Steinbeis experts turn to digital technology and collaboration
Caring for others – as a relative at home or as a professional care worker at a care facility – is strenuous, physically and mentally. It is also becoming increasingly challenging, not only due to current demographic trends and structural changes in society, but also because of growing cost pressures. To manage this complex situation, in 2018 the Ferdinand Steinbeis Institute (FSTI) launched a micro testbed called Nursing and Care in Rural Areas. The aim was to come up with tangible solutions by working together with key stakeholders and experts in the field of nursing and care services.
The architecture and process sequence for notifications issued by patients on medical conditions
Caring for others poses a number of challenges for family members and those around them. It is often an additional burden to everyday life and is stressful, not only mentally but also because of time pressures [1]. This situation is being made worse by the current upheaval in care services fueled by a nursing crisis, the feeling that staff are not generally appreciated, and structural changes. This is happening against a backdrop of demographic developments, which will result in a nationwide rise in people requiring long-term care of 47.4% by 2030 [2], underscoring current and future demand for long-term care and the “care gap.” Nursing staff will also be expected to perform more complex duties in the future, including routine medical tasks [3]. The stakeholders that are affected by these trends in the care sector are senior citizens themselves, their families, caregivers, business and financial policymakers, and ultimately those who contribute to the finances of the social security system [4].
The current pandemic highlights how important it is to improve nursing. The aforementioned challenges will require new solutions, however, especially if we want to avoid overloading the medical infrastructure. This becomes all the more important if one considers the squeeze on costs in the nursing industry and care homes, which often results in providers competing on cost rather than quality [4].
Putting micro testbeds to the test
Digital solutions provide us with a number of new opportunities to solve this problem in the form of technologies and methods being developed and tested at the Ferdinand Steinbeis Institute. Some forms of technology, such as the internet of things, can be used to help people caring for others at home by building a bridge between inpatient hospital care and follow-on care at home. Other solutions also make it easier to access care services through digital technology, support family members providing care, and improve the standards of outpatient care. For this to work, however, a variety of specialist disciplines and different types of stakeholders need to be dovetailed. This is where the methods used by the FSTI with its micro testbeds (MiTb) come in, creating business networks that make it possible to develop digital platforms that deliver benefit on a number of fronts. With an MiTb, the business capabilities of participating companies are pooled with the complementary capabilities of other firms in order to facilitate collaboration based on trust in a space in which all stakeholders feel protected. The aim is to leverage digital solutions in order to develop use cases that deliver benefit. During the execution of the project, use cases are identified for implementation as proof of concepts. These are then used to assess the concept underpinning the business model and work with the other MiTb partners in making it more concrete [5].
The Nursing and Care in Rural Areas MiTb, launched in September 2018, involves five stakeholders working in the field of care and nursing as well as four experts in implementing the identified application scenario. The project kicked off with two workshops to allow the participants and experts to present their goals, discuss challenges, and formulate the specific problems they face, especially given current capabilities. There was then a third workshop in which the team started defining the use case. The participants came up with the following vision of the processes of nursing and care services, which is also being used to derive use cases.
Saving lives thanks to a voice-activated assistant
One of the use cases describes Selma M., an 85-year-old who still lives in a small apartment and is capable of looking after herself without outside help. One day, she slips in the bathroom and injures herself. She can’t move one of her legs and is lying helpless on the floor. What a relief that she has her voice-activated assistant – Calliope. Selma instructs Calliope to call for help. Aside from describing the nature of the emergency, it also sends information about her medical background stored in a health app on Selma’s smartphone. This includes medical authorizations (a patient decree) and information on her blood group, her medical history, details of any previous treatment, and any medicines she is currently taking. It also highlights that Selma is taking an anticoagulant.
The rescue service realizes that her case is urgent and arrives only a short time after the emergency call made by Calliope. A paramedic makes a quick diagnosis – he suspects that Selma has fractured her hip and administers first aid. In parallel to this, he is helped by Calliope to identify if there is a nearby hospital with a free bed and capacity in surgery or intensive care to treat the hip fracture. Within minutes, Calliope has received the required information and recommends that Selma be transported to St. Barbara’s Hospital. When Selma arrives at the hospital, she is already expected because Calliope has forwarded her vital information. There is a surgeon at the hospital and a process has been initiated for a traumatic hip joint replacement. The incident is very difficult for Selma at first, but she makes a good recovery and is soon transferred into post-operational convalescence. Calliope is also kept fully informed by the hospital.
When Selma is discharged from convalescent care, Calliope already knows what happens next and initiates a program: “discharge from the convalescent care home after a hip joint replacement.” The care services already know about the situation when Selma gets home and have the key to the apartment ready for her. By now, Calliope has also informed her doctor and set up the first home visit. A nearby pharmacy ensures she is supplied with the medicine stored on her medication schedule. Naturally, Calliope will also remind Selma to take her medication and do her exercises. Physiotherapy appointments are lined up and orders are sent to a local supermarket to deliver food and drinks. And of course, Calliope will still be there for Selma in case there’s another emergency.
A brave new world?
The information stored by Calliope, data in the health app, plus any information on the hospital, the convalescence home, the family doctor, and the overall healthcare system, is all gathered by the MiTb platform and evaluated alongside data on comparable medical incidents in the area. This allows the Steinbeis experts to acquire information on a macro level, which can not only be shared with patients, but can also be made available to service providers. This information helps optimize processes, ensures quick care can be provided – ideally without error – and helps safeguard the comparative quality of services.
The question that users often have is how Calliope knows what to do. It was programmed by experts at the MiTb and it will always keep users up to date with the latest developments. The system is also underpinned by human “pilots” in the area, who have a detailed understanding of the healthcare system and initially monitor semi-automated processes used by Calliope. Later they allow Calliope to work automatically, meaning they have less and less involvement in routine processes.
This vision of the potential process, which was drafted with the support of the stakeholders involved in the testbed, has been combined with research into typical geriatric processes to come up with a list of requirements for developing a proof of concept. This spans the following use cases:
- Information on the condition of the patient (medication box, patient movements, etc.)
- Medicine deliveries
- Optimized routes for nursing staf
One thing that the use case highlights is that the goal of the MiTb implementation phase is to develop a system platform. This platform will store required data on the patient gathered by sensors in the home. Data is then fed into a patient database and made available for the platform to conduct evaluations. Patients are also provided with a medication box fitted with sensors to determine whether they take the right medicine and whether it needs replenishing. This information is analyzed by algorithms so that it can be decided whether caregivers need notifying or whether more medicines need ordering. Orders can be signed digitally by a doctor.
Medicines can be delivered from a nearby pharmacy by a specialist delivery service. The routes used by delivery drivers can also be optimized by algorithms to ensure they are kept efficient and thus environmentally friendly. This can also help avoid potential emergency deliveries, and improving care in the home even helps minimize supply gaps.
How did it go for the medical experts?
For the two experts with a medical background, Dr. Thomas Heinz (hospital specialist) and Dr. Ralf Hardenberg (expert in internal medicine), the whole idea of micro testbeds took them into completely uncharted territory – it was an adventure, but also an enriching and exciting experience. The entire approach to providing medical care in rural areas needs to be reinvented. “In Lower Saxony, the main issue is that there are insufficient human resources and long distances between different stakeholders. If you don’t dovetail outpatient or pre-admission care structures properly with inpatient and post-release structures, it’s not possible to provide care that is not just patient-centric and individualized, but also cost-efficient,” says Ralf Hardenberg, with conviction.
Calliope should help all stakeholders involved in the process to make it easier for people who require help to “come on board” – patients, their families and friends, and the experts. Information should be gathered and shared without data redundancies so that it “fits like a glove” for those who are looking after others, despite data protection guidelines. But this will not be possible if case management and AI are not used meaningfully.
How did it go for nursing staff?
Three nursing specialists were involved in the testbed project – two gerontologists, Melanie Philip and Philipp Zell, and Michael Wilhelm, who has worked for many years in care homes. “The things we experienced on the MiTb were new for all of us, but they were exciting. We were able to shed light on the support required by the target group – from a variety of angles – and this made it possible to formulate goals accordingly,” says Michael Wilhelm. The Calliope system that emerged from the process will make everyday work safer and easier for everyone involved in the ecosystem. It will be safer because support needs will be recognized by careworkers (more rapidly), and it will become easier because the limited resources available in the healthcare system will be used more efficiently.
Data will be gathered once, made jointly accessible, and fixed processes can be implemented. Until now, a great deal of time had to be invested in getting in touch with all stakeholders, such as after discharge from hospital, and agreeing care plans. Artificial intelligence also offers clear advantages, because it pools experiences made in patient care, logs risks, and makes adaptations for future care services.
Next step: implementation
The MiTb will now move on to implementing the outlined use cases. In doing so, it will be important to merge capabilities and realize value creation scenarios in order to ensure benefit is gained by all parties. To execute the project, a provider of care services and a pharmacy have been chosen to translate the described process in practice. After implementation, it will be important to share experiences again and identify any impact the process has on existing business models – plus any new opportunities that may arise. Because the new system will be introduced to nursing and care homes, it will also be necessary to consider regulatory implications to ensure the system is feasible in practice. Some major challenges are anticipated in this respect. Nonetheless, without the MiTb it would not be possible to capture these issues in detail and highlight the potential offered by such “network solutions.” The MiTb shows that partnerships in networks are key to making the value added by digital solutions more tangible. Also, particularly when it comes to care services, networks are important for tackling public policy factors, demographic issues, and structural challenges. Such projects add transparency to the journey undertaken when identifying solutions. They also make it possible to define detailed methods for the future – and for example they allow you to gauge the impact a solution like Calliope has in plugging the healthcare gap.
MiTb: Nursing and Care in Rural Areas
Participants:
- Dr. Thomas Heinz (specialist clinic)
- Melanie Philip and Philipp Zell (care pioneers) and Michael Wilhelm (care homes)
- Dr. Ralf Hardenberg (specialist in internal medicine)
- Bernd Roder (pharmacy)
Experts:
- Hase & Igel, Jan Schoenmakers (data analysis): Hase & Igel is a consulting firm specialized in big data, processing large volumes of information on human behavior and using AI to spot patterns, assess situations, and make forecasts. The integrated analysis of patient information, prescriptions, and sensors makes it possible for Calliope to understand in detail the condition of people requiring care and identify courses of action that will work for individuals, thus allowing them to be looked after for longer periods at home. It also makes it possible to paint a broader picture of the impact and knock-on effects of different treatment options.
- J4S, Ingo Janssen and Lothar Martens: J4S is providing the edge devices for the project.
- MeinMarktstand, Garvin Hinrichs (delivery): MeinMarktstand is an e-commerce provider of regional, premium-value foods and drinks sourced from sustainable companies. It has kindly agreed to make its logistics concept available for the Calliope project, and this will make it possible to have fresh and long-life food and drinks delivered to the front door, without personal contact. It is currently able to deliver products to any area in the north-west of Germany within 24 hours. Customers can also request specific delivery times to ensure products are received regularly.
- compuGroup (platform): compuGroup is providing a data and service platform for the project.
Contact
Daniel Burkhardt (author)
Research Assistant
Ferdinand-Steinbeis-Institut (FSTI) (Stuttgart)
www.steinbeis-fsti.de