Harvesting from pan-european experiences. Marco d Angelantonio Health Information Management

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2 2 Harvesting from pan-european experiences Marco d Angelantonio Health Information Management

3 Table of contents 3 The context Barriers for the large scale deployment of ICT in support of care The human element: the change management tool box Best practice sharing and beyond The ICT PSP made it possible What support can we expect from the EU in the future?

4 4 The context Western Europeans constitute an ageing society marked slowdown of the fertility rate extraordinary increase in the life expectancy The ageing of the EU population is not expected to stop and even less to go backwards Ageing of the EU population means: an increase in chronic diseases and in the frailty among the general population a deterioration of the dependency ratio a shortage of financial resources and personnel in the care sector to cope with the increase in demand

5 5 The context The healthcare and welfare systems that we have known in the last decades will not be sustainable any longer in the (near) future Small adjustments to traditional care organisation and processes are unlikely to provide a solution Technology in itself does not provide solutions old organisation + technology = more expensive old organisation

6 6 What are the real barriers for the large scale deployment of ICT in support of care? Fragmented systems and organizations Financing: cure rather than prevention (is this actually changing or are politicians just paying lip service to it?) Inadequate knowledge of change management and strategies at management level; innovation fatigue, and resistance to change at shop-floor level Lack of evidence on impact and cost/benefit ratio N.B. In our surveys, technology is never ever mentioned as a barrier to deployment of ICT in support of care!

7 7 What can we do to remove these barriers? Financing of the care system: feed the decision makers with unmistakable evidence that we are heading towards a catastrophe (collapse of the care system) Empowering the transformation potency by managing change adequately Lack of evidence: use to the very best all the data that we have collected so far and develop predictive models to extrapolate experimental results to longer term/different contexts

8 8 Managing the change needed: what we know already Barriers Fragmented organizational structures and regulations Current social and healthcare working force ill-prepared for transformation Opportunities Growing sense of urgency and willingness for transformation, and unused potency within workforce Increasing % of executives willing to take up transformational leadership Attitude & Behaviour are key to transformation: Healthcare is built on effective relationships and sharing of information

9 9 The change management tool box Executive change management master class series: embedding evidence based knowledge Medical leadership curriculum: physicians becoming champions in quality and change 2 fundamental strategic approaches: Implementing the Sandwich Model Battling the Pizza Dilemma The 7 Effective Habits and Conditions for sustainable implementation of ICT enabled integrated care

10 10 Does the sharing of best practices really help? If I were the Ministry of Health of, let s say, Andalusia, would the fact that a certain ICT-enabled care solution has provided a very positive outcome in South Karelia help me in making a decision about introducing the same solution in my region? South Karelia ( inhabitants distributed over 6,873 Km², extreme winter conditions, a totally integrated social and health system, a typical Nordic culture where the interest of the community always prevails over the interest of the individuals, no reliance on families for elderly care, etc.) Andalusia (8,4 million inhabitants distributed over 87,268 Km², snow ever seen only at the top of Sierra Nevada, extreme summer conditions, separate responsibility for social and health system, a typical Southern culture where the interest of the individuals always prevails over the interest of the community, high reliance on families for elderly care, etc.)

11 11 Does the sharing of best practices really help? Would I be tented to run my own trial in my own context before I make any decision? What would be the practical consequences of running my own trial? Delays (5 years?) Costs (several MEuros?)

12 12 Beyond best practice sharing Why predictive modelling which works in context as complex as weather forecast shouldn t work in the care sector? Could we close the loop and create a continuum where from prediction we move to implementation, support implementation with a change management toolbox, evaluate results and use the experimental results to improve the predictive model?

13 13 SmartCare, BeyondSilos and CareWell have allowed us to close the loop Making decisions Implementing Predicting Evaluating

14 14 The ICT PSP made it possible ICT PSP means (or rather it meant ) Policy Support Programme It has funded, between 2007 and 2013, projects aimed at evaluating the impact of existing ICT solutions on a number of health, QoL, economic, organisational, etc. indicators It has funded in particular 3 projects (SmartCare, BeyondSilos and CareWell) aimed at deploying and measuring with a rigorous methodology the impact of ICTenabled Integrated Care Trials have covered 22 regions in Europe

15 15 The three projects have capitalised on solid previous experiences Year Complexity Ambient Assisted Living 2011 Integrated Care Telehealth 2010 PRE-MAST RCT RCT MAST Integrated Healthcare 2007 Users

16 16 Two different but complementary axes Chronicity management Renewing Health United4Health CareWell Support to independence DREAMING HOME SWEET HOME SmartCare BeyondSilos ± chronic (mostly older) patients ± older people

17 17 The user population Mental Health MasterMind ± patients suffering from depression They constitute the largest base of evidence for ICT impact on care currently available in Europe!!!

18 18 The steps that we have taken to make the best possible use of data We have entrusted to a single organisation (Arsenàl.IT) the management and the hosting of the data for all the main projects we are currently managing We have aligned, whenever possible, the codebooks of the various projects for the data to be syntactically and semantically consistent We have prepared, in collaboration with the Odense University Hospital and Arsenàl.IT, a Data Sharing Agreement which allows partners to use data owned by other partners for further research and ethically acceptable exploitation We have reached an agreement about a publication policy to ensure consistency and quality of the information published

19 19 The heritage of the three projects 22 regions which have made the critical step towards ICTenabled car largest set of data about ICT-enabled care ever collected a well-structured corpus of lesson learned a set of guidelines for the successful deployment of ICTenabled integrated caree

20 20 Our final objective Providing care decision makers with evidence and allow them to use their own financial resources to deploy ICT for improving care delivery (spending somebody else s money is by far too easy!) The coming six months will tell us if we have reached it

21 21 What support can we expect from the EU in the future? Ageing of the European population is clearly recognised by the European Commission as a major problem of our society Launch of the European Innovation Partnership on Active and Healthy Ageing Creation of the Health, Demographic Change and Wellbeing challenge as part of Horizon 2020 Continuous support for the AAL Joint Programme (even the meaning of the AAL acronym has been modified AAL = Active and Assistive Living)

22 22 but Are these instrument adequate to address the problem? Yes from the point of view of the amount of resources mobilised Horizon 2020 = 7,4 billion Euros just for the entire duration of the Programme AAL = 34 million Euros for 2015 except for the EIP AHA which receives no funding from the EU Not from the point of view of time to market Horizon 2020 s time to market = 5-10 years AAL s time to market = 2-3 years Can we solve today s problems with solutions available only in 4 to 13 years?

23 23 Conclusions Patients are a resource that no industrialised country can afford to neglect if it wants to remain able to provide sustainable care services The current economic and financial situation forces public administrations Any questions? to rationalise the use of resources It will become increasingly unjustifiable to allow for uncoordinated care provision Can HIM help you to make the transition to integrated care as smooth as possible?

24 24 Contact us Health Information Management SA Boulevard Lambermont 84 B 1030 Bruxelles Tel: Fax: info@himsa-info.eu