MOSAIC roadmap for mobile collaborative work related to health and wellbeing.

The objective of the MOSAIC project is to accelerate innovation in Mobile Worker Support Environments. For that purpose MOSAIC develops visions and illustrative scenarios for future collaborative workspaces involving mobile and location-aware working. Analysis of the scenarios is input to the process of road mapping with the purpose of developing strategies for R&D leading to deployment of innovative mobile work technologies and applications across different domains. One of the application domains where MOSAIC is active is health and wellbeing. This paper builds on another paper submitted to this same conference, which presents and discusses health care and wellbeing specific scenarios. The aim is to present an early form of a roadmap for validation

The Development of eHealth in an Enlarged EU: Synthesis Report

In 2005, IPTS launched a project which aimed to assess the developments in eGoverment, eHealth and eLearning in the 10 New Member States at national, and cross-country level. At that time, the 10 New Member States were Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovenia and Slovakia. A report for each country was produced, describing its government and health systems and the role played by eGovernment and eHealth within these systems. Each report then analyzes, on the basis of desk research and expert interviews, the major achievements, shortcomings, drivers and barriers in the development of eGovernment and eHealth in one of the countries in question. This analysis provides the basis for the identification and discussion of national policy options to address the major challenges and to suggest R&D issues relevant to the needs of each country. In addition to national monographs, the project has delivered three synthesis reports, which offers an integrated view of the developments of each application domain in the New Member States. This report gives a comparative assessment of eHealth policies and institutions, problems and achievements with eHealth in the EU10. It also shows the examples of best practices with in eHealth developments, analyses the possible policy options at local, regional, national and European levels and highlights the most important future technical and non-technical R&D challenges specific to eHealth. Furthermore, a prospective report looking across and beyond the development of the eGoverment, eHealth and eLearning areas has been developed to summarize policy challenges and options for the development of eServices and the Information Society towards the goals of Lisbon and i2010.JRC.J.4-Information Societ

Converging outcomes in nationally shareable electronic health records (NEHRs): An historical institutionalist explanation of similar NEHR outcomes in Australia, England and the United States of America

The adoption of nationally shareable electronic health records (NEHRs) in Australia, England and the United States became major policy and political issues between c1998 and 2015. They continue to be so. As a policy issue, the benefits of ehealth, and subsequently NEHRs as mechanisms for institutional change, were rhetorically popular. Politically however, the development, implementation and regulation of NEHRs proved to be difficult and fraught with criticism from nearly all ehealth stakeholders. The NEHR programs each country pursued at the national level were exceptionally expensive and complex infrastructure undertakings. They involved institutional change management that produced tension amongst stakeholders, required the state to decide on trade-offs that produced winners and losers, and resulted in unintended consequences. Initially, each country approached these policy and political issues differently. Examining why they then had substantially similar outcomes is the substantive puzzle that lies at the centre of this research. This thesis adopts an historical institutionalist approach to explain why state efforts to pursue the development, implementation and regulation of NEHRs at the national level in Australia, England and the United States resulted in substantially similar outcomes despite adopting initially different approaches. The thesis first compares why each case study country pursued ehealth, embarked on organisational change in order to achieve its ehealth and NEHR goals, and adopted NEHRs, noting similarities and major differences. The thesis then compares the state's role in the development of NEHRs at the national level in each country, again noting similarities and differences. A comparative evaluation of the cases is then undertaken in order to explain why each state continued to pursue NEHRs, despite the significant barriers to institutional change they faced. Here, the theoretical concepts of path dependency, critical junctures and incremental change are used to enhance the explanation. The thesis will then explain why the outcomes, as assessed through the lens of public policy evaluation, were substantially similar in each country. Finally, the thesis details the findings of the research through the lens of historical institutionalism and states the significance and implications of the research. The research found that while each case study country approached the policy and political issues of ehealth and NEHRs differently, the outcomes were substantially the same because their goals, and the barriers they faced in trying to achieve them, were very similar. Australia started with a decentralised national health information network (NHIN) then changed to a centralised NEHR. England started with, and continued to pursue, a centralised NEHR. The United States eschewed government development and implementation of an NEHR and took the path of incentivising and regulating electronic health records (EHRs) in an effort to make them nationally shareable. Similar goals across the three countries included moving from a paper to an EHR system; giving patients more control over their health information; making EHRs interoperable; increasing EHR usability and the meaningful use of patient health information; and improving the efficiency and effectiveness of care. Similar barriers included: cost, privacy, trust, stakeholder preferences, and the state attempting to drive change too quickly producing stakeholder resistance and negative outcomes. The thesis findings also provide support for theoretical explanations of institutional stasis and change within the context of path dependency, critical junctures and incremental institutional change

Assessing the Impact of Integrated Personal Health and Care Services: the Need for Modelling

In Europe Public expenditure for healthcare and Long-Term Care (LTC) currently absorbs 6.8% of GDP and without innovative cost containment measures could almost double by 2050 and reach 12.8% of GDP due to several socio-economic and cultural trends. This challenge can be turned into an opportunity for inclusive innovation and growth if the potential of ICT would be fully exploited to deliver personal health and social care services to prevent and manage chronic diseases (i.e. remote monitoring and treatment) or to ensure a dignified and independent living at home for the elderly (i.e. Ambient Assisted Living, AAL). This potential is fully recognised in both the EU2020 Strategy and in the new Digital Agenda for Europe, and one of the first European Innovation Partnership in 2011 will focus on Health and Ageing and related services. This favourable context, however, suffers from a scientific gap with important strategic implications for policy making: there exists currently no micro or macro economic empirical or modelling analysis that would enable policy makers to either demonstrate ex post the impact of Health&Care services or to simulate ex ante their potential impacts. Lacking this support it is at times difficult to win traditional resistance to innovation and push full adoption of such services in Europe. This research explored the availability of tools and methods, both for macro- and micro- modelling tools and processes, assessed their implications, challenges and opportunities and reports on its findings. The paper concludes by laying the foundations for proposing a new research plan that would aim at filling the scientific and policy relevant gap by proposing a hands-on modelling exercise to study the impacts in one country for on chronic disease.JRC.DDG.J.4-Information Societ

Transforming healthcare: policy discourses of ICT and patient-centred care

Information Technology (IT) is increasingly seen in policy and academic literature as key to the modernization of healthcare provision and to making healthcare patient-centred. However, the concept of Patient-Centred Care (PCC) and the role of IT in the transformation of healthcare are not straightforward. Their meanings need unpacking in order to reveal assumptions behind different visions and their implications for IT-enabled healthcare transformation. To this end, this paper analyses England’s health policy between 1989 and 2013 and reviews literature on PCC and IT. English policy has set out to transform healthcare from organization-centric to patient-centred and has placed IT as central to this process. This policy vision is based on contested conceptualizations of PCC. IT implementation is problematic and this is at least partly due to the underpinning goals and visions of healthcare policy. If this misalignment is not addressed then producing technologically superior systems, or better IT implementation strategies, is unlikely to result in widespread and substantial changes to the way healthcare is delivered and experienced. For IT to support a healthcare service that is truly patient-centred, patients’ needs and wants should be identified and designed into IT-enabled services rather than simply added on afterwards

BRIDGING THE KNOWLEDGE GAP: TOWARDS A COMPREHENSIVE MHEALTH TRAINING FRAMEWORK

Mobile health (mHealth) solutions can improve the efficiency and effectiveness of healthcare services delivered by Primary Healthcare (PHC) workers in rural communities in developing countries. However, a host of barriers can hinder the success of new mHealth implementations including low technology literacy levels and failure to communicate the benefits of the solution for all stakeholders. This paper argues that effective training of end users and all stakeholders can remove the barriers which stem from these issues, thereby improving the likelihood of successful implementation and enabling the eventual improvement of healthcare delivery. During a visit to Nigeria, the perceptions of key stakeholders regarding IMPACT, a new mHealth solution, were explored to ascertain the training needs of all stakeholders in the healthcare ecosystem. The paper leverages data from this visit and presents IMPACTeD, a comprehensive mHealth training framework which aims to develop a collective understanding of the solution among all stakeholders, while also improving the technical ability and confidence of PHC workers. The framework will be implemented and evaluated during a second visit to Nigeria. This paper contributes to the scant literature in developing countries by providing a framework which can guide the implementation of further mHealth solutions in developing nations

Strategic Intelligence Monitor on Personal Health Systems (SIMPHS): Market Structure and Innovation Dynamics

Personal Health Systems (PHS) and Remote Patient Monitoring and Treatment (RMT) have the potential to alter the way healthcare is provided by increasing the quantity and quality of care. This report explores the current status of PHS and, more specifically of the RMT market in Europe. It addresses the question of how these technologies can contribute facing some of the challenges standing in front of the European healthcare delivery systems causes by higher demand pressures through chronic diseases and demographic change combined with diminishing resources for health care. An uptake and diffusion of these services would potentially lead to benefits through a reduction in death rates, and avoid recurring hospitalisation in a cost-effective manner. Yet the report identifies different categories of barriers hampering a full deployment of RMT in Europe. In the concluding part the reports provides a number of tentative policy options specifically aimed at fostering EU-wide deployment of RMT/PHS.JRC.DDG.J.4-Information Societ

The (m)Health Connection: An Examination of the Promise of Mobile Phones for HIV/AIDS Intervention in Sub-Saharan Africa

This thesis offers an examination of the complex opportunities and challenges that characterize the development of innovative, locally appropriate, sustainable, and scalable uses of mobile phones as instruments to support and advance HIV/AIDS work in sub-Saharan Africa. Drawing together the fields of ICT4D and health communication, this thesis establishes a theoretical framework for mobile health (mHealth) interventions in developing countries from a critical media studies perspective. It interrogates the varied applications of mobile phones vis-à-vis health that have been identified, promoted, or piloted in sub-Saharan Africa and elsewhere in the Global South, focusing on the potential for mobile phones to enhance two interrelated aspects of HIV/AIDS work: 1) scaling-up prevention and awareness programs; and 2) enhancing access to treatment, care, and support for people living with HIV. By critically examining real-life applications, focusing in particular on a case study from South Africa (the pioneering mHealth organization Cell-Life), this thesis explores both the opportunities presented by the increasing ubiquity of mobile phones in this region, and the corresponding challenges, limitations, and critical issues that inhibit effective realization of mHealth’s potential in this context

Occasioning Dialogic Spaces of Innovation: The pan-Canadian EHR, Infoway and the Re-Scripting of Healthcare

The Canadian public healthcare system appears to currently be under considerable strain. Escalating costs, dwindling budgets and growing patient dissatisfaction are just a few of the systemic pressures that have called into question our current ways of delivering healthcare. As a consequence, there is a growing recognition that renewal is needed, and that this renewal, to be successful, should meet the needs of a wide array of stakeholders, hence calling for unprecedented levels of collaboration among increasingly fragmented interests. In order to bring about this renewal, the federal government seems to be intent on implementing a pan-Canadian electronic health record (EHR) system. To that end, in 2001, Canada Health Infoway was born out of a novel collaboration between federal and jurisdictional health ministries with the specific mandate to accelerate the implementation of EHRs across Canada. In this thesis, I use material-semiotic and dialogic approaches to gain a more nuanced understanding of how the pan-Canadian EHR system is unfolding and in what ways Infoway is trying to accelerate that unfolding. I conclude by suggesting that a more dialogic approach to innovating, in which the innovator focuses on finding various ways to occasion dialogic spaces, may better foster the creation of new meanings of the innovation and therefore result in a more, and not less, harmonious change process. Furthermore, through these dialogic spaces, it is not just multiple meanings of the innovation that are being occasioned, but the innovation itself seems to become more meaningful