Thank you. The point of view of the health care organization using the XER system and
what we developed to enable care of a COPD patient and chronically ill patient using
the XER system and how we think it should be integrated into the regular flow of care
management of elderly people, chronically ill people and homebound people.
Just a few words about our health care organization. We are the second large HMO in Israel. We
are non-profit and mutual. We provide a basket of services and supplementary services. We
supply our services via contracting with the private and outside providers. We have around
2 million people, members, 9,000 employees, 5,000 physicians, 85% of them are private.
We have 700 pharmacies. We are divided to five districts all over the country. We have
a chain of private hospitals, for-profit hospitals, three hospitals, a SUTA, medical centers.
We are computerized for almost 20 years, fully computerized. We work with electronic
health records. All 100% of our doctors work on computers and we have many telemedicine
services including a teleradiology, teleconsultation, telewounds where we take the picture from
the place the patient is to the expert. Why we use telemedicine? First, equality. It gives
a chance for everyone, wherever he is, all over the country, remote or in cities, to
get the same service. We can have online diagnosis and treatment. You can have extension of hours
of treatment. A person can get the treatment whenever he needs it, wherever he needs it.
It's a more reliable diagnosis because when you get it from the remote to the center,
you can use experts, send it, get an expert diagnosis and not just the local doctor that
happens to be on place in the house of the patient. You can consult an expert. It also
enables standardization of service because everyone uses the same services. We can share
the information between health care professionals and also with the patient. The patient becomes
a partner and an active partner in his own care. Of course, it's a more efficient use
of resources. When we talk about chronic disease, we see that in the world today we have a growing
aging population. We have a decrease in number of doctors, experts, professionals, nurses.
There is also a growing expense on treating chronically ill patients. As you can see on
the right, about 20% of patients are chronically ill and it costs to the system about 55% of the
cost of care in health care, which means that we need a solution that will enable us to treat
this patient with a more effective and cost-effective way. The challenge in treating
chronically ill patient is because it's increased the cost. The average visit in a doctor's clinic
today is between five to seven minutes. No doctor can give effective, comprehensive treatment to
these patients in five to seven minutes. There is a variation in quality of treatment. Poor patient
compliance. Patients do not go to doctors. When they go, they don't always do. They don't treat
themselves. Availability and accessibility and quality problems exist in the system. We have a
lot of hospitalization, readmissions, going to the emergency care of these patients, an ineffective
way of delivering the system, and of course shortage of health care professionals. What we propose,
and we will show you how we do it in the XR system, is to combine the primary care with the personalized
telemedicine service and provide an integrative comprehensive care for the frail population. How
we do it. On one side we have the patient with the robot at home that are monitoring personal daily
monitoring data. He has a connection of both the data sent and video conference to the nurse in
the call center. All the data that the nurse sees is data that is based on the EHR of the patient and
the data that's coming from the home of the patient. She's communicating with the patient on one side and
on the other side she has all health care provider. She can refer problems to the doctors, to the
physiotherapist, and this way we create a whole multidisciplinary team that can treat the patient
using the system. The main development of the socially assistive mobile robot helps elderly
people in their daily activity, care and need of disease self-management. We have in the XR system
online diagnosis and treatment plan. We have high quality treatment because all the data is there
and the experts are there. It enables us to motivate the patient and increase his compliance
and address the problems of availability, accessibility and equality of care.
The system is proactive unlike other systems that are reactive. When something happens,
when the patient is hospitalized, then the system reacts. The XR system enables us to monitor the
patient continuously, to alert about things that are emerging, problems that even start before there
is an emergency and also to communicate and have a treatment plan to the patient without any
emergency event. It addresses social needs, all major factors, a major factor in health
and it enables early detection, alert and intervention, recommendation and prevention
of deterioration of the patient. The system is standardized. We have clinical protocols,
I will show you them shortly. Everybody is using the same guidelines, the same system,
using the same information. There is a sharing information among professionals and with the
patient and enables patient empowerment and it is enabled by an advanced technological platform
for disease management. Now the application, the disease management platform that we developed
for the XR system enables us to have alerts. Each patient has his own personalized level of
measurements. One patient can have different limits for blood pressure or pulse than another.
We can enter the personalized data of the patient and the alerts are personalized.
So when something is wrong, when the robot asks the patient to measure the oxygen and something
is wrong, the system alerts. Now there is a communication between the robot and the patient
whether he wants to communicate the system or not. But in any case, the center, the nurse,
in the call center, knows what is the condition of the patient. So if something requires
intervention, it's enabled by the system whether the patient chose to say something is wrong with
him or not. Also there is the task that are not emergency, like the green lights, which are the
treatment plan. These are the proactive things that we want the system to do. It communicates
through the robot to the patient and motivates him to do what he has to do to treat himself.
The nurse can see all the information. You can see the data and she can see what was the condition
of the patient in the last week. Is it one event or is it a trend that is developing? Something is
going wrong with the patient. She can look into the measurements in detail and she has all the
information about the patient. If the patient was hospitalized, if it took more medications,
allergies, his treatment plan, everything is available. She can see it and more than that,
the patient can see it on his side. So he can also know his measurements and how he is.
We can use the system to have questioners for the patient to monitor how he is, not just on
the clinical, what we have is clinical devices. For example, we can monitor
mental status, depression, ADL activities. This can be filled by asking him or by his own
active feeling. This questioner, the scores are sent to the center and used as alerts
in case there is something abnormal. Each patient has a treatment plan and the robot reminds him
when to take his medication, when to do exercise, how to do it and it can be changed according to
his condition. We also implemented clinical protocols that are clinical guidelines. When
something happens, now the robot creates connection between the patient and the center.
The center, the nurse in the center has guidelines, embedded guidelines, what to do.
This is just an example of what to do. She asks questions, she has answers and it tells her what
to do with the patient. This way the treatment is standardized, it's according to the organizational
and clinical guidelines and also, again, if something is wrong, this becomes an alert
for the clinical. To summarize what I have showed you, we have developed here a proactive system
for the patient for the professional care that is available 24-7.
It coordinated and integrated with the community network, it prevents deterioration, it alerts,
it tells the care organization when intervention is needed, it improves the physical and medical
condition of the patient. As Raymond showed, we have highly motivated and very satisfied with
the system and we also enhance this compliance.