The benefits of connected health or e-health technologies are potentially enormous in terms of improvements in patient care, enhancements of quality of life, and reductions in health costs. However, despite the technological revolution that has taken place over the past two decades, precious little progress appears to have been made in this critically important area.
There is no single reason for this, but among the main ones is the fact that any advances require close collaboration between private-sector technology firms and healthcare providers, and such alliances are not always easy.
This issue is about to be addressed by Susi Geiger, vice-principal of research, innovation and impact at the University College Dublin (UCD) College of Business. Prof Geiger has just been awarded an EU Marie Sklodowska-Curie fellowship to investigate how technology firms, policymakers, patient groups and healthcare providers can work together to be innovative in healthcare provision, increase welfare and engage patients.
“The main research question we are asking is how should technology firms engage in a complex, multi-stakeholder ecosystem to optimise the economic and societal impact of their technology innovations?” Geiger says. “Health technologies, such as e-health, m-health or digital health, hold vital promises to alleviate economic and demographic strain on national healthcare systems, but innovation has proven difficult in healthcare markets. With support from the European Commission’s Horizon 2020 programme, the project will examine how government agencies and firms can best work together to innovate complex health ecosystems through technology implementation.”
The project aims to conduct a comparative study of stakeholder engagement in the US and Irish health technology ecosystems and distil best practice from both markets. California was chosen as a good comparative study for the Irish market because it is widely considered one of the most progressive health technology ecosystems in the world and because the recent passing of the Affordable Care Act (or Obamacare) has meant significant opportunities for healthcare reform and innovation. It was also chosen because it is home to firms such as Apple and Google that are currently pushing health technologies into consumer markets.
The research will be conducted over 27 months at University of California, Berkeley's Center for Information Technology Research in the Interest of Society (Citris), at the Centre de Sociologie de l'Innovation (CSI) in Mines ParisTech, at UCD's Insight Centre for Data Analytics, at UCD's Applied Research for Connected Health Technology Centre (Arch), and at the multinational company Silicon and Software Systems (S3).
Chronic illnesses
“We are specifically looking at chronic illnesses,” Geiger says. “A lot of researchers believe that connected health can have the greatest impact in that area and in the elderly population. Take diabetes, for instance: if a patient with diabetes can have their sugar levels monitored remotely by a sensor device and transmitted back to a clinical setting, it could have enormous benefits for the quality of their care.”
Geiger is also principal investigator with the UCD Arch centre, which is currently looking at the benefits of connected health for patients with mild dementia.
“There are so many ways that it can help,” she says. “It can help keep patients in their homes with sensors on wall, floors, fridges, cookers, and so on. It can also offer peace of mind to the patient that they are always connected to their care-giver.”
According to Geiger, the biggest barrier to the implementation of these and other new technologies in the healthcare area is, in effect, a clash of cultures.
“Technology companies are very innovative, whereas healthcare providers are very cautious,” she says. “Healthcare systems also involve many diverse stakeholders. Practitioners are quite risk-averse and it takes a lot for them to try new practices and new technologies if their effectiveness hasn’t been proven, tried and tested. Of course, they are acting for the benefit of their patients.
“The gold standard in healthcare research is randomised, controlled clinical trials, and they want all new treatments to go through these to prove their effectiveness over existing treatment.”
The problem with connected health is that the technologies tend not to be standalone and the solutions usually involve a number of technologies being combined and then integrated with existing clinical technologies. This presents a difficulty in proving effectiveness in a connected environment. And if a trial can be organised, payment then becomes an issue.
“Who pays for the new technologies?” she asks. “That’s a big issue. One of the reasons we are going to California is because a lot of the new technologies are being developed there. There is also a trend there towards Accountable Care organisations, which will see care organisations coming together to be more patient-centric.”
E-health strategy
This should provide fertile ground for her study, as indeed will the Irish Government’s own e-health strategy. But simply having strategies, technologies and commitments will not be enough.
“One of the issues around the globe is that there are a lot of promising trials taking place, but the innovations aren’t being implemented,” Geiger says. “With this project we are hoping to come up with a stakeholder engagement model and a capability model for the industry which can help overcome this.
“We are approaching it from the perspective of the technology firms and helping them to collaborate with the different stakeholders in healthcare systems.
“If we can help firms understand the healthcare and payer practices in which their technologies will be embedded, usercentric healthcare technologies can be more effectively integrated into existing systems and processes, which in turn will assist welfare reform, innovation, and ultimately lead to increased patient wellbeing. The project will aid policymakers to recognise the market, payer and behavioural barriers to implementing a consistent e-health strategy.”
