TreC Diabetes and TreC Cardiology

The project implemented in the province of Trento is promoted in the context of the activities led by TrentinoSalute4.0, Competence Center for Digital Health (TS4.0). TS4.0 was formally established with an Act of the Local Government in December 2016: the partnership governance includes the Autonomous Province of Trento (PAT) through the Department of Health and Social Policies in the role of decision-maker, the local Healthcare Trust (APSS) in the role of the health service provider and the Bruno Kessler Foundation (FBK) as the research institute responsible for technological innovation. As the key local actor in digital health for Trentino Province, TS4.0 had the mandate to support the development and adoption of digital solutions, including new organizational assets to support management of chronic diseases (diabetes and HF/heart failure in particular). TS4.0 is promoting a strategic cooperation on digital health among the three main stakeholders, to increasing digitalised services offered to the citizens in the Trentino Province, including both those strictly integrated with the healthcare system, that is, TreC Diabetes and TreC Cardiology. TreC Diabetes and TreC Cardiology are sustained by the ‘TreC’ (the Trentino Citizens Clinical Record) platform, which is the personal health record (PHR) of all Trentino citizens. TreC has been developed as a modular platform whose extensible architecture allows sub-systems to be integrated for the provision of additional and specific functionalities. TreC has become the pillar for the long-term strategy of healthcare digitalisation – a ‘one-stop-shop’ for the Trentino healthcare system. Moreover, TreC can include third party apps and microservices, and is compliant from the legal and ethical viewpoints (e.g. GDPR). Whilst a limited number of patients are using TreC Diabetes and TreC Cardiology, currently a large number of the Trentino population is using the general TreC platform (over 160,000 users adopting the web-based portal, 60.000 the mobile version) as tool for accessing healthcare system. This is potentially facilitating the scaling-up of new digital services and applications to the general population of TreC users. TreC Diabetes aims at implementing a new organizational asset to manage patients with diabetes, supported by new technologies. The project constructively brings together both technological innovations and organizational aspects, to promote healthy lifestyles in and efficient management of patients with diabetes. The TreC Diabetes platform includes (i) a mobile app for patients and (ii) a web dashboard for health care staff. Trec Diabete mobile app for patients includes a) list of functionalities grouped by the conversation types with the chatbot; b) a diary with reminder and self-reported patient’s data. The diabetologist prescribes the app (TreC Diabetes) and a personalised care plan. During the weeks after the visit, the patient’s adherence to the treatment is monitored also via TreC Diabetes virtual coaching platform. On the medical dashboard, the healthcare professional can view the patient’s data on a regular basis and modify the treatment following a step-based approach in order to increase the patient’s adherence. When needed, the healthcare staff can prescribe the patient a tele visit and other exams to perform before the visit and upload the results (pdf, images, etc.) on the tele visit system: these tests will be examined during a tele visit in order to have an even more complete clinical picture of the patient. The same approach adopted for patients with diabetes has been expanded to patients with heart failure (HF) with a specific platform, TreC Cardiology. This system – parallel to the one developed for diabetes – additionally includes the possibility of administering a specific questionnaire via chatbot, to monitor self-reported HF-related symptoms of the patients on a periodical basis. For both TreC Diabetes and Cardiology, the app/dashboard platform is improving the communication between patients and health care staff, as well as the quality of both monitoring and management of the patients. From a citizens’ perspective, this is enabling patients to easily access health documents and to manage their contacts with the health care staff. From a health care team viewpoint, this technology is improving prompt management of patients and efficiency in resources’ use. Technical, behavioural, economical and organizational issues are considered as part of the TreC assessment.