1 Introduction and purpose of Twinnings
1.1 The European Commission’s Communication on enabling the digital transformation of health and care
The Digital Single Market (DSM) Strategy of the European Commission1, backed up by its mid- term review in May 20172, recognised the beneficial role of digital technologies in transforming today’s world, especially in several key policy areas, including health and care3.
In line with the DSM Strategy, the Council of the European Union adopted a set of conclusions on digital health4 in December 2017, inviting Member States and the Commission to work together to seize the potential offered by digital technologies in health and care. In response, the European Commission also published a Communication on “enabling the digital transformation of health and care in the Digital Single Market; empowering citizens and building a healthier society”5 (referred to hereafter as the Communication). The vision outlined in the Communication is to promote health, prevent and control disease, help address patients' unmet needs and make it easier for citizens to have equal access to high quality care through the meaningful use of digital innovations. It will also strengthen the resilience and sustainability of Europe’s health and care systems. The Communication also lays out European Union (EU) actions in three priority areas (from here on called “priorities”) to be followed in the coming years:
► citizens’ secure access to and sharing of health data across borders - enabling citizens to access their health data across the EU;
► better data to advance research, disease prevention and personalised health and care - allowing researchers and other professionals to pool resources (data, expertise, computing processing and storage capacities) across the EU;
The main purposes of this important policy document and its three key priorities are outlined in Figure 1. Various key initiatives have already started to take concrete action and address different aspects of these priorities, but these key initiatives do need to work together in order to boost the envisioned digital transformation of health and care (DTHC). This includes joining up their efforts on research and innovation (in line with activities supported by Horizon2020 (H2020)) as well as political coordination, stakeholder mobilisation, deployment and uptake of digital solutions for health and care. Sections 1.2 and 1.3 briefly outline the role of the DigitalHealthEurope project and its Twinning programme in addressing these challenges and supporting the objectives and priorities outlined above.
Figure 1. EC infographic on the transformation of health care in the Digital Single Market
1.2 DigitalHealthEurope’s role in supporting the objectives of
DigitalHealthEurope is a Coordination and Support Action funded by the European Commission (EC) under the H2020 programme, with Grant Agreement No. 826353. The project is coordinated by empirica Technology Research and comprises 17 partners from across Europe. It runs from January 2019 to December 2020.
DigitalHealthEurope provides comprehensive, integrated and centralised support to initiatives on digital health and care innovation in the context of the DSM Strategy. The project's approach involves actions that will boost innovation and advance the Communication’s three overall priorities for the digital transformation of health and care, as described in the previous section.
To achieve these three priorities, the project work plan offers two forms of support:
Support to large scale deployment of digital solutions for person-centred care
DigitalHealthEurope's main objective is to facilitate the deployment of digital solutions for person-centred care. Assessment tools will be used to identify, analyse and select successful initiatives which are highly impactful and replicable, can be easily adapted to different contexts, and which can benefit from further support, such as providing structured advice on EU funding instruments and financing sources.
The selected initiatives will have the opportunity to pursue replication and scaling-up. This will be done with the aid of instruments such as twinning matchmaking via a marketplace and the Twinning Programme presented in this document.
Insights from the initiatives and from the twinning actions will contribute to a centralised deployment support service which will include guidelines, checklists and documented successful approaches.
These results will contribute to capacity building of Twinning Adopter(s) and elaboration of useful resources (“building blocks”) for the scaling-up of innovative practices - new resources that will be available to the various stakeholders engaged in scaling up digital tools for person- centred care. The aim is to encourage even wider uptake of twinned digital innovation and assimilate lessons learned.
Support to DTHC innovation through collaboration with key stakeholders
DigitalHealthEurope will also facilitate the creation of a collaboration platform that directly addresses the three priorities for the digital transformation of health and care. It can be considered as a multi-stakeholder community.
The outcomes will include collaboration agreements, the drafting of a common agenda and actionable recommendations that guide and inform decisions pursued at the policy level.
Figure 2. Overview of DigitalHealthEurope activities
1.3 The DigitalHealthEurope Twinning Programme
In DigitalHealthEurope, the twinning programme is a support mechanism for scaling up innovative digital solutions. Twinnings are used as a mechanism for accelerating fulfilment of the Communication’s priorities, by enabling the transfer of innovative solutions from one European region or country to another. An overview of the twinning concepts is outlined in Figure 3.
The approach has been successfully applied in a number of EU projects and studies, including the ScaleAHA study6, which funded 20 twinnings. The region/country with the innovative practice is called a Twinning Originator, and the implementing region/country is referred to as a Twinning Adopter. There can be more than one Twinning Adopter per twinning. In some cases, third parties may be involved, e.g. as an external facilitator or as tenderer/Twinning Contractor.
Interested organisations and individuals will first exchange ideas on twinning solutions which they can offer or would like to adopt. A twinning marketplace has been set up by DigitalHealthEurope to facilitate the matchmaking process. Potential Twinning Originators can post information about their available twinning solutions, and those wishing to be Twinning Adopters can specify their solution requirements.
The outputs of the twinning are expected to inform key work areas of DigitalHealthEurope, such as elaboration of policy recommendations and development of useful resources (“building blocks” for scaling up innovative solutions). These are a crucial part of the capacity building of European health and care institutions.
Twinning Activities may include, for example, hosting meetings, organising technical groups, travelling, acquiring licenses, paying fees for professional services. Twinnings typically last up to ten months, depending on complexity and Twinning Type.
2 Twinnings in DigitalHealthEurope
This section outlines what types of digital solutions might be expected to be covered by the tenders for twinnings; what types of twinnings exist; the twinning marketplace and its role; the overall funding budget and distribution; and the twinning outputs.
2.1 Expected Digital Solutions to be covered by Twinnings
The innovative digital solutions whose adoption in a new region can be supported through DigitalHealthEurope twinnings must be related to one or more of the three priorities defined in the Communication, namely:
► citizens’ secure access to and sharing of health data across borders
► better data to advance research, disease prevention and personalised health and care ► digital tools for citizen empowerment and person-centred care.
A tender for twinning (i.e., an application made by a tenderer) must specify the twinning solution(s) to be addressed and how it relates to one or more of the overall priorities.
The following three non-exhaustive lists relate to each of the three priorities stated in the Communication. They serve to provide guidance to tenderers on what topics the proposed twinnings are expected to address. The lists name between 7-20 different digital solutions. The lists do not preclude submission of proposed twinnings relating to other topics linked to the three priorities.
Priority 1: Citizens' secure access to and sharing of health data across borders
► Citizens' secure access to their health data - e.g., via secure online portal, citizen’ access to an Electronic Health Record (EHR), a Personal Health Record (PHR) incl. telemonitoring data and shared with health professionals
► Interoperable electronic health records deployed at national and regional level enabling citizens' secure access to and sharing of health data; General Data Protection Regulation (GDPR) compliant, secure health data exchange
►Citizen-enabled sharing of health data across borders: patient summary and/or ePrescription, discharge letter, medical images, lab results
► Citizen-controlled data governance, health data cooperatives, health data donation
► Other: please specify
Twinning Solutions are the digital know-how which is transferred through the twinning activities to the Twinning Adopter. They may be products, services, processes, methodologies, strategies and/or business models. The topics must be based on digital technologies. They must be innovative7 and should not have been used in the adopting region(s) before the twinning takes place.
Note: the three priorities are numbered for ease of reference. No prioritisation of the importance of the digital solutions listed is implied within or across the three priorities.
Innovation here is used to refer to a product, service, process, methodology, strategy, business model as described in https://ec.europa.eu/growth/industry/innovation_en. For the novelty aspect of innovations, please refer to the definition here: https://ec.europa.eu/eurostat/statistics-explained/index.php/Glossary:Innovation
Priority 2: Better data to promote research, disease prevention and personalised health and care
►Digital infrastructure for personalised medicine, -omics databanks, biomedical infrastructures
► Good practice in digital genomics, incl. whole genome sequencing
► Use of real-world data (RWD), data quality assessment and improvement
► Health data analytics (Artificial Intelligence, algorithm development and calibration, machine
learning, risk stratification tools, etc.)
► Big data analysis, particularly for preventive medicine and treatment
► Health data donation, public preference models on data use for research
► Interoperability of disease registries including for rare diseases, data aggregation and sharing
across borders, incl. at EU level
► Digital tools for public health, epidemiology, pharmacovigilance, clinical research, incl. reuse
of EHRs for clinical research
► Other: please specify
Priority 3: Digital tools for citizen empowerment and for person-centred care Citizen/patient-focused solutions:
► Digital tools to support health education (health literacy), digital health literacy
► mHealth systems, wearable devices for monitoring and prevention, alerts, reminders
► Digital tools to support patient feedback and reporting of outcomes and experiences
► Digital tools to support proactive prevention, self-management, homecare, telemonitoring ► Tele-mentoring/coaching, virtual consultations, virtual coach, personal assistant
► ICT supporting adherence to medication and care plans
► Robotics (e.g., companion robots)
► Tools and services supporting independent living, ambient assisted living technologies,
► Other: please specify
Care practitioners’ solutions
► Advanced digital tools to support Integrated Care, including integration of health and social care services
► Interoperable digital solutions to support person-centred and integrated care
► Regional and national Electronic Health Record (EHR) systems and ePrescription solutions
enabling person-centred care
► Regional, national and local Electronic Integrated Care Record (EICR) systems, integration of
EHR and social care records
► Digital shared care plan (e.g., support to multi-disciplinary team(s))
► Decision support for multi-morbidity and polypharmacy management
► ICT support for management of frailty
► ICT support for falls prevention
► eLearning to support workforce development for person-centred integrated care ► Other: please specify
2.2 Twinning Types
Twinnings can be grouped into four types. They range from knowledge exchange to adaptation or adoption (whether partial or full) of the transferred solution. The different twinning types require different forms of funding, have different deployment time frames and need different experts.
► Knowledge exchange and training: This type of twinning mainly targets local authorities which do not have much experience with EU networking but are eager to learn from experiences in other parts of Europe. The twinning is seen as a first step to discuss a concrete solution (product, service, methodology) and how it can be transferred to the adopting region(s). The capacity needed is built during the twinnings. This includes identification of appropriate staff, setting up a process roadmap, defining expected outcomes, etc.
► Adaptation: Well-established solutions are adapted to the local context (e.g. translation of the contents of an app into another language, a prevention programme, etc.). This type of twinning is suitable for multiple adopters. The adaptation process across the various adopters is expected to be similar.
► Partial adoption: Twinnings that undertake partial adoption of a digital solution will have to provide concrete evidence on impact of the adoption, as well as the reasons why a full adoption is not possible (e.g. different healthcare systems, organisational differences, reimbursement issues, etc.).
► Full adoption / acquisition: This type of twinning mainly targets local authorities with well established relations with other authorities in Europe (e.g. through memorandums of understanding, past EU project partnerships, etc.), that have already planned collaboration on a specific topic/solution and have made first steps, such as adaptation. The twinning aims to achieve a full adoption of the solution in the adopting region(s) using local infrastructure (including adaptation) or the Twinning Originator’s infrastructure (via acquiring, including buying the solution or licensing it using appropriate business models).
Focus on knowledge (know-how) exchange and training, a central aspect of the innovation are the required staff skills
A mature innovation is being adopted by adjusting it to local conditions (e.g. translation into local language)
Elements or aspects of the innovation (product, service, methodology, strategy) are being implemented using locally available infrastructure
The innovation (product, service, methodology, strategy) is being implemented in its full scope by using the originator’s or local infrastructure i.e. the innovation is transferred and managed fully by the adopter
To facilitate the forming of twinnings, DigitalHealthEurope offers an online twinning marketplace. On it, Twinning Originators can post information about their available Twinning Solutions, and Twinning Adopters can specify their requirements, enabling matchmaking and preparation of a twinning tender.
The twinning marketplace can be accessed via https://digitalhealtheurope.eu/twinnings.html.
Full adoption / acquisition
Participation in the marketplace is not a prerequisite for participation in this call. Nevertheless, potential twinning tenderers are encouraged to use the service so as to ensure the greatest possible transparency and openness about twinning availability throughout Europe.