Connected Health and the Digital Content Sector Opportunities for Growth

Connected Health and the Digital Content Sector Opportunities for Growth INTERREG IVA REGION Northern Ireland (excluding greater Belfast), western Scotland and the six Republic of Ireland border counties

© 2015 Honeycomb – Creative Works Partnership comprising Ulster University, Creative Skillset, Dundalk Institute of Technology and University of the West of Scotland.

Report written on behalf of Honeycomb – Creative Works

by PMCA Economic Consulting and Ruby Consulting (Pat McCloughan, Alan Costello and Eoghan Jennings).

All rights reserved.

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Requests for permission should be directed to: Regional Development Centre, Dundalk Institute of Technology, Dublin Road, Dundalk, Co. Louth, Ireland.

Disclaimer While the Honeycomb – Creative Works Partnership believes that the information in this document is correct at the time of printing, it does not guarantee that this is so, nor that the information is suitable for any particular purpose. By virtue of preparing the report or otherwise in connection with this study, the Honeycomb Partnership and the authors of the book will not assume any responsibility or have any liability to any third party or for any loss or damage arising from any use of the information contained therein.

The views and opinions expressed in this report do not necessarily reflect those of the European Commission or the Special EU Programmes Body.

EXECUTIVE SUMMARY

SECTION A INTRODUCTION, CONTEXT AND PROFILE

01

4

INTRODUCTION 6

03 PROFILE OF THE CONNECTED HEALTH SECTOR

16

3.1 Introduction

16

3.2 Segmentation

17

3.3 Service Offering

18

1.1 Purpose of the Report

6

3.4 Venture Funding

20

1.2 Summary of the Digital Content and Connected

6

3.5 Connected Health within the Honeycomb Region

22

1.3 Objectives of the Report

7

04

1.4 Methodology

8

1.5 Summary of Relevant Strengths and Weaknesses of the

8

Health Sectors

Eligible Area

1.6 Summary of National and Regional Policies and Initiatives in

10

Support of Digital Health

1.7 Research Capacity and the Emergence of Connected Health

11

Clusters

02 PROFILE OF THE DIGITAL CONTENT SECTOR

12

2.1 Definitional and Measurement Issues

12

2.2 International Trends – Evidence from the OECD

12

2.3 The Digital Content Sector in the Countries of the Eligible Area

13

2.4 The Digital Content Sector within the Eligible Area

13

2.5 EU Digital Single Market Strategy

15

REVIEW OF RELEVANT RESEARCH

23

SECTION B CONNECTED HEALTH SUBSECTORS FOR GROWTH

05 THEMES HIGHLIGHTED IN CONSULTATIONS WITH STAKEHOLDERS 26 5.1 Connectivity

26

5.2 Data Analytics

27

5.3 Patient Outcomes

27

5.4 Patient Adoption

27

5.5 Regional Localisation

28

5.6 Regulatory Oversight

28

5.7 Human-Centric Design

28

5.8 Selling to Monopolistic Buyer (‘Monopsony’)

28

5.9 Summary

29

– 1 –

09

06 CRITERIA USED TO DETERMINE RELEVANT SUBSECTORS

32

6.1 Nature and Intensity of Links between Connected Health

32

and Digital Content Sectors

6.2 Leverage Local Industry and Academic Resources

32

6.3 Export-Oriented

32

6.4 Taps Skill Base

33

6.5 Addresses a Real Problem – Meeting Need as well as

33

being Technologically Sound 6.6 Competitive Landscape and Speed of Industry

33

07 RELEVANT SUBSECTORS FOR COLLABORATION AND GROWTH

34

7.1 Infrastructure: Analytics and Training

36

7.2 Treatment: Personalised and Assisted Care Coordination

38

7.3 Engagement: Emotional Health Tracking, Patient

39

10 MEASURES TO BOOST FUNDING AND INCREASE SUPPORT

44

11 MEASURES TO CATALYSE CULTURAL CHANGE IN HEALTHCARE

45

11.1

Cultural Change among Clinicians and Patients

45

11.2

Increased Awareness of the Communicative/

45

Transformative Power of Digital Media

11.3

Collaboration with Universities as Customers

46

11.4

Move Away from a ‘One-Size-Fits-All’ Approach

46

CONCLUSION

47

REFERENCES 48

Engagement & Advocacy

7.4 Diagnosis: Self-Diagnosis and Home Monitoring

MEASURES TO DEVELOP SKILL SETS AND STRENGTHEN NETWORKS 43

40

SECTION C MEASURES TO ASSIST GROWTH

ANNEX 1 EXAMPLES OF CONNECTED 50 HEALTH INITIATIVES SUPPORTED BY HONEYCOMB

08 COMPANY MEASURES

41

8.1 Consumer Companies in Healthcare

41

8.2 Medical Companies in the Consumer Space

42

– 2 –

LIST OF FIGURES Figure 1: Digital Health Market Projection by Segment

16

Figure 2: Digital Health Funding Snapshot, 2010-2014 YTD

20

Figure 3: Digital Health Venture Funding, 2011-2014

20

LIST OF TABLES Table 1: Summary of Key Strengths and Weaknesses of the Eligible Area

9

Table 2: Scale and Segmentation of the Connected Health Market

17

Table 3: Summary of Service Offerings in Connected Health

19

Table 4: Funding of Top Categories of Digital Health, 2014 (US)

21

Table 5: Summary of Recent and Relevant Publications

23

Table 6: Summary Table of Key Themes in the Market for Connected Health

30

Table 7: Subsectors of the Connected Health Market with the Most Promising Growth Potential

35

Table 8: Subsectors of the Connected Health Market with the Most Promising Growth Potential

Subsectors within Healthcare Infrastructure

37

Table 9: Subsectors of the Connected Health Market with the Most Promising Growth Potential

Subsectors within Healthcare Treatment

38

Table 10: Subsectors of the Connected Health Market with the Most Promising Growth Potential

Subsectors within Healthcare Engagement

39

Table 11: Subsectors of the Connected Health Market with the Most Promising Growth Potential

Subsectors within Healthcare Diagnosis

40

– 3 –

Executive Summary This scoping study report

The digital content sector is part of the wider

Greater integration between the connected health

has been prepared for

creative sector, bringing together creative and design

and digital content sectors forms part of each of

activities with IT, thereby embodying both artistic

the economic development strategies of Ireland, NI

Honeycomb – Creative Works

and technical/engineering skills. The digital content

and Scotland, where the aims are to improve patient

at the Dundalk Institute of

sector is a malleable and fast-moving sector, and

outcomes and reduce the costs imposed on the

includes as subsectors games, animation and online

national health systems.

Technology. It considers the

content. While employment in absolute terms is currently comparatively low in the digital content

In the eligible area, the digital content sector is

prospects for integrating the

sector, it is nevertheless a sector in which jobs are

largely fragmented – the vast majority of businesses

growing, even during the crisis years, and its share of

are small (typically micro businesses), there are

overall employment has increased over recent years.

many freelancers working in the sector on a part-

the digital content sector in the

It is synonymous with the knowledge economy and

time basis and markets served are predominantly

Honeycomb eligible area, which

is pervading other sectors of the economy rapidly

local in nature. In addition, the extent of foreign

and playing an increasingly important part of our

direct investment (FDI) in digital content activities

comprises the six border counties

everyday lives.

is low in the eligible area compared with that in the

of Ireland, Northern Ireland (NI)

The pervasive influence of the digital content sector

Edinburgh) and broadband availability remains a

(excluding the greater Belfast

is becoming more evident in the health sector, with

major issue in some parts of the eligible area. The

the development of connected health, which seeks

digital economy and its development thrives mostly

area) and the western seaboard

to use digital technologies to link the main players

in larger economic centres, which benefit from talent

in the industry more effectively, most importantly

pools, clusters and infrastructure (including groups

clinicians and patients (and their families, which

of third-level institutions and high-speed broadband

are very important because children and the elderly

as well as ‘hard’ infrastructure such as transport

are among the biggest users of healthcare and their

networks).

connected health sector with

of Scotland, between now and the end of the decade, and beyond.

main urban centres (Belfast, Dublin, Glasgow and

families are often the “voice” of these patients).

– 4 –

Given that healthcare policy is to a large

Geographically, while most of the convergence

extent determined nationally, and owing to the

opportunities are likely to occur in the major urban

concentration of digital content sector activities

centres in each of the three countries of the eligible

in larger urban centres, it is envisaged that over

area, there is nonetheless the opportunity for

the next number of years the main connections

the eligible area proper to benefit in the process.

will occur in these centres and in sectors that

Accordingly, initiatives (like Honeycomb) need to

have a proven track record of connection between

ensure that the region is well-placed to respond to

the digital content and healthcare sectors. These

the opportunities and are connected to a greater

include big data and predictive analytics; clinician

extent to the developments occurring in the main

training and assisted living/aging; other convergence

urban centres of the countries.

opportunities include clinical trials, virtual care coordination and navigation; patient education and advocacy, and self-diagnosis.

– 5 –

SECTION A 01 Introduction Introduction, Context and Profile

1.1 PURPOSE OF THE REPORT

use of IT technologies in our lives. Increasingly, as witnessed by enterprise developments in the

This report provides a scoping study regarding the

Honeycomb eligible area, entrepreneurs and

possibilities for collaboration between the digital

innovators are looking to make connections between

content sector and the connected health sector in

digital technologies (hardware and software) and

the Honeycomb eligible area, which comprises the

other sectors of the economy, notably health.

six border counties of Ireland, Northern Ireland (excluding the greater Belfast area) and the western

Digital healthcare or ‘eHealth’ involves the application

seaboard of Scotland. The report considers the

of digital technologies to healthcare; for example,

opportunities for growing cross-collaboration

the use of smart devices to tell patients when to take

between the two sectors in the eligible area for

their medicines or to relay medical information about

the mutual benefit of providers in both sectors and

concurrent health measures to centralised monitoring

patients in the connected health sector.

systems. The interconnectedness between digital media and healthcare presents those working in the

1.2 SUMMARY OF THE DIGITAL CONTENT AND

sectors with unique interdisciplinary possibilities

CONNECTED HEALTH SECTORS

to research and promote healthy lifestyles while managing illness and health risk. Moreover, digital

There is no universally agreed definition of the digital

healthcare technology development for eHealth

content sector but nevertheless it is generally

systems enables regional and national healthcare

closely associated with the digital media and creative

investment to respond to emerging health and ageing

industries, and includes (but is not necessarily

population trends highlighted in the EU task force

limited to) film and broadcasting, animation, games

report ‘Redesigning health in Europe for 2020’, which

development, music technology and interactive media

aims to ensure that all citizens have consistent

(online interactive content). Across the eligible

access to a high level of healthcare across Europe,

region and internationally, digital content today

at a reasonable cost to national healthcare systems.

pervades our daily lives, reflecting the widespread

In advanced economies, eHealth has the potential to

– 6 –

Introduction

bring together medical and healthcare professionals,

1.3 OBJECTIVES OF THE REPORT

social scientists and public health policy advocates,

demand. Both are needed. For example, a new health initiative may be technologically sound but

computational and computer scientists, and digital

Honeycomb is an EU INTERREG IV-funded

will not be amenable to commercialisation if it fails

media platform experts to invest in helping patients

programme aimed at supporting the digital content

to capture a market demand based on patient need;

and clinicians to optimise health management in new,

sector in the aforementioned eligible region. It has

similarly, different types of patient may have well-

cost-efficient, and patient-focused ways.

acted as a research hub, a collaborative network and

identified needs but these will not be feasibly met if

a resource for small and medium enterprises (SMEs)

the technologies available are not fit-for-purpose. In

Undoubtedly one of the main trends in global

in the region seeking to partner and grow their way to

this way, new digital developments in the healthcare

healthcare now occurring is the shift towards more

success.

sector need to be both demand and supply-led. They

personalised healthcare and this is reflected in

also need to be cost-competitive – to attract the

the movement by pharmaceutical companies from

Honeycomb is seeking to develop pathways between

attention of buyers, which occur at different levels

‘blockbuster’ drugs to ‘niche-buster’ treatments on

the digital content sector and other sectors, so that

of the healthcare value chain, namely national health

a more customised basis. The availability of mobile

companies and research groups in the eligible region

executives, down to hospitals and primary care

technology also means that people have greater

can benefit from further growth. Convergence

centres and ultimately to patients and their families.

information regarding diagnosis and management

between sectors is a common theme in the current

(including testimonials from other people with

economic development strategies underway in

This scoping report seeks to identify the extent

the same or similar conditions) and this is leading

Ireland, NI and Scotland – a common denominator in

to which the health sectors in the three parts of

to greater patient empowerment in the process

each case being the role of the digital content sector

the Honeycomb eligible area are connected with

(including through apps etc.).

(as part of the wider IT sector) and the opportunities

the digital content sector, and, in each case, which

presented in terms of assisting employment growth

parts of the health sector are particularly digitally

in other sectors, like health.

connected and where the best opportunities for sectoral collaboration are likely to occur between

Generally speaking, underpinning the opportunities relating to enhanced convergence between the digital economy and other sectors, including health, are the conditions of technological feasibility and market

– 7 –

now and the end of the decade, and beyond.

Introduction

1.4 METHODOLOGY

1.5 SUMMARY OF RELEVANT STRENGTHS AND WEAKNESSES OF THE ELIGIBLE AREA

The research methodology for this report has entailed the following work elements:

Table 1 opposite presents a summary of the eligible area’s strengths and

• Desk research – where we have reviewed market reports and policy

weaknesses in relation to developing greater connectivity between the digital

documents;

content and connected/eHealth sectors. While there may be some opportunities

• Primary research – in which we have conducted interviews with individuals in

stemming from the identified strengths, there are also considerable challenges

the digital content and connected health sectors;

to developing connected health technologies in the eligible area, arising from the

• Validation of findings – in addition, we shared our emerging findings with a

identified weaknesses.

second set of selected stakeholders to confirm our understanding of the opportunities and to seek ‘road-testing’ of our high-level measures to assist

No single initiative – such as Honeycomb – can realise the opportunities or

integration between the sectors.

address the challenges on its own; however, what it can seek to achieve is to facilitate the environment in which entrepreneurial connections can be made

We conducted the interviews mostly by telephone, with some face-to-face

to assist in the development of eHealth, in tandem with other business support

meetings in addition. Some respondents have chosen not to be identified given

agencies and in line with national policy goals.

commercial considerations and/or not to have any views directly attributed (some of those with whom we spoke are therefore not identified in the report).

– 8 –

Table 1

Summary of Key Strengths and Weaknesses of the Eligible Area STRENGTHS

WEAKNESSES

• National economic development strategies in place – health sector identified as a key economic sector, both in its own right as a major employer but also as a user of digital technology, thereby helping to stimulate development of the digital economy

• Eligible areas peripheral for the most part

• Emphasis on growing local companies as well as attracting foreign direct investment (FDI) in the IT and digital economy sectors • Strong third-level educational attainment in the eligible area

• Variable broadband availability • Significant damage caused by the economic recession from 2008 • Tradition of relatively high unemployment and emigration, which persists throughout the region following the economic collapse of 2008

• Relatively high levels of enterprise and entrepreneurship

• Challenge of retaining or attracting graduates back to live and work in the eligible area

• Some clusters of digital content activities and/or eHealth developments underway in the eligible area

• Small scale of enterprises in the digital content sector

• Strong cultural linkages among the parts of the eligible area

• Narrow economic base arising from over-dependence on agriculture, traditional manufacturing and the public sector • Low penetration of knowledge-economy in comparison with the more developed parts of the three countries concerned • Reliance on traditional funding sources and little in the way of advanced sources (e.g. VC)

Source: Consultancy team review and assessment of various socio-economic data from official sources in the eligible area.

1.6 SUMMARY OF NATIONAL AND REGIONAL POLICIES AND INITIATIVES IN SUPPORT OF DIGITAL HEALTH

– 9 –

Introduction

75%

15%

of people search online for health information

potential reduction in emergency admission

1.6 SUMMARY OF NATIONAL AND REGIONAL

14%, while potentially reducing mortality rates by up

sector, and greater recognition of qualifications in

POLICIES AND INITIATIVES IN SUPPORT OF

to 45%.

the digital and IT sectors. While there is recognition

DIGITAL HEALTH

of the potential for convergence between the One of the major connected health initiatives in the

digital content and connected heath sectors (in the

The 2015 policy document ‘Digital Health’ pertains

UK (CellNovo) has resulted in the development of a

coming years), the immediate priority of the digital

to the UK and thus applies to the NI and Scottish

mobile-connected diabetes management system,

economy strategy is to ensure the availability of a

parts of the Honeycomb eligible area. Overall,

and similar connected health facilities are now in

range of skills in digital content and IT (including

the document seeks to support digital healthcare

full operation with Scottish Connected Health for

software development) rather than also promoting a

solutions nationally, regionally and locally across

over 270,000 diabetic patients in that part of the

concurrent major program of initiatives in connected

the UK.

UK. Moreover, projects focused on the application

health.

of digital communication technologies to mental To date, the UK strategy for rolling out eHealth

health issues have begun to generate community

Ireland, on the other hand, not only has an EU policy

has tended to focus on a self-care, patient-centric

acceptance through initiatives such as the Glasgow

directive agenda (2020) to accommodate, but also

approach for diabetic, pulmonary and cardiac

High SafeSpot local e-service for teenagers suffering

a national policy document aimed specifically at

diseases. Research shows that about 75% of people

with mood disorders or related symptoms, and

eHealth, namely the ‘eHealth Strategy for Ireland’

not only search online for health information but also

GreyMatters, which provides an online resource

(2013). That document outlines a comprehensive

that approximately half of those that do, seek to self-

promoting real-time communication and non-

and detailed approach to implementing an eHealth

diagnose (not completely, without also consulting

hospitalised treatment supporting patients with

program of healthcare solutions developed within a

with their doctors, but as a first step in the diagnosis-

long-term conditions such as dementia, hypertension

national framework. The Health Services Executive

treatment-management process). In this context,

and rheumatoid arthritis.

(HSE) notes that eHealth involves not only the

the provision of digital healthcare would have the

connected health agenda, but also the “integration of

effect of enhancing the effectiveness of the self-care,

The ‘Northern Ireland: A Global Leader of the Digital

all healthcare information and knowledge sources via

patient-centric approach, in the process reducing

Economy – A Sectoral Action Plan’ document (2014)

information technology systems, including patients

A&E visits (by 15%, it has been estimated), reducing

outlines policy intentions regarding the development

and their records, caregivers and their systems,

emergency admissions by 20%, reducing bed days by

of the digital economy in NI, with a strong focus on

monitoring devices and sensors, and management

skills training, attracting global investment in the IT

and administrative functions” (p. 5). The HSE’s policy

– 10 –

Introduction

document provides a framework setting out what the

An analysis by each part of the Honeycomb eligible

digital media hubs within NI, such as the Creggan

eHealth framework intends to achieve; the actions or

area suggests that the enterprise expertise base is

Enterprises Digital Media Arts Studio in Derry/

systems changes that need to be in place to realise

most likely to occur in the main urban centres.

Londonderry, is also relevant to note in the context of

eHealth strategies and objectives; the patient-based

Western Scotland, and the greater Glasgow area

this report.

and economic costings advantageous to eHealth

in particular, are at the forefront of digital health

solutions; a framework for the evaluation of eHealth

research and digital hub creative enterprise clusters,

The north eastern part of the cross-border region

intervention effectiveness; and a life-cycle of

in having a Digital Health Institute with a specific

on the island of Ireland (along the Dublin-Belfast

connected health solutions framework that evolves

focus on exploratory, laboratory, and factory digital

corridor) is seen by stakeholders consulted as

with technological intervention without placing

and Connected Health roll-out programs, ranging in

providing an opportunity to link-up enterprises,

patients at untested risk. While forward-looking in

applications from clinical decision support platforms

research institute capacity, health service systems,

its approach, the report is realistic to recognise that a

to mental well-being. The Digital Health Institute is

and digital media hub development beyond the

significant amount of systems re-structuring will be

a collaborative initiative between the Glasgow School

national eHealth strategic policy’s intent. The

required to realise the policy’s potential, particularly

of Art’s Creative Media Hub and a new creative digital

resources and the framework appear to exist, for

in changing working systems practice.

hub at Pacific Quay Glasgow. The initiative has

example in the potential link-up of researchers at

benefitted from recent funding and includes digital

Dundalk Institute of Technology (Netwell Centre),

1.7 RESEARCH CAPACITY AND THE

enterprises (e.g. IOMART Cloud Computing), giving a

the Boyne Research Institute (Drogheda), HSE

EMERGENCE OF CONNECTED HEALTH

boost to the region and presenting an opportunity for

service provision in the border counties of Ireland

CLUSTERS

digital and connected health collaborative initiatives.

(Louth, Cavan and Monaghan) and local digital media

For connected health technology to fully realise

While NI remains committed to IT skills training and

the solutions that the national and regional policies

qualifications recognition within its digital sector,

purport to be both possible and essential, the

the region has recently invested in linking up with

appropriate information technology resources,

forerunners in the digital health sector and the

labour market skill sets, research and development

New York initiative. The Western Scotland network,

opportunities, and connected health-specific

including the aforementioned Digital Health Institute

enterprises must all be in place.

has links to the NI policy drive. The development of

enterprises in that part of the Irish cross-border

– 11 –

region.

02 Profile of the digital content sector 2.1 DEFINITIONAL AND

According to the report, in 2012, information

The OECD report concludes by saying that new

MEASUREMENT ISSUES

industries accounted for about 3.8% of all

statistical tools are needed to measure the digital

employment in the OECD area. In addition, the same

economy and it proposes a forward-looking

While the digital content or media sector embraces

industries contributed 6% to total value added, and

international agenda built around six areas as

a number of subsectors, such as games, animation

labour productivity in the information economy

follows:

and online content, there is no universally agreed

sector was found to be 60% higher than the overall

• Improve the measurement of ICT investment and

definition of what precisely makes up the sector. This

economy. Revealingly, the digital economy has been

in turn makes it difficult to accurately estimate the

resilient during the economic crisis; however, while

size of the sector, which is made all the more difficult

employment has grown, it has not reached the peak

by the fact that the official statistics agencies in

rate of 4.1% of all employment witnessed in 2001,

the eligible area do not make publicly available

just before the IT/dot.com bubble crash at that time.

information on the disaggregated subsectors

its link to macroeconomic performance; • Define and measure skills needs for the digital economy; • Develop metrics to monitor issues of security, privacy and consumer protection; • Promote the measurement of ICT for social goals

regarded to make up the digital content sector. The

Within the sector, employment growth is occurring

pace of change inherent in the sector also works

in IT and other information services and generally

against accurate delineation and estimation of scale

away from products and traditional activities, such

and growth.

as publishing, audiovisual and broadcasting and telecommunications. The OECD report notes that the

and the impact of the digital economy on society; • Invest in a comprehensive, high quality data infrastructure for measuring impacts; and • Build a statistical quality framework suited to exploiting the internet as a data source.

2.2 INTERNATIONAL TRENDS – EVIDENCE

gap in productivity in favour of information services

FROM THE OECD

relative to the total economy is especially high in

The fourth of these proposals is relevant in the

Ireland (it is found to be highest in the US).

context of this report, in that healthcare would

The Organisation for Economic Cooperation and

According to the report, the information society

be seen as a social as well as an economic sector

Development (OECD) published a report in December

economy, which includes the digital content sector, is

and one affording the opportunity of synergy

2014 entitled ‘Measuring the Digital Economy: A New

opening up new employment and skills opportunities

development with the digital content sector.

Perspective’ which maps existing indicators of digital

as the sector continues to grow and this will present

activity against digital policy issues and suggests a

challenges for educational institutions as well as

forward-looking international measurement agenda.

people seeking to work in the sector.

– 12 –

Profile of the digital content sector

2.3 THE DIGITAL CONTENT SECTOR IN THE

Getting other sectors to appreciate and work with

In Ireland, NI and Scotland, the majority of digital

COUNTRIES OF THE ELIGIBLE AREA

the much shorter lead-times associated with the

economy activities occurs in the main urban centres

digital economy is one of the great challenges for

(Dublin, Belfast, Derry, Glasgow and Edinburgh),

Data analysis undertaken by the consultancy team

facilitating further integration of digital activities

where talented people hoping to build careers in

reveals that the digital content sector (as can be

throughout the economy.

the sector are most likely to be attracted. Over the

reasonably defined and measured with the available

coming years, there is little doubt that the digital

official data) would account for up to approximately

In each of the three countries, there are foreign

content sector will continue to develop mostly

14,000 people in work in NI, and between 25,000

direct investment (FDI) firms active in the sector

in these centres and it is in these cities that the

and 30,000 workers in each of Ireland and Scotland.

as well as indigenous enterprises. With its low

greatest scope for convergence between healthcare

Reflecting the OECD report of 2014, the sector

corporation tax, Ireland has been especially

and the digital economy lies.

accounts for between 1-4% of all employment in each

successful in attracting IT FDI in recent years.

country/region, depending on whether one takes a

While many of the activities of these firms are

2.4 THE DIGITAL CONTENT SECTOR WITHIN

wide or narrow view of the sector.

directed towards international servicing operations,

THE ELIGIBLE AREA

recent years have seen more focus on core functions, Also chiming with the OECD study is that gross value

like software engineering and development, which

Within each country and focusing on the eligible area

added (GVA) tends to be higher in the digital content

tend to predominate among the Irish-owned

spanning the Honeycomb region, we find that the

sector compared with other sectors of the economy,

enterprises operating in the sector.

digital content sector is more scattered, fragmented

which in turn points to the productivity gap in favour

and diverse. This is not surprising and reflects the

of the digital content industries – they attract

Recognising the pervasiveness and influence of the

generally low population density of the eligible area

well-educated and talented people, and the pace of

sector, all three countries’ economic development

and the absence of big urban centres. A particular

change in the sector tends to occur more rapidly than

strategies recognise the important opportunities

issue in the Irish border counties is the availability of

in other parts of the economy, whether research or

afforded by the digital economy and in particular

broadband in more rural and peripheral parts, which

technology development (e.g. software development

the scope (but also challenges) for digital media

is hampering digital development in that part of the

occurs much more rapidly than pharmaceutical

activities to connect further with other sectors of the

country and may be contributing to a “digital divide”

development).

economy, including health and education.

(mobile telecommunications as well as broadband can be patchy and variable in quality in this part

– 13 –

Profile of the digital content sector

of the country). Through its National Broadband Plan, the Irish government is

While there are some variations, and exceptions, within the eligible area, it is

seeking to resolve the issue of broadband availability by 2016.

reasonable to observe that the digital content sector in the Honeycomb region is characterised by the following features:

For example, within the border counties of Ireland, the penetration of the digital content sector is low when compared with the country as a whole. This is

Business organisation;

illustrated by the estimate that approximately 0.5% of all employment in the

• Predominantly micro-firms (less than 10 employees), with a good many

border counties is accounted for by the sector, which is lower than the estimate that about 1.2% of all employment in Ireland is due to digital content activities

freelancers working on a part-time basis (on their own) • Low direct employment and low turnover (although the low turnover is

(taking a narrow definition of the digital content sector).

reflective of the downturn in the region more generally, which has impacted on all small businesses)

How does the estimated 0.5% employment density in the Irish border counties

• Reliance on government support to grow (and reliance on a small number of

compare with the other two parts of the eligible area? On the basis of estimates of employment for digital content sector activities provided to us through

buyers/clients, such as broadcasting organisations) • Compared with the main urban centres, low presence of FDI firms, which in

Honeycomb, it appears that the corresponding proportion in NI (excluding Greater

turn reflects their searching for talent and infrastructure in larger population

Belfast) is about half that in the Irish border counties (c. 0.2%) and double the

centres/capitals

Irish border counties’ proportion in the Scottish part of the Honeycomb Region (c. 1%).

Technology; • Predominantly low technical/capital requirements accompanying, which is

On this basis, the Scottish part of the eligible region would appear to be the

both a positive and a negative

most advanced, at least in terms of employment impact, which is a key policy

- A positive because it implies low barriers to entry to the sector (making

consideration (bearing in mind that the aforementioned proportions relate to a

entrepreneurship and competitive outcomes more likely)

narrow definition of the digital content sector in the eligible area).

- A negative because there are clearly identifiable scaling and efficiency issues due to skills gaps (which are both general and sector-specific as helpfully identified in the Honeycomb survey of providers conducted in 2014)

– 14 –

Profile of the digital content sector

Market need;

There will be three strands to the new EU digital strategy:

• Heavy reliance on the local/domestic market (and small number of purchasers)

• Better access for consumers and business to digital goods and services,

• Low incidence of exporting

namely unlocking the potential of cross-border e-commerce by making it more

• Low intensity of innovation.

straightforward and affordable, by tackling online geo-blocking restrictions, by modernising copyright law and by simplifying cross-border VAT arrangements

The aforementioned Honeycomb survey of providers in the eligible area (2014),

and costs for companies;

which is a useful information source, not least given the paucity of official data

• Shaping the environment for digital networks and services to flourish, which

on the sector, also highlights the various developmental needs of the sector,

includes efforts to boost the roll-out of faster (4G) broadband to enable new

including skills (both general/business and technical to keep pace with new

digital services, applications and content, and to examine, with the aim of

developments) and networking (to learn about new opportunities, expand client

realising, the potential afforded by online platforms, like social media, apps and

bases and absorb new learning). These areas are especially important and ones to which institutions like DkIT and Ulster University can contribute.

downloads etc.

• Creating a European Digital Economy and Society with long-term growth potential, which relates to helping all sectors to integrate new technologies

2.5 EU DIGITAL SINGLE MARKET STRATEGY

and to manage the transition to a smart industrial system through a fasttracking of standardisation in the interoperability for new technologies,

The European Commission’s ’Digital Single Market Strategy’ – one of the priorities

including tapping into the economic potential of big data and data analytics

of the Juncker Commission in terms of ensuring that Europe should benefit

(which are particularly relevant to this study).

fully from the digital age with better services, more participation and new job creation opportunities – was launched on 6 May 2015. The strategy (a long-inthe-making co-production of no fewer than 13 Commission Directorates-General) is an attempt to recognise the borderless nature of digital technologies and the opportunities due to deeper integration between digital content activities and other sectors of the economy.

– 15 –

03 Profile of the connected health sector 3.1 INTRODUCTION The global digital health market is estimated to

FIGURE 1

Digital Health Market Projection by Segment

more than double over the next three years, and to exceed US$200 billion in 2020. A key driver of this impressive development will be an increasing mobile health market with innovative mobile solutions, applications and services. Additionally, such offerings will trigger growth in neighbouring areas such as wireless network technologies, sensors and devices.

This momentum will invariably attract new players to the market and disrupt current business models.

New market entrants will most likely be technology companies who may lack significant healthcare expertise.

Thus far, however, digital health solutions have not quite delivered on their promise. Established companies from the traditional health sector struggle to combine and enrich their offerings with digital elements, while very few of the digital health

Source: Arthur D. Little, GSMA, Allied Market Research, Accenture, IHS, MarketsandMarkets.

start-ups have developed to their full potential.

Notes: Other includes health telematics, informatics and further sub-segments with an estimated additional 20% market volume.

– 16 –

TABLE 2

Scale and Segmentation of the Connected Health Market KEY SUBSECTORS

ESTIMATED MARKET SIZE 2014

HONEYCOMB RELEVANCY

Payment processing

$6.0bn*

1

HER and Clinical Workflow

$9.0bn*

1

Big Data/Predictive Analytics

$6.0bn*

4

Hospital Administration

$6.0bn*

1

distinct main segments based upon the subsectors

Physician Training

$3.0bn*

4

that have received significant funding over the last

Population Health Management

$5.0bn*

2

five years (Table 2).

Clinical Trials

$4.0bn*

3

Assisted Living/Aging

$3.3bn

4

Virtual Care Coordination & Navigation

$4.1bn

3

Personalized Medicine

$4.0bn*

2

Medication Management

$1.4bn

1

MARKET SECTOR

VENTURE FUNDING 2008-2013

3.2 SEGMENTATION We may divide the digital health market into four

• Infrastructure, largely the bearer of regulatory mandates and incentives, which includes health

Infrastructure

Treatment

$2.9bn

$2.6bn

analytics and interoperability solutions and is the leader with $2.9 billion of total funding.

Nutrition Tracking

$1.9bn

2

Physical Fitness Tracking & Wearables

$8.5bn

1

has garnered $2.6 billion as new, alternative care

Behavioural & Emotional Health Tracking

$1.7bn

channels are pursued.

Patient Education & Advocacy

$3.1bn

3

Provider Diagnosis

$4.0bn*

1

Self-Diagnosis

$3.0bn*

3

Emergency Detection

$2.6bn

1

Remote (Vital Sign) Monitoring

$3.8bn

2

• Treatment, which includes personalised medicine, virtual care, tele-health and care coordination, and

Engagement

$2.6bn

• Engagement, which also received $2.6 billion and includes wearables, incentive programs and other patient engagement solutions that target

Diagnosis

$2.1bn

behavioural change.

• Diagnosis, which has captured $2.1 billion, representing a rapidly growing segment of clinical

Total

$10.2bn

c. $80.0bn

Source: Accenture, Arthur D Little, PricewaterhouseCoopers, KPMG.

and consumer tools that provides insights, such as

Notes: * Authors’ estimates based on research contained in reports by Accenture, Arthur D Little, PricewaterhouseCoopers,

remote monitoring.

and KPMG.

– 17 –

3

The final column of the table above contains the consultancy team’s assessment of the relevance of the connect health subsectors in the context of this report, namely the potential for greater convergence between the connected health and digital content sectors.

The main convergence opportunities are in: (1) big data and predictive analytics; (2) physician training, where by ‘physician’ is meant the decision-maker in respect of clinical engagement with patients; and (3) assisted living/aging (although the latter will necessitate involvement with patients’ families because, for example, people with advanced dementia/Alzheimer’s are generally not in a position to liaise with healthcare providers and require the ‘voice’ and support of family carers).

Other potentially significant convergence opportunities are (a) clinical trials (processing and management etc.), (b) virtual care coordination and navigation, (c) behaviour and emotional health tracking, (d) patient education and advocacy and (e) self-diagnosis, which refers to greater patient involvement in diagnosis and care (e.g. pregnancy testing, eye care, dental care, skin care etc.).

3.3 SERVICE OFFERING Many leading pharmaceutical companies, the majority of health insurers and numerous medical devices companies have already successfully designed and launched early generations of digital healthcare offerings.

An overview of the typical offerings currently available is tabulated below.

– 18 –

Table 3

Summary of Service Offerings in Connected Health Offering

Focus

Health management

General wellbeing/ prescription drugs

Device

Health management

Digital reference book

Hurdle to Wide

Platform

Benefit

Adoption

Adherence

Physician integration

√

Adherence, monitoring

Physician integration

Education, Encyclopaedia

No patient input

√

Adherence, drug instructions, education

Only generic inputs

Adherence, monitoring

Physician integration

Education

Only limited patient inputs

Education

Patient input

Education, scheduling

Limited patientspecific inputs

Monitoring, scheduling appointments

Physician integration

Education, scheduling

No patient inputs

App

√

Portal

√

Multiple Sclerosis

Medical/pharma information

Activity and exercise management

Diabetes (and its complications – eye care, weight etc.)

Symptoms recording and analysis

Diabetes (and its complications – eye care, weight etc.)

Environment assessment

Asthma, hayfever, allergies and auto-immune conditions

Digital reference

Primary Patient

Digital Offering

√

√

√

√

√

Community

√

√

General information √

Self-assessment

Haemophilia √

Symptoms recording

√

Prostate cancer √

Virtual practice

Diabetes (and its complications – eye care, weight etc.)

√

Source: Company websites, Arthur D Little, consultancy team review.

– 19 –

FIGURE 2

Digital Health Funding Snapshot, 2010-2014 YTD

3.4 VENTURE FUNDING Two recent information sources show the

Source:

importance of digital health for venture capital

StartUp Health www.startuphealth.com/insights,

providers. StartUp Health, a New York-based

consultancy team review.

accelerator, and Rock Health, a San Francisco-based accelerator and seed fund, have independently reported that funding for new digital health ventures in the US has grown substantially recently. Funding in

Even regarding investments worth at least $2 million. Rock Health estimates that $4.1 billion of new capital was invested in digital health, up from less than $1 billion in 2011.

2014 more than doubled from the previous year ($6.5 billion invested compared to $2.9 billion in 2013), with each quarter in 2014 attracting more capital than all of 2010. Signs of a maturing market continue, as investors are apparently investing larger amounts

FIGURE 3

Digital Health Venture Funding, 2011-2014

on fewer companies. By any measure, venture funding of digital health companies surpassed $4 billion in 2014, nearly equivalent to the prior three years (2011-2013) combined.

Source: Rock Health Funding Database www.rockhealth.com Note: only includes US deals > $2m

– 20 –

Profile of the connected health sector

3.4.1 VENTURE FUNDING FOR CONNECTED HEALTH BY SUBSECTOR

3.4.2 VENTURE FUNDING FOR CONNECTED HEALTH IN EUROPE

Both sources agree that analytics and big data are the largest subsector,

The outlook for VC funding directed towards connected health is less optimistic in

accounting for $1.46 billion (over one-fifth) of StartUp Health’s estimate and

Europe than in the US. The amount of capital invested in digital health start-ups is

$393 million (just under 10 per cent) of Rock Health’s estimate. In the case of

less than one-tenth of the comparable US figure. There are, as yet, only a few VC

both companies, there was rapid growth in VC funding between 2013 and 2014.

providers targeting the sector in Europe while there are less than a handful of firms specialising exclusively on digital health as an investment strategy.

Nevertheless, new firms are being formed in Europe to capitalise on the

Table 4

opportunities developing in the US. XLHealth is one such firm newly created in

Funding of Top Categories of Digital Health, 2014 (US)

2014 in Berlin to develop fund and support digital health solutions in Europe. This firm is closely partnered and funded by one of Europe’s largest software suppliers

STARTUP HEALTH Analytics/Big Data

in the health space, CompuGroup Medical. Some of the strongest supporters of the

ROCK HEALTH $1.46 bn

Analytics/Big Data

$393 m

$1.14 bn

Healthcare consumer engagement

$323 m

Navigating the Care System

$974 m

Digital medical devices

$312 m

Diagnostics

$962 m

Telemedicine

$285 m

Consumer health

$880 m

Personalized medicine

$268 m

Practice Management

$783 m

Population health management

$225 m

Payor/Insurance

$699 m

Workflows

$681 m

Genomics

$632 m

Clinical research

$624 m

Population Health

Source: Company info, consultancy team review.

digital health agenda in the US have been investors with large, valuable portfolios in the life sciences sector. Their European counterparts have organised along the same lines as the pharmaceutical industry with their focus aligned to major disease areas. As such, they have been somewhat slower to view the more holistic benefits of digital health solutions as viable investment opportunities. Some of the leaders such as Inventages are, however, beginning to view the promise of digital health solutions, particularly in the areas of nutrition and wellness as complementary to their investments in life sciences. Recent commitments by more VC investors in digital health start-ups are also acting as beacons for additional capital to be directed towards the sector. Mangrove Capital, one of Europe’s high profile investors, led an investor round for Zesty, a UK-based service aimed at simplifying the making of appointments with healthcare specialists. So far, however, European investors have been more cautious in that they seem to be backing only start-ups with already proven markets in the US, as opposed to new product areas with nascent customer markets.

– 21 –

Profile of the connected health sector

3.5 CONNECTED HEALTH WITHIN THE

to aid prevention and reduce cost pressures in their

0.3% of a total annual budget of over €13 billion

HONEYCOMB REGION

health systems, so that governments as well as

(this proportion is much smaller than the equivalent

patients and companies active in the development of

amount in the UK, namely the aforementioned 1.1%

Connected Health in the eligible area has been a

the technologies are seen as winners; however, the

incurred by the NHS). With a limited budget, the

focus of both private and public initiatives for several

ramifications for clinicians may be more complex and

HSE must still address similar challenges to the

years. For example, the Northern Ireland Connected

there is a sense of apprehension from the medical

NHS in terms of coping with an increasingly elderly

Health Ecosystem was launched in 2012 as a forum

professions in respect of the advent of digital/

population, living with a growing burden of chronic

to bring together stakeholders from the health

eHealth.

disease, while adopting complex and costly medical

system, academia and business to discuss and take forward connected health solutions within NI.

advances. Despite the financial constraints, a major EHI Intelligence calculates that the UK NHS spends

re-organisation of the health and social care system

around £1 billion a year on healthcare IT, or around

and reforms of Ireland’s healthcare funding systems

3.5.1 REGIONAL PUBLIC ENGAGEMENT AND

1.1% of the NHS’s approximately £110 billion budget.

are already underway. However, a strong sense

EXPENDITURE ON CONNECTED HEALTH

In 2011, the NI Ministers for Health and the Economy

of cynicism is associated with the reforms, which

Despite the fact that constrained budgets limit

agreed the Connected Health and Prosperity

include the possibility of de-centralising healthcare

public investment in digital health initiatives, health

Memorandum of Understanding. One of the priorities

decisions (it will be recalled that the HSE was

authorities and decision-makers in the eligible area

in the MOU is the development of a Connected Health

instituted in 2005 by amalgamating the

at least recognise the inexorably important role that

Ecosystem in Northern Ireland bringing together the

previous regional health boards

digital technology will play in reforming healthcare

public, independent and private sectors, research

in an attempt to ensure

systems. Every European healthcare system

bodies and patients and families to share good

greater efficiency in

currently struggles to achieve a balance between

practice, learn from experiences and help to prioritise

the provision of

ensuring access to high-quality healthcare services

and develop connected health solutions.

healthcare in

and long-term financial sustainability. The outcome is

Ireland).

that public authorities are open to private initiatives

Comparative figures for public spending on

from technology companies with cost-effective

connected health in Ireland indicate a future

solutions. Policymakers therefore recognise the

lack of funding. The HSE’s annual expenditure on

potential for digitally-based healthcare initiatives

healthcare IT of around €40m accounts for only

– 22 –

04 Review of Relevant Research As part of this study, we undertook a research review to examine what other researchers, government bodies and consultants have done in the field to date on the subject of healthcare information technology and connected health, with a particular view towards applications that make use of digital media. The table below summarises the reports from various government bodies and other bodies that we have deemed relevant here (table continued overleaf).

Table 5

Summary of Recent and Relevant Publications AUTHOR

TITLE

KEY FINDINGS

PUBLICATION DATE

BioBuisness Ltd. commissioned by Enterprise Ireland

Connected Health in Ireland – An All Island Review

• Review of a considerable number of connected health activities on the island

Apr. ‘10

Irish Department for Communications, Energy and Natural Resources

Baseline Report on eHealth Development in Ireland

• One of a series of reports under the Knowledge Society Strategy.

Sinclair Stockman commissioned by Invest Northern Ireland

Digital Northern Ireland 2020

• Identifies the opportunities which exist in the short, medium and longer term for the economy of NI, and for the population as a whole, arising from the significant investment which has been undertaken in building a high speed communications infrastructure

• Highlights the opportunities and challenges for local companies to develop new products and to evolve new services Jul. ‘11

• Examines implementation of a series of e-Health actions which, for example, could provide an alternative to nursing home/hospital care and has important societal and economic implications

– 23 –

Sep. ‘10

AUTHOR

TITLE

KEY FINDINGS

PUBLICATION DATE

European Commission

eHealth Action Plan 2012-2020 - Innovative healthcare for the 21st century

• Identifies barriers to implementing nationwide eHealth strategy

Dec. ‘12

• Clarifies policy domain and outlines the vision for eHealth in Europe, in line with the objectives of the Europe 2020 Strategy and the Digital Agenda for Europe.

• Presents and consolidates actions to deliver the opportunities that eHealth can offer, describes the EU’s role and encourages Member States and stakeholders to work together

Irish Department of Health

eHealth Ireland Strategy

• Provides an outline and definition of eHealth

Dec. ‘13

• Demonstrates how citizens, Irish healthcare delivery systems - both public and private - and the economy as a whole benefit from eHealth • Identifies challenges and enablers to implementing a nationwide eHealth strategy

Proof Communications

Communicating Connected Health

• Highlights challenges for organisations operating in the emerging world of connected health

Jan. ‘14

• Demonstrates how connected health organisations can overcome major barriers to the widespread adoption of connected health technologies Scottish Development International

Digital Healthcare in Scotland

European Commission (DG Information Society & Media, ICT for Health Unit)

eHealth Strategies: Country Brief England

• Positions Scotland as a location for eHealth

Oct. ‘12

• Lists academic institutions, infrastructure and companies involved in digital healthcare space • Analyses policy development and planning, implementation measures as well as progress achieved with respect to national and regional eHealth solutions in EU and EEA Member States, with emphasis on barriers and enablers beyond technology.

• The focus is on infrastructure elements and selected solutions emphasised in the European eHealth Action Plan of 2004.

– 24 –

Oct. ‘10

AUTHOR

TITLE

KEY FINDINGS

PUBLICATION DATE

European Commission (DG Information Society & Media,

eHealth Strategies: Country Brief Ireland

• Summarises main findings and an assessment of progress made towards realising key objectives of the eHealth Action Plan

Oct. ‘10

• Presents lessons learned from the national eHealth programme, planning and implementation efforts and provides an outlook on future developments

ICT for Health Unit) Karl Stroetmann, Jörg Artmann and Veli Stroetmann

Developing national eHealth infrastructures – results and lessons from Europe

• Summaries the progress made in establishing national/regional EHR systems in EU Member States and other European countries

Oct. ‘11

• Provides an assessment of progress made towards realising key objectives of the eHealth Action Plan across Europe, • Details a variety of good practice examples and lessons learned from national eHealth programmes and related planning and implementation efforts

Wendy Currie and Jonathan Seddon

A cross-national analysis of eHealth in the European Union: Some policy and research directions

• Analyses the relationship among eHealth profiles across 27 European Union Member States.

• Reveals that four distinct country groupings emerge as frontrunners, followers, leapfroggers and laggards. Frontrunners combine a strong ICT infrastructure with relatively high adoption of eHealth technologies.

• Suggests that a one-size-fits-all approach to health IT is not recommended for EU Member States because policy-makers at the national level need to develop an eHealth roadmap that reflects national, regional and local conditions that go beyond technical imperatives.

Source: Consultancy team review.

– 25 –

Sep. ‘14

SECTION B 05 Themes Highlighted in Consultation with Stakeholders Connected Health Subsectors for Growth

What follows is a summary

5.1 CONNECTIVITY

of the key points emerging

Digital or eHealth solutions must connect all

from the consultancy team’s

stakeholders in a healthcare system – patient, physician/

engagement with stakeholders

facilitate more effective communication and transaction

clinician, payer, healthcare provider and supplier – and

during the course of the study,

among the parties involved. One of the principal

arranged by the main themes

chain is the physician. Ultimately, in most healthcare

to have emerged from the discussions.

stakeholders for the entire digital healthcare value ecosystems, physicians determine patient behaviour.

Pharmaceutical companies have an in-built association with physicians and therefore may be in a potentially strong position to drive the adoption of digital solutions through clinicians, provided their offerings address the patient’s needs. However, the connectivity opportunity is also inherently challenging. For example, some doctors are more digitally aware than others and some practitioners may therefore be less willing to consider potentially effective digital technologies that may benefit patients. Another factor illustrating the complexity surrounding connectivity is the patient’s family or informal carers (beyond paid carers and professionals). For example, in the case of dementia patients, technologies may be targeted at family members rather than the patient, who may not be in a position to use the technology.

– 26 –

Themes highlighted in consultantions with Stakeholders

In the current healthcare value chain, medical

tracking and sharing the patient’s health status

are notoriously opaque. As patients take a greater

devices companies tend not to interact directly with

and customising treatment. Any offering that does

role in managing their own care, there is a demand

clinicians but this gap may need to be addressed

not leverage the patient’s data to track and record

for tools that de-mystify pricing and value. Tools

in the environment where digital technologies

what is going on over time cannot leverage the full

to help patients evaluate health insurance options

in healthcare are expected to become more

potential. Superior offerings are seeking to go beyond

will also be needed, particularly with new users

commonplace. Forging successful relationships will

data collection and its digital expression. Intelligent

entering the system that do not have experience

be dependent on meeting clinicians’ and patients’

systems seek to make use of individual and patient

navigating their options. Greater transparency is

needs – this is the most fundamentally important

group data to identify and track changes to their

paramount in achieving better patient outcomes.

requirement to ensure greater penetration of digital

health status in real time. By considering external

Value for consumers means a combination of cost,

technologies in the healthcare value chain: doctors

factors, digitally-based treatments and solutions

convenience, and outcome. Digital technologies have

must benefit from the technologies (e.g. patient

(through the use of apps, for example) have the

the potential to add value to patient outcomes by

management systems that will enhance their

potential to become predictive instead of reactive.

helping them to better access the healthcare system

productivity and the profitability of their practices in the primary care environment) as must patients and

for their own needs (where, when and how).

5.3 PATIENT OUTCOMES

their families.

5.4 PATIENT ADOPTION Offerings must provide real value to the patient

5.2 DATA ANALYTICS

and their families (the young and the elderly, where

Successful digital health solutions must reflect

healthcare demand tends to be greatest). Digital

the whole customer journey and target specific

Successful digital health solutions must aim to

solutions have to target unmet needs and improve the

interactions in the healthcare system. By connecting

enable meaningful insights and make use of big data

human condition or life with a disease, utilising the

the stakeholders – patient, physician, payer,

to become more proactive, rather than reactive. One

full potential and broad spectrum of digital solutions.

healthcare provider and supplier – the solution will

of the undoubted major opportunities for connecting

The digital health solutions may be enabled by digital

facilitate easier communication and transaction

digital content and healthcare is the rich data

media, though they need to be led by healthcare/

between the parties involved.

maintained by healthcare providers, in the primary,

clinical imperatives. The focus needs to be on

secondary etc. points of the healthcare value chain.

patient outcomes, and not just upon time and/or

Electronic health records offer the possibility of

money savings. Healthcare costs and outcomes

– 27 –

Themes highlighted in consultantions with Stakeholders

5.5 REGIONAL LOCALISATION

policymakers because it unites a number of vastly

system works and until the regulatory bodies have

different sectors and services for the first time and

adapted so as to integrate connected health.”

Digital health solutions must reflect regional

this is new ground for most of the people policing

differences in the regulatory and care environment,

the sector’s reputation and performance. In the

understand and address local pinch-points as well

case of the communications infrastructure allowing

as adjusting their technology and value-added

devices to talk to each other, for example, the GSMA

Human-centred designs are those that respect user

accordingly. Successful digital health solutions

(Groupe Speciale Mobile Association, an international

diversity and living contexts. A first factor in this

cannot be developed as one-size-fits-all solutions.

group of mobile operators which seeks to promote

context is the user diversity. Individual differences,

The most successful offering will reflect the

connected living) suggested in a 2012 report that

such as demographic variables, computer experience,

regulatory and care environment in each respective

the main regulatory challenge in connecting digital

cognitive abilities and personality factors are all

region. Not only will it understand, but it will also

technologies and healthcare lies in striking a balance

important in explaining both technology acceptance

recognise local pinch-points and accordingly adjust

between the very different regulatory motivations

and user behaviour with respect to digital health

its value proposition. Ground-breaking and successful

of the telecommunication and healthcare industries.

products. Successful digital health solutions will

offerings need to address all of the above-mentioned

Influencing those that can help shape this regulation

offer multiple interfaces to suit the patient’s lifestyle

aspects. If only one aspect is not considered in the

is a new and considerable challenge for many

and will prioritise patient convenience, especially

solution design, chances are high that at least one

organisations entering the sector, largely because it

when products impact patients’ comfort and/

stakeholder will never experience any added value

is very different to selling technology products. As

or appearance, as is the case with, for example,

and consequently will not utilise the offering.

Emmanuelle Pierga of Orange Healthcare explains,

wearable sensors.

5.7 HUMAN-CENTRIC DESIGN

“One of my main goals is to prove that connected 5.6 REGULATORY OVERSIGHT

health works, and that it is the answer to society’s

5.8 SELLING TO MONOPOLISTIC BUYER

future healthcare problems. We are lobbying and

(‘MONOPSONY’)

The complexity of regulation and lack of qualification

targeting the people in a position to influence the

for new connected health services is currently seen

evolution of regulation in this industry before trying

Engaging with the NHS or HSE is considered by those

as a major barrier to adoption. Connected health

to convince the buyers. We are ready to implement,

with whom we consulted to be notoriously difficult

presents unique challenges for regulators and

but we cannot sell anything until we prove the whole

for private companies. According to recent figures,

– 28 –

Themes highlighted in consultantions with Stakeholders

60% of UK-based entrepreneurs from the health technology sector claim there

In the connected health space this is especially difficult; “Technology companies

is resistance within the NHS to working with private sector companies. 85%

are making a case for buying Y instead of X, rather than two versions of Y, so there

identified barriers such as excessive decision-making times and difficulty finding

is little evidence to support a change in strategy to incorporate new technologies.”

the right person with whom to speak. Over 80% feel that NHS procurement

A 2012 report from Accenture, ‘Making the Case for Connected Health’, asserted

processes are too complicated.

that connected health is not simply a tactical intervention in an organisation or

1

system, “Developing connected health means carefully orchestrating change There is other evidence , however, that the NHS is increasingly outsourcing

across the organisation that aligns directly to a mission and a vision. This

contracts to the private sector, and the Healthcare Industry Barometer 2013

transformation should have a strong positive impact on culture, management and

showed that senior figures in the private sector believe an increase in the number

clinical systems, behaviour and patient-provider-payer interactions, well beyond

of hospitals in financial difficulties will provide further opportunities for them

the changes required by technology alone.”

2

over the next few years. Stephen McComb, Centre Leader for the Connected Health Innovation Centre (CHIC), explains that the NHS looks for differentiation

Brian O’Connor, Chair of the European Connected Health Alliance (ECHAlliance),

between offerings that present a ‘better’ service versus a ‘cheaper’ service,

believes this is certainly true of the NHS in the UK, and for private technology

but ultimately organisations need to be able to offer both convincingly. This is

companies targeting the NHS for the first time this can be a seemingly impossible

extremely difficult in a tender situation, and therefore influencing the buyer at the

prospect. O’Connor warns that there is still not a complete acceptance of the

earliest point can be pivotal. “If you can connect with a buyer before the tender

need for connected health technology as a whole.

is even written, you can educate them as to what constitutes value, quality and 5.9 SUMMARY

impact.”

A tabulated summary of the above outline of the consultations is presented overleaf, where in the final column of the table we also give some examples in each case.

1 ‘The NHS must keep its pledge to embrace tech entrepreneurs’, The Guardian, November 2013 http://www.theguardian.com/healthcare-network/2013/nov/25/nhs-pledge-techentrepreneurs-start-ups.

2 ‘Arms race over £5bn in NHS work’, Financial Times, July 2013 http://www.ft.com/ cms/s/0/6424b29e-f60a-11e2-a55d-00144feabdc0.html#axzz2lr8VGEER.

– 29 –

Themes highlighted in consultantions with Stakeholders

Table 6

Summary Table of Key Themes in the Market for Connected Health THEME

STRATEGIES OF SUCCESSFUL DIGITAL HEALTH OFFERINGS

EXAMPLES

Connectivity

• Connect all stakeholders across the healthcare system

MyHealthSpecialist

• Overcome the disconnections between healthcare provider and patient (and the patient’s family, who in many instances is the only ‘voice’ of the patient – children and elderly patients)

MedXNote Nursebuddy

• Address the challenge, or opportunity, of ubiquitous digital channels – through harnessing social media, web site, apps as touch points Data Analytics

Patient Outcomes

• Take advantage of comprehensive user data (e.g. maintained by clinicians and health service executives) • Gather meaningful insights from the data, through applying quantitative techniques to the data, which can now be carried out relatively quickly • Ensure interoperability, accessibility and security of the data and results from data analysis • Use big data to become predictive, not reactive, for the benefit of patients and their families

OralEye

• User smart solutions that offer tangible value-add: time, quantity though most importantly, outcomes (that can be measured)

MySugr

Nutritics MySugr

RestoredHearing goACT

Patient Adoption

• Follow-on customer journeys – target specific interactions in the healthcare system

Nursebuddy goACT RestoredHearing

– 30 –

Themes highlighted in consultantions with Stakeholders

THEME

STRATEGIES OF SUCCESSFUL DIGITAL HEALTH OFFERINGS

EXAMPLES

Regional Localization

• Reflect regulatory and care environment • Understand and address local pain/pinch-points • Adjust technology and value-add accordingly

Pharmapod MySugr Nursebuddy

Regulatory Oversight

Phamapod • Need to engage with regulator and shape regulation • Prove efficacy • Need to engage with the professional regulatory bodies and ultimately the potential of digital healthcare RestoredHearing needs to be recognised in the academic and professional training of healthcare professionals/decisionmakers

User-Centric Design

• User multiple interfaces to suit patient/family lifestyle • Consider patient convenience (e.g. wearable sensors)

RestoredHearing

• Improve patient-provider-payer interactions • Identify and address unintended barriers to greater adoption of digital healthcare • Need to educate the buyer on what constitutes value, quality and impact

MedXNote

Monopolistic Buyer

OralEye

Nursebuddy

Source: Company websites and interviews with founders of Nutritics, Pharmapod, MedXNote, OralEye, MySugr, Nursebuddy, TouchSurgery, MyHealthSpecialist, TransplantBuddy, Silvercloud, TickerFit, goACT, RestoredHearing, John Nosta (journalist and writer for Forbes.com).

– 31 –

06 Criteria used to determine relevant subsectors In identifying relevant

6.1 NATURE AND INTENSITY OF LINKS

academic expertise and resources in each part of the

subsectors with the most

BETWEEN CONNECTED HEALTH AND DIGITAL

eligible area and in the countries concerned, meaning

CONTENT SECTORS

the capital cities of Ireland and Scotland as well as

promising outlooks for growth in the eligible area, we devised a list

the regional resources in Belfast, Galway, Glasgow, The first criterion is the extent to which connected

Derry/Londonderry, Letterkenny, Dundalk etc.

health activities currently utilise digital content to

of criteria to select the strategies

deliver their services or enhance their offering to

that offered the best collaborative

large extent on building on, and diversifying, the links

The internal markets for connected health within

gained to date.

the eligible area are not large enough to sustain

potential with the digital content sector in the Honeycomb eligible area.

6.3 EXPORT-ORIENTED

the customer. Further convergence will rest to a

a significant number of technology suppliers. The 6.2 LEVERAGE LOCAL INDUSTRY AND

leaders in the field will undoubtedly have to export

ACADEMIC RESOURCES

the majority of their production to countries and regions outside the region of interest. This has

Any initiative to build and capture value by addressing

implications for the design and functionality of

the opportunities in connected health and digital

products and services as well as for the type of

content must leverage existing business success

organisational structure that will be successful in the

stories. Several successful and well-known

marketplace. Subsectors that exhibit a high degree

companies have already paved the way. Kainos and

of features that cannot be transferred or translated

Almac are examples of such companies in the NI part

for export markets will not be as successful as

of the eligible area. The wider Honeycomb region is

subsectors in which products and services are more

today home to scores of leaders in their respective

homogeneous between regions or can be adapted

markets be that in medical device development and

relatively quickly and at low cost for deployment in

manufacturing or pharmaceutical testing and related

external markets.

services. In addition, the convergence opportunities between the sector must also be plugged into

– 32 –

Themes highlighted in consultantions with Stakeholders

6.4 TAPS SKILL BASE

6.5 ADDRESSES A REAL PROBLEM – MEETING

is likely to be tentative because of the threat posed

NEED AS WELL AS BEING TECHNOLOGICALLY

by potential new entrants, even if actual competition

SOUND

within some markets may seem to be lessening.

existing skills developed in academic/research

A technologically sound solution designed for the

Technological advances will ensure maintenance

institutions, private industry and/or the public

connected health market will likely fail if it does not

of competitive pressures and thereby open up new

health service. Fortunately, market entrants in the

command a market demand or need and vice-versa,

market opportunities for entrants, provided, of

eligible area can draw on all three sources. Those

in which case the list of criteria needs to include

course, that their offerings are technologically sound

companies that can best attract talented and skilled

soundness in respect of both the demand and supply-

and meet a user need, as outlined earlier.

employees will exert a significant advantage over

side of the relevant market.

The extent to which a connected health market opportunity can be captured will depend upon the

their competitors. Owing to the fragmented nature of

Europe lags behind the US, as outlined earlier, but

the digital content sector in the Irish and NI parts of

this need not detain or stop the eligible area from

the eligible areas, the main skills base on the island

6.6 COMPETITIVE LANDSCAPE AND

benefiting from the developments underway in

of Ireland capable of facilitating the development of

SPEED OF INDUSTRY

connected health. Accordingly, the potential for the

links with healthcare will likely be in the main urban centres, especially Dublin and Belfast.

region to attract FDI from connected health firms The pace of technical change in the healthcare

(US) will also be important – in addition to supporting

industry has increased over the past few years.

indigenous entrepreneurs and enterprises emerging

Due to a number of factors, the US has taken the

within the eligible area.

clear lead in developing digital health solutions.

Certain sectors, such as clinical workflow, are highly competitive and contested by hundreds of competing companies. In the most advanced subsectors, large suppliers are already exhibiting oligopolistic behaviour (i.e. there are some signs of market concentration and market power) – but this tendency

– 33 –

07 Relevant subsectors for collaboration and growth By applying the criteria outlined above, we eliminated a number of subsectors that do not or are unlikely to satisfy one or more of the conditions.

In addition, we also compared the list of relevant subsectors to independent analysis completed elsewhere of the categories that continue to attract funding in the form of venture capital. What results is a selection of the most promising subsectors for enhanced collaboration between the digital content and connected health sector in the eligible area.

– 34 –

Relevant subsectors for collaboration and growth

Table 7

Subsectors of the Connected Health Market with the Most Promising Growth Potential MARKET SECTOR

KEY SUBSECTORS

GLOBAL MARKET SIZING 2014

• Big Data/Predictive Analytics

$6.0bn*

Digital content becomes increasingly important to making sense of, presenting and making decisions based upon health and health-related data and information.

• Physician Training & Patient Education

$3.0bn*

Emerging use cases with 3D, excellent use of media in health, links with university and researchers.

• Assisted Living/Aging with Vitality

$3.3bn

Addressing a large and growing needs problem as populations get older; excellent fit with digital content developments.

• Virtual/Care Coordination & Navigation

$4.1bn

Large excellent fit with digital content technologies (existing and to come).

• Behavioural & Emotional Health Tracking

$1.7bn

Lower competition than fitness or nutrition; addressing a growing need as mental illness becomes mainstream and more accepted.

• Patient Engagement & Advocacy

$3.1bn

Addresses a key problem of health ‘adherence’; good use of digital media currently.

• Self-Diagnosis

$3.0bn*

Good use of digital media currently (e.g. eye care, skin conditions) and taps into medical device industry expertise.

• Remote (Vital Sign) Monitoring

$3.8bn

Existing skill base and excellent local links; good use of digital media to visualize and interact with data.

Infrastructure

Treatment

COMMENT

Engagement

Diagnosis

Source: Accenture, Arthur D Little, PricewaterhouseCoopers, KPMG. Notes: * Author estimates based on research contained in reports by Accenture, Arthur D Little, PricewaterhouseCoopers, and KPMG.

– 35 –

Relevant subsectors for collaboration and growth

7.1 INFRASTRUCTURE: ANALYTICS AND

7.1.1 ANALYTICS

In order to achieve these objectives, analytics

TRAINING

Analytics can provide the mechanism to sort through

(including the use and analysis of big data sets) needs

the complexity of data in health, and help healthcare

to be both content-driven and clinician-driven, and

Infrastructure is by far the largest market sector

organisations to deliver on the demands placed

supported by health executive systems (like the NHS

within the global health industry and has also

upon them. Analytics may be descriptive, predictive

and the HSE) and by regulatory authorities, including

received the most amount of funding over the

or prescriptive and encompasses everything that

those responsible for the regulation of the medical

past decade. As the implementation of systems to

supports fact-based decision making for planning,

professions (GPs, hospital consultants, dentists and

manage health records and patient data continues

management, measurement and learning. Supporting

allied professions)

apace, the sector is maturing. The sector is still

technologies may also simply remove barriers to

highly competitive with hundreds, if not thousands,

collection and understanding data. The objectives of

7.1.2 TRAINING

of software and hardware suppliers. A few large

applying analytics in healthcare are to:

Training covers both simulation of medical

players, however, are beginning to exert strength

• Improve clinical quality of care and/or patient

procedures and clinical scenarios using a variety of

in the sector. In the area of health infrastructure, the competitive landscape and relative dynamics of industry events are the key determinant of whether a subsector presents an attractive opportunity.

The subsectors that represent attractive growth opportunities are those in which the competitive landscape is still fluid without appreciable market

safety as well as reduce medical errors;

physical and virtual technologies. Virtual reality and

• Improve wellness, prevention and disease

computer-enhanced simulation represent the future

management;

of medical education. Despite the embryonic nature

• Understand physician profiles and clinical performance;

of the technology, several applications have already shown themselves to be effective teaching tools

• Improve customer satisfaction, acquisition and retention.

(including in universities in Ireland and Scotland).

Given this early success and the near certainty that

power. Two subsectors in particular are at an early

computer and engineering technology will continue

stage in their development: analytics and training.

to advance rapidly, the potential of virtual reality and simulation for medical education and training is astounding. It is envisaged by those with whom we spoke that, once they have reached a sufficient level

– 36 –

Relevant subsectors for collaboration and growth

of sophistication and cost-efficiency, VR applications

Table 8

and simulators will be broadly accepted into medical education. One can easily foresee an educational system in which medical students and residents will

Subsectors of the Connected Health Market with the Most Promising Growth Potential – Subsectors within Healthcare Infrastructure

first learn procedures and other elements of patient care on simulators or in the virtual world. Once these trainees have safely mastered certain basic skills, they can then begin to hone these skills

SUBSECTOR

POTENTIAL USES

Analytics

• Evidence-based medicine • Population wide data to aid research (public heath, epidemiology) • Predictive analysis • Data visualisation in healthcare • Early disease detection • Patient outcome tracking

Training

• • • •

with patients in the real world.

Virtual reality devices & 3D imaging Advanced simulation software Gamification of training applications Distance medical education

Source: Consultancy team review and analysis.

– 37 –

Relevant subsectors for collaboration and growth

7.2 TREATMENT: PERSONALISED AND ASSISTED CARE COORDINATION

Table 9

7.2.1 ASSISTED LIVING

Subsectors of the Connected Health Market with the Most Promising Growth Potential – Subsectors within Healthcare Treatment

Assisted living technologies offer a promising perspective on autonomous aging in place. This is in the interests of the older patients themselves, family and careers, not forgetting policymakers struggling to control healthcare budgets in the face of the ever- growing elderly population.

However, these technologies are still in their infancy and little is known whether older adults, and/ or their families/carers, are ready to adopt and use them. Much depends on the state of the elderly patients themselves – their physical and mental/memory capabilities – and the extent to which they can live independently. In the nursing home and hospice sectors, where many elderly people spend

SUBSECTOR

POTENTIAL USES

Assisted Living/ Aging with Vitality

• Assisted living games, social, video, sound and hardware • Assisted living and video, images, memory-loss, music, games • Social media and ageing with vitality • Health infotainment • Emergency health advice via telephone and remote monitoring devices • Audio/visual user interfaces

Virtual care

• Social media and chronic disease management • Real-time health information and services delivery – such as teleradiology and tele-cardiology • Communication among multidisciplinary care teams

their remaining time, assisted living continues to be needed by the health professionals looking after their elderly residents, even if their independence has deteriorated since they left their homes.

Thus, with the proportion of elderly people aged over 65 years set to grow in the coming years and decades in the eligible area and in other advanced economies, there will likely be an increasing demand for assisted living technologies, whether in the home or in the nursing home or hospice environments – cost will likely become a key factor as well as need and technological soundness.

7.2.2 VIRTUAL CARE Virtual care represents a major shift in current standards and delivery of care. Virtual care would extend reach and expand service to patients who require more access, such as patients who live in rural or remote areas. It has the potential to minimise hospital admissions and re-admissions by addressing non-emergency health concerns via digital means. Virtual care could also ease the burden of monitoring and managing long-term and post-hospital patient care while patients recuperate in their own home. Economically, virtual care could increase the number of patients who can be seen and treated during a given period of time and potentially open new revenue streams in the form of virtual consultations.

Source: Consultancy team review and analysis.

– 38 –

Relevant subsectors for collaboration and growth

7.3 ENGAGEMENT: EMOTIONAL HEALTH TRACKING, PATIENT ENGAGEMENT AND ADVOCACY With sensors, smart phones, wearable devices and

Table 10

Subsectors of the Connected Health Market with the Most Promising Growth Potential – Subsectors within Healthcare Engagement

mobile apps, one can today track just about every aspect of one’s physical health – from nutrition to physical activity to vital signs. But a range of new

SUBSECTOR

POTENTIAL USES

Behavioural & Emotional Health Tracking

• Apps that make use of digital media within a programme of cognitive-based therapy to improve, measure and manage moods in specific situations

Patient Engagement Patient Advocacy

• Applications that leverage digital media to trigger and motivate prescribed or beneficial behaviour for patients

apps is showing that beyond tracking steps, counting calories and recording heart rate, one’s smart phone can now track mental health in addition to physical health. App developers are already beginning to consider tackling some of the biggest mental health issues faced today.

Source: Consultancy team review and analysis.

– 39 –

Relevant subsectors for collaboration and growth

7.4 DIAGNOSIS: SELF-DIAGNOSIS AND HOME MONITORING Self-diagnosis is about to undergo a new period of growth as devices and software get more

Table 11

Subsectors of the Connected Health Market with the Most Promising Growth Potential – Subsectors within Healthcare Diagnosis

sophisticated. There are home tests for an array of conditions, including high cholesterol levels, gluten intolerance and sexually transmitted infections like HIV and syphilis (at the time of finalising this report,

SUBSECTOR

USE CASES

Self-Diagnosis

• Connected devices as diagnostic tools • Interactive symptom checklists • At-home diagnostic products are today many and varied, and include (but are not limited to): blood glucose monitors, home pregnancy tests, blood pressure monitors, blood cholesterol level monitors, heart-rate monitors, kits that require a blood or other tissue sample to be sent for testing, HIV, Hepatitis C and DNA tests that can be used to evidence paternity

Remote (Vital Sign) Monitoring

• Clinical trial, testing, management • Record keeping/health identifiers and social media • Health identifiers and devices to aid in the prevention, diagnosis and treatment of diseases using remote monitoring tools

the first legally approved HIV self-test kits went on sale in Great Britain). Many are quick and easy to use, generally requiring only a finger-prick, or a urine sample. They can also, in some cases, actually do what their labels claim: uncover indications of a medical condition (which would necessitate further consultation with a medical practitioner).

Source: Consultancy team review and analysis.3

3 See also http://medcitynews.com/2014/10/digital-areas-offer-greatest-least-investment-risk/.

– 40 –

08

SECTION C

Company measures

8.1 CONSUMER COMPANIES IN HEALTHCARE Generally speaking, consumer products firms tend to have strong brands and command consumer loyalty, and they also tend to be in a better position to create new markets for health products because of their large existing consumer bases. These firms may be considered potential entrants or competitors to the connected health market, either by themselves or in conjunction with specialist digital content providers.

The healthcare market is maturing, with better-informed patients with a desire for more information and looking for ways to make use of their data. However, when selling to healthcare providers, the market is extremely challenging for new players and particularly so for those without a device to demonstrate.

They have no idea what a telecoms provider can do in healthcare and do not understand the power of data transfer in this industry. The main challenge for us is to create an identity in healthcare; for technology companies without a new tangible product, showcasing the relevance of a broad technology capability is not easy.”

Emmanuelle Pierga, Orange Healthcare

– 41 –

Measures to Assist Growth

Company measures

Dan Jones from th Association of British Healthcare

“Many are trying to stay on the consumer side so as

that increasing numbers of services will be delivered into

Industries (ABHI) also warns that consumer firms

not to have to deal with it, which may hold them back,

people’s homes, brings with it new aspects of risk and

must not underestimate the difficulties faced in

but I expect the market to change and become more

vulnerability considerations for healthcare providers.

regulating their products within the medical space:

encouraging as the first big wins come through.”

Perhaps more challenging still is the need to understand

The regulation process is considerably

Consumer organisations will also particularly

consumer needs and attitudes, particularly buying

more difficult in healthcare than it is for

struggle with distributing through healthcare

behaviours, which have never been more important for

standard consumer apps, for example, and

professionals because they lack relationships

medical devices makers. Turning these insights into

there is currently not a great deal of direct support

with this community, and the duration of the sales

products and features – with consumer-friendly interfaces

available in terms of helping organisations to navigate

process. Emmanuelle Pierga says Orange Healthcare

– and marketing them effectively poses further difficulties.

the regulatory minefield. I expect we will see the level

has been talking about connected health and

Many organisations would benefit from the support of third-

of support improve further down the line, but for now

influencing key audiences for ten years;

party experts in these fields.

“It is especially slow because it relies

Sue Dunkerton of the HealthTech KTN adds that

on public will as much as professional buy-in”.

organisations originating in the medical space will also

the healthcare sector is dealing with a number of more pressing challenges.”

Regulatory challenges are impacting the nature of products currently in development, according to Sue Dunkerton, Co-Director of the HealthTech and Medicines Knowledge Transfer Network (KTN).

Dunkerton suggests that, whilst the healthcare industry is regulated for good reason, many product developers are trying to avoid the challenge;

struggle to identify and measure success in a consumer 8.2 MEDICAL COMPANIES IN THE

world; “How do you know what’s a good system and what

CONSUMER SPACE

isn’t? Listening to the consumer voice – reviews and frequency of use – will be the only way to know.”

Medical devices companies, on the other hand,

Dunkerton expects that connected health will follow a

have more credibility and experience working with

consumer model initially, which is already sparking interest

care providers and navigating the strict regulatory

with the ‘worried well’ and the IT literate. She suggests,

requirements; but there are challenges aplenty in

“The healthcare industry is likely to be the follower in this

the emerging connected health space. The tele-

sector as the consumers start to realise what is possible

care proposition, for example, where it is expected

and help create the demand in the more classic healthcare market.”

– 42 –

09 Measures to develop skill sets and strengthen networks It is widely accepted by those with whom we consulted that key to

In addition to this, other networking initiatives to aid in convergence between the digital content and connected health sectors include:

providing technologically sound and market/

• Development of a freely accessible database of ideas in

demand-oriented products and services at

• Speaking events from experts in clinical efficacy

competitive cost/price is the need to facilitate linkages between established companies in the healthcare industry and enterprises in the digital

connected health; and clinical trials; • Liaising with national and local enterprise agencies to champion the potential of connected health and the interfacing of digital media and

media and connected health sectors, including

healthcare – to ensure that

entrepreneurs and freelancers. Networking

is recognised and advanced

this particular opportunity

events between such companies, under a

in national enterprise policy,

special conference theme, can facilitate such

of the business support

linkages, and academic institutions, such as Dundalk Institute of Technology, can assist in the process, by promoting and organising such events.

so that it becomes part infrastructure; • Third-level institutions ensuring that the skills sets are available to support the convergence of eHealth and related technologies.

– 43 –

10 Measures to boost funding and increase support Information regarding the

As such, funding streams can be drawn from

to be focused in capital cities and is a rare form

different types of funding

many sources, with different capital and timeline

of finance in general to IT firms in the eligible

requirements of each, including:

area. However, this situation can often reflect a

needed by companies seeking to

simple lack of information about what is occurring • Research grants and pump-priming funding, which

in practice and there is a role for institutions like

are available from public bodies throughout the

DkIT to address such market failures by making

health and digital media is also

eligible area, through competitive application, and

VC firms more aware of existing activities and

from other organisations, such as the Welcome

potential opportunities. As may be expected, to

relevant.

Trust. Research grants are also available through

gain the attention of VC investors, pitches and

the NHS primary care trusts, including for projects

businesses cases, if they are sought, need to be

It is generally felt by stakeholders consulted that

capable of demonstrating cost reduction and/or

world-class and compelling to gain the interest of

connected health projects can be created with

enhanced patient outcomes.

this form of capital.

bridge the gap between connected

relatively little capital, as shown in the wider digital media/IT sector, but the clinical utility of

• Accelerators and business angel funding, which

it must be paramount, requiring early input from

can play an important role in disseminating

funding, whereby companies can access funding

clinical centres. That is why collaborative networks

knowledge, acting as an archive of projects (what

informally through social media by enticing wide

highlighted above are seen to be so important –

has worked, and what has not), adding key team

share/equity share ownership. However, the

bringing different skill sets from IT and healthcare

members and expertise, and offering mentoring.

regulation of the practice is still in its infancy and stakeholders with whom we spoke do not expect

together to address a new technology opportunity with a market need.

• Crowdfunding – this is a relatively new form of

• Venture capital, which is especially alert to the

it to fund projects which are more than one year

opportunities associated with digital media and

from delivery, or companies that do not have a

connected healthcare, although VC activity tends

consumer-orientated device.

– 44 –

11 Measures to catalyse cultural change in healthcare In bridging the fast pace of digital media

11.1 CULTURAL CHANGE AMONG

11.2 INCREASED AWARENESS OF THE

CLINICIANS AND PATIENTS

COMMUNICATIVE/TRANSFORMATIVE POWER OF DIGITAL MEDIA

activities, we see the difference

The increasing availability of personalisation of

in the way healthcare moves and

healthcare means that it is being rapidly devolved

Digital media empowers the end user, but it is glib to

to the consumer. This is shifting the relationship

suggest this without also acknowledging the shift in

determines solutions. This gap

between clinician and patient, with greater

control away from the provider. Research suggests

empowerment of the latter, which would be a

that over 70% of the buying decisions in the US today

must be bridged and requires a

salient feature of eHealth or connected health. This

are made before a sales or marketing impression

inexorable shift needs to be embraced by clinicians to

is made upon the consumer. This is driven by

aid the realisation of connected health opportunities.

consumers researching their own solutions and being

allow co-development to occur

This will require a combination of education (at

empowered and enabled to deliver upon those by the

(timeframes in IT tend to be

academic and professional level in the formation of

shift towards digital media. This commoditisation

clinicians) as well as acceptance of the trend through

and consumer enablement is a global shift and is

economic forces.

unheralded by the clinical profession to date.

cultural shift in both sectors to

much more rapid compared with healthcare).

– 45 –

Measures to catalyse cultural change in healthcare

11.3 COLLABORATION WITH UNIVERSITIES AS CUSTOMERS

11.4 MOVE AWAY FROM A ‘ONE-SIZE-FITS-ALL’ APPROACH

Medical schools and allied medical schools giving rise to the academic

Digital media enables ‘mass ‘customisation’. This is the approach that has

development of nurses and physiotherapists, for example, need to embrace

already been felt by traditional industries such as media, whereby the mass

the trend by becoming customers of new technologies and media for

population can personalise and directly plan their activity online, be that

communicating/managing consumers in the pursuit of healthcare. They

preventative and/or treatment of healthcare conditions. Medicine has actually

are the conduits to larger research budgets, they are the sources of

already started to make this transition, with the move towards biologics being

innovation through both sectors and as such, third-level institutions have

targeted against specific sub-sub population cohorts, but digital media allows

a responsibility to aid the convergence of digital media/healthcare for the

this level of customisation by clinical group to occur also.

benefit of the wider population.

The move away from the one-size-fits-all approach is also evident in the strategies and practices of the world’s major pharma companies, where the trend today is towards niche-buster treatment and away from former blockbusters, which may not work for all patients and populations, or may be too blunt a response for smart infections.

– 46 –

CONCLUSION The opportunities for connected health

placed centre-stage. In this report, we have set

– which brings together technological

out the background and content to this important

developments in the digital content sector with

development and looked at the key sectors

healthcare – are firmly on the radars of the

where we believe the opportunities for enhanced

respective health executives in Ireland, Northern

connections between digital content and healthcare

Ireland and Great Britain, and more widely across

are likely to occur in the eligible area in the coming

the European Union and the US, reflecting the

years, based on objective criteria and measures

transition to more effective and cost-competitive

most amenable to assisting the growth of eHealth in

healthcare provision, where the patient is being

the countries.

– 47 –

References Accenture (2012) ‘Making the Case for Connected Health’, http://www.accenture.com/SiteCollectionDocuments/PDF/ Accenture-Making-Case-Connected-Health.pdf.

European Commission (2010) ‘eHealth Strategies: Country Brief England’, http://www.ehealth-strategies.eu/database/ documents/England_CountryBrief_eHStrategies.pdf.

Health Service Executive (2013) ‘eHealth Strategy for Ireland’, http://www.hse.ie/eng/about/Who/OoCIO/ ehealthstrategy.pdf.

BioBuisness (2010) ‘Connected Health in Ireland – An All Island Review’, http://www.cardi.ie/userfiles/Connected_ Health_in_Ireland_An_All_Island_Review.pdf.

European Commission (2010) ‘eHealth Strategies: Country Brief Ireland’, http://ehealth-strategies.eu/database/ documents/Ireland_CountryBrief_eHStrategies.pdf.

Health Service Executive (2013) ‘National Service Plan 2013, www.hse.ie/eng/services/Publications/corporate/ NSP2013.pdf

Currie, W. and Seddon J. (2014) ‘A cross-national analysis of eHealth in the European Union: Some policy and research directions’, Information and Management, Vol. 51, Issue 6, pp. 783-797 (http://www.sciencedirect.com/science/ article/pii/S0378720614000536).

European Commission (2012) ‘eHealth Action Plan 20122020: Innovative healthcare for the 21st century’, https:// ec.europa.eu/digital-agenda/en/news/ehealth-action-plan2012-2020-innovative-healthcare-21st-century.

Honeycomb (2014) ‘Baseline survey of the Digital Content Sector of Creative Industries in Northern Ireland (excluding Greater Belfast), west of Scotland and six border counties in the Republic of Ireland: Summary Report’, report produced in conjunction with Ashbrook Research and Consultancy.

Department for Communications, Energy and Natural Resources (2011) ‘Baseline Report on eHealth Development in Ireland’.

Department of Health (UK) ‘Digital Health’, https:// digitalhealth.blog.gov.uk/2012/12/20/the-dh-digitalstrategy/.

Department of Health, Social Services and Public Safety (2011) ‘Connected Health and Prosperity Memorandum of Understanding Between The Department of Health, Social Services and Public Safety, and Invest Northern Ireland (Sponsored by the Department of Enterprise, Trade and Investment)’, http://www.dhsspsni.gov.uk/connected_ health_mou_dhssps_and_invest_ni_2.pdf. eHealth Task Force Report (2012) ‘Redesigning health in Europe for 2020’, http://ec.europa.eu/digital-agenda/ en/news/eu-task-force-ehealth-redesigning-healtheurope-2020.

European Commission (2015) ‘Digital Single Market: Bringing down barriers to unlock online opportunities’, http://ec.europa.eu/priorities/digital-single-market/.

Groupe Speciale Mobile Association (2012) ‘mHealth and the EU regulatory framework for medical devices’, http://www.gsma.com/connectedliving/ wp-content/uploads/2012/03/mHealth_Regulatory_ medicaldevices_10_12.pdf.

Groupe Speciale Mobile Association (2012) ‘Policy and regulation for innovation in mobile health’, http://www.gsma.com/ mobilefordevelopment/wp-content/uploads/2012/04/ policyandregulationforinnovationinmobilehealth.pdf.

Groupe Speciale Mobile Association (2012) ‘Understanding Medical Device Regulation for mHealth A Guide for Mobile Operators’, http://www.gsma. com/connectedliving/wp-content/uploads/2012/03/ gsmaunderstandingmedicaldeviceregulationformhealth report1.pdf.

– 48 –

IBM (2012) ‘The value of analytics in healthcare: From insights to outcomes’ http://www.ibm.com/smarterplanet/ global/files/the_value_of_analytics_in_healthcare.pdf.

Momentum (2014) ‘Northern Ireland: A Global Leader of the Digital Economy – A Sectoral Action Plan’, http://www. momentumni.org/getdoc/5b9eb664-b17e-41ef-a1781d4a52acb598/Digital-Action-Plan-Cover---Copy.aspx.

OECD (2014) ‘Measuring the Digital Economy: A New Perspective’, http://www.oecd.org/sti/measuring-thedigital-economy-9789264221796-en.htm (also available at http://ec.europa.eu/eurostat/documents/341889/725159/ OECD+Manual+Measuring+the+Digital+Economy/641 8c566-4074-4461-9186-9ad509bc4a4d).

Oliver Wyman (2014) ‘The Patient to Consumer Revolution’, http://www.oliverwyman.com/content/dam/oliver-wyman/ global/en/images/insights/health-life-sciences/2014/ October/The-Patient-To-Consumer-Revolution.pdf.

References

PMCA Economic Consulting (2015) ‘Foresight Report on the Digital Content Sector in Ireland and the Irish Border Counties’, prepared for Dundalk Institute of Technology (PMCA in association with Ruby Consulting).

Ziefle, M. and Röcker, C. (2011) ‘Human-Centered Design of E-Health Technologies: Concepts, Methods and Applications (2011), http://www.humtec.rwth-aachen.de/ files/igi_book_wilkowska_ziefle_2011_1.pdf

Proof Communications (2014) ‘Communicating Connected Health’, http://proofcommunication.com/connectedhealth.

Royal College of Surgeons in Ireland (2011) ‘smjstaff review: eHealth:Ireland’s approach to medicine in the digital age’, http://www.rcsismj.com/4th-edition/ehealth/.

Saddle Ranch Digital (2012), Author: Paul Flanigan ‘Digital Media in Healthcare: Bringing the Patient, the Staff, and the Hospital Together’ http://www.digitalsignagefederation. org/Resources/Documents/Articles%20and%20 Whitepapers/SRDPaper_Digital%20Signage%20in%20 Healthcare.pdf.

Scottish Development International (2012) ‘Digital Healthcare in Scotland’.

Sinclair Stockman (2010) ‘Digital Northern Ireland 2020’, https://secure.investni.com/static/library/invest-ni/ documents/digital-northern-ireland-2020-report.pdf.

Stroetmann K., Artmann J. and Stroetmann, V. (2011) ‘Developing national eHealth infrastructures – results and lessons from Europe’, AMIA Annual Symposium Proceedings Archive, pp. 1347-1354 (http://www.ncbi.nlm. nih.gov/pmc/articles/PMC3243126/).

The Guardian (2013) ‘The NHS must keep its pledge to embrace tech entrepreneurs’, http://www.theguardian. com/healthcare-network/2013/nov/25/nhs-pledge-techentrepreneurs-start-ups.

– 49 –

Annex I Examples of connected health initiatives supported by Honeycomb MEDUCATE Meducate is an app that allows patients to

Working with the Belfast Health and Social Care Trust,

understand more about their current medical

Meducate has identified prostate cancer as a suitable

condition and any associated treatments for their

user group for the first iteration of the app. This smaller

condition. This understanding will have many

pool of individuals will allow Meducate to monitor the

benefits as people absorb information and transmit

impact on the patients, as well as to focus on the quality

information in different ways and the traditional way

of the technology, the structure, the interface and the

in medicine of providing leaflets may not work for

adaptability features. These can be developed further

everyone.

before the product is adapted not only for other cancers but also for other medical conditions including diabetes,

Meducate presents information to a patient in a

mental illnesses etc.

way that can be altered to every individual patient’s learning needs. No other method of delivery of

Ulster University, the driving force behind Meducate, is

patient information similar to Meducate exists in the

currently collaborating with the Belfast Trust to write

UK, Ireland or Europe. The Meducate technology

the protocols and ethics for this pilot version focusing

will be available in a mobile format so that patients

on Prostate Cancer. The pilot to demonstrate that this

can use it in private or with family members. Most

method of delivery will enable patients to have a better

importantly, it will be available to them 24/7, so

awareness of their condition, help them to understand

that they can absorb, process and evaluate the

their treatments and help the hospital with patient

information in their own time.

consent of chosen methods of treatment.

Currently, Meducate is developing a pilot of the

It will also alleviate the problems associated with

technology to a smaller group of patients that will

self-diagnosis through the use of external/unapproved

allow for continuous evaluation and feedback before

sources of information and will also allow patients’

the application will be restructured and populated

families to understand better their loved one’s conditions

with content applicable to other conditions.

and treatment.

– 50 –

The benefits of Meducate include: • Assists with patient consent • Decreases the potential for misinformation, increasing peace of mind for the patient • Heightened trust in medical practitioners • Reduces toxicity of potential side effects of approved

For further information on

treatments

Meducate, contact Martin

• Reduces time and costs of patient care

McGinn at Ulster University on mh.mcginn@ulster.ac.uk

Annex 1

VBOT MEDICAL TV VBOT Medical TV for hospitals and healthcare

The apps allow registered users to easily record,

VBOT in Use - Medical staff training video for

organisations can enhance delivery of care at a

review and upload their smartphone or tablet

embedded learning modules

distance between patients, clinicians and specialists.

recordings via VBOT’s 2- clicks app design.

Video-enabled training exposes healthcare professionals and students to a greater variety of

VBOT’s mobile-centric video software integrates high-definition video recording and playback

Health organisations can ingest and control

cases, experts and treatment scenarios that can

applications to enable convenient access to efficient

reference videos (training, lectures,

be gathered and shared among hospitals, medical

patient care.

rehabilitation videos, conference videos, interviews)

schools and research centres around the world.

in order to create learning modules that can be

Video-enabled training is more convenient, accessible

From video training material for medical staff

personalised, privately distributed and viewed via TVs

and affordable than ever before and it is easy to

and patient pre-assessments recorded on their

and other devices such as tablets, smartphones and

manage and update, which is ideal for health care

mobile phones to personalised video physiotherapy

web browsers.

organisations with limited technical capabilities.

programmes – VBOT Medical TV provides flexibility, safety and full control of video assets.

Video material can be published in video players and apps for mobile, web and TV for a range of purposes,

VBOT’s secure mobile recording applications are

such as:

For further information on VBOT

specially designed for:

Medical TV, go to • training

http://vbot.tv/

• controlled recording

• research

solutions/#medical-tv or contact

• data protection curation

• learning

Frédéric Herrera on fred@vbot.tv

• filtering control

• communications

or +353 86 0256358.

• auto-archiving for reporting purposes.

• marketing

– 52 –

The Honeycomb - Creative Works Team STAFF AND MANAGEMENT COMMITTEE

PROJECT PARTNERS

David Brown

Fiona McElroy

Ulster University

Scottish Programme Coordinator, Creative Skillset

Programme Manager, Ulster University

Dundalk Institute of Technology

Dr Paul Beaney

Stephen Michael

Project Director, Ulster University

Web Developer, Ulster University

Deirbhile Doherty

Dr Colm Murphy

Finance Assistant, Ulster University

Intelligence Director, Ulster University

Professor Sarah Edge

Aisling Murtagh

Creative Scotland

Skills Director, Ulster University

Research Associate, Ulster University

Letterkenny Institute of Technology

Kevin Fearon

Dr Douglas Nanka-Bruce

Networks of Scale Coordinator, Dundalk Institute of Technology

Research Associate, Dundalk Institute of Technology

Professor Nick Higgins Research Associate, University of West Scotland

Ian Kennedy Management Committee, Creative Skillset Northern Ireland

Camilla Long Skills Coordinator, Ulster University

Irene McCausland Management Committee, Dundalk Institute of Technology

Caroline O’Sullivan Skills Coordinator, Dundalk Institute of Technology

Maria Prince Programme Administrator, Ulster University

Alasdair Smith Management Committee, Creative Skillset Scotland

Agnieszka Walsh, Project Administrator, Dundalk Institute of Technology

Dan Wilks Research Associate, Creative Skillset London

Creative Skillset University of the West of Scotland DELIVERY PARTNERS

MG Alba ScreenHI The Nerve Centre

– 54 –

Design by Elementdesign.ie

About Honeycomb The Honeycomb – Creative Works programme is a collaborative project led by Ulster University, in partnership with Dundalk Institute of Technology, Creative Skillset and the University of the West of Scotland.

Honeycomb is part-financed by the European Union’s European Regional Development Fund through the INTERREG IVA Cross-border Programme managed by the Special EU Programmes Body.