1 ICT & Health Care Marco d Angelantonio
Table of contents 2 The context Barriers for the large scale deployment of ICT in support of care The role played by the EU The EIP AHA Best practice sharing and beyond The gold mine The available funding instruments in Europe Pros and cons
3 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
4 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 If we are all convinced that something radical should be changed to satisfy demand while keeping the system sustainable, why so little has happened so far?
5 What are the real barriers for the large scale deployment of ICT in support of care? Financing of the care system: cure rather than prevention (is this actually changing or are politicians just paying lip service to it?) Resistance to change by care professionals (do all categories of care professionals show the same resistance?) Lack of evidence on impact and cost/benefit ratio N.B. Technology is never ever mentioned as a barrier to deployment of ICT in support of care!
6 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) Resistance to change by care professionals: change management tool box and coaching 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 Can the Commission help in this process?
7 The EU has shown consciousness of the problem Ageing of the European population is 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)
8 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?
9 but Do we really need more technology? It does not seem so Source: Complexity Avalanche by J.B. Wood
10 Is the EIP AHA the right instrument to address the problem? How long public entities, which constitute the spine of EIP AHA, will keep investing in an initiative which falls outside their mandate without any financial support from the EU? Are the best practices identified by the EIP AHA really best practices? Is the concept of best practice suitable for reaching the goal (fostering the take-up of ICT by care providers)?
11 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 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 (132.000 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.)
12 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?)
13 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?
14 Closing the loop Making decisions Implementing Predicting Evaluating
15 The theory of predictive models To predict a response variable using a series of explanatory variables Independent Variables/ Predictors Transition Probabilities Dependent Variables/Observed Outcomes Statistical Model/Simulation MODEL RESULTS
16 How to apply predictive modelling in care Reference deployment site If NOT valid Assessment Modeling technique Build model Run model Validate model Improve model If VALID Potential deployment site Support decisionmaking Compare predictions Run model Revise model Investigate differences
17 ICT PSP - The gold mine 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 We have won and managed a large number of these projects all dealing with the telemonitoring of chonic patients or with the delivery of integrated care supported by ICT in home settings Trials have covered 30 + regions in Europe
18 Year The chronological sequence Complexity 2013 2012 Ambient Assisted Living 2011 Integrated Care Telehealth 2010 PRE-MAST RCT RCT 2009 2008 MAST Integrated Healthcare 2007 Users 200 300 1.000 5.000 8.000 10.000
19 Two different but complementary axes Chronicity management Renewing Health United4Health CareWell Support to independence DREAMING HOME SWEET HOME SmartCare BeyondSilos ± 30.000 chronic (mostly older) patients ± 20.000 older people
20 The user population Mental Health MasterMind ± 5.200 patients suffering from depression They could constitute the largest base of evidence for ICT impact on care currently available in Europe!!!
21 The steps that we have taken to make the best possible use of the 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 are completing, 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
22 The available funding instruments in Europe a A A A
23 The available funding instruments in Europe Pros Large (7,4 BEuros) Cons 100% funding (which leads to high appeal and cutthroat competition) Very much oriented towards technological R&D Broad focus of individual topics (which leads to poor match between content of proposals and competence of the evaluators) Evaluation process out of control
24 The available funding instruments in Europe Pros Narrow focus Relatively short time to market Reasonable competition Cons Relatively small budget Complicated structure central evaluation Consortium reconfiguration multiple contracting authorities Disparate eligibility rules and funding rates
25 The available funding instruments in Europe Pros???? Cons????
26 Challenging the Commission about their recommendation to use the EU structural funds to finance ICT deployment in care and ask them to play an active role in this (need to combine bottom-up an top-down approach to overcome inertia and win against established lobbies)
27 Other steps that we are taking to fund deployment of ICT based innovation in care 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!)
28 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?
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