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Report

Teaser, summary, work performed and final results

Periodic Reporting for period 2 - VALUeHEALTH (Establishing the value and business model for sustainable eHealth services in Europe - VALUeHEALTH)

Teaser

Summary

VeH was set up with the remit to develop a business model and business plan for the sustainability of cross-border eHealth services: for cross-border exchange of information between Member States, in relation to supporting the health of citizens who either cross borders and then need healthcare, or are deliberately referred to go across a national border to receive healthcare. This means exchanging patient-related data and supporting healthcare professionals to maintain some degree of continuity of care, in potentially multiple locations.
VeH has therefore investigated how eHealth interoperability can create, deliver, and capture value for all stakeholders, to justify a sustainable market in scaling up cross-border interoperability. VeH comprised a rich multi-stakeholder consortium of experienced partners and funded experts, to bring together many essential viewpoints to undertake the work plan and to champion its results. Starting with the cross-border interoperability use cases already approved by the eHealth Network, the VeH partners engaged with multiple stakeholders though a robust methodology to prioritise use cases relevant to Member States for cross-border and also within border health service business needs. The project has examined the technical and organisational strategies needed to deliver these additional use cases, and the multi-stakeholder value chains that are needed to sustain the funding of these services. Finally, the project has integrated these perspectives into a recommended business plan for the immediate years following the existing period of public funding.
VeH has now completed the development of an evidence-based business plan for sustainable interoperability, with sustainable revenue streams for developing and operating priority pan-European eHealth Services beyond 2020.
The VeH project objectives were:
1. Develop a prioritised set of use cases reflecting Member State health business needs for cross-border and within-border digital services on a European scale.
2. Design an over-arching business model framework that encompasses and delivers customised value propositions across a wide range of relevant stakeholders, a Cost Benefit Assessment, risk assessments and sustainability strategies.
3. Develop a roadmap of scale-up adoption strategies, conditions for success including clinical documentation and care collaboration, and recommended incentives.
4. Develop an ICT and interoperability deployment roadmap, defining the digital infrastructure services that are needed to deliver the priority use cases, and the interoperability assets and platform services that will be needed to design, implement, deploy and maintain these services.
5. Deliver a Business Plan and Sustainability Plan which will identify sustainable streams of revenue to establish, operate and grow pan-European eHealth Services beyond 2020, when such services will need to be self-funding.

Work performed

The VeH project partners worked with a wide range of European experts to undertake a careful analysis of scenarios that could add value to the existing unplanned care scenarios, by defining a list of additional business use cases which would be feasible to deliver and useful both within and across borders. A set of prioritisation criteria were developed to assess these use cases, and through a robust methodology two were prioritised, one of which was safe prescribing.
The project convened a Business Modelling Task Force to examine in detail the actors who need to be involved and motivated to contribute to collective success, and what the value propositions would be for each. It further built on the work and ideas of this set of actors to develop value chains that showed how this value can be realised only when the actors are correctly aligned.
The Business Model Canvas was used to model more formally the ways in which the value propositions could be realised: who are the customers that will pay, who are strategic partners to help co-create the solution and ensure its acceptance, and what are the main activities that need to be undertaken to deliver collective value. VeH elected to focus it on the physical or virtual entity or structure designated with the responsibility for managing and coordinating (or contracting out) the new pan-European shared cross-border eHealth services that will be established via the CEF.
A cost effectiveness analysis from a health systems perspective was also carried out, in order to assess the value of eHealth interoperable solutions compared to current practices for the optimal management of patients with Type 1 diabetes, as the reference use case. The results of this cost-effectiveness analysis suggested that significant added-value could be generated from investing in such enhanced eHealth services, enabling more Type 1 diabetes patients to be optimally managed, and at lower costs, within and across borders in Europe.
The information flows for the diabetes business use case and the interoperability assets and services needed to deliver them were also examined. The project found that much of what is needed in terms of the eHDSI is already in place. Additional investments would be needed only in so far as necessary to build on the existing unplanned care infrastructure. Indeed, the major implications of VeHâ€™s proposals are to convey more information through the existing infrastructure and add incrementally additional needed services such as the HealthCare Encounter Report. VeH has proposed an EC project-like roadmap for how these additional components might be developed and deployed across MS and at a European level.
Several kinds of organisational change are also needed to take advantage of these enhanced cross border services which should improve trust and accountability in sharing data and sharing care. For example, data quality challenges to ensure that accurate and complete enough patient summaries can be generated to adequately inform the recipient about the patient. VeH has in particular examined the strategies for improving data quality, working with a selected group of European hospitals.
The final VeH business plan itself, brings the main findings of the project together as proposals to be considered by the eHealth Network and the E.C. This two-year Business Plan proposes the establishment of an EU eHealth Business Unit (EU eHBU) which is envisioned to play a central role in the sustainability of the eHDSI, post 2020, i.e. after the end of the CEF programme. It sets out the top five business plan objectives, as activities to be fulfilled by the EU eHBU during its first two years of operation, after being successfully set up and rendered operational. It outlines the financial scheme that is proposed through this plan, and a financial forecast, emphasising a mixed model of public funds, non-monetary (in-kind) contributions, and commercial revenues.
The results of VeH have been disti