Reports by Nicola Mountford
The European Network for the Joint Evaluation of Connected Health Technologies (ENJECT) is a COST... more The European Network for the Joint Evaluation of Connected Health Technologies (ENJECT) is a COST action that brings together an international consortium, including business and revenue modellers, clinicians, technologists, engineers, economists, ethnographers, and health researchers to help society to answer one question – how to connect therapies, patients, and care-givers to deliver optimum health results in an era of stretched resources and increasing demands. This report, which has grown out of an ENJECT survey of 19 European countries, examines the situation of Connected Health in Europe today. It focuses on creating a clear understanding of the current and developing presence of Connected Health throughout European healthcare systems under five headings: The Policy Environment, Education, Business and Health Models, Interoperability, and The Person.
Quality, privacy, and safety, major elements of Connected Health, were evident policy concerns in the Connected Health context. Attention is paid as to how the healthcare systems are evaluated. Evaluation methods and responsibilities range from macro state-level evaluation to more dispersed local evaluation. The constant evolution of European healthcare is reflected in the changing methods of evaluation in countries such as Norway, Greece, Malta, and Serbia.
The vast majority (almost 80%) of respondent countries have eHealth strategies in place or are working on implementing such strategies. In general, e-prescribing and Electronic Health Records are the most common forms of Connected Health activities throughout Europe. There is a clear distinction between patient and consultant usages of these forms of Connected Health. A major issue, especially with the creation of Electronic Health Records, has been ensuring that they are safe and secure and that privacy is attainable. Health Insurance companies also make use of electronic patient records for the storage of and quick access to patient records.
Privacy is recognised as an important factor in the development of accessible patient databases. While two thirds of respondent countries rely on national data protection legislation to protect such databases, others have been more proactive and generated eHealth-specific legislation. Croatia, Germany, Slovenia, the UK, and Macedonia have all begun to recognise the need to draw up legislation which prioritises the protection of patient information recorded through these types of technologies. Public statements and political instruments directly address the topic of Connected Health, helping to protect patients while increasing their awareness of the Connected Health options. Websites and manifestos dedicated to health related activities in various countries are at the centre of this public awareness. Additionally, political parties in some of the respondent countries identify eHealth and Connected Health as an area for improvement in their own manifestos.
Of the nineteen respondents to the survey, fifteen countries contributed specific information on university based programmes that help to ensure that healthcare professionals are aware of and in a position to utilise Connected Health. While few of the programmes focus solely on Connected Health, its inclusion in health and biomedical informatics courses ensures that it will be a part of these future healthcare providers’ understanding of the provision of healthcare. Awareness of Connected Health and the development of health literacy is not solely a concern at third level. Health literacy is a challenge across Europe as a whole. Ad hoc health literacy programmes have been proven to work in some countries, but the public’s infrequent exposure to these forms of literacy, such as television and poster campaigns, means that their benefit is often not fully felt in the long term. The role that Connected Health can play in the improving health literacy does not seem to have been realised, with most countries still relying on leaflets and information booklets to improve patients’ understanding of medical and health related issues. For those countries who actively and regularly promote health literacy, this is done through school systems and specific research communities.
Presenting the business and health models of the healthcare systems in each of the ENJECT respondent’s countries helps to develop an understanding of the level of priority placed upon Connected Health. The majority of European healthcare systems are organised through cooperation between private and public bodies. Their funding and finances primarily come from the public sector, with revenue created through direct and indirect taxes. eHealth models within these healthcare systems’ business models vary significantly across the region and are gradually becoming an accepted part of a healthcare system’s general business models.
To attain an understanding of its healthcare model and patient care pathways, each country has provided a case study of common illnesses. The difference in each country’s method of treatment of the same illness shows how each of the systems operate, with a clear focus on the funding of the treatment in each of the instances.
eHealth Records and digital prescriptions top the list of technically integrated systems at national and
regional levels enabling electronic systems to work across a variety of healthcare contexts. The unification of language and classification systems emerged as a major issue when considering the interoperability of eHealth.
Generally, the level of patient involvement in the design, delivery, and development of health related research programmes is on the increase. With 30% of the respondent countries having a system in place which encourages the inclusion of patients in the design and development of healthcare, this can be seen as a clear starting point for creating even more connected healthcare systems throughout Europe.
In summary, confusion abounds in the area of Connected Health – around wording, application, models, and systems. It involves a complete transformation of the healthcare system in a long-term play that requires dedicated resources and political will. Many of these elements are difficult to capture with data points being largely qualitative and non-comparable. Different countries are at different stages of readiness in terms of Connected Health – both in terms of its research and its implementation. The evaluation criteria employed in different circumstances and different geographies across Europe are neither clear nor standardised. The majority of states and regions are so engaged in the process of ensuring interoperability at a regional or national level that they have little time or attention left to focus on the thorny issue of international interoperability.
We recommend an agenda for future research in Connected Health for Europe that creates a shared language around health records and a database that would facilitate the development of a Connected Health or eHealth scorecard. We would support a common evaluation framework for Connected Health implementations that is multi-faceted, ranging from technology robustness to regulatory compliance, from economic sustainability to user acceptance, and including both qualitative and quantitative measures. There is evident confusion as to the application of existing rights in the context of Connected Health. We recommend an approach specific to eHealth that helps citizens, researchers, companies, and healthcare providers to understand how we live safely and privately in an era of healthcare data. We suggest that studying how some of the ENJECT countries have done this and distilling learnings and best practice from their experience could help to better design future guidelines and interpretations.
Peer Reviewed Conference Papers by Nicola Mountford
Coordinated, integrated care requires connected " inputs, delivery, management and organization o... more Coordinated, integrated care requires connected " inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion " (Grone & Barbero, 2002). Connected health (CH) offers a key building block as a " paradigm shift, looking after the individual and community health in a process that speaks to the health journey of the person, through the entire lifespan, leveraging a variety of technologies to do so " (ENJECT, 2016). However, CH is failing to reach its full potential – and therefore failing in its contribution to the realization of integrated care. We conducted a multidisciplinary literature review across business, technology and healthcare journals, triangulated with a survey of CH experts from academia, industry and clinical settings representing 19 European countries (ENJECT, COST Action TD1405). We hereby identify key vectors for CH and related drivers of change: Policy and regulation There is a gap between national policy/strategy statements and local or regional implementation, despite 80% of European countries having a national CH strategy and political support of CH. Currently, 2/3 of European countries rely on generic privacy, security or other legislation whereas customised regulation would better recognise the uniqueness of health-related data and its need to flow within specified channels. Technology and interoperability Interoperability is an ongoing process in healthcare across Europe with ePrescription and Electronic Health Records leading the field while personal health systems adoption varies. Again privacy and security concerns come to the fore, as well as usability and ease-of-adoption related issues. Training and education Training programmes are beginning to incorporate CH elements to equip future healthcare leaders to fully exploit CH's potential, however this is neither widespread nor in-depth. An emerging topic is education of health professionals in skills needed to participate in the design and adoption of CH solutions. Health literacy programmes targeting the general public are largely ad hoc and rely on unconnected methods such as leaflets and booklets. Business and revenue models Europe's healthcare business models typically involve public and private providers while relying largely on public funding. CH reimbursement and revenue models are limited and non-standard. Innovation at both service and process levels is slow to diffuse and reimbursement models stymied due to a lack of standardised evaluation methodologies or agreement on what constitutes value. Value creation models in health are primarily built to address medical conditions, rather than prevention and self-care. Citizen and Clinician engagement Actors considered across both academic papers and survey vary – from industry giants, start-ups, researchers and social entrepreneurs, to government and regulatory agencies. Academic authors speak of users, patients, customers, funders and payers, highlighting the complex nature of CH markets. On the practice side, inclusion of patients in the design and development of connected health solutions relies on voluntary methods in 2/3 of European countries. We lack methods-to include a wider range of citizens, and to develop skills for both care professionals and citizens to fully participate in design and development of CH solutions. Conclusion Key enablers for CH span multiple directions and scales.
Peer Review Journal Publications by Nicola Mountford
As markets become increasingly complex it is more and more important that we understand their und... more As markets become increasingly complex it is more and more important that we understand their underlying market networks. While much research has been conducted into the interrelationships and impacts between the firm and the network, less attention has been paid to the study of the whole network itself. Understanding the origins, structures, and potential futures of whole market networks is vital to the understanding of whole markets. This is particularly the case in light of the multiplicity of societal and institutional conditions attached to an increasingly globalized economy. The insertion of technology into incumbent markets such as finance or healthcare causes market and network evolutions that firms must understand if they are to navigate them safely. Traditional business research methods are, however, often locked to the firm perspective through case study approaches, or quantitative network analyses. Despite some recent methods that take a more situated, biographical approach, a bird's eye view of the whole network remains elusive. Anthropological methods offer assistance-both in making sense of the evolution of the network within the market context, and in understanding the intricacies of such networks. Unfortunately, the concept of network analysis remains disconnected across disciplines apart from some exceptions such as Berthod, Grothe-Hammer and Sydow's (2016) combining of social network analysis with ethnographic research methods to produce 'Network Ethnographies.' We build on that approach, combining market network research methods with ethnographic research methods, illustrated through case examples from our research in the connected health domain. We illustrate ethnography's potential for in-depth capture of network detail, showing how ethnographic methods can be used to understand each player's position and function within that system, as well as reflecting the life and culture of the whole network.
Papers by Nicola Mountford
Academy of Management Proceedings
Education and New Developments 2022 – Volume 2
International Journal of Management Reviews
Education and New Developments 2022 – Volume 2
"As we enter the Transformative Age of digital and green transitions, the European Commissio... more "As we enter the Transformative Age of digital and green transitions, the European Commission and other global policy-makers herald universities as key players in innovation and transformation. PhD students ostensibly represent the pinnacle of higher education and suitable candidates for policymakers’ visions. Academic research has shown that traditional PhD programmes may fail to equip their graduates with the necessary skills and knowledge required. Practitioners’ voices have, however, been less well heard. We review thirteen policy and industry reports relating to doctoral education including EU policy documents, wider policy contributions across the EU, and industry-led reports. We also conduct thirteen semi-structured interviews with PhD employers or experts in PhD recruitment/placement. Findings highlight the lack of transferable skills in doctoral graduates, but also shed new light on attributes and experience as key hiring factors. We examine interdisciplinarity and intersectorality as potential solutions to employer and policymaker demands."
Education and New Developments 2022 – Volume 2
"Collaborative doctoral programmes assist the knowledge society in finding innovative ways t... more "Collaborative doctoral programmes assist the knowledge society in finding innovative ways to address sustainable development goals by asking creative questions and finding creative solutions. The aim of CHAMELEONS (Championing A Multi-Sectoral Education and Learning Experience to Open New Pathways for Doctoral Students, H2020-SwafS-2018-2020), is to develop interdisciplinary, inter-sectoral and international modules that broaden the skills of PhD graduates improving their employability in academic and non-academic environments. Through a co-design process 4 learning outcomes were developed which formed the foundation for 3 modules. Each module advanced the students’ depth of knowledge and understanding. The 4 learning outcomes were as follows: • Develop networking and communication skills; • Understand user-centred design; • Market research capacity and research skills; and • Build an understanding of themselves and others. Fifteen doctoral students from five European universities were recruited. This paper represents evaluation conducted on the first two modules which, due to COVID-19 restrictions, were delivered via Zoom. At the conclusion of each module the students were invited to complete a questionnaire consisting of sixteen questions, thirteen of which were on a five-point Likert Scale, and three of which were free text. The closed questions explored student perceptions of: programme objectives; programme delivery; opportunities to engage; satisfaction; and links between theory and practice. Students were asked to identify three aspects of the module which assisted their learning, three changes they would suggest to enhance their learning, and were offered the opportunity to provide additional comments. Programme content: Students perceived that real-time assessment, reflective learning, engagement with course coordinators and the opportunity to engage with practical research tools (Photovoice, Ecosystem Mapping and Walk My ID) all enhanced their learning. They suggested more group activities, breakout groups (possibly themed), and real-life coffee breaks, to enable them to better network with their doctoral colleagues. There was a desire for more practical activities with some suggesting the development of career-pathway skills (Curriculum Vitae, Interviews). Programme delivery: A theme that frequently appeared was the desire to have more physical face-to-face engagements in Module Three. The students understood the Covid-19 constraints but expressed a strong desire for meeting face-to-face. When given the opportunity to add freeform and unprompted comments, students almost without exception expressed their satisfaction with both modules, and their appreciation for them. Nevertheless, a number of participants reiterated their desire to undertake Module Three in person. Programme outcomes: One student expressed an aspiration to be “more sure” of their skill set and marketability upon completion of Module Three complimenting the focus on practical learning in the programme content review."
7th International Conference on Higher Education Advances (HEAd'21), 2021
Solving grand societal challenges such as equitable healthcare provision and climate change will ... more Solving grand societal challenges such as equitable healthcare provision and climate change will require institutional entrepreneurs – people who can challenge prevailing regulations, behaviors, and ways of thinking. As the pinnacle of educational achievement, the doctoral degree should be the fire in which such fledgling institutional entrepreneurs are forged. Doctoral education has, however, been criticized as overspecialized and divorced from reality. We systematically review the doctoral education literature in our search for doctoral education programs that challenge institutional norms by bridging sectoral and disciplinary divides. We ask whether such programs can help to nurture institutionally entrepreneurial researchers. We find that students must manage ambiguous identities and wide networks but that such programs have the potential to equip them for both sense-making and sense-giving activities of institutional entrepreneurship.
Studies in Higher Education, 2021
While institutional logics theory has increasingly been applied in higher education research, esp... more While institutional logics theory has increasingly been applied in higher education research, especially in the past five years, agreement is lacking on how to approach institutional logics analysi...
Education and New Developments 2021, 2021
Typically, less than half of doctoral graduates will be employed in academia immediately after gr... more Typically, less than half of doctoral graduates will be employed in academia immediately after graduation, with less than 10%-15% achieving a long-term academic career. This leaves 85-90% of PhD graduates seeking employment outside the academic setting, for example in industry and government. The objective of the CHAMELEONS study (CHampioning A Multi-sectoral Education and Learning Experience to Open New pathways for doctoral Students) is to develop innovative educational interventions that shape more adaptable, entrepreneurial, and employable graduates, ready to meet the challenges of the future. Stakeholders from the connected health industry, clinical care, charities, patients, patient representatives, government, recent doctoral graduates, and academics were invited to participate in a “World Café” participatory method for collecting qualitative data. Owing to the COVID-19 health situation this took place via Zoom. Analysis of the results revealed 4 key learning objectives for d...
This report is based upon work from COST Action (ENJECT TD1405), supported by COST (European Coop... more This report is based upon work from COST Action (ENJECT TD1405), supported by COST (European Cooperation in Science and Technology).
International Journal of Integrated Care, 2017
As markets become increasingly complex it is more and more important that we understand their und... more As markets become increasingly complex it is more and more important that we understand their underlying market networks. While much research has been conducted into the interrelationships and impacts between the firm and the network, less attention has been paid to the study of the whole network itself. Understanding the origins, structures, and potential futures of whole market networks is vital to the understanding of whole markets. This is particularly the case in light of the multiplicity of societal and institutional conditions attached to an increasingly globalized economy. The insertion of technology into incumbent markets such as finance or healthcare causes market and network evolutions that firms must understand if they are to navigate them safely. Traditional business research methods are, however, often locked to the firm perspective through case study approaches, or quantitative network analyses. Despite some recent methods that take a more situated, biographical appro...
Proceedings of the 3rd International Conference on Higher Education Advances, Jun 21, 2017
It has been found that most PhD graduates (>85%) do not achieve a long-term academic career an... more It has been found that most PhD graduates (>85%) do not achieve a long-term academic career and thus there is a growing need to re-imagine PhD education that incentivizes doctoral students to engage with research consumers, not only within their discipline, but also, across other disciplines and sectors to have real social impact for an improved society. The aim of this work is to identify intersectoral/interdisciplinary courses that are considered to broaden student career outside and inside academia. For this purpose, a survey was designed to identify modules which lead to the improvement of students' skills while an analysis of their attributes was also performed. Two target groups have been considered: (a) young researchers and (b) program directors each of which can provide different information regarding the courses of interest. 52 students and 11 directors from 5 European Universities, participated in the study. An absence of such courses in the standard PhD program wa...
Healthcare Activism
This chapter combines two streams of scholarship—social media marketing and influence, and market... more This chapter combines two streams of scholarship—social media marketing and influence, and market organization—to examine two case studies of patient activism in the context of Irish drug pricing. The first is the provision of Orkambi, a drug for cystic fibrosis, which was approved in Ireland after eleven months of state/pharma negotiations held in a context of public debate and social media campaigning by people living with cystic fibrosis, their loved ones, and their advocates. The second case concerns the provision of Spinraza, a drug for patients with spinal muscular atrophy. In each case the chapter identifies key actors and tracks their social media activity with a view to identifying key turning points in the debate, relational links, and shifts. Ultimately the goal is to understand how activist organizations and individuals organize and reorganize the pharmaceutical market and the collective good through their actions and interactions on social media.
AMS Review
We borrow the notion of field from institutional theory to think through how markets and their ‘o... more We borrow the notion of field from institutional theory to think through how markets and their ‘outsides’–or at least one particular manifestation of an ‘outside’–stand in a dynamic and interactive relationship. We distinguish the field and the market in terms of issues versus exchange and identity versus position. We argue that the lack of clarity as to how fields and markets differ, relate, overlap, and are bounded, jeopardizes our ability to address important societal debates concerning the roles of markets within and across other areas of social life. It also hinders a consolidation of insights across different approaches to studying markets, even though researchers from different disciplines often address similar concerns. Key questions for which both conceptual and analytical clarity are essential include how markets and their ‘outsides’ (here: fields) intersect; whether and how diverse sets of actors interact, work, and migrate between fields and markets; and what dynamics ma...
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Reports by Nicola Mountford
Quality, privacy, and safety, major elements of Connected Health, were evident policy concerns in the Connected Health context. Attention is paid as to how the healthcare systems are evaluated. Evaluation methods and responsibilities range from macro state-level evaluation to more dispersed local evaluation. The constant evolution of European healthcare is reflected in the changing methods of evaluation in countries such as Norway, Greece, Malta, and Serbia.
The vast majority (almost 80%) of respondent countries have eHealth strategies in place or are working on implementing such strategies. In general, e-prescribing and Electronic Health Records are the most common forms of Connected Health activities throughout Europe. There is a clear distinction between patient and consultant usages of these forms of Connected Health. A major issue, especially with the creation of Electronic Health Records, has been ensuring that they are safe and secure and that privacy is attainable. Health Insurance companies also make use of electronic patient records for the storage of and quick access to patient records.
Privacy is recognised as an important factor in the development of accessible patient databases. While two thirds of respondent countries rely on national data protection legislation to protect such databases, others have been more proactive and generated eHealth-specific legislation. Croatia, Germany, Slovenia, the UK, and Macedonia have all begun to recognise the need to draw up legislation which prioritises the protection of patient information recorded through these types of technologies. Public statements and political instruments directly address the topic of Connected Health, helping to protect patients while increasing their awareness of the Connected Health options. Websites and manifestos dedicated to health related activities in various countries are at the centre of this public awareness. Additionally, political parties in some of the respondent countries identify eHealth and Connected Health as an area for improvement in their own manifestos.
Of the nineteen respondents to the survey, fifteen countries contributed specific information on university based programmes that help to ensure that healthcare professionals are aware of and in a position to utilise Connected Health. While few of the programmes focus solely on Connected Health, its inclusion in health and biomedical informatics courses ensures that it will be a part of these future healthcare providers’ understanding of the provision of healthcare. Awareness of Connected Health and the development of health literacy is not solely a concern at third level. Health literacy is a challenge across Europe as a whole. Ad hoc health literacy programmes have been proven to work in some countries, but the public’s infrequent exposure to these forms of literacy, such as television and poster campaigns, means that their benefit is often not fully felt in the long term. The role that Connected Health can play in the improving health literacy does not seem to have been realised, with most countries still relying on leaflets and information booklets to improve patients’ understanding of medical and health related issues. For those countries who actively and regularly promote health literacy, this is done through school systems and specific research communities.
Presenting the business and health models of the healthcare systems in each of the ENJECT respondent’s countries helps to develop an understanding of the level of priority placed upon Connected Health. The majority of European healthcare systems are organised through cooperation between private and public bodies. Their funding and finances primarily come from the public sector, with revenue created through direct and indirect taxes. eHealth models within these healthcare systems’ business models vary significantly across the region and are gradually becoming an accepted part of a healthcare system’s general business models.
To attain an understanding of its healthcare model and patient care pathways, each country has provided a case study of common illnesses. The difference in each country’s method of treatment of the same illness shows how each of the systems operate, with a clear focus on the funding of the treatment in each of the instances.
eHealth Records and digital prescriptions top the list of technically integrated systems at national and
regional levels enabling electronic systems to work across a variety of healthcare contexts. The unification of language and classification systems emerged as a major issue when considering the interoperability of eHealth.
Generally, the level of patient involvement in the design, delivery, and development of health related research programmes is on the increase. With 30% of the respondent countries having a system in place which encourages the inclusion of patients in the design and development of healthcare, this can be seen as a clear starting point for creating even more connected healthcare systems throughout Europe.
In summary, confusion abounds in the area of Connected Health – around wording, application, models, and systems. It involves a complete transformation of the healthcare system in a long-term play that requires dedicated resources and political will. Many of these elements are difficult to capture with data points being largely qualitative and non-comparable. Different countries are at different stages of readiness in terms of Connected Health – both in terms of its research and its implementation. The evaluation criteria employed in different circumstances and different geographies across Europe are neither clear nor standardised. The majority of states and regions are so engaged in the process of ensuring interoperability at a regional or national level that they have little time or attention left to focus on the thorny issue of international interoperability.
We recommend an agenda for future research in Connected Health for Europe that creates a shared language around health records and a database that would facilitate the development of a Connected Health or eHealth scorecard. We would support a common evaluation framework for Connected Health implementations that is multi-faceted, ranging from technology robustness to regulatory compliance, from economic sustainability to user acceptance, and including both qualitative and quantitative measures. There is evident confusion as to the application of existing rights in the context of Connected Health. We recommend an approach specific to eHealth that helps citizens, researchers, companies, and healthcare providers to understand how we live safely and privately in an era of healthcare data. We suggest that studying how some of the ENJECT countries have done this and distilling learnings and best practice from their experience could help to better design future guidelines and interpretations.
Peer Reviewed Conference Papers by Nicola Mountford
Peer Review Journal Publications by Nicola Mountford
Papers by Nicola Mountford
Quality, privacy, and safety, major elements of Connected Health, were evident policy concerns in the Connected Health context. Attention is paid as to how the healthcare systems are evaluated. Evaluation methods and responsibilities range from macro state-level evaluation to more dispersed local evaluation. The constant evolution of European healthcare is reflected in the changing methods of evaluation in countries such as Norway, Greece, Malta, and Serbia.
The vast majority (almost 80%) of respondent countries have eHealth strategies in place or are working on implementing such strategies. In general, e-prescribing and Electronic Health Records are the most common forms of Connected Health activities throughout Europe. There is a clear distinction between patient and consultant usages of these forms of Connected Health. A major issue, especially with the creation of Electronic Health Records, has been ensuring that they are safe and secure and that privacy is attainable. Health Insurance companies also make use of electronic patient records for the storage of and quick access to patient records.
Privacy is recognised as an important factor in the development of accessible patient databases. While two thirds of respondent countries rely on national data protection legislation to protect such databases, others have been more proactive and generated eHealth-specific legislation. Croatia, Germany, Slovenia, the UK, and Macedonia have all begun to recognise the need to draw up legislation which prioritises the protection of patient information recorded through these types of technologies. Public statements and political instruments directly address the topic of Connected Health, helping to protect patients while increasing their awareness of the Connected Health options. Websites and manifestos dedicated to health related activities in various countries are at the centre of this public awareness. Additionally, political parties in some of the respondent countries identify eHealth and Connected Health as an area for improvement in their own manifestos.
Of the nineteen respondents to the survey, fifteen countries contributed specific information on university based programmes that help to ensure that healthcare professionals are aware of and in a position to utilise Connected Health. While few of the programmes focus solely on Connected Health, its inclusion in health and biomedical informatics courses ensures that it will be a part of these future healthcare providers’ understanding of the provision of healthcare. Awareness of Connected Health and the development of health literacy is not solely a concern at third level. Health literacy is a challenge across Europe as a whole. Ad hoc health literacy programmes have been proven to work in some countries, but the public’s infrequent exposure to these forms of literacy, such as television and poster campaigns, means that their benefit is often not fully felt in the long term. The role that Connected Health can play in the improving health literacy does not seem to have been realised, with most countries still relying on leaflets and information booklets to improve patients’ understanding of medical and health related issues. For those countries who actively and regularly promote health literacy, this is done through school systems and specific research communities.
Presenting the business and health models of the healthcare systems in each of the ENJECT respondent’s countries helps to develop an understanding of the level of priority placed upon Connected Health. The majority of European healthcare systems are organised through cooperation between private and public bodies. Their funding and finances primarily come from the public sector, with revenue created through direct and indirect taxes. eHealth models within these healthcare systems’ business models vary significantly across the region and are gradually becoming an accepted part of a healthcare system’s general business models.
To attain an understanding of its healthcare model and patient care pathways, each country has provided a case study of common illnesses. The difference in each country’s method of treatment of the same illness shows how each of the systems operate, with a clear focus on the funding of the treatment in each of the instances.
eHealth Records and digital prescriptions top the list of technically integrated systems at national and
regional levels enabling electronic systems to work across a variety of healthcare contexts. The unification of language and classification systems emerged as a major issue when considering the interoperability of eHealth.
Generally, the level of patient involvement in the design, delivery, and development of health related research programmes is on the increase. With 30% of the respondent countries having a system in place which encourages the inclusion of patients in the design and development of healthcare, this can be seen as a clear starting point for creating even more connected healthcare systems throughout Europe.
In summary, confusion abounds in the area of Connected Health – around wording, application, models, and systems. It involves a complete transformation of the healthcare system in a long-term play that requires dedicated resources and political will. Many of these elements are difficult to capture with data points being largely qualitative and non-comparable. Different countries are at different stages of readiness in terms of Connected Health – both in terms of its research and its implementation. The evaluation criteria employed in different circumstances and different geographies across Europe are neither clear nor standardised. The majority of states and regions are so engaged in the process of ensuring interoperability at a regional or national level that they have little time or attention left to focus on the thorny issue of international interoperability.
We recommend an agenda for future research in Connected Health for Europe that creates a shared language around health records and a database that would facilitate the development of a Connected Health or eHealth scorecard. We would support a common evaluation framework for Connected Health implementations that is multi-faceted, ranging from technology robustness to regulatory compliance, from economic sustainability to user acceptance, and including both qualitative and quantitative measures. There is evident confusion as to the application of existing rights in the context of Connected Health. We recommend an approach specific to eHealth that helps citizens, researchers, companies, and healthcare providers to understand how we live safely and privately in an era of healthcare data. We suggest that studying how some of the ENJECT countries have done this and distilling learnings and best practice from their experience could help to better design future guidelines and interpretations.