connected health and the digital content sector opportunities for growth
DESCRIPTION
The pervasive influence of the digital content sector is becoming more evident in the health sector, with the development of connected health, which seeks to use digital technologies to link the main players in the industry more effectively, most importantly clinicians and patients.TRANSCRIPT
Connected Health and the Digital Content Sector Opportunities for Growth
INTERREG IVA REGION
Northern Ireland (excluding greater Belfast), western Scotland and the six Republic of Ireland border counties
© 2015 Honeycomb – Creative Works Partnership comprising Ulster University, Creative Skillset, Dundalk Institute of Technology and University of the West of Scotland.
Report written on behalf of Honeycomb – Creative Works by PMCA Economic Consulting and Ruby Consulting (Pat McCloughan, Alan Costello and Eoghan Jennings).
All rights reserved.No part of this book may be reproduced or transmitted in any form or by any means, including photocopying and recording, without written permission of the copyright holder, the Honeycomb – Creative Works Partnership. Such written permission must also be obtained before any part of this book is stored in a retrieval system of any nature.
Requests for permission should be directed to: Regional Development Centre, Dundalk Institute of Technology, Dublin Road, Dundalk, Co. Louth, Ireland.
Disclaimer While the Honeycomb – Creative Works Partnership believes that the information in this document is correct at the time of printing, it does not guarantee that this is so, nor that the information is suitable for any particular purpose. By virtue of preparing the report or otherwise in connection with this study, the Honeycomb Partnership and the authors of the book will not assume any responsibility or have any liability to any third party or for any loss or damage arising from any use of the information contained therein.
The views and opinions expressed in this report do not necessarily reflect those of the European Commission or the Special EU Programmes Body.
03 PROFILE OF THE CONNECTED HEALTH SECTOR 16
3.1 Introduction 16
3.2 Segmentation 17
3.3 Service Offering 18
3.4 Venture Funding 20
3.5 Connected Health within the Honeycomb Region 22
04 REVIEW OF RELEVANT RESEARCH 23
SECTION B
CONNECTED HEALTH SUBSECTORS FOR GROWTH
05 THEMES HIGHLIGHTED IN CONSULTATIONS WITH STAKEHOLDERS 26
5.1 Connectivity 26
5.2 Data Analytics 27
5.3 Patient Outcomes 27
5.4 Patient Adoption 27
5.5 Regional Localisation 28
5.6 Regulatory Oversight 28
5.7 Human-Centric Design 28
5.8 Selling to Monopolistic Buyer (‘Monopsony’) 28
5.9 Summary 29
– 1 –
EXECUTIVE SUMMARY 4
SECTION A
INTRODUCTION, CONTEXT AND PROFILE 01 INTRODUCTION 6
1.1 Purpose of the Report 6
1.2 Summary of the Digital Content and Connected 6
Health Sectors
1.3 Objectives of the Report 7
1.4 Methodology 8
1.5 Summary of Relevant Strengths and Weaknesses of the 8
Eligible Area
1.6 Summary of National and Regional Policies and Initiatives in 10
Support of Digital Health
1.7 Research Capacity and the Emergence of Connected Health 11
Clusters
02PROFILE OF THE DIGITAL CONTENT SECTOR 12
2.1 Definitional and Measurement Issues 12
2.2 International Trends – Evidence from the OECD 12
2.3 The Digital Content Sector in the Countries of the Eligible Area 13
2.4 The Digital Content Sector within the Eligible Area 13
2.5 EU Digital Single Market Strategy 15
– 2 –
06 CRITERIA USED TO DETERMINE RELEVANT SUBSECTORS 32
6.1 Nature and Intensity of Links between Connected Health 32
and Digital Content Sectors
6.2 Leverage Local Industry and Academic Resources 32
6.3 Export-Oriented 32
6.4 Taps Skill Base 33
6.5 Addresses a Real Problem – Meeting Need as well as 33
being Technologically Sound
6.6 Competitive Landscape and Speed of Industry 33
07 RELEVANT SUBSECTORS FOR COLLABORATION AND GROWTH 34
7.1 Infrastructure: Analytics and Training 36
7.2 Treatment: Personalised and Assisted Care Coordination 38
7.3 Engagement: Emotional Health Tracking, Patient 39
Engagement & Advocacy
7.4 Diagnosis: Self-Diagnosis and Home Monitoring 40
SECTION C
MEASURES TO ASSIST GROWTH
08 COMPANY MEASURES 41
8.1 Consumer Companies in Healthcare 41
8.2 Medical Companies in the Consumer Space 42
09 MEASURES TO DEVELOP SKILL SETS AND STRENGTHEN NETWORKS 43
10 MEASURES TO BOOST FUNDING AND INCREASE SUPPORT 44
11 MEASURES TO CATALYSE CULTURAL CHANGE IN HEALTHCARE 45
11.1 Cultural Change among Clinicians and Patients 45
11.2 Increased Awareness of the Communicative/ 45
Transformative Power of Digital Media
11.3 Collaboration with Universities as Customers 46
11.4 Move Away from a ‘One-Size-Fits-All’ Approach 46
CONCLUSION 47
REFERENCES 48
ANNEX 1 EXAMPLES OF CONNECTED 50
HEALTH INITIATIVES SUPPORTED BY
HONEYCOMB
– 3 –
LIST OF FIGURES
Figure 1: Digital Health Market Projection by Segment 16
Figure 2: Digital Health Funding Snapshot, 2010-2014 YTD 20
Figure 3: Digital Health Venture Funding, 2011-2014 20
LIST OF TABLES
Table 1: Summary of Key Strengths and Weaknesses of the Eligible Area 9
Table 2: Scale and Segmentation of the Connected Health Market 17
Table 3: Summary of Service Offerings in Connected Health 19
Table 4: Funding of Top Categories of Digital Health, 2014 (US) 21
Table 5: Summary of Recent and Relevant Publications 23
Table 6: Summary Table of Key Themes in the Market for Connected Health 30
Table 7: Subsectors of the Connected Health Market with the Most Promising Growth Potential 35
Table 8: Subsectors of the Connected Health Market with the Most Promising Growth Potential
Subsectors within Healthcare Infrastructure 37
Table 9: Subsectors of the Connected Health Market with the Most Promising Growth Potential
Subsectors within Healthcare Treatment 38
Table 10: Subsectors of the Connected Health Market with the Most Promising Growth Potential
Subsectors within Healthcare Engagement 39
Table 11: Subsectors of the Connected Health Market with the Most Promising Growth Potential
Subsectors within Healthcare Diagnosis 40
– 4 –
Executive Summary
This scoping study report
has been prepared for
Honeycomb – Creative Works
at the Dundalk Institute of
Technology. It considers the
prospects for integrating the
connected health sector with
the digital content sector in the
Honeycomb eligible area, which
comprises the six border counties
of Ireland, Northern Ireland (NI)
(excluding the greater Belfast
area) and the western seaboard
of Scotland, between now and the
end of the decade, and beyond.
The digital content sector is part of the wider
creative sector, bringing together creative and design
activities with IT, thereby embodying both artistic
and technical/engineering skills. The digital content
sector is a malleable and fast-moving sector, and
includes as subsectors games, animation and online
content. While employment in absolute terms is
currently comparatively low in the digital content
sector, it is nevertheless a sector in which jobs are
growing, even during the crisis years, and its share of
overall employment has increased over recent years.
It is synonymous with the knowledge economy and
is pervading other sectors of the economy rapidly
and playing an increasingly important part of our
everyday lives.
The pervasive influence of the digital content sector
is becoming more evident in the health sector, with
the development of connected health, which seeks
to use digital technologies to link the main players
in the industry more effectively, most importantly
clinicians and patients (and their families, which
are very important because children and the elderly
are among the biggest users of healthcare and their
families are often the “voice” of these patients).
Greater integration between the connected health
and digital content sectors forms part of each of
the economic development strategies of Ireland, NI
and Scotland, where the aims are to improve patient
outcomes and reduce the costs imposed on the
national health systems.
In the eligible area, the digital content sector is
largely fragmented – the vast majority of businesses
are small (typically micro businesses), there are
many freelancers working in the sector on a part-
time basis and markets served are predominantly
local in nature. In addition, the extent of foreign
direct investment (FDI) in digital content activities
is low in the eligible area compared with that in the
main urban centres (Belfast, Dublin, Glasgow and
Edinburgh) and broadband availability remains a
major issue in some parts of the eligible area. The
digital economy and its development thrives mostly
in larger economic centres, which benefit from talent
pools, clusters and infrastructure (including groups
of third-level institutions and high-speed broadband
as well as ‘hard’ infrastructure such as transport
networks).
Given that healthcare policy is to a large
extent determined nationally, and owing to the
concentration of digital content sector activities
in larger urban centres, it is envisaged that over
the next number of years the main connections
will occur in these centres and in sectors that
have a proven track record of connection between
the digital content and healthcare sectors. These
include big data and predictive analytics; clinician
training and assisted living/aging; other convergence
opportunities include clinical trials, virtual care
coordination and navigation; patient education and
advocacy, and self-diagnosis.
Geographically, while most of the convergence
opportunities are likely to occur in the major urban
centres in each of the three countries of the eligible
area, there is nonetheless the opportunity for
the eligible area proper to benefit in the process.
Accordingly, initiatives (like Honeycomb) need to
ensure that the region is well-placed to respond to
the opportunities and are connected to a greater
extent to the developments occurring in the main
urban centres of the countries.
– 5 –
1.1 PURPOSE OF THE REPORT
This report provides a scoping study regarding the
possibilities for collaboration between the digital
content sector and the connected health sector in
the Honeycomb eligible area, which comprises the
six border counties of Ireland, Northern Ireland
(excluding the greater Belfast area) and the western
seaboard of Scotland. The report considers the
opportunities for growing cross-collaboration
between the two sectors in the eligible area for
the mutual benefit of providers in both sectors and
patients in the connected health sector.
1.2 SUMMARY OF THE DIGITAL CONTENT AND
CONNECTED HEALTH SECTORS
There is no universally agreed definition of the digital
content sector but nevertheless it is generally
closely associated with the digital media and creative
industries, and includes (but is not necessarily
limited to) film and broadcasting, animation, games
development, music technology and interactive media
(online interactive content). Across the eligible
region and internationally, digital content today
pervades our daily lives, reflecting the widespread
SECTION A
Introduction, Context and Profile
use of IT technologies in our lives. Increasingly,
as witnessed by enterprise developments in the
Honeycomb eligible area, entrepreneurs and
innovators are looking to make connections between
digital technologies (hardware and software) and
other sectors of the economy, notably health.
Digital healthcare or ‘eHealth’ involves the application
of digital technologies to healthcare; for example,
the use of smart devices to tell patients when to take
their medicines or to relay medical information about
concurrent health measures to centralised monitoring
systems. The interconnectedness between digital
media and healthcare presents those working in the
sectors with unique interdisciplinary possibilities
to research and promote healthy lifestyles while
managing illness and health risk. Moreover, digital
healthcare technology development for eHealth
systems enables regional and national healthcare
investment to respond to emerging health and ageing
population trends highlighted in the EU task force
report ‘Redesigning health in Europe for 2020’, which
aims to ensure that all citizens have consistent
access to a high level of healthcare across Europe,
at a reasonable cost to national healthcare systems.
In advanced economies, eHealth has the potential to
01Introduction
– 6 –
bring together medical and healthcare professionals,
social scientists and public health policy advocates,
computational and computer scientists, and digital
media platform experts to invest in helping patients
and clinicians to optimise health management in new,
cost-efficient, and patient-focused ways.
Undoubtedly one of the main trends in global
healthcare now occurring is the shift towards more
personalised healthcare and this is reflected in
the movement by pharmaceutical companies from
‘blockbuster’ drugs to ‘niche-buster’ treatments on
a more customised basis. The availability of mobile
technology also means that people have greater
information regarding diagnosis and management
(including testimonials from other people with
the same or similar conditions) and this is leading
to greater patient empowerment in the process
(including through apps etc.).
1.3 OBJECTIVES OF THE REPORT
Honeycomb is an EU INTERREG IV-funded
programme aimed at supporting the digital content
sector in the aforementioned eligible region. It has
acted as a research hub, a collaborative network and
a resource for small and medium enterprises (SMEs)
in the region seeking to partner and grow their way to
success.
Honeycomb is seeking to develop pathways between
the digital content sector and other sectors, so that
companies and research groups in the eligible region
can benefit from further growth. Convergence
between sectors is a common theme in the current
economic development strategies underway in
Ireland, NI and Scotland – a common denominator in
each case being the role of the digital content sector
(as part of the wider IT sector) and the opportunities
presented in terms of assisting employment growth
in other sectors, like health.
Generally speaking, underpinning the opportunities
relating to enhanced convergence between the digital
economy and other sectors, including health, are the
conditions of technological feasibility and market
demand. Both are needed. For example, a new
health initiative may be technologically sound but
will not be amenable to commercialisation if it fails
to capture a market demand based on patient need;
similarly, different types of patient may have well-
identified needs but these will not be feasibly met if
the technologies available are not fit-for-purpose. In
this way, new digital developments in the healthcare
sector need to be both demand and supply-led. They
also need to be cost-competitive – to attract the
attention of buyers, which occur at different levels
of the healthcare value chain, namely national health
executives, down to hospitals and primary care
centres and ultimately to patients and their families.
This scoping report seeks to identify the extent
to which the health sectors in the three parts of
the Honeycomb eligible area are connected with
the digital content sector, and, in each case, which
parts of the health sector are particularly digitally
connected and where the best opportunities for
sectoral collaboration are likely to occur between
now and the end of the decade, and beyond.
Introduction
– 7 –
– 8 –
1.4 METHODOLOGY
The research methodology for this report has entailed the following work
elements:
• Desk research – where we have reviewed market reports and policy
documents;
• Primary research – in which we have conducted interviews with individuals in
the digital content and connected health sectors;
• Validation of findings – in addition, we shared our emerging findings with a
second set of selected stakeholders to confirm our understanding of the
opportunities and to seek ‘road-testing’ of our high-level measures to assist
integration between the sectors.
We conducted the interviews mostly by telephone, with some face-to-face
meetings in addition. Some respondents have chosen not to be identified given
commercial considerations and/or not to have any views directly attributed (some
of those with whom we spoke are therefore not identified in the report).
1.5 SUMMARY OF RELEVANT STRENGTHS AND WEAKNESSES OF THE
ELIGIBLE AREA
Table 1 opposite presents a summary of the eligible area’s strengths and
weaknesses in relation to developing greater connectivity between the digital
content and connected/eHealth sectors. While there may be some opportunities
stemming from the identified strengths, there are also considerable challenges
to developing connected health technologies in the eligible area, arising from the
identified weaknesses.
No single initiative – such as Honeycomb – can realise the opportunities or
address the challenges on its own; however, what it can seek to achieve is to
facilitate the environment in which entrepreneurial connections can be made
to assist in the development of eHealth, in tandem with other business support
agencies and in line with national policy goals.
Introduction
Table 1
Summary of Key Strengths and Weaknesses of the Eligible Area
STRENGTHS WEAKNESSES
• National economic development strategies in place – health sector identified as a key economic sector, both in its own right as a major employer but also as a user of digital technology, thereby helping to stimulate development of the digital economy
• Emphasis on growing local companies as well as attracting foreign direct investment (FDI) in the IT and digital economy sectors
• Strong third-level educational attainment in the eligible area
• Relatively high levels of enterprise and entrepreneurship
• Some clusters of digital content activities and/or eHealth developments underway in the eligible area
• Strong cultural linkages among the parts of the eligible area
• Eligible areas peripheral for the most part
• Variable broadband availability
• Significant damage caused by the economic recession from 2008
• Tradition of relatively high unemployment and emigration, which persists throughout the region following the economic collapse of 2008
• Challenge of retaining or attracting graduates back to live and work in the eligible area
• Small scale of enterprises in the digital content sector
• Narrow economic base arising from over-dependence on agriculture, traditional manufacturing and the public sector
• Low penetration of knowledge-economy in comparison with the more developed parts of the three countries concerned
• Reliance on traditional funding sources and little in the way of advanced sources (e.g. VC)
Source: Consultancy team review and assessment of various socio-economic data from official sources in the eligible area.
1.6 SUMMARY OF NATIONAL AND REGIONAL POLICIES AND INITIATIVES IN SUPPORT OF DIGITAL HEALTH
– 9 –
– 10 –
1.6 SUMMARY OF NATIONAL AND REGIONAL
POLICIES AND INITIATIVES IN SUPPORT OF
DIGITAL HEALTH
The 2015 policy document ‘Digital Health’ pertains
to the UK and thus applies to the NI and Scottish
parts of the Honeycomb eligible area. Overall,
the document seeks to support digital healthcare
solutions nationally, regionally and locally across
the UK.
To date, the UK strategy for rolling out eHealth
has tended to focus on a self-care, patient-centric
approach for diabetic, pulmonary and cardiac
diseases. Research shows that about 75% of people
not only search online for health information but also
that approximately half of those that do, seek to self-
diagnose (not completely, without also consulting
with their doctors, but as a first step in the diagnosis-
treatment-management process). In this context,
the provision of digital healthcare would have the
effect of enhancing the effectiveness of the self-care,
patient-centric approach, in the process reducing
A&E visits (by 15%, it has been estimated), reducing
emergency admissions by 20%, reducing bed days by
sector, and greater recognition of qualifications in
the digital and IT sectors. While there is recognition
of the potential for convergence between the
digital content and connected heath sectors (in the
coming years), the immediate priority of the digital
economy strategy is to ensure the availability of a
range of skills in digital content and IT (including
software development) rather than also promoting a
concurrent major program of initiatives in connected
health.
Ireland, on the other hand, not only has an EU policy
directive agenda (2020) to accommodate, but also
a national policy document aimed specifically at
eHealth, namely the ‘eHealth Strategy for Ireland’
(2013). That document outlines a comprehensive
and detailed approach to implementing an eHealth
program of healthcare solutions developed within a
national framework. The Health Services Executive
(HSE) notes that eHealth involves not only the
connected health agenda, but also the “integration of
all healthcare information and knowledge sources via
information technology systems, including patients
and their records, caregivers and their systems,
monitoring devices and sensors, and management
and administrative functions” (p. 5). The HSE’s policy
14%, while potentially reducing mortality rates by up
to 45%.
One of the major connected health initiatives in the
UK (CellNovo) has resulted in the development of a
mobile-connected diabetes management system,
and similar connected health facilities are now in
full operation with Scottish Connected Health for
over 270,000 diabetic patients in that part of the
UK. Moreover, projects focused on the application
of digital communication technologies to mental
health issues have begun to generate community
acceptance through initiatives such as the Glasgow
High SafeSpot local e-service for teenagers suffering
with mood disorders or related symptoms, and
GreyMatters, which provides an online resource
promoting real-time communication and non-
hospitalised treatment supporting patients with
long-term conditions such as dementia, hypertension
and rheumatoid arthritis.
The ‘Northern Ireland: A Global Leader of the Digital
Economy – A Sectoral Action Plan’ document (2014)
outlines policy intentions regarding the development
of the digital economy in NI, with a strong focus on
skills training, attracting global investment in the IT
Introduction
of people search online
for health information75% 15% potential reduction
in emergency admission
document provides a framework setting out what the
eHealth framework intends to achieve; the actions or
systems changes that need to be in place to realise
eHealth strategies and objectives; the patient-based
and economic costings advantageous to eHealth
solutions; a framework for the evaluation of eHealth
intervention effectiveness; and a life-cycle of
connected health solutions framework that evolves
with technological intervention without placing
patients at untested risk. While forward-looking in
its approach, the report is realistic to recognise that a
significant amount of systems re-structuring will be
required to realise the policy’s potential, particularly
in changing working systems practice.
1.7 RESEARCH CAPACITY AND THE
EMERGENCE OF CONNECTED HEALTH
CLUSTERS
For connected health technology to fully realise
the solutions that the national and regional policies
purport to be both possible and essential, the
appropriate information technology resources,
labour market skill sets, research and development
opportunities, and connected health-specific
enterprises must all be in place.
An analysis by each part of the Honeycomb eligible
area suggests that the enterprise expertise base is
most likely to occur in the main urban centres.
Western Scotland, and the greater Glasgow area
in particular, are at the forefront of digital health
research and digital hub creative enterprise clusters,
in having a Digital Health Institute with a specific
focus on exploratory, laboratory, and factory digital
and Connected Health roll-out programs, ranging in
applications from clinical decision support platforms
to mental well-being. The Digital Health Institute is
a collaborative initiative between the Glasgow School
of Art’s Creative Media Hub and a new creative digital
hub at Pacific Quay Glasgow. The initiative has
benefitted from recent funding and includes digital
enterprises (e.g. IOMART Cloud Computing), giving a
boost to the region and presenting an opportunity for
digital and connected health collaborative initiatives.
While NI remains committed to IT skills training and
qualifications recognition within its digital sector,
the region has recently invested in linking up with
forerunners in the digital health sector and the
New York initiative. The Western Scotland network,
including the aforementioned Digital Health Institute
has links to the NI policy drive. The development of
digital media hubs within NI, such as the Creggan
Enterprises Digital Media Arts Studio in Derry/
Londonderry, is also relevant to note in the context of
this report.
The north eastern part of the cross-border region
on the island of Ireland (along the Dublin-Belfast
corridor) is seen by stakeholders consulted as
providing an opportunity to link-up enterprises,
research institute capacity, health service systems,
and digital media hub development beyond the
national eHealth strategic policy’s intent. The
resources and the framework appear to exist, for
example in the potential link-up of researchers at
Dundalk Institute of Technology (Netwell Centre),
the Boyne Research Institute (Drogheda), HSE
service provision in the border counties of Ireland
(Louth, Cavan and Monaghan) and local digital media
enterprises in that part of the Irish cross-border
region.
Introduction
– 11 –
– 12 –
02
According to the report, in 2012, information
industries accounted for about 3.8% of all
employment in the OECD area. In addition, the same
industries contributed 6% to total value added, and
labour productivity in the information economy
sector was found to be 60% higher than the overall
economy. Revealingly, the digital economy has been
resilient during the economic crisis; however, while
employment has grown, it has not reached the peak
rate of 4.1% of all employment witnessed in 2001,
just before the IT/dot.com bubble crash at that time.
Within the sector, employment growth is occurring
in IT and other information services and generally
away from products and traditional activities, such
as publishing, audiovisual and broadcasting and
telecommunications. The OECD report notes that the
gap in productivity in favour of information services
relative to the total economy is especially high in
Ireland (it is found to be highest in the US).
According to the report, the information society
economy, which includes the digital content sector, is
opening up new employment and skills opportunities
as the sector continues to grow and this will present
challenges for educational institutions as well as
people seeking to work in the sector.
The OECD report concludes by saying that new
statistical tools are needed to measure the digital
economy and it proposes a forward-looking
international agenda built around six areas as
follows:
• Improve the measurement of ICT investment and
its link to macroeconomic performance;
• Define and measure skills needs for the digital
economy;
• Develop metrics to monitor issues of security,
privacy and consumer protection;
• Promote the measurement of ICT for social goals
and the impact of the digital economy on society;
• Invest in a comprehensive, high quality data
infrastructure for measuring impacts; and
• Build a statistical quality framework suited to
exploiting the internet as a data source.
The fourth of these proposals is relevant in the
context of this report, in that healthcare would
be seen as a social as well as an economic sector
and one affording the opportunity of synergy
development with the digital content sector.
Profile of the digital content sector
2.1 DEFINITIONAL AND
MEASUREMENT ISSUES
While the digital content or media sector embraces
a number of subsectors, such as games, animation
and online content, there is no universally agreed
definition of what precisely makes up the sector. This
in turn makes it difficult to accurately estimate the
size of the sector, which is made all the more difficult
by the fact that the official statistics agencies in
the eligible area do not make publicly available
information on the disaggregated subsectors
regarded to make up the digital content sector. The
pace of change inherent in the sector also works
against accurate delineation and estimation of scale
and growth.
2.2 INTERNATIONAL TRENDS – EVIDENCE
FROM THE OECD
The Organisation for Economic Cooperation and
Development (OECD) published a report in December
2014 entitled ‘Measuring the Digital Economy: A New
Perspective’ which maps existing indicators of digital
activity against digital policy issues and suggests a
forward-looking international measurement agenda.
2.3 THE DIGITAL CONTENT SECTOR IN THE
COUNTRIES OF THE ELIGIBLE AREA
Data analysis undertaken by the consultancy team
reveals that the digital content sector (as can be
reasonably defined and measured with the available
official data) would account for up to approximately
14,000 people in work in NI, and between 25,000
and 30,000 workers in each of Ireland and Scotland.
Reflecting the OECD report of 2014, the sector
accounts for between 1-4% of all employment in each
country/region, depending on whether one takes a
wide or narrow view of the sector.
Also chiming with the OECD study is that gross value
added (GVA) tends to be higher in the digital content
sector compared with other sectors of the economy,
which in turn points to the productivity gap in favour
of the digital content industries – they attract
well-educated and talented people, and the pace of
change in the sector tends to occur more rapidly than
in other parts of the economy, whether research or
technology development (e.g. software development
occurs much more rapidly than pharmaceutical
development).
Getting other sectors to appreciate and work with
the much shorter lead-times associated with the
digital economy is one of the great challenges for
facilitating further integration of digital activities
throughout the economy.
In each of the three countries, there are foreign
direct investment (FDI) firms active in the sector
as well as indigenous enterprises. With its low
corporation tax, Ireland has been especially
successful in attracting IT FDI in recent years.
While many of the activities of these firms are
directed towards international servicing operations,
recent years have seen more focus on core functions,
like software engineering and development, which
tend to predominate among the Irish-owned
enterprises operating in the sector.
Recognising the pervasiveness and influence of the
sector, all three countries’ economic development
strategies recognise the important opportunities
afforded by the digital economy and in particular
the scope (but also challenges) for digital media
activities to connect further with other sectors of the
economy, including health and education.
In Ireland, NI and Scotland, the majority of digital
economy activities occurs in the main urban centres
(Dublin, Belfast, Derry, Glasgow and Edinburgh),
where talented people hoping to build careers in
the sector are most likely to be attracted. Over the
coming years, there is little doubt that the digital
content sector will continue to develop mostly
in these centres and it is in these cities that the
greatest scope for convergence between healthcare
and the digital economy lies.
2.4 THE DIGITAL CONTENT SECTOR WITHIN
THE ELIGIBLE AREA
Within each country and focusing on the eligible area
spanning the Honeycomb region, we find that the
digital content sector is more scattered, fragmented
and diverse. This is not surprising and reflects the
generally low population density of the eligible area
and the absence of big urban centres. A particular
issue in the Irish border counties is the availability of
broadband in more rural and peripheral parts, which
is hampering digital development in that part of the
country and may be contributing to a “digital divide”
(mobile telecommunications as well as broadband
can be patchy and variable in quality in this part
Profile of the digital content sector
– 13 –
– 14 –
of the country). Through its National Broadband Plan, the Irish government is
seeking to resolve the issue of broadband availability by 2016.
For example, within the border counties of Ireland, the penetration of the digital
content sector is low when compared with the country as a whole. This is
illustrated by the estimate that approximately 0.5% of all employment in the
border counties is accounted for by the sector, which is lower than the estimate
that about 1.2% of all employment in Ireland is due to digital content activities
(taking a narrow definition of the digital content sector).
How does the estimated 0.5% employment density in the Irish border counties
compare with the other two parts of the eligible area? On the basis of estimates
of employment for digital content sector activities provided to us through
Honeycomb, it appears that the corresponding proportion in NI (excluding Greater
Belfast) is about half that in the Irish border counties (c. 0.2%) and double the
Irish border counties’ proportion in the Scottish part of the Honeycomb Region
(c. 1%).
On this basis, the Scottish part of the eligible region would appear to be the
most advanced, at least in terms of employment impact, which is a key policy
consideration (bearing in mind that the aforementioned proportions relate to a
narrow definition of the digital content sector in the eligible area).
While there are some variations, and exceptions, within the eligible area, it is
reasonable to observe that the digital content sector in the Honeycomb region is
characterised by the following features:
Business organisation;
• Predominantly micro-firms (less than 10 employees), with a good many
freelancers working on a part-time basis (on their own)
• Low direct employment and low turnover (although the low turnover is
reflective of the downturn in the region more generally, which has impacted on
all small businesses)
• Reliance on government support to grow (and reliance on a small number of
buyers/clients, such as broadcasting organisations)
• Compared with the main urban centres, low presence of FDI firms, which in
turn reflects their searching for talent and infrastructure in larger population
centres/capitals
Technology;
• Predominantly low technical/capital requirements accompanying, which is
both a positive and a negative
- A positive because it implies low barriers to entry to the sector (making
entrepreneurship and competitive outcomes more likely)
- A negative because there are clearly identifiable scaling and efficiency
issues due to skills gaps (which are both general and sector-specific as
helpfully identified in the Honeycomb survey of providers conducted in
2014)
Profile of the digital content sector
Market need;
• Heavy reliance on the local/domestic market (and small number of purchasers)
• Low incidence of exporting
• Low intensity of innovation.
The aforementioned Honeycomb survey of providers in the eligible area (2014),
which is a useful information source, not least given the paucity of official data
on the sector, also highlights the various developmental needs of the sector,
including skills (both general/business and technical to keep pace with new
developments) and networking (to learn about new opportunities, expand client
bases and absorb new learning). These areas are especially important and ones
to which institutions like DkIT and Ulster University can contribute.
2.5 EU DIGITAL SINGLE MARKET STRATEGY
The European Commission’s ’Digital Single Market Strategy’ – one of the priorities
of the Juncker Commission in terms of ensuring that Europe should benefit
fully from the digital age with better services, more participation and new job
creation opportunities – was launched on 6 May 2015. The strategy (a long-in-
the-making co-production of no fewer than 13 Commission Directorates-General)
is an attempt to recognise the borderless nature of digital technologies and the
opportunities due to deeper integration between digital content activities and
other sectors of the economy.
There will be three strands to the new EU digital strategy:
• Better access for consumers and business to digital goods and services,
namely unlocking the potential of cross-border e-commerce by making it more
straightforward and affordable, by tackling online geo-blocking restrictions, by
modernising copyright law and by simplifying cross-border VAT arrangements
and costs for companies;
• Shaping the environment for digital networks and services to flourish, which
includes efforts to boost the roll-out of faster (4G) broadband to enable new
digital services, applications and content, and to examine, with the aim of
realising, the potential afforded by online platforms, like social media, apps and
downloads etc.
• Creating a European Digital Economy and Society with long-term growth
potential, which relates to helping all sectors to integrate new technologies
and to manage the transition to a smart industrial system through a fast-
tracking of standardisation in the interoperability for new technologies,
including tapping into the economic potential of big data and data analytics
(which are particularly relevant to this study).
Profile of the digital content sector
– 15 –
– 16 –
3.1 INTRODUCTION
The global digital health market is estimated to
more than double over the next three years, and to
exceed US$200 billion in 2020. A key driver of this
impressive development will be an increasing mobile
health market with innovative mobile solutions,
applications and services. Additionally, such offerings
will trigger growth in neighbouring areas such as
wireless network technologies, sensors and devices.
This momentum will invariably attract new players
to the market and disrupt current business models.
New market entrants will most likely be technology
companies who may lack significant healthcare
expertise.
Thus far, however, digital health solutions have
not quite delivered on their promise. Established
companies from the traditional health sector
struggle to combine and enrich their offerings with
digital elements, while very few of the digital health
start-ups have developed to their full potential.
03
Digital Health Market Projection by Segment
Source: Arthur D. Little, GSMA, Allied Market Research, Accenture, IHS, MarketsandMarkets.
Notes: Other includes health telematics, informatics and further sub-segments with an estimated additional 20% market volume.
FIGURE 1
Profile of the connected health sector
3.2 SEGMENTATION
We may divide the digital health market into four
distinct main segments based upon the subsectors
that have received significant funding over the last
five years (Table 2).
• Infrastructure, largely the bearer of regulatory
mandates and incentives, which includes health
analytics and interoperability solutions and is the
leader with $2.9 billion of total funding.
• Treatment, which includes personalised medicine,
virtual care, tele-health and care coordination, and
has garnered $2.6 billion as new, alternative care
channels are pursued.
• Engagement, which also received $2.6 billion
and includes wearables, incentive programs and
other patient engagement solutions that target
behavioural change.
• Diagnosis, which has captured $2.1 billion,
representing a rapidly growing segment of clinical
and consumer tools that provides insights, such as
remote monitoring.
Scale and Segmentation of the Connected Health Market
MARKET SECTOR
VENTURE FUNDING 2008-2013
KEY SUBSECTORS ESTIMATED MARKET SIZE
2014
HONEYCOMB RELEVANCY
Infrastructure $2.9bn
Payment processing $6.0bn* 1
HER and Clinical Workflow $9.0bn* 1
Big Data/Predictive Analytics $6.0bn* 4
Hospital Administration $6.0bn* 1
Physician Training $3.0bn* 4
Population Health Management $5.0bn* 2
Clinical Trials $4.0bn* 3
Treatment $2.6bn
Assisted Living/Aging $3.3bn 4
Virtual Care Coordination & Navigation $4.1bn 3
Personalized Medicine $4.0bn* 2
Medication Management $1.4bn 1
Engagement $2.6bn
Nutrition Tracking $1.9bn 2
Physical Fitness Tracking & Wearables $8.5bn 1
Behavioural & Emotional Health Tracking
$1.7bn3
Patient Education & Advocacy $3.1bn 3
Diagnosis $2.1bn
Provider Diagnosis $4.0bn* 1
Self-Diagnosis $3.0bn* 3
Emergency Detection $2.6bn 1
Remote (Vital Sign) Monitoring $3.8bn 2
Total $10.2bn c. $80.0bn
Source: Accenture, Arthur D Little, PricewaterhouseCoopers, KPMG.
Notes: * Authors’ estimates based on research contained in reports by Accenture, Arthur D Little, PricewaterhouseCoopers,
and KPMG.
TABLE 2
– 17 –
– 18 –
The final column of the table above contains the consultancy team’s assessment of the
relevance of the connect health subsectors in the context of this report, namely the potential for
greater convergence between the connected health and digital content sectors.
The main convergence opportunities are in: (1) big data and predictive analytics; (2) physician
training, where by ‘physician’ is meant the decision-maker in respect of clinical engagement
with patients; and (3) assisted living/aging (although the latter will necessitate involvement
with patients’ families because, for example, people with advanced dementia/Alzheimer’s are
generally not in a position to liaise with healthcare providers and require the ‘voice’ and support
of family carers).
Other potentially significant convergence opportunities are (a) clinical trials (processing and
management etc.), (b) virtual care coordination and navigation, (c) behaviour and emotional
health tracking, (d) patient education and advocacy and (e) self-diagnosis, which refers to
greater patient involvement in diagnosis and care (e.g. pregnancy testing, eye care, dental care,
skin care etc.).
3.3 SERVICE OFFERING
Many leading pharmaceutical companies, the majority of health insurers and numerous medical
devices companies have already successfully designed and launched early generations of digital
healthcare offerings.
An overview of the typical offerings currently available is tabulated below.
Summary of Service Offerings in Connected Health
Offering Focus Digital Offering Primary Patient
Benefit
Hurdle to Wide
AdoptionDevice Platform App Portal Community
Health management General wellbeing/ prescription drugs √ √ √
Adherence Physician integration
Health management Multiple Sclerosis √
Adherence, monitoring
Physician integration
Digital reference book Medical/pharma information √
Education, Encyclopaedia
No patient input
Activity and exercise management
Diabetes (and its complications – eye care, weight etc.) √ √
Adherence, drug instructions, education
Only generic inputs
Symptoms recording and analysis
Diabetes (and its complications – eye care, weight etc.) √ √ √
Adherence, monitoring
Physician integration
Environment assessment Asthma, hayfever, allergies and auto-immune conditions √
Education Only limited patient inputs
Digital reference General information √
Education Patient input
Self-assessment Haemophilia √ √
Education, scheduling
Limited patient-specific inputs
Symptoms recording Prostate cancer √
Monitoring, scheduling appointments
Physician integration
Virtual practice Diabetes (and its complications – eye care, weight etc.) √
Education, scheduling
No patient inputs
Source: Company websites, Arthur D Little, consultancy team review.
Table 3
– 19 –
3.4 VENTURE FUNDING
Two recent information sources show the
importance of digital health for venture capital
providers. StartUp Health, a New York-based
accelerator, and Rock Health, a San Francisco-based
accelerator and seed fund, have independently
reported that funding for new digital health ventures
in the US has grown substantially recently. Funding in
2014 more than doubled from the previous year ($6.5
billion invested compared to $2.9 billion in 2013),
with each quarter in 2014 attracting more capital
than all of 2010. Signs of a maturing market continue,
as investors are apparently investing larger amounts
on fewer companies. By any measure, venture
funding of digital health companies surpassed $4
billion in 2014, nearly equivalent to the prior three
years (2011-2013) combined.
Digital Health Funding Snapshot, 2010-2014 YTD
Even regarding investments worth at least $2 million. Rock Health estimates that $4.1 billion of
new capital was invested in digital health, up from less than $1 billion in 2011.
Digital Health Venture Funding, 2011-2014
FIGURE 2
Source:
StartUp Health
www.startuphealth.com/insights,
consultancy team review.
FIGURE 3
Source:
Rock Health Funding Database
www.rockhealth.com
Note: only includes US deals > $2m
– 20 –
3.4.1 VENTURE FUNDING FOR CONNECTED HEALTH BY SUBSECTOR
Both sources agree that analytics and big data are the largest subsector,
accounting for $1.46 billion (over one-fifth) of StartUp Health’s estimate and
$393 million (just under 10 per cent) of Rock Health’s estimate. In the case of
both companies, there was rapid growth in VC funding between 2013 and 2014.
Funding of Top Categories of Digital Health, 2014 (US)
STARTUP HEALTH ROCK HEALTH
Analytics/Big Data $1.46 bn Analytics/Big Data $393 m
Population Health $1.14 bn
Healthcare consumer
engagement $323 m
Navigating the Care
System $974 m
Digital medical
devices $312 m
Diagnostics $962 m Telemedicine $285 m
Consumer health $880 m Personalized medicine $268 m
Practice Management $783 m
Population health
management $225 m
Payor/Insurance $699 m
Workflows $681 m
Genomics $632 m
Clinical research $624 m
Source: Company info, consultancy team review.
3.4.2 VENTURE FUNDING FOR CONNECTED HEALTH IN EUROPE
The outlook for VC funding directed towards connected health is less optimistic in
Europe than in the US. The amount of capital invested in digital health start-ups is
less than one-tenth of the comparable US figure. There are, as yet, only a few VC
providers targeting the sector in Europe while there are less than a handful of firms
specialising exclusively on digital health as an investment strategy.
Nevertheless, new firms are being formed in Europe to capitalise on the
opportunities developing in the US. XLHealth is one such firm newly created in
2014 in Berlin to develop fund and support digital health solutions in Europe. This
firm is closely partnered and funded by one of Europe’s largest software suppliers
in the health space, CompuGroup Medical. Some of the strongest supporters of the
digital health agenda in the US have been investors with large, valuable portfolios
in the life sciences sector. Their European counterparts have organised along the
same lines as the pharmaceutical industry with their focus aligned to major disease
areas. As such, they have been somewhat slower to view the more holistic benefits
of digital health solutions as viable investment opportunities. Some of the leaders
such as Inventages are, however, beginning to view the promise of digital health
solutions, particularly in the areas of nutrition and wellness as complementary
to their investments in life sciences. Recent commitments by more VC investors
in digital health start-ups are also acting as beacons for additional capital to
be directed towards the sector. Mangrove Capital, one of Europe’s high profile
investors, led an investor round for Zesty, a UK-based service aimed at simplifying
the making of appointments with healthcare specialists. So far, however, European
investors have been more cautious in that they seem to be backing only start-ups
with already proven markets in the US, as opposed to new product areas with
nascent customer markets.
Table 4
– 21 –
Profile of the connected health sector
– 22 –
3.5 CONNECTED HEALTH WITHIN THE
HONEYCOMB REGION
Connected Health in the eligible area has been a
focus of both private and public initiatives for several
years. For example, the Northern Ireland Connected
Health Ecosystem was launched in 2012 as a forum
to bring together stakeholders from the health
system, academia and business to discuss and take
forward connected health solutions within NI.
3.5.1 REGIONAL PUBLIC ENGAGEMENT AND
EXPENDITURE ON CONNECTED HEALTH
Despite the fact that constrained budgets limit
public investment in digital health initiatives, health
authorities and decision-makers in the eligible area
at least recognise the inexorably important role that
digital technology will play in reforming healthcare
systems. Every European healthcare system
currently struggles to achieve a balance between
ensuring access to high-quality healthcare services
and long-term financial sustainability. The outcome is
that public authorities are open to private initiatives
from technology companies with cost-effective
solutions. Policymakers therefore recognise the
potential for digitally-based healthcare initiatives
to aid prevention and reduce cost pressures in their
health systems, so that governments as well as
patients and companies active in the development of
the technologies are seen as winners; however, the
ramifications for clinicians may be more complex and
there is a sense of apprehension from the medical
professions in respect of the advent of digital/
eHealth.
EHI Intelligence calculates that the UK NHS spends
around £1 billion a year on healthcare IT, or around
1.1% of the NHS’s approximately £110 billion budget.
In 2011, the NI Ministers for Health and the Economy
agreed the Connected Health and Prosperity
Memorandum of Understanding. One of the priorities
in the MOU is the development of a Connected Health
Ecosystem in Northern Ireland bringing together the
public, independent and private sectors, research
bodies and patients and families to share good
practice, learn from experiences and help to prioritise
and develop connected health solutions.
Comparative figures for public spending on
connected health in Ireland indicate a future
lack of funding. The HSE’s annual expenditure on
healthcare IT of around €40m accounts for only
0.3% of a total annual budget of over €13 billion
(this proportion is much smaller than the equivalent
amount in the UK, namely the aforementioned 1.1%
incurred by the NHS). With a limited budget, the
HSE must still address similar challenges to the
NHS in terms of coping with an increasingly elderly
population, living with a growing burden of chronic
disease, while adopting complex and costly medical
advances. Despite the financial constraints, a major
re-organisation of the health and social care system
and reforms of Ireland’s healthcare funding systems
are already underway. However, a strong sense
of cynicism is associated with the reforms, which
include the possibility of de-centralising healthcare
decisions (it will be recalled that the HSE was
instituted in 2005 by amalgamating the
previous regional health boards
in an attempt to ensure
greater efficiency in
the provision of
healthcare in
Ireland).
Profile of the connected health sector
04
As part of this study, we undertook a research review to examine what other researchers, government bodies and consultants have done in the field to date on the
subject of healthcare information technology and connected health, with a particular view towards applications that make use of digital media. The table below
summarises the reports from various government bodies and other bodies that we have deemed relevant here (table continued overleaf).
Summary of Recent and Relevant Publications
AUTHOR TITLE KEY FINDINGS PUBLICATION DATE
BioBuisness Ltd. commissioned by Enterprise Ireland
Connected Health in Ireland – An All Island Review
• Review of a considerable number of connected health activities on the island
• Highlights the opportunities and challenges for local companies to develop new products and to evolve new services
Apr. ‘10
Irish Department for Communications, Energy and Natural Resources
Baseline Report on eHealth Development in Ireland
• One of a series of reports under the Knowledge Society Strategy.
• Examines implementation of a series of e-Health actions which, for example, could provide an alternative to nursing home/hospital care and has important societal and economic implications
Jul. ‘11
Sinclair Stockman commissioned by Invest Northern Ireland
Digital Northern Ireland 2020 • Identifies the opportunities which exist in the short, medium and longer term for the economy of NI, and for the population as a whole, arising from the significant investment which has been undertaken in building a high speed communications infrastructure
Sep. ‘10
Table 5
– 23 –
Review of Relevant Research
– 24 –
AUTHOR TITLE KEY FINDINGS PUBLICATION DATE
European Commission eHealth Action Plan 2012-2020 - Innovative healthcare for the 21st century
• Identifies barriers to implementing nationwide eHealth strategy
• Clarifies policy domain and outlines the vision for eHealth in Europe, in line with the objectives of the Europe 2020 Strategy and the Digital Agenda for Europe.
• Presents and consolidates actions to deliver the opportunities that eHealth can offer, describes the EU’s role and encourages Member States and stakeholders to work together
Dec. ‘12
Irish Department of Health
eHealth Ireland Strategy • Provides an outline and definition of eHealth
• Demonstrates how citizens, Irish healthcare delivery systems - both public and private - and the economy as a whole benefit from eHealth
• Identifies challenges and enablers to implementing a nationwide eHealth strategy
Dec. ‘13
Proof Communications Communicating Connected Health
• Highlights challenges for organisations operating in the emerging world of connected health
• Demonstrates how connected health organisations can overcome major barriers to the widespread adoption of connected health technologies
Jan. ‘14
Scottish Development International
Digital Healthcare in Scotland • Positions Scotland as a location for eHealth
• Lists academic institutions, infrastructure and companies involved in digital healthcare space
Oct. ‘12
European Commission (DG Information Society & Media, ICT for Health Unit)
eHealth Strategies: Country Brief England
• Analyses policy development and planning, implementation measures as well as progress achieved with respect to national and regional eHealth solutions in EU and EEA Member States, with emphasis on barriers and enablers beyond technology.
• The focus is on infrastructure elements and selected solutions emphasised in the European eHealth Action Plan of 2004.
Oct. ‘10
AUTHOR TITLE KEY FINDINGS PUBLICATION DATE
European Commission (DG Information Society & Media,
ICT for Health Unit)
eHealth Strategies: Country Brief Ireland
• Summarises main findings and an assessment of progress made towards realising key objectives of the eHealth Action Plan
• Presents lessons learned from the national eHealth programme, planning and implementation efforts and provides an outlook on future developments
Oct. ‘10
Karl Stroetmann, Jörg Artmann and Veli Stroetmann
Developing national eHealth infrastructures – results and lessons from Europe
• Summaries the progress made in establishing national/regional EHR systems in EU Member States and other European countries
• Provides an assessment of progress made towards realising key objectives of the eHealth Action Plan across Europe,
• Details a variety of good practice examples and lessons learned from national eHealth programmes and related planning and implementation efforts
Oct. ‘11
Wendy Currie and Jonathan Seddon
A cross-national analysis of eHealth in the European Union: Some policy and research directions
• Analyses the relationship among eHealth profiles across 27 European Union Member States.
• Reveals that four distinct country groupings emerge as frontrunners, followers, leapfroggers and laggards. Frontrunners combine a strong ICT infrastructure with relatively high adoption of eHealth technologies.
• Suggests that a one-size-fits-all approach to health IT is not recommended for EU Member States because policy-makers at the national level need to develop an eHealth roadmap that reflects national, regional and local conditions that go beyond technical imperatives.
Sep. ‘14
Source: Consultancy team review.
– 25 –
– 26 –
SECTION B
Connected Health Subsectors for Growth
05
What follows is a summary
of the key points emerging
from the consultancy team’s
engagement with stakeholders
during the course of the study,
arranged by the main themes
to have emerged from the
discussions.
5.1 CONNECTIVITY
Digital or eHealth solutions must connect all
stakeholders in a healthcare system – patient, physician/
clinician, payer, healthcare provider and supplier – and
facilitate more effective communication and transaction
among the parties involved. One of the principal
stakeholders for the entire digital healthcare value
chain is the physician. Ultimately, in most healthcare
ecosystems, physicians determine patient behaviour.
Pharmaceutical companies have an in-built association
with physicians and therefore may be in a potentially
strong position to drive the adoption of digital solutions
through clinicians, provided their offerings address the
patient’s needs. However, the connectivity opportunity
is also inherently challenging. For example, some
doctors are more digitally aware than others and
some practitioners may therefore be less willing to
consider potentially effective digital technologies that
may benefit patients. Another factor illustrating the
complexity surrounding connectivity is the patient’s
family or informal carers (beyond paid carers and
professionals). For example, in the case of dementia
patients, technologies may be targeted at family
members rather than the patient, who may not be in a
position to use the technology.
Themes Highlighted in Consultation with Stakeholders
In the current healthcare value chain, medical
devices companies tend not to interact directly with
clinicians but this gap may need to be addressed
in the environment where digital technologies
in healthcare are expected to become more
commonplace. Forging successful relationships will
be dependent on meeting clinicians’ and patients’
needs – this is the most fundamentally important
requirement to ensure greater penetration of digital
technologies in the healthcare value chain: doctors
must benefit from the technologies (e.g. patient
management systems that will enhance their
productivity and the profitability of their practices in
the primary care environment) as must patients and
their families.
5.2 DATA ANALYTICS
Successful digital health solutions must aim to
enable meaningful insights and make use of big data
to become more proactive, rather than reactive. One
of the undoubted major opportunities for connecting
digital content and healthcare is the rich data
maintained by healthcare providers, in the primary,
secondary etc. points of the healthcare value chain.
Electronic health records offer the possibility of
tracking and sharing the patient’s health status
and customising treatment. Any offering that does
not leverage the patient’s data to track and record
what is going on over time cannot leverage the full
potential. Superior offerings are seeking to go beyond
data collection and its digital expression. Intelligent
systems seek to make use of individual and patient
group data to identify and track changes to their
health status in real time. By considering external
factors, digitally-based treatments and solutions
(through the use of apps, for example) have the
potential to become predictive instead of reactive.
5.3 PATIENT OUTCOMES
Offerings must provide real value to the patient
and their families (the young and the elderly, where
healthcare demand tends to be greatest). Digital
solutions have to target unmet needs and improve the
human condition or life with a disease, utilising the
full potential and broad spectrum of digital solutions.
The digital health solutions may be enabled by digital
media, though they need to be led by healthcare/
clinical imperatives. The focus needs to be on
patient outcomes, and not just upon time and/or
money savings. Healthcare costs and outcomes
are notoriously opaque. As patients take a greater
role in managing their own care, there is a demand
for tools that de-mystify pricing and value. Tools
to help patients evaluate health insurance options
will also be needed, particularly with new users
entering the system that do not have experience
navigating their options. Greater transparency is
paramount in achieving better patient outcomes.
Value for consumers means a combination of cost,
convenience, and outcome. Digital technologies have
the potential to add value to patient outcomes by
helping them to better access the healthcare system
for their own needs (where, when and how).
5.4 PATIENT ADOPTION
Successful digital health solutions must reflect
the whole customer journey and target specific
interactions in the healthcare system. By connecting
the stakeholders – patient, physician, payer,
healthcare provider and supplier – the solution will
facilitate easier communication and transaction
between the parties involved.
– 27 –
Themes highlighted in consultantions with Stakeholders
– 28 –
5.5 REGIONAL LOCALISATION
Digital health solutions must reflect regional
differences in the regulatory and care environment,
understand and address local pinch-points as well
as adjusting their technology and value-added
accordingly. Successful digital health solutions
cannot be developed as one-size-fits-all solutions.
The most successful offering will reflect the
regulatory and care environment in each respective
region. Not only will it understand, but it will also
recognise local pinch-points and accordingly adjust
its value proposition. Ground-breaking and successful
offerings need to address all of the above-mentioned
aspects. If only one aspect is not considered in the
solution design, chances are high that at least one
stakeholder will never experience any added value
and consequently will not utilise the offering.
5.6 REGULATORY OVERSIGHT
The complexity of regulation and lack of qualification
for new connected health services is currently seen
as a major barrier to adoption. Connected health
presents unique challenges for regulators and
policymakers because it unites a number of vastly
different sectors and services for the first time and
this is new ground for most of the people policing
the sector’s reputation and performance. In the
case of the communications infrastructure allowing
devices to talk to each other, for example, the GSMA
(Groupe Speciale Mobile Association, an international
group of mobile operators which seeks to promote
connected living) suggested in a 2012 report that
the main regulatory challenge in connecting digital
technologies and healthcare lies in striking a balance
between the very different regulatory motivations
of the telecommunication and healthcare industries.
Influencing those that can help shape this regulation
is a new and considerable challenge for many
organisations entering the sector, largely because it
is very different to selling technology products. As
Emmanuelle Pierga of Orange Healthcare explains,
“One of my main goals is to prove that connected
health works, and that it is the answer to society’s
future healthcare problems. We are lobbying and
targeting the people in a position to influence the
evolution of regulation in this industry before trying
to convince the buyers. We are ready to implement,
but we cannot sell anything until we prove the whole
system works and until the regulatory bodies have
adapted so as to integrate connected health.”
5.7 HUMAN-CENTRIC DESIGN
Human-centred designs are those that respect user
diversity and living contexts. A first factor in this
context is the user diversity. Individual differences,
such as demographic variables, computer experience,
cognitive abilities and personality factors are all
important in explaining both technology acceptance
and user behaviour with respect to digital health
products. Successful digital health solutions will
offer multiple interfaces to suit the patient’s lifestyle
and will prioritise patient convenience, especially
when products impact patients’ comfort and/
or appearance, as is the case with, for example,
wearable sensors.
5.8 SELLING TO MONOPOLISTIC BUYER
(‘MONOPSONY’)
Engaging with the NHS or HSE is considered by those
with whom we consulted to be notoriously difficult
for private companies. According to recent figures,
Themes highlighted in consultantions with Stakeholders
60% of UK-based entrepreneurs from the health technology sector claim there
is resistance within the NHS to working with private sector companies. 85%
identified barriers such as excessive decision-making times and difficulty finding
the right person with whom to speak. Over 80% feel that NHS procurement
processes are too complicated.1
There is other evidence2, however, that the NHS is increasingly outsourcing
contracts to the private sector, and the Healthcare Industry Barometer 2013
showed that senior figures in the private sector believe an increase in the number
of hospitals in financial difficulties will provide further opportunities for them
over the next few years. Stephen McComb, Centre Leader for the Connected
Health Innovation Centre (CHIC), explains that the NHS looks for differentiation
between offerings that present a ‘better’ service versus a ‘cheaper’ service,
but ultimately organisations need to be able to offer both convincingly. This is
extremely difficult in a tender situation, and therefore influencing the buyer at the
earliest point can be pivotal. “If you can connect with a buyer before the tender
is even written, you can educate them as to what constitutes value, quality and
impact.”
1 ‘The NHS must keep its pledge to embrace tech entrepreneurs’, The Guardian, November 2013 http://www.theguardian.com/healthcare-network/2013/nov/25/nhs-pledge-tech-entrepreneurs-start-ups. 2 ‘Arms race over £5bn in NHS work’, Financial Times, July 2013 http://www.ft.com/cms/s/0/6424b29e-f60a-11e2-a55d-00144feabdc0.html#axzz2lr8VGEER.
– 29 –
Themes highlighted in consultantions with Stakeholders
In the connected health space this is especially difficult; “Technology companies
are making a case for buying Y instead of X, rather than two versions of Y, so there
is little evidence to support a change in strategy to incorporate new technologies.”
A 2012 report from Accenture, ‘Making the Case for Connected Health’, asserted
that connected health is not simply a tactical intervention in an organisation or
system, “Developing connected health means carefully orchestrating change
across the organisation that aligns directly to a mission and a vision. This
transformation should have a strong positive impact on culture, management and
clinical systems, behaviour and patient-provider-payer interactions, well beyond
the changes required by technology alone.”
Brian O’Connor, Chair of the European Connected Health Alliance (ECHAlliance),
believes this is certainly true of the NHS in the UK, and for private technology
companies targeting the NHS for the first time this can be a seemingly impossible
prospect. O’Connor warns that there is still not a complete acceptance of the
need for connected health technology as a whole.
5.9 SUMMARY
A tabulated summary of the above outline of the consultations is presented
overleaf, where in the final column of the table we also give some examples in
each case.
– 30 –
Summary Table of Key Themes in the Market for Connected Health
THEME STRATEGIES OF SUCCESSFUL DIGITAL HEALTH OFFERINGS EXAMPLES
Connectivity • Connect all stakeholders across the healthcare system
• Overcome the disconnections between healthcare provider and patient (and the patient’s family, who in many instances is the only ‘voice’ of the patient – children and elderly patients)
• Address the challenge, or opportunity, of ubiquitous digital channels – through harnessing social media, web site, apps as touch points
MyHealthSpecialist
MedXNote
Nursebuddy
Data Analytics • Take advantage of comprehensive user data (e.g. maintained by clinicians and health service executives) • Gather meaningful insights from the data, through applying quantitative techniques to the data, which
can now be carried out relatively quickly• Ensure interoperability, accessibility and security of the data and results from data analysis • Use big data to become predictive, not reactive, for the benefit of patients and their families
OralEye
Nutritics
MySugr
Patient Outcomes • User smart solutions that offer tangible value-add: time, quantity though most importantly, outcomes (that can be measured)
MySugr
RestoredHearing
goACT
Patient Adoption • Follow-on customer journeys – target specific interactions in the healthcare system Nursebuddy
goACT
RestoredHearing
Table 6
Themes highlighted in consultantions with Stakeholders
THEME STRATEGIES OF SUCCESSFUL DIGITAL HEALTH OFFERINGS EXAMPLES
Regional Localization • Reflect regulatory and care environment• Understand and address local pain/pinch-points • Adjust technology and value-add accordingly
Pharmapod
MySugr
Nursebuddy
Regulatory Oversight • Need to engage with regulator and shape regulation• Prove efficacy• Need to engage with the professional regulatory bodies and ultimately the potential of digital healthcare
needs to be recognised in the academic and professional training of healthcare professionals/decision-makers
Phamapod
RestoredHearing
User-Centric Design • User multiple interfaces to suit patient/family lifestyle• Consider patient convenience (e.g. wearable sensors)
RestoredHearing
OralEye
Monopolistic Buyer • Improve patient-provider-payer interactions• Identify and address unintended barriers to greater adoption of digital healthcare• Need to educate the buyer on what constitutes value, quality and impact
MedXNote
Nursebuddy
Source: Company websites and interviews with founders of Nutritics, Pharmapod, MedXNote, OralEye, MySugr, Nursebuddy, TouchSurgery, MyHealthSpecialist, TransplantBuddy, Silvercloud, TickerFit, goACT,
RestoredHearing, John Nosta (journalist and writer for Forbes.com).
– 31 –
Themes highlighted in consultantions with Stakeholders
– 32 –
In identifying relevant
subsectors with the most
promising outlooks for growth in
the eligible area, we devised a list
of criteria to select the strategies
that offered the best collaborative
potential with the digital content
sector in the Honeycomb eligible
area.
06
6.1 NATURE AND INTENSITY OF LINKS
BETWEEN CONNECTED HEALTH AND DIGITAL
CONTENT SECTORS
The first criterion is the extent to which connected
health activities currently utilise digital content to
deliver their services or enhance their offering to
the customer. Further convergence will rest to a
large extent on building on, and diversifying, the links
gained to date.
6.2 LEVERAGE LOCAL INDUSTRY AND
ACADEMIC RESOURCES
Any initiative to build and capture value by addressing
the opportunities in connected health and digital
content must leverage existing business success
stories. Several successful and well-known
companies have already paved the way. Kainos and
Almac are examples of such companies in the NI part
of the eligible area. The wider Honeycomb region is
today home to scores of leaders in their respective
markets be that in medical device development and
manufacturing or pharmaceutical testing and related
services. In addition, the convergence opportunities
between the sector must also be plugged into
academic expertise and resources in each part of the
eligible area and in the countries concerned, meaning
the capital cities of Ireland and Scotland as well as
the regional resources in Belfast, Galway, Glasgow,
Derry/Londonderry, Letterkenny, Dundalk etc.
6.3 EXPORT-ORIENTED
The internal markets for connected health within
the eligible area are not large enough to sustain
a significant number of technology suppliers. The
leaders in the field will undoubtedly have to export
the majority of their production to countries and
regions outside the region of interest. This has
implications for the design and functionality of
products and services as well as for the type of
organisational structure that will be successful in the
marketplace. Subsectors that exhibit a high degree
of features that cannot be transferred or translated
for export markets will not be as successful as
subsectors in which products and services are more
homogeneous between regions or can be adapted
relatively quickly and at low cost for deployment in
external markets.
Criteria used to determine relevant subsectors
6.4 TAPS SKILL BASE
The extent to which a connected health market
opportunity can be captured will depend upon the
existing skills developed in academic/research
institutions, private industry and/or the public
health service. Fortunately, market entrants in the
eligible area can draw on all three sources. Those
companies that can best attract talented and skilled
employees will exert a significant advantage over
their competitors. Owing to the fragmented nature of
the digital content sector in the Irish and NI parts of
the eligible areas, the main skills base on the island
of Ireland capable of facilitating the development of
links with healthcare will likely be in the main
urban centres, especially Dublin
and Belfast.
6.5 ADDRESSES A REAL PROBLEM – MEETING
NEED AS WELL AS BEING TECHNOLOGICALLY
SOUND
A technologically sound solution designed for the
connected health market will likely fail if it does not
command a market demand or need and vice-versa,
in which case the list of criteria needs to include
soundness in respect of both the demand and supply-
side of the relevant market.
6.6 COMPETITIVE LANDSCAPE AND
SPEED OF INDUSTRY
The pace of technical change in the healthcare
industry has increased over the past few years.
Due to a number of factors, the US has taken the
clear lead in developing digital health solutions.
Certain sectors, such as clinical workflow, are highly
competitive and contested by hundreds of competing
companies. In the most advanced subsectors,
large suppliers are already exhibiting oligopolistic
behaviour (i.e. there are some signs of market
concentration and market power) – but this tendency
is likely to be tentative because of the threat posed
by potential new entrants, even if actual competition
within some markets may seem to be lessening.
Technological advances will ensure maintenance
of competitive pressures and thereby open up new
market opportunities for entrants, provided, of
course, that their offerings are technologically sound
and meet a user need, as outlined earlier.
Europe lags behind the US, as outlined earlier, but
this need not detain or stop the eligible area from
benefiting from the developments underway in
connected health. Accordingly, the potential for the
region to attract FDI from connected health firms
(US) will also be important – in addition to supporting
indigenous entrepreneurs and enterprises emerging
within the eligible area.
– 33 –
Themes highlighted in consultantions with Stakeholders
– 34 –
By applying the criteria outlined
above, we eliminated a number
of subsectors that do not or are unlikely
to satisfy one or more of the conditions.
In addition, we also compared the list
of relevant subsectors to independent
analysis completed elsewhere of the
categories that continue to attract funding
in the form of venture capital. What
results is a selection of the most promising
subsectors for enhanced collaboration
between the digital content and connected
health sector in the eligible area.
07Relevant subsectors for collaboration and growth
Subsectors of the Connected Health Market with the Most Promising Growth Potential
MARKET SECTOR KEY SUBSECTORS GLOBAL MARKET SIZING
2014
COMMENT
Infrastructure
• Big Data/Predictive Analytics $6.0bn*Digital content becomes increasingly important to making sense of, presenting and making decisions based upon health and health-related data and information.
• Physician Training & Patient Education $3.0bn*Emerging use cases with 3D, excellent use of media in health, links with university and researchers.
Treatment• Assisted Living/Aging with Vitality $3.3bn
Addressing a large and growing needs problem as populations get older; excellent fit with digital content developments.
• Virtual/Care Coordination & Navigation $4.1bn Large excellent fit with digital content technologies (existing and to come).
Engagement
• Behavioural & Emotional Health Tracking $1.7bnLower competition than fitness or nutrition; addressing a growing need as mental illness becomes mainstream and more accepted.
• Patient Engagement & Advocacy $3.1bnAddresses a key problem of health ‘adherence’; good use of digital media currently.
Diagnosis
• Self-Diagnosis $3.0bn*Good use of digital media currently (e.g. eye care, skin conditions) and taps into medical device industry expertise.
• Remote (Vital Sign) Monitoring $3.8bnExisting skill base and excellent local links; good use of digital media to visualize and interact with data.
Source: Accenture, Arthur D Little, PricewaterhouseCoopers, KPMG.
Notes: * Author estimates based on research contained in reports by Accenture, Arthur D Little, PricewaterhouseCoopers, and KPMG.
Table 7
– 35 –
Relevant subsectors for collaboration and growth
– 36 –
7.1 INFRASTRUCTURE: ANALYTICS AND
TRAINING
Infrastructure is by far the largest market sector
within the global health industry and has also
received the most amount of funding over the
past decade. As the implementation of systems to
manage health records and patient data continues
apace, the sector is maturing. The sector is still
highly competitive with hundreds, if not thousands,
of software and hardware suppliers. A few large
players, however, are beginning to exert strength
in the sector. In the area of health infrastructure,
the competitive landscape and relative dynamics of
industry events are the key determinant of whether
a subsector presents an attractive opportunity.
The subsectors that represent attractive growth
opportunities are those in which the competitive
landscape is still fluid without appreciable market
power. Two subsectors in particular are at an early
stage in their development: analytics and training.
7.1.1 ANALYTICS
Analytics can provide the mechanism to sort through
the complexity of data in health, and help healthcare
organisations to deliver on the demands placed
upon them. Analytics may be descriptive, predictive
or prescriptive and encompasses everything that
supports fact-based decision making for planning,
management, measurement and learning. Supporting
technologies may also simply remove barriers to
collection and understanding data. The objectives of
applying analytics in healthcare are to:
• Improve clinical quality of care and/or patient
safety as well as reduce medical errors;
• Improve wellness, prevention and disease
management;
• Understand physician profiles and clinical
performance;
• Improve customer satisfaction, acquisition and
retention.
In order to achieve these objectives, analytics
(including the use and analysis of big data sets) needs
to be both content-driven and clinician-driven, and
supported by health executive systems (like the NHS
and the HSE) and by regulatory authorities, including
those responsible for the regulation of the medical
professions (GPs, hospital consultants, dentists and
allied professions)
7.1.2 TRAINING
Training covers both simulation of medical
procedures and clinical scenarios using a variety of
physical and virtual technologies. Virtual reality and
computer-enhanced simulation represent the future
of medical education. Despite the embryonic nature
of the technology, several applications have already
shown themselves to be effective teaching tools
(including in universities in Ireland and Scotland).
Given this early success and the near certainty that
computer and engineering technology will continue
to advance rapidly, the potential of virtual reality
and simulation for medical education and training is
astounding. It is envisaged by those with whom we
spoke that, once they have reached a sufficient level
Relevant subsectors for collaboration and growth
of sophistication and cost-efficiency, VR applications
and simulators will be broadly accepted into medical
education. One can easily foresee an educational
system in which medical students and residents will
first learn procedures and other elements of patient
care on simulators or in the virtual world. Once these
trainees have safely mastered certain basic skills,
they can then begin to hone these skills
with patients in the real world.
Subsectors of the Connected Health Market with the Most Promising Growth Potential – Subsectors within Healthcare Infrastructure
SUBSECTOR POTENTIAL USES
Analytics • Evidence-based medicine• Population wide data to aid research (public heath,
epidemiology)• Predictive analysis• Data visualisation in healthcare• Early disease detection• Patient outcome tracking
Training • Virtual reality devices & 3D imaging• Advanced simulation software• Gamification of training applications• Distance medical education
Source: Consultancy team review and analysis.
Table 8
– 37 –
Relevant subsectors for collaboration and growth
– 38 –
7.2 TREATMENT: PERSONALISED AND ASSISTED CARE COORDINATION
7.2.1 ASSISTED LIVING
Assisted living technologies offer a promising perspective on autonomous aging in place. This is
in the interests of the older patients themselves, family and careers, not forgetting policymakers
struggling to control healthcare budgets in the face of the ever- growing elderly population.
However, these technologies are still in their infancy and little is known whether older adults, and/
or their families/carers, are ready to adopt and use them. Much depends on the state of the elderly
patients themselves – their physical and mental/memory capabilities – and the extent to which they
can live independently. In the nursing home and hospice sectors, where many elderly people spend
their remaining time, assisted living continues to be needed by the health professionals looking
after their elderly residents, even if their independence has deteriorated since they left their homes.
Thus, with the proportion of elderly people aged over 65 years set to grow in the coming years and
decades in the eligible area and in other advanced economies, there will likely be an increasing
demand for assisted living technologies, whether in the home or in the nursing home or hospice
environments – cost will likely become a key factor as well as need and technological soundness.
7.2.2 VIRTUAL CARE
Virtual care represents a major shift in current standards and delivery of care. Virtual care would
extend reach and expand service to patients who require more access, such as patients who live
in rural or remote areas. It has the potential to minimise hospital admissions and re-admissions
by addressing non-emergency health concerns via digital means. Virtual care could also ease
the burden of monitoring and managing long-term and post-hospital patient care while patients
recuperate in their own home. Economically, virtual care could increase the number of patients who
can be seen and treated during a given period of time and potentially open new revenue streams in
the form of virtual consultations.
Subsectors of the Connected Health Market with the Most Promising Growth Potential – Subsectors within Healthcare Treatment
SUBSECTOR POTENTIAL USES
Assisted Living/Aging with Vitality
• Assisted living games, social, video, sound and hardware
• Assisted living and video, images, memory-loss, music, games
• Social media and ageing with vitality
• Health infotainment• Emergency health advice via
telephone and remote monitoring devices
• Audio/visual user interfaces
Virtual care • Social media and chronic disease management
• Real-time health information and services delivery – such as tele-radiology and tele-cardiology
• Communication among multidisciplinary care teams
Source: Consultancy team review and analysis.
Table 9
Relevant subsectors for collaboration and growth
7.3 ENGAGEMENT: EMOTIONAL HEALTH
TRACKING, PATIENT ENGAGEMENT AND
ADVOCACY
With sensors, smart phones, wearable devices and
mobile apps, one can today track just about every
aspect of one’s physical health – from nutrition to
physical activity to vital signs. But a range of new
apps is showing that beyond tracking steps, counting
calories and recording heart rate, one’s smart phone
can now track mental health in addition to physical
health. App developers are already beginning to
consider tackling some of the biggest mental health
issues faced today.
Subsectors of the Connected Health Market with the Most Promising Growth Potential – Subsectors within Healthcare Engagement
SUBSECTOR POTENTIAL USES
Behavioural & Emotional Health Tracking
• Apps that make use of digital media within a programme of cognitive-based therapy to improve, measure and manage moods in specific situations
Patient Engagement Patient Advocacy
• Applications that leverage digital media to trigger and motivate prescribed or beneficial behaviour for patients
Source: Consultancy team review and analysis.
Table 10
– 39 –
Relevant subsectors for collaboration and growth
– 40 –
7.4 DIAGNOSIS: SELF-DIAGNOSIS AND HOME
MONITORING
Self-diagnosis is about to undergo a new period
of growth as devices and software get more
sophisticated. There are home tests for an array of
conditions, including high cholesterol levels, gluten
intolerance and sexually transmitted infections like
HIV and syphilis (at the time of finalising this report,
the first legally approved HIV self-test kits went
on sale in Great Britain). Many are quick and easy
to use, generally requiring only a finger-prick, or a
urine sample. They can also, in some cases, actually
do what their labels claim: uncover indications of a
medical condition (which would necessitate further
consultation with a medical practitioner).
Subsectors of the Connected Health Market with the Most Promising Growth Potential – Subsectors within Healthcare Diagnosis
SUBSECTOR USE CASES
Self-Diagnosis • Connected devices as diagnostic tools• Interactive symptom checklists• At-home diagnostic products are today many and varied,
and include (but are not limited to): blood glucose monitors, home pregnancy tests, blood pressure monitors, blood cholesterol level monitors, heart-rate monitors, kits that require a blood or other tissue sample to be sent for testing, HIV, Hepatitis C and DNA tests that can be used to evidence paternity
Remote (Vital Sign) Monitoring
• Clinical trial, testing, management• Record keeping/health identifiers and social media • Health identifiers and devices to aid in the prevention,
diagnosis and treatment of diseases using remote monitoring tools
Source: Consultancy team review and analysis.3
3 See also http://medcitynews.com/2014/10/digital-areas-offer-greatest-least-investment-risk/.
Table 11
Relevant subsectors for collaboration and growth
They have no idea what a telecoms provider can do in
healthcare and do not understand the power of data
transfer in this industry. The main challenge for us is to
create an identity in healthcare; for technology companies without
a new tangible product, showcasing the relevance of a broad
technology capability is not easy.”
Emmanuelle Pierga, Orange Healthcare
8.1 CONSUMER COMPANIES IN HEALTHCARE
Generally speaking, consumer products firms tend to have strong brands and command
consumer loyalty, and they also tend to be in a better position to create new markets for health
products because of their large existing consumer bases. These firms may be considered
potential entrants or competitors to the connected health market, either by themselves or in
conjunction with specialist digital content providers.
The healthcare market is maturing, with better-informed patients with a desire for more
information and looking for ways to make use of their data. However, when selling to healthcare
providers, the market is extremely challenging for new players and particularly so for those
without a device to demonstrate.
SECTION C
Measures to Assist Growth
08Company measures
– 41 –
– 42 –
Dan Jones from th Association of British Healthcare
Industries (ABHI) also warns that consumer firms
must not underestimate the difficulties faced in
regulating their products within the medical space:
The regulation process is considerably
more difficult in healthcare than it is for
standard consumer apps, for example, and
there is currently not a great deal of direct support
available in terms of helping organisations to navigate
the regulatory minefield. I expect we will see the level
of support improve further down the line, but for now
the healthcare sector is dealing with a number of more
pressing challenges.”
Regulatory challenges are impacting the nature
of products currently in development, according
to Sue Dunkerton, Co-Director of the HealthTech
and Medicines Knowledge Transfer Network (KTN).
Dunkerton suggests that, whilst the healthcare
industry is regulated for good reason, many product
developers are trying to avoid the challenge;
“Many are trying to stay on the consumer side so as
not to have to deal with it, which may hold them back,
but I expect the market to change and become more
encouraging as the first big wins come through.”
Consumer organisations will also particularly
struggle with distributing through healthcare
professionals because they lack relationships
with this community, and the duration of the sales
process. Emmanuelle Pierga says Orange Healthcare
has been talking about connected health and
influencing key audiences for ten years;
“It is especially slow because it relies
on public will as much as professional buy-in”.
8.2 MEDICAL COMPANIES IN THE
CONSUMER SPACE
Medical devices companies, on the other hand,
have more credibility and experience working with
care providers and navigating the strict regulatory
requirements; but there are challenges aplenty in
the emerging connected health space. The tele-
care proposition, for example, where it is expected
that increasing numbers of services will be delivered into
people’s homes, brings with it new aspects of risk and
vulnerability considerations for healthcare providers.
Perhaps more challenging still is the need to understand
consumer needs and attitudes, particularly buying
behaviours, which have never been more important for
medical devices makers. Turning these insights into
products and features – with consumer-friendly interfaces
– and marketing them effectively poses further difficulties.
Many organisations would benefit from the support of third-
party experts in these fields.
Sue Dunkerton of the HealthTech KTN adds that
organisations originating in the medical space will also
struggle to identify and measure success in a consumer
world; “How do you know what’s a good system and what
isn’t? Listening to the consumer voice – reviews and
frequency of use – will be the only way to know.”
Dunkerton expects that connected health will follow a
consumer model initially, which is already sparking interest
with the ‘worried well’ and the IT literate. She suggests,
“The healthcare industry is likely to be the follower in this
sector as the consumers start to realise what is possible
and help create the demand in the more classic healthcare
market.”
Company measures
It is widely accepted by those with
whom we consulted that key to
providing technologically sound and market/
demand-oriented products and services at
competitive cost/price is the need to facilitate
linkages between established companies in the
healthcare industry and enterprises in the digital
media and connected health sectors, including
entrepreneurs and freelancers. Networking
events between such companies, under a
special conference theme, can facilitate such
linkages, and academic institutions, such as
Dundalk Institute of Technology, can assist in
the process, by promoting and organising such
events.
09Measures to develop skill sets and strengthen networks
In addition to this, other networking initiatives to aid in convergence between the
digital content and connected health sectors include:
• Development of a freely accessible database of ideas in
connected health;
• Speaking events from experts in clinical efficacy
and clinical trials;
• Liaising with national and local enterprise
agencies to champion the potential
of connected health and the
interfacing of digital media and
healthcare – to ensure that
this particular opportunity
is recognised and advanced
in national enterprise policy,
so that it becomes part
of the business support
infrastructure;
• Third-level institutions
ensuring that the skills sets
are available to support the
convergence of eHealth and
related technologies.
– 43 –
– 44 –
10
Information regarding the
different types of funding
needed by companies seeking to
bridge the gap between connected
health and digital media is also
relevant.
It is generally felt by stakeholders consulted that
connected health projects can be created with
relatively little capital, as shown in the wider
digital media/IT sector, but the clinical utility of
it must be paramount, requiring early input from
clinical centres. That is why collaborative networks
highlighted above are seen to be so important –
bringing different skill sets from IT and healthcare
together to address a new technology opportunity
with a market need.
As such, funding streams can be drawn from
many sources, with different capital and timeline
requirements of each, including:
• Research grants and pump-priming funding, which
are available from public bodies throughout the
eligible area, through competitive application, and
from other organisations, such as the Welcome
Trust. Research grants are also available through
the NHS primary care trusts, including for projects
capable of demonstrating cost reduction and/or
enhanced patient outcomes.
• Accelerators and business angel funding, which
can play an important role in disseminating
knowledge, acting as an archive of projects (what
has worked, and what has not), adding key team
members and expertise, and offering mentoring.
• Venture capital, which is especially alert to the
opportunities associated with digital media and
connected healthcare, although VC activity tends
to be focused in capital cities and is a rare form
of finance in general to IT firms in the eligible
area. However, this situation can often reflect a
simple lack of information about what is occurring
in practice and there is a role for institutions like
DkIT to address such market failures by making
VC firms more aware of existing activities and
potential opportunities. As may be expected, to
gain the attention of VC investors, pitches and
businesses cases, if they are sought, need to be
world-class and compelling to gain the interest of
this form of capital.
• Crowdfunding – this is a relatively new form of
funding, whereby companies can access funding
informally through social media by enticing wide
share/equity share ownership. However, the
regulation of the practice is still in its infancy and
stakeholders with whom we spoke do not expect
it to fund projects which are more than one year
from delivery, or companies that do not have a
consumer-orientated device.
Measures to boost funding and increase support
In bridging the fast
pace of digital media
activities, we see the difference
in the way healthcare moves and
determines solutions. This gap
must be bridged and requires a
cultural shift in both sectors to
allow co-development to occur
(timeframes in IT tend to be
much more rapid compared with
healthcare).
11
11.1 CULTURAL CHANGE AMONG
CLINICIANS AND PATIENTS
The increasing availability of personalisation of
healthcare means that it is being rapidly devolved
to the consumer. This is shifting the relationship
between clinician and patient, with greater
empowerment of the latter, which would be a
salient feature of eHealth or connected health. This
inexorable shift needs to be embraced by clinicians to
aid the realisation of connected health opportunities.
This will require a combination of education (at
academic and professional level in the formation of
clinicians) as well as acceptance of the trend through
economic forces.
11.2 INCREASED AWARENESS OF THE
COMMUNICATIVE/TRANSFORMATIVE POWER
OF DIGITAL MEDIA
Digital media empowers the end user, but it is glib to
suggest this without also acknowledging the shift in
control away from the provider. Research suggests
that over 70% of the buying decisions in the US today
are made before a sales or marketing impression
is made upon the consumer. This is driven by
consumers researching their own solutions and being
empowered and enabled to deliver upon those by the
shift towards digital media. This commoditisation
and consumer enablement is a global shift and is
unheralded by the clinical profession to date.
Measures to catalyse cultural change in healthcare
– 45 –
– 46 –
11.3 COLLABORATION WITH UNIVERSITIES AS CUSTOMERS
Medical schools and allied medical schools giving rise to the academic
development of nurses and physiotherapists, for example, need to embrace
the trend by becoming customers of new technologies and media for
communicating/managing consumers in the pursuit of healthcare. They
are the conduits to larger research budgets, they are the sources of
innovation through both sectors and as such, third-level institutions have
a responsibility to aid the convergence of digital media/healthcare for the
benefit of the wider population.
11.4 MOVE AWAY FROM A ‘ONE-SIZE-FITS-ALL’ APPROACH
Digital media enables ‘mass ‘customisation’. This is the approach that has
already been felt by traditional industries such as media, whereby the mass
population can personalise and directly plan their activity online, be that
preventative and/or treatment of healthcare conditions. Medicine has actually
already started to make this transition, with the move towards biologics being
targeted against specific sub-sub population cohorts, but digital media allows
this level of customisation by clinical group to occur also.
The move away from the one-size-fits-all approach is also evident in the
strategies and practices of the world’s major pharma companies, where the
trend today is towards niche-buster treatment and away from former block-
busters, which may not work for all patients and populations, or may be too
blunt a response for smart infections.
Measures to catalyse cultural change in healthcare
The opportunities for connected health
– which brings together technological
developments in the digital content sector with
healthcare – are firmly on the radars of the
respective health executives in Ireland, Northern
Ireland and Great Britain, and more widely across
the European Union and the US, reflecting the
transition to more effective and cost-competitive
healthcare provision, where the patient is being
CONCLUSION
– 47 –
placed centre-stage. In this report, we have set
out the background and content to this important
development and looked at the key sectors
where we believe the opportunities for enhanced
connections between digital content and healthcare
are likely to occur in the eligible area in the coming
years, based on objective criteria and measures
most amenable to assisting the growth of eHealth in
the countries.
Accenture (2012) ‘Making the Case for Connected Health’, http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture-Making-Case-Connected-Health.pdf.
BioBuisness (2010) ‘Connected Health in Ireland – An All Island Review’, http://www.cardi.ie/userfiles/Connected_Health_in_Ireland_An_All_Island_Review.pdf.
Currie, W. and Seddon J. (2014) ‘A cross-national analysis of eHealth in the European Union: Some policy and research directions’, Information and Management, Vol. 51, Issue 6, pp. 783-797 (http://www.sciencedirect.com/science/article/pii/S0378720614000536).
Department for Communications, Energy and Natural Resources (2011) ‘Baseline Report on eHealth Development in Ireland’.
Department of Health (UK) ‘Digital Health’, https://digitalhealth.blog.gov.uk/2012/12/20/the-dh-digital-strategy/.
Department of Health, Social Services and Public Safety (2011) ‘Connected Health and Prosperity Memorandum of Understanding Between The Department of Health, Social Services and Public Safety, and Invest Northern Ireland (Sponsored by the Department of Enterprise, Trade and Investment)’, http://www.dhsspsni.gov.uk/connected_health_mou_dhssps_and_invest_ni_2.pdf.
eHealth Task Force Report (2012) ‘Redesigning health in Europe for 2020’, http://ec.europa.eu/digital-agenda/en/news/eu-task-force-ehealth-redesigning-health-europe-2020.
References
European Commission (2010) ‘eHealth Strategies: Country Brief England’, http://www.ehealth-strategies.eu/database/documents/England_CountryBrief_eHStrategies.pdf.
European Commission (2010) ‘eHealth Strategies: Country Brief Ireland’, http://ehealth-strategies.eu/database/documents/Ireland_CountryBrief_eHStrategies.pdf.
European Commission (2012) ‘eHealth Action Plan 2012-2020: Innovative healthcare for the 21st century’, https://ec.europa.eu/digital-agenda/en/news/ehealth-action-plan-2012-2020-innovative-healthcare-21st-century.
European Commission (2015) ‘Digital Single Market: Bringing down barriers to unlock online opportunities’, http://ec.europa.eu/priorities/digital-single-market/.
Groupe Speciale Mobile Association (2012) ‘mHealth and the EU regulatory framework for medical devices’, http://www.gsma.com/connectedliving/wp-content/uploads/2012/03/mHealth_Regulatory_medicaldevices_10_12.pdf.
Groupe Speciale Mobile Association (2012) ‘Policy and regulation for innovation in mobile health’, http://www.gsma.com/mobilefordevelopment/wp-content/uploads/2012/04/policyandregulationforinnovationinmobilehealth.pdf.
Groupe Speciale Mobile Association (2012) ‘Understanding Medical Device Regulation for mHealth A Guide for Mobile Operators’, http://www.gsma.com/connectedliving/wp-content/uploads/2012/03/gsmaunderstandingmedicaldeviceregulationformhealth report1.pdf.
Health Service Executive (2013) ‘eHealth Strategy for Ireland’, http://www.hse.ie/eng/about/Who/OoCIO/ehealthstrategy.pdf.
Health Service Executive (2013) ‘National Service Plan 2013, www.hse.ie/eng/services/Publications/corporate/NSP2013.pdf
Honeycomb (2014) ‘Baseline survey of the Digital Content Sector of Creative Industries in Northern Ireland (excluding Greater Belfast), west of Scotland and six border counties in the Republic of Ireland: Summary Report’, report produced in conjunction with Ashbrook Research and Consultancy.
IBM (2012) ‘The value of analytics in healthcare: From insights to outcomes’ http://www.ibm.com/smarterplanet/global/files/the_value_of_analytics_in_healthcare.pdf.
Momentum (2014) ‘Northern Ireland: A Global Leader of the Digital Economy – A Sectoral Action Plan’, http://www.momentumni.org/getdoc/5b9eb664-b17e-41ef-a178-1d4a52acb598/Digital-Action-Plan-Cover---Copy.aspx.
OECD (2014) ‘Measuring the Digital Economy: A New Perspective’, http://www.oecd.org/sti/measuring-the-digital-economy-9789264221796-en.htm (also available at http://ec.europa.eu/eurostat/documents/341889/725159/OECD+Manual+Measuring+the+Digital+Economy/6418c566-4074-4461-9186-9ad509bc4a4d).
Oliver Wyman (2014) ‘The Patient to Consumer Revolution’, http://www.oliverwyman.com/content/dam/oliver-wyman/global/en/images/insights/health-life-sciences/2014/October/The-Patient-To-Consumer-Revolution.pdf.
– 48 –
PMCA Economic Consulting (2015) ‘Foresight Report on the Digital Content Sector in Ireland and the Irish Border Counties’, prepared for Dundalk Institute of Technology (PMCA in association with Ruby Consulting).
Proof Communications (2014) ‘Communicating Connected Health’, http://proofcommunication.com/connectedhealth.
Royal College of Surgeons in Ireland (2011) ‘smjstaff review: eHealth:Ireland’s approach to medicine in the digital age’, http://www.rcsismj.com/4th-edition/ehealth/.
Saddle Ranch Digital (2012), Author: Paul Flanigan ‘Digital Media in Healthcare: Bringing the Patient, the Staff, and the Hospital Together’ http://www.digitalsignagefederation.org/Resources/Documents/Articles%20and%20Whitepapers/SRDPaper_Digital%20Signage%20in%20Healthcare.pdf.
Scottish Development International (2012) ‘Digital Healthcare in Scotland’.
Sinclair Stockman (2010) ‘Digital Northern Ireland 2020’, https://secure.investni.com/static/library/invest-ni/documents/digital-northern-ireland-2020-report.pdf.
Stroetmann K., Artmann J. and Stroetmann, V. (2011) ‘Developing national eHealth infrastructures – results and lessons from Europe’, AMIA Annual Symposium Proceedings Archive, pp. 1347-1354 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243126/).
The Guardian (2013) ‘The NHS must keep its pledge to embrace tech entrepreneurs’, http://www.theguardian.com/healthcare-network/2013/nov/25/nhs-pledge-tech- entrepreneurs-start-ups.
Ziefle, M. and Röcker, C. (2011) ‘Human-Centered Design of E-Health Technologies: Concepts, Methods and Applications (2011), http://www.humtec.rwth-aachen.de/files/igi_book_wilkowska_ziefle_2011_1.pdf
References
– 49 –
– 50 –
MEDUCATE
Meducate is an app that allows patients to
understand more about their current medical
condition and any associated treatments for their
condition. This understanding will have many
benefits as people absorb information and transmit
information in different ways and the traditional way
in medicine of providing leaflets may not work for
everyone.
Meducate presents information to a patient in a
way that can be altered to every individual patient’s
learning needs. No other method of delivery of
patient information similar to Meducate exists in the
UK, Ireland or Europe. The Meducate technology
will be available in a mobile format so that patients
can use it in private or with family members. Most
importantly, it will be available to them 24/7, so
that they can absorb, process and evaluate the
information in their own time.
Currently, Meducate is developing a pilot of the
technology to a smaller group of patients that will
allow for continuous evaluation and feedback before
the application will be restructured and populated
with content applicable to other conditions.
Annex IExamples of connected health initiatives supported by Honeycomb
Working with the Belfast Health and Social Care Trust,
Meducate has identified prostate cancer as a suitable
user group for the first iteration of the app. This smaller
pool of individuals will allow Meducate to monitor the
impact on the patients, as well as to focus on the quality
of the technology, the structure, the interface and the
adaptability features. These can be developed further
before the product is adapted not only for other cancers
but also for other medical conditions including diabetes,
mental illnesses etc.
Ulster University, the driving force behind Meducate, is
currently collaborating with the Belfast Trust to write
the protocols and ethics for this pilot version focusing
on Prostate Cancer. The pilot to demonstrate that this
method of delivery will enable patients to have a better
awareness of their condition, help them to understand
their treatments and help the hospital with patient
consent of chosen methods of treatment.
It will also alleviate the problems associated with
self-diagnosis through the use of external/unapproved
sources of information and will also allow patients’
families to understand better their loved one’s conditions
and treatment.
The benefits of Meducate include:
• Assists with patient consent
• Decreases the potential for misinformation, increasing peace
of mind for the patient
• Heightened trust in medical practitioners
For further information on
Meducate, contact Martin
McGinn at Ulster University
• Reduces toxicity
of potential side
effects of approved
treatments
• Reduces time and
costs of patient care
– 52 –
VBOT in Use - Medical staff training video for
embedded learning modules
Video-enabled training exposes healthcare
professionals and students to a greater variety of
cases, experts and treatment scenarios that can
be gathered and shared among hospitals, medical
schools and research centres around the world.
Video-enabled training is more convenient, accessible
and affordable than ever before and it is easy to
manage and update, which is ideal for health care
organisations with limited technical capabilities.
VBOT MEDICAL TV
VBOT Medical TV for hospitals and healthcare
organisations can enhance delivery of care at a
distance between patients, clinicians and specialists.
VBOT’s mobile-centric video software integrates
high-definition video recording and playback
applications to enable convenient access to efficient
patient care.
From video training material for medical staff
and patient pre-assessments recorded on their
mobile phones to personalised video physiotherapy
programmes – VBOT Medical TV provides flexibility,
safety and full control of video assets.
VBOT’s secure mobile recording applications are
specially designed for:
• controlled recording
• data protection curation
• filtering control
• auto-archiving for reporting purposes.
The apps allow registered users to easily record,
review and upload their smartphone or tablet
recordings via VBOT’s 2- clicks app design.
Health organisations can ingest and control
reference videos (training, lectures,
rehabilitation videos, conference videos, interviews)
in order to create learning modules that can be
personalised, privately distributed and viewed via TVs
and other devices such as tablets, smartphones and
web browsers.
Video material can be published in video players and
apps for mobile, web and TV for a range of purposes,
such as:
• training
• research
• learning
• communications
• marketing
For further information on VBOT
Medical TV, go to
http://vbot.tv/
solutions/#medical-tv or contact
Frédéric Herrera on [email protected]
or +353 86 0256358.
Annex 1
The Honeycomb - Creative Works Team
STAFF AND MANAGEMENT COMMITTEE
David Brown
Scottish Programme Coordinator, Creative Skillset
Dr Paul Beaney
Project Director, Ulster University
Deirbhile Doherty
Finance Assistant, Ulster University
Professor Sarah Edge
Skills Director, Ulster University
Kevin Fearon
Networks of Scale Coordinator, Dundalk Institute of Technology
Professor Nick Higgins
Research Associate, University of West Scotland
Ian Kennedy
Management Committee, Creative Skillset Northern Ireland
Camilla Long
Skills Coordinator, Ulster University
Irene McCausland
Management Committee,
Dundalk Institute of Technology
Fiona McElroy
Programme Manager, Ulster University
Stephen Michael
Web Developer, Ulster University
Dr Colm Murphy
Intelligence Director, Ulster University
Aisling Murtagh
Research Associate, Ulster University
Dr Douglas Nanka-Bruce
Research Associate, Dundalk Institute of Technology
Caroline O’Sullivan
Skills Coordinator, Dundalk Institute of Technology
Maria Prince
Programme Administrator, Ulster University
Alasdair Smith
Management Committee, Creative Skillset Scotland
Agnieszka Walsh,
Project Administrator, Dundalk Institute of Technology
Dan Wilks
Research Associate, Creative Skillset London
PROJECT PARTNERS
Ulster University
Dundalk Institute of Technology
Creative Skillset
University of the West of Scotland
DELIVERY PARTNERS
Creative Scotland
Letterkenny Institute of Technology
MG Alba
ScreenHI
The Nerve Centre
– 54 –
Honeycomb is part-financed by the European Union’s European Regional Development Fund through the INTERREG IVA Cross-border Programme managed by the Special EU Programmes Body.
About Honeycomb
The Honeycomb – Creative Works programme is a collaborative project led by Ulster University, in partnership with Dundalk Institute of Technology, Creative Skillset and the University of the West of Scotland.
Design by E
lemen
tdesig
n.ie