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Newsletter 2 • Greetings from the vice-president of the European Parliament • Final results of the Connected for Health project • Check the project YouTube video!

Editorial Connected for health – and for future cooperation Connected for Health is one of the key projects we have been running in the Regional Council of South Ostrobothnia. It has brought on the stage the importance of novel solutions in the social and health care and at the same time stressed the significance of fast fibre optic networks.

are still missing reliable connections, i.e. fibre networks, to be able to fully utilise digital possibilities. Neither should we forget the ones who are unable to use computers and other technological innovations but instead help them to cross this digital divide.

Undoubtedly we need eHealth innovations in all European countries and even globally. To be able to provide new kinds of services via telecommunication networks is not essential only for elderly and disabled people, but for all of us. Especially in countries with long distances and sparsely settled population, like in Scandinavia, this kind of future work is of vital importance.

Regional Council of South Ostrobothnia has been the lead partner of this unique project. The work has not always been easy because of the complexity of this kind of direct funding by the initiative of the European parliament. However, I am extremely satisfied and happy with the results of this project. And still there is so much to do in the fields of eHealth and digitalisation. That’s why I hope this kind of cooperation can continue and deepen in the future.

Digitalisation is high on the EU agenda. At the moment it is difficult or even impossible to grasp what kind of changes it will bring in our daily lives and behaviour. As its best it can give remarkable savings at the same time when improving our communication and networking. It can help to ease one of the biggest problems of old people, namely loneliness. And even better: via digitalisation we can also help to save our precious environment by cutting down unnecessary travelling. To get most out of this new opportunity it is crucial that all the people around Europe have well functioning and fast enough connections via internet. In the cities most of the Europeans get already connected without difficulties but in the countryside many

Today digitalisation is everywhere. It is up to us to fully utilise the huge opportunities brought by it, not only in the field of health care but also on the other spheres of life. Via transnational projects we can learn from each other’s experiences, spread awareness of new opportunities and create value added all around the Europe.

I would like to thank warmly all our regional partners and their professionals in Finland, Sweden, Denmark and Czech Republic. And special thanks go to our devoted and enthusiastic team who has carried on this project through all the unforeseen challenges. May this project encourage all the professionals in social and health care all around the Europe to develop eHealth solutions for the benefit of European citizens.

Asko Peltola

Region Mayor of South Ostrobothnia

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E-Health remains high on the European agenda Digitalisation is a megatrend and a priority for the EU. Digitalisation speeds up production processes and brings huge cost savings. It changes the way we work, and transforms the very way we own, consume and communicate. Digitalisation is everywhere and an inevitable process which should be seen most of all as a huge opportunity for Europe. Also health care can widely benefit from digitalisation. I’m happy that Connected for Health -project has brought together professionals of four regions in Finland, Sweden, Denmark and Czech Republic to develop e-health solutions for the benefit of European citizens. As we have learned from our pilot project, e-health solutions reduce costs, treat people, prevent future illnesses and encourage to healthier lifestyle. E-solutions bring added value to everywhere, also to rural areas where they can diversify and improve health care services. Public health issues remain high on the agenda of European decision making. I believe that e-health will be a burning political matter in years to come as people live longer than before. We need new innovative ideas in health care. In this regard, e-health solutions will be fundamental. It has been a great pleasure for me to be able to be a part of the very successful Connected for Health -project as an initiator of the funding in the European parliament. I would like to further encourage the regions to propose their innovations at the EU level. My experience is that the most feasible innovations come from the regions. The regions and local communities have the best grasp of real needs of the people.

Anneli Jäätteenmäki Vice-President of the European parliament

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Fibre enabling eHealth -conference presented the results of the project in Brussels Elina Manninen The Connected for Health project presented its results at the final conference in Brussels on 27th of April. The title of the seminar was “Fibre enabling eHealth”, and the audience heard presentations from various points of view related to the subject. The funding for the project would not have been possible without the Finnish vice-president of the European Parliament, Mrs. Anneli Jäätteenmäki. Mrs. vice-president stated that the proposal for the Commission for the project was prepared in a record speed because of the importance of the subject. - eHealth solutions bring added value to everywhere, not only in rural areas but also in big cities and for those who need to commute from one EU country to another. Jäätteenmäki reminded that health issues are not ruled on a European level, but eHealth issues on the contrary are. The vice-president encouraged people to take part in pilot projects:

One of the main pilot results: Activities will be continued The pilots conducted in the project have reached various relevant and concrete outcomes. The coordinator responsible for all the four pilots was South Ostrobothnia Health Technology Development Center EPTEK. The results of the research and analysis of the project will be finalized by the end of May. The partner responsible for the research actions has been Acreo Swedish ICT. The project will present recommendations for the whole Europe in utilizing open access fibre networks in eHealth. The Palacký University of Olomouc, Czech Republic, is writing the recommendations report in collaboration with all the partners. The conference was held at the premises of the Permanent Representation of Sweden to the EU, at Square de Meeûs, close to the European Parliament.

-Propose your innovative ideas. And remember, that the local level is the most important. The theme of the project was so urgent and important, that the Commission decided to co-fund the project. The DG Connect has been coordinating the project on behalf of the Commission. The project officer Adina Ratoi attended the conference and greeted the audience telling about the background of the project funding.

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The project officer in charge of the project in DG Connect, Mrs. Adina Ratoi, described the project as unique in itself, and that was a reason for the Commission to take it on board. Picture: Elina Manninen

“The Digital Single Market has the largest of potentials to create growth” Elina Manninen Policy coordinator at the DG Connect, Dr Nancy Pascall, in her presentation gave an overview of EU broadband policy at the final conference of the Connected for Health project. She underlined the two elements which need to be remembered: connectivity and regulation.

According to the policy coordinator, there are several funding opportunities for broadband projects, such as European Structural and Innovation Funds (ESIF), the Connecting Europe facility (CEF), and the European Fund for Strategic Investments (EFSI).

The Connected for Health project belongs to a large policy package: the Digital Single Market.

For more information, please contact Regional Council of South Ostrobothnia: Marjatta Eväsoja, Director of International Affairs and Culture / +358 40 5296 046

- The Digital Single Market has the largest of potentials to create growth, Dr Pascall noted. Dr Pascall highlighted the economic benefits of eHealth, which are clearly set in the Digital Single Market strategy: eHealth belongs to the pillar III, “Digital as a driver for growth”.

Jaakko Hallila, Manager of International Affairs / +358 40 3565 630

The importance and urgency of developing eHealth is often linked to the demographic challenge of the ageing Europe. Dr Pascall remarked that the demographic crisis should in fact be seen as an opportunity.

Elina Manninen, Project Coordinator / +358 400 241 813

- “Silver economy” is full of possibilities. And it is a scalable market, since there are more and more ageing people.

Follow Connected for Health on LinkedIn!

As one of the examples of a network tackling the challenges of ageing and digitalization, Nancy Pascall mentioned the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA). One of the basic elements supporting eHealth development is broadband. -We need fast, accurate, reliable broadband everywhere for everyone, stated Dr Pascall.

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Pilot 1: Encouraging results from Hudiksvall pilot: Smoothly working open platform and cost efficiencies Marco Forzati The scope of pilot 1 was to test both aspects of the project goal: what digital home-care services can be delivered over (1) an open network, (2) based on FTTH. The pilot runs on the FTTH network run by the municipality of Hudiksvall. The network operates according to an open access model, open at the active layer (Active Layer Open Network). The pilot goes one step further and investigates openness at the digital service level, by providing an open-interface platform, over which service from different providers, using different hardware, are tested. For the sake of evaluation of FTTH within the context of home-care service delivery, users connected to different infrastructure types than fibre are included. The uniqueness of the pilot was that the delivery of these services was approached in a holistic way, by testing: • • •

A shared open platform over which third party digital homecare providers (DHP) can develop services. New business models and new ways of interacting, which such a shared open platform requires; A solution that works across the administrative borders (in our case municipalities, which are responsible for elderly care); with the goal to be able to leverage scaling economies and synergies.

A digital homecare gateway aggregates and prioritises the communication streams from the all the digital homecare services (sensors and communication units in the home) and transports them securely over a dedicated VPN (put in place by the layer two home gateway,

alongside three optional commercial channels – for Internet, TV and telephony) to a so-called “Welfare Router”. The solution relied two servers for the two municipalities involved (Hudiksvall and Bollnäs). The Home Care delivery centre, the digital homecare providers, as well as the public internet, were set behind proper firewalls. The business model put in place followed a full-procurement procedure, whereby the (once the pilot enters into the commercial phase, in the coming months), money will flow from the the homecare authority (the municipality) towards the open platform provider, the digital homecare providers (DHP), and the network provider. In the project we have also analysed further developments of this model (see deliverable D4.2 for details). The results of the pilot were extremely encouraging. First of all, the open platform worked smoothly, hosting services from different vendors, internally and externally to the project. Secondly, despite a certain degree of technical problems, both the pilots and the homecare personnel viewed with favour the introduction of the digital homecare services. Finally, significant cost efficiencies can be realised for the municipality.

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Pilot 2: Distance wound treatment consultations are planned to expand Minna Luhtanen During the pilot, distance care solutions were tested in home care in Alavus. Best results were achieved in wound treatment distance consultations, in which each involved group - home care nurses, home care clients and the specialised wound nurse in health centre - gained notable benefits. Thanks to the distance consultation, home care clients’ need to visit the local health centre decreased. Instead, they could stay at home during the wound treatment, with the home care nurse physically present and the specialised nurse available via a video connection. Clients felt that the tested method was easy and comfortable, and due to decreased travel need, financial savings were also received. As a result of the distance consultation, home care nurses who were tending the wound received support and advice from the specialised nurse, improving their own wound treatment skills in the course of the pilot. For the specialised nurse, distance consultation meant significant time savings, as doing a distance consultation was much quicker (15min) than a physical appointment (45min). This meant that she could receive more patients during one day, and concentrate on the wound itself, since the home care nurses did the pre-work with the client (e.g. helping the client to undress, removing bandages, and cleaning the wound). Following the highly beneficial results, pilot organisations plan to expand the wound treatment consultations to further clients. Enhanced co-operation between home and health care will ease the future collaboration.

Picture: Hanne Rantala

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Pilot 3: A new distance care model developed Minna Luhtanen The main result of the pilot 3 was a new distance care model which was developed and tested during the pilot with a group of diabetes patients at the South Ostrobothnia Health Care District (SOHCD). The model integrated eHealth supported self-monitoring, information delivery through the electronic health care portal and virtual nurse appointments into the care process. Virtual appointments were carried out via video communication. To support the self-monitoring, a follow-up template was designed for patients to use in recording the monitored data. This template has been received well and is being used also by patient groups outside the pilot. The new care method offers patients more freedom of choice, since they can now select between the traditional care pathway and the eHealth supported distance care model. The distance care model offers patients flexibility, as participation in the virtual appointment can be arranged practically from anywhere, as long as the patient has a reliable, high quality internet access available. Transportation need is reduced as the amount of physical appointments decreases, resulting in financial and time savings for the patient. Thus the distance care model improved citizens’ accessibility to health services. From the SOHCD’s perspective, the pilot was very successful. The organisation has decided to integrate the piloted distance care method into their regular diabetes care services. The hospital is planning to establish a diabetes center of excellence: in future, distance care will be offered as part of its operations. Also other hospital units have expressed interest toward the method.

South Ostrobothnia Health Technology Development Centre EPTEK has been the pilot coordinator in the Connected for Health project. From the left: Minna Luhtanen, Arttu Mustajärvi and Sami Perälä.

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Pilot 4: “Patients do not seem to be afraid of e-health technologies“

Text: Katrine Vedel, Anna-Britt Krog Picture: Morten Sand Valkær The purpose of the pilot carried out in the Region of Southern Denmark (pilot 4) was to test and specify an infrastructure/ecosystem for telemedicine, thus investigating how to best support the implementation and scaling up of telemedicine. Pilot 4 consists of 3 different tests: Vejen Municipality, Esbjerg Municipality and Odense University Hospital (OUH). Both patients and health care personnel were involved and interviewed Results The three main findings from the pilot study were: 1. No strong and immediate difference between FTTH and other types of connections The internet connection and the quality of it was determined as part of the interviews. Generally, both FTTH and other connections seem to perform equally well. One patient however, did experience serious technical difficulties and this may be due to the fact that FTTH was not available to this participant. This might be an indicative for some cases where FTTH gives a better result. 2. Patients experienced very few technical difficulties Most of the users were trained users of technology, but the pilot also included users less familiar with ICT. The need for support has been very limited for both groups. One patient experienced more difficulties that the rest and this

may be due to the network connectivity available to this patient. The patient does not have FTTH and the technology chosen in this case do seem to require a certain quality of network connection in order to function properly. 3. Patients do not seem to be afraid of e-health technologies As part of the interviews carried out in pilot 4 the participants were asked a series of questions in order to determine their experience with ICT in general. The patients mentioned feeling more empowered. And the patients generally said that they felt “safe” and comfortable using the technology available to them in the pilot – this include patients who were unfamiliar with the type of communication technologies used in the pilot.

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Facts of the pilot: • Number of interviews including patients, health care personnel, and managers: 17 • Total number of patients interviewed: 7 • Total number of health care personnel interviewed: 6 • Total number of managers interviewed: 4 • Partners included in the pilot: Esbjerg Municipality (testing data and video), Vejen Municipality (testing video) and Odense University Hospital (testing video) – each of the partners is testing the eHealth service including different kind of patients.

Research, analysis & ethics summary Christina Lagerstedt, Minna Zechner and research team During the project, four pilots were carried out in Finland, Sweden and Denmark. The pilots engaged real end users, patients, clients and professionals, mainly from sparsely populated areas that have built FTTH network infrastructure. A number of eHealth services were tested within the pilots such as distance consultations, diabetes wound care, night time monitoring, electronic home care recording and video call service and the end user experiences have been collected and analysed during the project. The pilots have also tested infrastructure for delivering eHealth services for different setups and selection of patients/clients. The activities of the Connected for Health project involved human beings and therefore there was a need for ethical planning and assessment. For ethical issues, there are seldom straightforward rules, since situations and circumstances where project actions take place are multifaceted (Dench et al. 2004). Hence the Connected for Health project set up guidelines where the main ethical principles were the respect for individuals: right to self-determination, avoiding harm, protecting privacy and integrity. The pilot evaluations are based on data collected in interviews and questionnaires provided by the participating partners using similar interview protocols in all three countries. Pre- and post conditions were assessed and compared at the beginning, in the middle and at the end of the project based on the Model for Telemedici-

ne applications (MAST) multidimensional methodology. Due to the extensive nature of a full MAST evaluation, the methodology was adapted to suit the purposes of the pilot evaluations but the seven domains of MAST were covered in the evaluation the pilots; health problem and characteristics of the application safety; clinical effectiveness; patient perspectives; economic aspects; organizational aspects and socio-cultural, ethical and legal aspects. The project has also analysed the current business model options for the delivery of homecare, and mapped out a possible evolution towards a closer integration with the established open FTTH business model. The results indicate that introducing an open platform over which to deliver all digital homecare services has the potential to ensure more secure service delivery and lead to savings in terms of reduced communications costs (connectivity fees and hardware), and hence to be a viable model. As the market matures and digital homecare becomes more commonplace, the market will grow, and it will start to make sense to combine an open platform functionality into the business role of the connectivity provider, with the potential to further simplify the value chain and reduce transaction and hardware costs.

Head of Master Degree Programme Minna Zechner, PhD, Seinäjoki University of Applied Sciences SeAMK.

Adding technology changes work routines and time use of professionals and time and effort is needed for adjustment, changes and learning new ways to work. To be able to deploy quality eHealth services to clients/pa-

Reference: Dench, Sally, Iphofen, Ron & Huws, Ursula (2004) An EUcode of Ethics for Socio-Economic Research. Brighton: Institute for Employment Studies Report 412. http://www. (15.10.2015).

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tients in an equal way puts demands on the infrastructure and requires provisioning of bandwidth to all clients/ patients, something that future projects and initiatives should take into account when developing their initiatives. Digitizing services also has a price tag: devices, connections, learning to use, maintenance and upgrading demand time and money. In all of the pilots, the results indicate clearly the importance of a robust and well functioning infrastructure to be able to deploy and use the services as intended. All of the results from the research and analysis done within the project will result in a recommendations report for future initiatives.

Night vision camera in the Swedish home care services Silas Olsson, Madeleine Hedin In Sweden the municipalities are responsible for the public part of the care of the elderly. Private providers operate under a contract with the municipalities i.e. both private and public providers are paid by tax money. Included in this is the provision of different kind of home care services (under the social care act) such as dressing, cleaning, making meals, help with medication, being available for acute calls (social alarms) and generally caring for their clients. For some older persons this includes one or several physical visits during the night.

tally capable to decide him- or herself. On this issue the current legal framework in Sweden is interpreted differently in each of the municipalities.

Some years ago in Sweden, trials were started to see if it was possible to exchange the physical visits at night with a night-vision camera allowing the home-care staff to make virtual visits instead of physical visits to the clients during the night. The rationale behind this was clear economic benefit for the municipality and the benefits for the clients not to be disturbed at night-time with physical visits.

The pilot results were very positive and the municipality decided to continue with the use of the night-vision cameras also after the project. Now the cameras are a part of the homecare services provided by the Hudiksvall municipality and were a part of the Connected for Health project as a way to test the open platform technology, the Alleato Box.

In Hudiksvall in Sweden, one of the pilots in the Connected for Health project, nine night-vision cameras, in use since three years, were included in the pilot. There is full political support in Hudiksvall municipality to use the night-vision cameras, provided that certain rules are followed in the decision-making process.

Of course, this initially created an ethical debate in Sweden. However, after some debates and discussions with different stakeholders, not the least with clients and their families involved, the opinions are starting to turn. The use of night vision cameras in home care is now generally accepted in Sweden. However, one issue that still remains in the decision-making process to use the night-vision camera and that is if the client is not men-

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A virtual visit to the care-receiver (the clients) by the home care staff during night time.

Partners got practical examples in Finland See an inspiring video clip on Connected for Health in YouTube!

Elina Manninen In February 2016 the Connected for Health partners had a partnership meeting and a seminar in Finland. The first day was spent in city of Alavus, where especially the wound nurse explained how she has been working in the pilot. The distance care model created during the pilot has been successful and will be most probably maintained in the organization’s normal practices. The second day and the seminar were held in Seinäjoki, in the Health Technology Centre Mediwest. After the se-

minar the partners could join a tour in the central hospital of South Ostrobothnia Health Care District (SOHCD). SOHCD has been one piloting partner, and developing especially a distance care model for diabetes patients. South Ostrobothnia Health Technology Development Centre (EPTEK) has its office in Mediwest, Seinäjoki. EPTEK has been in charge of all the four pilots of the project, of which one has been conducted in Sweden, two in South Ostrobothnia Finland and one in Denmark.

The Connected for Health YouTube -video clip was finalized during April 2016 and it was launched under the lead partner’s, Regional Council of South Ostrobothnia, YouTube channel. The main video designer was Morten Sand Valkaer, from the partner organization RSD from Denmark. Watch the video by clicking here:

Picture: Elina Koivisto

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