Implementing eHealth: from pilot to practice
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Pilots of eHealth services often remain small or are discontinued due to various limitations in assessing their effectiveness and integrating them fully into care. A comprehensive evaluation tool called MAST assesses eHealth services across clinical, economic, user and organizational impacts to determine their potential for scale-up. Catalonia uses MAST to evaluate pilots, certify their interoperability, deploy necessary infrastructure to support scale-up, and conduct ongoing monitoring as services expand. This process helps decision-makers scale effective eHealth services that improve care in a sustainable way.
Implementing eHealth: from pilot to practice
- 1. Implementing eHealth: from pilot to practice Anna Kotzeva, MD, MPH Catalan Agency for Healthcare Quality and Assessment - Catalan Ministry of Health
- 2. ?pilots Assessment & Decision-making eHealth promotion Implementation in the routine care Real value of eHealth services Why so many pilots stay small or are even discontinued? How does it happen ? Which are the requirements and necessary conditions for successful scale up? Background: Reality check 1? 2? 3? € € £ € $ €
- 3. Generally, two types of pilots with specific limitations for scale-up 1? Pilot study Trigger Policy Needs Funding Research/industry Setting’s own budget Service scope Restricted to selected patients =efficacy All residents in the area = effectiveness Service integration Running parallel to traditional care Integrated in the care processes Training Only involved professionals All professionals Setting-based solution Lack of external validity (?generalizability of results) Limited funding, lack of b-model (?discontinuation) Slow adoption among professionals who didn’t experience the results Lack of internal validity (?sufficient scientific evidence on benefits) Limited dissemination (?undetected as good practice) Region- and setting-specific (?interoperability with other systems) Limitations / Risks
- 4. Evidence-based decision-making? EVIDENCE = needs time DECISION-MAKERS = no time to wait Comprehensive tools that allow for fast, but systematic and comparable evaluations need for 2?
- 5. Such tool is MAST Model for Assessment of Telemedicine applications* • Rigorous and comprehensive development (SMART 2008/0064) • Widespread use – Assessment model in 5 European projects/14 European countries – Adopted by 4 regions: Norbotten (SE), Veneto (IT), Basque country (ES), Catalonia (ES) – Development of a French version: MEETIC: Modèle pour l'Evaluation (Economique) de la Télémédecine • 3 stages of assessment: *Kidholm K et al. A model for assessment of telemedicine applications: MAST. Int J Technol Assess Health Care. 2012 Jan;28(1):44-51. I. Preceding considerations II. Multidisciplinary Assessment III. Transferability of results
- 6. • This stage is about “setting the context”, relevance and timeliness of the assessment • Aspects to be taken into consideration: – Purpose and place in care continuum – Selection of appropriate comparator (usual care? alternative technologies?) – Maturity of the technology use – Number of patients, duration of testing period – Regulatory legislation and reimbursement conditions in place I. Preceding considerations Potential barriers to scale-up
- 7. II. Multidisciplinary assessment Organized in 7 domains, with specific study designs and outcomes Clinical condition & eHealth solution used Clinical effectiveness Safety User perspective Economic impact Organizational aspects Socio-cultural, ethical and privacy issues quality of life, healthcare services use, etc workflow, training, barriers/facilit to adoption satisfaction, acceptability, empowerment costs, economic evaluation 1 2 3 4 5 6 7 adverse events
- 8. This consideration has to be made within each of the domains! III. Transferability assessment ? • Generalizability of results and transferability from one setting to another • Assessment of interoperability and homologation procedures The scaling up potential is assessed by considering issues related to existing facilitators and barriers, resources needed, as well as possible risks.
- 10. Important step As a result of the assessment of all above- mentioned aspects, a recommendation on the appropriateness of scaling up of the telehealth service can be issued DECISION TO SCALE-UP AND REIMBURSMENT PLAN DEFINITION
- 11. Impact monitoring and evaluation Infrastructure, service support and integration with existing IT systems Successful implementation and service sustainability 3?
- 12. Impact monitoring and evaluation* *WHO and ITU 2012. National eHealth strategy toolkit. Part 3. Monitoring and Evaluation Governance model = aligned collective efforts Meaningful indicators ? Baseline and target measures definition ? Regular process audits & variations analyses Analysis &feedback to key stakeholders Service improvement ? ? ? ?
- 13. PILOT SCALED UP SERVICE Multidisciplinary assessment of the impact of the eHealth technology/service using MAST Assessment and certification of the interoperability with the Catalan ICT system 1 2 Deployment of necessary services and infrastructure to support service scaling up 3 Comprehensive monitoring and evaluation of the impact on the healthcare system 5 Catalan Ministry of Health defines the policy and strategy for eHealth Close collaboration with care providers and users to identify potential improvements 4 Based on the results of step 1 and step 2, recommendations on the potential for scaling up of the eHealth service are issued Executive Board of the Catalan Ministry of Health In Catalonia Framework for scaling up eHealth services