1. Piemonte healthcare initiatives: role of ICT and
possible sustainable actions
Antonio Sciarappa
(ISMB-Istituto Superiore Mario Boella)
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2. Contents
• Needs and trends for Europe Health SystemsGeneral e-Health needs
• Challanges for Piemonte Healthcare
• Projects
– Chronic diseases
• Home care solution
• Tele-rehabilitation solution (classification and tracking of the movements) for
– Post Trauma Rehabilitation
– Parkinson disease
– Predictive Medicine
• Lifestyle (risk factors: diet, movement, stress)
• Biomarker investigation (hardware and software genoma analysis)
– Assistive Technologies
• Monitoring of aged people
• Robot service
• Alzheimer disease monitoring
• General sustainable architecture
• eHealth for sustainability
– eHealth: efficiency & productivity
– eHealth: from ‘hospital-based’ to ‘patient-centred’ care”
– eHealth: from "late disease" to "early health"
• Market impact
– Living Labs goals
– Pre-Commercial Procurement

3. Needs and Trends for Europe Health Systems
Pressure on healthcare systems:
– Citizens’ expectations for high-quality care
– Demographic changes
– Increased prevalence of chronic diseases
– Increased mobility of citizens and patients
– Staff shortages, unequal territorial distribution
– Reactive model of healthcare delivery
– Rising healthcare costs
How to offer high quality services ?
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4. Challenges for Piemonte Health Care
• Increase in regional citizens expectations;
• Reduction of public health care expenditure;
• Patient mobility: tourists, immigrants and long term resitents;
• Lack of health professionals (mainly nurses….);
• Reduce hospitalisation and improve disease management (ageing
population)
• Increase links and interaction between patients and health professionals,
facilitating more active participation of patients in care processes
• Improvement of quality of life for patients suffering form chronic conditions
• Provide a convincing business case to be presented to National, Regional
and Local Health Authorities and to stimulate them to speed up the
deployment of patient-centered eHealth service solution
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5. Piemonte vision : ICT to support a paradigm shift
From ‘curative care’ to ‘preventive care’
From ‘hospital-based’ to ‘patient-centred’
By using ICT to enable collaborative, personalised care  empowering
By aiming at sustainability of healthcare systems  reengineering
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6. Projects
– Chronic diseases
• Home care solution (PHS 4*4)
• Tele-rehabilitation solution (classification and tracking of the movements)
for
– Post Trauma Rehabilitation (Clabs Salute)
– Parkinson disease
– Predictive Medicine
• Lifestyle (risk factors: diet, movement, stress)
• Biomarker investigation (hardware and software genoma analysis)
– Assistive Technologies
• Monitoring of aged people (DREAM)
• Robot service (KSERA)
• Alzheimer disease monitoring (Clabs Salute)
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7. ISMB PHS 4*4 monitoring solution (I)
…at home
Web
Service center
Personal Health Systems (PHS) assist in the provision of continuous, quality
controlled, and personalised health services to empowered individuals
regardless of location. It consist of:
• Diseases monitoring (audio, video ,data, usable interface..)
• Telediagnosis
• IoT platform
• Intelligent processing of the acquired information
• Active feedback based on such new insights, either from health professionals or
directly from the devices to the individuals

8. ISMB PHS telerehabilitation – Solution (II)
Solution based on:
• Zigbee / Bluetooth Low Energy
Sensors
 3 axis accelerometer
 3 axis gyroscope
 sensor for monitoring muscle
activity
• Gateway:
 COTS smartphone
• Movement analysis (walking…)
• Remote monitoring
• Bio feedback
sitting walking standing lying
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9. Predictive Medicine: Point of Care (running project)
• Predictive medicine offers the possibility of Hospital platform
detecting many common diseases that have a
genetic basis.
• Advances in genomics and molecular biology
reveal a large number of possible new, genome-
related, molecular markers for the presence of
disease, susceptibility o disease, or differential
response to treatment.
• These markers support new genomics-based
diagnostic tests for identifying and/or confirming
PoC Lab on chip
disease, assessing an individual’s risk of disease,
identifying patients who will benefit from
particular interventions. Fornitura patient premises
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10. mobile Lifestyle solution (running project)
Majority of the health risks and diseases in the
modern world are related to lifestyles, e.g.,
overweight, unhealthy diet, physical inactivity, sleep
deprivation, and stress.
The project considers three main risk factors such as:
– Obesity; The primary cause of obesity is an
energy intake consistently greater than the
energy used in everyday life.
– Stress is a state of anxiety, frustration and
other unpleasant feelings caused by an
individual’s response to a specific situation
– Inactivity; regular exercise assists in
controlling other risk factors such as blood
pressure, obesity, and stress.
Goal: to generate an aggregate indicator of daily
lifestyle
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11. Safety indoor-outdoor monitoring (aged people)
Personal parameters  skin temperature, heart beat rate,
mobility
Environmental parameters  temperature, light
System parameters  removal from wrist, fault,
radio coverage, battery level
Emergency Button
Indoor base station
Service Center indoor-outdoor solution

12. KSERA: service robot for ageing people
KSERA
GOAL
To develop a Knowledgeable Service Robot for Aging (KSERA)
that will serve several related purposes for elderly people in general
and those with pulmonary disease in particular.
Specifically KSERA provides
• a mobile assistant to follow and monitor the health and behavior
of a senior,
• useful communication (video, internet) services including
needed alerts to caregivers and emergency personnel,
• a robot integrated with smart household technology to monitor the
environment and advise the senior or caregivers of anomalous or
dangerous situations.
KSERA aims at an adaptive technical aid that will provide needed
and useful services in a pleasant, easy‐to‐use format via a robot that
also acts as a companion and assistant

13. Alzheimer - Dementia diseases
Prototyped solutions for “ Wandering” and “at home” monitoring
Goal:
To favour the stay at home and monitoring of people
suffering from severe forms of Dementia and Alzheimer’s
disease, thanks to mobile internet services
“SONO QUI ”: ("Here, I am")
Personal Localization Web Based System: Place
identification by GoogleMaps website
interface based on “ parents images”
Exit Detection: Enabling this functionality, when
the patient goes out from the house, (acoustic
Buzzer Alarm or SMS to caregivers.)
05/03/2013 ISMB – Copyright 2013 13

14. GENERAL ARCHITECTURE
• Model to support concretely sustainability
• Overcoming fragmentation, modular solution, based on Future
Internet services
• Cooperation with patient organisations, hospitals, academia
• Cooperation with SME, Large industries
Control Unit Personal/home
Gateway
Internet of
Things
Middleware
IoT server Zigbee,
bluetooth (BLE)
Near Real time data communication Other Applications: Biodiagnosis,
Dementia diseases
Publish/subscribe paradigm
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15. eHealth: from ‘hospital-based’ to ‘patient-centred’ care
Improving quality of healthcare through more personalised,
continuous, efficient and responsive services.
– Improving access to healthcare for patients living in underserved areas,
and to a lesser extent, for socio-economically disadvantaged patients.
– Higher involvement of patients in the disease management process and
hence more awareness of the importance to adhere.
– Helping patients and health professionals stay more regularly in touch,
which is a fundamental condition for maintaining trust.
– Improving quality of healthcare through more personalised, continuous,
efficient and responsive services.
– Improving access to healthcare for patients living in underserved areas,
and to a lesser extent, for socio-economically disadvantaged patients.
– Fostering patient adherence because of the higher involvement of
patients in the disease management process and hence more
awareness of the importance to adhere.
– Helping patients and health professionals stay more regularly in touch,
which is a fundamental condition for maintaining trust.
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16. eHealth: from "late disease" to "early health"
Factors determining a health status of an individual & population:
ICT has shown impact on sustainability but this impact needs to scale:
– patients need to take more active role in health & care and use ICT in their
health/wellness management (changing consumer behavior pattern)
– stronger focus but health delivery system on prevention and early diagnosis
Solutions presented are direct to support new options dor diseases
management in terms of:
– Quality/efficacy of healthcare services (improve home services, support for
informal and volunteers caregivers )
– Management of Lifestyle
– Physical and social environment (for ageing population)
– Genetic profile and monitoring genetic changes
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17. eHealth: Living Labs and Pre Commercial Procurement (I)
“Innovation tools and market in the public sector”
• two additional instruments have been recently added to in support to RDI
(Research, Development and innovation) : Living Labs and Pre-
Commercial Procurement (PCP).
• Their common trait is the ambition to improve the traditional RDI process
that moves
– from the laboratory to the prototyping phase,
– from the testing phase to product or service engineering
Definition of Living Lab
the Living Lab approach refers to a set of (quantitative and qualitative)
methodologies and tools for the co-creation and validation of innovation
together with (and by) the end users in real-world environments.
Compared to traditional testbeds, where users are not necessarily involved and
the laboratory setting is controlled, Living Labs place
people at the centre of the innovation process
Living Lab may represent a valid instrument to support territorial development
policies. 17

18. eHealth: Living Labs and Pre Commercial Procurement (II)
Definition of Pre-Commercial Procurement (PCP):
PCP is a special tendering instrument that is only accessible to public administration and
that derogates (attenuates) the most binding provisions of the general procurement law,
by virtue of the following characteristics:
– PCP is restricted to RDI services, i.e. not usable to purchase goods or
services that are already commercialised as is. Eligible activities can range,
just to make a few examples, from problem-driven research to the design of
viable solutions and applications, from development and/or refinement of
prototypes to the installation of a limited number of them in the form of test
series, etc.;
– PCP must award a plurality of bidders, as its aim is not of purchasing the
single ‘best solution’ to a given problem, but promoting collaborative RDI to solve
specific needs of the procuring organisation, and consequently testing the validity
of alternative prototypes in accordance with some predefined requirements and
quality standards;
– PCP has to share RDI risks and benefits between each bidder and the
procurer. This means that the public purchaser will pay a lower amount than the
market price for the RDI services, the results of which, however will not be
restricted to its exclusive usage (exploitation), as it happens in conventional calls
for tender. Conversely, the bidding enterprise will be part financed in its effort to
develop and validate new and innovative solutions, but in case these become
successful, the resulting IPR will have to be shared with the procuring agency
itself;
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19. eHealth: Living Labs and Pre Commercial Procurement (III)
• PCP is a special tendering instrument that is only accessible to public administration
for procurement actions.
• It follows a staged operational procedure, designed to gradually lead the public
purchaser to select the most appropriate pre-commercial solutions. This can be
approximately described as follows:
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20. Thank you for your kind attention!
sciarappa@ismb.it
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