EIT Health considers the challenges and opportunities involved in delivering digital health solutions to the market and into healthcare practice.
EIT Health leverages the expertise of leading healthcare organisations and academic institutions to translate ideas into actions and commercialise patient-focused solutions to some of the biggest challenges facing healthcare today. Established by the European Institute for Innovation & Technology (EIT), the cross-border network is committed to fostering the development of innovative digital health solutions that move beyond conventional approaches to treatment, prevention and healthy lifestyles and enable European citizens to live longer, better lives.
To this end, EIT Health divides its activities across three central pillars:
- Accelerator is a business creation programme designed to support health industry entrepreneurs by creating a favourable environment for innovation and providing skills and services to get promising business ideas into the market
- Campus is an education programme providing the brightest learners with the industry knowledge and skills they need to become the healthcare leaders and entrepreneurs of the future
- The Innovation Projects programme helps turn promising ideas into commercially viable products through a multidisciplinary approach involving business, medicine, IT and other fields of knowledge.
Here, EIT Health tells Health Europa Quarterly about its work to support the adoption of digital health solutions and the key challenges facing innovators and entrepreneurs in this space.
What would you describe as the main barriers holding back the adoption of digital health solutions in wider healthcare practice? Could incentives play a useful role in overcoming these?
There are many complexities at play here; however, if we start with reimbursement, health systems tend to finance ‘treatments’ or ‘face-to-face interactions with patients’ not ‘digital solutions or interactions’, and this makes it difficult for digital health solutions to really penetrate markets – they are not always focused on treating, they are actually often about prevention, which is equally as important yet receives very little funding. In fact, OECD countries allocate less than 3% of their health spending on average to public health and prevention activities.1
Coupled with this, there is a lot of red tape, which is also the case for medtech and biotech of course. Finally, time and cost savings are not easily measurable immediately and therefore health systems are reluctant to take risks, particularly when you factor in the added infrastructure investment requirement to provide the digital solution via a health service. Constrained health services simply may not have the funds available to support the introduction of such solutions.
Taking a step back from reimbursement, there are also the regulatory challenges which are blocking the use of innovative digital health solutions. There is no clear process for digital solutions in line with routine regulatory requirements to get a stamp of approval that allows for uptake and adoption in health services, and this makes it difficult for entrepreneurs and start-ups to gain large scale uptake.
One of the partners in our EIT Health network, Fibricheck, are one of the few who have successfully navigated this environment. With the first ever mobile app for atrial fibrillation detection and monitoring to be approved by the FDA (it also has a CE-Class IIa in Europe), their strategy was to start small. They proved they could do it by focusing on their native Belgium first, where it is now available to patients via prescription. From there, they aim to expand.
The skillsets and capacity of those delivering the care is also a challenge when it comes to digital health solutions. Suddenly, we are asking doctors who have previously had a traditional approach to treating patients to adopt new ideas and technology and this takes a lot of time and infrastructure. They also may be concerned that such solutions take away their ‘face-to-face’ time with patients (eliminating the benefits of a personal interaction) and that they will, instead, spend much of their time analysing data.
Healthcare provider IT departments are also often very small, and integrating new digital technology into existing systems is no small task. Incentives can only work when the infrastructure is there, otherwise it is impossible for healthcare providers to meet incentives and realise savings from adoption of innovative digital health solutions.
EIT Health offers innovators the opportunity to pilot new solutions so that they can begin to generate the necessary data that provides a sufficient evidence base in order to determine what is ultimately effective and beneficial in clinical practice. This knowledge and experience can be shared with others with the ultimate objective of recognising and replicating what works well.
Is there a greater role for end users to play in the design and development of digital health solutions? How might this help to support their implementation?
Absolutely, co-creation is crucial – not just with patients and citizens but also with the medical professionals who will hopefully one day recommend the solution. You cannot work on a new technology in isolation of the people who will actually use (or not use) it – this is often a recipe for failure. Patients should be placed firmly at the centre of the process of developing digital health solutions – and there are many opportunities for patients to be involved from concept through to market entry.
An effective solution can empower the patient to take control and provide a more optimised self-management of their condition or, in health promotion, provide patients and citizens information for more effective decision making. In order to do this properly, it is paramount that the solution takes into account all aspects of the patient experience and reflects the most relevant insights to ensure the solution can be seamlessly slotted into their day-to-day life – if it doesn’t then it is unlikely that the patient will fully adopt it and/or take advantage of its full potential.
Patients are often very engaged, particularly with digital health, and here at EIT Health we offer programmes that support entrepreneurs and start-ups to gain input on their prototypes in our Living Labs and Test Beds. This brings real people together with the technology creator so that they can test whether their solution really meets the needs of the people, or whether, with some small tweaks, it would better meet their needs.
Do healthcare organisations have the digital infrastructure in place to be able to effectively support large-scale digital technology implementation? Is this a hurdle for businesses looking to develop products in this space?
This is no easy task, and the answer is no; right now the infrastructure isn’t in place for healthcare providers to host vast amounts of data. There is also the challenge of a lot of data being generated by apps or other devices that is not being shared or integrated into healthcare provider IT systems and therefore the evaluation or intelligence these data offer is lost. This is part of the debate on how we realise the potential of big data in health. In December 2018, EIT Health released a report following a large programme of work looking at this very topic, and as you might expect there are many challenges and conclusions.
In terms of whether it is a hurdle for businesses looking to develop in the health space, the answer would be yes. We see many tech innovators being initially very excited by the health space; however, it doesn’t take long for them to realise that healthcare is more complex than they had originally thought and that there are many barriers.
The regulatory framework, for example, can often lead to a loss of momentum, and this is all too often to the detriment of the end user, the patients, as such innovations with great potential may never see the light of day. We are seeing a shift here, however, with companies lacking heritage in health who are bringing healthcare experts and other relevant stakeholders into their process in the hope of improving their ability to penetrate the market.
It is imperative, certainly in Europe, that we continue to foster a cross-border collaborative mindset to achieve this. The important points, as always in health, are trust, transparency, validation and security.
What support is there for companies beyond the prototype/proof-of-concept stage? Do they receive enough attention in terms of policy/funding?
The issue is that the policies are very new and there is uncertainty about how to navigate processes, particularly for companies who already had technology under development and now have to rethink their approach in line with new regulations.
There is clear and repeated intent from European policymakers that there is a desire to make more financing available for investments to drive efficiency in the delivery of health services, and the integration of digital solutions must be a key consideration in the way that healthcare is delivered in the future.
This is a positive stride towards addressing the healthcare challenges that exist. Organisations such as the European Investment Fund and the European Investment Bank are also focused on closing this funding gap, and EIT Health complements and collaborates with these instruments.
As well as providing funding to the Head Start programme, which offers innovators support at proof-of-concept stage, EIT Health also offers help with connecting start-ups with experts in the regulatory and reimbursement space, as well as helping them to find the investment that is inevitably needed for this stage in the journey.
How is EIT Health working to support the adoption of digital health solutions and assist companies in this space?
We provide an ecosystem to enable the development and availability of health innovations. We connect the relevant actors with innovators and entrepreneurs such as health service providers, payers, investors and other relevant experts to create the right construct to improve the chances of success in the market.
Removing barriers and providing support to innovators means their time to market is also greatly decreased, along with improvements in their business model to ensure the proposition is more compelling. More specifically, we offer support to companies to navigate the current challenges, including funding (typically a non-dilutive grant), proof of concept, research, financing, and regulatory and reimbursement guidance.
Our Think Tank will be looking at how we can optimise the full pathway for innovative digital solutions in 2019, and we hope to release some clear and tangible action points that can be considered by all parties, including policymakers, to advance our impact in this area.
- Gmeinder M, D Morgan and M Mueller (2017), How much do OECD countries spend on prevention? OECD Health Working Papers, No. 101, OECD Publishing, Paris. http://dx.doi.org/10.1787/f19e803c-en
Please note, this article will appear in issue 9 of Health Europa Quarterly, which will be available to read in April 2019.