Driving affordability and sustainability improving eHealth

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nurse 527622 640BACKGROUND

Health care systems move from volume to value to ensure that cost reduction or optimization is driven by improvements in clinical and operational quality.

In this process we occur identifying proven and evidence based strategies that demonstrate efficiency , through the removal of waste, harm and variation.

The economic climate , changing demographics, and other pressures facing health care delivery systems combine to make this a major issue. Build equitable and sustainable solutions I.H.I. is developing innovative approach to help organization transition from high volume care to high value care and shift the balance of care from the hospital to the community.

This approach involved:

  • Creating or designing and applying a diagnostic assessment methodology that will help organization through quality improvement with measures and metrics.
  • Identifying the most impactful interventions and methods with a view to scaling up and speeding this approach.
  • Designing , testing and spreading methods to improve quality and reduce costs for people with chronic conditions, including risk prediction, preventive care, reducing readmission and emergency events.
  • Design technology can help to play a technology that be matches the context, the user, and the other stakeholders. When a design is suboptimal (this will be avoided at all costs) it is frustrating, dull, annoying or unremarkable. Bad design is a barrier instead of an enabler which means that it can have a negative influence in the effectiveness of health intervention. If the design does not match its users it might cause them to stop using technology. It usually happens when developers have unclear picture of the users they are designing . Text based interventions as research say attract mostly higly educated people.


Designing different things for different people this is part of the holistic approach in e-health: "life is too short for bad software" .

How we can design a good technology?

These problems are related to efficency, effectiveness, timely delivery of care and safety. Health care provide care cutting across Ethics of genomic medicine, health inequalities, quality improvement and patient empowerment.

In Italy App market in health care are growing up ; as described in the search Research 2 guidance published on the institutional site U.E.
App. to global level they consist of it 165.000 and in Italy 5000. In our country there is a good question of app for the health but there is scarce offer.

They affirm therefore rooted Anglo-Saxon sanitary App in italia for instance runtastic in the sector comfort and mysugar for the diabetes instead that born app and you think for us.

We can distinguish two types of app: app of service and access tied to administrative aspects of the health, these are and gratiutes will stay.

App tied to the phases of care: app cure them or medical that monitor, check or they transform data what they represent physiological parameters of the patient, these differentiate him to them it turns among to:
1) App of utilities and of access tied to administrative aspects of the health; these are and they will stay free
2) Care process: chronic pathologies, alert of emergency calculation of the assimilable, doses of insuline to the medical device
3) Apps for the health that you/they work on the motivation of the patient to the care, contain clinical information, a shared clinical diary with the taking care of one, furnishes information on the interaction among medicines in the first case he comes into the play of the normative one of the medical devices. In the U.S. the food and drug organization has regulated this subject pointing out with clarity what device must be considered medical.

These last ones can help the patient to manage chronic pathologies, the urgencies, the doses of insuline these are assimilable to medical device.
App for the health that you work on the motivation of the patient in self caring. Clinical information, shared clinical diary with the taking care of physician, furnishes an informative on the interaction among medicines, memo, reminder.
in the first case he enters the case of the normative one of the medical devices clinical information, furnishes an informative on the interaction among medicines, memo, reminder.
In U.S. the Food and Drug Administration the F. it has regulated this subject pointing out with clarity what App must be considered medical devices. In Europe it is applied the normative community that asks for different controls for the classes of risk of the application and it is very more urgent as taller it is the in partnership risk to the use. In the second case the code of the consumption is applied only. Some is European you/they have created where portals you/they are built and valued app ehealth to low risk for the health.
Few apps have been certificate as medical device and the impression it is that the producers avoid this situation. These polemics in G.B. have brought to the closing of the portal devoted to the reliability and the safety of the App (http://apps.nhs.uk.)

In a system "universalistic" and publish the apps for health they belong to the sanitary context to some conditions:
a) to guarantee on the clinical contents must to be signed by institutions and scientific society
b) integration in the sanitary (what you/he/she must be able to exchange data with the apps) system.

In the future inside the processes of care to prescribe an App for a pathology or to realize app to hoc competes to resolve the problems of redeemability in the respect of the privacy by design as described in the rule U.E. The app for the record vital parameters as it regards the privacy he/she offers the greatest safety in how much gifted smaller connectivity.
The problems of redeemability in the respect of the privacy by design as described in the rule E.U.. The app for the vital parameters as it regards the privacy he offers the greatest safety in how much gifted. Any U.S. Health Insurance Companies as Kaiser permanent, Veterans Administration or Maccabi they have inserted in the sanitary nets and in the processes of care.


Health information is an important resource for patients to understand and engage in the management of there health conditions we discuss the role of health litheracy and improving patient partecipation and propose future research in this field. The world health organisation has defined H.L. as "The cognitive and social skills witch determine the motivation and ability of individuals to gain access to, understand, and use information in ways wich promote and maintain good health based on this definition , three levels of H.L. have been described; functional, communicative and critical. To still remain gap between conceptual definition of H.L. and its application. Thus empirical evidence of its impact on patient health/illness related behaviour is still limited.
Future research needed to develop measures of H.L. beyond the functional level and that consider the interaction of the individual patient H.L. with the health and social context in which the patient lives reduce anxiety and improving promote well being.


Mobile medical applications. Guidance for Industry and Food and Drug administration staff- September 25,2013/February 9,2015 (U.S.)-
Codice del Consumo aggiornato al 16/09/15 (Italy)
MEDDEV 2.1/6 (E.U.GOV)
Rapid estimate in adult literacy in medicine
Quick screening tool to assist phisicians in identifyng patients with limited readings skillsand estimating patient reading levels this information consent to tailor materials and instructions to patient abilitiens .REALM takes three or five minutes to administer and score. Appears to be a practical instrument to to estimate patient litheracy in before informed consent subscription.
Europe P.M.C.org.
The evaluation of health literacy assessment tool a sistematic review .
B.M.C. Public health
Sibel Vildan Altin-Isabelle Finke, Sibyelle Kautz- Freimuth and Stephany Stock
P.M.C. I.D.: PMC 4289240
HLS-EU Project 2012
Sorensen et A.L.

E-Health Literacy E.Azzali Kindle publishing (2017)

Foto di Miguel Á. Padriñán