Procuring eHealth solutions - Policy & conceptual context, key challenges -

1. Procuring eHealth solutions- Policy & conceptual context,key challenges - Karl A. Stroetmann ePractice workshop "Procurement of eHealth solutions"

2. Outline • The context: EU and MSs health policies • eHealth solutions – health policy tools and Lead Market • Key procurement challenges • Case: telemonitoring equipment procurement in NHS England • Outlook ePractice workshop "Procurement of eHealth solutions"

3. Health policy priorities and challenges ePractice workshop "Procurement of eHealth solutions"

4. Common values of European health systems • Universality: everyone • Good quality: everywhere • Equity: according to needs, no discrimination • Solidarity: insurance fees/taxes according to financial ability to contribute A set of overarching values shared across Europe – European Social Model ePractice workshop "Procurement of eHealth solutions"

5. Health policy challenges • Ensuring healthcare provision which is “patient-centred and responsive to individual need” • Making the systems financially sustainable • Shifting the focus towards personalised and preventive measures • Reconciling individual needs with the available finances, as the population of Europe ages, as expectations rise, and as medicine advances What can the contribution of procurement be? ePractice workshop "Procurement of eHealth solutions"

6. eHealth – a key health policy tool ePractice workshop "Procurement of eHealth solutions"

7. EU vision: eHealth enabled citizen-centred health services • Research & Development activities • Research Framework Programmes (since 1989) • To date > 450 projects, > €1 billion • In cooperation with health services, industry, universities • Policy instruments (since 2004) • Communications, Recommendations to Member States, working with stakeholders • Strategy studies, road maps, evidence • Support to deployment • Market validation and implementation • Competitiveness and Innovation Programme: fostering cooperation among MSs ePractice workshop "Procurement of eHealth solutions"

8. The future: A Digital Agenda for Europe • Continued strong European support for eHealth solutions • One of seven flagship initiatives of the Europe 2020 strategy for smart, sustainable and inclusive growth “To exploit the full potential of new eHealth services, the EU needs to remove legal and organisational barriers, particularly those to pan-European interoperability, and strengthen cooperation among Member States.” Source: European Commission: A Digital Agenda for Europe. Brussels, 19.05.2010 - COM(2010) 245 European Commission: EUROPE 2020 A strategy for smart, sustainable and inclusive growth. Brussels, 3.3.2010. COM(2010) 2020 ePractice workshop "Procurement of eHealth solutions"

9. Procurement – definition and context ePractice workshop "Procurement of eHealth solutions"

10. Defining procurement • “Procurement refers to the function of purchasing inputs used in the firm’s value chain, not to the purchased inputs themselves.” • As purchased inputs are present in every value activity, including support activities, procurement is classified as a support activity itself. It is an activity that supports the primary value activities of the generic value chain. Porter, Michael E. Competitive Advantage - Creating and Sustaining Superior Performance. New York: The Free Press, 1985, p. 41 ePractice workshop "Procurement of eHealth solutions"

11. Porter’s value chain concept Source: Porter, Michael E, 1985 ePractice workshop "Procurement of eHealth solutions"

12. eHealth procurement – a deficient process? • The EC Communications on the Lead Market Initiative that followed the Aho-Report, and the one on Telemedicine, both identified deficient procurement processes as hindering factors to the wider deployment of eHealth solutions Accelerating the Development of the eHealth Market in Europe. eHealth Taskforce report 2007 in preparation for the Lead Market Initiative. EC: Telemedicine for the benefit of patient, healthcare systems and society. Brussels, 2 November 2008 ePractice workshop "Procurement of eHealth solutions"

13. The EC / Lead Market Initiative definition of the eHealth (procurement) market The eHealth Market comprises broadly the following (overlapping) major categories and subcategories: 1) Clinical information systems 2) Telemedicine and homecare systems and services 3) Integrated regional/national health information networks and distributed electronic health record systems and associated services 4) Secondary usage non-clinical systems Accelerating the Development of the eHealth Market in Europe. eHealth Taskforce report 2007 Composed in preparation for the Lead Market Initiative ePractice workshop "Procurement of eHealth solutions"

14. Key challenges for eHealth procurement ePractice workshop "Procurement of eHealth solutions"

15. The benchmark: good procurement Good procurement may be defined as the fine art of purchasing eHealth goods and services • at the most cost effective price, • while assuring that delivered goods and services provide optimal value ePractice workshop "Procurement of eHealth solutions"

16. Good procurement: key issues (I) • Total cost of ownership over the product/service liefecycle • Supplier sustainability • Supply chain management • Quality metrics • Public Private Partnerships (PPP) ePractice workshop "Procurement of eHealth solutions"

17. Good procurement: key issues (II) • Managing Service Level Agreements (SLAs) • Deference to national suppliers and, where relevant national/regional policies and priorities • Time of year and budget cycle • Standards compliance • Risk assessment ePractice workshop "Procurement of eHealth solutions"

18. Health system procurement challenges • Sourcing is highly fragmented, and procurement is often decentralised and uncoordinated • Contracts focus on inputs rather than end-to-end accountabilities for health outcomes • Sourcing acts as a bottleneck, hindering the delivery of better economic and often also service outcomes • Lack of alignment between procurement agency and requestor respectively the end user, resulting in conflicting goals and expectations Adapted from Tom Boyle, Co-Chair European Connected Health Campus: eHealth Procurement. Presentation at the WoHIT in Barcelona, 2010 ePractice workshop "Procurement of eHealth solutions"

19. Further challenges • Increasing complexity of procurement processes, implying obscure decision making and malleable prioritisation • The end user/requestor tends to be disassociated from the final procurement process, and as a corollary the procurement agent lacks application experience • Dialectic tension between vision versus practicality (or today versus tomorrow - PCP). • Ensuring interoperability of solutions, especially when old solutions are already in place, is a critical issue for health authorities ePractice workshop "Procurement of eHealth solutions"

20. HarmonizationThe Problem of Square Pegs and Round Holes Source: Tom Boyle: eHealth Procurement. Presentation at the WoHIT in Barcelona, 2010 ePractice workshop "Procurement of eHealth solutions"

21. An exemplar solution approach Overall policy analysis framework ePractice workshop "Procurement of eHealth solutions"

22. Product comparison “Too many Technology choices? Alvolution's comprehensive product comparison website, developed by health and social care commissioners, can help with the selection of assisted living technologies for service users and patients: The new Alvolution technology comparison website gives you a comprehensive, objective view of the choices of assisted living technology to meet your objective. And saves you making these classic commissioning mistakes: • Buying the first plausible product - We will show you a wider choice, for an informed decision. • Buying the cheapest, irrespective of spec and performance – We will help you to compare like for like, to get best value. • Not knowing what competing suppliers charge - Our price comparisons give you real bargaining power” ePractice workshop "Procurement of eHealth solutions"

23. An illustrative case: telemonitoring procurement in NHS EnglandSource: George Mac Ginnis, Barcelona 2010 ePractice workshop "Procurement of eHealth solutions"

24. Complexity of integrating telehealth devices through good procurement Alerts to users, carers etc eg pagers Other AT devices Alerts, measurements in the home – bells, sirens, screen readout Integrated Telecare Alerts, info to mobile phones, home PCS etc Monitoring (including parameters), response/call handling Installation, maintenance Autodiallers, phone line, 3g/GPRS transmission modules, broadband Home visits, users/carers, emergency services, clinician response etc Home Sensors – CO, PIR, pressure mat etc Standalone glucose monitors Community alarm – handset/pendant Autodiallers, phone line, 3g/GPRS transmission modules, broadband Cameraphones Cameras Autodiallers, phone line, 3g/GPRS transmission modules, broadband Housing systems, door entry, bogus caller Sensors worn by users, falls, wristcare, wandering etc Telehealth units Telehealth peripherals – glucose, peak flow, weight etc Medication monitoring Environmental controls Note: These pictures are for illustrative purposes and do not mean that the specific items shown are available through the Telecare NFA

25. Missed out challenges and constraints • NHS England established a national framework agreement on sup-.plies of devices & services for telecare, telehealth, home automation • A tremendously long and complicated initial procurement process which, after many rounds of negotiations, led to framework agreements with 13 prime suppliers being able to deliver 2,800+ products in the defined field of telehealth and care • Only afterwards, various initially missed out challenges and constraints surfaced, like that most suppliers did not show a drive for conforming to national or international standards (preferring their own proprietary technology and erecting unintended and unforeseen barriers to innovation and interoperability) • This also led to a severe lack of flexibility to accommodate new offerings, and implied only a very limited scope for enhancements and new added value services • Another observation was that the overall cost of ownership remained unclear at the point of sale Adapted from George Mac Ginnis, NHS Technology Office: National procurement framework for telecare /telehealth: experience, learning and plans. Presentation at the WoHIT, Barcelona 2010. ePractice workshop "Procurement of eHealth solutions"

26. Suggested solution approach Establishing precise formal technical requirements in order to • Offer buyers greater confidence in the services they are acquiring • Provide a level playing field for bid evaluation • Drive desired market behaviours (e.g. interoperability) It will also be necessary to better tailor solutions to strategic factors like: • Expected duration (life cycle management) • Size • Degree of integration • Future enhancements • Privacy risk ePractice workshop "Procurement of eHealth solutions"

27. Outlook (I) In the EU, political as well as stakeholder interest in eHealth policies and implementation has gained great momentum: • The overall level of awareness, activities and concrete undertakings has considerably increased • EC as well as Member State initiated activities like epSOS or theeHealth Governance Initiative have significantly contributed • Implementing eHealth solutions has proven to be much morecomplex and time-consuming than anticipated • Exchange of experience gained, also from failures, and lessons learned may prove most beneficial to all ePractice workshop "Procurement of eHealth solutions"

28. Outlook (II) Lessons learned include that achieving an in-novative market through effective procurement requires: • Strategic thinking by buyers • Valuing integration with clinical processes • Commercial clarity on the use of standards • Clear direction on regulation ePractice workshop "Procurement of eHealth solutions"

29. Outlook (III): What the EU/EC/MSs can do together Enhance the procurement of ICT solutions for the support of integrated health services by • providing guidelines to decision makers and procurers within public healthcare authorities and care delivery organisations • on how to conduct consistent and systematic planning processes when strategic considerations point to the adoption of eHealth solutions and • how to transfer the planning to the procurement specification and process ePractice workshop "Procurement of eHealth solutions"

30. Acknowledgement The ideas, insights and information presented are partially derived from studies commissioned by the European Commission, DG Information Society and Media, and research projects which received funding from the EC - support which is gratefully acknowledged. Neither the European Commission nor any person acting on behalf of the Commission is responsible for the use which might be made of the information presented. The views expressed in this presentation are solely those of the author and do not necessarily reflect those of the European Commission. ePractice workshop "Procurement of eHealth solutions"

31. Thank you for your attention!The eHealth teamc/o empirica GmbHBonn, Germanyhttp://www.empirica.biz/themen/telemedizin/projekte_en.php ePractice workshop "Procurement of eHealth solutions"