Brief description of the opportunity

Older people have a potentially longer medical history and a higher likelihood of several illnesses at once, which all need to be taken into account when treating a patient. Some older people may also not be able to express their health status, for example because of dementia. In addition, older people may receive care in different setups such as hospitals and care homes. The lack of interoperability of the health care system hinders the prevention and treatment of illnesses. Electronic and mobile health solutions could help increase the quality of care for older people and chronically ill (older) people. Objectives include:

• The development of integrated and personalised health and care for the elderly
• The development of a digital patient record
• Increase digital skills for carers
• Increased efficiency in the health system
• Improve prevention of chronic illnesses

Benefits to older people include: better diagnosis, better prescription of medicines, decrease in adverse drug reactions.

There is substantial interest in promoting connected health across Europe, with many member states running national programmes concerned with the digitisation of health and social care.  This kind of transformation clearly has the potential to deliver health gains for older people, and others, and improve the productivity and efficiency of national healthcare systems.  Connected health initiatives are also delivering direct economic benefits through the procurement of a range of goods and services, from organisational design consultancy through to ICT. 

System-wide innovation is challenging by definition, so while there is substantial and growing activity in this space, the rate of progress remains quite modest in many countries and older citizens are not so far consuming healthcare in radically different ways or altering spending patterns.

There is evidence of faster progress in several narrower domains, with new companies launching software aps to improve people’s access to primary care services.  There are examples of charged, subscription-based services.  These new-generation healthcare providers are beginning to submit to inspections by national regulators, to check basic compliance with the law and to more generally test the extent to which they are safe, effective, caring and well-managed.

NHS England has a network of digital innovation hubs and centres of excellence working with entrepreneurs and businesses on the development of new, innovative solutions that may ultimately be purchased by primary and secondary healthcare providers nationally and internationally.  The NHS is also working to create a useable healthcare aps library that will inspect apps and wearables with a view to allowing approved systems access to our own medical records.  There are other initiatives encouraging bottom-up innovation as a means by which to get round some of the challenges of system-wide reform, as well as using other policy levers (e.g. certification) to overcome other barriers (e.g. access to medical records) and help markets emerge and work more efficiently.

A draft description of the case, including barriers, market opportunities, and recommended actions is unloaded below. Thank you for your patience!

Barriers and market failures

• The acceptability of electronic and mobile health solutions by both practitioners and patients can be a barrier Carers are often human centred, not technology orientated. By professional intuition, they will spend time on acquiring new skills to enhance the relationship with their patients.
• The lack of platforms for health and care based on open standards is regarded as one of the most significant market barriers within the ICT industry. Having common standerds and interoperable solutions can bring to new market opportunities for cost-effective solutions that can enhance quality of life and open a new and big market to health device provider and producer. Issues of data security and protection will also need to be addressed.
• The interdependency of skills levels of carers and elderly have a limiting impact on digital skills development of carers. In 2012, 63% of citizens between 65 and 74 years old had never used the internet, and 57% of citizens had even never used a computer (Growing the Silver Economy, European Commission). In order to increase the number of skilled elderly, carers are needed that help with the integration of these technologies in people’s lives. However, also carers are still largely under-skilled, forming a major barrier for the uptake of these technologies.
• Prime financers for elderly care are health insurance companies. Many of these signal high ambitions where it concerns expectations about digitalisation and welfare and health support of elderly. These ambitions materialise in short term subsidies or loans for health organisations for pilots, training and continuous professional development of personnel has to be paid from regular fees.

Market prospects – size, growth trends and scalability

It is expected that in 2060, the ratio of people in the EU that are aged 65 or above compared to the people aged 15-64 will be 50.1 percent (compared to 27.8 percent in 2015). Correspondingly, the number of people above 65 that will need care will also increase, and it is expected that the largest increase in age-related public expenditure will come from healthcare and long-term care spending, which together will be around two percentage point of GDP (health care: +0.9pp., long-term care: +1.1pp.).

Challenges - identified need for action

Access to information about digital technologies and services for elderly people needs urgent improvement. Carers in formal health care are primarily trained at vocational level; their skills for digital information retrieval are often relatively low. In informal care the situation is mixed; some informal carers may develop effective search strategies, sometimes assisted by younger people in their social network. Others, in particular the informal carers who are themselves elderly, might have limited access to digital services.

Added value of EU action

Regarding the low level of digital skills among carers that were trained in vocational education, focus could be on technologies that support and stimulate their practice based learning styles, for instance on web based video and tele consultation and on ambient sensor networks.

Where national markets or public service systems are in the short run too small to boost innovations and related skills development, thematic coalitions of health service providers could be promoted that jointly develop learning content and digital learning services.

Existing or planned initiatives to build on

Vocational education that is highly relevant for adoption and further development of digital skills for carer and there exist various example here that can be adopted more widely.

There are various EU Framework Projects that have a focus on information management and ICT for digital content -  eg http://cordis.europa.eu/project/rcn/194204_en.html and http://cordis.europa.eu/project/rcn/194272_en.html

Digital patient records are for example piloted in the English Nation Health Service Rotherham Foundation Trust (http://www.therotherhamft.nhs.uk/Electronic_Patient_Record/EPR_Frequently_Asked_Questions/).

Recommended EU policy actions

The EU can provide support by removing barriers through policy actions at EU level and by leveraging national policy. An urgent action is to assist formal and informal carers in finding their way across the scattered landscape of evolving digital skills offerings. EU policy-makers could support pilot projects for electronic and mobile health in different European regions, this way systems can be developed which works for the whole of Europe.  New/improved legislation may help address the data security and protection issues.

Key stakeholders

Key stakeholders include national governments, regional and local authorities, health insurance companies, health organisations, vocational training organisations and elearning suppliers, and informal carers.