Establishing the value and business model for sustainable eHealth services in Europe

Objectives

The principal objective of VALUeHEALTH has been to develop a business model and a business plan for the sustainability of cross-border eHealth services, in relation to supporting the health of citizens who either cross borders and then need healthcare, or are deliberately referred to go across a national border to receive healthcare. This business plan is intended as a strategy to assist both European policy-makers and Member States in promoting and sustaining these services, and to guide future planning

VALUeHEALTH has achieved its intended results for all of its five specific work plan objectives. Each of these objectives corresponds to the work of a specific work package. The relationship between the objectives and the work package is identified in each case. All work packages have worked collaboratively and been supportive of the collective work of the consortium.

  1. Develop a prioritised set of use cases reflecting Member State health business needs for cross-border and within-border digital services on a European scale.

    Pursuing this objective, reported under work package 1 in this report, was the dominant activity of the first half of the project. It resulted in the formal prioritisation of two business use cases: safe prescribing and integrated care and self-management for long-term conditions. Its first two deliverables, in year 1, presented the full set of candidate use cases and prioritisation criteria, and the method and results of conducting that prioritisation. Recognising that this use case driven approach might be revisited at a European level in future years, and also undertaken on a national basis by Member States, the final WP1 deliverable has presented guidance on how a use case driven approach might be developed alongside, and in the context of, a high-level reference architecture for eHealth services. WP1 has contributed to all of the other work packages during year 2, to ensure alignment between them, and in particular to the final business plan led by WP5.

  2. Design an over-arching business model framework that encompasses and delivers customised value propositions across a wide range of relevant stakeholders, a Cost Benefit Assessment, risk assessments and sustainability strategies.

    Work package 2 has provided the focus of the project on methods and frameworks. During year 1 this work package established a Business Modelling Task Force to develop value chains and value propositions, clinical cases, and to start to populate a Business Model Canvas. Its first deliverable presented the value propositions for eHealth interoperability. In addition, jointly with WP1, WP2 designed and conducted advanced prioritisation methodologies to establish the priorities as regards the VALUeHEALTH use cases. During year 2 WP2 completed the Business Model Canvas, to model formally the ways in which the value propositions can be realised. VALUeHEALTH considered carefully which perspective to take when designing this canvas, and after much consultation elected to focus the Business Model Canvas on the physical (or virtual) entity or structure designated with the responsibility for managing and coordinating (or contracting out) the new pan-European shared cross-border eHealth services that will be established via the CEF. WP2 also conducted a cost-effectiveness analysis from a health systems perspective in order to assess the value of eHealth interoperable solutions compared to current practices for the optimal management of patients with Type 1 diabetes, as the reference use case. Having completed the Business Model and Cost Effectiveness Analysis, WP2 contributed especially to the final business plan, particularly as regards the financial scheme and forecasts.

  3. Develop a roadmap of scale-up adoption strategies, conditions for success including clinical documentation and care collaboration, and recommended incentives.

    Work package 3 focused on the organisational and workforce changes needed to scale up adoption and maximise the benefit from investments in interoperability. During year 1 this WP undertook a substantial amount of desk research on integrated care, complemented by interactions with the experts and stakeholders during the main project meetings. Its first deliverable examined the barriers, in particular stakeholder resistance, and experience gained in overcoming these difficulties. In its interactions, WP3 identified that an important priority is to ensure that source electronic health record (EHR) systems have data of sufficient quality to ensure that accurate and complete enough patient summaries can be generated so as to inform the health/care professional recipient adequately about the patient and his/her condition. WP3 has examined the strategies for improving data quality, working with a selected group of European hospitals. This work is reported in its second deliverable, along with a wider European perspective on adoption strategies, incentives, and scaling-up.

  4. Develop an ICT and interoperability deployment roadmap, defining the digital infrastructure services that are needed to deliver the priority use cases, and the interoperability assets and platform services that will be needed to design, implement, deploy and maintain these services.

    During the first year of the project, work package 4 paid particular attention to the evolution of the Connecting Europe Facility (CEF) and the first wave of eHealth Digital Services. It worked with the prioritised use cases, the reference clinical case of diabetes and the three patient stories to develop use case description templates and a functional needs assessment for the cross-border digital services that would be needed to support unplanned care, planned care and transfers of care or specialist referral between Member States. In year 2, the three information flows corresponding to the three stories were examined in terms of the additional services and clinical content (bundles of interoperability assets) that would be needed to deliver the use cases. In year 2, it was possible to foresee more accurately than in year 1 the first wave of eHSDI services on which these extensions would be built. It was also possible to see how the EC has positioned its calls for proposals to part-fund and co-ordinate Member State participation in the first CEF calls. WP4 therefore developed its final roadmap as a similar kind of call for the design and deployment of the diabetes extended patient summary.

  5. Deliver a Business Plan and Sustainability Plan which will identify sustainable streams of revenue to establish, operate and grow pan-European eHealth Services beyond 2020, when such services will need to be self-funding.

    In the first year of the project, work package 5 formed an Alliance of experts and stakeholders, convening meetings and webinars to obtain inputs and feedback. It also established links to the Joint Action on Rare Diseases, which supports the ongoing formation of European Reference Networks (ERNs). This Alliance was reported in year 1. During year 2, WP5 ran events (sometimes jointly with the Business Modelling Task Force of WP2) to define the value chains that are vital to ensure that multiple stakeholders derive direct or indirect value from interoperability, and are therefore incentivised to play their vital roles in enabling that interoperability. Finally, and importantly, WP5 led the consortium wide work to develop the final VALUeHEALTH business plan and its promotion to various stakeholders at events during the closing months of the project.

Workpackage 6 is not elaborated in detail here. It has fulfilled its more background roles of managing the project, ensuring smooth co-operation amongst the partners, enabling and overseeing the engagement of funded experts, arranging meetings, webinars and TCs, supporting promotional activities, managing all reporting including financial reporting, and negotiating matters with the EC including the three month no-cost extension that was recommended by the project’s first year reviewers.