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If you come across anybody who has not heard of Internet of Things (IoT) be careful, the person surely comes from another planet. IoT is at the centre of any ICT research. Everybody is developing devices, claiming that these will interconnect to anything you already have or will have.

And yet, at home we still have several remote controls for our smart TV, for recording devices, and for the all present black box that allows us to enjoy hours of the most degrading TV shows. Of course, the sound system runs under another completely different set of remote controls: for the CD player, the tuner, not to mention the necessary turntable that we have brought to life again after having been convinced that the sound is a lot more natural on an analogic record than in a digitalized CD.

IoT’s promise is that all our gadgets will be interconnected inside our homes and even with the exterior. A different problem is whether I really want my fridge to send messages to my grocery store to replace that uneatable marmalade that my daughter in law gave me and that I have been struggling to finish for the past two months.

Although the promise is great, reality strikes back. As of today, only 6% of American households have a smart-home device, and 72% of Britons have no plans to adopt smart-home technology in the near future (The Economist 11.06.2016). Of course it does not help that some of the smart gadgets like the Samsung´s smart fridge goes for almost $ 6,000.

IoT marketing is probably missing the point, as has been the case in many new ICT developments. Putting the focus on the ICT novelty will not attract people. Unless the smart-home gadget solves a real problem, it is difficult to convince people to adapt it. Technology is available today for doing almost anything that anybody can think of. The problem is the generational divide. Young people full of energy devise new things that are meant for older people maybe two or even three generations apart. Have they asked those people what they really need? Have they participated in every phase of the development?

Just as a marker, go to the pictures of any of the ICT gatherings in the world and try to spot anybody older than 65. Even those gatherings especially dedicated to ageing, like the yearly AAL Forum which I have attended many years, are packed with young people full of ideas that will be tested on older people just because the rules say so, not really because they feel like it.

And then we come to the pure ICT problem of interconnectivity. It is essential to develop a common standard to allow seamless connectivity among gadgets from different makers. From what I know, that is being done more or less for industrial IoT, but something similar for the domestic domain is lacking.

In all, my bet is that IoT as something integrated in everyday life is a long way off. Only a concerted effort to develop an overall global standardisation, coupled with real intergeneration symbiosis, will bring forward the realization of the home IoT.

If the number of projects focusing on eHealth is any indication, the market must be huge. The recently published brochure “Research and Innovation in the field of ICT for Health and Wellbeing: an overview” lists 97 on-going or recently finished projects funded by the European Commission. By this measure eHealth apps should now be treated as an uncountable.

It has been said too many times that the ageing of the population will put an unmanageable strain on the social and healthcare sectors. It is (almost) public knowledge that only home-care delivery can somehow tackle the coming situation. If you still have any doubts, a recent article in The Economist can, in a nutshell, reassure you about the existence of a growing demand.

In order to respond to the challenge posed by the growing demand, we need to change the way care is delivered. Regarding social care, maybe only some small adjustments will be needed but, for healthcare, a drastic reengineering of the process is necessary.

Assessing the market by simply counting the number of prospective clients is not a valuable marketing approach. We already know that the number of older people living alone at home will increase. The problem is not the number of prospective clients. The problem is twofold: a) how can we reach that population? and b) what business model will bring eHealth into public domain?

The business model has to be ingrained within the care process. Unless distance care can deliver standards similar to face to face care, eHealth will remain the poor relative to traditional healthcare. To attain those standards the redesigning of the care process has to accommodate: a) the idiosyncrasies of the care professionals; b) the legal implications of distance care; and last but not least c) the trust of the care recipient.

Once the care process has been reengineered, then we could focus on designing the business model. For that, the main issue is who pays for what. Because today, most systems link care acts and payment, while home delivery is meant to reduce care acts, switching the burden from the care giver to the care receiver. Again, the alternative funding mode, per-capita payment, is directed to a single organization, while eHealth will switch the burden from healthcare to social-care. So the eHealth business model has to take into account that the healthcare giver is more successful when a) the care receiver does more towards his or her wellbeing, and b) social-care organizations are more active. Summing up, designing a business model that rewards the success of the organization by measuring how it activates other entities (care-recipient and/or social-care) is not easy.

If we successfully solve the business model conundrum, reaching out to our primary customers (care recipients) should be a piece of cake. Anybody will be willing to use a system that reduces the burdensome features of face to face care, e.g. time consumed in transportation and waiting to be seen. Anybody, – and the number of bodies is only increasing -, will grasp the advantages of permanent monitoring, easy access to advice and other advantages that eHealth can deliver. The point is, is eHealth ready to deliver?

Going through a check list of the situation today against the bare needs listed above, the answer is an unqualified NO.

The process from research to market for any drug includes, in a nut-shell, four phases: identify the need, research, test, and bring it to the market. The last two tasks could be translated into proving the efficacy of the drug (testing), and proving its efficiency (bringing it to the market) so that it is cost-effective. Are all those phases undertaken when dealing with eHealth systems? I think that a clear no is the answer. And if any of those phases are clearly missing, they are the last two a) is the eHealth system more efficient than the current system? b) is the eHealth system cost-effective? Therein lies probably one of the keys to the lack of adoption of eHealth systems across the EU in particular and the world in general.

We’ll assume that organizations are rational entities (I know it is a big assumption) and will not plunge into costs just for the sake of it. So, let us think that if an organization launches the research effort to develop a new eHealth system, it is because it has spotted a need for such a system.

Now for the testing phase. We all know that no drug will be approved if it has not been properly tested. We also understand that the specifications for testing an eHealth system, even if they could be inspired in the methodology for drug testing, have to be adapted to the particularities of ICT. We cannot expect an app to go through the same process as a drug. Developing an app is in the range of thousands of euros, while the development phase for a drug is in the order of millions of euros. But some kind of testing should be done and its results made public so as to prove the efficacy of the system. Please go to any of the online stores that sell apps and check how many include, or make reference to, their efficacy tests results.

eHealth has also a particular characteristic that a drug does not: eHealth interferes with the healthcare process in a way that a drug doesn’t. In this respect, testing the efficacy of a particular eHealth system poses some problems since the efficacy effect is spread throughout the whole healthcare system, while a drug focusses clearly on its effect on patients.

But if testing eHealth has been, in the best of cases, a patchy process, efficiency is completely forgotten. How can we convince a healthcare provider to adopt a particular eHealth system without demonstrating its cost-saving potential? How many eHealth systems do you know that have carried out any of the available techniques for measuring the probable added value to the patient and the healthcare provider? And again we should recognize the difficulty involved in evaluating the efficiency of eHealth. It is not only the previously mentioned spread effect across the healthcare system, but also its effect across other systems such as the social care system. In fact, sometimes an eHealth system has a more profound effect on the social care system than on the healthcare system itself.

But all those difficulties should not blind us to the need to perform, and make available to the public, the testing procedure and the added value calculation of our eHealth systems. I would recommend that the healthcare authorities who have started to approve certain apps, such as in Andalusia or England, make available the results of the efficacy and efficiency evaluations of those apps they approve.

e-Health has been around for a long time; we could even say it is an old feature in today’s world. But yet, who is really using e-Health today? Do you know of a friend, a neighbor, a relative using any of the many gadgets that are part of e-Health? Don’t focus only on the internet, that is not e-Health by itself. The internet provides information, albeit a lot more information than what we used to have at home. Certainly a lot more, and up-to-date, than the classic “Our bodies, ourselves” which probably a lot of my readers haven’t even heard about and that, by the way, has moved to the www.

Let´s go through the process that has brought us to this point in the history of e-Health. The first push came from the R&D organizations. More specifically, the European Commission, through its many R&D programs, has been financing research for years into what we know today as e-Health. Millions of euros have been lavished all over Europe to make e-Health a reality. As always, in the USA the private sector has been the driving force behind this endeavor. The result is a myriad, I could safely say even a milliard, of what is known as Personal Health Systems and other types of gadgets and integrated e-health systems.

The second lever for securing a wide permeability of e-Health is the people, i.e. the patient or the primary user. The use of ICT technology by the population is increasing by leaps and bounds. The older population, probably the strata that could most profit from the use of ICT tools to maintain their living standards, is changing radically. There is very little in common between the older population of today, and the future older population coming out of the baby boomers of the post-war. A recent study in Spain by Fundación Telefónica reveals that the population older than 55, is using internet for productive proposes (e.g. banking or filing taxes) at the same level as the rest of the population. And it is in these population strata in which the use of smartphones applications is having the biggest boost.

The secondary end user, the socio-health professional, is obviously an important lever for spreading the use of ICT socio-health applications. Although maybe a little dated, PwC released a study in 2012 on m-Health concluding that “Healthcare’s strong resistance to change will slow adoption of innovative m-Health”. A closer look at the study reveals that it is the skepticism of the professionals that hinders the extensive use of m-Health in particular and e-Health in general. Because I believe that unless professionals prescribe e-Health gadgets with the same confidence that they prescribe today a medicine or a treatment, e-Health will not take off.

But for that to happen, the fourth lever has to act. This is no other than the socio-health care system; in Europe led by the public sector. It is very telling that while one branch of the public sector is pouring money into R&D, the other branch is simply ignoring the fact that ICT tools could save a lot of money in taking care of the socio and health ailments of the population they are covering. Is it so difficult for the politicians responsible for R&D and those in charge of the socio-health system to talk to each other? Apparently so, but I would appreciate your views on the subject so that among all of us we could find a path to a better and more e-Health world.

We are familiar with too many good ideas that never make it to the market and less frequently, brilliant marketing strategies selling a flop. A proper balance between the product and the business plan rarely occurs. That is probably why there are few companies like Zara or HM; only the chosen few can find the Holy Grail. But we all struggle to do our best and come up with the right balance that puts our product or services in the right spot in the market. The belief that that is achievable is what bring us together every time there is a gathering like this one. And the reason for this exposition is because we, the partners of AiB, believe that we are on the right track. First, let me go through briefly how the ideas that my colleagues have already explained can become a sellable thing. To start with, you may have gathered already that AiB has two heads, kind of like a Hydra.  The difference is that this one has only two heads, its breath is not poisonous but sweet, and its blood, instead of being deadly, heals. One of the heads of our friendly beast represents a service. AiB has been designed as a care service with the objective of detecting the risk of falls in the individual being cared for by a care service provider. Corresponding to that view, AiB as a service offers a complete software-hardware package that allows the care provider to screen the population under its care for a set of signs that will prompt the system to raise alarms. If this is the case, care professionals will perform a pre-evaluation of the person to double-check if the user should be included in the risk-prevention programme or if this is a false positive. Once the inclusion is decided upon, a multidisciplinary team will perform a complete check-up of the user and decide upon a personalized care plan for the user to follow. The care plan is a comprehensive set of neurological and physical exercises included in the system library, as well as any other action that the care professional decides, such as pharmacological therapy or dietetic recommendations. The system will request certain information by the user, mainly about environmental conditions, and prompt remedial actions to counter its risks. Once the personalized care plan is designed and introduced in the user terminal, the user will be asked to follow it by means of an agenda, reminders and so forth. Continuous follow-up of his or her performance will be recorded by the system, triggering alarms to the care professionals in case of deviation from the care plan or changes in the vital signs of the user. These events will allow the care professional to modify the personalized care plan accordingly. It will be obvious by now that AiB as a service is directed to socio-health organizations that can take advantage of the system to reduce the rate of falls in the population they cover, with a clear saving in the overall cost of care, which I am not going to go into since we all are aware of the cost of a hip replacement, for instance. The second nice head of our Hydra corresponds to the product that we envisage to earmark for the individual. In a nutshell, AiB as a product is a self-contained package for individual use by those concerned with their health, probably because they have already fallen or have seen their relatives fall. So it is for people who are aware of the personal cost of a fall in terms of days and/or health lost. The AiB product comprises a self-evaluation that will prompt a care plan, although obviously not at the level of the service care plan. The care plan includes a set of remedial actions that can be made in the environment, as well as physical and neurological exercises. A system of alarms will suggest the user refer to a care professional when deterioration in the performance of the user is detected. How does this translate into a business model? We have chosen the Business Model Canvas because it is as good or as bad as any other model but has the advantage of being simple and clear cut. I will concentrate on only two of the boxes of our model. First the customer segment, in the Canvas jargon. As you can see, we are targeting two completely different markets:  the professional care market and the individual, with basically the same body of knowledge.  Again our friendly Hydra comes to mind with two heads but only one body, and guarding against the perils of falls instead of the entrance to the Underworld. Second, the key activities. We have discussed a lot among the partners on how to proceed from here. We have been able to produce a thing, system and product for the prevention of falls, without killing each other.  A thing that is the sum of the efforts of very different organizations, from health care, to users, to ICT companies, to process designers, even an economist (myself). The result cannot be broken into parts so that each one takes its bit and markets it independently. So we arrived to a solution that has been in use for many years: the European Economic Interest Grouping. This legal figure is governed under European Community (EC) Council Regulation 2137/85. It allows us to continue collaborating while preserving the individuality of the members and separating the AiB undertaking from the other business of the partners. The use of the EEIG will allow the AiB partners to go on to the next step of industrializing our output. That will be our way forward. I am sorry I could not attend the event in person, but if you have any questions, feel free to ask either my colleagues present or contact me at the e-mail address shown on the screen. Thank you very much for your attention.

You can also whach the presentation at http://youtu.be/QZtK6AyvfN0

This is a real story of a real person in a real country that, I am afraid, can be replicated across many other countries in Europe. It is a story about cuts in healthcare services and its real influences in overall expending for the Government and for the people.

Mr. XXX is a manual worker whose job implies using his arms to move thing around. After several months of feeling that his right arm was hurting, he went to visit the primary care doctor. The diagnosis was clear: a strong tendinitis that prevents him from performing  his duties until he is properly treated. So the primary care physician sent him to the traumatologist for consultation and further treatment.

And here the nightmare starts. Due to cuts in healthcare personnel, the waiting list for traumatology is such that Mr. XXX receives an appointment for 90 days from now. What are the implications? First, Mr XXX cannot work and he will be on sick leave for at least the next three months. He will be paid  by the social security a percentage of his salary, with a complement by his employer to make up for the basic 100% of his salary. Secondly, his employer will have to employ another person to fulfil Mr. XXX duties.

So the outcome is that, by cutting back on personnel disregarding the actual demand, the health service has prompted an increase on the social security budget and at the employer’sexpense, while Mr. XXX lies in bed weighing to be taken care of!

Are these the savings that we are aiming for? I certainly doubt it.

If demographers are correct, an ageing population is coming and will put mounting pressure on social and health services. The pressure is already here and the response of most governments has been to make it more difficult to access them, reducing the population covered, or to cut the provision of services, reducing the coverage offered, or any combination of both. In other words, look for a quick fix and postpone the problem.

So much talking about structural changes and all our governments are coming out with is cutbacks in the services they provide, without looking at the way they are provided.

Social and health services have to be redesigned. This is so obvious that I am not going to talk about this aspect of the redesigning effort. The only thing that is needed is a political push in that direction. A political push that needs to interiorize that a certain investment has to be made before reaping the benefits.

I will focus on another aspect of the redesigning effort; namely the need to redesign keeping in mind the primary end-user i.e. the patient.

We may have achieved the most efficient work flow, with the possibility of reaching a level of efficacy not known till now, yet despite all our efforts neither that level of efficacy nor the expected efficiency is reached. The problem, I think, lies in the interface between the user and the system. Have we taken care of the lay-out of the system? Have we made it user-friendly not only for the ICT literate but also for those ICT illiterate so that no one feels bored or stressed? Have we considered the cultural differences not only among nations but also within a nation? A carefully designed process needs a carefully designed interface that allows the primary end-user to feel comfortable and at ease when using the service, from the screen in his or her smart-phone to the colour of the walls or the seating arrangement in the care centre. Not reaching that level of integrated design is at the root of so many good ideas gone to waste.

We all have experienced communication problems between process designers and ICT developers, but to that we have to add a third group of professionals, those in charge of making everything look amiable and user-friendly. If we tackle this problem from the beginning, we will have working towards the same objective the expertise of the socio-health professionals, the use of the latest ICT technology providing more efficient care processes, and the end user vision of their real socio-health demands.

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