Digital Single Market mid-term review and health-related priorities

8 June 2017

Transferring EU Public policies into Regional Social Innovation: improving AHA for a better society

Horst Krämer, DG CNECT

White Paper on the Future of the EU

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With a median age of 45 years, Europe will be “oldest” region in the world by 2030.

Digitisation of society is already blurring the lines between workers and self-employed, goods and services, consumers and producers

https://ec.europa.eu/commission/white-paper-future-europe-drivers-europes-future_en

One of the fields identified to deliver: Digital transformation of health and care

Eurobarometer: Digital Technologies

• 18% have used health and care services provided online in the last 12 months

• 70% would be willing to give their health and personal wellbeing data to others, most likely to their doctor or health care professional (65%)

http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/Survey/getSurveyDetail/instruments/SPECIAL/surveyKy/2160 https://ec.europa.eu/digital-single-market/en/news/attitudes-towards-impact-digitisation-and-automation-daily-life

•" • The Commission will adopt a Communication in

2017 addressing further measures in the area of digital health and care, in line with legislation on the protection of personal data, patient rights and electronic identification

•"

Citizens´ secure access to electronic health records and the possibility to share it across borders and the use of e-prescriptions

Supporting data infrastructure, to advance research, disease prevention and personalised health and care in key areas including rare, infectious and complex diseases

• Facilitating feedback and interaction between patients and healthcare providers, to support prevention and citizen empowerment as well as quality and patient-centred care, focussing on chronic diseases and on a better understanding of the outcomes of healthcare systems.

How?

• E.g. Possible approach to Pillar 3:

• Support to first movers

• Transfer of Innovation

• Scalable markets

• Not starting from scratch…

Twinning Support Scheme

• EIP on AHA Reference Sites as adopters or originators of digitally-enabled innovative ICT solutions of others

• 2016 Twinning Support Scheme call

• 20 pairs of adopters and originators

• Ongoing

Originator RS

Adopter(s) RS

Innovative practice

Action Group(s)

MACVIA-France Network

Campania, Catalonia, Porto, Olomouc, Lodz 4 Generations, Medical Delta, Northern Ireland, Piemonte, Southern Denmark, GARD Regional Network Turkey

MASK allergy diary B3

Northern Ireland Catalonia STEPSelect ICT app for selection and procurement of medicines for the elderly A1

Campania Asturias “ADD protection” home-monitoring system A1, B3

Basque country Nouvelle-Aquitaine Predictive modelling system for risk stratification B3

Pays de la Loire Porto4Ageing ALOHA system for prevention of infectious diseases for the elderly A1

Andalusia City of Zagreb Adopting elements of the Andalusian eHealth Strategy Diraya A1, B3

Northern Ireland Olomouc STEPSelect ICT app for selection and procurement of medicines for the elderly A1

Republic of Ireland Regional Network COLLAGE

Campania, Catalonia, Porto4Ageing Cognitive screening system RAPCOG A3

Basque country Liguria Predictive modelling system for risk stratification B3

Lazio Porto4Ageing Baseline assessment of frailty (BAF) application A3

North West Coast of England Oberbergischer Kreis Teleswallowing service delivery model to improve swallowing assessments B3

Campania Olomouc ICT based home monitoring-enabled care for early and protected hospital discharge B3

Twente Campania “Telerevalidatie” self-management platform for patients with chronic diseases and older adults A3

Scotland Andalusia Online self-management service for health and wellbeing management for elderly (Living It Up) B3

Northern Ireland North West Coast of England STEPSelect ICT app for selection and procurement of medicines for the elderly A1

Andalusia Kraljevo Adopting elements of the Andalusian Telecare Service A1, A2, A3, C2, D4

Scotland Basque country Online self-management service for health and wellbeing management for elderly (Living It Up) B3

Basque country Scotland Predictive modelling system for risk stratification B3

Galicia City of Zagreb Predictive modelling system for risk stratification A1, B3

Medical Delta Rotterdam Campania Digital modular gastrological platform to prevent and treat malnutrition A3

First reported successful twinning

• Baseline Assessment of Frailty (BAF) app

• Porto adopted a Baseline Assessment of Frailty (BAF) app from Lazio, a community-based program to prevent or manage frailty in community dwellings.

Basque country participates 4 times

• Partners: Scotland, Aquitaine, Liguria

Visit to Scotland 15/02/2017Visit from Scotland 21/02/2017

Visit from Liguria Region 21/03/2017

Risk stratification tool

• Basque Country as originator • Classifying patients according to their risks covering. Data based

on previous use of health resources, demographic, socioeconomic and clinical variables. Outcome: predicted healthcare cost for the next year.

Living It Up

• Basque Country as adopter of Scotland's

• Living It Up – • an online self-management hub and a

digitally enabled community that provides holistic opportunities to support improved health, wellbeing and active lifestyles.

• Twinning focus on experience and know-how in developing a patient empowerment hub

MACVIA-France: AIRWAYS

• Allergy Diary app used to assess rhinitis control by patients, includes a Clinical Decision Support System.

• Participating Reference Sites enrol 50 elderly patients and 100 adults <65 yrs.

• Started in January 2017

Experience: Twinning

• Continuation of the scheme will be welcomed

• Possible improvements:

• Timeframe

• Reporting

• Simplified overall process

• Budget

• Frequency of calls

Experience: Types of Transfer

• Digital skills & knowledge exchange & training: a central aspect of the innovation are the required staff skills, knowledge (know-how) and related training

• Adaptation: a mature innovation is being adopted by adjusting it to local conditions (e.g. translation into local language)

• Partial adoption: elements or aspects of the innovation (product, service, methodology, strategy) are being implemented using locally available infrastructure.

• Full adoption: the innovation (product, service, methodology,strategy) is being implemented in its full scope by using local infrastructure

• Acquisition: the innovation is being implemented in its full scope by paying for it and using it without significant adaptation effort

Creation of a Twinning Implementation Group between the transferring and the adopting organisations

Identificationand involvement interested actors in the adopter and originator region

Study visit: Involving actors, Agenda, Visit, documentation

Create working groups Implement possible improvements

Analysis of and potential adaptation of the innovative practice

Provide further information, organize webinars and training sessions

Good practice: Twinning

Twinning: Benefits for originators

• Reinforces good practice locally

• Enhances knowledge management and documentation

• Refreshes commitments

• Improves internal communication

• Enhances local coordination/”networking”

• External positive feedback incentive

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Twinning: Benefits for adopters

• Awareness raising among stakeholders

• Knowledge exchange on how to address gaps

• Evaluation of transferability: adequacy, implementation barriers, changes needed

• Collaboration in research to gather expertise and competences

• Improves internal communication and builds trust

Barriers to scaling up

Organisational structures related barriers

Lack of interdisciplinary communication and cooperation

Lack of interoperability and system integration

Time and effort related barriers

Financial and reimbursement problems

Resistance to change / Scepticism about effectiveness

Lack of awareness among professionals and patients

Technical barriers (infrastructure, connectivity)

Low digital literacy / Addressing the target group

Barriers to scaling up innovation in AHA

Barriers: Infrastructure, connectivity

Example 1: Unstable internet access in Twente, poor infrastructure in the University Hospital was the biggest barrier to implementation of a good practice targeting hypertension.

Example 2: In Galicia, network failures or slow systems led professionals to not embrace the advanced electronic medical record IANUS.

Barriers: Lack of interoperability

Example 1: In Languedoc Rousillon, the electronic pharmaceutical record Dossier Pharmaceutique was developed, but it cannot be connected to medical files.

Example 2: Fragmentation of applications caused delays and increased costs of the implementation of an integrated network in Emilia Romagna.

In Valencia it was identified that legacy systems slow down the implementation of innovative IT solutions due to connectivity issues.

Barriers: Financing, reimbursement

Initial investments in implementation and maintenance often regarded as too high/risky

Example: In Twente, the management of healthcare organisations found it difficult to make a definite decision on implementing a telemedicine portal, since the involved costs could not be linked directly to a specific treatment, thus presumably not being reimbursed by healthcare insurance.

Success factors

Clear vision and strong political commitment

Previous research and piloting

Addressing current healthcare needs and embedding the new

system into present healthcare policies

Public and private partnerships

New business models and innovations

Product development in close collaboration with the end-users

User experience design, user acceptance

Local services, integration of the new solution into

the existing environment

Faster benefit realisation of the innovative practices

Marketing and business communication

Funding, financial incentives and investments

Networking and collaboration

Success factors to scaling up innovation in AHA

Training and education of staff

Success factors: Clear vision and strong political commitment Example: In Andalusia, a clear vision of the leadership has been identified as one main factor facilitating the realisation of the digital solutions as part of the Andalusian eHealth Strategy and System “Diraya”. Continuous political support helped to overcome difficulties in the implementation of innovative electronic health practices (this was also the case in Scotland).

Success factors: Previous research and piloting

Example: In the Basque Country, research prior to the development process has been reported as a key to success. In particular, for instance, the development and pilot deployment of integrated care solutions in key EU projects such as CareWell and SmartCare.

Success factors: New business models

Example: In Ile-de-France it was identified that a business model based on a rental of a technology for eLearning rather than selling it, was supportive for scaling up the innovative digital solution

Success factors: Integration into existing environment

Organisationally and technically

Example: In Andalusia, the implementation of Diraya (system integrating all health information for each patient in one single record) has been aligned with the policies of the user organisation, thus promoting the successful realisation of the innovative system.

Success factors: Finance, investment

Example 1: In Saxony, it was identified that financial incentives might help to motivate GPs to participate actively in cross sector cooperation to introduce treatment pathways.

Example 2: In Valencia, the amount of payment for IT companies that developed the local Electronic Health Care Record was based on whether medical staff used the new system or not.

Example 3: In Northern Ireland, the cost reduction as well as the reinvestment of the respective cost savings in the health care system has been a key factor facilitating the implementation of the STEPSelect platform (application designed to optimise the selection and procurement of medicines).

Scale-AHA study messages

Further promotion of the Reference Sites and their work will facilitate the

achievement of the EIP on AHA objectives and the Digital Single Market

priorities

Facilitate efforts of EIP on AHA stakeholders to collaborate at different levels

and tap into regional, national, international and EU support

The Twinning Support Scheme is aligned with the priorities of the Digital Single

Market Strategy and should be used to support its agenda

More effort should be put into promoting different funding opportunities the

EIP on AHA stakeholders can utilise to achieve the Partnership’s goals

Facilitate further the assessment of the impact of digitally-enabled innovations

in a uniform way

Other DSM-related initiatives

mHealth

Focus has been on mobile health applications and in particular apps' data privacy and security

• Code of Conduct on privacy for mHealth apps

• Working Group on mHealth assessment guidelines

• Safety of apps and non-embedded software: result of the public consultation and study

• Research

mHealth Hub in the EU

48 months project started in March, ITU & WHO

The hub will facilitate:

• Development of national mHealth interventions in selected Member States to champion the uptake of mHealth

• ‘Knowledge and Innovations Hub for mHealth’ to monitor and enable mHealth adoption and innovation

• In future, the mHealth Hub will serve as a standalone resource for EU MS to support them in deploying and regulating mHealth

Homes and living environments

"Age-friendly connected homes" as element of sustainable systems for integrated health and social care Insecurity about returns on investment and a lack of clarity about the concrete elements of sustainable age-friendly living environments and the choice of building, retrofitting and adaptation measures to be implemented. Joint effort necessary to integrate digital innovations, support independence, and enable Europeans to lead healthy, meaningful and active lives, at home and in the neighbourhood.

Recap and reflection: DSM Mid-Term Review

How to translate into actions?

• Access to health data

• Research Infrastructures

• Integrated, patient-centred care at scale

• http://europa.eu/rapid/press-release_IP-17-1232_en.htm