2nd eHealth Innovation Workshop
Integrated care, patient empowerment & co-production of health
World of Health IT Congress, Copenhagen, May 2012
Dipak Kalra
Jörg Artmann
eHealth Innovation in support of the
EIP: barriers and enablers for patient
empowerment
Workshop agenda: first half
Workshop agenda: second half
Introduction: what we promised at the
beginning of eHealth Innovation
• Europe needs more person-centred health
services
- motivate and support people in caring for their own health
status
- engage and support health professionals, service providers
and other stakeholders
• This requires
- synthesising evidence from good practice examples,
learning from their success factors
- defining a realistic and high impact vision for person centred
services and person empowerment in health production
- proposing value propositions and business models
- identifying strategic steps at policy, organisational,
legislative and technical levels: a roadmap
Outline of this presentation
• Introduction: patient empowerment focus in the
EIP
• Case study material collected by the eHealth
Innovation project
• Some lessons learned on scaling-up local good
practice
• eHealth innovation as a political challenge:
lessons from a German Marshall Fund
symposium
• Conclusion
Patient empowerment as the new
paradigm for ageing in the EIP
• Ageing should be perceived as „a positive vision
which values older people and their contribution
to society; their empowerment to influence and
benefit from user-centred innovation in active
and healthy ageing.”
• Three priority action areas: “Improving
effectiveness of clinical outcomes through
improved health literacy, patient empowerment,
ethics and adherence programmes (A1)”
Patient empowerment as a strategic
pillar of the EIP operational plan
How does patient empowerment
translate to health services?
• The eHealth innovation project has collected
case study material from its partners and
publicly available sources
• Guided by a structured template
• All of the cases focus on the special needs of
elderly citizens with chronic conditions or other
impairements
Some examples of application areas
• eCaalyx project: Health monitoring of older and elderly persons with multiple chronic conditions, at home and on the move
• Prevent deterioration of the patient condition by providing continuous support, guidance, and relevant health education.
• eCAALYX is composed of three main subsystems - The Home Subsystem, which includes Customer Premises
Equipment (CPE), Set-top-box (STB)/interactive TV (to deliver health education and other functions), Tricorder and home sensors (those sensors that are stationary and not continuously worn on the body), all of them located at home;
- The Mobile Subsystem, which includes a ―smart‖garment, with all sensors integrated into a wireless BAN—Wearable Body Sensors (WBS), and a mobile phone;
- The Caretaker Site, which includes the Caretaker Server and the Auto-configuration Server.
Nexes project: facilitating cross-sectoral
care for the elderly
• University hospital Barcelona at the core
• Deploying four integrated care programs for chronic patients based on structured interventions addressing prevention, healthcare and social support.
• ICT enabled care platform provides: - Health portal,
- Call centre service,
- Professional mobile access,
- Patient wireless monitoring service,
- Collaborative work service,
- Security modules
- Interoperability module with hospital information systems and shared electronic patient records.
Sotiria hospital: providing ICT enabled
rehabilitation services
The hospital has deployed a number of services:
• Two-way real time interactive video and voice to allow the patient to electronically meet face to face with a nurse or doctor on a scheduled or on emergency basis.
• Real-time transmission of patients’ vital signs (ECG, electronic stethoscope, spirometry, oximetry, blood glucose, weight, blood pressure), which are automatically collected and logged into patient’s
• Medical Health Record, located in the central database of the Unit. The control of the database is conducted by a management system, which is supported by specifically designed medical expert systems.
• Continuous monitoring of biosignals through the use of innovative, non-invasive wearable systems that allow transmission of ECG, heart and respiratory rate, oxygen saturation, activity and body position.
• Intelligent Internet access to electronic libraries, via the management system, for automatic retrieval of medical information related to patients’ diseases.
Some lessons learned from cases
• Build on predecessor structures or projects to
expand promising approaches further (eCaalyx
was preceded by Caalyx)
• Rely on medical leadership and experience
(Nexes)
• Build solutions based on a medical and social
service vision and NOT around a promising
technology (Sotiria)
• Both NEXES and Sotiria rely on shared access to
an electronic patient record
• Consider the upscaling from pilot to running
service already in the project design
Strategic insights from a GMF
symposium
• EU-US memorandum of understanding
surrounding “surrounding health related
information and communication technologies” in
2010
• In November 2011, the German Marshall Fund of
the United States (GMF) and the U.S. Mission to
the EU gathered in Brussels a small high-level
group of experts from both sides of the Atlantic,
policy makers, academics, and private sector
representatives, to produce a set of concrete
policy recommendations on innovation and
healthcare.
Key recommendations from the German
Marshall Fund on eHealth innovation (1)
1. Business models for healthcare services must be adapted to better encourage efforts towards having healthy citizens and good clinical outcomes that are aligned between payers/insurers and providers.
2. New reimbursement models must be designed and effected to give preferential return for investments in sharing care with patients and for richer empowerment services (focusing on long term conditions).
3. Codes of professional practice need to be developed for high quality patient education and support of self-care and health promotion, which must be endorsed by professional bodies and professional insurers to give confidence across all stakeholder groups.
4. Codes of practice and legal clarification of accountability are needed for care organisations and individual practitioners receiving and using patient provided health information.
Key recommendations from the German
Marshall Fund on eHealth innovation (2)
5. Procurement guidance is required for regional level organisations to encourage more interoperable and standards based eHealth solutions.
6. Investments are needed in education of the clinical workforce and of society in the use of health IT, in supporting self-care, and how the public can critically assess Internet resources.
7. Investment is needed into evaluations (including standardised metrics) to better demonstrate evidence of clinical and economic outcomes, and containment of risk, from self--management and patient empowerment eHealth solutions.
8. Strong leadership is needed to actively champion relevant initiatives that accelerate the adoption of eHealth innovations.
SLIDE ARCHIVE from 1st Workshop in Budapest
EC workshop on chronic disease management for an ageing population:
good practice and innovative solutions
World of Health IT Congress, Budapest, May 2011
Dipak Kalra
Veli Stroetmann
Towards a European roadmap for
sustained eHealth Innovation
eHealth Innovation context
• Existing models of health care services are
unsustainable (rising needs and costs)
• e.g. rising incidence of chronic diseases and increased complexity
of their treatment
• Need for better integration across wellness, health care,
public health, occupational health & social care
• Need to harness the immense contributions that patients
and citizens can make in:
• managing their own health and conditions
• preventing illness
• promoting well-being
Changing roles and relationships
Personalised health services and Infostructure
• Focus on prevention and support of patient self-care and
life style management
• Improve management of long term conditions
• virtual teams
• close to home and ambulatory health services
• person-centric information capture and delivery
• patient-tailored knowledge at the point of decision making
• Share power and responsibility with patients
• co-production of health
Strategic success factors
• Policy, organisational, insurance and reimbursement
changes
• Attitude and culture changes
• Ethical considerations
• Educational of professionals, managers, patients and
health citizens
• Willingness to share decision making and responsibility
with patients
• Willingness to collaborate with social care, domiciliary
care, health charities, complementary therapists,
families, workplaces, social networks
Objectives of eHealth Innovation
• Analyse, achieve consensus on and prepare a detailed eHealth
Innovation Roadmap on medium-term practical steps towards
more patient/person-centred health services
• Analyse, achieve consensus on how this can be facilitated by
innovative eHealth solutions and services – in particular
electronic health records (EHR), personal health records (PHR)
and personal health systems (PHS)
• Prepare the Roadmap with the clear aim to support and
empower patients in managing their health
• Define the resulting needs and requirements for a supporting
ICT infra- and infostructure
• Articulate efficiently further development, innovation and large
scale deployment measures as perceived by various
stakeholder and expert groups
Overall strategy
eHealth Innovation Partners
UCL Consultants Royal College of Physicians
empirica European Connected Health
Campus
Klinisk Informatik University of Sheffield
EuroRec AOK Rheinland/Hamburg
Continua Health Alliance Government of Catalonia HTA
Agency
University of Manchester Czech National eHealth Forum
National Institute of Public Health EHTEL
Republic of Slovenia COCIR
French Ministry of Health Universitat Pompeu Fabra
Dutch Association for Primary and Health Consumer Powerhouse
Integrated Healthcare University Hospitals of Geneva
County Council of Uppsala F. Hoffmann-La Roche AG
WP1: Chronic disease management for an ageing
population
• Identify good practice and innovative solutions
• Examine models of cooperation between patient and
health professionals
• patient access to his/her health data
• improved information sharing, decision-sharing and care co-
ordination
• Formulate recommendations for large scale
deployments based on good practice examples
• drivers
• barriers and mitigations
• success factors, including incentives
WP2: Personalised health services and patient centred
care
• Define distinct and concrete patient/citizen engagement
scenarios, focusing on older and frail patients
• Prioritise those of greatest feasibility and impact
• Examine legal and regulatory issues, public policy,
health technology assessment, business models
• Encapsulate the European vision, culture, goals and
objectives for patient-centred healthcare
• Personal Health Systems (PHS), Personal Guidance Systems
(PGS)
• Chronic disease management (CDM) and integrated care (IC)
WP3: Patient empowerment systems and solutions
• Identify key success factors for establishing patient
online portals and patient access to their health
information
• Examine the determining factors for patients to be co-
producers of health in a societal and organisational
context
• Define value-creation models of the
co-production paradigm
• Define possible eco-system architectures of
co-production
• Analyse data, information and knowledge flows needed
for PGS integration with PHS and PHR
WP4: EU-wide eHealth infostructure
• Aim to build on existing national infrastructures
• Support scenarios for patient care,
self-management, health education, public health, health
research
• Infostructure challenges:
• semantic interoperability
• advanced EHR based solutions
• infrastructure and interfaces
• knowledge generation (e.g. from patient monitoring)
• feedback to patients (and doctors)
• data re-use
WP5: European roadmap for realising personalised health
services
• A framework of axes and axis values reflecting
orthogonal perspectives on the eHealth Innovation
challenge
• Strategic steps, policy ingredients, actions, mile-stones
and outcomes
• including specific guidelines, for the large scale deployment of
innovative eHealth services
• derived from WP 1-4
The ehealth Innovation landscape
