Multi-morbidity is a growing challenge for healthcare systems, due to the ageing populations across Europe. Care co-ordination is a special problem due to the still poor connectivity between many hospital and GP electronic health record systems. Decision making is more complex because most clinical guidelines and care pathway systems (including computerised systems) have been designed to manage single conditions. These guidelines and systems rarely take into account that the first line treatment choice or management strategy for a patient can be altered by the co-existence of another condition. Polypharmacy is a well-known patient safety and treatment optimisation concern. Cross-team collaboration is difficult due to poor communications channels within and between healthcare organisations, even if they are geographically close.
C3-Cloud is a European Commission sponsored project that is developing innovative ICT solutions to multi-morbidity. Its starting point is to assess how clinical guidelines published for four long term conditions may be harmonised (for diabetes, heart failure, renal failure and depression). These harmonised guidelines are being embedded within a novel care pathway platform that is capable of integration with a patient’s electronic health record so that it can provide patient-specific information to support clinician led decision making and support patients in self-management. The platform contains care pathway software for clinical use, and patient empowerment and self management software that patients and caregivers can use.
The C3-Cloud platform and applications have been developed with interoperability in mind, and use popular interoperability standards to make it easier to connect with hospital and GP electronic health record systems. State of the art security measures protect patient privacy to an extent that meets information security requirements of health systems across Europe, and complies with the latest data protection legislation (including the GDPR).
C3-Cloud aims to support clinical workflow and workload by making it easier to plan and to document care for patients with multi-morbidity, and to communicate with other care actors involved with a patient through a collaboration platform that supports secure messages and video-links for case conferences. The involvement of patients in more effective, clinician-guided and software supported self-care should reduce treatment complications and we hope it will reduce unscheduled care encounters.