eCare & Ageing

With people living longer than before, but also with changing behaviours and expectations, our society and the place and role of older people in it changes constantly. Care providers, employers and civil society have to keep abreast of those changes. Supporting them in addressing the challenges arising from this is one of our core competencies.

Policies, Strategies & Markets

One of the key challenges of European care systems today is to improve the quality, availability, and access to their services. At the same time, the sustainability of present care systems is endangered by the limited availability of financial, human, and other resources, as well as by the spread of chronic diseases among the young and the old, changing ratios of active and retired people and rising expectations of citizens and professionals. ICTs are a promising means to tackle these challenges, but they are often and too easily declared as a fast way out for many problems. Reality is however more complex and a range of barriers exist including uncertainty about the role and relative value of ICT-based solutions in meeting the needs of clients, professional and organisational willingness and capacity to change.

Policy and practice have to rethink, and re-structure existing strategies, directions and operational processes in order to address these challenges and ensure sustainability of our care systems. This needs to be based on a good understanding of the reality of the current situation as regards ICT-supported care provision and existing policies and governance mechanisms.

Against the background of our solid experience from many research and deployment projects and on the basis of both qualitative policy analyses and representative empirical data, we develop strategic concepts, policy recommendations and definitive courses of action for policy makers, service providers interest groups and other civil society organisations. We have extensive experience in the market validation of ICT-based care services and in studies of eHealth and eCare market trends and developments as well as benchmarking and RTD road mapping. We apply business process analyses to new organisational forms or value systems and help clients to analyse and improve their business processes and workflows.

We have provided services to the European Commission, the European Parliament, OECD, WHO, European Space Agency, global industrial players, national and regional governments as well as health & social care service providers. Our work is based on a broad understanding of policy, strategic, clinical, business and socio-economic issues surrounding health and care.

Ambient Assisted Living (AAL)

The promise of AAL, or ambient-assisted living, can be traced back to the emergence of smart home technology in the 1960s. It has grown, in step with technological progress, ever since. At the heart of AAL is the conviction that IT systems and service surrounding older people, at home and outside, can make life easier and help cope with the consequences of age-related physical and mental decline. But a plethora of research and development projects over the last few decades has shown that making good on the promise of AAL is far from easy. Before any AAL solution can become a success, end-user requirements need to be understood and brought to bear on system design, ethical requirements need to be understood and met, systems must fit into daily routines and work processes, and services must be based on viable business models.

The AAL field is one of the business areas where empirica has the longest experience, with projects dating back to the late 1980s. We offer a wide spectrum of services that is constantly updated to reflect recent developments. This includes methods for requirements analysis among older people, informal carers, professionals and decision makers; and the design of service processes. We frequently play the role of mediator between system users and developers, collecting requirements from both sides and developing workable solutions accordingly. Furthermore, we help to understand and address ethical issues on the conceptual and the practical level. By applying our tools and methods for value case development, we help IT and service providers to build sustainable economic models even for complex revenue configurations. On the strategic side, we offer market analysis, benchmarking and country comparison, as well as policy analysis and consulting.

eCare service innovation

There is widespread consent that information and communication technology (ICT) can be beneficial to people receiving health and care as well as increase service efficiency. Yet while ICTs are making their way into daily practice and life, developing eCare services that are fit for the market and beneficial for their clients remains a challenging task. Levels of uptake often remain under the expectations of providers, service clients and policy makers let alone is there an equal distribution across European countries.

Factors that contribute to the situation being as it is include the perception of the role, place and value of services such as telecare and telehealth in overall care service provision, fragmentation between different bodies with reimbursement responsibility, technology infrastructure readiness, the challenge of transition from pilot activities to mainstream service provision and many more.

Depending on situation and perspective, these factors can either be regarded as market barriers or as characteristics of the underlying service provision systems. Regardless of what they are called, these factors have to be actively addressed in order to be able to achieve successful and sustainable deployment of eCare services and to fulfil the promises of improved quality of life for older people, people with chronic conditions and family carers, of better quality of care services, and of increased efficiency of service provision.

Working with health and care providers and the IT industry has been a core and continuous activity of empirica since more than 20 years. In the framework of numerous projects we have developed our own successful approach for the design, development and deployment of eCare services. This approach covers requirements analysis, service design and implementation support, socio-economic impact assessment and business model development. It combines scientific and methodological soundness with applicability in challenging real-life contexts.

Integrating care

Older people often need different types of support at the same time, for example support with activities of daily living and chronic disease management. Today, these support services (including healthcare, social care, voluntary support and informal care) are often delivered in independently operating service silos. This leads to inefficiencies, duplication of resources, and to dissatisfaction both among the people receiving support and those giving it. At the same time, the potential of Information and Communication Technology (ICT) to support effective and efficient integrated service delivery is far from being exploited to the extend needed in order to keep Europe’s health and social care systems sustainable.

empirica‘s involvement in integrated care started in 2008, as co-ordinator of the project CommonWell and we have expanded our knowledge and experience in the field since then. As of today, we have been involved in several pilot projects and scientific studies, supporting both the development of a deeper understanding of the topic and its challenges and the deployment of sustainable integrated care services.

Accordingly we offer a comprehensive range of services, including policy analysis and consultancy, concept development, requirements analysis, service design and implementation support, business case modelling and socio-economic impact assessment, and project co-ordination and management. Our portfolio combines scientific and methodological soundness with applicability in challenging real-life contexts.

Impact assessment

For Europe and in many countries around the word, demographic developments have significant implications for social care and healthcare systems and for the provision of care services. There will be more older people in absolute and relative terms, and more very old people likely to need more intensive and diverse support. At the same time it is expected that the number of carers will decrease due to societal and economic reasons.

Finding ways of sustaining or improving care outcomes with limited financial resources becomes increasingly challenging. New technology applications can help address these challenges. But making the case for investment in these services and applications requires robust evaluation, not only to demonstrate that eCare works, but also to show how and in what context. Any technological intervention and implementation has to be evidence-based. Reliable evidence is becoming a prerequisite for political decisions on changing or implementing new technologies, routines and interventions.

Interventions in the area of eCare are in most cases complex interventions building upon a number of components that may act independently or interdependently and involving and affecting a range of stakeholders. Reliable evaluation of these interventions requires methods that deal with the complexity of the care environment and its different stakeholders. We have in-depth knowledge and expertise in careful study design and a complex set of qualitative and quantitative evaluation methods, their advantages and caveats.

From a European perspective, the provision of ICT-supported integrated care has to address a heterogeneous array of regional care ‘eco-systems’. The decision on a study design always needs to consider local circumstances as well as the objective to be reached. The choice of design must always be clearly stated and explained. We offer our clients and partners the optimal mix of methods for their objectives, including quantitative approaches such as RCT study designs, control group designs, before and after measures, post-hoc evaluations and reference data comparisons; qualitative research methods such as focus groups, observations, case studies; and in-depth process evaluations.

Business model development

The introduction of ICT into health and care affects a multitude of stakeholders, from service clients and patients, to providers and governance bodies. It has impacts on how people live in old age or with chronic conditions, on the way care is delivered and on how it is governed. Decision makers aiming to improve the situation of care recipients, of professional and informal carers or of entire care systems are faced with transferring one situation into another. They have to improve concepts and practice without leaving anyone behind. Understanding the different impacts on all stakeholders and applying this understanding for strategic decision making is a key prerequisite for long-term viability in such an endeavor and we use the ASSIST framework, an approach to socio-economic impact assessment, to serve this purpose.

ASSIST is a methodological framework developed to provide an objective, impartial assessment of the impact of a service (retrospective), as well as a meaningful estimation of future potential, taking into account different options (prospective). ASSIST covers a series of analytic steps beginning with an analysis of the stakeholder affected by a service and of the expected impacts to be measured. Quantitative or quantifiable data is collected by various means including surveys (such as our eCCIS – eCare Client Impact Survey addressing patients/clients, informal carers and care professionals), work process and cost flow analysis, log data analysis and others. This data is analysed in a dedicated software tool, using a Cost-Benefit Analysis (CBA) approach. Outcomes are different sensitivity-tested economic performance measures relevant for decision making, including socio-economic return and ROI.

The outcome of an ASSIST assessment can be used for the formulation of sustainable service models, for business model and business case development and for regulatory and strategy impact assessments.

ASSIST was originally developed by empirica, but is now an open framework, with its methodological basis and software tools available under open licenses.

Employment

Successful participation in working life has a strong impact on life satisfaction, not just for older people. In line with Hannah Arendt’s understanding of the vita activa, work is one of the defining elements of the human condition. Although often regarded as a simple given fact, ageing presents unique challenges and opportunities in the employment domain, first of all for older employees themselves, but also for their friends and family, and their employers, as well as for society, a country’s pension system and its wider economic performance.

Being able to remain in employment until retirement age can be an important source of self-affirmation for older people, with positive impacts on health and wellbeing. It can also be an economic necessity, whenever employees or family members depend on the income. From the point of view of a company, older employees can be an invaluable source of experience and knowledge with an important role to play in customer relations, production teams, co-worker education and other areas. At the same time, ageing can lead to a decrease in productivity, especially in jobs demanding high physical and/or mental performance. Without innovation to better attune work organisation to an ageing workforce, employers may feel themselves hard-pressed to retain older workers.

We support policy making on ageing and employment, and also provide expertise to companies in need of organisational innovation, for example in adapting business processes and work patterns to increases in the share of older employees. Our experience ranges from the analysis of labour markets to the development of highly effective methods and IT tools for use in companies. We specifically address issues of work-life balance for employees in need of flexibility. For example, we implement measures to strengthen resilience and reduce the burden of care for people with caring responsibilities (informal or family carers), accompanied by systems-level innovation to better integrate informal carers in the professional care loop. We also have a long track record in enabling organisations to implement IT-supported, flexible forms of work such as smart work / working from home.

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