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BackgroundItaly was the first country to largely experience the COVID-19 epidemic among other Western countries during the so-called first wave of the COVID-19 pandemic. Proper management of an increasing number of home-quarantined individuals created a significant challenge for health care authorities and professionals. This was especially true when considering the importance of remote surveillance to detect signs of disease progression and consequently regulate access to hospitals and intensive care units on a priority basis. ObjectiveIn this paper, we report on an initiative promoted to cope with the first wave of the COVID-19 epidemic in the Spring/Summer of 2020, in the Autonomous Province of Trento, Italy. A purposefully built app named TreCovid19 was designed to provide dedicated health care staff with a ready-to-use tool for remotely monitoring patients with progressive symptoms of COVID-19, who were home-quarantined during the first wave of the epidemic, and to focus on those patients who, based on their self-reported clinical data, required a quick response from health care professionals. MethodsTreCovid19 was rapidly developed to facilitate the monitoring of a selected number of home-quarantined patients with COVID-19 during the very first epidemic wave. The app was built on top of an existing eHealth platform, already in use by the local health authority to provide home care, with the following functionalities: (1) to securely collect and link demographic and clinical information related to the patients and (2) to provide a two-way communication between a multidisciplinary health care team and home-quarantined patients. The system supported patients to self-assess their condition and update the multidisciplinary team on their health status. The system was used between March and June 2020 in the province of Trento. ResultsA dedicated multidisciplinary group of health care professionals adopted the platform over a period of approximately 3 months (from March-end to June 2020) to monitor a total of 170 patients with confirmed COVID-19 during home quarantine. All patients used the system until the end of the initiative. The TreCovid19 system has provided useful insights of possible viability and impact of a technological–organizational asset to manage a potentially critical workload for the health care staff involved in the periodic monitoring of a relevant number of quarantined patients, notwithstanding its limitations given the rapid implementation of the whole initiative. ConclusionsThe technological and organizational model adopted in response to the COVID-19 pandemic was developed and finalized in a relatively short period during the initial few weeks of the epidemic. The system successfully supported the health care staff involved in the periodic monitoring of an increasing number of home-quarantined patients and provided valuable data in terms of disease surveillance.

BackgroundOver the past few years, the development of technologies supporting active aging has been increasing. Among the activities that promote physical exercise by using technologies is geocaching—a treasure hunt of sorts in which participants use a receiver GPS to hide or find real or virtual objects. Although this activity is particularly suited to the promotion of healthy lifestyles in older people, geocaching remains to be unexplored in this area. ObjectiveThis study aimed to investigate the effectiveness of activities combining geocaching and self-tracking technologies to promote active aging, evaluate the usability of technologies, and explore the ways in which technologies have been integrated in the organizational context under examination to determine the user experience of participants. MethodsA group of individuals aged 65 years and older (N=14) attending a senior center managed by a social cooperative was involved in the study. Some of them created the geocaching contents, and others, split into 2 teams, participated in the game. Each participant was given a pedometer bracelet and the geocaching app. The steps taken by individual participants along with the number of caches found by each group translated into team scores. ResultsThe main results of the study were as follows: (1) activities in favor of active aging that involve the use of new technologies can foster the participation of elderly people; in particular, adding gamification to self-tracking can be a valid strategy to promote physical exercise among the elderly; (2) for this to happen, involvement of older people firsthand is crucial, and there must be a focus on their active involvement and empowerment in every phase of the project; and (3) the mediation of conflicts and competition that arise from the gamification could only take place because of the strong support of the organization in the form of social workers. ConclusionsThe results show that promoting active aging through technologies requires more effort than simply using these tools; it requires a wider process that involves an articulated organizational network with heterogeneous actors, technologies, and relations.

In the outbreak of Covid-19, healthcare systems needed to reinvent the provision of good care to outpatients. The doctor-patient's relationship, even if at a distance, has been established to be a strikingly important factor to both monitor patient's clinical conditions and to provide reassurance avoiding sense of abandonment. Digital innovation opened up to new solutions and possibilities that haven't being considered before, particularly in the heavily test-based-evaluation field of ophthalmology. In this scarcely explored field, the role and cooperation of patients became central and essential. Patients need to become active actors in the management of their own health, teaming up with clinicians throughout a process of empowerment. A digital teleophthalmology platform, TreC-Ophthalmology, has been designed and created by a multidisciplinary team including actors from the local Healthcare Trust, the Autonomous Province of Trento, the Bruno Kessler Foundation and the competence center on digital health (TrentinoSalute4.0). The digital system, which is prescribed and activated directly by the clinician, allows the direct involvement of patients, autonomously collecting and safely providing information to the clinician allowing a better remote evaluation of patient's sight. Several self-administer tests have been selected and loaded on the platform, tutorials have been created and training sessions have been performed. Throughout the platform, patients and clinicians have had the chance to communicate, either asynchronously and real-time, via an encrypted chat and a video-meeting channel. Feedback both from patients and clinicians were collected at the end of a testing phase showing an overall appreciation for the system and the remote interaction from both sides. Participants feedback allowed also to plan ameliorations and new development of the platform (e.g. telecooperation setting, devices integration, etc.), supporting new protocols and work organization. 92 patients have had the possibility to use this service so far. Particularly during the extraordinary containment measures imposed at a national level, TreC-Ophthalmology allowed the remote communication between patients and healthcare professionals in a proactive way while preventing the spread of the virus. This experience represents a successful attempt towards the innovation of the health care system, supported by digital solutions and the active involvement of its actors, such as patients and clinicians. Thanks to the novelty of the protocol and the characteristics of the platform, which is created by public stakeholders for the local public healthcare, other regional healthcare providers have decided to start using TreC-Ophthalmology platform, validating its efficiency. [ABSTRACT FROM AUTHOR]

TrentinoSalute4.0 (TS4.0) is the recently created "Competence Center on Digital Health" after approval from the Trentino Provincial Council as a policy instrument to coordinate the work on digital health in the region. TS4.0 represents the meeting point between the health system, research and the territory, becoming the instrument of cohesion between the guidelines of health planning, the innovation needs expressed by the Provincial Health Service and the opportunities offered by research and new digital technologies [1]. The TS4.0 initiative responds to the need to fill the gap between planning, research and actual implementation of innovative solutions on digital healthcare to support the local Healthcare Trust while empowering Citizens for better management of their own health in Trentino Region in a sustainable way. The Center active from 2017 responds to the objectives set by policy makers and local, national and European health planning, starting from the needs expressed by health professionals and citizens, identifying new organizational models and technological solutions, studying the legal aspects and evaluating their socio-organizational and economic impact of digital health initiatives. The ultimate goal is to transform the technical-organizational solutions tested into innovative services for the healthcare sector. The Province of Trento allocated a start-up fund of 1,350,000 Euros for the three-year period 2017-2019. Since its creation, the Center has been the container for new projects on digital health cofunded at Local, National and International level with the objective of being put into service in the Trentino territory. The Center is jointly governed, by a Steering Committee and an Executive Committee composed by the Autonomous Province of Trento, the Provincial Health Services Agency and the Bruno Kessler Foundation. The TS4.0 initiative is open to all Civil Society, Enterprises, Academy, Associations and interested actors in the domain of digital healthcare innovation and since its creation has attracted co-funding for over 1ME through European Projects such as H2020 WellCo [2] and Upright [3]. The TS4.0 initiative has attracted interest and is part of ongoing discussions in other projects such as Interreg Central Europe Digital Life project [4] and recently funded H2020 Vigour in which is presented as a good practice in Europe. Additionally, TS4.0 initiative has been presented as a commitment in the EIP-AHA network in which which Trento is a reference site [5]. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic puts health and care systems under pressure globally. This current paper highlights challenges arising in the care for older and vulnerable populations in this context and reflects upon possible perspectives for different systems making use of nested integrated care approaches adapted during the work of the EU-funded project VIGOUR ("Evidence based Guidance to Scale-up Integrated Care in Europe", funded by the European Union's Health Programme 2014-2020 under Grant Agreement Number 826640)., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)