Background Due to the many restrictions imposed during the COVID-19 emergency, the normal clinical activities have been stopped abruptly in view of limiting the circulation of the virus. The extraordinary containment measures have had a dramatic impact on the undertaking and follow-up of ophthalmic outpatients. Objective In order to guarantee proper monitoring and routine care, the Pediatric Ophthalmology equipe of Rovereto Hospital (North-East of Italy) supported by the Competence Center on Digital Health TrentinoSalute4.0, designed and implemented a digital platform, TreC Oculistica, enabling teleophthalmology. We report our innovative—albeit restricted—experience aiming at testing and maximizing the efficacy of remote ophthalmic and orthoptic visits. Methods A multidisciplinary team created the TreC Oculistica platform and defined a teleophthalmology protocol. The system consists of a clinician web interface and a patient mobile application. Clinicians can prescribe outpatients with the App and some preliminary measurements to be self-collected before the televisit. The App conveys the clinician’s requests (i.e. measurements) and eases the share of the collected information in a secure digital environment, promoting a new health care workflow. Results Four clinicians took part in the testing phase (2 ophthalmologists and 2 orthoptists) and recruited 37 patients (mostly pediatric) in 3 months. Thanks to a continuous feedback between the testing and the technical implementation, it has been possible to identify pros and cons of the implemented functionalities, considering possible improvements. Digital solutions such as TreC Oculistica advance the digitalization of the Italian health care system, promoting a structured and effective reorganization of the workload supported by digital systems. Conclusions The study tested an innovative digital solution in the teleophthalmology context and represented the first experience within the Italian healthcare system. This solution opens up new possibilities and scenarios that can be effective not only during the pandemic, but also in the traditional management of public health services.

Background Italy 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. Objective In 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. Methods TreCovid19 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. Results A 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. Conclusions The 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.

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Aim In response to the SARS-CoV-2 emergency, the Competence Centre on digital health ‘TrentinoSalute4.0’ has developed TreC_Televisita, a tele visit solution that meets the needs of the Trentino healthcare system and maintains high-quality patient–doctor interactions while respecting social distancing. This paper highlights how ‘TreC_Televisita’ was integrated into the Trentino healthcare system and its potential to become a structural and durable solution for the future local healthcare service provisioning. Subject and methods This paper presents the multifactorial context that TreC_Televisita has faced for its implementation and the strategies adopted for its structural integration into the healthcare system. The analysis focuses on the main issues faced for the integration of the tele visits (e.g. privacy, payments) and how the context of TrentinoSalute4.0 permitted responding quickly to its implementation during the pandemic. It also describes how TreC_Televisita fits into the healthcare continuum from the organisational and technological standpoint, the end-user perspective and the barriers that could hamper the solution scalability. Results TreC_Televisita has demonstrated to be a technological solution that can be contextualised for different clinical domains beyond SARS-CoV-2. Moreover, it has shown its potential to scale up the solution beyond the COVID-19 emergency to the whole healthcare provisioning system in the long term. Conclusion Being a positive experience in the first months of its implementation, the long-term goal is to transform TreC_Televisita into a structural pillar of the Trentino healthcare system, setting the bases for a sustainable, win–win situation for all the stakeholders involved in healthcare service provisioning.

Clinicians and patients co-creating a new healthcare. The case of TreC-Ophthalmology platform in the Province of Trento, Italy.

BACKGROUND The large majority of patients infected by the latest coronavirus disease (COVID-19) reports mild symptoms and are usually recovering at their home (quarantine). A proper monitoring of such patients through a system user-friendly for patients and sustainable for healthcare staff is a key aspect to prevent potential worsening of symptoms and to ensure proper medical interventions. OBJECTIVE The aim of this work was to pilot a telemedicine technical and organizational model specifically designed to provide dedicated healthcare staff with a sustainable and reliable tool for periodically monitoring patients with progressive COVID-19 who are home-quarantined. METHODS An easy-to-use App was purposely developed to facilitate the monitoring of a selected number of home-quarantined patients affected by COVID-19. The App was accurately linked with a pre-existing e-health platform adopted by the local health trust to provide home care, allowing: (i) proper and safe link of collected data with demographic and clinical information related to the patients; (ii) a two-way communication between a multidisciplinary healthcare team and home-quarantined patients. The system supported patients to self-assess their conditions and to update the multidisciplinary team on the health status. The system was piloted between March and June 2020, in the Autonomous Province of Trento (Italy). RESULTS A dedicated multidisciplinary group of healthcare professionals adopted the platform over a period of approximately 3 months (from end of March to June 2020) to monitor a total of 170 patients with confirmed COVID-19 while in home-quarantine. All the patients used the system until the end of the study. CONCLUSIONS The technological and organizational model adopted in the context of this piloting has proved to be acceptable for both patients and health care staff when monitoring the progression of COVID-19 during the quarantine period. The system was purposely developed to pilot an innovative system supporting healthcare staff involved in the periodic monitoring of a relevant number of quarantined patients. CLINICALTRIAL NA

- The management of waiting times within the access system to sanitary services represents a highly critic factor for the sanitary system, because it negatively affects the perception of quality by the citizen, limiting the guarantee of an equal access. The reorganisation of the Cup system represents a central point in the administration of the sanitary offer to the Emilia Romagna Region, due to the maximum exploitation of the synergies with other technological and social networks (SOLE/Toll-free regional number/Monitoring networks for the performance control). The projects "Sparta" and "Cup Integratore" focus on technological and re-organisational aspects, in order to foster not only equity and the fruition of outpatient services, but also the definition and implementation of access system based on clinical priorities, and on the principle of providing for the citizen in order to guarantee the maximum respect of waiting times. It is finally illustrated the latest online access, capable of guaranteeing an availability which is intended to more and more conform to the citizens' modern lifestyles regarding their approach to the Health P.A.Keywords: Cup system; clinical priorities; equal access; waiting lists; health care; system.