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.No part of this book may be reproduced or transmitted in any form or by any means, including photocopying and recording, without written permission of the copyright holder, the Honeycomb – Creative Works Partnership. Such written permission must also be obtained before any part of this book is stored in a retrieval system of any nature.

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.

03 PROFILE OF THE CONNECTED HEALTH SECTOR 16

3.1 Introduction 16

3.2 Segmentation 17

3.3 Service Offering 18

3.4 Venture Funding 20

3.5 Connected Health within the Honeycomb Region 22

04 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 –

EXECUTIVE SUMMARY 4

SECTION A

INTRODUCTION, CONTEXT AND PROFILE 01 INTRODUCTION 6

1.1 Purpose of the Report 6

1.2 Summary of the Digital Content and Connected 6

Health Sectors

1.3 Objectives of the Report 7

1.4 Methodology 8

1.5 Summary of Relevant Strengths and Weaknesses of the 8

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

02PROFILE 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

– 2 –

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

Engagement & Advocacy

7.4 Diagnosis: Self-Diagnosis and Home Monitoring 40

SECTION C

MEASURES TO ASSIST GROWTH

08 COMPANY MEASURES 41

8.1 Consumer Companies in Healthcare 41

8.2 Medical Companies in the Consumer Space 42

09 MEASURES TO DEVELOP SKILL SETS AND STRENGTHEN NETWORKS 43

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

ANNEX 1 EXAMPLES OF CONNECTED 50

HEALTH INITIATIVES SUPPORTED BY

HONEYCOMB

– 3 –

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

– 4 –

Executive Summary

This scoping study report

has been prepared for

Honeycomb – Creative Works

at the Dundalk Institute of

Technology. It considers the

prospects for integrating the

connected health sector with

the digital content sector in the

Honeycomb eligible area, which

comprises the six border counties

of Ireland, Northern Ireland (NI)

(excluding the greater Belfast

area) and the western seaboard

of Scotland, between now and the

end of the decade, and beyond.

The digital content sector is part of the wider

creative sector, bringing together creative and design

activities with IT, thereby embodying both artistic

and technical/engineering skills. The digital content

sector is a malleable and fast-moving sector, and

includes as subsectors games, animation and online

content. While employment in absolute terms is

currently comparatively low in the digital content

sector, it is nevertheless a sector in which jobs are

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

overall employment has increased over recent years.

It is synonymous with the knowledge economy and

is pervading other sectors of the economy rapidly

and playing an increasingly important part of our

everyday lives.

The pervasive influence of the digital content sector

is becoming more evident in the health sector, with

the development of connected health, which seeks

to use digital technologies to link the main players

in the industry more effectively, most importantly

clinicians and patients (and their families, which

are very important because children and the elderly

are among the biggest users of healthcare and their

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

Greater integration between the connected health

and digital content sectors forms part of each of

the economic development strategies of Ireland, NI

and Scotland, where the aims are to improve patient

outcomes and reduce the costs imposed on the

national health systems.

In the eligible area, the digital content sector is

largely fragmented – the vast majority of businesses

are small (typically micro businesses), there are

many freelancers working in the sector on a part-

time basis and markets served are predominantly

local in nature. In addition, the extent of foreign

direct investment (FDI) in digital content activities

is low in the eligible area compared with that in the

main urban centres (Belfast, Dublin, Glasgow and

Edinburgh) and broadband availability remains a

major issue in some parts of the eligible area. The

digital economy and its development thrives mostly

in larger economic centres, which benefit from talent

pools, clusters and infrastructure (including groups

of third-level institutions and high-speed broadband

as well as ‘hard’ infrastructure such as transport

networks).

Given that healthcare policy is to a large

extent determined nationally, and owing to the

concentration of digital content sector activities

in larger urban centres, it is envisaged that over

the next number of years the main connections

will occur in these centres and in sectors that

have a proven track record of connection between

the digital content and healthcare sectors. These

include big data and predictive analytics; clinician

training and assisted living/aging; other convergence

opportunities include clinical trials, virtual care

coordination and navigation; patient education and

advocacy, and self-diagnosis.

Geographically, while most of the convergence

opportunities are likely to occur in the major urban

centres in each of the three countries of the eligible

area, there is nonetheless the opportunity for

the eligible area proper to benefit in the process.

Accordingly, initiatives (like Honeycomb) need to

ensure that the region is well-placed to respond to

the opportunities and are connected to a greater

extent to the developments occurring in the main

urban centres of the countries.

– 5 –

1.1 PURPOSE OF THE REPORT

This report provides a scoping study regarding the

possibilities for collaboration between the digital

content sector and the connected health sector in

the Honeycomb eligible area, which comprises the

six border counties of Ireland, Northern Ireland

(excluding the greater Belfast area) and the western

seaboard of Scotland. The report considers the

opportunities for growing cross-collaboration

between the two sectors in the eligible area for

the mutual benefit of providers in both sectors and

patients in the connected health sector.

1.2 SUMMARY OF THE DIGITAL CONTENT AND

CONNECTED HEALTH SECTORS

There is no universally agreed definition of the digital

content sector but nevertheless it is generally

closely associated with the digital media and creative

industries, and includes (but is not necessarily

limited to) film and broadcasting, animation, games

development, music technology and interactive media

(online interactive content). Across the eligible

region and internationally, digital content today

pervades our daily lives, reflecting the widespread

SECTION A

Introduction, Context and Profile

use of IT technologies in our lives. Increasingly,

as witnessed by enterprise developments in the

Honeycomb eligible area, entrepreneurs and

innovators are looking to make connections between

digital technologies (hardware and software) and

other sectors of the economy, notably health.

Digital healthcare or ‘eHealth’ involves the application

of digital technologies to healthcare; for example,

the use of smart devices to tell patients when to take

their medicines or to relay medical information about

concurrent health measures to centralised monitoring

systems. The interconnectedness between digital

media and healthcare presents those working in the

sectors with unique interdisciplinary possibilities

to research and promote healthy lifestyles while

managing illness and health risk. Moreover, digital

healthcare technology development for eHealth

systems enables regional and national healthcare

investment to respond to emerging health and ageing

population trends highlighted in the EU task force

report ‘Redesigning health in Europe for 2020’, which

aims to ensure that all citizens have consistent

access to a high level of healthcare across Europe,

at a reasonable cost to national healthcare systems.

In advanced economies, eHealth has the potential to

01Introduction

– 6 –

bring together medical and healthcare professionals,

social scientists and public health policy advocates,

computational and computer scientists, and digital

media platform experts to invest in helping patients

and clinicians to optimise health management in new,

cost-efficient, and patient-focused ways.

Undoubtedly one of the main trends in global

healthcare now occurring is the shift towards more

personalised healthcare and this is reflected in

the movement by pharmaceutical companies from

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

a more customised basis. The availability of mobile

technology also means that people have greater

information regarding diagnosis and management

(including testimonials from other people with

the same or similar conditions) and this is leading

to greater patient empowerment in the process

(including through apps etc.).

1.3 OBJECTIVES OF THE REPORT

Honeycomb is an EU INTERREG IV-funded

programme aimed at supporting the digital content

sector in the aforementioned eligible region. It has

acted as a research hub, a collaborative network and

a resource for small and medium enterprises (SMEs)

in the region seeking to partner and grow their way to

success.

Honeycomb is seeking to develop pathways between

the digital content sector and other sectors, so that

companies and research groups in the eligible region

can benefit from further growth. Convergence

between sectors is a common theme in the current

economic development strategies underway in

Ireland, NI and Scotland – a common denominator in

each case being the role of the digital content sector

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

presented in terms of assisting employment growth

in other sectors, like health.

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

demand. Both are needed. For example, a new

health initiative may be technologically sound but

will not be amenable to commercialisation if it fails

to capture a market demand based on patient need;

similarly, different types of patient may have well-

identified needs but these will not be feasibly met if

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

this way, new digital developments in the healthcare

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

also need to be cost-competitive – to attract the

attention of buyers, which occur at different levels

of the healthcare value chain, namely national health

executives, down to hospitals and primary care

centres and ultimately to patients and their families.

This scoping report seeks to identify the extent

to which the health sectors in the three parts of

the Honeycomb eligible area are connected with

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

parts of the health sector are particularly digitally

connected and where the best opportunities for

sectoral collaboration are likely to occur between

now and the end of the decade, and beyond.

Introduction

– 7 –

– 8 –

1.4 METHODOLOGY

The research methodology for this report has entailed the following work

elements:

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

documents;

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

the digital content and connected health sectors;

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

second set of selected stakeholders to confirm our understanding of the

opportunities and to seek ‘road-testing’ of our high-level measures to assist

integration between the sectors.

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

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

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).

1.5 SUMMARY OF RELEVANT STRENGTHS AND WEAKNESSES OF THE

ELIGIBLE AREA

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

weaknesses in relation to developing greater connectivity between the digital

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

stemming from the identified strengths, there are also considerable challenges

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

identified weaknesses.

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

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

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

agencies and in line with national policy goals.

Introduction

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

• 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

• Relatively high levels of enterprise and entrepreneurship

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

• Strong cultural linkages among the parts of the eligible area

• Eligible areas peripheral for the most part

• 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

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

• Small scale of enterprises in the digital content sector

• 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 –

– 10 –

1.6 SUMMARY OF NATIONAL AND REGIONAL

POLICIES AND INITIATIVES IN SUPPORT OF

DIGITAL HEALTH

The 2015 policy document ‘Digital Health’ pertains

to the UK and thus applies to the NI and Scottish

parts of the Honeycomb eligible area. Overall,

the document seeks to support digital healthcare

solutions nationally, regionally and locally across

the UK.

To date, the UK strategy for rolling out eHealth

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

approach for diabetic, pulmonary and cardiac

diseases. Research shows that about 75% of people

not only search online for health information but also

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

diagnose (not completely, without also consulting

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

treatment-management process). In this context,

the provision of digital healthcare would have the

effect of enhancing the effectiveness of the self-care,

patient-centric approach, in the process reducing

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

emergency admissions by 20%, reducing bed days by

sector, and greater recognition of qualifications in

the digital and IT sectors. While there is recognition

of the potential for convergence between the

digital content and connected heath sectors (in the

coming years), the immediate priority of the digital

economy strategy is to ensure the availability of a

range of skills in digital content and IT (including

software development) rather than also promoting a

concurrent major program of initiatives in connected

health.

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

directive agenda (2020) to accommodate, but also

a national policy document aimed specifically at

eHealth, namely the ‘eHealth Strategy for Ireland’

(2013). That document outlines a comprehensive

and detailed approach to implementing an eHealth

program of healthcare solutions developed within a

national framework. The Health Services Executive

(HSE) notes that eHealth involves not only the

connected health agenda, but also the “integration of

all healthcare information and knowledge sources via

information technology systems, including patients

and their records, caregivers and their systems,

monitoring devices and sensors, and management

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

14%, while potentially reducing mortality rates by up

to 45%.

One of the major connected health initiatives in the

UK (CellNovo) has resulted in the development of a

mobile-connected diabetes management system,

and similar connected health facilities are now in

full operation with Scottish Connected Health for

over 270,000 diabetic patients in that part of the

UK. Moreover, projects focused on the application

of digital communication technologies to mental

health issues have begun to generate community

acceptance through initiatives such as the Glasgow

High SafeSpot local e-service for teenagers suffering

with mood disorders or related symptoms, and

GreyMatters, which provides an online resource

promoting real-time communication and non-

hospitalised treatment supporting patients with

long-term conditions such as dementia, hypertension

and rheumatoid arthritis.

The ‘Northern Ireland: A Global Leader of the Digital

Economy – A Sectoral Action Plan’ document (2014)

outlines policy intentions regarding the development

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

skills training, attracting global investment in the IT

Introduction

of people search online

for health information75% 15% potential reduction

in emergency admission

document provides a framework setting out what the

eHealth framework intends to achieve; the actions or

systems changes that need to be in place to realise

eHealth strategies and objectives; the patient-based

and economic costings advantageous to eHealth

solutions; a framework for the evaluation of eHealth

intervention effectiveness; and a life-cycle of

connected health solutions framework that evolves

with technological intervention without placing

patients at untested risk. While forward-looking in

its approach, the report is realistic to recognise that a

significant amount of systems re-structuring will be

required to realise the policy’s potential, particularly

in changing working systems practice.

1.7 RESEARCH CAPACITY AND THE

EMERGENCE OF CONNECTED HEALTH

CLUSTERS

For connected health technology to fully realise

the solutions that the national and regional policies

purport to be both possible and essential, the

appropriate information technology resources,

labour market skill sets, research and development

opportunities, and connected health-specific

enterprises must all be in place.

An analysis by each part of the Honeycomb eligible

area suggests that the enterprise expertise base is

most likely to occur in the main urban centres.

Western Scotland, and the greater Glasgow area

in particular, are at the forefront of digital health

research and digital hub creative enterprise clusters,

in having a Digital Health Institute with a specific

focus on exploratory, laboratory, and factory digital

and Connected Health roll-out programs, ranging in

applications from clinical decision support platforms

to mental well-being. The Digital Health Institute is

a collaborative initiative between the Glasgow School

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

hub at Pacific Quay Glasgow. The initiative has

benefitted from recent funding and includes digital

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

boost to the region and presenting an opportunity for

digital and connected health collaborative initiatives.

While NI remains committed to IT skills training and

qualifications recognition within its digital sector,

the region has recently invested in linking up with

forerunners in the digital health sector and the

New York initiative. The Western Scotland network,

including the aforementioned Digital Health Institute

has links to the NI policy drive. The development of

digital media hubs within NI, such as the Creggan

Enterprises Digital Media Arts Studio in Derry/

Londonderry, is also relevant to note in the context of

this report.

The north eastern part of the cross-border region

on the island of Ireland (along the Dublin-Belfast

corridor) is seen by stakeholders consulted as

providing an opportunity to link-up enterprises,

research institute capacity, health service systems,

and digital media hub development beyond the

national eHealth strategic policy’s intent. The

resources and the framework appear to exist, for

example in the potential link-up of researchers at

Dundalk Institute of Technology (Netwell Centre),

the Boyne Research Institute (Drogheda), HSE

service provision in the border counties of Ireland

(Louth, Cavan and Monaghan) and local digital media

enterprises in that part of the Irish cross-border

region.

Introduction

– 11 –

– 12 –

02

According to the report, in 2012, information

industries accounted for about 3.8% of all

employment in the OECD area. In addition, the same

industries contributed 6% to total value added, and

labour productivity in the information economy

sector was found to be 60% higher than the overall

economy. Revealingly, the digital economy has been

resilient during the economic crisis; however, while

employment has grown, it has not reached the peak

rate of 4.1% of all employment witnessed in 2001,

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

Within the sector, employment growth is occurring

in IT and other information services and generally

away from products and traditional activities, such

as publishing, audiovisual and broadcasting and

telecommunications. The OECD report notes that the

gap in productivity in favour of information services

relative to the total economy is especially high in

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

According to the report, the information society

economy, which includes the digital content sector, is

opening up new employment and skills opportunities

as the sector continues to grow and this will present

challenges for educational institutions as well as

people seeking to work in the sector.

The OECD report concludes by saying that new

statistical tools are needed to measure the digital

economy and it proposes a forward-looking

international agenda built around six areas as

follows:

• Improve the measurement of ICT investment and

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

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.

The fourth of these proposals is relevant in the

context of this report, in that healthcare would

be seen as a social as well as an economic sector

and one affording the opportunity of synergy

development with the digital content sector.

Profile of the digital content sector

2.1 DEFINITIONAL AND

MEASUREMENT ISSUES

While the digital content or media sector embraces

a number of subsectors, such as games, animation

and online content, there is no universally agreed

definition of what precisely makes up the sector. This

in turn makes it difficult to accurately estimate the

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

by the fact that the official statistics agencies in

the eligible area do not make publicly available

information on the disaggregated subsectors

regarded to make up the digital content sector. The

pace of change inherent in the sector also works

against accurate delineation and estimation of scale

and growth.

2.2 INTERNATIONAL TRENDS – EVIDENCE

FROM THE OECD

The Organisation for Economic Cooperation and

Development (OECD) published a report in December

2014 entitled ‘Measuring the Digital Economy: A New

Perspective’ which maps existing indicators of digital

activity against digital policy issues and suggests a

forward-looking international measurement agenda.

2.3 THE DIGITAL CONTENT SECTOR IN THE

COUNTRIES OF THE ELIGIBLE AREA

Data analysis undertaken by the consultancy team

reveals that the digital content sector (as can be

reasonably defined and measured with the available

official data) would account for up to approximately

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

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

Reflecting the OECD report of 2014, the sector

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

country/region, depending on whether one takes a

wide or narrow view of the sector.

Also chiming with the OECD study is that gross value

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

sector compared with other sectors of the economy,

which in turn points to the productivity gap in favour

of the digital content industries – they attract

well-educated and talented people, and the pace of

change in the sector tends to occur more rapidly than

in other parts of the economy, whether research or

technology development (e.g. software development

occurs much more rapidly than pharmaceutical

development).

Getting other sectors to appreciate and work with

the much shorter lead-times associated with the

digital economy is one of the great challenges for

facilitating further integration of digital activities

throughout the economy.

In each of the three countries, there are foreign

direct investment (FDI) firms active in the sector

as well as indigenous enterprises. With its low

corporation tax, Ireland has been especially

successful in attracting IT FDI in recent years.

While many of the activities of these firms are

directed towards international servicing operations,

recent years have seen more focus on core functions,

like software engineering and development, which

tend to predominate among the Irish-owned

enterprises operating in the sector.

Recognising the pervasiveness and influence of the

sector, all three countries’ economic development

strategies recognise the important opportunities

afforded by the digital economy and in particular

the scope (but also challenges) for digital media

activities to connect further with other sectors of the

economy, including health and education.

In Ireland, NI and Scotland, the majority of digital

economy activities occurs in the main urban centres

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

where talented people hoping to build careers in

the sector are most likely to be attracted. Over the

coming years, there is little doubt that the digital

content sector will continue to develop mostly

in these centres and it is in these cities that the

greatest scope for convergence between healthcare

and the digital economy lies.

2.4 THE DIGITAL CONTENT SECTOR WITHIN

THE ELIGIBLE AREA

Within each country and focusing on the eligible area

spanning the Honeycomb region, we find that the

digital content sector is more scattered, fragmented

and diverse. This is not surprising and reflects the

generally low population density of the eligible area

and the absence of big urban centres. A particular

issue in the Irish border counties is the availability of

broadband in more rural and peripheral parts, which

is hampering digital development in that part of the

country and may be contributing to a “digital divide”

(mobile telecommunications as well as broadband

can be patchy and variable in quality in this part

Profile of the digital content sector

– 13 –

– 14 –

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

seeking to resolve the issue of broadband availability by 2016.

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

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

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

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

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

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

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

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

Irish border counties’ proportion in the Scottish part of the Honeycomb Region

(c. 1%).

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

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

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

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

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

reasonable to observe that the digital content sector in the Honeycomb region is

characterised by the following features:

Business organisation;

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

freelancers working on a part-time basis (on their own)

• Low direct employment and low turnover (although the low turnover is

reflective of the downturn in the region more generally, which has impacted on

all small businesses)

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

buyers/clients, such as broadcasting organisations)

• Compared with the main urban centres, low presence of FDI firms, which in

turn reflects their searching for talent and infrastructure in larger population

centres/capitals

Technology;

• Predominantly low technical/capital requirements accompanying, which is

both a positive and a negative

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

entrepreneurship and competitive outcomes more likely)

- 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)

Profile of the digital content sector

Market need;

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

• Low incidence of exporting

• Low intensity of innovation.

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

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

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

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

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

bases and absorb new learning). These areas are especially important and ones

to which institutions like DkIT and Ulster University can contribute.

2.5 EU DIGITAL SINGLE MARKET STRATEGY

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

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

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-in-

the-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.

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

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

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

straightforward and affordable, by tackling online geo-blocking restrictions, by

modernising copyright law and by simplifying cross-border VAT arrangements

and costs for companies;

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

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

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

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

downloads etc.

• Creating a European Digital Economy and Society with long-term growth

potential, which relates to helping all sectors to integrate new technologies

and to manage the transition to a smart industrial system through a fast-

tracking of standardisation in the interoperability for new technologies,

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

(which are particularly relevant to this study).

Profile of the digital content sector

– 15 –

– 16 –

3.1 INTRODUCTION

The global digital health market is estimated to

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

start-ups have developed to their full potential.

03

Digital Health Market Projection by Segment

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

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

FIGURE 1

Profile of the connected health sector

3.2 SEGMENTATION

We may divide the digital health market into four

distinct main segments based upon the subsectors

that have received significant funding over the last

five years (Table 2).

• Infrastructure, largely the bearer of regulatory

mandates and incentives, which includes health

analytics and interoperability solutions and is the

leader with $2.9 billion of total funding.

• Treatment, which includes personalised medicine,

virtual care, tele-health and care coordination, and

has garnered $2.6 billion as new, alternative care

channels are pursued.

• Engagement, which also received $2.6 billion

and includes wearables, incentive programs and

other patient engagement solutions that target

behavioural change.

• Diagnosis, which has captured $2.1 billion,

representing a rapidly growing segment of clinical

and consumer tools that provides insights, such as

remote monitoring.

Scale and Segmentation of the Connected Health Market

MARKET SECTOR

VENTURE FUNDING 2008-2013

KEY SUBSECTORS ESTIMATED MARKET SIZE

2014

HONEYCOMB RELEVANCY

Infrastructure $2.9bn

Payment processing $6.0bn* 1

HER and Clinical Workflow $9.0bn* 1

Big Data/Predictive Analytics $6.0bn* 4

Hospital Administration $6.0bn* 1

Physician Training $3.0bn* 4

Population Health Management $5.0bn* 2

Clinical Trials $4.0bn* 3

Treatment $2.6bn

Assisted Living/Aging $3.3bn 4

Virtual Care Coordination & Navigation $4.1bn 3

Personalized Medicine $4.0bn* 2

Medication Management $1.4bn 1

Engagement $2.6bn

Nutrition Tracking $1.9bn 2

Physical Fitness Tracking & Wearables $8.5bn 1

Behavioural & Emotional Health Tracking

$1.7bn3

Patient Education & Advocacy $3.1bn 3

Diagnosis $2.1bn

Provider Diagnosis $4.0bn* 1

Self-Diagnosis $3.0bn* 3

Emergency Detection $2.6bn 1

Remote (Vital Sign) Monitoring $3.8bn 2

Total $10.2bn c. $80.0bn

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

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

and KPMG.

TABLE 2

– 17 –

– 18 –

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.

Summary of Service Offerings in Connected Health

Offering Focus Digital Offering Primary Patient

Benefit

Hurdle to Wide

AdoptionDevice Platform App Portal Community

Health management General wellbeing/ prescription drugs √ √ √

Adherence Physician integration

Health management Multiple Sclerosis √

Adherence, monitoring

Physician integration

Digital reference book Medical/pharma information √

Education, Encyclopaedia

No patient input

Activity and exercise management

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

Adherence, drug instructions, education

Only generic inputs

Symptoms recording and analysis

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

Adherence, monitoring

Physician integration

Environment assessment Asthma, hayfever, allergies and auto-immune conditions √

Education Only limited patient inputs

Digital reference General information √

Education Patient input

Self-assessment Haemophilia √ √

Education, scheduling

Limited patient-specific inputs

Symptoms recording Prostate cancer √

Monitoring, scheduling appointments

Physician integration

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

Education, scheduling

No patient inputs

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

Table 3

– 19 –

3.4 VENTURE FUNDING

Two recent information sources show the

importance of digital health for venture capital

providers. StartUp Health, a New York-based

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

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

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.

Digital Health Funding Snapshot, 2010-2014 YTD

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.

Digital Health Venture Funding, 2011-2014

FIGURE 2

Source:

StartUp Health

www.startuphealth.com/insights,

consultancy team review.

FIGURE 3

Source:

Rock Health Funding Database

www.rockhealth.com

Note: only includes US deals > $2m

– 20 –

3.4.1 VENTURE FUNDING FOR CONNECTED HEALTH BY SUBSECTOR

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

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

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

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

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

STARTUP HEALTH ROCK HEALTH

Analytics/Big Data $1.46 bn Analytics/Big Data $393 m

Population Health $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

Source: Company info, consultancy team review.

3.4.2 VENTURE FUNDING FOR CONNECTED HEALTH IN EUROPE

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

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

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

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

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

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

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

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.

Table 4

– 21 –

Profile of the connected health sector

– 22 –

3.5 CONNECTED HEALTH WITHIN THE

HONEYCOMB REGION

Connected Health in the eligible area has been a

focus of both private and public initiatives for several

years. For example, the Northern Ireland Connected

Health Ecosystem was launched in 2012 as a forum

to bring together stakeholders from the health

system, academia and business to discuss and take

forward connected health solutions within NI.

3.5.1 REGIONAL PUBLIC ENGAGEMENT AND

EXPENDITURE ON CONNECTED HEALTH

Despite the fact that constrained budgets limit

public investment in digital health initiatives, health

authorities and decision-makers in the eligible area

at least recognise the inexorably important role that

digital technology will play in reforming healthcare

systems. Every European healthcare system

currently struggles to achieve a balance between

ensuring access to high-quality healthcare services

and long-term financial sustainability. The outcome is

that public authorities are open to private initiatives

from technology companies with cost-effective

solutions. Policymakers therefore recognise the

potential for digitally-based healthcare initiatives

to aid prevention and reduce cost pressures in their

health systems, so that governments as well as

patients and companies active in the development of

the technologies are seen as winners; however, the

ramifications for clinicians may be more complex and

there is a sense of apprehension from the medical

professions in respect of the advent of digital/

eHealth.

EHI Intelligence calculates that the UK NHS spends

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

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

In 2011, the NI Ministers for Health and the Economy

agreed the Connected Health and Prosperity

Memorandum of Understanding. One of the priorities

in the MOU is the development of a Connected Health

Ecosystem in Northern Ireland bringing together the

public, independent and private sectors, research

bodies and patients and families to share good

practice, learn from experiences and help to prioritise

and develop connected health solutions.

Comparative figures for public spending on

connected health in Ireland indicate a future

lack of funding. The HSE’s annual expenditure on

healthcare IT of around €40m accounts for only

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

(this proportion is much smaller than the equivalent

amount in the UK, namely the aforementioned 1.1%

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

HSE must still address similar challenges to the

NHS in terms of coping with an increasingly elderly

population, living with a growing burden of chronic

disease, while adopting complex and costly medical

advances. Despite the financial constraints, a major

re-organisation of the health and social care system

and reforms of Ireland’s healthcare funding systems

are already underway. However, a strong sense

of cynicism is associated with the reforms, which

include the possibility of de-centralising healthcare

decisions (it will be recalled that the HSE was

instituted in 2005 by amalgamating the

previous regional health boards

in an attempt to ensure

greater efficiency in

the provision of

healthcare in

Ireland).

Profile of the connected health sector

04

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).

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

• Highlights the opportunities and challenges for local companies to develop new products and to evolve new services

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.

• 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

Jul. ‘11

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

Sep. ‘10

Table 5

– 23 –

Review of Relevant Research

– 24 –

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

• 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

Dec. ‘12

Irish Department of Health

eHealth Ireland Strategy • Provides an outline and definition of eHealth

• 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

Dec. ‘13

Proof Communications Communicating Connected Health

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

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

Jan. ‘14

Scottish Development International

Digital Healthcare in Scotland • Positions Scotland as a location for eHealth

• Lists academic institutions, infrastructure and companies involved in digital healthcare space

Oct. ‘12

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

eHealth Strategies: Country Brief England

• 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.

Oct. ‘10

AUTHOR TITLE KEY FINDINGS PUBLICATION DATE

European Commission (DG Information Society & Media,

ICT for Health Unit)

eHealth Strategies: Country Brief Ireland

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

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

Oct. ‘10

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

• 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

Oct. ‘11

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.

Sep. ‘14

Source: Consultancy team review.

– 25 –

– 26 –

SECTION B

Connected Health Subsectors for Growth

05

What follows is a summary

of the key points emerging

from the consultancy team’s

engagement with stakeholders

during the course of the study,

arranged by the main themes

to have emerged from the

discussions.

5.1 CONNECTIVITY

Digital or eHealth solutions must connect all

stakeholders in a healthcare system – patient, physician/

clinician, payer, healthcare provider and supplier – and

facilitate more effective communication and transaction

among the parties involved. One of the principal

stakeholders for the entire digital healthcare value

chain is the physician. Ultimately, in most healthcare

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.

Themes Highlighted in Consultation with Stakeholders

In the current healthcare value chain, medical

devices companies tend not to interact directly with

clinicians but this gap may need to be addressed

in the environment where digital technologies

in healthcare are expected to become more

commonplace. Forging successful relationships will

be dependent on meeting clinicians’ and patients’

needs – this is the most fundamentally important

requirement to ensure greater penetration of digital

technologies in the healthcare value chain: doctors

must benefit from the technologies (e.g. patient

management systems that will enhance their

productivity and the profitability of their practices in

the primary care environment) as must patients and

their families.

5.2 DATA ANALYTICS

Successful digital health solutions must aim to

enable meaningful insights and make use of big data

to become more proactive, rather than reactive. One

of the undoubted major opportunities for connecting

digital content and healthcare is the rich data

maintained by healthcare providers, in the primary,

secondary etc. points of the healthcare value chain.

Electronic health records offer the possibility of

tracking and sharing the patient’s health status

and customising treatment. Any offering that does

not leverage the patient’s data to track and record

what is going on over time cannot leverage the full

potential. Superior offerings are seeking to go beyond

data collection and its digital expression. Intelligent

systems seek to make use of individual and patient

group data to identify and track changes to their

health status in real time. By considering external

factors, digitally-based treatments and solutions

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

potential to become predictive instead of reactive.

5.3 PATIENT OUTCOMES

Offerings must provide real value to the patient

and their families (the young and the elderly, where

healthcare demand tends to be greatest). Digital

solutions have to target unmet needs and improve the

human condition or life with a disease, utilising the

full potential and broad spectrum of digital solutions.

The digital health solutions may be enabled by digital

media, though they need to be led by healthcare/

clinical imperatives. The focus needs to be on

patient outcomes, and not just upon time and/or

money savings. Healthcare costs and outcomes

are notoriously opaque. As patients take a greater

role in managing their own care, there is a demand

for tools that de-mystify pricing and value. Tools

to help patients evaluate health insurance options

will also be needed, particularly with new users

entering the system that do not have experience

navigating their options. Greater transparency is

paramount in achieving better patient outcomes.

Value for consumers means a combination of cost,

convenience, and outcome. Digital technologies have

the potential to add value to patient outcomes by

helping them to better access the healthcare system

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

5.4 PATIENT ADOPTION

Successful digital health solutions must reflect

the whole customer journey and target specific

interactions in the healthcare system. By connecting

the stakeholders – patient, physician, payer,

healthcare provider and supplier – the solution will

facilitate easier communication and transaction

between the parties involved.

– 27 –

Themes highlighted in consultantions with Stakeholders

– 28 –

5.5 REGIONAL LOCALISATION

Digital health solutions must reflect regional

differences in the regulatory and care environment,

understand and address local pinch-points as well

as adjusting their technology and value-added

accordingly. Successful digital health solutions

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

The most successful offering will reflect the

regulatory and care environment in each respective

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

recognise local pinch-points and accordingly adjust

its value proposition. Ground-breaking and successful

offerings need to address all of the above-mentioned

aspects. If only one aspect is not considered in the

solution design, chances are high that at least one

stakeholder will never experience any added value

and consequently will not utilise the offering.

5.6 REGULATORY OVERSIGHT

The complexity of regulation and lack of qualification

for new connected health services is currently seen

as a major barrier to adoption. Connected health

presents unique challenges for regulators and

policymakers because it unites a number of vastly

different sectors and services for the first time and

this is new ground for most of the people policing

the sector’s reputation and performance. In the

case of the communications infrastructure allowing

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

(Groupe Speciale Mobile Association, an international

group of mobile operators which seeks to promote

connected living) suggested in a 2012 report that

the main regulatory challenge in connecting digital

technologies and healthcare lies in striking a balance

between the very different regulatory motivations

of the telecommunication and healthcare industries.

Influencing those that can help shape this regulation

is a new and considerable challenge for many

organisations entering the sector, largely because it

is very different to selling technology products. As

Emmanuelle Pierga of Orange Healthcare explains,

“One of my main goals is to prove that connected

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

future healthcare problems. We are lobbying and

targeting the people in a position to influence the

evolution of regulation in this industry before trying

to convince the buyers. We are ready to implement,

but we cannot sell anything until we prove the whole

system works and until the regulatory bodies have

adapted so as to integrate connected health.”

5.7 HUMAN-CENTRIC DESIGN

Human-centred designs are those that respect user

diversity and living contexts. A first factor in this

context is the user diversity. Individual differences,

such as demographic variables, computer experience,

cognitive abilities and personality factors are all

important in explaining both technology acceptance

and user behaviour with respect to digital health

products. Successful digital health solutions will

offer multiple interfaces to suit the patient’s lifestyle

and will prioritise patient convenience, especially

when products impact patients’ comfort and/

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

wearable sensors.

5.8 SELLING TO MONOPOLISTIC BUYER

(‘MONOPSONY’)

Engaging with the NHS or HSE is considered by those

with whom we consulted to be notoriously difficult

for private companies. According to recent figures,

Themes highlighted in consultantions with Stakeholders

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

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

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

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

processes are too complicated.1

There is other evidence2, however, that the NHS is increasingly outsourcing

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

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

of hospitals in financial difficulties will provide further opportunities for them

over the next few years. Stephen McComb, Centre Leader for the Connected

Health Innovation Centre (CHIC), explains that the NHS looks for differentiation

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

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

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

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

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

impact.”

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-tech-entrepreneurs-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

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

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

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

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

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

system, “Developing connected health means carefully orchestrating change

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

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

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

the changes required by technology alone.”

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

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

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

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

need for connected health technology as a whole.

5.9 SUMMARY

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.

– 30 –

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

• 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)

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

MyHealthSpecialist

MedXNote

Nursebuddy

Data Analytics • 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

Nutritics

MySugr

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

MySugr

RestoredHearing

goACT

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

goACT

RestoredHearing

Table 6

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 • 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

needs to be recognised in the academic and professional training of healthcare professionals/decision-makers

Phamapod

RestoredHearing

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

RestoredHearing

OralEye

Monopolistic Buyer • 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

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 –

Themes highlighted in consultantions with Stakeholders

– 32 –

In identifying relevant

subsectors with the most

promising outlooks for growth in

the eligible area, we devised a list

of criteria to select the strategies

that offered the best collaborative

potential with the digital content

sector in the Honeycomb eligible

area.

06

6.1 NATURE AND INTENSITY OF LINKS

BETWEEN CONNECTED HEALTH AND DIGITAL

CONTENT SECTORS

The first criterion is the extent to which connected

health activities currently utilise digital content to

deliver their services or enhance their offering to

the customer. Further convergence will rest to a

large extent on building on, and diversifying, the links

gained to date.

6.2 LEVERAGE LOCAL INDUSTRY AND

ACADEMIC RESOURCES

Any initiative to build and capture value by addressing

the opportunities in connected health and digital

content must leverage existing business success

stories. Several successful and well-known

companies have already paved the way. Kainos and

Almac are examples of such companies in the NI part

of the eligible area. The wider Honeycomb region is

today home to scores of leaders in their respective

markets be that in medical device development and

manufacturing or pharmaceutical testing and related

services. In addition, the convergence opportunities

between the sector must also be plugged into

academic expertise and resources in each part of the

eligible area and in the countries concerned, meaning

the capital cities of Ireland and Scotland as well as

the regional resources in Belfast, Galway, Glasgow,

Derry/Londonderry, Letterkenny, Dundalk etc.

6.3 EXPORT-ORIENTED

The internal markets for connected health within

the eligible area are not large enough to sustain

a significant number of technology suppliers. The

leaders in the field will undoubtedly have to export

the majority of their production to countries and

regions outside the region of interest. This has

implications for the design and functionality of

products and services as well as for the type of

organisational structure that will be successful in the

marketplace. Subsectors that exhibit a high degree

of features that cannot be transferred or translated

for export markets will not be as successful as

subsectors in which products and services are more

homogeneous between regions or can be adapted

relatively quickly and at low cost for deployment in

external markets.

Criteria used to determine relevant subsectors

6.4 TAPS SKILL BASE

The extent to which a connected health market

opportunity can be captured will depend upon the

existing skills developed in academic/research

institutions, private industry and/or the public

health service. Fortunately, market entrants in the

eligible area can draw on all three sources. Those

companies that can best attract talented and skilled

employees will exert a significant advantage over

their competitors. Owing to the fragmented nature of

the digital content sector in the Irish and NI parts of

the eligible areas, the main skills base on the island

of Ireland capable of facilitating the development of

links with healthcare will likely be in the main

urban centres, especially Dublin

and Belfast.

6.5 ADDRESSES A REAL PROBLEM – MEETING

NEED AS WELL AS BEING TECHNOLOGICALLY

SOUND

A technologically sound solution designed for the

connected health market will likely fail if it does not

command a market demand or need and vice-versa,

in which case the list of criteria needs to include

soundness in respect of both the demand and supply-

side of the relevant market.

6.6 COMPETITIVE LANDSCAPE AND

SPEED OF INDUSTRY

The pace of technical change in the healthcare

industry has increased over the past few years.

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

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

is likely to be tentative because of the threat posed

by potential new entrants, even if actual competition

within some markets may seem to be lessening.

Technological advances will ensure maintenance

of competitive pressures and thereby open up new

market opportunities for entrants, provided, of

course, that their offerings are technologically sound

and meet a user need, as outlined earlier.

Europe lags behind the US, as outlined earlier, but

this need not detain or stop the eligible area from

benefiting from the developments underway in

connected health. Accordingly, the potential for the

region to attract FDI from connected health firms

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

indigenous entrepreneurs and enterprises emerging

within the eligible area.

– 33 –

Themes highlighted in consultantions with Stakeholders

– 34 –

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.

07Relevant subsectors for collaboration and growth

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

MARKET SECTOR KEY SUBSECTORS GLOBAL MARKET SIZING

2014

COMMENT

Infrastructure

• 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.

Treatment• 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).

Engagement

• Behavioural & Emotional Health Tracking $1.7bnLower competition than fitness or nutrition; addressing a growing need as mental illness becomes mainstream and more accepted.

• Patient Engagement & Advocacy $3.1bnAddresses a key problem of health ‘adherence’; good use of digital media currently.

Diagnosis

• 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 $3.8bnExisting skill base and excellent local links; good use of digital media to visualize and interact with data.

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

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

Table 7

– 35 –

Relevant subsectors for collaboration and growth

– 36 –

7.1 INFRASTRUCTURE: ANALYTICS AND

TRAINING

Infrastructure is by far the largest market sector

within the global health industry and has also

received the most amount of funding over the

past decade. As the implementation of systems to

manage health records and patient data continues

apace, the sector is maturing. The sector is still

highly competitive with hundreds, if not thousands,

of software and hardware suppliers. A few large

players, however, are beginning to exert strength

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

power. Two subsectors in particular are at an early

stage in their development: analytics and training.

7.1.1 ANALYTICS

Analytics can provide the mechanism to sort through

the complexity of data in health, and help healthcare

organisations to deliver on the demands placed

upon them. Analytics may be descriptive, predictive

or prescriptive and encompasses everything that

supports fact-based decision making for planning,

management, measurement and learning. Supporting

technologies may also simply remove barriers to

collection and understanding data. The objectives of

applying analytics in healthcare are to:

• Improve clinical quality of care and/or patient

safety as well as reduce medical errors;

• Improve wellness, prevention and disease

management;

• Understand physician profiles and clinical

performance;

• Improve customer satisfaction, acquisition and

retention.

In order to achieve these objectives, analytics

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

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

supported by health executive systems (like the NHS

and the HSE) and by regulatory authorities, including

those responsible for the regulation of the medical

professions (GPs, hospital consultants, dentists and

allied professions)

7.1.2 TRAINING

Training covers both simulation of medical

procedures and clinical scenarios using a variety of

physical and virtual technologies. Virtual reality and

computer-enhanced simulation represent the future

of medical education. Despite the embryonic nature

of the technology, several applications have already

shown themselves to be effective teaching tools

(including in universities in Ireland and Scotland).

Given this early success and the near certainty that

computer and engineering technology will continue

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

Relevant subsectors for collaboration and growth

of sophistication and cost-efficiency, VR applications

and simulators will be broadly accepted into medical

education. One can easily foresee an educational

system in which medical students and residents will

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

with patients in the real world.

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

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

Source: Consultancy team review and analysis.

Table 8

– 37 –

Relevant subsectors for collaboration and growth

– 38 –

7.2 TREATMENT: PERSONALISED AND ASSISTED CARE COORDINATION

7.2.1 ASSISTED LIVING

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

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.

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

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 tele-radiology and tele-cardiology

• Communication among multidisciplinary care teams

Source: Consultancy team review and analysis.

Table 9

Relevant subsectors for collaboration and growth

7.3 ENGAGEMENT: EMOTIONAL HEALTH

TRACKING, PATIENT ENGAGEMENT AND

ADVOCACY

With sensors, smart phones, wearable devices and

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

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.

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

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

Source: Consultancy team review and analysis.

Table 10

– 39 –

Relevant subsectors for collaboration and growth

– 40 –

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

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,

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).

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

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

Source: Consultancy team review and analysis.3

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

Table 11

Relevant subsectors for collaboration and growth

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

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.

SECTION C

Measures to Assist Growth

08Company measures

– 41 –

– 42 –

Dan Jones from th Association of British Healthcare

Industries (ABHI) also warns that consumer firms

must not underestimate the difficulties faced in

regulating their products within the medical space:

The regulation process is considerably

more difficult in healthcare than it is for

standard consumer apps, for example, and

there is currently not a great deal of direct support

available in terms of helping organisations to navigate

the regulatory minefield. I expect we will see the level

of support improve further down the line, but for now

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;

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

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

but I expect the market to change and become more

encouraging as the first big wins come through.”

Consumer organisations will also particularly

struggle with distributing through healthcare

professionals because they lack relationships

with this community, and the duration of the sales

process. Emmanuelle Pierga says Orange Healthcare

has been talking about connected health and

influencing key audiences for ten years;

“It is especially slow because it relies

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

8.2 MEDICAL COMPANIES IN THE

CONSUMER SPACE

Medical devices companies, on the other hand,

have more credibility and experience working with

care providers and navigating the strict regulatory

requirements; but there are challenges aplenty in

the emerging connected health space. The tele-

care proposition, for example, where it is expected

that increasing numbers of services will be delivered into

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

vulnerability considerations for healthcare providers.

Perhaps more challenging still is the need to understand

consumer needs and attitudes, particularly buying

behaviours, which have never been more important for

medical devices makers. Turning these insights into

products and features – with consumer-friendly interfaces

– and marketing them effectively poses further difficulties.

Many organisations would benefit from the support of third-

party experts in these fields.

Sue Dunkerton of the HealthTech KTN adds that

organisations originating in the medical space will also

struggle to identify and measure success in a consumer

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

isn’t? Listening to the consumer voice – reviews and

frequency of use – will be the only way to know.”

Dunkerton expects that connected health will follow a

consumer model initially, which is already sparking interest

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

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

sector as the consumers start to realise what is possible

and help create the demand in the more classic healthcare

market.”

Company measures

It is widely accepted by those with

whom we consulted that key to

providing technologically sound and market/

demand-oriented products and services at

competitive cost/price is the need to facilitate

linkages between established companies in the

healthcare industry and enterprises in the digital

media and connected health sectors, including

entrepreneurs and freelancers. Networking

events between such companies, under a

special conference theme, can facilitate such

linkages, and academic institutions, such as

Dundalk Institute of Technology, can assist in

the process, by promoting and organising such

events.

09Measures to develop skill sets and strengthen networks

In addition to this, other networking initiatives to aid in convergence between the

digital content and connected health sectors include:

• Development of a freely accessible database of ideas in

connected health;

• Speaking events from experts in clinical efficacy

and clinical trials;

• Liaising with national and local enterprise

agencies to champion the potential

of connected health and the

interfacing of digital media and

healthcare – to ensure that

this particular opportunity

is recognised and advanced

in national enterprise policy,

so that it becomes part

of the business support

infrastructure;

• Third-level institutions

ensuring that the skills sets

are available to support the

convergence of eHealth and

related technologies.

– 43 –

– 44 –

10

Information regarding the

different types of funding

needed by companies seeking to

bridge the gap between connected

health and digital media is also

relevant.

It is generally felt by stakeholders consulted that

connected health projects can be created with

relatively little capital, as shown in the wider

digital media/IT sector, but the clinical utility of

it must be paramount, requiring early input from

clinical centres. That is why collaborative networks

highlighted above are seen to be so important –

bringing different skill sets from IT and healthcare

together to address a new technology opportunity

with a market need.

As such, funding streams can be drawn from

many sources, with different capital and timeline

requirements of each, including:

• Research grants and pump-priming funding, which

are available from public bodies throughout the

eligible area, through competitive application, and

from other organisations, such as the Welcome

Trust. Research grants are also available through

the NHS primary care trusts, including for projects

capable of demonstrating cost reduction and/or

enhanced patient outcomes.

• Accelerators and business angel funding, which

can play an important role in disseminating

knowledge, acting as an archive of projects (what

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

members and expertise, and offering mentoring.

• Venture capital, which is especially alert to the

opportunities associated with digital media and

connected healthcare, although VC activity tends

to be focused in capital cities and is a rare form

of finance in general to IT firms in the eligible

area. However, this situation can often reflect a

simple lack of information about what is occurring

in practice and there is a role for institutions like

DkIT to address such market failures by making

VC firms more aware of existing activities and

potential opportunities. As may be expected, to

gain the attention of VC investors, pitches and

businesses cases, if they are sought, need to be

world-class and compelling to gain the interest of

this form of capital.

• Crowdfunding – this is a relatively new form of

funding, whereby companies can access funding

informally through social media by enticing wide

share/equity share ownership. However, the

regulation of the practice is still in its infancy and

stakeholders with whom we spoke do not expect

it to fund projects which are more than one year

from delivery, or companies that do not have a

consumer-orientated device.

Measures to boost funding and increase support

In bridging the fast

pace of digital media

activities, we see the difference

in the way healthcare moves and

determines solutions. This gap

must be bridged and requires a

cultural shift in both sectors to

allow co-development to occur

(timeframes in IT tend to be

much more rapid compared with

healthcare).

11

11.1 CULTURAL CHANGE AMONG

CLINICIANS AND PATIENTS

The increasing availability of personalisation of

healthcare means that it is being rapidly devolved

to the consumer. This is shifting the relationship

between clinician and patient, with greater

empowerment of the latter, which would be a

salient feature of eHealth or connected health. This

inexorable shift needs to be embraced by clinicians to

aid the realisation of connected health opportunities.

This will require a combination of education (at

academic and professional level in the formation of

clinicians) as well as acceptance of the trend through

economic forces.

11.2 INCREASED AWARENESS OF THE

COMMUNICATIVE/TRANSFORMATIVE POWER

OF DIGITAL MEDIA

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

suggest this without also acknowledging the shift in

control away from the provider. Research suggests

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

are made before a sales or marketing impression

is made upon the consumer. This is driven by

consumers researching their own solutions and being

empowered and enabled to deliver upon those by the

shift towards digital media. This commoditisation

and consumer enablement is a global shift and is

unheralded by the clinical profession to date.

Measures to catalyse cultural change in healthcare

– 45 –

– 46 –

11.3 COLLABORATION WITH UNIVERSITIES AS CUSTOMERS

Medical schools and allied medical schools giving rise to the academic

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

the trend by becoming customers of new technologies and media for

communicating/managing consumers in the pursuit of healthcare. They

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

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

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

benefit of the wider population.

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

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

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

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

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

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

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

this level of customisation by clinical group to occur also.

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 block-

busters, which may not work for all patients and populations, or may be too

blunt a response for smart infections.

Measures to catalyse cultural change in healthcare

The opportunities for connected health

– which brings together technological

developments in the digital content sector with

healthcare – are firmly on the radars of the

respective health executives in Ireland, Northern

Ireland and Great Britain, and more widely across

the European Union and the US, reflecting the

transition to more effective and cost-competitive

healthcare provision, where the patient is being

CONCLUSION

– 47 –

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

out the background and content to this important

development and looked at the key sectors

where we believe the opportunities for enhanced

connections between digital content and healthcare

are likely to occur in the eligible area in the coming

years, based on objective criteria and measures

most amenable to assisting the growth of eHealth in

the countries.

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

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).

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-digital-strategy/.

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-health-europe-2020.

References

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

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

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

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.

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

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

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.

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-a178-1d4a52acb598/Digital-Action-Plan-Cover---Copy.aspx.

OECD (2014) ‘Measuring the Digital Economy: A New Perspective’, http://www.oecd.org/sti/measuring-the-digital-economy-9789264221796-en.htm (also available at http://ec.europa.eu/eurostat/documents/341889/725159/OECD+Manual+Measuring+the+Digital+Economy/6418c566-4074-4461-9186-9ad509bc4a4d).

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.

– 48 –

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).

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%20Whitepapers/SRDPaper_Digital%20Signage%20in%20Healthcare.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-tech- entrepreneurs-start-ups.

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

References

– 49 –

– 50 –

MEDUCATE

Meducate is an app that allows patients to

understand more about their current medical

condition and any associated treatments for their

condition. This understanding will have many

benefits as people absorb information and transmit

information in different ways and the traditional way

in medicine of providing leaflets may not work for

everyone.

Meducate presents information to a patient in a

way that can be altered to every individual patient’s

learning needs. No other method of delivery of

patient information similar to Meducate exists in the

UK, Ireland or Europe. The Meducate technology

will be available in a mobile format so that patients

can use it in private or with family members. Most

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

that they can absorb, process and evaluate the

information in their own time.

Currently, Meducate is developing a pilot of the

technology to a smaller group of patients that will

allow for continuous evaluation and feedback before

the application will be restructured and populated

with content applicable to other conditions.

Annex IExamples of connected health initiatives supported by Honeycomb

Working with the Belfast Health and Social Care Trust,

Meducate has identified prostate cancer as a suitable

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

pool of individuals will allow Meducate to monitor the

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

of the technology, the structure, the interface and the

adaptability features. These can be developed further

before the product is adapted not only for other cancers

but also for other medical conditions including diabetes,

mental illnesses etc.

Ulster University, the driving force behind Meducate, is

currently collaborating with the Belfast Trust to write

the protocols and ethics for this pilot version focusing

on Prostate Cancer. The pilot to demonstrate that this

method of delivery will enable patients to have a better

awareness of their condition, help them to understand

their treatments and help the hospital with patient

consent of chosen methods of treatment.

It will also alleviate the problems associated with

self-diagnosis through the use of external/unapproved

sources of information and will also allow patients’

families to understand better their loved one’s conditions

and treatment.

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

For further information on

Meducate, contact Martin

McGinn at Ulster University

on mh.mcginn@ulster.ac.uk

• Reduces toxicity

of potential side

effects of approved

treatments

• Reduces time and

costs of patient care

– 52 –

VBOT in Use - Medical staff training video for

embedded learning modules

Video-enabled training exposes healthcare

professionals and students to a greater variety of

cases, experts and treatment scenarios that can

be gathered and shared among hospitals, medical

schools and research centres around the world.

Video-enabled training is more convenient, accessible

and affordable than ever before and it is easy to

manage and update, which is ideal for health care

organisations with limited technical capabilities.

VBOT MEDICAL TV

VBOT Medical TV for hospitals and healthcare

organisations can enhance delivery of care at a

distance between patients, clinicians and specialists.

VBOT’s mobile-centric video software integrates

high-definition video recording and playback

applications to enable convenient access to efficient

patient care.

From video training material for medical staff

and patient pre-assessments recorded on their

mobile phones to personalised video physiotherapy

programmes – VBOT Medical TV provides flexibility,

safety and full control of video assets.

VBOT’s secure mobile recording applications are

specially designed for:

• controlled recording

• data protection curation

• filtering control

• auto-archiving for reporting purposes.

The apps allow registered users to easily record,

review and upload their smartphone or tablet

recordings via VBOT’s 2- clicks app design.

Health organisations can ingest and control

reference videos (training, lectures,

rehabilitation videos, conference videos, interviews)

in order to create learning modules that can be

personalised, privately distributed and viewed via TVs

and other devices such as tablets, smartphones and

web browsers.

Video material can be published in video players and

apps for mobile, web and TV for a range of purposes,

such as:

• training

• research

• learning

• communications

• marketing

For further information on VBOT

Medical TV, go to

http://vbot.tv/

solutions/#medical-tv or contact

Frédéric Herrera on fred@vbot.tv

or +353 86 0256358.

Annex 1

The Honeycomb - Creative Works Team

STAFF AND MANAGEMENT COMMITTEE

David Brown

Scottish Programme Coordinator, Creative Skillset

Dr Paul Beaney

Project Director, Ulster University

Deirbhile Doherty

Finance Assistant, Ulster University

Professor Sarah Edge

Skills Director, Ulster University

Kevin Fearon

Networks of Scale Coordinator, 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

Fiona McElroy

Programme Manager, Ulster University

Stephen Michael

Web Developer, Ulster University

Dr Colm Murphy

Intelligence Director, Ulster University

Aisling Murtagh

Research Associate, Ulster University

Dr Douglas Nanka-Bruce

Research Associate, 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

PROJECT PARTNERS

Ulster University

Dundalk Institute of Technology

Creative Skillset

University of the West of Scotland

DELIVERY PARTNERS

Creative Scotland

Letterkenny Institute of Technology

MG Alba

ScreenHI

The Nerve Centre

– 54 –

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.

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.

Design by E

lemen

tdesig

n.ie