Sonja Müller

Conjoint PERSONA – SOPRANO Workshop

Being both EU-IST integrated projects in the field of AAL, PERSONA and SOPRANO organized a conjoint workshop on the occasion of the AmI-07 conference in order for the researchers of the projects to exchange insights of the approaches to the key field challenges, the achievements so far in each of the projects, and possible synergies in the future. Here, we summarize the exchanged info and the workshop results. The paper gives a good overview of the two projects and their status by the end of October 2007.

Achieving Effective Integrated E-Care Beyond the Silos

Gesundes Kinzigtal is a population-based integrated care approach in Germany that organises care across all health service sectors and indications. This chapter describes the development of an electronic networking system in the project between 2006 and 2013. The IT system that was developed shall supply physicians’ offices and other providers such as ambulant nursing care services and hospitals with time saving services providing the complete relevant information of the patient. The status of IT systems in practices at the start of the project and steps to achieve a mutual IT system and intersectoral cooperation are described. Pros and cons for small or large IT companies as partners and patients concerns on data safety and confidentiality are discussed. The chapter closes with an outlook on expanding the project to further healthcare sectors and raises ideas for future studies on self tracking and mobile health data from APPs as well as community resources and voluntary networks to join electronic patient networks.

Ambient Assisted Living Systems in Real-Life Situations: Experiences from the SOPRANO Project

The challenge of an aging population requires innovative approaches to meet the needs of increasing numbers of older people within society (Sixsmith & Sixsmith, 2008). In particular, there is a need to move from a health and social agenda that emphasizes dependency to one that promotes active aging and creates supportive environments to enable healthy aging in the settings where older people live (Sixsmith et al., 2010). Emerging information and communication technologies (ICTs), such as pervasive computing and ubiquitous computing, have considerable potential for enhancing the lives of many older people throughout the world and helping them to age in place (Sixsmith & Sixsmith, 2008). Ambient Assisted Living (AAL) refers to ICT systems, products, and services that integrate sensors, actuators, smart interfaces, artificial intelligence, and communications networks to provide more supportive environments for frail and disabled older people (Mokhtari, Khalil, Bauchet, Zhang, & Nugent, 2009; van den Broek, Cavallo, & Wehrmann, 2010). AAL has been an important emerging area of research over recent years involving collaboration between domain experts (health sciences, rehabilitation, gerontology, and social sciences) and technical experts (engineering, computing science, robotics). Research and development within AAL has aimed to develop applications and systems to facilitate independence (van den Broek et al., 2010), such as activity monitoring to detect potential emergencies, reminder devices for supporting and encouraging mobility and activities of daily living, monitoring activity patterns as indicators of change in cognitive and physical status, and smart interfaces to help people control their everyday environment. The European research project SOPRANO (Service-oriented Programmable Smart Environments for Older Europeans) developed supportive environments for older people based on the concept of AAL.

How to Make a Service Sustainable? An Active Learning Simulation Approach to Business Model Development for Integrated Care

When developing and implementing integrated care services, decision makers need to create complex business models involving many stakeholders, both for-profit and non-profit, and rely on reimbursement from statutory health and social care bodies as well as on other revenue streams. The needs of these stakeholders have to be identified and duly balanced within the framework of what is possible. This requires the handling of a large amount of economic data, the capacity to anticipate future developments, and creativity in dealing with unintended consequences. Furthermore, the development of a business model is likely to involve stakeholders that are not economic experts. We present a combined approach to business model development that allows stakeholders to get acquainted with economic assessments through active learning and to carry out their own assessment and business model development.

Digital Technologies as a Catalyst for Change towards Integrated Care Delivery: Hype or Reality?

The quest for more integrated care is not in itself new, but recent technology developments have nourished hopes that application of advanced digital solutions can make a major contribution to better joined-up care delivery, in particular to those suffering from chronic conditions. However, in contrast, with an enormous breadth of research activities, few instances of routine application of integrated eCare have yet emerged. This raises the question whether the concept of digitally-supported care delivery is indeed a present-day reality transforming traditionally separated care systems or just a hyped-up vision of what could be. Based on a review of recent evidence, including lessons learned from pilot implementations in different countries, the authors argue that the inherent properties of digital technologies do not by themselves lead to better-integrated care delivery. Rather, a reasonable implementation strategy needs to take account of the fact that desired end user support is not delivered by such technologies alone, but by socio-technical systems. An implementation approach that pays simultaneous attention to the stakeholders involved, to the particular working models of the different care actors, and to the technologies to be employed is shown to considerably increase the likelihood of achieving positive impacts on different levels, even if risks and uncertainty cannot be completely avoided.

Kann e-Health einen Beitrag zu verstärkter Integration von Gesundheitsdienstleistungen und verbesserter Kooperation beteiligter Akteure leisten?

Die gesundheitspolitische Debatte uber eine verbesserte Kooperation unterschiedlicher Akteure im Gesundheitswesen ist keineswegs auf das deutsche Gesundheitssystem beschrankt. In vielen europaischen Landern wird derzeit ein Fachdiskurs daruber gefuhrt, wie bestehende Silostrukturen in der gesundheitlichen und pflegerischen Versorgung der Bevolkerung uberwunden werden konnen (Struijs et al. 2015).

How to make an integrated care service sustainable? An interactive workshop on business model development

When developing and implementing integrated care services spanning across established organisational boundaries, decision makers frequently need to create new business models involving diverse stakeholders, both profit and non-profit. These may rely on reimbursement from statutory health and social care bodies as well as on other revenue streams. In practice, the needs of a wide range of stakeholders may need to be identified and duly balanced within the framework of what is possible, e.g. in relation to legislation and regulation. Achieving service integration within day-to-day practice therefore often requires joint planning – sometimes tough bargaining - by many stakeholders potentially concerned. Not at least, a certain amount of “looking into the future” will be necessary, that is anticipating developments, testing different service deployment scenarios and seeing how they respond to changes in patient populations, changes in reimbursement regimes and changes to other factors. If economic modelling of service integration is to be done in an evidence-based manner, a large amount of data on economic and other impacts, both positive (benefits) and negative (costs), thus needs to be handled and systematically brought to bear on the development of an economic case for the desired service integration. Other than merely managerial staff and accountants will most likely need to be involved as well. Care professionals, IT staff, call centre personnel and others can be holders of valuable information in relation to work processes, the actual impacts of process innovation within day-to-day practices as well as acceptability new solutions by staff and/or service clients/patients. While a narrower economic viewpoint might tend to exclude such factors from a business model, they are in reality just as crucial to success as immediately monetary factors such as revenues (see for example (Meyer et al., 2011), (Goodwin and Alonso, 2014) or (Rigby, 2014)). Taking a strictly interactive format, the workshop will enable participants to gain hands-on experiences in service related economic modelling. In particular, workshop participants will get acquainted with economic assessments through an “active learning” approach (Bonwell and Eison, 1991) enabling them to carry out their own assessment and business model development. For this purpose the so-called “Service Implementation Simulator – Integrated eCare” will be used. This tool was created in the framework of the SmartCare project (SmartCare, 2015) to support stakeholders in health and social care when it comes to establishing sustainable economic models for integrated care services currently under development. Since the Simulator is filled with data already, workshop participants can instantly delve into understanding the economic characteristics of an example case and begin modifying data to see how the sustainability model of the service reacts to changes in costs and benefits. While doing this, they will also be made acquainted with the functionalities of an open-source software tool (ASSIST) publicly available for service related business modelling and the underlying methodological assumptions (Hammerschmidt and Meyer, 2014). In didactic regard, this approach will allow workshop participants to get into immediate contact with the content-related aspects of the assessment, while (initially) by-passing methodological questions and the need for data collection. The Simulator is provided with guidance material containing a number of lessons to be learned by the workshop participants. These lessons are designed to make the workshop participants acquainted with the open-source software tool and then to carry out a series of ever more complex tasks. These tasks take the workshop participants on a journey of first understanding how the service works in economic terms and second identifying and then solving a number of problems that were built into the service’s sustainability model. Each lesson in the guidance begins with a description of the problem, followed by a series of ever more concrete hints as to how the problem might be solved. The lessons are generally designed to be solved by working alone, but a group setting can also be used. The latter can be considered particularly useful for those lessons where no single solution exists, but there are rather alternative options, each with its own advantaged and disadvantages. Since the Simulator carries out all calculations on-the-fly, the impact of any solution on the relevant key performance measures can be checked by the workshop participants immediately and without need of feedback from a “teacher”. References : 1- Meyer, I., Muller, S. & Kubitschke, L. AAL markets – knowing them, reaching them. Evidence from European research. In: Augusto, J. C., Huch, M., Kameas, A., Maitland, J., Mccullagh, P. J., Roberts, J., Sixsmith, A. & Wichert, R. (eds.) Handbook of Ambient Assisted Living. Technology for Healthcare, Rehabilitation and Well-being.: IOS Press. 2011. 2- Goodwin, N. & Alonso, A. Understanding Integrated Care: The Role of Information and Communication Technology. In: Meyer, I., Muller, S. & Kubitschke, L. (eds.) Achieving Effective Integrated E-Care Beyond the Silos. Hershey, PA: IGI Global. 2014. 3- Rigby, M. The Core Vision of Person-Centred Care in a Modern Information-Based Society. In: Meyer, I., Muller, S. & Kubitschke, L. (eds.) Achieving Effective Integrated E-Care Beyond the Silos. Hershey, PA: IGI Global. 2014. 4- Bonwell, C. & Eison, J. Active Learning: Creating Excitement in the Classroom AEHE-ERIC Higher Education Report No. 1. Washington, D.C.: Jossey-Bass. 1991. 5- SMARTCARE. Service Implementation Simulator – Integrated eCare. 2015. Available from: http://pilotsmartcare.eu/outcomes/service-implementation-simulator/ 6- Hammerschmidt, R. & Meyer, I. Socio-economic impact assessment and business models for integrated eCare. In: Meyer, I., Muller, S. & Kubitschke, L. (eds.) Achieving Effective Integrated E-Care Beyond the Silos. Hershey, PA: IGI Global. 2014.