Good practice examples addressing market barriers
Click on the heading to see the full case description.
The Veterans Health Administration’s CCHT Programme:
Care Coordination/Home Telehealth (CCHT) is a national programme operated by the Veterans Health Administration (VHA) in the United States. It was set up to coordinate the care of veterans with chronic conditions and avoid their unnecessary admission to long-term institutional care. With more than 30,000 (mostly elderly) patients being currently served, CCHT is probably the largest and most integrated/mainstreamed example of home telehealth in the US and internationally.
TAUNUS BKK Disease Management Programme:
TAUNUS BKK, a German public health insurer, has mainstreamed home telehealth solutions within dedicated disease management programmes addressing patients suffering from diabetes or heart insufficiency, many of which are older people. This was enabled through regulatory changes adopted in the context of a national health care reform.
National Framework Agreement on Telecare (NFA):
The National Framework Agreement on Telecare (NFA) was developed as a public procurement mechanism to support the delivery of telecare policy in the UK. It eliminates the need for local care services to individually undertake their own procurement exercises and more generally aims to contribute to the creation of a competitive market place for telecare for the public sector. This award winning initiative has been rated as very successful, being used by over 80% of local authorities and delivering substantial cost savings.
FASS Tele-assistance:
In Spain, the Fundación Andaluza de Servicios Sociales (FASS) has mainstreamed basic telecare in the framework of its legal duty to provide care in the community under the ambit of social legislation enacted at the national policy level. The latter makes explicit reference to tele-assistance as a mean of supporting vulnerable people in living independently in the community.
The West Lothian Home Safety Service:
The West Lothian authority has launched an innovative programme reshaping existing community services for older people, whereby the introduction of telecare has acted as a catalyst of organisational and cultural change. Further service innovation is currently being explored in the framework of the national Scottish Telecare Strategy.
The SOPHIA Telecare Service:
SOPHIA is a fully up and running service offering that has become available in certain parts of Germany since 2004. The service provides social support to older people living in their own home environment, including the management of age-related risks. The service concept which has developed from a publicly funded pilot project has been successfully mainstreamed by means of an innovative franchise model primarily addressing housing organisations.
The Dutch Domotics Programme:
The Dutch Ministry of Health, Care and Welfare provides subsidies for the mainstreaming of independent living technology in the serviced housing sector. Following the funding of a variety of smart home / telecare technology pilots, public funds have been channelled into the serviced housing domain, with a view to incentvise mainstream deployment of a broad range of relevant technologies.
Telecare Business Case Planning Model:
The Telecare Learning & Improvement Network in the UK has developed a business case modelling tool to support social service departments in the development of strategy and business cases for the mainstreaming of telecare. The immediate aim was to support councils in making decisions about how to spend public funds available from a national government programme in an economically sustainable manner.
Recommendations for Reimbursement of Home Telehealth and Remote Monitoring:
The recommendations on reimbursement of home telehealth and remote monitoring by the American Telemedicine Association provide the most comprehensive analysis of this topic internationally. Although developed in the US and not yet implemented by payers, they nevertheless provide a very useful and instructive analysis of relevance in the European context.
“Vivago Watch” – A European Success Story:
The Vivago Watch is part of a commercially available telecare product range developed by a Finnish company (Vivago Oy, formerly IST) that is now being used in a number of European countries. It represents a significant innovation on traditional social alarm products and is said to be the world’s first security device that automatically monitors a person’s well-being 24 hours a day. The product has received many innovation awards in Finland and internationally. It shows that success in the market requires good understanding and cooperation with health and social services that comprise the core target markets, and that it can take time to break into these markets.
Pillar of Rural Excellence “Domotique et Santé”: A regional approach addressing social and economic needs
The initiative “Pôle Domotique et Santé de Guéret” is an example of a regional approach aiming to capitalise on the opportunities that innovations in domotic services could present for meeting both social and economic needs in the area. A core issue for the region was to tackle the demographic challenge of a low density, rural and ageing population. The domotics project was set up to improve the quality of life of inhabitants, to promote the implementation of domotic services and business that create new jobs and to trigger the growth of a new market for innovative technologies.
Résidences “Maisons Vill’Âge”: Smart Retirement Villages
The Résidences “Maisons Vill’Âge” project is an example of an initiative that aims to provide older people with a complete, purpose-built community that incorporates domotic and telehealth services from its inception. The project was set up to meet the needs of an ageing population and to support independent living for older people aged between 65 and 85 who have some form of disability. The initiative offers activity monitoring, vital signs monitoring and access to a range of entertainment and communication facilities via a dedicated TV interface.
The TRIL Centre: Technology Research for Independent Living
The TRIL Centre in Ireland is an interesting example of a public-private collaboration established with the aim to discover and deliver technology solutions to support independent living for older people. The Centre focuses on three key areas: improving health and social engagement for older people, detecting and preventing falls in the home, and helping those with memory loss to maintain their independence.
Non Piu’ Soli. Mainstreamed combination of social alarm and telehealth services
Non Piu’ Soli is a combined social alarm and telehealth service that has been mainstreamed in the Municipality of Rome since 2002. It is an example of ICT-supported services being integrated with existing public social services. The service is operated in partnership by FARMACAP, the public agency that manages the municipal pharmacies of Rome, and the Municipality of Rome.
FOLD Housing Association: Housing-with-care and telehealthcare
This is an example of mainstreaming of telecare and telehealth being driven by a not-for-profit housing association, as part of its overall emphasis on service improvement and innovation. Telecare was launched by Fold in Northern Ireland in 1993, and telehealth was launched as a mainstream service in 2007. The case also illustrates the importance of ensuring buy-in from existing health and social services in order to successfully mainstream ICT-based services.
The E-Care Project: A coordinated regional approach
E-Care provides an example of an initiative operating on a regional basis that aims to connect various actors – public, voluntary and private – to deliver co-ordinated ICT-supported health and social care services to older people. The project integrates activities between the different service providers at regional and municipal levels and will ultimately integrate telecare and telehealth projects that are currently at pilot stage.
Gwynedd Telecare: Mainstreaming from a local initiative
The Gwynedd Telecare service developed from a small local pilot project that allowed localisation of the telecare technology to suit the community (i.e. the provision of Welsh-speaking home units). There has been rapid growth in demand for packages, mainly due to ‘word of mouth’ and local council publicity. Telecare has since been rolled-out at county and regional levels in North Wales.
Just Checking: Supporting Independent Living for people with Dementia
‘Just Checking’ is a telecare system that monitors daily life activities of people with dementia in their own homes and presents the information in a meaningful format to professional or informal carers via a secure web site. The system is commercially available and has been installed by a number of social care services and other care providers in the UK. Evaluation studies have demonstrated that the system can enable people with dementia to live independently at home for longer.
The National Telecare Development Programme, Joint Improvement Team
The National Telecare Development Programme is a government-sponsored policy and practice initiative that aims to support independent living for older people and people with a disability by promoting the use of telecare in Scotland. It is a good example of a government-driven programme to expand and mainstream telecare services, accompanied by a comprehensive policy, learning and development strategy. The Programme has also benefited from thorough independent evaluation, with input from health and social care partnerships across Scotland.
PAL4- Personal Assistant 4 Life: Cooperate on infrastructure, compete on services
PAL4 (Personal Assistant for Life) is a non-profit organisation running an open platform that enables provision of a variety of supportive services into older peoples’ homes. Organisations providing social care, health care and/or other forms of support to older people in the community can utilise a common technology platform for developing and providing services according to their own branding and layout. Currently, over 30 organisations have joined PAL4 with a view to pursuing service innovation according to a joint motto: cooperate on infrastructure, compete on services.
Preventative Technology Grant: A centrally-funded grant to kick-start mainstream telecare services
The Preventative Technology Grant is a focused and centrally-funded policy measure directed towards pump priming of telecare services in the UK. Overall, £80 million (105 million €) were made available by the national government over the period 2006-2008. Councils were expected to invest in telecare services, to help an additional 160,000 older people to live at home safely and securely and reduce the number of avoidable admissions to residential/nursing care and hospital. Various models are now emerging as organisations consider the best use of the grant and other resources for telecare and telehealth. At one end, organisations are cautiously using the funding to run small scale pilots. At the other end, there appears to be a phased mainstreaming of telecare as a long term health, housing and social care operation.
Healthcare centres Dr. Hein: Integrating telerehabilitation into established on-site therapy concepts
The Dr.Hein group operates a chain of health care centres providing occupational and speech therapy services with help of a patented e-health system (EvoCare). Also, a dedicated dementia prevention appliance was developed. The health care centres are staffed with interdisciplinary teams addressing different target populations such as older people, patients with chronic disease and children. Four centres are now in operation across the country, and further centres are planned to be set up in the near future.
Whole System Demonstrator (WSD) Programme: Improving the evidence base on telecare and telehealth impacts
The Whole System Demonstrator (WSD) programme was launched in May 2008. It is funded by the UK Department of Health with the aim to find out how technology can help people managing their own health and maintaining their independence. A further aim is to evaluate the benefits potentially yielded by integrated care service delivery with help of advanced technologies in a randomised control trial environment. The WSD programme is conducted at three sites – Cornwall, Kent and Newham. By means of a robust evaluation programme, the initiative is expected to significantly improve the current evidence base on impacts yielded by the implementation of telecare and telehealth solutions under real world conditions.
HyvinvointiTV®: A learning environment for client-driven service development
The CaringTV (HyvinvointiTV®) concept was developed by a consortium comprising public institutions, municipalities and commercial parties. In technological regard the concept relies on an interactive TV system utilising a safe broadband connection for delivering supportive services into the homes of older people. The system has been developed in the framework of a national programme (Finn Well / InnoElli Senior) directed towards developing supportive solutions for older people living at home and for municipalities facing challenges providing health and social services to them. CaringTV® provides also a “learning environment” for variouse sub-projects seeking to develop supportive services according to a client-driven methodological approach.
ACTION: Strengthening self-management capabilities of older people & informal carers
The ACTION service is directed towards frail older persons who prefer to stay in their own homes but who are in need of support. The service includes remote provision of dedicated information and training programmes in order to strengthen the self-management capabilities of older people and their families, thus enabling them to better cope with their situation. By means of ICT, family carers can get on-demand support from local service centres that are staffed with qualified professionals. Also, networking and mutual exchange between service users is facilitated. The service is available in several municipalities.
FinnWell: Interlinking industrial and welfare objectives
FinnWell is a five-year (2004-2009) technology programme of the National Technology Agency of Finland, Tekes. Its objective is to improve the quality and profitability of healthcare, and to promote business activities and export in the field. Three main themes are addressed by the programme: development of technologies for diagnostics and care; development of IT products and systems that support care, follow-up or prevention of illnesses; development of the operational processes of healthcare. Independent living and home care services for older people are one area that was supported, amongst many others. The overall value of the programme was more than 170 million euro, of which Tekes invested about half and the participants in the programme fund the other half.
German Society for Gerontechnology- GGT: A competence centre addressing the seniors market
The GGT German Society for Gerontechnology (GGT Deutsche Gesellschaft für Gerontotechnik®) has been set up with a view to advancing the market for so called geronotechology. Amongst variouse other product categories, this includes ICT-based products and services. A particular aim is to empower small and medium sized enterprises to produce, merchandize, install and maintain products that are of particular relevance to the seniors market. Another focus of the association’s work is on general awareness rising addressing the demand side. Variouse services are offered to industry partners, service provider organizations as well as older consumers and their families. GGT has set up a dedicated certification scheme for senior-friendly products and services.
The InnoELLI SENIOR Programme: Facilitating ICT-enabled process innovation in the field of elderly care
The InnoELLI Senior Programme (2006 – 2008) was set up with a view to developing integrated service models that enable public, private and third-sector organisations to adopt new working methods and provide technology-enabled (in particular, IT-enabled) cost-effective services in the field of elderly care. Particular emphasis was given to the mainstreaming potential of innovative care practices beyond local pilot settings. The programme was expected to contribute to the building up of a regional “elderly care services” cluster, thereby interlinking both industrial and welfare objectives.
The PWT Foundation – Investments in Public Welfare Technology (ABT-fonden): ICT enabled streamlining of public service delivery
The Danish government has allocated 3 billion DKK (about 400 million Euros) to a dedicated programme (2009 to 2015) directed towards developing and improving public sector services through the implementation of labour-saving technologies and more efficient working processes. In particular, the programme is intended to enable public services to meet increasing demand with fewer human resources, a challenge that is expected to take effect over the coming years as ongoing demographic developments will accelerate further. The programme spans across all public sector activities, and a range of projects are currently funded across different thematic areas including “Telecommunications Solutions and Information and Communication Technology (ICT)”, “Robotics and Automation”, “Digitalisation” and “CareTechnology.
Smart Living in Hattingen: ICT deployment in the mainstream housing sector
Due to strategic considerations connected with the accelerating trend towards population ageing, Hattinger Housing Association (Hattinger Wohnungsgenossenschaft – hwg eG), a mainstream housing provider based in Germany, entered into a cooperation with two institutes of the Fraunhofer Association, a leading German RTD organisation, in order to develop and implement mature smart home technology into its existing housing stock. Pursuing a strictly demand-driven approach, the “smart living” platform was installed in about 60 flats. Customisation of the standard system according to individual needs turned out to be challenging because of economic and managerial obstacles.
bonacasa®:
Under the umbrella of its brand ‘bonacasa®‘, Bracher and Partner AG specialises in consultancy services and project development in the area of senior citizen housing. The company offers a range of customer-tailored services to municipalities and private investors, ranging from the generation of project ideas up to full project implementation. Implementation of a networked home infrastructure – the so called bonacasa® net – constitutes a central element of the bonacasa® concept. It enables on-demand access to interpersonal communication services, personal security appliances and entertainment services.