We have previously reported on a number of EU projects designed to promote eHealth interoperability (the ability of EU Member States to share healthcare information between their respective IT systems), including the Commission’s eHealth standards project, which aims to build consensus on the standards to be applied to eHealth products, and EURO-CAS, which aims to develop tools to assess the conformity of eHealth products with those standards.
In parallel with those projects, the VALUeHEALTH project, which ran from April 2015 to June 2017 as part of the Commission’s broader research and innovation program, Horizon 2020, focused on developing a business plan for the implementation and funding of eHealth services across the EU. Trans-European digital services are currently funded by the Connecting Europe Facility (“CEF”), which has committed to investing EUR 1.04 billion for this purpose between 2014 and 2020. VALUeHEALTH was concerned with ensuring the sustainable interoperability of European eHealth services beyond 2020.
To this end, the VALUeHEALTH project had five objectives, summarized in the following schematic:
VALUeHEALTH Overall Concept, and Objectives:
Objective 1: Develop a set of prioritized use cases
The VALUeHEALTH prioritized “use cases” for eHealth services on the basis of a number of criteria, including their potential positive impact on patients, improved health outcomes, and reduced healthcare costs. Using these criteria, two use cases were prioritized:
- Safe prescribing: Ensuring that existing algorithms to support prescribing decisions are able to access critical safety information (e.g., other current medication, allergies and intolerances, clinical conditions, significant family history, relevant bio-markers).
- Individual disease management: Condition-specific information-sharing between actors involved in the healthcare, social care and self-care of a patient’s portfolio of long-term conditions.
These use cases were used to inform the analysis underlying the business plan under the remaining objectives.
Objective 2: Design an overarching business model framework
The project sought to identify the expected benefits of interoperability for various stakeholders — in particular, those whose involvement was necessary to sustain interoperability, and those who most needed to realise value from interoperable information. Further, it was intended to produce a cost-benefit analysis for stakeholders who would be required to drive investments. Finally, business modelling methodologies would be used to establish the value of eHealth interoperability and to determine how cost savings and growth in capacity could justify financial investment in eHealth services, with minimal dependence on public funding.
As a result of this work, VALUeHEALTH has established a Business Modelling Task Force, tasked with developing the value chains and value propositions described above. However, further details are not yet available on the project website.
Objective 3: Develop a scale-up roadmap
The VALUeHEALTH project identified high quality data capture as a necessary pre-condition for the scale-up of self-financed cross-border eHealth services. With this in mind, it aimed to examine the barriers to, and the conditions and incentives required for, wide-scale, high quality data capture, which could inform a scale-up strategy.
Barriers identified by the project were (i) the reliance on busy, often junior, clinicians to capture health information from patients, and (ii) the existence of reimbursement models that pay for activity rather than clinical outcomes. Incentives were needed to address these issues.
The Commission intends to use this information to scope the interoperability deployment roadmap and scale-up strategy, as well as its structure and costs. However, it appears that this exercise is ongoing.
Objective 4: Design an information communication technology and interoperability deployment roadmap
VALUeHEALTH has defined the interfaces, services and tools need to deliver the prioritized use cases identified in Objective 1 and, from this, has derived a design and deployment roadmap for eHealth services in general. However, this is not yet available publicly.
There appears to be some overlap between the roadmaps envisaged by Objective 3 and Objective 4. From the available information, we understand that the scale-up roadmap described in Objective 3 is designed to address issues with data capture (i.e., the practical human barriers to ensuring that the data required for cross-border eHealth services is collected and entered into the system), whereas the ICT and interoperability roadmap described in Objective 4 is intended to address the technical requirements of the service.
Objective 5: Deliver a business plan and sustainability plan
The results of Objectives 1-4 have been used to produce a Business Plan and Strategy for future public-private investment in EU eHealth services. In particular, the plan provides guidance to the CEF on how to construct digital service infrastructure for health to ensure maximum value and sustainability beyond 2020. Again, this plan has not yet been published.