Solution White Paper

Terivan Antico

Virtual anticoagulant treatment follow-up

Terivan Oy ● Kuninkaankatu 30 ● FIN-33200 Tampere Finland www.terivan.com ● [email protected]

Company Terivan Ltd was established in 2000. At first the company and its personnel participated in a number of research activities in the field of eHealth. Currently, the company is extending its three-year experience in the field of networked health care multimedia services by enlarging its pilot systems for major operational activities in various application areas. The company’s activity is targeted to both primary and secondary health care. Terivan Ltd is producing innovative technical solutions for networked health care multimedia. The customers of the company are both from the public and private sectors (hospitals, clinics, hospital districts and pharmaceutical companies), from the third sector (organizations and associations) and from the final end-customers, as well. The company has a solid expertise in communication and IT technologies combined with a profoundly relevant medical expertise. The personnel of the company cover both technical and medical areas. The company has a partnership network covering both technology and system vendors, research institutes and medical professionals and practitioners.

Motivation The post-industrial age has manifested itself in the emergence of the information society. The ways people access and utilize information is changing through the adoption of computer technology in information processing, storage, and communication. This information technology enables novel approaches in various domains of human society. This development coincides with the fact of an emerging un-sustainability in current health care provision service models in industrialized countries. Due to the ageing of the populations, rising costs of new treatments and procedures, and continued limits placed on public health care spending new methodologies are required to sustain equality and quality in care access.

Terivan Oy ● Kuninkaankatu 30 ● FIN-33200 Tampere Finland www.terivan.com ● [email protected]

Technology The Terivan philosophy is to attenuate the effect of these changes through the adoption of innovative information technology solutions. The manifestation of this philosophy is the development of an information technology platform for networked health care multimedia. This digital media platform provides time and location independence in health care service provision and helps distil the essence of the health care professional’s expertise by enabling methodologies, which help them to optimally use their resources and concentrate on the relevant. Furthermore, the platform facilitates the empowerment of the individual patient. The realization of the Terivan platform relies on the adoption of open and modular information technology standards including standard Internet and mobile networking and hypermedia technologies and modern Java and J2EE software architectures. A novel aspect of the Terivan platform is adoption of standardized broadcast multimedia, interactive digital television, both as a distribution channel for health information and in interactive health care service provision. Media convergence is a key functionality of the platform enabling the combined use of various Internet, mobile, and digital television platforms.

Terivan Antico Service Medical background The use of digital media in health care often requires the development of new service models establishing a well-defined scenario for the implementation of the approach in an actual health care environment. Follow-up of oral anticoagulant treatment is an example of a health care modality where a possibility for such service models exists. The number of patients on oral anticoagulant treatment in Finland has, based on drug sale statistics, increased by 50 % in the past six years calling for new methodologies in the arrangement of the follow-up. Conventionally anticoagulant treatment in primary health care follow-up is realized through regular anticoagulation level laboratory testing from venous samples. Physicians evaluate the results of the tests, normalized INR (International Normalized Ration) values, and determine new weekly anticoagulant dosages and next follow-up dates. The anticoagulant dosages of the patients are adjusted according to the physician’s instructions. All follow-up data, INR values and dosage schedules, is contained in paper-based follow-up cards. Functionality Terivan Antico is a virtual environment for the follow-up of oral anticoagulant treatment in primary health care. It is developed on top of the Terivan platform. The Terivan Antico service can be considered a virtual collection of follow-up Terivan Oy ● Kuninkaankatu 30 ● FIN-33200 Tampere Finland www.terivan.com ● [email protected]

cards replacing old paper-based cards. It serves as nexus for all information required in anticoagulant treatment follow-up of individual patients. It is accessible through the public Internet with web browsers, from GSM mobile phones through SMS and MMS messaging and from DVB-MHP compliant digital television with proprietary value-added applications. From a practical point of view, the service provides a virtual interface for patients, nurses, and physicians in primary health care clinic to add, view, maintain and process information contained in the virtual follow-up cards. The interfaces are personalized for each relevant patient, nurse and physician group. The service provides added value compared to conventional paper-based follow-up by providing graphical visualizations of follow-up data, intelligent decision support tools, automatic conveyance of laboratory follow-up test results and other comparable enhancements. The service supports the realization of various service models existing in the follow-up of anticoagulant treatment in primary health care facilities. Figure 1 presents the structure and functionality of the Terivan Antico service. Antico Core provides the virtual anticoagulant treatment follow-up cards accessible by the various users from the supported media.

Figure 1. Structure and functionality of the Terivan Antico service

Terivan Oy ● Kuninkaankatu 30 ● FIN-33200 Tampere Finland www.terivan.com ● [email protected]

Service models A detailed description is given here for four primary health care service models supported by the Terivan Antico service. Self follow-up patients The patient has a portable meter for anticoagulant treatment follow-up testing at home. She submits the results of the tests using a personalized patient web or digi-TV hypertext interface or as an SMS message to the virtual follow-up card. The physician, using her personalized web interface, sets the new treatment guidelines, the new anticoagulant dosage and the date of the next follow-up, using the virtual follow-up card. The patient can access the updated follow-up card with the new guidelines using the patient web or digi-TV interface. The patient can also access them via an SMS or MMS message using her mobile phone. In addition, results from laboratory follow-ups can be conveyed automatically to the system. Laboratory follow-up patients Patients have laboratory follow-up tests as in conventional follow-up. The results of the tests are automatically conveyed to the patients’s virtual follow-up cards from a laboratory system. The physician, using her personalized web interface, sets the new treatment guidelines, the new anticoagulant dosage and the date of the next follow-up, to virtual the follow-up card. The patients can query the new guidelines by phone from the health care center. The health care center patient office nurses use a personalized web interface to provide access to the patients’ virtual follow-up cards. Home-care patients Home-care nurses use portable meters for anticoagulated home-care patient follow-up testing. The results of the tests and the distributed new anticoagulant medication dosages are inserted with a personalized web interface to the virtual follow-up card. The physician, again using her personalized web interface, confirms or alters the new dosage to the patients’s virtual follow-up card. In addition, the results from laboratory follow-ups can be conveyed automatically to the system. Hospitalized patients Follow-up tests are made with portable meters for hospitalised patients. Hospital ward nurses submit the results using a personalized web interface to the virtual follow-up card. The physician, again using a personalized web interface, confirms or alters the new dosage to the patients’s virtual follow-up card. In addition, results from laboratory follow-ups can be conveyed automatically to the system. In addition, advanced messaging between the various users is facilitated as either group-based or individual-to-individual messaging. A super user interface exists for maintaining the treatment database.

Terivan Oy ● Kuninkaankatu 30 ● FIN-33200 Tampere Finland www.terivan.com ● [email protected]

Benefits Terivan Antico service provides several benefits compared to conventional paperbased follow-up. Table 1 lists the benefits of Terivan Antico in a typical primary health care setting when compared to traditional paper-based follow-up. Table 1. Benefits of Antico service to the patient and the treatment organization Patient Primary health care clinic Improved treatment balance

Reduced costs

Reduced complication risk

Reduced routine work load

Security

Improved communication

Reduction in laboratory testing

Elimination of erroneous markings

Time and location independence

Time and location independence

Cost Benefits A case study evaluated the economic feasibility of the Terivan Antico service in a sparsely populated and rural setting. Two patient groups, home-care and self follow-up patients, were covered. The results of the case study showed that even with a small number of patients (