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Policy background

SmartCare in the EU policy context

Ageing is a major challenge for almost all European societies. The average age of populations is increasing and the proportion of older people growing. Demographic change is caused by various determinants (progress in medicine and health care technologies, improved living environment, and falling birth rates) and therefore one of the main drivers of change within the health and social care systems. Expenditures for long-term care will increase and changing family structures may limit the supply of informal care in future. In addition, chronic diseases like dementia or cancer are increasing as well [1].

Besides occasional care in acute situations, health care should imply a more continuous and overarching service. It should represent a response to apparent needs and avoid unanticipated urgent responses and phases of costly treatment. To prevent inefficient funding and management and increase service quality for clients and patients, health care, care for long-term conditions and social care services must be linked. To assure the sustainability of our care systems and improve the quality of care, various national governments, the European Commission, WHO Europe and many others are recommending the implementation of integrated health and social care service models. A response to the fragmented delivery of health and social services is the integrated care approach, which aims to improve services in connection to access, quality, user satisfaction and performance [2].

Although the European Commission has no mandate to regulate health/social services in the Member States, health and social care systems in the countries of the European Union are considered as a fundamental part of Europe’s social infrastructure [3]. Hence, there are multiple European Directives [4] that are important to the healthcare and social care systems in the countries of the European Union. These deal e.g. with topics like protection of personal data privacy, safety of medical devices or patient rights in cross-border healthcare. Besides those legislative acts, there are various European policy objectives, which address health and social care systems.

 


[1] Stroetmann, K. A., Kubitschke, K., Robinson, S., Stroetmann, V., Cullen, K. a. D. McDaid (2010). How can telehealth help in the provision of integrated care? Health Systems and Policy Analysis.

[2] Ibid.

[3] (2006). "Council Conclusions on Common values and principles in European Union Health Systems." Offical Journal of the European Union 49.

[4] E.g. The European Data Protection Directive (Directive 95/46/EC), the Council Directive (93/42/EEC), the EU Directive on the application of patients’ rights in cross-border healthcare (2011/24/EU)

European Innovation Partnership on Active and Healthy Ageing

Strategic Implementation Plan for the European Innovation Partnership on Active and Healthy Ageing

Of capital importance are the Europe 2020 strategy framework and its “Innovation Union” flagship initiative. The European Commission aims to overcome the barriers to innovation, especially for addressing the major societal challenges through this framework. It put forward the novel concept of European Innovation Partnerships (EIPs). Active and Healthy Ageing (AHA) was chosen as the pilot area. In the conclusions of its meeting of 4 February 2011, the European Council endorsed the Commission’s proposal for an Innovation Union, and in particular the launch of a European Innovation Partnership on Active and Healthy Ageing ((SEC (2010) 11611)). With its Strategic Implementation Plan, the Steering Group (SG) of the EIP AHA delivers its rational, its vision and suggestions for addressing the challenge of active and healthy ageing. It is highlighted that innovation, in all its forms – spanning across technology, process and social innovation – can be a crucial contributing factor to improve the health and well-being of citizens as well as the sustainability of care systems, and to enhancing Europe’s global competitiveness and growth. Furthermore, the Strategic Implementation Plan emphasises that it is important to guarantee the continuity across the innovation chain, starting from research, to pilot projects, to the diffusion and scaling up of innovation into mainstream care.

As an overarching operational objective, the Partnership aims to increase by 2 the average number of healthy life years (HLYs) in the European Union by 2020. It aims at a triple win for Europe:

  • Improving the health status and quality of life of European citizens, with a particular focus on older people.
  • Supporting the long-term sustainability and efficiency of health and social care systems.
  • Enhancing the competitiveness of EU industry through an improved business environment providing the foundations for growth.

In order to determine the best way forward and focus on those innovation actions which deliver the highest impact, the Steering Group has structured the work needed in three pillars:

  • Pillar A: Prevention, screening and early diagnosis as an integral part of live-event approaches to keeping people healthy and postponing the onset of the illnesses;
  • Pillar B: Care and cure as integral pathways of integrated care, aiming to develop a more holistic and personalised approach to multi-dimensional health needs;
  • Pillar C: Active ageing and independent living as a felt need and a future reality for many older Europeans.

Through its action plan the Steering Group has recognised the importance of innovation within each of the three “pillars”. It is highlighted that – while priorities and actions are defined within each pillar – one should however view these in a broader perspective as several priorities and actions proposed in the Action Plan are relevant to more than one pillar, hence synergies and complementarities are expected to develop. In addition, horizontal issues are identified that address framework conditions and are enablers for all other priorities and actions. These include the mapping of research, funding schemes, compiling an evidence base, monitoring and evaluating actions, as well as working on the regulatory framework and (public) procurement.

Action Plan for EIP AHA: B3 Integrated Care

A continuation of the Strategic Implementation Plan (SIP) of the European Innovation Partnership for Healthy and Active Ageing (EIP AHA) is the B3 Action Group on Integrated Care. It was established to develop a response to the challenges set by the SIP. The Action Plan for EIP AHA: B3 Integrated Care was presented in 2012 for the first time and refers to Pillar 2: Care and Cure of the SIP. Part of the Pillar is the Priority Action Area B3: Capacity building and replicability of successful integrated care systems based on innovation tools and services.

The B3 Action Group is made up of 144 participants representing regions, delivery organisations, patient / user and carer organisations, academic institutions, industry and members organisations. The Action Group aims to reduce the avoidable/unnecessary hospitalisation of older people with chronic conditions, through the effective implementation of integrated care programmes and chronic disease management. The following objectives are the main targets of the group:

  • By 2015: Availability of programmes for chronic conditions/case management (including remote management/monitoring) serving older people in at least 50 regions, available to at least 10% of the target population (patients affected by chronic diseases in the regions involved).
  • By 2015-2020: Based in validated, evidence-based cases, scale-up and replication of integrated care programmes serving older people, supported by innovative tools and services, in at least 20 regions in 15 Member States [1].

The key objective of the Action Plan is to support Regions and provider organisations in solving the key challenges they have identified in implementing integrated care. The B3 Action Group members established nine Action Areas, linked to specific timed deliverables and milestones.

1) Organisation models

2) Change management

3) Workforce development

4) Risk Stratification

5) Care pathways

6) Patient empowerment

7) Electronic care records/ICT/Teleservices

8) Finance/Funding

9) Communication and dissemination

Furthermore, the Action Plan defines the governance structure, the governance principles, the role and the responsibilities of the partners, coordinators and the European Commission. It proceeds on services that are currently on-going activities in pilot initiatives and programmes, and aims for the further deployment of services in a large number of regions.



[1] European Commission (2012). Action Plan for EIP AHA: B3 Integrated Care.

Digital Agenda for Europe

In connection with health and social care in Europe, the Digital Agenda is another relevant policy framework. The Digital Agenda was published 2010 by the European Commission and its main objective is to deliver sustainable economic and social benefits from a digital market based on fast and ultra fast internet and interoperable applications[1]. Furthermore, it aims to reboot the EU economy and to enable Europe’s citizens and businesses to get the most out of digital technologies. The Digital Agenda is one of seven flagship initiatives of the Europe 2020 Strategy which aims to prepare the EU economy for the challenges of the next decade. The Digital Agenda defines 7 pillars:

  • Pillar I: Digital Single Market
  • Pillar II: Interoperability & Standards
  • Pillar III: Trust & Security
  • Pillar IV: Fast and ultra-fast internet access
  • Pillar V: Research and innovation
  • Pillar VI: Enhancing digital literacy, skills and inclusion
  • Pillar VII: ICT-enabled benefits for EU society

Pillar VII addresses the challenges faced by European societies like climate change and the ageing population. Smart use of technology and exploitation of information are identified as the main attributes to improve the current situation and address the challenges. It is mentioned that the development of eHealth technologies can improve the quality of care, reduce medical costs and foster independent living. Two key actions are related to health care:

  • Key Action 13: Undertake pilot actions to equip Europeans with secure online access to their medical health data by 2015 and to achieve by 2020 widespread deployment of telemedicine services;
  • Key Action 14: Propose a recommendation defining a minimum common set of patient data for interoperability of patient records to be accessed or exchanged electronically across Member States by 2012[2].

Other actions aim for enhanced standards, interoperability testing and certification, and for the reinforcement of the Ambient Assisted Living (AAL) Joint Programme[3].



[1] European Commission (2010). A Digital Agenda for Europe. Communication from the commission to the european parliament, the council, the european economic and social committee and the committee of the regions.

[2] Ibid.

[3] The AAL JP aims to create better condition of life for the elderly through the use of ICT.

eHealth Action Plan 2012-2020

Within the framework of the implementation of the first eHealth Action Plan in 2004 the European Commission has been developing targeted policy initiatives which foster extensive adoption of eHealth throughout the European Union. The new eHealth Action Plan emphasises that the challenges of the economic crisis, market fragmentation and other barriers limit the benefits of eHealth. These barriers are addressed in the new eHealth Action Plan, which aims to overcome them. It presents and intensifies measures to deliver the opportunities that eHealth can offer, describes the EU’s role and animates Members and stakeholders to cooperate.

Beside the identification of multiple barriers impeding or at least delaying the wider uptake of eHealth, the Action Plan lists several visions to utilise and develop eHealth. These are brought together in following operational objectives:

  • Achieving wider interoperability;
  • Supporting research, development and innovation in eHealth and wellbeing to address the lack of availability of user-friendly tools and services;
  • Facilitating uptake and ensuring wider deployment;
  • Promoting policy dialogue and international cooperation on eHealth at global level

In addition to the challenges of an ageing population, rising expectations, and mobility of patients and health professionals, the Action Plan stresses the budgetary constrains restricting the EU health systems. Through the specified operational objectives the new Action Plan approaches these barriers and fosters a spirit of innovation in eHealth in Europe that ensures better health and care for EU citizens[1].



[1] European Commission (2012). eHealth Action Plan 2012-2020 - Innovative healthcare for the 21st century. Communication from the commission to the european parliament, the council, the european economic and social committee and the committee of the regions.

eHealth European Interoperability Framework

The eHealth European Interoperability Framework (EIF) is a specific action of the Digital Agenda and faces the lack of interoperability between eHealth solutions. The framework, developed by the European Commission in 2012, aims to achieve convergence in the way standards are used, and to facilitate the take-up of eHealth standards. Interoperability does not only imply a technological notion associated with connectivity and connectedness within various systems. In the context of eHealth, interoperability represents a wider concern. It is a precondition for better coordination and integration across the entire chain of healthcare delivery and health data exchange[1].

The eHealth EIF is meant to be an operational toolkit for implementers and purchasers deploying eHealth systems. It is supposed to be used as reference guide in calls for proposals, tenders for the Connecting Europe Facility and also for deployment at the national and regional level. The framework is intended to promote convergence on the use of interoperability standards and technical specifications and contribute to increase the interoperability of implemented eHealth Systems.

The main components of the eHealth EIF are governance, principles and agreements. Furthermore, the following four levels of interoperability were analysed in great detail:

1) Legal interoperability

2) Organisational interoperability

3) Semantic interoperability

4) Technical interoperability



[1] European Commission (2013). eHealth European Interoperability Framework.

Health 2020

Health 2020 is another relevant policy framework. It was approved at a session of the WHO Committee for Europe in September 2012. It affects not only the European Union but entire Europe. The main objective of Health 2020 is improving health for the European citizens and reducing health inequalities through improved leadership and governance for health.

Primary targets were suggested as part of the first common health policy in 1984. Back then, the WHO Regional Committee for Europe adopted 38 specific regional targets and 65 indicators to monitor and evaluate progress at the regional level. These targets were updated 1981 and the Regional Committee adopted a renewed policy “HEALTH21 – Health for All in the 21st century” in 1998. On contrary to expectations, the new targets of HEALTH21 were prone to be too specific and in most instances unachievable[1].

Based on the previous approaches Health 2020 aims to update them in a contemporary context. In 2012 the Regional Committee approved the Health 2020 policy, the overarching targets and the need for specific targets and indicators to enable the monitoring of implementation by 2020. The targets are connected to the strategic objectives (stronger equity and better governance for health) and policy priorities of Health 2020. They conform either to contemporary global target-setting efforts or extend and update previous European approaches.

Overarching targets:

  1. Reduce premature mortality in Europe by 2020.
  2. Increase life expectancy in Europe.
  3. Reduce inequities in health in Europe.
  4. Enhance the well-being of the European population.
  5. Provide universal coverage in Europe.
  6. Establish national targets set by Member States.

The following policy priorities were approved by Member States at the global level and have been adapted to the special requirements and experiences of Europe:

  1. Investing in health through a life-course approach and empowering people;
  2. Tackling the Region’s major health challenges of noncommunicable and communicable diseases;
  3. Strengthening people-centred health systems, public health capacity and emergency preparedness, surveillance and response;
  4. Creating resilient communities and supportive environments.

While the overarching targets are not referring to integrated care, the policy priorities tangent the approach slightly. In relation to the third priority area it is said, that the changing demography and patterns of disease require a reorientation of health care systems to give priority to disease prevention. Furthermore, the continual quality improvement should be fostered and service delivery integrated. The continuity of care should be ensured, the self-care patients supported and care relocated as close to home as is safe and cost-effective[2].

In addition, Health 2020 is a policy framework which gives policy-makers a strategic path, a set of priorities and variety of suggestions about what works to improve health. It addresses health inequalities and is supposed to guarantee the health of European future generations.



[1] World Health Organization (2013). The European health report 2012 - Charting the way to well-being.

[2] World Health Organization (2013). Health 2020 - A European policy framework and strategy for the 21st century.

Integrated care by WHO

While Health 2020 mentions the concept of integrated care, a previous paper published by WHO in 2008 emphasises the approach in more detail. The Technical Brief “Integrated Health Services – What and Why?” demonstrates the various definitions of integrated care as well as the fact that integration is an important and topical issue. The following six main usages of “integrated health services” were identified:

1) Integration as a package of preventive and curative health interventions for a particular population group.

2) Integration in terms of multi-purpose service delivery points.

3) Integrated services to some means achieving continuity of care over time.

4) Integration can also refer to the vertical integration of different levels of service.

5) Integration in context of integrated policy-making and management.

6) Integration in terms of working across sectors[1].

The Technical Brief highlights that the six definitions should be seen as continuum. Furthermore, it is mentioned that the different perspectives of users, providers, senior managers and policy-makers, organization and professionals should be involved as well.

In addition, the Brief stresses both the fact that integration is an issue which awakes strong feelings and that there is much scope for misunderstanding and inefficient polarization. According to the WHO integration can be broken down into a series of practical questions about who does what at what levels of a health system. Clarity about these questions can be the basis for a sustainable development of integrated health services.



[1] World Health Organization (2008). Integrated Health Services - What and Why? Making health systems work.