eHealth for people with multimorbidity: Results from the ICARE4EU project and insights from the “10 e’s” by Gunther Eysenbach

Background People with multimorbidity, especially older people, have complex health and social needs, and require an integrated care approach. In this respect, eHealth could be of support. This paper aims to describe the implementation of eHealth technologies in integrated care programs for people with multimorbidity in Europe, and to analyse related benefits and barriers according to outcomes from ICARE4EU study and within the more general conceptual framework of the “10 e's” in eHealth by Gunther Eysenbach. Methods In 2014, ICARE4EU project identified 101 integrated care programs in 24 European countries. Expert organizations and managers of the programs completed an on-line questionnaire addressing several aspects including the adoption of eHealth. Findings from this questionnaire were analyzed, by linking in particular benefits and barriers of eHealth with the “10 e's” by Eysenbach (Efficiency, Enhancing, Evidence-based, Empowerment, Encouragement, Education, Enabling, Extending, Ethics, and Equity). Results Out of 101 programs, 85 adopted eHealth tools, of which 42 focused explicitly on older people. eHealth could improve care integration/management, quality of care/life and cost-efficiency, whereas inadequate funding represents a major barrier. The “10 e's” by Eysenbach seem to show contact points with ICARE4EU findings, in particular when referring to positive aspects of eHealth such as Efficiency and Enhancing quality of care/life, although Empowerment/Education of patients, care Equity and Ethics issues seem crucial in this respect. Encouragement of a new relationship patient-health professional, and Enabling standardized exchange of electronic information, represent further aspects impacting integration/management of care. Conclusions Aspects of eHealth, which emerged as benefits and barriers impacting integration/management of care, as well as cost-efficiency and quality of care/life, can be identified on the basis of both ICARE4EU findings and the “10 e's” in eHealth by Eysenbach. They could represent objectives of new policies for supporting the deployment of eHealth technologies within integrated care across Europe.

[1]  Robert Kerchner,et al.  Interim Report , 1996 .

[2]  D. Bainbridge Data protection , 2000 .

[3]  C. T. Orleans,et al.  Does the chronic care model serve also as a template for improving prevention? , 2001, The Milbank quarterly.

[4]  G. Eysenbach What is e-health? , 2001, Journal of Medical Internet Research.

[5]  Richard Curry,et al.  The design of pilot telecare projects and their integration into mainstream service delivery , 2003, Journal of telemedicine and telecare.

[6]  D. McDaid,et al.  Evaluating health interventions: exploiting the potential. , 2003, Health policy.

[7]  J. Kahan,et al.  What Is eHealth (4): A Scoping Exercise to Map the Field , 2005, Journal of medical Internet research.

[8]  Chun Wei Choo Creating knowledge-based healthcare organizations , 2005 .

[9]  G. Eysenbach The Law of Attrition , 2005, Journal of medical Internet research.

[10]  Debbe Thompson,et al.  A framework for evaluating eHealth research. , 2006, Evaluation and program planning.

[11]  M. Knapp,et al.  Moving beyond the mental health care system: An exploration of the interfaces between health and non-health sectors , 2007 .

[12]  William D. Marder,et al.  Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs , 2007, Journal of General Internal Medicine.

[13]  J. Barlow,et al.  A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions , 2007, Journal of telemedicine and telecare.

[14]  Debbie Singh,et al.  How can chronic disease management programmes operate across care settings and providers ? , 2008 .

[15]  G. Eysenbach,et al.  Patient Accessible Electronic Health Records: Exploring Recommendations for Successful Implementation Strategies , 2008, Journal of medical Internet research.

[16]  Johnny Saldaña,et al.  The Coding Manual for Qualitative Researchers , 2009 .

[17]  Rosa María Baños,et al.  An e-Health System for the Elderly (Butler Project): A Pilot Study on Acceptance and Satisfaction , 2009, Cyberpsychology Behav. Soc. Netw..

[18]  John G F Cleland,et al.  Telemonitoring for heart failure: the only feasible option for good universal care? , 2009, European journal of heart failure.

[19]  Stuti Dang,et al.  Evaluating the evidence base for the use of home telehealth remote monitoring in elderly with heart failure. , 2009, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[20]  K. Jain The Role of Nanobiotechnology in the Development of Personalized Medicine , 2010, Medical Principles and Practice.

[21]  Erwin R Seydel,et al.  Evaluation of a web-based lifestyle coach designed to maintain a healthy bodyweight , 2010, Journal of telemedicine and telecare.

[22]  Luca Roffia,et al.  An Integrated Framework to Achieve Interoperability in Person-Centric Health Management , 2011, International journal of telemedicine and applications.

[23]  Nicol Nijland,et al.  A Holistic Framework to Improve the Uptake and Impact of eHealth Technologies , 2011, Journal of medical Internet research.

[24]  Frank Olsen,et al.  Smarter elder care? A cost-effectiveness analysis of implementing technology in elder care , 2011, Health Informatics J..

[25]  C. Anandan,et al.  The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview , 2011, PLoS medicine.

[26]  M. Gagnon,et al.  Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review , 2011, BMC medicine.

[27]  S. Riedel-Heller,et al.  Review: Health Care Utilization and Costs of Elderly Persons With Multiple Chronic Conditions , 2011, Medical care research and review : MCRR.

[28]  S. Kirn,et al.  Critical issues for the development of sustainable e-health solutions. , 2012 .

[29]  H. van den Bussche,et al.  The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study , 2012, BMC Health Services Research.

[30]  Impacts de la télésanté sur les résultats sanitaires dans les pays à revenu faible et moyen: Quelle direction prendre? , 2012 .

[31]  R. Bal,et al.  Disease management projects and the Chronic Care Model in action: baseline qualitative research , 2012, BMC Health Services Research.

[32]  K. Coleman,et al.  Integrated care for chronic conditions: the contribution of the ICCC Framework. , 2012, Health policy.

[33]  Ioannis Maghiros,et al.  European Hospital Survey: Benchmarking deployment of e-Health services (2012–2013) – Synthesis of outcomes , 2013 .

[34]  Catherine L Backman,et al.  Exploring eHealth Ethics and Multi-Morbidity: Protocol for an Interview and Focus Group Study of Patient and Health Care Provider Views and Experiences of Using Digital Media for Health Purposes , 2013, JMIR research protocols.

[35]  H. Turunen,et al.  Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. , 2013, Nursing & health sciences.

[36]  A. Sheikh,et al.  The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview , 2013, PloS one.

[37]  Sara J Czaja,et al.  Consumers' Perceptions of Patient-Accessible Electronic Medical Records , 2013, Journal of medical Internet research.

[38]  Erik Taal,et al.  Impact of patient-accessible electronic medical records in rheumatology: use, satisfaction and effects on empowerment among patients , 2014, BMC Musculoskeletal Disorders.

[39]  Theodoros N. Arvanitis,et al.  Patients’ online access to their electronic health records and linked online services: a systematic interpretative review , 2014, BMJ Open.

[40]  T. Lorenc,et al.  A systematic review of barriers to and facilitators of the use of evidence by policymakers , 2014, BMC Health Services Research.

[41]  Janet E. Anderson,et al.  Patient safety risks associated with telecare: a systematic review and narrative synthesis of the literature , 2014, BMC Health Services Research.

[42]  M. Härter,et al.  How do health services researchers understand the concept of patient-centeredness? Results from an expert survey , 2014, Patient preference and adherence.

[43]  Geoff M. Anderson,et al.  Providing integrated care for older people with complex needs Lessons from seven international case studies , 2014 .

[44]  Antto Seppälä,et al.  Privacy-Related Context Information for Ubiquitous Health , 2014, JMIR mHealth and uHealth.

[45]  C. Millett,et al.  Association between multimorbidity and healthcare utilisation and health outcomes among elderly people in Europe , 2014 .

[46]  Vishnu Mohan,et al.  Beyond information retrieval and electronic health record use: competencies in clinical informatics for medical education , 2014, Advances in medical education and practice.

[47]  Tom H van de Belt,et al.  “What Is eHealth”: Time for An Update? , 2015, JMIR research protocols.

[48]  Mary K. Lam,et al.  The impact of eLearning on health professional educators’ attitudes to information and communication technology , 2015, Journal of multidisciplinary healthcare.

[49]  Deborah A. Greenwood,et al.  The eHealth Enhanced Chronic Care Model: A Theory Derivation Approach , 2015, Journal of medical Internet research.

[50]  M. Mckee,et al.  European health professionals’ experience of cross-border care through the lens of three common conditions , 2015 .

[51]  Anneke L Francke,et al.  Determinants of the intention to use e-Health by community dwelling older people , 2015, BMC Health Services Research.

[52]  F. Schellevis,et al.  Innovating care for people with multiple chronic conditions in Europe: An overview , 2015 .

[53]  George Demiris,et al.  A systematic review of telehealth tools and interventions to support family caregivers , 2015, Journal of telemedicine and telecare.

[54]  Martin McKee,et al.  Macroeconomic implications of population ageing and selected policy responses , 2015, The Lancet.

[55]  Hélène Kerhervé,et al.  Bridging the digital divide in older adults: a study from an initiative to inform older adults about new technologies , 2015, Clinical interventions in aging.

[56]  M. Moharra,et al.  Implementation of a cross-border health service: physician and pharmacists' opinions from the epSOS project. , 2015, Family practice.

[57]  Cristina Masella,et al.  Empowering patients through eHealth: a case report of a pan-European project , 2015, BMC Health Services Research.

[58]  G. Onder,et al.  Time to face the challenge of multimorbidity. A European perspective from the joint action on chronic diseases and promoting healthy ageing across the life cycle (JA-CHRODIS). , 2015, European journal of internal medicine.

[59]  Eric J Topol,et al.  State of Telehealth. , 2016, The New England journal of medicine.

[60]  Simon Bo Larsen,et al.  Towards a shared service centre for telemedicine: Telemedicine in Denmark, and a possible way forward , 2015, Health Informatics J..

[61]  A. Mccabe,et al.  Health Information Literacy among Healthy Older Irish Adults , 2016 .

[62]  M. Duplaga Searching for a Role of Nursing Personnel in Developing Landscape of Ehealth: Factors Determining Attitudes toward Key Patient Empowering Applications , 2016, PloS one.

[63]  J. Sloand,et al.  Remote Monitoring of Chronic Diseases: A Landscape Assessment of Policies in Four European Countries , 2016, PloS one.

[64]  E. Hanson,et al.  A Web-Based Psychosocial Intervention for Family Caregivers of Older People: Results from a Mixed-Methods Study in Three European Countries , 2016, JMIR research protocols.

[65]  E. Richardson How to strengthen patient- centredness in caring for people with multimorbidity in Europe? , 2017 .

[66]  Alison M. Devlin,et al.  Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the United Kingdom , 2017, Journal of medical Internet research.

[67]  Christine Hamel,et al.  Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies , 2017, Journal of medical Internet research.

[68]  R. Righi,et al.  Personal Health Records: A Systematic Literature Review , 2017, Journal of medical Internet research.

[69]  Mariusz Duplaga,et al.  Digital divide among people with disabilities: Analysis of data from a nationwide study for determinants of Internet use and activities performed online , 2017, PloS one.

[70]  Clair Sullivan,et al.  Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice. , 2017, Australian health review : a publication of the Australian Hospital Association.

[71]  Marina Bastawrous Wasilewski,et al.  Web-based health interventions for family caregivers of elderly individuals: A Scoping Review , 2017, Int. J. Medical Informatics.

[72]  Carolyn M. Rutledge,et al.  Telehealth and eHealth in nurse practitioner training: current perspectives , 2017, Advances in medical education and practice.

[73]  C. Loiselle,et al.  Is Connected Health Contributing to a Healthier Population? , 2017, Journal of medical Internet research.

[74]  K. Tates,et al.  The Effect of Screen-to-Screen Versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients , 2017, Journal of medical Internet research.

[75]  Floor Sieverink,et al.  Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence , 2017, Journal of medical Internet research.

[76]  L. Peyrin-Biroulet,et al.  E-health in inflammatory bowel diseases: More challenges than opportunities? , 2017, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[77]  R. Halfens,et al.  Involvement of the end user: exploration of older people’s needs and preferences for a wearable fall detection device – a qualitative descriptive study , 2016, Patient preference and adherence.

[78]  E. Richardson How to improve care for people with multimorbidity in Europe? , 2017 .

[79]  Sarah S Richtering,et al.  Examination of an eHealth literacy scale and a health literacy scale in a population with moderate to high cardiovascular risk: Rasch analyses , 2017, PloS one.

[80]  G. Haugan,et al.  Enhancing Doctors’ Competencies in Communication With and Activation of Older Patients: The Promoting Active Aging (PRACTA) Computer-Based Intervention Study , 2017, Journal of medical Internet research.

[81]  Huilong Duan,et al.  Patients’ Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test , 2017, JMIR mHealth and uHealth.

[82]  Bertalan Meskó,et al.  Digital health is a cultural transformation of traditional healthcare. , 2017, mHealth.

[83]  W. Duggleby,et al.  Web-Based Interventions to Improve Mental Health, General Caregiving Outcomes, and General Health for Informal Caregivers of Adults With Chronic Conditions Living in the Community: Rapid Evidence Review , 2017, Journal of medical Internet research.

[84]  F. Schellevis,et al.  Patient-centeredness of integrated care programs for people with multimorbidity. Results from the European ICARE4EU project. , 2018, Health policy.

[85]  E. van Ginneken,et al.  Managing multimorbidity: Profiles of integrated care approaches targeting people with multiple chronic conditions in Europe. , 2018, Health policy.

[86]  Trisha Greenhalgh,et al.  Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study , 2018, Journal of medical Internet research.

[87]  S. Nancarrow,et al.  Telehealth Interventions Delivering Home-based Support Group Videoconferencing: Systematic Review , 2018, Journal of medical Internet research.

[88]  Linda C. Li,et al.  eHealth Technologies, Multimorbidity, and the Office Visit: Qualitative Interview Study on the Perspectives of Physicians and Nurses , 2018, Journal of medical Internet research.

[89]  Stylianos Kavadias,et al.  Digital Transformation and Disruption of the Health Care Sector: Internet-Based Observational Study , 2018, Journal of medical Internet research.

[90]  Francesco Barbabella,et al.  eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project. , 2018, Health policy.

[91]  Making a difference: Patient centred integrated care: nib Health Funds discharge support service in partnership with Vitalis Health Care , 2018 .

[92]  J. Clemensen,et al.  General Practitioners’ Perspective on eHealth and Lifestyle Change: Qualitative Interview Study , 2018, JMIR mHealth and uHealth.

[93]  Manon Lette,et al.  The SUSTAIN Project: A European Study on Improving Integrated Care for Older People Living at Home , 2018, International journal of integrated care.

[94]  Sofian Berrouiguet,et al.  From eHealth to iHealth: Transition to Participatory and Personalized Medicine in Mental Health , 2018, Journal of medical Internet research.

[95]  Kim M. Nazi,et al.  Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging , 2018, Journal of medical Internet research.

[96]  A. Story,et al.  What works in inclusion health: overview of effective interventions for marginalised and excluded populations , 2017, The Lancet.

[97]  Liang Zhang,et al.  Evaluation and Exploration on the Effect of the Management of Chronic Obstructive Pulmonary Disease in Rural Areas through an Internet-Based Network Consulting Room , 2018, Medical Principles and Practice.

[98]  Steinar Krokstad,et al.  Innovative technologies and social inequalities in health: A scoping review of the literature , 2018, PloS one.

[99]  M. Johansen,et al.  Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature , 2018, Journal of medical Internet research.