Slides from National eHealth Summit, 30 Sept 2015 at Carton House, Kildare: Maria Quinlan, Research Lead Change Work-Package, ARCH. #eHealthSummit15 http://www.ehealthsummit.ie http://mhealthinsight.com/2015/09/25/mhealth-insights-from-the-ehealth-summit/

1. Unlocking the potential
of Connected Health
Dr Maria Quinlan
maria.quinlan@ucd.ie
Applied Research for Connected Health (ARCH), UCD

2. • Applied Research for Connected Health centre
• EI & IDA funded technology centre
• UCD and UL collaboration – mixture of academic,
clinical and industry partners
• Academically multi-disciplinary group – health
sciences; social sciences; business studies; computer
science
• Carry out research on the adoption, deployment and
sustainability of Connected Health solutions
ARCH – who we are
2

3. ARCH members
include….

4. • CH is a conceptual model for health care delivery
where devices, services or interventions are designed
around the patient’s needs,
• ….and health related data is shared to allow the
patient to receive the most proactive and efficient care
possible (Caulfield and Donnelly, 2013)
What we mean by‘Connected
Health’
4
The right information, when, where and how the patient/clinician
requires it

5. tele-care
m-health
digital health
wireless health
integrated care
histological
tele-health
sustainable
healthcare
remote monitoringhealth 2.0
e-health
‘CH’encompasses….
CH is a patient centered
approach to health
management -
Leverages technology but is
not merely technology
focused

6. ARCH
Research
Themes
• Implementa+on
at
scale
–
financial
and
organisa+onal
• Adop+on
issues
–
mo+va+ng
key
stakeholders
• Behavioural
change
–
micro
level
• Business
models
for
Connected
Health
CHANGE
How
can
the
barriers
to
the
use
of
Connected
Health
technologies
be
overcome
and
maximum
impact
achieved?
• Care
Pathways
• Pa+ent
journey
• Pain
points
in
delivery
of
care
CARE
How
care
is
delivered
today
and
how
might
it
be
improved
by
Connected
Health
technologies?
• Data
Security
• Regula+ons
• Storage
and
analysis
• Standards
&
Quality
DATA
How
will
soJware,
technology,
data
and
processes
be
amalgamated
and
evaluated
for
use
by
differing
stakeholders?

7. ARCH
Research
Themes
• Implementa+on
at
scale
–
financial
and
organisa+onal
• Adop+on
issues
–
mo+va+ng
key
stakeholders
• Behavioural
change
–
micro
level
• Business
models
for
Connected
Health
CHANGE
How
can
the
barriers
to
the
use
of
Connected
Health
technologies
be
overcome
and
maximum
impact
achieved?
• Care
Pathways
• Pa+ent
journey
• Pain
points
in
delivery
of
care
CARE
How
care
is
delivered
today
and
how
might
it
be
improved
by
Connected
Health
technologies?
• Data
Security
• Regula+ons
• Storage
and
analysis
• Standards
&
Quality
DATA
How
will
soJware,
technology,
data
and
processes
be
amalgamated
and
evaluated
for
use
by
differing
stakeholders?

8. Unlocking the Opportunity for
Connected Health?
8
Rising
HC
demand
Pressure
on HC
funding
New, more cost-
effective +
clinically
efficient ways of
providing care
• Overall consensus that there is a lot of market ‘potential’
• There's a problem in HC systems (a need to ‘do more with less’ – decrease costs
but maintain/improve clinical outcomes)
….and there's technology that can
assist with this goal (and go beyond
this goal to provide a whole new level
of integrated patient-centred care)
But how is this opportunity for CH unlocked? – systemic, behavioural,
financial, IT systems, and clinical barriers to adoption need to be explored,
understood and then changed

9. • HC systems under pressure to‘do more with less’
• Government initiatives to support and drive uptake
• Healthcare reforms (including reimbursement reform)
• Pilot projects – Technology Centres; HIH etc
• Technological innovation pushing solutions
• Increasingly tech-savvy consumers (Providers/Payers
and Patients) – already imagine we use CH more than
we do…
Key Drivers of CH
9

10. • Lots of push factors driving CH
• Govt. initiatives
• CH provider tech push
• Lack of scalability and traction
• Difficulty moving from pilot to wide-spread
implementation
• Customer requirements demand industry collaborate
and have dynamic capability to change – not always
easy!
What we’ve found so far?...
10

11. Enablers and Barriers – a summary
from US and UK
11
Unsustainable HC systems – a need to
‘do more with less’
Govt policy to drive use of CH
HC payment and practice reform
Reimbursements - move from Fee-4-
Service to Pay-4-Performance
Movement towards integrated care
Single payer/provider model
Industry tech innovation
Lack of health economics case
Lack of purchaser awareness
Fragmented HC supply-chain
Lack of consumer market
CH provides long-term savings at odds
with short-term HC metrics
Lack of industry collaboration /
interoperability
Reimbursements - restrictive definitions
of what CH can be reimbursed for; F4S
model
HCP resistance to change
Multi-payer/provider HC model
Complex market dynamics for CH companies to get a handle on – regulation;
reimbursements; access channels; mono-payer vs. multi-payer market characteristics –
different market drivers

12. Key Stakeholder Perceptions of CH
in Ireland
12
Key stakeholders positive about CH
potential
Perceived benefits include – patient
empowerment; increased efficiencies;
improved safety and quality of care;
more patient-centred service
Empowered end-consumer seen as a
key future driver of CH
Govt backing for CH in Ireland
Chronic underfunding of HC
Legacy issues – dispersed
management structures; poor IT
infrastructure; fragmented service
delivery.
Perception of poor leadership – poor
policy and planning; lack of integrated
care
Lack of investment in change
management
Fear of investing in IT
Staff shortages
Poor evidence base for CH
How do we introduce cutting edge patient-centred connected health processes
and technologies to a healthcare system which is perceived as ailing….and to
individual healthcare organisational settings which appear to have a low level of
readiness for innovation and change?

13. Financing
structure must
support….
Integrated,
connected,
provision of care
Which delivers
best practice
outcomes for
patients and
providers of care
Unlocking Connected Health
13
! Alignment of incentives (financial; performance etc.) with
connected healthcare philosophy
! CH companies need to understand the different market
dynamics; payment structures; routes to market and align
their offerings with payer and customer requirements

14. empowering clinicians
empowering patients
empowering planners
• But ‘change’ is required across these key stakeholders to implement CH
• Perceptual; organisational; economic-logic
• Step-change in public and professional awareness about HC technologies
• CH has great potential to empower…..

15. • There is a general consensus that
eHealth/CH is a‘good thing’
• But there is a large degree of change
required across the HC system in
order to really unlock the potential for
all key stakeholders
• Fundamental changes required to
payment and provision of HC
• Resistance to change - fear of what
technology will do
• Balancing the positives with the
perceived negatives
• Perceptual shifts required across the
board
Perceptual change challenge
15
Key
Stakeholders
Patients
Health care
providers
CliniciansPayers
Industry

16. • Influenced by a multiplicity of factors
! The right technology
! Systemic change – integration of care; a healthcare
system that is in a position to use that technology
! Payment structure that supports CH
! Data standards and quality
! Empowering patients
! HCP adapting/adopting
Sustainable Adoption of CH
16

17. Business Model for CH
17

18. • Business case must be there for all stakeholders
! Society, all service-users
! Public and private payers
! Public and private providers
! Health care professionals
• Who pays?
• Issues with how we fund healthcare
• Payback period for CH in line with what payers (public and
private) can tolerate?
Business Models for CH
18

19. What’s the
opportunity for
CH providers?
Where can you
add value?
What’s the route
to market and the
business model to
get you there?
Business and Revenue Models
19
• How can CH providers work together to unlock the value in the market?
• Sustainable value for customers, suppliers and other market partners

20. Business Models for CH
External
• Understanding and potentially
(co)-creating the market
• Who is my customer? – can they
pay for it? – how will the pay for it?
• Are there care-pathways/models
into which my product can fit?
• User-centred design?
Internal
• What’s my Business Model?
• Competencies and resources
• Customer Value Proposition
• Economic Logic
• Managerial capability?
• Dynamic capability to change?
20

21. Implementing CH at Scale
21

22. • The scale of transformation required calls for a deep
understanding of how to implement new ways of
working within the healthcare service
• We are attempting to learn from best-practice
examples internationally, e.g. in the US
• Kaiser Permanente
• Partners
• Wellmed
Organisational Level
22What can we learn from organisations at the cutting edge of HC transformation,
innovation and new-process implementation ?

23. • Are good at
• …small safe steps
• …leveraging existing resources
• Struggle with
• …risk
• …agility and speed
Organisational level
2370% of change programmes fail, and 70% of those that fail do so because cultural
barriers impede successful implementation (NHS, 2009)
“…[implementing
CH] is not a
technology issue it
is a change issue”
CH@Partners
The implementation challenge … large HC organisations…

24. • Moving from pilot phase to large-scale
implementation remains a key challenge
• We need to be thinking about implementation right
from the start
• How would this CH solution/intervention get into
routine practice?
• HC change is a slow, complex process
• Communication and small-scale piloting key
Some Initial Findings…
24

25. Critical mass feels
the urgency for
change
Broad and deep
commitment to a
shared vision
Visible and
committed
leadership and
management
Some Initial Findings…
25The case for change has to be compelling and supported from the top if it is to move
others in the organisation to take action
“The invisible
hold of
the status quo
is very
Strong”
“Champions on
the ground were
crucial players in
spreading
adoption”

26. Incentivising HCPs
• Requires transforming long-
standing habits and deeply held
assumptions and values
• What does‘too much work’look
like?
• What’s the pain point?
• How useful does the CH solution/
process need to be for HCPs to
undertake the necessary change?
“HCPs don’t like
CH solutions that
mean more work
for them”
US Physician (AAFP)

27. • The national eHealth strategy identifies
• ‘…willingness to re-organise and redesign existing
work practices’as key enabler which is…
• ‘…dependent on highly committed collaboration and
buy-in from key stakeholders’
! Structural and cultural issues a key challenge in HC
transformation
ARCH/HSE eHealth Research
Collaboration
2770% of change programmes fail, and 70% of those that fail do so because cultural
barriers impede successful implementation (NHS, 2009)

28. • Working with the ooCIO to evaluate/support HSE
national eHealth implementation
• Analysis of the implementation journey of a disruptive
connected healthcare intervention in motion (beginning
with the eRefferral project)
• Mutual learning process….what works, what doesn’t
• HSE organisation’s‘adaptive reserve’for change?
• Innovation readiness?
• How do we motivate HCPs to change?
eHealth Research Programme
28

29. • Listening to the views of those on the ground tasked
with implementing, using, paying for new technology,
adopting new processes, changing how they work and
so forth
• Time and again research shows the importance of user-
centred design of technology; human-centred design of
how we work in teams and organisations; co-creation of
new work-flows
! Supporting innovation-out, not just innovation-in
eHealth Research Programme
29

30. • There are several key drivers of CH – consensus that
there is a lot of market‘potential’
• However in order for market potential to be realised or
unlocked – many things need to happen in the
healthcare eco-system
• Change at the macro, meso and micro level is required
In Conclusion
30
ARCH research focused on understanding the issues
of sustainable adoption from a holistic perspective

31. Back-Up
31

32. MACRO
ORGANISATIONAL:
1. HC PROVIDER STRUCTURES
AND CULTURES
2. CH COMPANIES – BUS
MODELS
PATIENT, CONSUMER,
INDIVIDUAL
STAKEHOLDER?
HC financing - who pays?
What are the financial
incentives for CH?
What technology trends
can support the
development of CH
Health-economics –
evidence-base for CH
Data regulation and
Standards?
Market evaluations
Care pathway mapping;
analysis; innovation
Application of IT to support/
deliver CH solutions
Integrated care
Resources – time, money,
people, technology to
facilitate innovation?
Strategic leadership;
management structures?
Clinician behaviour/
engagement and motivation
CH companies - business
model innovation; capability
CH data analytics?
Technology evaluation – does
the technological intervention
work? – does it change
behaviour? usability; user-
acceptance
Technology enhance
healthcare safety and quality
Behaviour change – at the
person/patient, individual-
level
Self-management; patient-
empowerment
Adherence – medication and
technology
Consumer behaviour; trends
User-centred design
32 |
Macro,
Meso
and
Micro
issues
need
to
be
understood….It’s
complicated!
Key
ARCH
Themes