A framework to research the social determinants of ICTs for e-health

This article discusses the challenges of combining significantly different methodological approaches to investigate citizens' access to e-health. We define the term access beyond broadband connectivity (material access), to also include motivation, skills and different type of usages, which in e-health ranges from accessing online healthcare information, services and clinical treatment, to self-support. Around the globe, e-health has continued to expand with the expectations that it will both reduce healthcare expenditure and improve quality and access to healthcare for all citizens. However, emerging evidence suggests that, if not managed carefully, e-health will further exacerbate health inequities because those with poorer health are often those with lower or no information and communication (ICT) use

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3). INAA (The Netherlands) Case Study Report

The aim of INAA is to improve the quality of life (reducing feelings of loneliness, maintaining a meaningful life, creating a feeling of solidarity) and autonomy of frail elderly people living independently, allowing them to maintain a high level of physical functioning. In addition, this approach also aims to reduce the burden on informal caregivers who can benefit from the expertise of active elderly people (social/community participation) and contribute to enhancing cohesion in the suburb/neighbourhood. INAA aims to reinforce the coordination between residents, the social care and the healthcare systems at a neighbourhood level, improving the social network around frail older people and their informal caregivers in order to detect potential problems early on.JRC.J.3-Information Societ

International health IT benchmarking : learning from cross-country comparisons

Objective To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning. Materials and Methods A prior Organization for Economic Cooperation and Development–led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and tele-health. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking. Results While electronic records are widely used to store and manage patient information at the point of care—all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%—patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist. Discussion Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., struc-tural and health systems issues that can affect measurement) important for future comparisons. Conclusion While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and ac-celerate the progress of individual countries.First published: 22 August 201

Influence of the Business Revenue, Recommendation, and Provider Models on Mobile Health App Adoption:Three-Country Experimental Vignette Study

Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits of mHealth for patients and health care providers, scientific research examining factors explaining the adoption level of mHealth tools remains scarce. Objective: We performed an experimental vignette study to investigate how four factors related to the business model of an mHealth app affect its adoption and users' willingness to pay: (1) the revenue model (ie, sharing data with third parties vs accepting advertisements); (2) the data protection model (General Data Protection Regulation [GDPR]-compliant data handling vs nonGDPR-compliant data handling); (3) the recommendation model (ie, doctor vs patient recommendation); and (4) the provider model (ie, pharmaceutical vs medical association provider). In addition, health consciousness, health information orientation, and electronic health literacy were explored as intrapersonal predictors of adoption. Methods: We conducted an experimental study in three countries, Spain (N=800), Germany (N=800), and the Netherlands (N=416), to assess the influence of multiple business models and intrapersonal characteristics on the willingness to pay and intention to download a health app. Results: The revenue model did not affect willingness to pay or intentions to download the app in all three countries. In the Netherlands, data protection increased willingness to pay for the health app (P<.001). Moreover, in all three countries, data protection increased the likelihood of downloading the app (P<.001). In Germany (P=.04) and the Netherlands (P=.007), a doctor recommendation increased both willingness to pay and intention to download the health app. For all three countries, apps manufactured in association with a medical organization were more likely to be downloaded (P<.001). Finally, in all three countries, men, younger individuals, those with higher levels of education, and people with a health information orientation were willing to pay more for adoption of the health app and had a higher intention to download the app. Conclusions: The finding that people want their data protected by legislation but are not willing to pay more for data protection suggests that in the context of mHealth, app privacy protection cannot be leveraged as a selling point. However, people do value a doctor recommendation and apps manufactured by a medical association, which particularly influence their intention to download an mHealth app

Strategic Intelligence Monitor on Personal Health Systems, Phase 3 (SIMPHS3). NEXES (Spain) Case Study Report

The NEXES case, based on a project co-funded by the ICT Policy Support Programme Area (CIP-ICT-PSP-2007.2.2 – ICT for ageing well), aims to deploy “integrated care services for chronic patients based on structured interventions addressing not only prevention, but also healthcare and social support”. NEXES is currently in the transitional phase from existing pilot experiences to extended deployment of health/social services for elderly populations. It can supplement existing institutional approaches or offer an alternative to them. The services are grouped in four programmes that represent a broad spectrum of health problems, from those affecting citizens at risk or in the early stages of a disease to those that affect patients with advanced chronic disorders. The programmes comprise the following: (1) Wellness advice and rehabilitation for in clinically stable chronic patients to promote healthy life-styles, enhancing their self- management and improving adherence to prescribed treatments; (2) Enhanced care for frail patients, which aims to assess prevention for frail patients at high risk of hospitalisation; (3) Home hospitalisation (HH) and early discharge, which aims to explore the potential for generalisation of HH and the analysis of the interplay with other Integrated Care Services (ICS) for chronic patients; and (4) Remote support to primary care for diagnosis and therapy (Support), transferring specialised diagnostic and therapeutic interventions to primary care.JRC.J.3-Information Societ

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3). BSA (Spain) Case Study Report

Badalona Serveis Assistencials (BSA) is an integrated private care organisation, funded entirely by public capital. It manages the Hospital Municipal de Badalona, the Homecare Integrated Service, the Socio Health Centre El Carme, 7 Primary Care Centres and the Centre for Sexual and Reproductive Health, providing care to a total population of 419,797 inhabitants in a very populated suburban area of Barcelona (Spain). BSA has been responsible for both health and social care services in this area since 2000, when the Badalona’s City council included social care in the service provided by BSA . This has fostered a new model which puts citizens' and patients’ needs at the centre of the system.JRC.J.3-Information Societ

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3) - PDTA (Italy) Case Study Report

Percorsi Diagnostico e Terapeutici Assistenziali (PDTA, in English “Assisted Diagnostic and Therapeutic Pathways”) is a patient-centric Integrated Care service organised by the Brescia Health Care Unit in Brescia Province (Italy). Brescia is the largest province of the Lombardy region and is second in terms of number of inhabitants after the province of Milan with 1.25 million inhabitants in 2013. The PDTA case started about 15 years ago as an initiative of a local health unit, which developed the PDTA approach with the support of the local GPs’ Unions and the local Associations of Health Care Specialists. The PDTA case addresses patients with complex illnesses, as well as vulnerable subgroups (e.g. persons that suffer for dementia/Alzheimer's). In order to exemplify and deepen the analysis of the case study, we have specifically studied the PDTA case applied to dementia/Alzheimer patients who represent 5% of the Brescia province population of the age group 64 and older (about 15,000 individuals). Currently, the PDTA case is providing services to 50% of the people suffering from dementia.JRC.J.3-Information Societ

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3) - ARIA (Italy) Case Study Report

The ARIA case emerged from an idea of some pulmonology specialists, who have been dedicated for some time to the care and follow up of patients with acute and chronic respiratory failure caused by neuromuscular, neurological and reb cage diseases. These specialists are members of the Italian Association of Muscular Dystrophy Patients (UILDM) and belong to the Arcispedale Santa Maria Nuova (Santa Maria Nuova General Hospital) and to the San Sebastiano Hospital, within the Local Health Unit of Reggio Emilia. The basic idea underpinning the ARIA case is that telecare can play an important and powerful role in the care of patients with chronic diseases. In particular, it can contribute to the delivery of services that benefit patients in terms of independent living and quality of life through improved collaboration amongst caregivers and health workers, while simultaneously helping to cut the cost of the regional healthcare system.JRC.J.3-Information Societ

Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS3). Gesundes Kinzigtal (Germany) Case Study Report

The Gesundes Kinzigtal case started about ten years ago as an initiative of OptiMedis AG, a management company with a health sciences background providing integrated care, and the local physicians network (Ärztenetz - MQNK). These two organisations had the capability to convince and fully commit two health Insurance companies, AOK Baden-Württemberg and LKK, to the initiative, within one and a half year of negotiation. OptiMedis and the GP network established together Gesundes Kinzigtal GmbH, with the aim of improving the health status and the inter-sectoral quality level of the services provided, and the inter-sectoral health care experience. It also aimed to reduce the total costs of care (and earn a share of the cost savings from the health insurances involved). Since 2006, Gesundes Kinzigtal has been operating in the Kinzigtal Region in the Southwest of Germany, providing health services to about 33,000 policy holders.JRC.J.3-Information Societ