eHEALTH eNOUGH?or pHEALTH?

Dr Henk G. SolProfessor of Business and ICT and Founding Dean

Faculty of Economics and Business

Professor of Systems Engineering and Founding Dean

Faculty of TPM

Delft University of Technology

eHEALTH eNOUGH?

› The Arena› Observations› Deeper Insights› Towards pHealth

Chronic disorder 1

Chronic disorder 2

Complication…

AgeBirth

HealthQoLWellbeingetc.

Well-being perspective

Preconception“Obstetrics””

CHC

Intervention

Prevention

Ageing is on-going process“Ageing starts at fertilization”

Healthy Ageing

I2Care

100

90

80

70

60

50

40

30

20

10

% Insured of health plan

Costs ofinsured

ManagementType of patient

• Distress• Short episode of illness• Mild acute illness Primary care

Health planLow

Individualised care

trajectories

• Chronic illness• Moderate to serious illness

Disease management

Medium

High

Complex PatientsMulti-morbidity, including psychiatric

Multiple health care providers

Psychological-, social- and financial deregulations

Classification patients base €

Agingcitizen

Informalcare

Communitycenter

Paidwork

Reintegration

Health

Contacts

Voluntarywork

Livingsituation

Mobility

Home care

Physician

Welfarework

Care technology

Caretaker

Housingassociation

Volunteers

Public transport

Taxi

Nursinghome

Generalhospital

Psychiatrichospital

Needs and facilities for the aging citizens

Source: NHL, Lw

eHEALTH eNOUGH?

eDrivers in the Arena› Push for Ambient Assisted Living,› e Inclusion and e Integration› To handle effectively › Exploding needs for care and cure

eHEALTH eNOUGH?

eHealth› The development of› Information› And communication technologies› In› Health care

eHEALTH eNOUGH?

› But, not all eHEALTH initiatives are positive

› Many observations in the North of the Netherlands, a rural area with social cohesion and double ageing,

› Do raise the question› Is eHEALTH eNOUGH?

The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview, A.D.Black et al, PLOS Medicine, January 2011

eHEALTH eNOUGH?

› Observations in Multiple Case Studies› With Anecdotal Evidence› Through the Lens of Decision

Enhancement

Keen, P.G.W. and H.G.Sol, Decision Enhancement Services: Rehearsing the Future for Decisions that Matter, IOP Press, 2008

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Decision Enhancement (DE)

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Healthy Ageing is challenging …Care

networks

Effective intervention

s

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Dorps- verpleegkundi

ge

Video phone

Web portal

EPD

Image watch

Care vouchers

Serious Games

Wegwiezers

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Dorps- verpleegkundige – marginal

Video phone - failure Web

portal - critical

EPD - resistanc

e

Image watch – low

effectivenes

Care vouchers –

little innovation

Serious Games - marginal

Wegwiezers - difficult

Case Observation Reflection

Image watch Talant low effectiveness new processes to be defined

Videophone Talant low effectiveness technology and processes outdated

Videophone Veldspaat failure technology not thought through

Portal Gilde critical lack of patient centered development

Dorpsverpleegkundige marginal processes not clear and not supported

EPD WZG resistance technology push, processes unclear

EPD Tjongerschans resistance technology push, processes unclear

Care vouchers Plantijn little innovation capturing new services difficult

Close to the citizen difficult to imagine guidance for patients needed

Portal Steunstee difficult technology push, no processes

Care Arrangements difficult collaboration processes not individualized

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Case Observation Reflection

Prevention Counseling marginal lack of patient centered tasks

WMO support non existent technology push and data neglect

Telecare ACTIZ marginal processes and patient involvement unclear

WMO Business Intelligence nearly non existent legacy of IS

Wegwiezers Aa en Hunze difficult low sustainability of concept

Cogknow Alzheimer marginal processes unclear

eDentistry limited applicability process and patient centered

Home care route planning limited applicability rethinking processes

Health and real estate marginal processes and patient role unclear

Health insurance and BI marginal no individual assessments

Serious games for …. marginal technology push

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Healthy Ageing

Referral

Services

MotherMil

k Facto

ry

Tele Medici

neHealt

hy Agein

g Sanitary

Services

E-Inclusio

n

Water and Sewage

Management

eHEALTH eNOUGH?

Deeper insights

No positive business cases

› Processes neglected› People not central› Technology pushed

eHEALTH eNOUGH?

Deeper insights

› eHEALTH is eNOUGH

› mHEALTH the new bandwagon?

eHEALTH eNOUGH?

Deeper insights

› pHEALTH needed• Personal(ized) • Preventive• Process driven• Patient oriented• Participatively designed

eHEALTH eNOUGH?Deeper insights

› Guidance needed for pHEALTH enabled self management› Network orchestration replaces chain

management› Health Apps are to be co-ordinated

eHEALTH eNOUGH?

From mHEALTH to pHEALTH!› Processes are key, but are people really

interested?› Patient participation is great, but is

patient able to contribute?› Technology is enabler, but is too much

technology push in EC not dangerous?

eHEALTH eNOUGH?

From mHEALTH to pHEALTH!

› How to create › effective › individual › interventions?

eHEALTH eNOUGH?

From mHealth to pHEALTH!Create services for individual care and cure › with pCentered pAps› supported in the cloud› for effective interventions› in networked arrangements› tested in living labs

eHEALTH eNOUGH?

pHEALTH the eChallenge!

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