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The COVID-19 pandemic has significantly impacted on the organisation of healthcare systems, accelerating the development and use of telemedicine as a way to mitigate the issue of accessing healthcare services and to avoid interruptions in service provision. Telemedicine solutions are particularly effective in case of remote monitoring (RM) of patients with Heart Failure (HF), especially those with Cardiac Implantable Electronic Devices (CIEDs). TreC Cardiology is a multilayer platform embracing a novel organizational asset to advance telecardiology in the Province of Trento. The initiative has been jointly promoted by the local Healthcare Trust, the Autonomous Province, the Bruno Kessler Foundation and the local competence centre on digital health (TrentinoSalute4.0). TreC Cardiology is conceived with a flexible architecture, allowing the collection and management of heterogeneous data, ranging from Patient-Generated Health Data (PGHD) to CIEDs data. Both the platform and the organizational model have been co-designed with the support of medical staff and patients, in line with a Stepped Care and the eHealth Enhanced Chronic Care Model. The system includes i) an App for patients and ii) a dedicated dashboard for healthcare staff. The App is designed to incorporate medical and lifestyle recommendations, and to record disease and health-related information (PGHD). The medical dashboard is conceived as an easy-to-use console, supporting healthcare staff in managing clinical and non/clinical information collected through different sources, as well as setting up (personalizing) specific triggering patterns to collect specific data through the App. The dashboard also includes a unique console gathering data from CIEDs, allowing combination of PGHD and CIEDs for each patient. The platform has been further developed during COVID-19 pandemic, by adding a tele-visit feature, enabling remote appointments, chat and video calls. At December 2021, 271 patients have been enrolled and monitored adopting the TreC Cardiology model in Trento and Rovereto, the two main Departments of Cardiology in the Province, as part of their standard procedure. This platform has led to significant optimization of in-person outpatient activities, whilst advancing the continuity and quality of the service with remote assessments and remote visits. Additionally, the collection and combination of PGHD and CIEDs is potentially providing the basis for big data modelling (patients' health trajectories), further improving quality and personalization of the service for the patient, as well as shaping organizational asset in line with the expected workload. At national level, different regional healthcare providers have decided to adopt TreC Cardiology as effective tool to promote telemedicine, whilst contributing to the validation of the model across different settings. [ABSTRACT FROM AUTHOR]

Tesino (population 2200) in the Province of Trento (PAT) is part of Italy's National Strategy for "Inner Areas", an innovative policy for development and territorial cohesion in isolated areas, characterized by the distance from the main hospitals and clinics, infrequent clinicians' coverage, and the increase of an aging population with chronic diseases. To counteract marginalization and demographic decline and to meet the health needs of the residents in Tesino, the Autonomous Province of Trento (PAT), with the support of TrentinoSalute4.0, a joint competence centre on digital health of the local Healthcare Trust (APSS), PAT and the research centre Bruno Kessler Foundation (FBK), is developing a new model of a decentralized clinic managed by a community nurse, linking people and clinicians with the support of telemedicine, in a stepped-care strategy. Within this context, the clinic also aims to engage the community and promote the empowerment of the patients in taking an active role in their health self-care. The clinic is currently involved in remotely following up discharged patients from the hospitals and promoting, together with the local governments and main people associations, the use of TreC+, a free digital health platform that allows citizens to manage their clinical profile (currently covering around 30% of PAT population). TreC+ also enables the replacement of some in-person outpatient activities with remote assessments and remote visits. Within this ecosystem, TrentinoSalute4.0 is co-creating with clinicians an organizational model where the nurse-clinic can assist patients, in particular chronic elderly that more frequently need follow ups with the doctors, but have low digital competences, by supporting them during the tele-visits requested by clinicians and potentially measuring and sharing clinical data remotely (es: oxygenation level) using tele-cooperation. TreC+ also enables remote monitoring of patients (i.e. TreC Cardiology for Hearth Failure patients), a tool that the community nurse could use to act as a first step between patients and clinicians. A collaboration between the community nurse-clinic and doctors (i.e. General Practitioners, Pediatricians and Specialist Doctors) needs an organizational change and an integrated digital system such as TreC+ platform, that takes into account the different professional roles and the specific needs of the region. The community-clinic in Tesino is the first of several that are being planned to open in the region, and can also serve as a reference model for the new decentralized community health clinics that will probably be implemented elsewhere in the foreseen future. [ABSTRACT FROM AUTHOR]