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

eHEALTH eNOUGH?
The Arena Observations Deeper Insights Towards pHealth

Preconception Health Obstetrics CHC QoL Wellbeing etc.

Healthy Ageing
Prevention

Well-being perspective

Intervention
Ageing is on-going process Ageing starts at fertilization

Age
Birth Chronic disorder 1 Complication Chronic disorder 2

Classification patients base

Type of patient
Distress Short episode of illness Mild acute illness
% Insured of health plan
100

Costs of insured

Management

90 Low 80

Primary care Health plan

Chronic illness Moderate to serious illness

70

60 Medium

Disease management

Complex Patients Multi-morbidity, including psychiatric Multiple health care providers Psychological-, social- and financial deregulations

50

40

30

20

High

Individualised care trajectories

10

Community center Care technology Caretaker Living situation Housing association Mobility Public transport Taxi Paid work Volunteers Reintegration Informal care Health Home care

Nursing home General hospital Physician Psychiatric hospital Welfare work Contacts Voluntary work

Aging citizen

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

Decision Enhancement (DE)

Healthy Ageing is challenging

Care networks Effective interventions

Image watch

Video phone

Web portal EPD

Dorpsverpleegkundige

Serious Games

Care vouchers

Wegwiezers

Image watch low effectivenes

Video phone failure EPD resistance

Web portal - critical

Dorpsverpleegkundige marginal
Care vouchers little innovation

Serious Games marginal

Wegwiezers difficult

Case
Image watch Talant Videophone Talant Videophone Veldspaat Portal Gilde Dorpsverpleegkundige EPD WZG EPD Tjongerschans

Observation
low effectiveness low effectiveness failure critical marginal resistance resistance

Reflection
new processes to be defined technology and processes outdated technology not thought through lack of patient centered development processes not clear and not supported technology push, processes unclear technology push, processes unclear

Care vouchers Plantijn

Close to the citizen Portal Steunstee Care Arrangements

little innovation
difficult to imagine difficult difficult

capturing new services difficult

guidance for patients needed technology push, no processes collaboration processes not individualized

Case
Prevention Counseling WMO support

Observation
marginal non existent

Reflection
lack of patient centered tasks technology push and data neglect

Telecare ACTIZ
WMO Business Intelligence

marginal
nearly non existent

processes and patient involvement unclear

legacy of IS

Wegwiezers Aa en Hunze
Cogknow Alzheimer eDentistry Home care route planning Health and real estate Health insurance and BI Serious games for .

difficult
marginal limited applicability limited applicability marginal marginal marginal

low sustainability of concept

processes unclear process and patient centered rethinking processes processes and patient role unclear no individual assessments technology push

Healthy Ageing

Referral Services Healthy Ageing Tele Medicine

Mother Milk Factory

Sanitary Services EInclusion

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!