Best practice for Corona virus emergency: a telemonitoring system in operation in an entire country

luscii-app

The Covid19 emergency was underestimated in its initial phase, especially in many Northern European countries, including the Netherlands. A country with more than 17 million inhabitants that only in the last few days understood that the health emergency situation had to be managed.

Their approach to crisis management is very similar to the British one: they are prepared for the worst but do not bother so much to carry out mass diagnostic campaigns.

Their problem was and remains that of keeping the phenomenon under control and avoiding hospitalization.

As known, the Dutch insurance system is private, and hospitals tend to hospitalize as little as possible. This is on average a good thing under normal conditions, also because the Dutch (and ex-pat residents) have access to a primary care system that is quite well equipped and able to filter out cases that here in Italy would most likely end up in the ER.

This system does not hold up very well in emergency conditions, and this can be seen in spite of the fact that the Dutch seem to be much less worried about it than we were, at least in their first phase (to give you an idea, in the last 24 hours 292 infections have been diagnosed in the Netherlands and 19 victims have been counted).

There was a problem in the last few days: how to effectively monitor the population in a context where, except for last-minute changes, it was decided not to force the hand with respect to the freedom of movement of citizens and campaigns “to stay at home” were not activated.

The problem has found a solution, and this solution is undoubtedly interesting and could also be adopted in contexts where citizens are obliged not to go out.

Mass telemonitoring.

At the moment, the telescreening app (called “Luscii”) is used by 50% of Dutch hospitals and family doctors, who in the Netherlands are paid by health insurers, the same that pay hospitals, and therefore have every interest in shifting spending to primary care, have “strongly” invited their patients to download and use it once a day on a regular basis. There is no public data quantifying how much Dutch people use the app, but it seems to be a few million.

Luscii2

The App requires a series of information from citizens every day: sore throat, nasal congestion, difficulty breathing, cough, body temperature, and returns graphs representing the temporal trend.

The Provider’s central system collects all the information received and a software filters out those that highlight anomalies, which are managed by a contact center for further investigation and possible clinical follow-up.

It seems that in the coming days this App will be brought to all hospitals and promoted by all primary care physicians in order to cover the whole country.

The result, at least after these first few days of the adoption of the solution, seems to be encouraging in terms of less clogging up of the Emergency Room and reduction of improper access to primary care physicians.

The solution is certainly interesting and could easily be dropped (or “copied”) in a reality like the Italian one, with the aim of keeping even healthy subjects under control without increasing the workload of the GPs and hospital facilities.

It also has the advantage of intercepting worrying trends in the state of health of the monitored subjects  (even if today “healthy”) and of activating the emergency very quickly in case of strong suspicion of contagion.

Once again, from the various branches of telemedicine comes a good idea at low cost and high effectiveness.

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