Healthy Ageing, Chronic Disease Management, and Co-production of Health and Care in the European Union
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Healthy Ageing, Chronic Disease Management, and Co-production of Health and Care in the European Union

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Presentation carried out by Niels Boye during the presention of MCI Healthy Living in Valencia the 29th Setember, 2011....

Presentation carried out by Niels Boye during the presention of MCI Healthy Living in Valencia the 29th Setember, 2011.
Healthy Ageing, Chronic Disease Management, and Co-production of Health and Care in the European Union

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    Healthy Ageing, Chronic Disease Management, and Co-production of Health and Care in the European Union Healthy Ageing, Chronic Disease Management, and Co-production of Health and Care in the European Union Presentation Transcript

    • Healthy Ageing, Chronic Disease Management, andCo-production of Health and Care in the European Union - seen in a combined medical and ICT perspective From Diseases to Health Niels BoyePhysician, specialist in Endocrinology and Internal Medicine Klinisk Informatik (ClinicalInformatics.dk)
    • Healthy Ageing, Chronic Disease Management, and Co-production of Health and Care in the European Union - seen in a combined medical and ICT perspectiveFrom pathology-oriented to outcome focused Niels Boye Physician, specialist in Endocrinology and Internal Medicine Klinisk Informatik (ClinicalInformatics.dk)
    • Who Am I Physician, specialist in Endocrinology and Internal Medicine with a conventional clinical and scientific career in biomedicine ending – at least for now - as head of a evaluation unit for acute admissions For more than 15 years active in ICT for Health Danish Technological Institute , AAL unit Ambient Assisted Living Joint Programme The PREVE project
    • Pre –requisites (my interpretation)Conventional healthcare cannot by organizing the deliveryof care cheaper and smarter, by better coordination andcollaboration – with or without conventional “ICT for Health” -by (mass)production counteract the challenges in healthand welfare that Western societies are facingWe must provide ways to organize the consumption of careprovisions more intelligent and with higher impact
    • Pre –requisites (my interpretation)Conventional healthcare cannot by organizing the deliveryof care cheaper and smarter, by better coordination andcollaboration – with or without conventional “ICT for Health” -by (mass)production counteract the challenges in healthand welfare that Western societies are facingWe must provide ways to organize the consumption of careprovisions more intelligent and with higher impact as phrased by Mr. Barrosso: Two more healthy years for European citizens (in 2020)
    • European Innovation Partnerships on Active and Healthy AgeingA triple win for Europe• Enabling EU citizens to lead healthy, active and independent lives until old age• Improving the sustainability and efficiency of social and health care systems• Developing and deploying innovative solutions, thus fostering competitiveness and market growth
    • Innovation in support of older people…• At Work – Staying active and productive for longer – Better quality of work and work-life balance• In the Community – Overcoming isolation & loneliness – Keeping up social networks – Accessing public services• At Home – Better quality of life for longer – Independence, autonomy and dignity 7
    • AHAIP – what? Main areas of work Innovation in Integrated Care Innovation in Innovation in Prevention Active and and early Independent diagnosis Living Communication and Awareness 8
    • AHAIP – The Wider Picture Active and Healthy Ageing Partnership  Public Health Programme JPI  FP7 HealthPolicy Areas More    Years, eHealth action plan  Natio  FP7 Struct Better CIP eHealth ural nal Lives eHealth Funds funds EIB Ageing well action plan ESF FP7 ICT & Ageing well  AAL  CIP ICT & Ageing well 9 Time to market
    • So as my preliminary conclusion The areas of e-health and ambient assisted living are attaching increasingly European attention and funding No new instruments or procedures will be introduced, integration of health, prevention and AAL activities are anticipated in broad Joint Programmes A bureaucratic overhead should ensure a steady course towards a common vision and recruit the Memberstates co-funding – on the other hand it might give a better flow from idea to product in the market http://ec.europa.eu/active-healthy-ageing
    • PREVE partnersValtion teknillinen tutkimuskeskus, VTTAarhus UniversityFondazione Centro San Raffaele del Monte TaborUniversidad Politécnica de Valenciawww.preve-eu.org
    • Directions for ICT Research in Disease Prevention www.preve-eu.org
    • What is a disease ?
    • What is a disease ?The internationalClassification of Diseasesis a continuationof a classificationof dead-causes -mainly developedbetween 1850-1900by a seriesof internationalcongresses.http://www.who.int/classifications/icd/en/HistoryOfICD.pdf
    • 1452- 1519
    • The disease classifications (ICD), coding, grouping,and “complexity reducing computing”have been giving much more insight in diseasecauses, disease progressions, and abilities intreatment - but still ON THE GROUP LEVELBUT this general computing paradigm will not beenough to ensure HEALTH on the INDIVIDUAL leveland it will only result in endless discussionsof semantics.We must turn to non-complexity-reducing computing
    • WHO definition of Health (1946) (individual level) “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”
    • Taking offset in the WHO Health definition –then prevention and procrastination ofdisease are meaningful for Preservation of health, cognitive, and physical functions Side remark: An update in the conceptual idea of diseases as tightly coupled to pathology may be instrumental The rest of this talk will be about The evidences and foundation How to orchestrate it and the IT? Potential business models(?)
    • Are there any evidence in thehealth dimension?
    • Co-production of Disease Prevention Connections between Risk Factors and ConditionsCitizen Modifiable Risk Factors Tobacco smoking Conditions Citizen Modifiable Risk Factors Type 2-diabetes Alcohol consumption Preventable cancer Diet Cardiovascular disease Physical inactivity Osteoporosis Obesity Non-Modifiable Risk Factors Musculoskeletal disorders Accidents Hypersensitivity disorders Working environment Mental disorders Environmental factors Chronic obstructive pulmonary disease Family history and gender
    • Example: Evidence of food having impact in Cardio Vascular Disease CVD=Cardiovascular Disease, CI = Confidence interval Reduction i CVD disease risk (%) Reference (95% CI) Wine 32 ( 23-41) Circulation 2002;105:2836-44 (150 ml/day) Fish 14 (8-19) Am J Cardiol 2004;93:1119-23 (114 gr 4x/week) Dark chocolate 21 (14-27) JAMA 2003;290:1029-30 (100g/day) Fruit and vegetables 21 (14-27) Lancet 2002;359:1969-74 (400 g/day) Garlic 25 (21-27) Arch Intern Med 2001;161:813-24 (2.7 g/day) Almonds 13 (11-14) Circulation 2002;106:1327-32 (68 g/day) Am J Clin Nutr 2003;77:1379-84 Combined effect 76 (63-84) Franco OH et al. BMJ 2004;329:1447-50.A “polymeal” of the above would cost 21.60 Great British Pounds per week (2004)and give an average increase in life expectancy of 6.6 years for men and 4.8 years for womenAnd give men 9.0 years more life without heart disease for women (8.1 years).
    • Impact of medical evidence
    • Was it Insulin, the proactive care modelor the personification that did the job? YES, all of them (except maybe INSULIN per se)
    • ICT for health? Let’s look at telemedicine first
    • We identified 53 systematic reviews that focused onassessing the impact of eHealth interventions on thequality and/or safety of health care and55 supplementary systematic reviews providingrelevant supportive information.(approximately 46.000 primary papers)
    • We found that despite support from policymakers,there was relatively little empirical evidence tosubstantiate many of the claims made in relationto these technologies.
    • Whether the success of those relatively fewsolutions identified to improve quality and safetywould continue if these were deployed beyond thecontexts in which they were originally developed,has yet to be established.Importantly, best practice guidelines ineffective development and deploymentstrategies are lacking.
    • Whether the success of those relatively fewsolutions identified to improve quality and safetywould continue if these were deployed beyond thecontexts in which they were originally developed,has yet to be established.Importantly, best practice guidelines ineffective development and deploymentstrategies are lacking.
    • Conclusions: There is a large gap betweenthe postulated and empirically demonstratedbenefits of eHealth technologies.......In the light of the paucity of evidence inrelation to improvements in patient outcomes,as well as the lack of evidence on their cost-effectiveness,
    • So the conclusion must be –we should do something else and in another way.We will come back to this.............
    • The Present Digital Health “Biological age” (“years”) Demand-side 100 AAL Supply-side Driven 0 100 %(100% PatientCitizen) Prevention Tele med 0
    • The Citizen as Co-producer of Health – enabled by ICT Health Service Delivery Citizen as proactive subject Client Centred Approach Patient Centred Medicine Citizen as co-Producer of Health Disease prevention Disease compensation PREVE (Disease cure) Models & Concepts Assisted living Maturity of ICTUser as OperatorExpert Systems User as UserCorporate Centred Contemporary Layman Systems State of the Art Individual Centred Ambient Assisted Living in ICT and Empowerment Citizen as object
    • The Digital Health Continuum 100% 100 % Citizen Patient Synergism? Impact Impact ?70% of chronic diseases are preventable70% of healthcare activities (costs) are spend on chronic diseasesChronic non-communicable diseases and conditions are much more prevalent among oldercitizensSYNERGY OF PHARMACUTICALS AND COPRODUCTION OF HEALTH HAVE POTENTIAL OF A HIGHIMPACT IN THE OLDER SEGMENT OF SOCIETY Contemporary health provision service model Citizen as Co-producer of Health (CPH)
    • The Digital Health Continuum100% 100 %Citizen Patient
    • Special Preven- AAL Chronic Tele- Health legal and tion Disease medicine Care and regulatory Profes- Lifestyle Shared sional issues Change Management apply Management D D Know- D D ledgeSociety Hospital
    • The Co-production ServiceArchitecture (eco system) diabetes as example General Super- Practice marketSpecialist- Restaurant centre Car Pharmacy Farm MuseumHospital Home Sports centre Work Next section: Models and information flows
    • Co-production – a formal definitionCoproduction of health is a term we use to representthat health considerations and knowledge can be embeddedand utilized in any activity in society andthat synergies between professional healthcare,selfcare, informal care, and commodity will be turnedinto “health added value”.
    • Co-production – a formal definitionCoproduction takes place in an “ecosystem”,which is cross-sectional to the formal organisationof society. In the eco-system are formed“value networks” that share information resourcesand can generate the “value propositions”which are the basis of the “business models”that fund the services delivered and consumed bycitizens (consumers, not patients).
    • Co-production – formal In “Governance for health in the 21st century: a study conducted for the WHO Regional Office for Europe” (dated 18th of August and presented in the 61th session at Baku, Azerbaijan, 12–15 September 2011) - coproduction of health is seen as one of the main pillars of future healthcare.
    • Co-production (Sweden)Co-production means plugging into a servicethe knowledge, energy and commitment of itsusers and those close to them, who reallyunderstand and care about the service.This means treating users and communities asassets, not obstacles.In this way, co-produced services can producemore of the outcomes that really matter to users.
    • Data–Information–Knowledge- Decisions• Data is a simple value-set without context, than can be stored and exchanged electronically - if there is technical interoperability e.g. 130/95• Information is a simple message where the value-set is provided a predefined context. Information can be exchanged electronically if there is semantic interoperability (e.g. blood pressure measured to the value of 130/95 mmHg)• Knowledge is information provided a dynamic personal and organisational context and in relations to other knowledge. Knowledge can be utilized and exchanged using computer-models and ontologies (e.g. blood pressure of 130/95 is abnormal i for Peter a 25 year old diabetic patient)• Decisions are made on the basis of knowledge www.preve-eu.org
    • The Personal Guidance Systems Service model diabetes as example Commodity service providers Information Health providers Knowledge Personal Data device Exercise Diabetic
    • The Machine-room of the “Citizen as Co-producer of Health” the ECO-system building blocks Political, social, economic Co- Choice producers architectures Data Information HealthGPS (digital avatar) Knowledge access Platform services (security, ID) PHR
    • Choice architectures embody the regulations, policies,and incentives at societal levelCo-production / ecosystem / value networks / businessmodels are where services are delivered and consumedby citizens (consumers, not patients)ICT enables and supports this
    • BExample GPSA Analogue problem A-D transformation Digital model representation Calculation D-A transformation Analogue presentation (map) Decision support
    • Skagen, Denmark year 2017
    • Childrens menu
    • Decision support (information flows) Clinical Data- and Information encounter flow EHRHMO/ Research/Region Pharmaceutical Co Health-PGS Quality Virtual Individual Model Assurance Digital avatar Healthcare Co-production Research Hospital Patient-NGO/ Trusted information banker and brooker
    • Infrastructure
    • Platforms anddatabases
    • Customization:App-storeVirtual Individual Model
    • But what is healthcare actually “selling”
    • Knowledge Philosophical Abstract models, theories, paradigms layer (abstract) Heuristic Mechanisms, archetypes, patterns layer methods (general)Phenomenological layer Phenomenons, problems, acts (specific)
    • In storytelling Philosophical Philosophy, hate, life, love, layer and death (abstract) Heuristic layer Stereotypes, story-type (general)Phenomenological layer Action, plot, story line (specific)
    • Knowledge in (western) medicine Philosophical Pato-anatomical disease model, layer Gene-theory (abstract) Heuristic layer Diagnoses, Syndromes, (general) MethodsPhenomenological layer Patient specific knowledge, (specific) Acts, Treatments, Observations, Signs, Symptoms
    • What is aHealthcare provisionThe first publicdemonstration ofanaesthesia16th of October 1846Detail from a painting(1882) of Robert HinckleyMassachusetts GeneralHospital, Boston
    • Team work Knowledge Manual workTechnology
    • Delivering healthcare and care provisionsin a co-production eco-systemcould be “packaged” as: Knowledge: Evidence based knowledge in activity-related model based applications (transition from pathology-focused to activity focused ICT may also be a good idea in the Electronic Health Record) Manual work: professional healthcare, selfcare, informal care, and commodity actors Teamwork – communication: Support for the DIGITAL HEALTH CONTINUUM Technology: Social technologies (Web2.0)
    • The Age of Networked Intelligence: 1. Openness 2. Sharing 3. Integrity 4. Interdependence As the characteristics of legal and security issues
    • Business model framework
    • Messages to take home: To serve personalized, individual health needs we should: Create a parallel information flow serving an eco-system with model-based non-complexity reducing computing in which health is co-produces health This could create new business opportunities and lower the total costs of health care, provide morbidity compression, and hence more healthy life years
    • Have a happy ageing!