Dispatching and Management Center for Optimizing Home Care

Integrated Services

Virginia Săndulescu

, Sorin Pușcoci

, Monica Petre

, Sorin Soviany

Mirabela Chirvașă

and Alexandru Gîrlea

National Communications Studies and Research Institute (INSCC Bucharest), Bucharest, Romania

QuickWeb Info, Romania

Keywords: Home Care, Home Care Services Provider, Integrated Services, Teleassistance, Assisted Living.

Abstract: The paper summarizes the design specifications for a complex ICT platform for optimizing home care

integrated services. It is based on the work involved in implementing the project with the same title –

“Dispatching and Management Center for Optimizing Home Care Integrated Services”. The project aims to

create a network of centers that offer services to home care service providers (HCPs). The centers in the

network should optimize the activity of the home care service providers and support them in offering quality

standardized services through the usage of a complex platform that optimizes most of the activities involved

in offering home care services. The proposed system does not focus on the home care system, but

concentrates on the software and hardware components that will allow a home care services provider to

perform in a very efficient way. It may be compared to an ERP (Enterprise Resource Planning) system

customized and dedicated to HCPs. As far as we know, there is no such system implementation currently on

the market. The main beneficiaries are the home care service providers along with their end-users (elders,

chronic patients or people who need ambulatory treatment), who will ultimately receive better services.

1 INTRODUCTION

Population aging is a growing problem that needs to

be addressed. The 2018 Ageing Report (European

Commission, 2018) shows projections of age-related

expenditure on the basis of a new population

projection by Eurostat. The report shows that the

category of people aged 65 and over will become a

much larger share, rising from 19% (2016) to 29%

(2070) of the population, those age 80 and over will

also become more numerous rising from 5% (2016)

to 13% (2070). This is projected to happen while the

active share of the population will become

substantially smaller, declining from 65% (2016) to

56% (2070). The old-age dependency ratio (people

aged 65 and above relative to those aged 15-64) in

the EU is projected to increase by 21.6 pps., from

29.6% in 2016 to 51.2% in 2070. The EU would go

from having 3.3 working-age people for every

person aged over 65 years to only two working-age

persons. Most of this increase is being driven by the

very old-age dependency ratio (people aged 85 and

above relative to those aged 15-64) which is rising

by 14 pps (8.3% to 22.3%). This leads to new

challenges in providing assistance for aging people

in maintaining an independent living, preferably at

home. Solutions are sought in using ICT support for

delivering care services at home to those that need it

(due to age/ non-age-related problems).

Offering medical and social care services at

home may be accomplished by the means of an

integrated home care system aimed towards people

with a high dependency degree or with low mobility

for maintaining their autonomy and increasing their

quality of life.

Home care services should be available and

affordable for all the elderly and contribute to their

wellbeing, in their living environment. The purpose

of these services is to allow the main beneficiaries to

live in their own homes as independent as possible,

while maintaining their safety and enjoying social

activities. The elderly should be able to choose the

timing and the types of support services they wish to

receive.

In the presented context, the paper describes the

work involved in implementing the project with the

same title – “Dispatching and Management Center

for Optimizing Home Care Integrated Services”. The

project aims to create multiple partnerships for

knowledge transfer in order to develop the ICT

andulescu, V., Pus

coci, S., Petre, M., Soviany, S., Chirvas

a, M. and Gîrlea, A.

Dispatching and Management Center for Optimizing Home Care Integrated Services.

DOI: 10.5220/0007743902550261

In Proceedings of the 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2019), pages 255-261

ISBN: 978-989-758-368-1

255

support necessary for the implementation of multiple

Dispatching and Management Centers for

optimizing home care integrated Services (referred

to as CDMS), as a support for offering medical and

social services at home. A CDMS is designed to be a

platform operated by a service provider for multiple

Home Care Providers (HCP).

HCPs represent a field of activity with an

increasing demand in the current years in Romania

and also in Europe. Considering the increasing

number of old people in Romania and the fact that

the medical system struggles to handle the long-term

hospitalization of people suffering from chronic

affections, the role of home care services providers

increases. HCPs may offer social and/ or medical

services. Offering medical and social services at

home can be optimized by using a support platform

based on ICT integrated in a CDMS.

A CDMS may bring significant improvements in

the management of technical, human and economic

resources of an HCP as the project aims to solve the

technical and organizational matters involved in the

development and implementation of HCPs.

The project proposes a platform that facilitates

and optimizes the integrated (medical and social)

services offered by home care providers. Figure 1

shows a quick overview of the proposed services to

be offered by HCPs through the usage of a CDMS

platform, ranging from medical/ palliative care,

daily basic services (like toileting, aid in preparing

and consuming food, etc.), services for independent

living (e.g. shopping, cleaning, bill payment, etc.),

home adaptation to specific needs that the user may

have (accessibility adaptations for low mobility or

for different impairments), socialization services.

The paper describes the design specifications of

the CDMS platform, as developed by the project’s

team, which comprises engineers, as well as medical

personnel, after multiple research meetings with

direct beneficiaries (representatives of three HCPs).

A market study related to the HCPs in Romania

paved the way for the funding application for the

current project, and the first results of the project

comprised a number of studies concerning the

possibilities of improving the functioning of an

HCP.

There are multiple already-on-the-market

platforms or research implementations for home care

ICT solutions: software and/ or hardware platforms.

In the traditional approach, these platforms usually

only implement layer 3 – the “smart home”

consisting of the components installed at the

monitored subject’s home and, possibly a

supervising level that gathers data acquired from

multiple home care systems and manages different

situations. The proposed system does not focus on

the 3

layer, or on the home care system, but

concentrates on the 1

layer of figure 2 – the

software and hardware components that allow an

HCP to offer home care services in a very efficient

way. It may be compared to an ERP (Enterprise

Resource Planning) system customized and

dedicated to HCPs. As far as we know, there is no

such system implementation currently on the market.

2 GENERAL DESCRIPTION OF

THE PROPOSED PLATFORM

A CDMS is an entity that offers services to an HCP,

in order to optimize and simplify the delivery of care

services at home, by offering technical support at

hardware and software level. A CDMS is designed

to offer software modules that allow for an easier

management/ deployment of different home care

services and to minimize the required hardware so

that an HCP can optimize most of its operation.

The services offered by an HCP are grouped in

three categories:

- Medical Services: comprising all the health care

delivered at home – aid in following prescribed

medication, monitoring physiological parameters,

palliative care, aid in performing recommended

physical exercises, etc.;

- Social Services: various services for assistance

with the daily activities or for maintaining an

independent living like dressing, help in feeding or

Figure 1: Medical andocial services at home.

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Figure 2: General architecture of the CDMS platform.

doing the hygiene activities, shopping, house

cleaning, etc.;

- Socio-medical Services: mixt services from the

above categories.

An HCP may choose to deliver one or more of

these types of services and a CDMS will offer

personalized services to an HCP, as per request. A

CDMS is designed to offer the following support

services to an HCP:

- Human Resources Management: management

of the employees delivering home care services and

of the employees performing administrative/

managerial tasks: management of the employees list,

management of the home care services delivered by

each home carer, the patients list and the work

schedule assigned to each home carer, etc.

- Patients Management: managing the data for

every patient – identification data, medical data, data

about the assigned caregivers, of the desired/

received services, cost data, etc.;

- Inventory Management: managing the

inventory of products used in home care services:

automatic/ manual inventory management, creating

alerts when inventory reaches specific thresholds,

generating reports about used inventory, etc.;

- Dispatching Services: Two types of dispatchers

are envisaged: the management dispatcher offering

technical support for each HCP – this level manages

the health status of the hardware equipment used,

maintaining logs regarding the functioning of all the

components of the system; the teleassistance/

telemonitoring dispatcher: This component offers

the possibility for each HCP to organize its own

telemonitoring dispatcher with minimum investment

and has the main purpose of monitoring the data

acquired from the teleassistance/ telemonitoring

systems supervised by each HCP;

- Reporting Services: This component will

support each HCP in generating reports, statistics on

different activities, costs, information regarding

personnel, etc.

- Remote Monitoring/ Assistance Services: This

component will allow an HCP to offer the following

services: physiological parameters monitoring; the

detection and management of dangerous/ abnormal

situations at home.

3 GENERAL ARCHITECTURE

OF THE CDMS PLATFORM

The proposed platform has a layered architecture as

provided in figure 2:

 layer 1: the actual dispatching and management

center;

This layer consists mainly of web applications to

be accessed by the employees and the clients of the

health care providers and the needed hardware

equipment to run these applications: server

equipment.

A dispatching and management center is

designed to provide services to multiple home care

providers.

 layer 2: the hardware and software components

that each home care provider must use at their main

location;

As the purpose of this entire platform is to ease

the burden on the home care providers, at this level

there are very few requirements. The personnel of

the home care providers only need to use terminals

to access the web apps running at the higher level.

These terminals don't need powerful specifications

(neither concerning computing power nor storage),

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257

as they can be implemented using any type of

terminal with Internet connectivity capable of

running a modern browser.

Two mobile applications are also implemented at

this level:

- a mobile app for managing the supplies used in

home care activities;

- a mobile app for aiding the nursing staff during

field visits at the patients’ homes.

 layer 3: the hardware and software components

required in each patient's home.

Each patient and his informal caregivers

(relatives, close friends, etc.) may access a web

portal using an Internet-enabled terminal. The

patients may also use a dedicated mobile app that

offers information about the services they are

receiving and allows them to make requests.

Also at this level, devices for remote monitoring

and assistance may be deployed: medicine

reminders, medicine dispensers, physiological and

environmental sensors for activity recognition and

for health status assessment, panic buttons, etc.

4 SOFTWARE ARCHITECTURE

OF THE CDMS PLATFORM

The software components of the platform are

presented in figure 3.

The main components are the web applications

running at the CDMS center as most of the

functionalities offered to HCPs are implemented as

web applications. The management dispatcher is

also running at the server level.

4.1 The Management Dispatcher

The management dispatcher offers technical support

for the HCPs that it serves. It may be accessed by

HCPs through a web portal.

All hardware is monitored and the resulting logs

(information on health status of/ errors raised by each

component of the system, etc.) are kept at this level.

4.2 HCPs Containers

Each HCP will access the CDMS servers only

through the web apps. Each HCP has a dedicated

software container that runs the required web apps

and keeps the related database up to date.

This design approach (each HCP may only access

its own container on the server) has multiple benefits:

it allows for the implementation of a strong security

policy and it also allows for a modular

implementation. A new HCP that joins the platform

only needs a new container. Also, this approach

allows for a clear delimitation between the data of

Figure 3: Software components of the CDMS platform.

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each HCP client, so there is no concern about unfair

competition. Each database may only be accessed

through the web apps from the same container.

The web apps available for every HCP are

described in the following paragraphs.

4.2.1 Web Portal for HCP (Administrative

Portal)

The administrative web portal for HCPs is designed

to offer the following functionalities:

 Employees Management

This functionality allows the HCP to manage

the human resource, to schedule field visits for the

nursing staff and offers a centralized view of the

activities performed by each employee. It allows the

following activities:

- manage employees list;

- schedule activities for the nursing staff

(schedule the home visits);

- automatically estimate work hours performed

by each of the nursing staff and the associated

monetary retribution;

- generate reports regarding the field activity of

the nursing staff.

 Clients Management

This section allows an HCP to access and

organize the medical files of their clients and the

field visits required/ requested for/ by their clients.

This module must allow the HCP to:

- manage clients information:

- manage the general and medical

information of the clients

- manage the information of their clients

informal caregivers

- manage requests/ feedback from clients

- generate reports on the provided services to a

client/ group of clients

- send messages to clients (response to feedback/

additional requirements form or informing

clients on news like: schedule changes, nurse

change, etc.).

 Inventory Management

The inventory management component is

designed as an integrated system for managing the

supplies needed for the home care activities. This

module must allow HCPs’ employees to:

- manage the supply records for different

products (syringes, band aids, etc.)

- generate alerts (manual alerts - generated by

employees or automated alerts - system

generated) when supply levels reach certain

predetermined values.

- generate reports concerning the current levels of

supplies, used materials in certain time

intervals, for certain procedures or different

custom reports.

- generate predictions/ estimations concerning the

required supplied levels for certain time

intervals/ procedures, etc.

 HCP Management

This module allows the HCP to:

- manage the offer of services: create subscription

methods, create packages of services, etc.

- create reports concerning the functioning and

the information collected by any of the modules

presented above.

4.2.2 Web Portal for the Nursing Staff

The main purpose of this web portal is to offer the

nursing staff support during their field visits.

The main support for a nurse will be the mobile

app installed on a mobile device that is required

during field visits. The web portal doubles some of

the functionalities offered through the mobile app.

4.2.3 Web Portal for Doctors

The web portal for doctors is an application used for

the management of the patients’ medical charts.

In order to access the applications the doctor has

to be authorized by the HCP or by the client/ patient.

Authorized medics may:

- view the medical history of the patient;

- view the performed/ scheduled procedures;

- view the prescribed/ followed medication;

- view the recorded physiological data along with

context information;

- recommend medical procedures or medication;

- recommend a visit to/ from a doctor.

4.2.4 Web Portal for Clients

The web portal for clients (patients and their

informal caregivers) is designed to offer the

following functionalities:

 display complete medical file;

 view the data collected in the system;

 manage the services offered by the HCP: the

client may opt for additional services (on top of

the services recommended by a medic or the

services included in his home care package);

 manage doctors: the client may allow a doctor

to access his personal file;

 manage list of informal caregivers (users

interested in the wellbeing of the patient like

relatives, close friends, etc.) and their access to

the clients medical file;

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 manage general information about his account;

 initiate communications with employees of the

HCP/ send feedback to HCP.

4.2.5 Remote Monitoring/ Assistance

Dispatcher

The remote monitoring/ assistance dispatcher is an

optional module, as, for the moment, not many

HCPs offer remote monitoring/ assistance services.

The designed functionalities for this module are:

 Management of data from remote monitoring

devices;

 Management of medical alarms (e.g. when a

value of a certain physiological parameter is

outside predefined normal values, usage of a

panic button, etc.);

 Management of alarms from home environment

monitoring devices;

 Management of technical alarms (e.g. a remote

device stopped communicating, a device sends

corrupted data, etc.)

4.3 Supply Management Software

(Installed at a HCP)

The supply management software installed at an

HCP is designed as a mobile application for

smartphones/ tablets that will allow users (HCP

employees) to record supplies in their own database

in an easy manner, by scanning the bar codes from

the products using the camera integrated in the

mobile device. The bar code identification number

may also be manually inputted using the mobile app

or directly in the web portal for HCP management.

4.4 Mobile Apps for the Nursing Staff

Each of the nurses performing home visits will use a

mobile device (smartphone/ tablet) with an Android

app installed that gives assistance in performing the

activities during visits.

By using the mobile application, the nursing

staff can remotely access, during visits, certain

information related to visited clients (contact

information, requested procedures to be performed,

etc.)

The functionalities of this app are related to:

 management of assigned clients:

- access clients general information (name,

contact information);

- access clients medical information;

- send messages to clients (responses to feedback/

additional requirements or send messages like

changes in schedule).

 Management of the scheduled appointments

- access the list of procedures requested by /

recommended for the clients;

- record information on each performed

procedure: type of activity, date and hour,

additional observations, supplies used;

 Management of the remote monitoring/

assistance devices deployed in the homes of the

visited clients:

- program the devices with certain parameters,

like: the schedule for taking medications, the

schedule for monitoring physical parameters,

alarm levels, etc.

- collect information for the devices (read

measurements performed by the devices and

send them for storage to a superior level of the

platform).

4.5 Software for Remote

Monitoring/ Assistance for Clients

The software installed in the homes of the clients

will communicate with the remote monitoring

component from the CDMS server.

The designed functionalities are:

 monitoring vital/ different health parameters at

predefined time intervals or continuously;

 detect dangerous situations/ events, signal them

and trigger the procedures for effectively

manage the alarms;

 remote communication functionalities: send

acquired measurements to the CDMS server for

logging;

 monitor health status of hardware components

and log hardware and software functioning

parameters and anomalies.

5 CONCLUSIONS

The presented platform offers multiple benefits for

an HCP:

 simplify the starting procedures in becoming an

HCP by:

- minimizing the necessary hardware and

offering a list of minimal equipment needed

along with their technical specifications;

- supporting the HCP in offering complex

services: medical, social services and

teleassistance/ telemedicine services;

 simplify the running procedures of an HCP by:

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- optimizing the administrative management

activities;

- optimizing the home care activities of the

nursing staff;

- optimizing the communication processes

between the administrative staff, medical and

nursing staff and clients.

The end beneficiaries of the project are the end-

users: elders, chronic patients or people who need

ambulatory treatment who may get a variety of

services from an HCP. As the activity of an HCP is

optimized it is expected that the prices for services

for the end-users to be minimized while maintaining

or increasing the quality of service.

The development of the presented platform is a

work in progress, as the related project will end in

September 2020. In the current development phase,

the implementation of the proposed platform, based

on the presented specification is ongoing, having

already reached the phase of experimental platform.

In the next phase, the experimental platform will be

used to implement a pilot CDMS that will connect a

number of HCPs, each with its own clients. The

experimental results of the platform will be

presented in following papers.

ACKNOWLEDGEMENTS

This work was partially funded from the European

Development Fund through the Operational

Programme Competitiveness 2014-2020, project no.

P_40_251, Dispatching and Management Center for

Optimizing Home Care Integrated Services.

REFERENCES

European Commission, 2018. The 2018 Ageing report –

Economic and Budgetary Projections for the EU

Member States (2016-2070)

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