Geri System

Inspiration

With the emergence of COVID-19, healthcare institutions and regulatory bodies have been forced to resort to alternative ways of providing healthcare while limiting exposure to the virus. In this context, telemedicine has been considered as a critically essential service to help mitigate the spread of the disease and flat the curve of demand on health systems worldwide.

During the last months, telehealth use has suffered a remarkable rise due to the COVID-19 pandemic. These services range from tools that remotely allow to monitor and diagnose patients, to robots that help in the delivery of medication. Most of the proposals seem new, but actually, they already existed.

Why haven’t technologies like these been integrated into the healthcare system before? Legal, cultural and economic aspects constituted the main barriers. Unfortunately, an event like this had to occur so public health authorities could understand the advantages and necessity of telemedicine solutions.

Spain, where coronavirus outbreak knows no borders, has also implemented telemedical measures against COVID-19. Owing to the collapse of hospitals and the partial closure of primary care centers, most of the consultations are being accomplished via telephone or videoconference. Nevertheless, in some cases this is not enough.

When talking about nursing homes, medical assistance has not met the actual needs. It results hazardous since residents belong to the main risk group. The lack of health professionals due to sick leaves and the scarce communication between care homes and medical institutions has been reflected in the devastating statistics.

Given this dramatic situation, the number of contagions must be reduced. This could be accomplished by minimizing the flow of people and unnecessary displacements. Furthermore, it is required to provide a proper supervision to these elder pluripathological patients.

The people involved in this project share a common and deep affection for the elderly. We must take care of the generation that did the most for us to be here.

What it does

Geri System allows the connection between the sanitary personnel from the nursing homes and primary health doctors or other specialists through a teleconsultation. This way, residents can be remotely assisted. Teleconsultations can also be established among health professionals in order to provide training or exchange opinions. Geri System is a multidisciplinary platform, that means, more than one specialist could connect to the same videoconference.

But, what is this teleconsultation about? In the case of our platform, a videoconference is established and patient medical data and parameters are exchanged. This data includes symptoms, medication,cardiac and respiratory frequencies, oxygen saturation or glucose level, for example, and acoustic or visual files such as photos, videos and audio. This information could be manually or automatically introduced, and then it would appear in an organised and clear manner so that the specialist can get the best global vision of the patient's status.

Data is collected by the health personnel of the residence. Not all the centres have all the measurement devices. Our platform allows the adaptation of the teleconsultation to the means available.

It is necessary that the platform is easy to use and also that eases the health professionals work. To carry out different exams or obtain data information, the nursing home professional might need doctor guidance. The platform would include guides and tutorials for every data that can be introduced. Additionally, an interactive atlas of the human body where the doctor can point out the parts where the specialist need to palpate or take a picture or video would also be included.

Moreover, the platform has an appointment calendar where the different encounters will be programmed. In a future appointment scheduling, the specialist could indicate the examinations and data that will be required in order to have everything prepared for the meeting. This way, efficiency is improved and time would not be wasted.

Geri System allows to provide synchronous and asynchronous teleconsultations. Data can be collected and be latter analysed by the specialists when possible. It also counts on an electronic notebook for each patient, specially important for those with chronic pathologies who need control and monitoring of their conditions.

Accomplishments that we're proud of

The project was selected along with other 19 to evaluate its implantation during the Hackathon #VencealVirus, organised by the Community of Madrid (Spain). In this challenge, 7.400 people from 49 countries participated and 244 proposals were delivered. Scientists, college students, entrepreneurs and different members of our society reunited to face COVID-19 actual and future challenges.

What we learned

Along this path, we have noticed that telemedicine has a wonderful and promising present and future. We have the capability and the means to overcome current barriers, we just needed a reason to start the journey. Now we have it, we must learn about it and set the following steps to not to trip over the same stone again. This stone deals with the health of the global population, so we can't turn our back on it.

Let's bring together the existent and available resources to create new solutions for the upcoming future.

What's next for Geri System

For the project to be implemented and developed, a proper analysis of the situation happening in nursing homes is required. This involves the evaluation of medical assistance, the prevalence and incidence of different pathologies, the methods to monitor and control chronic patients and those with reduced mobility or impairments, the communications with medical institutions, and legal and interoperability aspects, among others.

Due to the lack of transparence and the absence of this information, this first process should be accomplished by on-site analysis. We need to do the best analysis possible and find out the weak points of the current system to solve them and be prepared for any future similar situation.

This is not only a platform but it is a work system. For the system to work, we need the cooperation of all the actors involved.

On one side, we need the presence of health professionals (nurses and/or nursing assistants) in the nursing home to collect the data. On the other side, there must be a network of specialists that assist these teleconsultations.

These networks exist by two ways:

1. Public health: normally, each nursing home has a primary care center and a hospital assigned.
2. Private health: some nursing homes are assisted by a private insurance company or hospital.

As we have seen, urgency of a global and rapid solution is both public and private. The main goal of this project is that the public system integrates telehealth solutions for nursing homes. And for that, we would need its cooperation to overcome legal and interoperability barriers.

Additionally, it would be equally necessary and great for private insurance companies and hospitals to integrate this system in order to offer the best service and medical assistance possible to their residents in a time where social distancing primes.

Once the cooperation and scenario analysis is done, the prototype and functionality of the system would be modified and adapted. Next:

1. Development of the platform and integration with the IT
2. Training
3. Pilot
4. Clinical trial
5. Supervised use

The project will need to count on software and UI developers, health information systems, telecommunications, medicine and geriatrics, cybersecurity and legal experts.

Challenges we run into

As we have mentioned before, telemedicine solutions already existed. Some of them existed individually and were not integrated into a single one, like Geri System. Others, were already on the market but, unfortunately, they didn't see the light until this crisis took place. The main reasons why they are not integrated in the actual system are:

• Legal: absence of an international legal framework to allow health professionals to deliver telehealth services in different jurisdictions and countries; lack of policies that govern patient privacy and confidentiality of vis-a-vis data transfer, storage and sharing between health professionals and jurisdictions; health profesional authentication.
• Interoperability: there are many different health information systems across one single area in one single country. Hence, integrating these platforms with EHC (Electronic Health Record) and calendars in one single way is practically impossible. For that, it is necessary the cooperation of the different sanitary authorities so these platforms can be adapted to their systems. Another solution is to separate the platform from EHC and calendars and introduce appointments and import or export other data manually, a practical and urgent-responsive solution.
• Economic: until now, the optimisation of resources, costs and timing had not been truly noticed and studied. Lack of studies documenting economic benefits and cost-effectiveness of the usage of telemedicine was also a barrier to convince stakeholders to invest in it.
• Culture and ethics: some health professionals and patients are very conservative with their traditions and resist adopting new service models.

Now we have seen the benefits of telemedicine, we can no longer stay passive and join forces to promote the new solutions that technology offers to us.