed included it among its priorities – said Chiara Sgarbossa, Head of Digital Innovation in Healthcare Observatory of Politecnico di Milano -. But we are still far from a real model of connected care; namely, a connected accuracy-based national system, geared towards the territory and care continuity, and that is capable of immediately providing all information on a patient, about their clinical history and health condition. The situation is still very piecemeal. And not all medical centres have yet enabled the electronic health record, for example».

The differences do not concern so much the North or the South of the country, but the single local health units: « Each one moves on its way, unevenly, even within the same region», Sgarbossa continued. The result is that there are only 18 million electronic health records: not even half the population has been reached. The Covid era has raised awareness of the strategic value of digitalisation to minimise waste and clinical risk. It has also brought about a cultural turning point in the world of family practitioners. According to a recent research project conducted by the Digital Innovation Observatory of the Polytechnic University of Milan, around 62% would currently like to use telemedicine and communicating with patients through platforms such as Skype or Zoom is indeed on the rise. «This said, investments are needed to achieve goals – Sgarbossa continued -. And the goal is offering a multitude of access channels to health services, with simple solutions at everyone’s fingertips».

The most critical period of the epidemic – during which over 50% of general practitioners worked remotely – confirmed the importance of new technologies also as regards access to information by citizens: 56% visited institutional web pages, 28% physicians’ and politicians’ social media, 12% coronavirus-related apps. « The fact remains that many hospitals are still at an early stage, and the journey is very long», – said Giorgio Pavesi, president and administrator of Deenova, a mechatronics company based in Gragnano Trebbiense, in the province of Piacenza, which develops automated systems for computerised management of drugs and medical devices. Deenova serves 25 hospitals, including university polyclinics and small provincial centres. The majority are concentrated in the North of the country, but there are also examples such as Rome-based Gemelli University Hospital, which is now able to track down 100% of medical devices, from the supply process to the operating room. Excellencies still disconnected. «Even if integration projects with already available IT systems are increasing – Pavesi explained -. After all, we are talking about an innovation pervading all specialist areas». Meaningful examples can be found abroad too. A study by the English University of Loughborough documented that the consumption of medicines decreased of 25% in the hospital of Leicester – where Deenova implemented a computerised prescription order entry system for drugs in four wards, by automatically preparing personalised treatments in unit doses. Now the project will be extended to the whole hospital.

However, there are already very advanced regions in Italy. Such is the case of Emilia-Romagna, where the electronic health record is already a reality for 89% of the population. To have some comparison parameters, suffice it to say that the involved citizens in Lombardy are 56% and in Tuscany 57%. «An element that proved crucial during the emergency – said Emilia Romagna’s health regional councillor Raffaele Donini – and that has become part of our health system as a structural component. For us, it is a core element of the system’s innovation. We can indeed state that we have taken a leap forward of extraordinary importance towards simplification and citizens’ health safety».

A single telemedicine software platform has now also been enabled here, with a set of services, from taking charge of chronic patients, through to managing them.

The waste of medicines decreased by more than 50 per cent in the Pavese area

First of all, the appropriateness of treatments significantly improved by reducing their risk margins: an installed system immediately alerts healthcare staff if they are administering a wrong drug, or if a patient is taking a given medicine at a different time than prescribed by the doctor. In addition, medicine stocks were reduced by 50% and expiring stocks removed, thus achieving a 7% reduction in wasted drugs. They also realised that 10% of nurses’ working time had been recovered – the time they used to spend preparing medicaments. All this as a result of computerisation and automation.

«A significant advantage even in the most challenging months of the Covid-19 epidemic – said Michele Brait -. We managed to continuously monitor the effectiveness of treatments and vital parameters of the patients, whereas, thanks to a very useful resource such as telemedicine, not severely ill patients could be assisted at their homes». Brait is the general manager of Pavia Local Healthcare Area (Asst),  a catchment area including 640 thousand people, located between the Pavia area and a part of Piedmont and Liguria. The Local Healthcare Area includes seven hospitals, the largest being those based in Vigevano and Voghera. In all, 43 wards – for a total staff of 1,500 doctors, nurses, pharmacists, social and health workers – where computerised management of drugs, from prescription to administration, was introduced in 2012. A project, commissioned by the Lombardy Region, jointly developed with Deenova, the Piacenza-based company specialised in developing automated systems for the management of medicines and medical devices.

In a small hospital in Mede, a town with about 6 thousand inhabitants, eight beds equipped with non-invasive sensors – some applied to the beds, others to patients – were also made available to measure body temperature, heart rate and quality of sleep. These sensors also alert nurses if the patient’s position needs to be changed, or if the patient tries to get out of bed at the risk of falling. «And now we are thinking of bringing the sensors into patients’ homes, or nursing homes – explains Brait – This way, doctors can keep everything under control remotely and hospitalise patients only when required. We are also testing with a bracelet which provides all vital signs as an intensive care monitor. In our opinion, the real challenge of health 4.0 is not so much linked to monitoring an acute phase, but rather to consistently monitoring the patient».

Drugs traceability is currently ensured in all the hospitals included in the Pavia Local Healthcare Area (Asst). Drug prescription is computerised, as are the cabinets automatically loading ward trolleys with single doses, to eliminate wasted drugs, while patients are equipped with electronic bracelets that make it possible for a nurse or doctor to always check patients’ identities, resulting in more appropriate treatments. «This way we could track down over 2.3 million administrations, including IV drip infusions and tablets» Brait continued – and we computerised operating theatres as well, by tracking down implantable medical devices».

Anti-Covid single doses at San Martino Hospital in Genoa

During the most challenging phase of the Covid-19 pandemic health emergency, being able to repackage drugs in unit doses was a real innovation and one of the weapons some hospitals took advantage of to guarantee access to treatments for the sick. Even hydroxychloroquine-based drugs (Plaquenil, manufactured by French multinational Sanofi), used against rheumatic diseases for decades, and then against the coronavirus as well, until the suspension decided by the Italian drug agency.

Technically, the conversion into single doses is called singling. And it is precisely through this method that hospitals such as the San Martino University Polyclinic in Genoa also managed to supply pharmacies throughout the Liguria region, bypassing the obstacle posed by this drug being scarcely available on the market. «We singled almost 45 thousand tablets in a week, thus supporting local communities», said Sabrina Beltramini, director of San Martino hospital’s pharmacy, which employs 60 people among pharmacists, nurses, technicians and warehouse workers. All thanks to automation and computerisation, jointly with Emilian company Deenova. «We have devised a whole singling plan aimed at preparing unit doses in sachets with bar codes for full traceability», Beltramini continued. As a matter of fact, a hydroxychloroquine pack contains thirty tablets, but the standard treatment initially envisaged by doctors called for just sixteen being administered. Thus, repackaging made it possible to avoid wasting drugs and to supply 590 pharmacies based in the Liguria region, as opposed to Sanofi’s difficulty in meeting the quick, massive increase in demand. A decision made by the Region, which secured a supply, and then commissioned the polyclinic to prepare the tablets in single doses, and send them to each Regional drug centre, in charge of distribution. «This way, we could also reach patients at home, while also managing to maintain the whole hospital production in place: a great effort that involved all staff», Beltramini explained.

An effort that also involved antiretroviral medicine – generally used for people with HIV, but also as an alternative for Covid patients – in many hospitals. San Martino Hospital in Genoa has 1,300 beds. Thirteen years have gone by since the computerisation operation for medicine management has kicked off. Here too, as a matter of fact, the path has been traced, from doctor prescription to nurse administration, with 26 automated cabinets dispensing medicines in unit doses. At any time, healthcare staff can know for each patient which treatment was selected, when it was prescribed and when it was administered: through the system 6,000 single doses can be daily packaged and tracked down. A solution that has also proved useful in better managing the use of antibiotics and reducing clinical risk: the latest internal study showed that it fell from 8.3 to 1.5%.