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April 10, 2023

Telehealthcare in EUExperiences on Integrated Personal

Health and Care Services (IPHS): Evidence from eight European countries

Disclaimer: "The views expressed in this presentation are purely those of the authors and may not in any circumstances be regarded as stating an official position of the European Commission“

Elena Villalba, Fabienne Abadie, Maria Lluch, Francisco Lupiañez, Ioannis Maghiros,Bernarda Zamora

JRC – IPTS, IS Unit

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April 10, 2023Introduction

European health and social care systems: PRESSURES

• To contain healthcare expenditure

• To further improve the health status of the population in terms of increasing

life expectancy and quality of life

At EC level, policy-making translated into the EIP target to increase the

average healthy lifespan of European citizens by two years by 2020

Strong focus on chronic diseases

Policy context

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April 10, 2023

Introduction

Integrated care from a clinical perspective (or clinical integration), as defined by Suter et al

(2007), involves organising functions and activities around patient care and services. The

focus is on continuity and coordination of care, disease management, good

communication among caregivers, smooth transfer of information, and the

elimination of duplicate testing and procedures.

Integrated care requires a central system of patient records, service delivery and best

practice protocols to deliver care successfully as an integrated system.

1. Health and Social care coordination2. ICT supported

Addressing Chronic diseases: from Disease Management Programmes to Integrated care

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April 10, 2023

SIMPHS2

Supply side •Market findings: size, trends, outlook

Demand side• Country studies & regional approach – Health indicators

• Integrated care cross-country comparison • Citizen survey online panel outcomes

Impact• IPHS deployment and its impact

Issues

Data collection

Transparency

Comparability

Granularity

Strategic Intelligent Monitor on Personal Health Systems

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April 10, 2023

Demand approach

1. Analysis of EU 27 Member States through secondary data collection and desk

research

• Socio-demographic statistics & Prevalence statistics

• Healthcare organisation, costs, financing, incentives and DMP & Social care

organisation

• ICT context – investment, applications, penetration, data exchange

2. Selection of the countries for field work based on the HC system market

mechanisms and eHealth readiness

3. Regional approach in 8 selected countries

• Analysis of ICT for Health deployment and case studies for TC and TH for 3

main chronic conditions

• Primary data collection in field work – interviews with:• Policy-makers/government officers incl. HTA agencies

• Healthcare managers – project/unit/HC centres & Health and social care

professionals

• Technology providers

• Patients

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April 10, 2023

Countries’ selection

Evidence of IPHS, high eHealth deployment

Denmark

High IT investments in Health

EstoniaeHealth large scale trials

UK

Regional approachEvidence of IPHS

ItalyRegional approachEvidence of IPHS

Spain

Quasi-market HC system

The Netherlands

Focus on CDM programs

France

Focus on CDM programs

Germany

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April 10, 2023Data gathering

10 interviews

Estonia

9 interviews

Denmark

8 interviews

The Netherlands17 interviews

United Kingdom

21 interviews

Spain

13 interviews

Italy

1 interview + 20 questionnaires

France

17 interviews

Germany

8 countries – 96 interviews8 countries – 96 interviews

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April 10, 2023Data gathering

VIRTU: 8 TC DREAMING: 60 TCELIKO: 40 TH

Estonia

Patient Briefcase: 800 Anticoagulant: 300Telekat: 132

Denmark (all TH, full coverage TC)

Koala: 838Health Buddy: 382

The Netherlands (all TH, full coverage TC)

WSD: 5721Telescot: 256

United Kingdom (towards IC)

Basque Country: 1338NEXES (Cat): 3600

Spain (regional & local)

Telemaco: 1000 THeCare: 3000 (TC/TH)

Italy (regional & local)

Domocare: 400Y-DOM: 6500

France (TC)

Heitel: 300 TH

Germany

Evidence Consolidation

8 countries - 31 initiatives - almost 20,000 patients8 countries - 31 initiatives - almost 20,000 patients

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April 10, 2023Findings

Key facilitators towards Integrated Care:

1. Reorganization of services – organisational change

2. Governance and funding mechanisms

3. Incentives and financing

4. Technology in place

5. Professionals as drivers

6. Patients as drivers

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April 10, 2023Findings

Organisational change needed in order to provide integrated care

Cooperation between tiers of care involving the creation of new roles

Example in Scotland

• Call handlers IPHS and co-located with NHS24 Social care services Ambulance services

• Accidents & Emergencies

• Community (primary care and matrons) Elderly care wards closing down

• Hospital – hospital discharge teams

Organisational change as key facilitatorOrganisational change as key facilitator

1. Reorganization of services – organisational change

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April 10, 2023Findings

2. Governance and funding mechanisms

Governance• There are policies promoting coordination between health and social care – UK,

Italy and Spain National versus regional implementation

• Policies promoting interoperability – DALLAS example• Need for legal framework / Liability – i.e.: Denmark• In Germany, although many cases exist, government intervention is needed to

deploy IC

Funding

• Needed for up-front costs, testing and crucial for long-term sustainability to avoid projects dying out

UK, Germany, Netherlands, France – national funding sources Denmark, Italy, Spain both EC and own sources Estonia – little funding at national level

Policy push & adequate funds as key facilitatorsPolicy push & adequate funds as key facilitators

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April 10, 2023Findings

• Differences in financing schemes among tiers as a main barrier:

• Payment and incentives to service providers

• Payment to Primary care: FeeForService (DE), eCare payment (DK),

capitation, Pay-for- Performance / P4P (UK, Andalusia),

• Payment to Hospital care: DRG in Italy (Lombardy) and Denmark

• BUT hospital staff-nurses-social care?

• Incentives alignment across tiers of care as a facilitator

• Andalusia – common indicators between primary and secondary care

negotiated at District level

Adequate incentives as key facilitatorAdequate incentives as key facilitator

3. Incentives and financing

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April 10, 2023Findings

• Interoperability in place as a driver and as an innovation process

• Involvement of Industry, e.g. France

• Policy towards nationwide EHR as a driver, e.g. Denmark High eHealth deployment

• However, the technology is not enough, e.g Estonia: 1st class nationwide EHR in place, but no IPHS uptake

Technology in place as key facilitatorTechnology in place as key facilitator

4. Technology in place

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April 10, 2023Findings

• Role of champions, also related to evidence consolidation

• Services mainly run by nurses or social carers but little direct

involvement from physicians (hospital and primary care)

• Need for cooperation between different tiers of care Interoperability Care pathways re-design Patient ownership issues

• Barriers to overcome:

Data overload, data granularity, data structure and interoperability Liability issues Threat to the doctor-patient relationship Lack of incentives

Professional resistance as a main barrierRole of champions as a key facilitator

Professional resistance as a main barrierRole of champions as a key facilitator

5. Professionals as drivers

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April 10, 2023Findings

• Integrated care around the patient - empowerment Organising functions and activities around patient care and services Patients willingness to stay within the community

• Learning to self-manage their condition Technology rotation is emerging as an option

• “Paternalism” of the system reliance on patient or on the service

(i.e.: SMS reminders)

• Influenced by their family/carers and GPs

• Barriers to overcome: Intrusiveness Fears of lack of care

Patients readiness and wiliness as key facilitatorsPatients readiness and wiliness as key facilitators

6. Patients as drivers

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April 10, 2023

Conclusions

Technology is not the issue, the issue is about re-organisation

of care (10% / 90%). However, for this, interoperability is key. More likely to deploy IPHS in countries where policy towards

integrated care, incentive frameworks and funding

mechanisms are in place. Forget about getting new evidence (e.g. more RCTs). Look at demand (users and patients) and raise awareness.

More on SIMPHS2: http://is.jrc.ec.europa.eu/pages/TFS/SIMPHS2.html

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April 10, 2023

Next Steps

“Amongst the 31 initiatives studied it is clear that there is a need to define a

common monitoring and assessment framework. Such a framework could

combine different indicators to enable decision makers to assess both the

state of maturity and the readiness for scaling up. It would represent a basis

for knowledge and evidence as well as enable better international

comparisons of performance”.

SIMPHS3 aims at developing a common Reference Framework for evaluation of EIP AHA actions.

Telehealthcare in EUExperiences on Integrated Personal

Health and Care Services (IPHS): Evidence from eight European countries

Disclaimer: "The views expressed in this presentation are purely those of the authors and may not in any circumstances be regarded as stating an official position of the European Commission“

Elena Villalba, Fabienne Abadie, Maria Lluch, Francisco Lupiañez, Ioannis Maghiros,Bernarda Zamora

JRC – IPTS, IS Unit

Elena.Villalba-Mora@ec.europa.eu