Establishing the value and business model for
sustainable eHealth services in Europe
VALUeHEALTH will demonstrate how interoperability of health information can consistently create, deliver, and capture value for all stakeholders, in order to justify sustainable investments in scaling up interoperability across Europe.
This project is being undertaken in the context of many years of activity in standardisation, many hundreds of millions of Euros invested in national eHealth programs, which have not yet delivered enough benefit to have become sustainable, and have to some extent called into question whether historic promises have been too bold. The second important context is substantial investment in Europe through the Connecting Europe Facility (CEF) in establishing a pan-European digital services infrastructure covering multiple public sectors. This investment provides a unique opportunity and momentum to define and deliver a more strategically sound, value driven, business plan to realize sustainable eHealth interoperability. The CEF will offer a time window of European funding in generic services, and for some specialised eHealth specific services, that eHealth can take advantage of. CEF (public) funding is not a long-term solution, but an important enabler. The permanent solution is to construct a value chain that maintains a perpetual cycle of investments in interoperability, that become embedded within the larger ecosystem of the health care delivery and health ICT sectors, and indeed bring sufficient benefit to enhance those sectors. VALUeHEALTH will demonstrate how this critical value chain can be constructed and optimised by developing an evidence-based business plan for sustainable pan-European services.
The starting point for developing our business plan is to prioritise use cases for interoperable health information and health knowledge flows. Recent European projects have developed use cases supporting cross-border patient flows, in preparation for citizen rights to cross-border health services. Importantly, we will build on the results of projects such as epSOS, SemanticHealthNet (SHN), EXPAND, eSENS (eHealth), Antilope, Trillium Bridge and PARENT Joint Action which have developed or are consolidating key building blocks which will help to address our challenge, and in which many of our consortium are also involved. VALUeHEALTH comprises a rich multi-stakeholder consortium of experienced partners and funded experts, to ensure that many essential viewpoints are brought together to undertake this project. A dedicated stakeholder engagement and empowerment work package will create synergies within this multi-stakeholder community towards the needed alignment in strategy and business plans as well as engagement and commitment to realize the assumptions that will drive CEF sustainability business planning. The positive experience of MS and stakeholder co-operation in CALLIOPE and the universally endorsed EU eHealth Interoperability Roadmap will be also exploited in VALUeHEALTH. We will work with these stakeholders - though a robust methodology - to develop this prioritised set of use cases starting from those approved by the eHealth Network as priorities to be addressed within the CEF, and which shall reflect the maximum added value for Member States. We will also go beyond these existing use cases, as there are many areas of cross-border collaboration which also deliver direct value to healthcare within Member States, which are in fact the priorities that are most likely to have strong underpinning business cases for Member State (national) investment and national market development, and yet benefit from pan-European collective action. VALUeHEALTH will demonstrate, in depth for these strategically prioritised use cases, the quality, safety, economic and scientific value that can be realized through interoperability on a European scale. This prioritised roadmap of use cases is itself a useful output of the project for MS. The prioritised use cases roadmap, and the associated services, based especially upon their anticipated clinical, humanistic, societal and economic value, will drive the rest of the project.
The expected benefits for each stakeholder will be clearly articulated and validated, especially for each of the stakeholders who need to play an active role within the eHealth ecosystem to sustain interoperability, with emphasis given to those who will fund parts of that ecosystem, and those who most need to derive the realisation of value from interoperable information. The business model framework will be used to undertake a robust Cost Benefit Assessment for the stakeholders who need to drive the targeted investments. State-of-the-art business modelling methodologies will be used to leverage the value creation, delivery and capture within a multisided market in which stakeholders and inter-dependent from each other, each one influencing and being part of the value chain process. There is a present day misalignment of incentives that has to be changed convincingly. The business model will establish the value of eHealth interoperability, and how cost savings and growth in capacity can justify and finance investments in eHealth services, with minimal dependency upon public funding. We will also develop a use-case driven deployment roadmap and scale up strategies to provide Member States, industry and other key players with sound business cases and direction for targeted investments in the adoption of interoperable eHealth systems and services, thus making a major contribution to the planning and road-mapping of the Connecting Europe Facility (CEF).
The benefits realisation from interoperability has to be underpinned by a growing heritage of high quality (structured and coded) health information, and a culture that puts this to good use to guide clinical decisions, healthcare management strategies, commissioning and reimbursement, population health and research. We will therefore tackle the legal and organisational (socio-technical) levels of the eHealth EIF, and also a financial level. We will examine the barriers, and enumerate the success factors and incentives needed for wide-scale high quality data capture and use, and turn this into an adoption and scale up strategy for self-financed cross border eHealth services. A good example needing incentives is the capture of high quality, complete, consistent, structured and coded health information at source, by busy, often junior, clinicians. Another example barrier to gaining value from interoperable health information is reimbursement models that pay for activity rather than for clinical outcomes. We will engage many stakeholders who influence the financial, organisational, professional and personal factors that presently discourage value realisation from interoperable health information, but who need instead to influence the major financial drivers for investing in it. We will make recommendations for incentives and changes to classical reimbursement models that will accelerate the capture of, and benefits realisation from, interoperable EHRs containing high-quality structured and coded health information. The behaviour changes, and changes to reimbursements, needed to promote adoption and successful use of interoperable systems is itself a potential cost, as well as source of benefits, to inform the business model. The adoption and sustainability roadmap will be a useful blueprint for health authorities, healthcare providers and health insurers.
The capability to procure interoperable solutions critically depends upon the availability of interoperable solutions in the form of IT products and services and national and European interoperability infrastructure, which in turn is enabled by the availability of appropriate interoperability assets. The deployment roadmap will correspond to the technical and semantic interoperability levels of the EIF. VALUeHEALTH will build on and leverage the work of SemanticHealthNet, epSOS, PARENT, Antilope, Trillium Bridge and EXPAND, together with intermediate results of the other CSAs running under H2020 PHC 34 topics, in defining the scope of the infrastructure and infostructure needed to realise the use case deployment roadmap. It will also incorporate EXPAND results, by considering the conditions and proven practices for sustainability of the interoperability assets inherited by epSOS, SHN and other projects for the implementation of the use cases roadmap. Taking in depth examples, and collaborating especially with SDOs and industry, we will chart out the resources needed, costs and timelines to develop selected interoperability services, to inform the business modelling activities of this category of cost to take into account. A key objective is to include in this roadmap the concept that eHealth services should be certified by appropriate entities/procedures, to move the workload and responsibility from each stakeholder to Vendors and a Third Party, reducing the adoption costs/risks. The development and deployment roadmap will be a useful project output in its own right, at both European and national levels.
Finally, VALUeHEALTH will bring all of these roadmaps and business models together to deliver a final business plan to take forward sustainable interoperability beyond the CEF. This will be a full business plan going beyond 2020, including all revenue streams and cost items. The stakeholder engagement and empowerment activities will focus on ensuring that the CEF sustainability plan and business plan takes full consideration of, and resonates appropriately with, the prospective national and regional strategic roadmaps to produce their maximal effect. It will equally focus on creating resonance with stakeholder current and future strategies and investments in creating, delivering and capturing value over a value chain that cross cuts the national, EU and international terrain. By including many influential stakeholders including representatives from health ministries in this consortium, we wish to ensure that the final business plan is not only co-developed with them, but that they feel able to take ownership of this plan and are committed to its long-term execution. Through this proposed approach, we believe that it is possible to provide convincing evidence of why, and also how, a self sustaining value realising multi-sited market can be constructed for investments in eHealth interoperability. Eventually, one may envisage that the cross border eHealth services will survive and thrive towards 2020 and beyond though public – private partnerships and investments.
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