Delivering care to Europe’s remote communities
As urbanisation increases across Europe, many rural areas face depopulation. Those who stay behind tend to be older and at higher risk from conditions which require long-term rehabilitation, such as stroke, joint problems and chronic obstructive pulmonary disease. The decline in the younger population also drains the number of healthcare professionals in the area. “Without enough patients to justify a specialist clinic, and without enough staff to run one, rural areas effectively become ‘service deserts’, places where the care exists in principle but not in practice,” explains Claus F. Nielsen, tech & innovation lead of ROSIA(opens in new window). The Barbastro area of Aragon in Spain is a mountainous terrain with scattered villages. Driving to the nearest rehabilitation centre can mean a two-hour round trip for a patient who may already struggle with mobility. “For someone recovering from a stroke or a spinal cord injury, that is simply not sustainable as a long-term care model,” remarks Sofía Moreno-Pérez, procurement coordinator for ROSIA. “In the regions we worked with, the issue is not that rehabilitation does not exist – it is that distance and workforce shortages make it inaccessible for the people who need it most,” she adds. To address this, the ROSIA team developed a new, flexible and scalable model of care organised around self-management to provide better clinical services to depopulated areas. “The core idea behind ROSIA was straightforward: if patients cannot reliably get to a rehabilitation clinic, bring the clinic to them – through their screen, their phone or a wearable device,” explains Nielsen.
A new tech-driven self-care model
The team developed the ‘ROSIA Service Catalogue’, a prescribable set of validated digital tools for use at home. The patient does their rehabilitative exercises, the system records the data, and the clinician monitors progress remotely and adjusts the programme as needed. The solutions didn’t fully exist when the project started, so the team used EU procurement rules to challenge the market: running a competitive process across three phases, with funding for R&D at each stage. This process delivered two platforms, RAISE and REHABILIFY, both developed and refined in response to consortium clinical requirements. “The pre-commercial procurement framework gave us something traditional procurement cannot: the ability to actively shape what gets built, rather than choosing from whatever already exists,” notes Moreno-Pérez. Real-world pilots then took place across Ireland(opens in new window), Portugal(opens in new window) (website in Portuguese) and Spain(opens in new window) (website in Spanish). Over 10 months, 124 patients and 36 healthcare professionals used the platforms across seven different conditions.
Demonstrating a digital rehabilitation platform
The most important result was that the systems worked both clinically and technically across three different health systems. “Getting a digital rehabilitation platform to function reliably across all three is the proof of concept that this approach can scale,” Nielsen says. Feedback from healthcare professionals was also encouraging. After initial scepticism, clinicians saw how remote monitoring gave more and continuous visibility of patient progress. Moreover, ROSIA demonstrates how procurement itself can be used to innovate: rather than waiting for the market, healthcare systems can commission exactly what they need. “That shift in mindset – from passive buyer to active shaper of the market – is, I think, the most transferable lesson from the project,” remarks Nielsen. Europe’s continuing demographic and urbanisation trends underscore the value of this approach, says Nielsen. “Remote care is not a ‘nice-to-have’, it is an inevitability”.
