Designing a socio-economic assessment method for integrative biomedical research: the Osteoporotic Virtual Physiological Human project.

In integrative biomedical research, methods assessing the clinical or even socio-economic impact of more complex technologies such as Information and Communication Technology (ICT)-based tools for modelling and simulation of human physiology have rarely been applied. The EU funded Osteoporotic Virtual Physiological Human (VPHOP) research project, part of the Virtual Physiological Human (VPH) European initiative, will create a patient-specific hypermodel to predict the absolute risk of bone fracture much more accurately than predictions based on current clinical practice. The project has developed an innovative, multilevel generic methodological framework to assess the clinical and socio-economic impact of biocomputational models. The assessment framework consists of three components: a socio-economic cost benefit analysis, health economic analysis of care pathways, and disease cost simulation models. Through its holistic perspective, the method provides a tool to appraise the overall value of biocomputational models for society.

An economic analysis of the national shared Emergency Care Summary in Scotland.

The Emergency Care Summary (ECS) in Scotland provides essential clinical and demographic information about patients needing unscheduled or emergency care. Information about patients' medications, adverse drug reactions and allergies is transferred twice every day from GP systems to the ECS. Access is then available to authorised health-care professionals at the national help line, at out-of-hours services and in accident and emergency departments. An economic analysis of the ECS implementation showed that annual benefits exceeded annual costs after about seven years. Approximately 77% of the benefits were non-financial and 23% from redeployed finance. No cash savings were planned and none were realised. As ECS utilisation increased from 2006, the net benefits became positive. This relationship between utilisation and net benefits is a common feature of successful e-health investment.

DebugIT for patient safety - improving the treatment with antibiotics through multimedia data mining of heterogeneous clinical data.

The concepts and architecture underlying a large-scale integrating project funded within the 7th EU Framework Programme (FP7) are discussed. The main objective of the project is to build a tool that will have a significant impact for the monitoring and the control of infectious diseases and antimicrobial resistances in Europe; This will be realized by building a technical and semantic infrastructure able to share heterogeneous clinical data sets from different hospitals in different countries, with different languages and legislations; to analyze large amounts of this clinical data with advanced multimedia data mining and finally apply the obtained knowledge for clinical decisions and outcome monitoring. There are numerous challenges in this project at all levels, technical, semantical, legal and ethical that will have to be addressed.

Tele-homecare for chronically ill persons: pilot trials, medical outcomes and future perspectives.

Socio-economic trends including the ageing of populations in the developed world have let to markedly increased interest in improving society's ability to deliver effective care to older and chronically ill patients at home. The paper reports progress from recent European research on three key fronts faced in the diffusion of tele-homecare: Pilot applications to explore the features of as yet untried care domains, full clinical trials to present hard evidence of desired medical outcomes, and R&D to expand the capability of tele-homecare systems to meet the needs of a yet wider variety of chronic illnesses and patient groups.

Implementation of TeleCare services: benefit assessment and organisational models.

All industrial societies are ageing. This has profound socio-economic and health sector implications. Innovative services based on Information Society Technologies (IST), like telehomecare are regarded as promising avenues to follow both to allow (national) health systems to cope with these challenges and to improve the quality of life of chronically ill and frail older citizens. The aim of the TEN-HMS project is to convincingly prove that telemonitoring of congestive heart failure (CHF) patients at home can improve medical outcome for these patients as well as their quality of life and the efficiency of healthcare delivery processes. But this will not (yet) be enough for the sustained success of such a service. Unless it takes into account the interests of the various players in the health care arena and a long-term Business Case can be proven, it will be very difficult to integrate such services into routine health care delivery processes. Before developing concrete delivery models for such a telemonitoring service, the "players" directly involved in such a service need to be identified--customers/patients, health services providers, IT services suppliers, and public/private insurance funds as payers--and their assessment perspectives considered. Then four concrete telemonitoring delivery models and their probability of success are discussed. Our analysis suggests that telemonitoring will presently only be successful if the service delivery model applied reflects national health system idiosyncrasies, takes into account established organisational boundaries and adapts to patient quality of life and health professional preferences. In the longer term, the new paradigm of seamless, patient-centred care will, however, require new, more efficient service delivery models integrating all aspects of the health services value chain.

The attitudes, expectations and needs of elderly people in relation to e-health applications: results from a European survey.

We have carried out a survey of elderly people in Europe relating to e-health and telemedicine issues. Telephone-based interview techniques were used in 13 countries and face-to-face interviews were used in Ireland and Portugal, where there are significant numbers of houses without telephones. Altogether 9661 interviews were performed. Most respondents (65%) lived in rural areas or small towns; the remainder lived in suburban areas or large towns. Virtually all respondents (98%) had access to a television set. About 30% received cable television and 13% had access to digital television. Almost half (48%) had access to mobile phones (with 42% actually using them), 36% had access to PCs (with 27% being active users) and 22% had access to the Internet (with 17% being active users). The respondents showed interest in various e-health applications, although this declined considerably with age. The survey showed that the older people get, the more they depend on medical and social care, and the more they tend to live alone, without a family member to look after them. Policy measures relating to infrastructure as well as training, education and awareness activities will be required to avoid a medical divide between those senior citizens who have access to advanced medical advice and services and those who do not.