D5.1 - Integrated and Person Centred Care Workshop Report - v · PDF file© e H e a l t h I n n o v a t i o n P r o j e c t P a g e | 7 Foreword by Professor George Crooks OBE Medical

eHealth InnovationScaling up eHealth facilitated personalisedhealth services: Developing a Europeanroadmap for sustained eHealth Innovation

Thematic Network CIP-270986

D5.1: 5th eHealth Innovation(Final) Workshop:

disseminationof findings

Deliverable 5.1

Work package 5:eHealth Innovation: main findings

© e H e a l t h I n n o v a t i o n P r o j e c t P a g e | 2

DOCUMENT INFORMATION

IST Project Number CIP-270986 Acronym eHealth Innovation

Full title Scaling up eHealth facilitated personalised health services: Developing a European roadmap for

sustained eHealth Innovation

EU Project officer Gisèle Roesems Kerremans

Authors (Partner) Dipak Kalra and Petra Dimmers (University College London, UK),

Jörg Artmann, Veli Stroetmann and Ingo Meyer (empirica Technology Research GmbH, DE)

Donna Henderson, Christine McClusky (Scottish Centre for Telehealth and Telecare, NHS24, UK)

Antonio Kung (Trialog, FR)

António Lindo da Cunha (Ageing@Coimbra, PT)

Benny Eklund (Uppsala Lans Landsting, SE)

Christian Lovis (Les Hopitaux Universitataires de Geneve, CH)

Diane Whitehouse (EHTEL - European Health Telematics Association, BE)

Julia Purvis (Capacity to Engage, Liverpool, UK)

John Matheson (Scottish Government – Health Finance & Information, UK)

Jon Dawson (dallas Liverpool, UK)

Mariëlle Swinkels (Province of Noord-Brabant, NL)

Michael Strübin (Continua Health Alliance, BE)

Nicola Bottone (InCasa project, IT)

Oskar Jonnson (Swedish Institute of Assistive Technology, SE)

Peter Larsson (East Sweden Region, SE)

Rod Hose (The University of Sheffield, UK)

Shabs Rajasekharan (Vicomtech-IK24, ES)

With contributions from

Andrea Pavlickova (Epposi - European Platform for Patients' Organisations, Science & Industry,

BE)

Christoph Rupprecht (AOK – Die Gesundheitskasse, Health Insurance, DE)

Francesca Avolio (Regional Healthcare Agency of Puglia, IT)

Montse Meya (TicSalut, ES)

Toni Dedeu (Ministry of Health, Catalonia, ES)

Responsible author Prof. Dipak Kalra

Contact [email protected]

mailto:[email protected]


Abstract This report summarises a workshop held in cooperation with the European InnovationPartnership on Active and Healthy Ageing Action Groups (C2 and B3) as a side event during theAAL Forum 2013 on the 24

thSeptember 2013 at Louis De Geer Konsert & Kongress Centre in

Norrköping, Sweden. The objective of this one day workshop on “Scaling up integrated andperson centred care through innovative uses of ICT / eHealth” was to present innovations andgather audience insights on the potential of ICT solutions to integrate care and support personcentred care, including home care.

This reports summarises the knowledge shared and the main discussion points on how toaccelerate the wider adoption of eHealth solutions as well as the presentations which in itsmajority were case study examples of innovative person centred services and the associatedenabling and success factors behind their case study and any challenges or barriers preventingthe scaling up of integrated care and self-care and solutions for independent living at regionaland national levels.

Keywords Person centred care, integrated care, clinical scenarios, European Innovation Partnership


Table of Contents

Foreword by Professor George Crooks OBE....................................................................... 7

Executive Summary .......................................................................................................... 8

Session 1 – Opportunities for Person Centred Care ......................................................... 12Person Centred Care – Dipak Kalra....................................................................................................................... 12

The European Innovation partnership on Active and Healthy Ageing – Donna Henderson ................................. 14

B3 Action Group on Integrated Care – Donna Henderson .................................................................................... 15

Development of interoperable independent living solutions (C2) – Mariëlle Swinkels......................................... 17

Discussion ............................................................................................................................................................. 18

Session 2 - Empowering individuals to stay healthy, manage their illness and liveindependently................................................................................................................ 21Overview of B3 Action Area 6: Patient/user empowerment, health education and health promotion – Dipak

Kalra on behalf of Francesca Avolio, Co-ordinator of B3 Action Area 6 (Patient / User Empowerment) ............. 21

Guidance for User Empowerment – Jon Dawson.................................................................................................. 22

inCASA – Nicola Bottone....................................................................................................................................... 23

The Mi (More Independent) Project - Julia Purvis................................................................................................. 26

Coproduction - Living it up - Christine McClusky................................................................................................... 28

RENEWINGHeALTH – Diane Whitehouse.............................................................................................................. 30

Discussion ............................................................................................................................................................. 33

Session 3 – Technology – a catalyst for change................................................................ 36Introduction to Session 3 – Veli Stroetmann......................................................................................................... 36

Overview of B3 Action Area 7: ICT and Teleservices – Donna Henderson on behalf of Andrea Pavlickova, B3 Co-

ordinator of Action Area 7 – ICT / Teleservices..................................................................................................... 37

Personal health records and patient access to their data in Uppsala - Benny Eklund.......................................... 38

A case study from Portugal - António Lindo da Cunha ......................................................................................... 40

How to achieve flexibility and interoperability of ICT solutions? Including at research and living lab level? –

Antonio Kung ........................................................................................................................................................ 40

Device interoperability: Case studies from the field - Michael Strübin ................................................................. 43

The Momentum Project - Diane Whitehouse on behalf of Montse Meya ............................................................ 46

Opportunities from the Virtual Physiological Human – Rod Hose ........................................................................ 47

Discussion ............................................................................................................................................................. 49


Session 4 - How business modelling and return on investment can accelerate products tothe market ..................................................................................................................... 52How business modelling and ROI can accelerate products to market - Shabs Rajasekharan .............................. 52

How does one evaluate ROI on technology? - John Matheson............................................................................. 53

The Digital Social Alarm programme - Oskar Jonnson.......................................................................................... 55

Socio-economics of integrated eCare – Ingo Meyer ............................................................................................. 57

Discussion ............................................................................................................................................................. 60

SESSION D1: EIP on Active and Healthy Ageing – Supporting Integrated Services andIndependent Living at Scale ............................................................................................ 62Introduction to European Innovation Partnership on Active and Healthy Ageing................................................ 62

Action Groups ....................................................................................................................................................... 63

Feedback from seminars day 1 during AAL forum 2013 ....................................................................................... 63

How business modelling and return on investment can accelerate products to the market................................ 64

Other discussion points......................................................................................................................................... 65


Scaling up integrated and person centred care through innovativeuses of ICT / eHealth

AAL Forum 2013 Side Event

Date: Tuesday 24th September 2013

Event Venue: Louis De Geer Konsert & Kongress,

Hamngatan 24,

SE-602 32 Norrköping, Sweden

www.louisdegeer.se

https://web.nhs.net/OWA/redir.aspx?C=X11eJ1-gakim5SUJ3mOL8RK7_xluUtBIo3OKdOXpGgheP2TqwCBy4X6cSqtJxm0KVXkt38NQLHQ.&URL=http%3a%2f%2fwww.louisdegeer.se


Foreword by Professor George Crooks OBE

Medical Director NHS 24, EIP Chairman of Action Group B3

When an individual feels vulnerable because they develop a health or care need,

they are often less interested in which organisation will provide the service they

require, and more in that there is a service there to support and assist them.

Then consider that, for a large number of people, often older people with multiple

health and care needs, where there is a requirement for multiple organisations to

have work together, we often find that organisational constraints become barriers to

seamless care.

That is why across Europe, health and care systems are all looking at the integration

of services to better serve their patients and service users. The vast majority of

countries have moved or are moving to a more integrated health system with

hospital and community health services working in a more joined up and coordinated

ways.

However a number of countries are looking to the integration of health and social

care services as a way of driving the quality of service provision by improving the

citizen’s experience as well as also generating service efficiencies.

Integrated care needs to be more than a simple aspiration – just thinking or talking

about it will not make it happen. There needs to be an alignment of policymakers and

all key players charged with delivery to make it work and, as with most good things, it

takes time to deliver.

There are a number of catalysts to support change, ranging from the demographic

challenges of an ageing population, the increasing service demands of multi-

morbidity and frailty, the financial constraints being experienced around the world

and the complex societal challenges we are wrestling with day in, day out. However

there is also an increasingly loud voice from the population who want to access

health and care on their terms and to take an increasing role in the delivery of their

own care.

This is where technology, appropriately focussed and designed, can play a

significant part. As part of innovative redesign of services, technology can empower

people, support individuals, families and health and care professionals. Through the

sharing of information and the co-ordination of activities it can be a true catalyst for

health and care integration, service improvement and citizen empowerment.


Executive Summary

This one day workshop was jointly organised by the B3 and C2 Action Groups of the

European Innovation Partnership on Active and Healthy Ageing and the eHealth

Innovation Project for which this event was the final project workshop.

The objective of the event was to present innovations and gather audience insights

on the potential of ICT solutions to integrate care and support person centred care,

including home care. The majority of the presentations were case study examples of

innovative person centred services, with each presenter specifically also reflecting

on the enabling factors, and success factors behind their case study, and also any

challenges and barriers that have hindered the scaling up of integrated care and self-

care and solutions for independent living at regional and national levels. The

workshop sought to share knowledge on success strategies for accelerating the

wider adoption of eHealth solutions.

The workshop covered: Dissemination of eHealth Innovation project findings on the opportunities and

success factors for the scaling up of integrated and person centred care.

Exploration into how ICT / eHealth can best support health and social care

integration, self-care and independent living.

Validation of the activities of B3 and C2 Action Groups.

Multi-stakeholder engagement and exchanges.

Building consensus on the critical components needed for large scale

(regional, national) integrated care services enabled through ICT

Exploring Return on Investment.

Agree priorities for the B3 Toolkits to support the implementation of integrated

care and C2 toolkits to support the implementation of innovative technologies

and services for self-care and independent living.

The event comprised of four different workshop sessions, each one focusing on a

different aspect of the European Innovation Partnership on Active and Health Ageing

(EIP-AHA) B3 and C2 Action Group activities – namely multi-actor collaborative care

pathways, user empowerment, change management and ICT / Teleservices /

eHealth.

A total of 48 people attended the workshops with an average of approximately 30-35

persons in each of the four sessions, with about three quarters of these participating

in all four sessions.


Workshop structure and key messages

Session 1 – Opportunities for Person Centred Care

Presentations

Introduction to Person Centred Care – Dipak Kalra (UCL)

The European Innovation partnership on Active and Healthy Ageing – Donna

Henderson (NHS 24 Scotland)

B3 Action Group on Integrated Care – Donna Henderson (NHS 24 Scotland)

Development of interoperable independent living solutions (C2) – Mariëlle Swinkels

Discussion: key messages

Hospital admission is often “acute” and not due to a complication in a chronic

condition.

A person centred innovation project must first examine what value needs to be

obtained from the ideal ICT solution. Once this has been understood the available

products, and their technical interoperability, should be assessed in further detail.

Understand the needs of current and future chronically ill patients, considering that

today’s 40-50 year olds have the risk of becoming tomorrow’s chronically ill.

Involve older people in service development! Deliver change with them rather than

for them.

Session 2 - Empowering individuals to stay healthy, manage their illness and

live independently

Presentations

Overview of B3 Action Area 6: Patient/user empowerment, health education and

health promotion – Dipak Kalra on behalf of Francesca Avolio

Guidance for User Empowerment – Jon Dawson (C2 Action Group)

inCASA – Nicola Bottone

The Mi Project - Julia Purvis

Coproduction - Living it up - Christine McClusky

RENEWINGHeALTH – Diane Whitehouse



More needs to be done to involve actual users/patients (and/or their representative

organisations) in the EIP.

A thorough user requirements analysis must drive the choice for specific

technologies.

Health and keeping citizens healthy must be the basis on which healthcare services

are rewarded.

Much more attention needs to be paid to how the proposed toolkits need to be

designed and worded.

It is both possible and beneficial to involve users in the design phase of

technologies.

Procurement must be agile and user-driven (as opposed to purchaser-driven).

Policy-makers need to plan and resource projects using longer timeframes.

Session 3 – Technology - a catalyst for change

Presentations

Introduction to Session 3 - Veli Stroetmann

Overview of B3 Action Area 7: ICT and Teleservices - Donna Henderson on behalf of

Andrea Pavlickova

Personal health records and patient access to their data in Uppsala - Benny Eklund

A case study from Portugal - António Lindo da Cunha

How to achieve flexibility and interoperability of ICT solutions? Including at research

and living lab level? - Antonio Kung

Device interoperability: Case studies from the field - Michael Strübin

The Momentum project - Diane Whitehouse on behalf of Montse Meya

Opportunities from the Virtual Physiological Human – Rod Hose


Device interoperability can be hampered by short product cycles

An app store type of service provision may be a viable response to the product cycle

problem

Solution procurement must be driven by a service vision, not a technology vision


Session 4 - How business modelling and return on investment can accelerate

products to the market

Presentations

How business modelling and ROI can accelerate products to market - Shabs

Rajasekharan

How does one evaluate ROI on technology? - John Matheson

The Digital Social Alarm programme - Oskar Jonnson

Socio-economics of integrated eCare - Ingo Meyer


Technology procurement needs to provide benefits of scale to SMEs to justify large

development costs.

Cost and benefit distribution may create perverse incentives that require a societal

focus to justify continued commitment to eHealth services.

The time to benefit realization of complex health IT projects is long and evidence

shows that SMEs will have to wait after the initial phases of the projects to see a

return on the investment.


Session 1 – Opportunities for Person Centred Care

This workshop focused on the following topics.

Why is it now vital for European health and care services to become more

person centred and empowering?

Overview of the eHealth Innovation project and its findings

Overview of EIP on Active and Healthy Ageing, the B3 and C2 Action Groups,

relevant and related activities

Case studies of person centred and empowering eHealth innovations

Discussion on the useful learning points from these case studies, and how to

scale up good empowerment practices across Europe

Person Centred Care – Dipak Kalra

Dipak began by explaining why the projected Europe wide increase in prevalence of

chronic diseases, coupled with the rise in the proportion of older persons, means that

the present models of healthcare are no longer sustainable. It is firstly necessary for

healthcare to be better integrated with social care, and other care services such as

occupational and school health, and with voluntary “third” sector services. This co-

ordination and co-operation is essential in order to enable older persons to remain

comfortably and happily at home with better support and more personalised care. It

is also important for services to focus more on the prevention of illness (or the

prevention of complications from an existing chronic disease) and the promotion of

healthy living.

The eHealth Innovation project has been collecting examples of good practice in

integrated and person centred care, many of which are included in its Deliverable

1.2. It has reviewed different models of person centred care, and also proposed

example scenarios of better integrated care (Deliverable 2.2). Some of the key

features of future personalised care solutions should be to:

integrate multiple health and social care actors;

interweave (streamline) multiple simultaneous chronic diseases, and

prevention;

profiled to personalised biology (personalised medicine);

profiled to personalised lifestyle and preferences (personalised care);


have reimbursement models that favour primary and secondary prevention

activities (whereas today reimbursements target treatment interventions);

have reimbursement models that favour care collaboration (whereas today

they are directed to single care organisations for individual components of

care).

ICT solutions are clearly important enablers of integrated and person centred care

because information and knowledge sharing are vital to their success. Successful

integrated ICT solutions will critically depend upon harmonised and widely adopted

interoperability standards, and will in future also leverage the smart use of cloud

computing, big data, open data, physiological modelling and social networks. ICT

solutions working near to the patient/citizen will often need to integrate multiple

vendor products, and to scale up such procurements (and to ensure best quality of

integration) vendors may been to co-operate to market product “bundles” that

together deliver a useful functional service and have been tested and assured to

work together well. Any wide scale deployment needs to invest in enhancing the ICT

and health informatics skills of the healthcare workforce, and in education and up-

skilling of patients and healthily citizens to make best use of empowering technology.

Dipak cautioned the audience to learn from the experience of the last decade of

major national eHealth programmes. Technological questions per se are rarely the

barrier to more innovation in ICT enabled delivery of chronic disease care. Solutions

must be based on and architected to deliver a medical and social service vision and

NOT to promote a promising technology. It is essential to identify and involve key

stakeholders right from the beginning to make person-centred healthcare a success.

The focus of future efforts should be on understanding the business context and the

diffusion of eHealth innovations, in order for good practice pilots to scale up across

Europe.


The European Innovation partnership on Active and Healthy Ageing – Donna

Henderson

Donna introduced the EIP, which is a response to the projections for Europe of the

number of persons who will be over 65 by 2030, the ratio of those over 65 to those in

employment, and the anticipated cost of health and care delivery (see Figure 1).

Figure 1: the global challenge of ageing

The EIP relates to two of the five flagship initiatives of Europe 2020: Innovation

Union and Digital Agenda. These focus on innovation for tackling societal

challenges, e.g. ageing and health, innovation for addressing the weaknesses &

removing obstacles in the European innovation system, ICT for tackling societal

issues - ageing, health care delivery, and sustainable healthcare & ICT-based

support for dignified & independent living.

There are 6 Action Groups targeting the triple win for Europe, two of which were

strongly represented in this workshop: B3 (Integrated care for chronic conditions,

including telecare) and C2 (ICT solutions for independent living and active ageing).

Each of the Action Groups have adopted some common activities, such as collecting

good practice case studies and intending to develop toolkits to support the


dissemination and adoption of innovative practices. A momentum of activity is

building up within each Action Group, through European networks (partnerships) of

committed individuals and organisations (see Figure 2). Horizon 2020 has already

been influenced by the EIP-AHA.

Figure 2: Added Value of the EIP on AHA

B3 Action Group on Integrated Care – Donna Henderson

The objective of the B3 Action Group is reducing avoidable / unnecessary

hospitalisation of older people with chronic conditions, through the effective

implementation of integrated care programmes and chronic disease management

models that should ultimately contribute to the improved efficiency of health systems.

The Action Group has sought to create a collaborative, in which those organisations

and individuals who make official commitments also contribute case studies and

expertise, and interact within the Action Areas.

The commitment to the EIP has increased substantially over the last two years,

starting with 65 organisations responding to the original call. During the 2nd round


the number rose to around 130 and now the Action Group has decided on an open

membership, and still creates interest and new members are subscribing.

The wide range of member organisations does impact on the deliverables and their

timings as the EIP is not a funded programme: every member contributes resources

at their own expense.

In a questionnaire survey (known as the Delta questionnaire) of 27 B3 Regions and

delivery organisation carried out in July 2012, the main challenges reported were in

the area of organisational models and change management (see Figure 3).

Figure 3: Future activities and challenges perceived by 27 European Regions and

delivery organisations in B3

The challenges and opportunities identified in the Delta Questionnaire were used to

inform the key actions within the B3 Action Plan. The Action Plan has 9 work

streams – Organisational Models, Change Management, Workforce Development,

Risk Stratification, Care Pathways, User Empowerment, ICT / Teleservices, Finance

and Funding and Dissemination (see Figure 4).


Figure 4: Overview of the Action Areas within B3

Throughout 2013, B3 Action Group members have contributed 89 good practice

integrated care examples, the largest number of which relate to ICT and

Teleservices. Members have also contributed to a Desktop Search activity. The

outputs of both activities will be used to populate a mapping of integrated care

across Europe.

Development of interoperable independent living solutions (C2) – Mariëlle

Swinkels

The focus of the C2 Action Group is to better enable the independent living of older

people, social inclusion and well-being, to enhance the quality of life for older people

and their carers, and to make overall health and social care provision economically

sustainable (e.g. by avoiding and reducing hospital stays).

However C2 has observed that, to date, ICT solutions in this area are largely

proprietary, based on single provider design and cannot be easily adapted to

multiple and changing user and organisational needs.


C2 have therefore set their prime objective as enhancing deployment and take up of

independent living solutions, based on open standards. Their aim is to enhance

quality of life for older people, and to promote the economic benefits of ICT solutions

that support that. By 2015 C2 intended to publish deliverables that detail:

The availability of key global standards and validated implementations of

interoperable platforms, solutions and applications for independent living;

The availability of evidence on the return on investment of these solutions and

applications, based on experience involving at least 10 major suppliers, 100

SMEs and 10,000 users

The deliverables will include a toolkit for user empowerment incorporating co-

creation, awareness raising and technology confidence building (due in 2014).

C2 also considers it important to nurture a digital marketplace, with users at

the centre (recognising, though, that it will be challenging to make this

marketplace really user centred and for users to feel empowered).

Mariëlle then presented a summary of the ENGAGED Thematic Network. This

project is a two year EC funded network, which will work closely with C2 and

help put some of its mission into practice. The main target of the project is

enabling the Action Group. In order to achieve the widest possible contribution

the project includes a budget to invite specially selected experts to relevant

workshops with a particular focus on the new member states.

The initial focus will be on user involvement, and setting up user tools for

cooperation (such as the use of online collaboration tools). The project will

also define new approaches for dissemination and raising awareness, and

develop roadmaps for deployment of innovative and sustainable AHA

services.

Discussion

Participants pointed out that it is not usually the chronic disease which brings older

patients to a hospital but an acute complication, since the chronic disease can

mainly be monitored remotely.

The ECHAlliance was quoted mentioning that currently spending in healthcare is

often looked at from the wrong perspective – healthcare spend for older people

should be seen as an opportunity not as a burden. We need to use this

understanding of the importance and value of person centred care to foster

discussion for policy development and implementation.


The SmartCare project has found that many Regions do not really understand and

distinguish integrated care, assisted living, tele-monitoring and social care. They

have come across common misconceptions e.g. that remote BP monitoring

equipment will (in itself) make people more independent. As a consequence the set

up of projects should not be tackled from the perspective of solutions looking for

problems: a more suitable approach would be to first identify the care delivery or the

support needs and then – based on these needs – to undertake a mapping exercise

through scanning the available technology. Technical solutions, especially if without

interoperability, should not be the focus of attention. A person centred innovation

project must first examine what value needs to be obtained from the ideal ICT

solution. Once this has been understood the available products, and their technical

interoperability, should be assessed in further detail.

People today are using more technology to monitor their personal exercise, like

jogging, than we use in healthcare using our “latest” technology. These techno-

joggers are often in their 40’s and 50's. These are our older people of tomorrow. The

people we focus on in these Action Groups acquired their chronic disease(s) many

years ago, their disease process has evolved and they have now a lot of

complications. The older people of tomorrow might have had their conditions

managed more smartly for many years. The challenge is to develop a technology

which can accommodate both kinds of patient, not only those like the fit (joggers). By

2030 we (the participants in the workshop) will become the older generation..

A lot of the smart technology on sale today is produced for a rich mass consumer

market. Currently blurred lines exist between smart health, smart care, smart living.

We can promote a healthy lifestyle supported by technology. A question was raised

on why the health and care sectors do not use up to date technology, especially for

citizens. The meeting felt that many staff have wrong expectations that older people

are too old to use ICT equipment.

Some participants expressed the belief that a key determinant of health for the

population over 80 is their perceived value to society. Technology is a tool that

contributes to this and acts as enabler. However, change is not easy without the

cultural insight. Children and older people understand the internet and technology

differently from each other.

The value to society of older people became the focus of the discussion as well as

how we currently engage with this generation. The consensus was to enable change

with them rather than for them. Technology is not the solution but the tool – we

should not be obsessed with the latest technology. Members of the audience felt that

it is not easy to change especially as a community or region. In order to change an

entire system in the health sector we need to consider how to cover the generations

and span change across them. Therefore one of the current challenges is how to


incorporate and implement change management. In addition, it was underlined that

the healthcare delivery system on its own is only accountable for a small share of the

population’s health and quality of life.

The skills divergence between those in a care profession, software developers and

the consumer market should be addressed, to bridge the gap in order and thereby to

encourage better applications in the health sector.

Cultural change is needed in order to take full advantage of new technology. Patients

need to train themselves to use new tools properly. Some participants felt that older

patients are too old to be familiar with the latest technology, considering the rapid

developments over the last fifteen to twenty years.

There was a suggestion that future older generations will have been exposed to

ICT: it is possible that these person will be more familiar with using technology in

their daily lives, although future technology might be very different to what we are

familiar with today.


Session 2 - Empowering individuals to stay healthy, manage their

illness and live independently


What is empowerment, and why is it now vital for care services to be

empowering?

How people can be empowered to prevent and self-manage chronic

conditions, and to live independently for longer, even when living with

functional impairment

Case studies of approaches to empower users

Discussion on the key enablers, success factors and how to overcome

barriers

Ideas for content of a user empowerment toolkit that can support scaling up of

self-care, integrated care and independent living solutions across Europe

Overview of B3 Action Area 6: Patient/user empowerment, health education and

health promotion – Dipak Kalra on behalf of Francesca Avolio, Co-ordinator of B3

Action Area 6 (Patient / User Empowerment)

The objective of B3 Action Area 6 is to support patients/users to participate actively

in their own healthcare management and demand more responsive and integrated

care programme for chronic diseases.

The first phase of work has been to invite good practice case studies of

empowerment, for which a template was designed. The activities carried out and

definitions adopted by Organisations/Institutions/Regions will be mapped to the

following themes:

empowerment (coaching) of patients (organizational model: structural

analysis);

health education processes (procedures and tools, process analysis);

evaluation of patients to guarantee an equal level of delivery (equity

processes) according to a mix of clinical indicators and social indicators:

o complexity of patient;

o intensity of care required personalised approach;


o level of integrated approach needed;

integrated approach (welfare system structure) and involvement of

communities.

Once these case studies have been collected, they will be analysed and used to help

define common indictors that may be used by future initiatives to:

evaluate the changes for each pathology (clinical outcome, clinical process:

adherence, compliance, follow up);

monitor self management ability;

monitor education processes (health literacy);

monitor integration processes an community involvement;

evaluate patient satisfaction.

These indicators and other feedback from organisations and Regions will be used to

develop a toolkit or toolkits that can encourage and guide good quality empowerment

initiatives across Europe.

Guidance for User Empowerment – Jon Dawson

The approach being taken is to document good practice and the state of the art for

user empowerment, and from this to develop a toolkit, disseminate the toolkit and

good practice, with the long term aim of sustainability of empowerment initiatives for

independent living and self-care.

The key empowerment themes within Action Group C2 are inclusion (focusing on the

social and digital divides, and the financial opportunity or funded provision needed to

access new solutions), co-creation (e.g. living labs), awareness raising (what smart

solutions exist) and confidence building. The agenda for user empowerment has four

main components, as shown in Figure 5.


Figure 5: The main components that can lead to user empowerment

Jon noted that not many real users are involved in the EIP. A key challenge is to see

how they can become more involved in the EIP and in contributing to what an ideal

user empowerment toolkit should contain and how it should be delivered. Again, on

the EIP, it was observed that a key goal of EIP action groups is to develop toolkits,

but there is a lack of clarity about their content and the form that these take if they

are to be most effective and to be widely used.

inCASA – Nicola Bottone

inCASA aims to improve the life conditions of older people and of people

(experiencing chronic diseases), by offering an integrated service of healthcare and

social care solutions to assist them directly in their own homes. The project has

developed a platform (such as a monitoring service) that can collect and combine

information from multiple devices in the patient’s home, and route this to decision

makers or to healthcare professionals (see Figure 6).


Figure 6: the inCASA service model

inCASA has run five pilot sites on remote monitoring for health (telecare) and social

care (alarms). A sixth site in Skive, Denmark tested the ability (i.e., transferability )to

transfer an existing pilot set-up to a second site. The organisational and clinical

variety between the sites is shown in Figure 7.

The project in Skive was created with the remit to base the first draft of tools on

existing internal best practise. It was therefore in a position to start implementation

within five weeks from the project starting. In the following phases, user responses

were taken into consideration and the content was updated accordingly.

The implementation time in the pilots was reliant on the existence of the relevant

technical infrastructure.

inCASA has achieved positive evaluations from patients and professionals. Patients

regarded the solution as non intrusive, and not raising any privacy concerns. They

felt more involved, and experienced less imposition on their time from healthcare

activities. The solution was importantly not perceived as a substitute for direct

contact with carers: they felt this contact was just as available to them as before.

Professionals appreciated the alignment of health and social care.


Figure 7: The inCASA Realization levels

A key success factor was that a user needs analysis was undertaken first, and that

needs and not technology were driving the process throughout. It was necessary to

streamline and re-organise the healthcare process.

It was also important to counter the “noise” from false alarm signals, so that the

alarms that were raised were likely to be genuine and were trusted rather than

ignored or regarded as irritants. It was also found helpful to have started the

integrated care from the health side, and to bring it into social care while at the same

time recognising the risk that health care needs and functions might dominate over

social care needs and functions.

inCASA also found that it was very important to secure the buy in from all the

connected organisations from the start. It did prove difficult to engage enough end

users early in the project.


The Mi (More Independent) Project - Julia Purvis

Julia was representing, Person Shaped Support, an organisation that has been

active for nearly 100 years supporting individuals, families and communities in

Merseyside, North England, North Wales and Scotland in the promotion of wellness,

and in people remaining independent in their own homes.

The Mi project is one of four UK demonstrators publicly funded by the Dallas project,

which is about delivering assistive living lifestyles at scale. In Liverpool Mi has

funded health trainers who offer 1:1 practical support to persons over 60 who are

referred to them, usually for a period of 12 weeks, for healthy behaviour change

(focusing on diet, exercise and alcohol). The trainers have often found the need to

look at the whole person irrespective of the health issue triggering the referral, and

have therefore also provided support with social concerns (e.g. debt, housing) and

with information on the services available in each person’s local area. The trainers

were based in general practices and other community settings. Mi has also recruited

over 100 volunteer champions to raise awareness about smart care and smart health

technologies that can support independent living and self-care.

Mi has found that the greatest barriers to improved health and interest in

technologies that can support them are often social factors (e.g. debt, housing, social

isolation and caring responsibilities), along with attitudes and apprehensions about

not being able to use innovative technologies. For instance, many people will not

engage in discussions about self-care unless they feel “safe” e.g., in their own

homes (see Figure 8). Empowerment can only result in freedom if the lower parts of

the triangle featured in the figure are addressed.

Health trainers needed to listen to their clients, work with them and open a

psychological door so that clinicians could then deal with the outstanding health

issues. Trainers can relate to family members if appropriate, and help a person to

retake control of decision making.

Digital exclusion has proved to be another barrier to empowerment. MI identified a

prevailing lack of interest and understanding of technology. Older people might also

be concerned that using technology (telecare, telemonitoring) will remove one of the

few personal contacts that they have in real life. An example solution has been to get

older persons to deliver an IT class called “IT for the terrified”, where the person also

acts as a role model.


Figure 8: Three essential components for full empowerment

Mi has found that it is vital to understand people, their concerns, their interests. A

key enabler is targeting people in multiple ways.


Coproduction - Living it up - Christine McClusky

Christine presented the Living it Up (LiU) project, another TSB funded dallas

initiative, based in Scotland. LiU aims to co-design sustainable and innovative

improvements and choices in health, care and wellbeing for 55,000 users by 2015,

using familiar technology.

The project’s starting premise has been that effective services must be designed

with and for people and communities. It has sought to help increase each person’s

circle of care, and to increase the following nine skills:

Self management

Resilience and Capacity

Connectedness

Effectiveness

Communications

Knowledge

Innovation

Choice

Collaborations

The LiU approach to achieving this is illustrated in Figure 9. The project team

collected community ideas, and talked to self help groups. in order to learn how best

to empower the individuals and communities. The community engagement was

created through co-design workshops and engagement events in a variety of

locations such as community centres and shopping centres. The aim was to

determine what services and tools would be useful to build up the project starting

with a focus on COPD, carers and technologies (Figure 10). This engagement

includes workshops, testing out concepts and prototypes before scaling up

development.


Figure 9: The Living it Up approach

Figure 10: Clear branding developed using community engagement in the design of

LiU


One of the suggestions from the co-design activities is Experience Guides. The

guides, which are written by people who have been through an experience such as

having a disease like COPD, a bereavement, coming out of the army, or being a

carer for a person with dementia, are now in prototype – first on paper and soon in

digital form. These guides are living documents and will be updated through online

contributions. People are also able to rank the contributions and their usefulness.

This has generated a “top 5” list of contributions which are perceived as the most

useful.

A reference book on co-production called “Co-production of Health and Wellbeing in

Scotland report may be downloaded from:

http://www.coproductionscotland.org.uk/files/8213/6189/6682/Co-

production_of_Health_and_Wellbeing_in_Scotland_2013.pdf

RENEWINGHeALTH – Diane Whitehouse

The RENEWINGHeALTH consortium comprises nine European Regions undertaking

real-life large-scale trials validating and evaluating innovative personal health

systems and telemedicine services with a patient-centred approach. These focus on

the management of patients with chronic conditions such as diabetes, COPD and

cardiovascular conditions (see Figure 11). The project aims to improve quality of life

by removing anxiety about health conditions and reducing the need to use

emergency services and the need for hospital stays (thereby also reducing costs).

This approach has also required the design of new healthcare models.

http://www.coproductionscotland.org.uk/files/8213/6189/6682/Co-production_of_Health_and_Wellbeing_in_Scotland_2013.pdf

http://www.coproductionscotland.org.uk/files/8213/6189/6682/Co-production_of_Health_and_Wellbeing_in_Scotland_2013.pdf


Figure 11: the RENEWINGHeALTH pilot sites

The Norbotten pilot focuses on medication reminders. This is achieved by integrating

the administration schedule with the patient’s digital calendar, and an application that

registers the taking of each medication dose. This can be accessed via a personal

computer, a television or a smartphone. The end-user can select if he/she would like

to get reminders when it is time to take the medication, and at what time different

reminders will be received for different kinds of medication. Figure 12 shows an

overview of the main ICT-enabled services and devices used.


Figure 12: Overview of the ICT services at the Norbotten pilot site

Home monitoring test results for the chronic condition are also entered via the

applications, which generate alerts when these results are outside the normal range.

It is also possible to specify alarm levels so that caregivers will be directly informed

when measurements exceed these alarm levels. It is also possible to specify

generally unrealistic value limits for each measurement type. If these limits are

exceeded, the values are rejected and the patient is asked to provide the correct

values. The end-user can select if he/she would like to get reminders when it is time

to make the next measurement. The caregiver can get permission from the patient to

view the diagnosis charts in order to get better information for changing any

treatment.

The application improves the patient’s willingness to complete taking medication,

exercise and eat a healthy diet. The healthcare professional gets access to the

follow-up information: it helps better decision-making regarding new prescriptions.

The key enablers for this pilot have been the buy-in of patients, institutional support,

and the fact that the applications are easy-to-use and are accompanied by education

and support. The main challenges have been mainly technical and have related to

interoperability.


Discussion

The workshop participants observed that there were common themes running

through the presentations, such as the balance between top-down and bottom-up

approaches. inCASA and RENEWINGHeALTH were seen to have used a top-down

approach, starting with existing technical solutions whose relevance was determined

on the basis of pre-existing knowledge and expertise, but then developed further

based on early user feedback. Mi started with a consultative patient-centred

approach which generated ideas for the ideal solutions, based on a rich

understanding of the many individuals and their needs and tested interest in potential

solutions. LivingItUp also used the latter approach with the added target of

establishing whether their structure could be feasible for others to adopt.

A more detailed discussion took place about which approach would be the most

suitable, in general. While inCASA started by having an existing technology in mind,

they used pilot experience and the uncovering of barriers and problems to direct a

detailed user need analysis. The feedback obtained was used as the basis for step-

by-step corrections which resulted in a prototype solution which the user was able to

test. The usability, acceptability and outcome of the prototype provided the basis for

developing the final product. This helped to ensure the solution was well-targeted to

the consumer need, although taking regional differences into account.

The premise in RENEWINGHeALTH was to evaluate existing projects which were

seen to be up-and-running and already able to meet local needs, as well as at least

in part able to meet the needs of their future European vision. A deeper

understanding of the requirements became the ambition of the project, once the

initial pilots were set up.

It was recognised that both bottom up and top down approaches have their place

and that each may be applicable depending on the situation.

The workshop participants felt that in the EIP on AHA user requirements were being

taken into account much more strongly than in historic initiatives, and that this

change in approach was very recognisable. The RENEWINGHeALTH project in

Norbotten was considered to reflect good practice as it had specifically captured

detailed user requirements and had shown a very professional and clearly promoted

approach to user involvement.

A question was raised on how we can improve health and care efficiency and inter-

agency information sharing, recognising that the collective focus now needs to be on

ensuring good health, and the avoidance and prevention of health care service use

rather than treating disease and managing medication.


Participants felt that most changes would be needed in legal frameworks and

achieving political consensus. Finding a balance between multiple interests would be

key. Professional groups were suggested to sometimes be one of the main

obstacles, as they were perceived to be reluctant to change, since changes may

impact on the monetary benefits they often gain from existing healthcare systems.

Unfortunately there is sometimes greater interest in potential budgetary gains and

profits (or protecting existing ones) on the part of healthcare professionals than in

patient benefits.

Through their involvement with existing initiatives, the Mi project found that patient

need and clinician practice sometimes showed considerable discrepancy. Despite

being confronted with patient requests and needs, day-to-day practice did not

change much. Change in practice was described as an uphill battle, with attitudes

and behaviours adapting very slowly.

The workshop participants agreed that scaling up empowerment initiatives would

have an important accelerating impact on change. The more that patient needs are

communicated and made central to an initiative, the easier change becomes.

It was considered important to bring all the relevant sectors (public, clinical and

industry) together under one funding stream. The workshop participants felt that in

the past it was difficult to get industry involved in the co-development of solutions.

Now, with widespread community engagement and clear demonstrations of

outcomes it is proving possible to get prototypes built and tested by industry, and for

existing products to be improved. Philips was mentioned as an example of a

company that has grasped the importance of basing solutions on familiar technology,

particularly of using technology that can be readily adapted to particular localised

needs and offering a lower or more basic level solution where required.

Unlike a standard consumer market, the people who use empowerment products are

not influencing the procurement of these products in healthcare, which prevents the

growth of a consumer-driven (bottom-up) market. There is, however, considerable

scope for the development of a consumer market in terms of many products for

smarter living and self-care. Indeed, this is a key focus of the Mi programme.

Nevertheless for industry, the buyer is often not the end-user but is the purchasing

departments in healthcare organisations or ministries. The workshop participants felt

that the market has to consider the consumer need in order to be successful – both

in relation to public procurement and in the creation of a consumer market. It was

recognised that technology is often created ahead of determining what is really

needed.


For this reason, people need to get smarter and be better informed about buying the

right products, and influencing decision makers. It would also be helpful if public

sector purchasing could be more agile and more service relevant.

A power shift was predicted as consumers start demanding products that can

support them to live independently and to self-care (such as telecare).

However, the length of the change cycle for implementation was emphasised by

various participants as a problem, as well as the discrepancy between the time taken

to demonstrate concrete outcomes (often between 15-20 years) and the four- or five-

year cycles that politicians, industry and finance departments usually operate on.

The consensus in the meeting was that one of the main battles to fight should not be

to operate on quarterly or annual planning cycles but to enable projects of a much

longer duration to be supported. (However, longer projects do risk working on

technology products that become out-of-date, an issue that surfaced in the next

session.)


Session 3 – Technology – a catalyst for change


How are ICT based services for integrated and patient-centred care, including

telecare and telemedicine services, currently deployed?

What are the most commonly encountered challenges in the implementation

of ICT supporting the delivery of patient-centred services / integration of

services across sectors and care providers?

What are “best practice” examples for solutions to crucial challenges such as

interoperability?

What tools do exist to support integration activities?

What explains the predominantly local character of many teleservices? What

can be done to support their scaling up?

What are topics to include in a toolkit to support activities in this field?

Introduction to Session 3 – Veli Stroetmann

Veli provided an overall introduction to Session 3, which focused on the role of

technology to catalyse more integrated and person-centred care. She drew attention

to the Deliverable 2.1 of eHealth Innovation, which has examined many models and

care studies of new models of care and collated the lessons learned from these.

These experiences have emphasised the importance of care processes being

designed around the patient. Organisational issues are among the most critical to get

right: in particular there is a need to understand and address cultural differences in

service provision between different care settings and care teams. It is important to

prepare staff for change, investing in training for health professionals and in training

for citizens and patients. Some case studies have demonstrated the value of a case

manager (usually a nurse) to coordinate care and to facilitate the adoption of the re-

designed service.

It is also important to ensure a shared vision and strategic leadership. A "smart

procurement" approach is needed, which is aware of the ICT market and any legal

issues that apply to procurement. Most importantly, there is not going to be a "one

size fits all" solution. People making choices about ICT must be well informed about

the enablers, success factors and key challenges.


Veli introduced the SmartCare model of integrated care services (see Figure 13,

which illustrates the essential building blocks of services and actors that ICT

solutions should support). Deliverable 2.1 of eHealth Innovation has examined each

of these smartcare building blocks, and proposed the key enablers, success factors

and challenges relating to each.

Figure 13: The SmartCare model of integrated services

Overview of B3 Action Area 7: ICT and Teleservices – Donna Henderson on behalf

of Andrea Pavlickova, B3 Co-ordinator of Action Area 7 – ICT / Teleservices

The objectives of Action Area 7 are to highlight the potential of ICT/Teleservices to

underpin the delivery of integrated care, to realise service efficiencies/cost-

effectiveness, and to improve the effectiveness of health and social care ICT

systems and data sharing by identifying solutions which improve interoperability

between record systems and data sharing. This Action Area has 86 members, who

have made commitments to the action area and are registered in the online

collaboration space.


The early work has been to develop a map of existing ICT solutions, which include

electronic health and care records, personal health records, teleservices and

common security components such as identification authorisation and content.

Using these basic components, the group has defined the set of services that is

needed for integrated care. It has begun collecting and analysing examples of over

30 good practices, complemented by literature reviews and inputs from several

relevant EC-financed projects.

The next stage of the work will be to identify key indicators, drawn from the good

practice examples, that may be used to evaluate other ICT initiatives in integrated

care.

Personal health records and patient access to their data in Uppsala - Benny Eklund

Benny described a regional initiative in Uppsala, Sweden, that has evolved over

many years and now provides patients with a wide range of information services and

functions which they can access through an online portal. Some of these have been

developed through the EC-funded Sustains project, of which Benny is the co-

ordinator. These services now include the ability to:

track referrals

examine the EHR

change GP (when moving home or similar)

book or rebook a consultation

pay a consultation fee

pose a question to the GP

fill out a Health Declaration Form

print out a drug and lab result list before travelling abroad

input one’s own opinion

update a phone number or e-mail etc.

Service provision has now been online for 10 months, although development of the

project began in 1997. This portal service now has over 32,000 citizen/patient users.

This number has grown steadily without any particular form of advertising or special

promotion. The services are still acquiring over 100 new users per day. In Uppsala


there is a change of GP by a patient on average every three minutes, and this

process can now take place fully online. One hundred and fifty GPs are contributing.

Of greatest interest to this workshop is that every Uppsala patient can now examine

his or her own EHR. This record contains just about everything that is in the

professionally-held record. When planning this access, there were a number of

professional concerns, about whether some kinds of information should not be

included (such as a recent diagnosis of cancer), or if there should be an inbuilt delay

in new information being accessible by patients (perhaps a one-week or two-week

delay). 98% of patients chose not to have a delay in information being accessible to

them.

It is planed for patients to be able to opt in or out of being an organ donor directly in

their health record. By Swedish law patients have the right to submit their own

opinion on treatment which can be directly inserted into their EHR. This can, for

instance, include comments on what the health professional has stated in their file

(the patient can point out misunderstandings or add to the file). This is a feature that

was only was rolled out in November 2013 and therefore there are currently no

reports on experience providing an analysis of how the initiative is progressing.

The information in the record has been shown to be understood by patients. Only

one out of every 400 contacts made to the central service were about a difficulty in

understanding something in the EHR. Healthcare professionals have reported no

increase in questions from patients as a result of their looking at their own health

record. It has been noted that the majority of users of this service have had recent

clinical encounters, suggesting that most of these are active users of the system.

The highest activity and main use of the service, with patients adding input, is during

mid-week and the lowest level of activity is during the weekend. Users span all ages

from the age of 18 (the age at which access to the record is permitted) until around

age 72 (after which the proportion of users to population drops).

The EHR has an audit log that displays information about every access to the record,

even within healthcare environments. Despite some initial concerns, patient access

to this log (by around 9,000 users to date) has not caused any concerns to patients

or to professionals.

Another feature is that users can state their satisfaction or provide suggestions for

improvements. Of the 300 comments received to date from patients about the

system only a few were negative.

This is an example of a successfully used patient portal. Benny felt that its success

should in part be attributed to the project team being free to “think outside the box”

(and not to be too constrained by any concerns voiced at the start). He felt that it had


also been important to allow the project to develop and gain acceptance over the

many years, to have sustained financial resources for a long-term project, and to

have excellent networking on all levels. Architecting the services on one integrated

record per patient has been an important success factor. It has also been important

to be constantly aware of and manage the risks as well as of the potential benefits.

A case study from Portugal - António Lindo da Cunha

António’s presentation focused on a new platform to support the development and

hosting of applications, products and services for the “Health and Quality of Life”

markets. It is a tool to support bottom-up developments that empower communities.

The platform is open and provides a common personal health record with which

third-party applications can interact, in order to provide them each with a common

underlying information resource and enable interoperability between them. The

portal functions rather like an app store, through which developers can upload and

test candidate applications, and mark them as being ready for public access (after

validation by a member of the core platform team). This platform is therefore an

enabler of the market for software applications to support empowered health. It is

also potentially a vehicle to promote the adoption of standards.

Example applications already available include supporting access to healthcare

services for persons with Alzheimer’s disease and their caregivers, a visualisation of

human anatomy, an application for physical rehabilitation, and for home monitoring

of metabolic conditions such as diabetes.

António indicated that the skills gap between the technology and end-users, poor

interoperability between different systems and a lack of adequate business models

were all barriers that needed to be overcome. An important success factor for the

platform has been to engage with and support the developer community, and to have

worked closely with health professionals.

How to achieve flexibility and interoperability of ICT solutions? Including at

research and living lab level? – Antonio Kung

Antonio pointed out that there are several barriers that inhibit the marketplace for ICT

solutions to support healthy ageing. These include fragmentation, with many pockets

of small-sized markets, and a tendency towards technology push rather than a user

pull. Business models are not strong, and there are issues of governance that have

to be better addressed. He presented a vision in which the French “Silver Economy”


(the market place of products and services supporting older persons) is growing and

is becoming more innovative to better support independent living.

He perceived the major barrier today as being interoperability. However, there needs

to be a critical mass of products that adopt standards in order to achieve successful

interoperability. At present the inverse exists: there is no critical mass, limited

adoption of standards and therefore limited interoperability. This situation needs to

reversed.

Antonio pointed out that today living labs are not particularly using standards within

their infrastructures. Solutions developed in one lab are therefore not portable to

another. This is a serious limitation on their potential to scale up. He emphasised the

need to adopt a platform architecture with standard interfaces and common services.

He drew attention to the IEEE definition of interoperability:

“the ability of two or more systems or components to exchange information and to

use the information that has been exchanged”

Source:

http://www.ieee.org/education_careers/education/standards/standards_glossary.html

Interoperability cannot be regional or national, but must occur at EU and/or global

levels.

Antonio cited the example of Integrating the Healthcare Enterprise (IHE) which

maintains a register of products that have demonstrated conformance to standards

and been shown to work together, so that purchasers can, with confidence, buy a

collection of inter-working products across vendors.

The C2 Action Group of the EIP on AHA is promoting interoperability through the

promotion of standards, and collating best practices including situations in which

standards have delivered benefit. Their intention is to use scenarios for ageing

developed by the Braid Project:

(www.braidproject.eu/sites/default/files/Ageing_scenarios.pdf , summarised in

Figures 14 and 15) as a taxonomy to classify good practices and interoperability

scenarios.

http://www.ieee.org/education_careers/education/standards/standards_glossary.html


Figure 14: C2 intends to use the Braid Ageing Scenarios to classify good practice (1)


Figure 15: C2 intends to use the Braid Ageing Scenarios to classify good practice (2)

Device interoperability: Case studies from the field - Michael Strübin

Michael began by introducing the Continua Health Alliance, which is a not-for-profit

industry association focusing on interoperability for medical devices and personal

health systems (see Figure 16). He explained the many benefits that consumers gain

from interoperability in the telecommunications area, such as ease of use, freedom

of choice, quality and innovation, competitiveness and lower cost. These advantages

should also occur in healthcare, if interoperable systems are more embraced. There

is also evidence of benefit to industry: lower design costs, faster time to market,

increased efficiency and the ability to expand services through a plug and play

capability.


Figure 16: The interoperability landscape of the Continua Health Alliance

Michael illustrated the benefits of interoperability in healthcare through case studies

from RENEWING HeALTH, in which Continua formed and led the industrial advisory

group. As also mentioned in Session 2 of the day's workshop, RENEWING HeALTH

is a large scale (multi-pilot) trial of telemedicine focusing on COPD, cardiovascular

disease and diabetes. The consortium comprises 26 pilot sites grouped in nine

clusters around Europe. He briefly summarised interoperability issues from two

example case studies: one in Germany (Berlin Pflegewerk) focusing on COPD, and

the other in Helse Nord, North Norway.

In both cases the pilots experienced difficulties with their technology choices, which

included problems with inter-connectivity, the reliability of standards such as

Bluetooth, and remarkably also with technology obsolescence. Some mobile devices

were discontinued and no longer supported part way through a trial. This required

the pilots to use mixtures of hardware, operating systems and eventually even

applications. Poor inherent design of some mobile devices was also a problem.


Michael noted that the pilot sites all relied on proprietary systems rather than open

standards, and would therefore find it difficult to update their systems or integrate

new devices. Partly this was due to the fact that at the time of procurement only a

few products that were compliant with Continua (or IHE) standards were available on

the market. Many pilots had to use telephone-based communications from the home

(e.g. to report readings) or manual data entry. He also stressed that there were

important legal and regulatory barriers to overcome.

A fundamental problem in this market is that the public (or purchasers on behalf of

the public) cannot easily demand standards compliance, which fails to create a

demand for interoperable devices, and therefore vendors have no incentive to bring

them to the market.


The Momentum Project - Diane Whitehouse on behalf of Montse Meya

Diane introduced the Momentum project, which is a thematic network running until

mid-2014, and mainly comprises telemedicine associations and competence centres

and healthcare professions, organisations, insurers and vendors. The four

Momentum Special Interest Groups are shown in Figure 17. They focus on strategy

and management; organisation and change management; legal, regulatory, and

security issues; and technical and market relations.

Figure 17: The Momentum project Special Interest Groups

Momentum is examining and building consensus on how integrated product results

become widely adopted. The Special Interest Groups will each tackle a different

dimension of this. For Strategy and Management, the provisional adoption factors

seem to be that the initiative is local and that the initiating body is responsible for the

end-to-end process, whereas legislative and policy factors do not seem to be so

important. For Organisational Change and Management, the success factors appear

to be people rather than organisations, and the involvement of doctors and nurses is

critical; an alternative care pathway to telemedicine should also always be offered.


For Legal, Regulatory and Security Issues, the project has so far observed that legal

hindrances are exaggerated, but that lack of clarity about reimbursement is the real

problem; there may be a need for special patient consent where telemedicine

services are to be used; and in general there is a lack of awareness about privacy

protection and information security. For Technical infrastructure and Market

Relations, the topic of main concern to this workshop session, the lack of integration

with other systems is the major concern: interoperability was cited as a critical barrier

by 47%-50% of studies.

Diane concluded, in relation to the topics of technical infrastructure and market

relations, that telemedicine is only achievable with the exchange of information

between patients, practitioners, suppliers and policy-makers. A common basis for

data exchange is needed for purposes such as real-time communication, access to

health records and other clinical documentation, access to specialised data (for

example, images), and software system interfacing.

Momentum is now developing maturity models and guidelines on the adoption of

telemedicine services: a Momentum Blueprint.

Opportunities from the Virtual Physiological Human – Rod Hose

In contrast to the previous presentations, which had focused on personalising care

based on an individual's healthcare ambitions and current status, Rod described the

novel opportunities for personalisation presented through the use of Virtual

Physiological Human (VPH) technologies. These technologies will enable

personalisation based on an individual's physiology, not just anatomy. They be

predictive and prognostic, rather than just characterising on the basis of the current

clinical picture, and yet will be fully integrated into the clinical care process.

Rod gave an example of research that is now well established arising from the

University of Sheffield, England, on the predictive value of virtual fractional flow

reserve, which can be computer modelled from angiography test results. As shown

in Figure 18, two identical looking anatomical narrowing might have very different

Fractional Flow Rate (FFR) values which indicate the extent of blood flow within

distal (downstream) blood vessels. In one case an operation on that narrowing will

make a substantial difference to a patient's quality of life, but in the other will make

almost no difference. These predictions have been confirmed using clinical trials,

and it is therefore now appropriate that this computation is used to assess patients

before considering such surgery.


Figure 18: Illustration of how different FFR rates might predict different benefits from

an operation on the same artery narrowing

This, and other examples of VPH modelling, are reaching a level of maturity when

they can be used to personalise treatment decisions. These could become very

powerful ways of ensuring that patients have individualised care and each patient

gains the best possible clinical outcome.

In order for VPH technologies to scale and become well adopted, Rod emphasised

the importance of targeting important clinical problems, ensuring clinical enthusiasm,

and having a sound ICT infrastructure so that the models can acquire relevant input

parameters. It is also important for success that comparisons are made with the

existing treatments and decision-making processes, in order to build up the evidence

base of their effectiveness and value. Funding is needed not just to develop

innovative models but to establish this evidence base, preferably in future as large-

scale clinical trials. Other potential barriers or challenges include the speed of

execution of the mathematical models, and how these models handle uncertainty

within the source diagnostic and EHR data.


It is essential that these computational models are embedded within an overall ICT

and information infrastructure in an appropriate way. Figure 19 shows an example of

such infostructure proposed by the VPH-Share project.

Figure 19: Example infostructre embedding physiological modelling components and

workflows

Discussion

The discussion initially focused on whether the presented projects and organisations

had been able to find, eventually, good solutions that met their needs, or whether

they had needed to make the best of solutions that they could pragmatically obtain.

There was general consensus that one of the major obstacles to well optimised and

interoperable solutions is the rapid evolution of technology products, their short life

cycle, and the brief time before they become obsolete, when support is no longer

provided and product evolution ceases.

However, interoperability was seen as the dominant issue in building integrated

(multi vendor) solutions and enabling them to scale and be ported across sites.


Single vendors will often make their own product portfolio interoperable, although

sometimes it is not clear what functional value that interoperability brings (the

example cited was between a television and a kitchen microwave). Some of the

examples encountered at the pilot sites were between communications protocols

and devices (in particular, many devices seemed not to work properly using

Bluetooth, with which they often dropped connections and needed to be Bluetooth-

paired again). Mobile devices purchased at different times might use different

operating systems, and could not always be upgraded. It was generally noted that

SMEs in this particular marketplace are generally more flexible, adaptable, and agile

in responding to functional requirements, whereas the large vendors are usually

driven by the desires of the mass consumer market.

One way of helping to stimulate a more plug and play marketplace, especially for

SMEs, is the app store concept. The workshop had had a presentation from Portugal

of this concept, and it was also noted that an app store is being developed in France.

Others apps store presentations were made during the main part of the AAL Forum

conference on the two following days. However, there was consensus that ideally

such a store should exist at a European level.

The Apple and Android approaches to stores were contrasted, with Apple noted to

have implemented a highly regulated approach, whereas Android is presently more

open and flexible. On the one side, a less regulated approach would be more

supportive of innovation, whereas on the other side a more restricted approach might

encourage greater trust in the quality and safety of the apps. In general, participants

favoured a self regulation approach to this market.

It was recognised that there are organisational and procurement layers between the

developers and vendors of products, and the end-users. These intermediate players

include healthcare professionals, health care provider organisations, and sometimes

health authorities, which may drive purchasing decisions. For large-scale

procurements, there may also be regulatory layers.

There was discussion of why health care technology has not achieved the level of

citizen (consumer) engagement that banking and online billing has done. The

outcome of that discussion was that these other sectors are not directly comparable,

as the incentive for banking – for example – was to automate the service as much as

possible - to replace people and reduce the number of physical branches. Health

care does not have that direct intention (although there is a general wish to reduce

the number of hospitals). Nevertheless, it some ways today's opportunities for the

developers of software and hardware applications for healthcare or care are at least

as large it was for those working in the banking/the financial sectors in the 1980s.


The discussion moved on to the processes of procurement and implementation.

Participants felt that the current processes are not problem-driven enough. Too often

they focus on the technology view (i.e. on the information services that could be

procured) rather than the care service business functions that need to be supported.

This sometimes results in a greater complexity of the end result and a failure to

resolve some of the fundamental challenges in delivering person-centred care.

There was a discussion on two contrasting solutions: for example, whether focusing

on problems is always the best approach, whereas sometimes it proved quite

appropriate to apply solutions to pragmatic elements. It may be beneficial to address

some easy-to-solve problems with readily available technology, and progressively

tackle new areas as they arise. The example from Uppsala in Sweden was noted

where the option to register for organ donation was added after the project had been

up-and-running for a while. The workshop participants agreed that a lot can be

achieved by starting with "low hanging fruit", implementations for which the benefits

can be measured and provide encouragement for downstream expansion. It was felt

that the "distance" between current mobile app stores and the health services market

is not as far as it initially seems. There was also optimism that standards are

gradually being adopted and European regulations are favouring a joined-up market

place and consistent care services.


Session 4 - How business modelling and return on investment can

accelerate products to the market


Who are the decision makers in procurement and what kind of Return on

Investment (ROI) are they looking for in order to take decisions?

How should procurement processes/negotiations be designed to achieve an

optimal eHealth solution for the “buyer”?

Are we currently in a “buyer-led” or “industry-led” market for eHealth services?

How does business modelling activity support (health) policy-makers in the

planning for and introduction of new services? Is it a mandatory part of policy-

making?

What kind of returns on investment are likely to accelerate deployment of

integrated care and independent living services: socio-economic ROI,

financial ROI, technological ROI and health outcome ROI?

What are current “best practice” examples in measuring these types of ROI?

Which are the decisive returns to trigger a decision for procurement?

Discussion with the audience, the presenters and moderator on how the EIP

can help to lower barriers of entry to the market

How business modelling and ROI can accelerate products to market - Shabs

Rajasekharan

Shabs presented from an industry perspective, especially representing the views of

SMEs that he engages within the Basque Country of Spain. Most of them contact his

organisation to transfer technology from the basic research stage to the working

prototype or minimally viable product. . He noted that transferring R&D results into

healthcare has often been unsuccessful, and there are many uncertainties about the

market. Return of investment in healthcare has a slightly different approach to many

other sectors - it focuses not only on financial aspects but also on patient savings. In

response to this, one of the C2 deliverables is establishing a marketplace, to enable

better connection between buyers and sellers. It can be very difficult to work out who

the buyer is within healthcare markets, and what the supply chain looks like and the

C2 marketplace must not be too complex to work within nor seek to propagate

complex models of service delivery.


The business models underpinning health ICT procurements (and underpinning

product development) are not straightforward, since improved health is not a

financial return that most investors look for. It may therefore be difficult to tell if a

detailed business model is really needed. He posed the question of whether there is

too much red tape that prevents a purchase and a provider agreeing a solution.

Shabs observed that most EIP Action Groups do not include much industry

representation except for a small number of SMEs. However, this has been noted by

both the coordination group members and the European Commission and will be

rectified in 2014 when the EIP will begin an industry outreach programme.

How does one evaluate ROI on technology? - John Matheson

Starting us with the quote below from Abraham Lincoln:

“Give me six hours to chop down a tree and I will spend the first four sharpening theaxe”

John emphasised that money should not be the prime driver when seeking to

improve healthcare services (but it will be a secondary driver). Healthcare is not like

the banking business: its first objective is to deliver high quality healthcare. Rushing

into solutions without understanding the problem causes a lot of issues.

Policies to improve care do take time to deliver results, often many years, and

Scotland has therefore committed to set and stick with a clear strategic direction in

order to provide consistency and stability to the political and economic landscape in

which service re-design is effected. Scotland’s national strategic objectives are for

the nation to be wealthier, fairer, smarter, healthier, safer and stronger, and greener.

The objective for health is helping people to sustain and improve their health,

especially in disadvantaged communities, ensuring better, local and faster access to

health care. The aims of the Healthcare Quality Strategy for Scotland are to deliver

the highest quality healthcare services to the people of Scotland, and for NHS

Scotland to be recognised as world-leading in the quality of healthcare it provides.

The triple aim is to improve health of the population, best value for money and


experience of care. Scotland has had a quality strategy in place for the last 3 years

which has resulted in 8000 fewer unexpected deaths.

Scotland’s 2020 Vision is that everyone is able to longer and healthier lives at home

of in a homely setting. The vision focuses on prevention – resetting the agenda by

bringing the health service to the patient. The aim is also to have a different

relationship with business – partnership requires change on both sides of the

partnership. The route map for achieving this has been distilled into 12 priority areas

for action (see Figure 20).

Figure 20: Scotland’s 12 priority areas for action, to deliver its 20:20 vision

John pointed out that, since £1 billion out of £12 billion pounds spent on healthcare

is on drugs. Scotland also has a pharmacy strategy to support the delivery of the

quality strategy in the critical areas of prescribing management.


John described the fora that have been established to help to deliver innovations, in

partnership within industry, including an Innovation Partnership Board, a new Digital

Health Institute and Scottish Health Innovations Limited. There is a wish to establish

laboratories in which prototype integrated and person centred care solutions

(including telemedicine) can be piloted. Return on Investment is not only budgetary

but also how it fits into the 2020 vision. One element of this is to address the use and

benefit of Intellectual Property by exploring how it can be shared between private

and public organisations. Cataluña, Basque Country and Scandinavia are very well

developed in this area and there are lessons to be learnt. The timescales for results

are the year 2020 (although with clear interim milestones and National Performance

Framework targets).

Examples of innovative projects being fostered are the dallas programme, Living it

Up, SmartCare and United4Health (the first three of which had been covered earlier

during the workshop).

The Digital Social Alarm programme - Oskar Jonnson

Oskar informed the audience that social alarms, such as an emergency call button

worn round the neck, may seem straightforward, but in fact there is a complex

service/value chain of stakeholders involved. He outlined a project that is underway

to upgrade the social alarms used throughout Sweden (200,000 users). This telecare

service is important as it increases the security and quality in social care for older

people and people with disabilities living in their own home. The cost of social alarms

is tiny compared to the cost of a hospital admission, which might be prevented

through prompt care intervention. If a user would have to be transferred to special

housing it will cost 170 Euros per day while the alarm service costs 1000 Euros per

year, which represents a considerable saving.

Oskar also proposed that innovation is about doing something new – most of the

time not knowing the final results. You have to test, develop, and deploy it. You can

not call it ‘an innovation’ before it has generated value back to companies, society

and/or a large group of individuals.

The triggers for the Swedish upgrade to digital social alarms are the global shift in

telecommunications from the use of PSTN to Internet Protocol, which will rapidly

render the older technology obsolete. Europe has over 2.6 million units that use

PSTN, all of which need to be upgraded. However, he stressed that this is not only a

technology issue: the full service and value chain has to be remodelled. However, it


is not necessary (and Europe cannot wait) for full Ambient Assisted Living services

to be deployed before upgrading the alarms.

Ideally a user who already has a PSTN alarm should not be disturbed or disrupted.

Monitoring of the system is also a key issue as the testing cycle has to be more often

than every 24 hours to avoid a failure of the alarm not being detected for a long time.

A wide range of stakeholders need to be involved in the decisions about the design

of the upgraded service and the upgrade programme itself, and in defining the

arrangements for procurement, the infrastructure, the delivery of the upgrade

programme, user and technical support (see Figure 21).

Figure 21: the actors involved in the programme to upgrade the social alarms


It proved a huge and important step for each municipality to take responsibility for its

local communications infrastructure, which ensured a consistent approach across

the area and gave economies of scale (e.g. in purchasing, in service contracts). The

key enabler for this has been the municipality recognising the need to change.

Oskar concluded that a technology shift of this kind will not succeed unless all of the

links in the value chain are considered.

Socio-economics of integrated eCare – Ingo Meyer

Ingo described in his presentation how socio-economic modelling can be used to

inform and to evaluate integrated care services. He made clear that socio-economics

means understanding the why and the how behind new service delivery models,

especially the care co-ordination aspects, and looking both at the money flows and

the people. This means measuring the financial benefits (investments and liberated

resources), the financial costs (any extra costs of care and redeployed resources)

and importantly the intangible benefits and costs, such as convenience and

inconvenience.

Ingo explained how these concepts are used through two examples. Both slides

depict the socio-economic return (SER), i.e. the ratio of costs to benefits, for

stakeholders involved in two different types of integrated support services. The

analysis is split into three phases: Phase I is the time during which the service was

implemented, but not yet operational. Phase II is the time of the service pilot, carried

out during the EU-co-funded project. Phase III is the mainstream operation of the

service after the end of the pilot project. Phases I & II are based on actual data from

the project and its evaluated pilot, Phase III is a projection based on the pilot data.

More details on the services that were evaluated as well as more detailed results will

soon be available from http://www.independent-project.eu).


Figure 22: An example of socio-economic return (“More for less”)

The “More for less” example in Figure 22 relates to a service in the UK built around

an online service facilitating the collaboration of the local council, a carer support

organisation (CarersMK) and the provision of support to informal carers. And an

example of integration serving as “business process reengineering”, i.e. a way to

improve the efficiency of service provision. One main benefit is to CarersMK, saving

financial and staff resources through a digitisation of their support services, including

switching from paper newsletters to online newsletters, introducing digital client

records, online event management and other changes. They achieve a very high

return rate in Phase II based on these benefits, without having (yet) to pay for the

online platform, as part of an internal arrangement with the IT provider. In

mainstream operation, they will actually pay a fee, bringing down their return rate in

Phase III, which stabilizes at the considerably high level of ~1000%. This

streamlining actually allows CarersMK t reply to a request to do “more for less”

stemming from austerity conditions that can today be found in many local councils in

England and elsewhere.


Figure 23: An example of socio-economic return (“More for more”)

The “More for more” example in Figure 23 relates to service in Trikala region in

Greece, built on the collaboration between different local service providers and

addressing informal carers of people with dementia through psychological

counselling via video communication. And an example of an integrated service

delivering improved client outcomes (in this case a reduction of carer burden) at an

increased cost (mainly in terms of staff time needed to deliver the service). The

service was clearly seen as beneficial by the informal carers (statistically significant

reduction in carer burden, measured by the Zarid Burden Interview). During Phase II,

the ratio of costs to benefits is ~200%. For mainstream operation, a client-payable

fee needs to be introduced in order to cover the costs of service provision. Paying

this fee in Phase III reduced the informal carers’ SER to about 100%. For the two

service providers DEKA (psychology services) and KAPI (community support

centres) the service seems to make a loss at first glance, since SER is about -20%

after 7 years. In reality, service provision is paid for from a public budget and the

additional revenue from the client-payable fee allows the reduction of that budget by

about 80% absolute (i.e. from-100% to -20%) in the medium- to long-term.


Discussion

Scottish Health Innovation limited is a PPP to hold the IP generated by innovation

projects acting as a public – private partnership. The way the partnership operates

provides IP benefit for both sides providing an integrated health system with focus on

a single sector. New Scottish legislation, the Adult Health and Social Care

Integration Bill, will enable integrated health and social care budgets which will

address some of the issues relating to shifting resources from acute sector care to

community / primary care based services.

The Basque Country has begun to adopt innovative procurements to facilitate uptake

of new independent living solutions. Examples and ways to measure success were

requested by the audience. Public funding for RTD is provided to SMEs as long as

they work with the knowledge founders. For successful cases additional funding is

provided. However, the biggest challenge was found to be to identify relevant pilots,

as well as the way government funds services. Procurement in general provides a

barrier as it on occasions leaves companies with an insufficient market to produce

complete enough solutions. Currently there is a trend in the Basque Country to utilise

Latin America as a secondary market to avoid being reliable on governmental

funding. This is a reaction to the realisation that looking for public funding is not

viable as a business model any more, as it often provides no return for the initial 2

years.

Health ICT start ups might not nowadays secure public funding, but might need to

borrow money for a couple of years and then look for an open market, maybe

internationally. Benefits often do not accrue to the private sector, but purely to public

and third sectors. The workshop found that as spending and saving are not aligned

and if the benefits are substantially intangible, it may be necessary to ask "from a

societal perspective does it makes sense to proceed in this way" (rather than to seek

a financial justification). Because many pilots are silos it can become difficult to

encourage developers to become involved.

Multiple stakeholders are needed for project success, but their engagement often

changes the design of a solution. This might be a positive step but will change any

business model projections. Some of the projects found during their workshops that

relevant solutions are already in place.


It was stressed that timeframes need to be realistic. It has to be taken into

consideration that there might be losses to start with which creates the need for

more sensitive models which are able to accommodate this. The question was asked

if business models are really required in policy making. The use of the business

model canvas is probably very helpful. Sometimes it serves as a tool to get

stakeholders to speak with each other. One suggestion was to make the best

system for 1 customer and then scale it up.

It may be necessary to change the language for healthcare staff who sometimes

resent business terms or English terms and adapt the language (literally and

metaphorically) based on the audience and country. In addition the involvement of all

stakeholders in the process give process value instead of “force feeding” solutions.

Return from ICT investments can take 5-7 years, but this can be justified if the

eHealth strategy is on that time scale. It needs to be realistic and as long as there

are realistic milestones the consensus was that it is important to get started, as

otherwise projects slip even further away from obtaining a solution.


SESSION D1: EIP on Active and Healthy Ageing – Supporting

Integrated Services and Independent Living at Scale

Chair: Christine McClusky, NHS 24, SCIT, Scotland

Speakers: Shabs Rajasekharan, Vicomtech, Spain and Donna Henderson, NHS 24,SCIT, Scotland and Mariëlle Swinkels, and Dipak Kalra and Jon Dawson, andAntonio Kung, EIP and Christine McClusky, NHS 24,SCIT, Scotland,

Rapporteur Peter Larsson (East Sweden Regional Development Agency)

A summary of the EIP and of the main workshop discussion points was presented at

a plenary session of the AAL Forum conference the following morning. This

conference session served as a dissemination event for the eHealth Innovation

project and Action Groups B3 and C2. Around 80 participants were present.

Introduction to European Innovation Partnership on Active and Healthy Ageing

A short introduction of ageing as a global challenge was given. Connection with

Health in Europe 2020 and the flagships for smart, sustainable and inclusive growth.

European Innovation Partnerships (EIPs) are a new approach to EU research and

innovation. EIPs are challenge-driven, focusing on societal benefits and a rapid

modernization of the associated sectors and markets. EIPs act across the whole

research and innovation chain, bringing together all relevant actors at EU, national

and regional levels in order to: (i) step up research and development efforts; (ii)

coordinate investments in demonstration and pilots; (iii) anticipate and fast-track any

necessary regulation and standards; and (iv) mobilise ‘demand’ in particular through

better coordinated public procurement to ensure that any breakthroughs are quickly

brought to market. Rather than taking the above steps independently, as is currently

the case, the aim of the EIPs is to design and implement them in parallel to cut lead

times.

EIPs streamline, simplify and better coordinate existing instruments and initiatives

and complement them with new actions where necessary. This should make it easier

for partners to co-operate and achieve better and faster results compared to what

exists already. Therefore, they build upon relevant existing tools and actions and,

where this makes sense, they integrate them into a single coherent policy

framework. Flexibility is important; there is not a 'one-size fits-all' framework.

EIPs are launched only in areas, and consist only of activities, in which government

intervention is clearly justified and where combining EU, national and regional efforts

in R&D and demand-side measures will achieve the target quicker and more

efficiently.


Action Groups

There are 6 Action Groups and in this seminar we focus on Action Groups B3 and

C2. Action Group B3 focuses on Integrated care for chronic conditions, Action Group

C2 focuses on ICT solutions for independent living and active ageing.

It is possible to join the EIP Action Groups when they are open with an application,

but for the moment only B3 is open. If someone wants to join they can contact the

Action Groups for more information. The value of EIP has been identified by the

partners. Most value is in forming partnership and exchange good practice.

Action Group B3 presented the membership and action plans. The key thing is to

challenge/sharing good examples and success factors and lesson learning.

Action Group C2 has focus on ICT solutions in 2 areas. Validating implementations

and evidence on return on investment. They are also working on a toolkit to in an

easy way share examples and what is going on. One of the goals is to build a

sustainable AHA engaged learning community of networks.

Communication between the Action Groups is important to develop. It is low

engagement from the industries. The network must also be built on trust and relation.

Feedback from seminars day 1 during AAL forum 2013

Person Centred Care

Drivers for person centred care include the rising cost of care. 80% of EU spending

on healthcare goes to the chronic ill. We must integrate multiple health and social

care actors and work with preventing and promoting wellbeing especially for the

group 65-75 years old. The chronic ill have to be taken care on in a person centred

way.

User empowerment: Focus, good practice, opportunities and challenges.

4 key points are Confidence building, Awareness raising, Co-creation and Inclusion.

Presentation of some examples from the previous day’s seminar was given. One of

the opportunities is more effective and commercially viable products and services.

Among the challenges there is a question if good practice is transferable and another

is how we can involve users to develop toolkits.


Innovation ecosystem

Will help to create a market. The barriers are no interoperability, no standards, and

no critical mass. The main challenge in the innovation ecosystem is to practice

interoperability and built an interoperability framework. How can big companies be

involved more and interact with small companies in innovation of new solutions. How

can we identify local needs?

How business modelling and return on investment can accelerate products to the

market.

An example on a value network in healthcare shows, it is very difficult to follow and

understand. That is one of the problems to get an overview over the system. The

Scottish government is a good example how to get all the stakeholder to the same

board. We have to build business modelling from a different viewpoint and look for

value for the customer.

Conclusions: Opportunities vs. Challenges

Policymakers are open to innovation

Time frames in politics vs. those in gathering evidence

Business model canvas and a new language

Involving all the value chain in process and time to market

There is a return in ICT for integrated care

Time to return is long

EIP-AHA, marketplace to drive demand and supply

Taxonomy, duplication and resources

Key questions for the future

What kind of toolkit what form should it take to be effective and how do we involve

users.

Transferability of deliverables to other regions

How the EIP digital marketplace should be defined to drive demand and supply.


Other discussion points

A question was raised about the affordability to society of increasing life expectancy

of individuals, thereby increasing further the proportion of older people persons in

Europe, and impacting adversely on the ratio of older people to working age

populations. There was agreement that, if older people do lead healthier lives, our

current transition age of 65 years from working to retirement should be able to be

increased to 70, or perhaps even 75. However the critical issue will be whether those

healthy old age adults are able to be employed, and to contribute productivity rather

than dependence. Our ability to employ these older persons will, and rightfully

should, be influenced by our ability to employ our young, for whom we do have

currently an unemployment problem.

A number of participants in that session expressed an interest in becoming more

involved in the EIP, and gave their contact details to various action group

representatives who were present.

Documents

D5.1 - Integrated and Person Centred Care Workshop Report - v · PDF file© e H e a l t h I n n o v a t i o n P r o j e c t P a g e | 7 Foreword by Professor George Crooks OBE Medical