eHEALTH eNOUGH? or pHEALTH? Dr Henk G. Sol Professor 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
Oct 24, 2014
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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