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Policy and strategy recommendations
Last update 08 Nov 2016
69 paragraphs, 114 comments
Research and Innovation (R&I) Priorities on Active and Healthy Ageing (AHA)
Last update 29 Nov 2016
67 paragraphs, 45 comments
Roadmap for standardization on AHA facing 2020
Last update 19 Jan 2017
74 paragraphs, 0 comments
Roadmap for standardization on AHA facing 2020
Last update 29 Nov 2016
74 paragraphs, 45 comments
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Methodological note The identification of the most relevant priorities in the AHA field was carried out through desk-based research focused on the collection and analysis of over 60 scientific documents and relevant reports. This was followed by a consultation of approximately 90 members of the EIP on AHA Action Groups and the discussion of the findings and proposed R&I areas in a workshop with the 9 members of the Scientific Advisory Board. The final step of this process is to ask the EIP on AHA Action Group members to comment on the final R&I priorities that have been identified. These comments will be included in a final report which will support the development of the R&I roadmap for the EIP on AHA. This document will serve as basis for policy decision, hopefully influencing the definition of future research priorities. Drivers, Barriers and Challenges Tentative prioritization of the different proposals Tentative prioritization of the different proposals Identified Research and Innovation (R&I) Priorities Participants were asked to validate, legitimise and comment on the analysis results of the report and its conclusions. The presenter went through the conclusions of the report related to the drivers, barriers and challenges of the related AHA policies at national and regional level. This chapter presents only a very limited number of points that the discussion highlighted the most important and relevant. Very high priority proposals (*****) Very high priority proposals (*****) P1. Increase technology awareness and improve user’s experience Barriers to AHA policies The following proposals have been identified, due to the factors indicated above, as top priority ones. The relevant European Standardization Organizations (or, if relevant, International Standardization Organizations), should be asked to launch them between January and June 2017. The following proposals have been identified, due to the factors indicated above, as top priority ones. The relevant European Standardization Organizations (or, if relevant, International Standardization Organizations), should be asked to launch them between January and June 2017. • P1-RIA1 - Methods and technologies for improving health literacy - Barrier 1: Lack of funding General proposals General proposals • P1-RIA2 - Methodologies for the co-creation of solutions - Barrier 2: Poor communication about existing funds - Establishment of a structured horizontal coordination of AHA standardization. - Establishment of a structured horizontal coordination of AHA standardization. • P1-RIA3 - Lifestyle patterns and cultural differences of users - Barrier 3: Mismatch between policy and funding - Increase the coordination and synergies between the European Standardization Organizations (CEN, CENELEC and ETSI) and the International Standardization Organizations (ISO, IEC and ITU), taking advantage of their collaboration agreements, such as the Vienna Agreement. - Increase the coordination and synergies between the European Standardization Organizations (CEN, CENELEC and ETSI) and the International Standardization Organizations (ISO, IEC and ITU), taking advantage of their collaboration agreements, such as the Vienna Agreement. • P1-RIA4 - Population cohorts / user’s stratification for better personalised intervention - Barrier 4: Silos and fragmentation in funding lines - Reinforcement of the cooperation between the ESOs and the SDOs on Health Informatics Standardization. - Reinforcement of the cooperation between the ESOs and the SDOs on Health Informatics Standardization. This priority addresses the need to raise awareness about the existing technologies and the impact they can have on improving the quality of life of older people and facilitating the provision of health and social care. It is a priority for the innovation and technology transfer agents to double their efforts in properly informing the users and educate them about the most recent technologies in the AHA sector. It includes the need for deeper knowledge on the user characteristics (e.g. age, gender) and specifications (e.g. social and cultural aspects) that can contribute for the development of better personalised interventions (e.g. changing from hospital-based models to home-centric approaches) and a more adequate design of new technologies and solutions for AHA. Also, it implies the active involvement of end-users in the definition and development phases of new solutions to ensure their appropriateness and suitability. Emphasis should be on improving the quality of care services, seeking to move from standardised health to personalised health under the motto “Less care is better care”. - Barrier 5: Capacity building to enable stakeholders to absorb funds e-Health proposals e-Health proposals P2. Cross-sectoral and multidisciplinary cooperation to improve the effectiveness of health and social care The economic environment and the lack of funding are considered as major barriers to develop and implement successful AHA policies. But allocating more money would solve all problems in policy-making and implementation. Funding might already be allocated and available but perhaps the communication about these opportunities is poor or the awareness about them is low. It could also be possible that the policy priorities and the funding priorities do not correspond and without funds allocated to the policy priorities, their implementation will suffer and will fail to deliver impact. Government often works in silo mentality and therefore, the funding made available is also in silos, without coherence or synergy between the funding lines. Stakeholders might not have the capacities and the skills to retrieve the available funding. In this case rather skills development than the increase in funding could be a remedy to the issue. - General semantic interoperability (further comprehensive mapping between the main standards on medical records, disease classification, clinical coding/terminology and electronic health information). - General semantic interoperability (further comprehensive mapping between the main standards on medical records, disease classification, clinical coding/terminology and electronic health information). • P2-RIA1 - Adoption of common terminologies Ageing as a constant and stable priority - Semantic interoperability: Cross-border interoperability of electronic health record systems. - Semantic interoperability: Cross-border interoperability of electronic health record systems. • P2-RIA2 - Knowledge management strategies If ageing became an economic or a financial priority rather than a political priority, this might help to ensure continuous and sustainable support to this challenge across the electoral cycles. - Semantic interoperability: Standardized patient and user-generated health data, able to be captured and acted upon in a meaningful way. - Semantic interoperability: Standardized patient and user-generated health data, able to be captured and acted upon in a meaningful way. • P2-RIA3 - Skills and knowledge [within organisations] identification mechanisms Challenges of AHA in the future - Semantic interoperability: Adherence use case. - Semantic interoperability: Adherence use case. • P2-RIA4 - Growing awareness on AHA actors The lack of political commitment will constitute a challenge for AHA in the future. The central governments should support the efforts that endeavour to address the ageing issues. - Semantic interoperability: Falls risk use case. - Semantic interoperability: Falls risk use case. • P2-RIA5 - Promote the dialogue amongst different actors Useful and efficient other measures to support AHA - Semantic interoperability: Risk categories for frailty use case. - Semantic interoperability: Risk categories for frailty use case. This priority refers to the need to bring together different actors in the AHA field and to get them “speaking” the same language and understanding each other’s roles in the development of the AHA sector. It is crucial that different sectors (e.g. closer cooperation between public and private sectors, with the first learning from the good practices of the latter) and areas of knowledge are able to work together on R&I initiatives, so that more comprehensive outcomes can be reached. SAB members highlighted that there is a need to accept that skills and expertise from the private sector are needed to create major innovations and a successful AHA sector.There is also a need to develop new working tools and methodologies for cooperation between sectors and actors from different cultures, languages, fields of knowledge, etc. Different and relevant stakeholders should be approached by eliminating communication barriers (e.g. common understanding of terminology) and by implementing knowledge management/sharing mechanisms, both of which are considered to be relevant aspects in this domain. The most efficient measure needed would be better cooperation between all types of stakeholders to act against the fragmentation between the policies. - Technical interoperability: Compatibility between standards based on different principles (e.g., EN ISO 13606/HL7 RIM) - Technical interoperability: Compatibility between standards based on different principles (e.g., EN ISO 13606/HL7 RIM) P3. Patient and citizen empowerment and health literacy Regions and ageing, citizens empowerment - Technical interoperability: Complement EN ISO/IEEE 11073 series to include short range RF devices. - Technical interoperability: Complement EN ISO/IEEE 11073 series to include short range RF devices. • P3-RIA1 - Mobile solutions - Regions 1: Subnational level managing ageing policies - Technical interoperability: Development of interoperability standards for Internet of Things. - Technical interoperability: Development of interoperability standards for Internet of Things. • P3-RIA2 - Social participation methods - Regions 2: Regions in intergovernmental programmes - Data privacy protection and security of patient and user-generated health and care data - Data privacy protection and security of patient and user-generated health and care data • P3-RIA3 - Health literacy strategies - Regions 3: Empowerment of citizens and professionals Care and healthcare proposals Care and healthcare proposals • P3-RIA4 - Translation of research results into a “common” language Below the European, sub-national level might be more appropriate to deal with ageing. By sub-national we mean equally regional and local as in some of the countries the local level is much stronger. It could increase efficiency in some cases if regions were invited to initiatives, programmes where usually the Member States should participate. Intergovernmental joint programmes could accept regions as full and legitimate members of the programme if the regions are more front runners than the national government. No care and healthcare proposals have been identified within this prioritization category. No care and healthcare proposals have been identified within this prioritization category. This priority focuses on the need to equip and train patients with the appropriate knowledge and skills so that they are able to understand their health condition and to adopt available solutions to manage their health and quality of life. Healthcare and social care providers play a key role in this area, namely in demystifying and clarifying prevention, care and cure aspects to the patients and citizens in general. Furthermore, it is also necessary that they translate the technical jargon into a “common” language so that patients (and citizens) are able to clearly understand the specific aspects of their cases and how they can act to better manage their health and lifestyle. Empowering the regions can be one step but it is crucial to empower citizens and professionals as well in order to understand and accept technologies, for instance. First of all, the professionals should be built the right skills and then they can “train” the citizens to become “ageing literate”. Independent living and age-friendly environments proposals Independent living and age-friendly environments proposals P4. Chronicity and frailty Wish-list towards the EIP on AHA No independent living and age-friendly environments proposals have been identified within this prioritization category. No independent living and age-friendly environments proposals have been identified within this prioritization category. • P4-RIA1 - Risk factors, determinants and patterns of multi-morbidity This chapter describes the results of the four working groups that the participants were divided into during the expert workshop. High priority proposals (****) High priority proposals (****) • P4-RIA2 - Methods and tools to assess the impact of preventive interventions Support to Reference Sites The following proposals have been identified, due to the factors indicated above, as high priority ones. The relevant European Standardization Organizations (or, if relevant, International Standardization Organizations), should be asked to launch them between July and December 2017. The following proposals have been identified, due to the factors indicated above, as high priority ones. The relevant European Standardization Organizations (or, if relevant, International Standardization Organizations), should be asked to launch them between July and December 2017. • P4-RIA3 - Development of biomarkers - Reference Sites 1: Ecosystem of stakeholders for the Reference Site status e-Health proposals e-Health proposals • P4-RIA4 - Strategies for the promotion of healthy lifestyles - Reference Sites 2: Involving the civil society and the young - Semantic interoperability: Standardized drug identifiers - Semantic interoperability: Standardized drug identifiers This priority relates to the evidence on the increase of chronic diseases and frailty amongst older people. In an ageing population such as Europe has today, tackling the challenges related to functional decline and loss of independence, namely through preventive measures that can contribute to the maintenance of the quality of life, are seen as a main area of concern and therefore a significant domain for further R&I initiatives. Besides, the need to move towards a proactive and preventive care (rather than continuing on a reactive care paradigm) has been highlighted and is nowadays being addressed by the healthcare systems of several European regions. - Reference Sites 3: Coordination and ownership of Directorate Generals - Semantic interoperability: Standardized biology and biomarkers data - Semantic interoperability: Standardized biology and biomarkers data P5. Interoperability and standardisation - Reference Sites 4: Recognition of the regions Care and healthcare proposals Care and healthcare proposals • P5-RIA1 - Definition and adoption of common standards Preparing a Reference Site application requires more than a simple partnership. It needs a local ecosystem of the stakeholders. Civil society and citizens should be involved right from the beginning and a strong political commitment should accompany the initiative. It is particularly important to obtain the young generation’s support to build the future strategy on them. The ecosystem should be able to collectively raise the voice of AHA issues. The coordination and ownership from the European Commission’s relevant Directorate Generals (DG) is crucial to ensure a balanced development and guidance from this level. No care and healthcare proposals have been identified within this prioritization category. No care and healthcare proposals have been identified within this prioritization category. • P5-RIA2 - Integration of care services The EC support could mean the recognition of the strong role of the regions and the recognition of the Reference Site status in the project applications for EU funding as a guarantee label. Independent living and age-friendly environments proposals - Cognitive accessibility of ICT products and services Independent living and age-friendly environments proposals - Cognitive accessibility of ICT products and services • P5-RIA3 - Knowledge about barriers for the interoperability of systems Communicating the benefits of being a Reference Site is very important because that can attract more applications and can convince other regions to take steps. Obtaining the Reference Site status can help to launch new services, and develop new start-ups. - Accessibility of mobile applications - Accessibility of mobile applications • P5-RIA4 - Regulatory framework Widening and deepening participation in the EIP on AHA - Standardization of age-friendly tourism (including accessibility). - Standardization of age-friendly tourism (including accessibility). This priority refers to the need for deeper knowledge on the existing barriers to the interoperability of systems across healthcare systems, as well as across health domains and countries (e.g. existing national infrastructures may not be yet prepared to respond to interoperability requirements). Standardisation plays an emerging role on enabling interoperability, especially regarding cross-European interoperable frameworks. Therefore, focus should be placed on the identification of data transmission details and on the technical requirements needed, so proper (and hopefully common) standards can be defined and implemented. - Participation 1: Widening vs deepening Medium priority proposals (***) Medium priority proposals (***) P6. Market access and business models - Participation 2: Engagement of politicians The following proposals have been identified, due to the factors indicated above, as medium priority ones. The relevant European Standardization Organizations (or, if relevant, International Standardization Organizations), should be asked to launch them between January and June 2018. The following proposals have been identified, due to the factors indicated above, as medium priority ones. The relevant European Standardization Organizations (or, if relevant, International Standardization Organizations), should be asked to launch them between January and June 2018. • P6-RIA1 - Enhance knowledge about the heterogeneity of the market/consumers - Participation 3: Valorisation of SMEs e-Health proposals e-Health proposals • P6-RIA2 - Identification of key partners for deployment - Participation 4: Enhanced technology use No e-Health proposals have been identified within this prioritization category. No e-Health proposals have been identified within this prioritization category. • P6-RIA3 - Reimbursement policies regarding health services The question still remains open if the EIP on AHA wants to widen its membership at all. Or it should only deepen the participation of the current members and increase the level of their engagement, like politicians and adapting the language that would be efficient to engage them. Care and healthcare proposals Care and healthcare proposals • P6-RIA4 - Impact assessment of the adoption of new solutions It could be attractive for the SMEs if some start-ups could be part of a high-level expert group of the EIP at steering level to better exploit on their experience and give them visibility. It could be convincing and motivating for the other SMEs. - Standardization of an integrated structure for care outside conventional care facilities - Standardization of an integrated structure for care outside conventional care facilities • P6-RIA5 - IPR support mechanisms for SMEs Greater use of technology, webinars, distant meetings and videos could increase the efficiency of communication and could enhance the cooperation. It could also multiply the meetings and the exchange of knowledge between the partners. The ICT communication tools could facilitate the creation of a virtual online knowledge-exchange platform. - Standardization of AHA management for rural populations taking advantage of intensive ICT use. - Standardization of AHA management for rural populations taking advantage of intensive ICT use. • P6-RIA6 – Feasibility studies on outcome-based models in Europe Stimulating public and private investment - Standardization of professional qualifications for health professions in EU. - Standardization of professional qualifications for health professions in EU. This priority is linked to the need for new business models that can support the market uptake of the new solutions in the AHA market. These models have to be based on a thorough understanding of the different markets and consumers – the EU market is strongly fragmented -, so the constraints and challenges of introducing a new solution can be overcome. A wider knowledge of key players in the AHA arena could also have a relevant impact in this area. Furthermore, issues regarding Intellectual Property Rights (IPRs) need to be investigated so that the owners of the solutions are protected in this very competitive market. It will be important to study the feasibility of the existing outcome-based models and possible alternatives to ensure a proper European care and health system. - Investment 1: New business models - Standardization of care interventions. - Standardization of care interventions. P7. Inclusion and active participation of older people in society - Investment 2: Mixture of funding - Standardization of reporting adherence related. - Standardization of reporting adherence related. • P7-RIA1 - Social participation strategies - Investment 3: Ageing is an opportunity - Standardization on the falls risk gerontological assessment. - Standardization on the falls risk gerontological assessment. • P7-RIA2 - Impact assessment of existing models (on social and health conditions The current amounts in healthcare, pension and insurance are huge. The introduction of new forms of public investments and new business models could ensure more efficiency thereof. It could also attract further private investments. - Standardization of an assessment of the protocols for rehabilitative interventions - Standardization of an assessment of the protocols for rehabilitative interventions • P7-RIA3 - Identification of good practices at international level As the prices of healthcare products and services, if they were only offered by private companies without public intervention, would be quite high. Therefore, a mixture of funding is needed. - Standardization of fall prevention services. - Standardization of fall prevention services. • P7-RIA4 - Multidisciplinary interventions (health, housing, social, urban planning…) Users and clients can drive innovation by expressing their needs. The elderly are not only users of services and not only consumers but they have important assets and wealth, like pension schemes, insurances, house that could be used in a creative way. The elderly can become successful entrepreneur as well and the elderly are more willing to buy social services from their peers than from other providers. Ageing is an opportunity. - Standardization of the assessment of the different dimensions of frailty. - Standardization of the assessment of the different dimensions of frailty. • P7-RIA5 - Foresight studies for the European age-friendly context Sustainability of the EIP on AHA and scaling up - Standardization of the interventions to deploy to the different risk categories of frailty. - Standardization of the interventions to deploy to the different risk categories of frailty. This priority focuses on the need for the ageing population to remain active in society and to prevent the exclusion of older people. This calls for age-friendly environments and communities where older people can remain active and engaged in society. Considering the specific qualities of an ageing population, R&I initiatives should try to contribute to the definition of inclusive and multidisciplinary intervention strategies such as adjusting urban and rural architecture fostering new models for participation in the labour market, etc. - Sustainability 1: Suggested scaling-up model - Standardization of the intermediate care risk prediction. - Standardization of the intermediate care risk prediction. P8. Funding and financing models - Sustainability 2: Use of quantitative and qualitative indicators for assessment Independent living and age-friendly environments proposals Independent living and age-friendly environments proposals • P8-RIA1 - Benchmark studies on financing models - Sustainability 3: Communicating the benefits of the EIPonAHA - Guidance on appropriate user interface adaptations for older people - Guidance on appropriate user interface adaptations for older people • P8-RIA2 - Interoperability of national research programmes/funding mechanism The suggested model to scale-up is first consult the Good Practice Repository, select the Good Practice by criteria and organize a meeting then a study trip to the site and scale up the good practice. - Standardization of age-friendly transport (including accessibility). - Standardization of age-friendly transport (including accessibility). • P8-RIA3 - Alternative funding mechanisms (e.g. funding schemes for industrialisation phases) A purely quantitative indicator (the number of regions engaged in innovation) cannot be enough to evaluate the efficiency of the EIP. Other indicators, like economic investment from the local and the global level should also be taken into consideration. Low priority proposals (**) Low priority proposals (**) • P8-RIA4 - Impact assessment of existing models The EIP is considered as a highly useful one-stop shop for innovation in AHA. It would be beneficial for the EIP to identifying “champions” who could verbalise, showcase and explain in a pragmatic way what the EIP has offered them and has achieved in their eyes. The following proposals have been identified, due to the factors indicated above, as low priority ones. The relevant European Standardization Organizations (or, if relevant, International Standardization Organizations), should be asked to launch them between July and December 2018. The following proposals have been identified, due to the factors indicated above, as low priority ones. The relevant European Standardization Organizations (or, if relevant, International Standardization Organizations), should be asked to launch them between July and December 2018. • P8-RIA5 - Methodologies to encourage the participation of the private sector in AHA Conclusions e-Health proposals e-Health proposals There is a need to find new ways and financing mechanisms to support the development of innovative technologies and solutions for AHA, which can include private financing schemes, crowdfunding models, etc. It will be important to understand how the funding models can be extended to also cover the early stage of the commercialisation of technologies, and not only the Research and Innovation phases. This might be supported by impact assessment studies on the added-value of the current models. The importance of the private sector in the future of AHA was highlighted on a number of occasions during the discussions, as can be seen in Priority P2, when SAB members emphasised the importance of private sector skills. Also, SAB members stressed the importance of the integration of public and private funding and the threat of competing markets in China and the US. The role of the government in integrating the private sector in AHA is paramount to making it a success in the future. The right conditions within the industry need to be created, and there should be a focus on SMEs (P8-RIA5). Exploring the P8-RIA3, SAB members defended that the possible economic incentives of sharing medical data (e.g. Projects such as VISC+ in Cataluña, Spain) should be investigated along with the development of a network made up of public and private investors. Regarding P8-RIA4 they stressed that a metrics framework is needed to measure the quality of life implications as a tool to stimulate investment. These are metrics for companies and this can stimulate the systemic innovation. A shift from SMART targets to HARD targets is also needed. There are many existing technologies and solutions, let’s give these solutions some numbers (impacts). The discussions resulted in the following conclusions categorised around three key issues: governance, engagement/commitment and funding. These categories are proposed by the authors of this report. Organising these conclusions in a structured way serves the bases for the draft recommendations. - Quality criteria for the development of health and wellness apps (ongoing proposal within CEN/TC 251, still not developed). - Quality criteria for the development of health and wellness apps (ongoing proposal within CEN/TC 251, still not developed). P9. Ethics and data privacy Governance Care and healthcare proposals Care and healthcare proposals • P9-RIA1 - New forms of data access and privacy 1) Faster developing regions could pass by the national level and join up to European initiatives if the Member State cannot commit. - Standardization of the quality of long-term care and social services for older people. - Standardization of the quality of long-term care and social services for older people. • P9-RIA2 - Responsible data management and security 2) Becoming a Reference Site requires building a regional ecosystem. Being a Reference Site can create numerous economic opportunities. - Standardization of social care support and independent living (activity, diet, falls, safety). - Standardization of social care support and independent living (activity, diet, falls, safety). • P9-RIA3 - Big Data 3) The wider and greater use of ICT technologies will be beneficial for the EIPonAHA members. - Standardization of education of AHA providers on good UX design, including accessibility aspects. - Standardization of education of AHA providers on good UX design, including accessibility aspects. • P9-RIA4 - Identification of good practices at international level 4) For assessing the achievements of the EIP, a complex set of quantitative and qualitative indicators should be selected. - Standardization of active (robotic) orthoses and prostheses, including wearable robots such as exoskeletons - Standardization of active (robotic) orthoses and prostheses, including wearable robots such as exoskeletons • P9-RIA5 - Professional ethics 5) The Action Groups, the Reference Sites and the EIP Community would need further support from the European Commission. The EIP is a useful one-stop shop for innovation in AHA. - Standardization of fall prevention devices. - Standardization of fall prevention devices. This priority is connected to the need to ensure the adoption and implementation of ethical patterns in R&I initiatives for the progress of modern science. Particular attention has to be given to strategies that can ensure data privacy and protection, looking for measures that can tackle the fragile nature of existing digital security systems. Furthermore, data management is increasingly more important and therefore there is a need for new methods that can support the analytical management and ethical use of the results. Engagement - Standardization of service robots for independent living - Standardization of service robots for independent living P10. Education and training on AHA 1) The engagement of the citizens is key to ensure the sustainability of the priorities and for their engagement and commitment. Independent living and age-friendly environments proposals Independent living and age-friendly environments proposals • P10-RIA1 – Re-thinking the education and training of AHA professionals in new care and health models 2) Besides policies, the most efficient measure needed would be better cooperation between all types of stakeholders. - Standardization on information and cognitive impairment - Standardization on information and cognitive impairment • P10-RIA2 - Education and training models on AHA for decision-makers 3) The EIP needs to deepen the engagement and the commitment of the existing partners . Very low priority proposals (*) Very low priority proposals (*) • P10-RIA3 – Education and training models on AHA for the general public Funding The following proposals have been identified, due to the factors indicated above, as low priority ones. The relevant European Standardization Organizations (or, if relevant, International Standardization Organizations), should be asked to launch them launched in 2019. The following proposals have been identified, due to the factors indicated above, as low priority ones. The relevant European Standardization Organizations (or, if relevant, International Standardization Organizations), should be asked to launch them launched in 2019. The positive relationship between education and health is widely acknowledged. It becomes imperative to educate people to deal and manage health issues, seeking to achieve a good understanding of a life course perspective on ageing. New education and training models should allow more effective intergenerational links and more self-responsible role in health preservation. Also, informed decision-makers can contribute to the development of AHA policies and the swift implementation of measures to improve the quality of life of the population and the quality of the care services. Finally, AHA professionals need to be trained and equipped with the skills required to respond to the care models (e.g. home-centric approaches) and technologies. 1) Available funding should be better communicated, the ways of applications should be clearer and the staff who are dealing with them should be better trained. Funding and policy priorities should be better aligned. e-Health proposals e-Health proposals 2) Public and private funding should equally support AHA solutions. No eHealth proposals have been identified within this prioritization category. No eHealth proposals have been identified within this prioritization category. 3) Ageing should be also seen as an economic opportunity. Care and healthcare proposals Care and healthcare proposals No care and healthcare proposals have been identified within this prioritization category. No care and healthcare proposals have been identified within this prioritization category. Independent living and age-friendly environments proposals Independent living and age-friendly environments proposals - Standardization of age-friendly built environments. - Standardization of age-friendly built environments. - Accessibility of products and services under a Design for All approach. - Accessibility of products and services under a Design for All approach. - Standardization of age-friendly smart cities (including accessibility). - Standardization of age-friendly smart cities (including accessibility)
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Dear Francesco. Thank for your comment.we will take it into consideration. In fact they seem similar, but they are a bit different. Here it is related to the new methodologies and technologies that should be created to help in the health literacy. the P3-RIA3 is more focus on the ground, helping Healthcare and social care providers to equip and train patients. Amilcar (Proeipaha Team)Dear Nick, Thank you for your comment. Amilcar (PROEIPAHA Team)Dear Charles. Thank you for your comment. In fact when we mentioned the "changing from hospital-based models to home-centric approaches" it refers to start to improve the models of health care and living conditions of the elderly in their own homes by giving them the conditions and all the necessary support to they can age well at their own homes avoiding as much as possible, hospitals and nursing homes. (Amilcar – PROEIPAHA Team)"Please find here some general comments instead of a line by line: First, to ask for a deep reflection on the perversion of this dynamic of fixing wider and wider priorities in order to cover all the matters and all the interest. It’s known that opting-out is a very difficult exercise, but it’s the only one that has proved to be effective in establishing manageable action areas and prioritizing them. Secondly, to remain that subsidiarity is a basic criterion to apply when talking about European actions. In fact, important aims, as “P1 Increase technology awareness and improve user’s eDear Maria. Thank you for your comment. in fact new methodologies will be created to be sure that knowledge and skills are strengthened and placed at the service of the ageing population. Amilcar (PROEIPAHA Team)Dear Maria, you are right. Focus on overall improvement of communication between all AHA stakeholders is a major concern to take into account in this Project. Thank you for your comment. Amilcar (PROEIPAHA Team) Dear Mike, Thank you for your comment. Amilcar (PROEIPAHA Team)"I believe there is an important aspect missing. The quality of the environment where people spend most of their time is of the utmost importance. Not only are older people generally less robust and able to respond to low air quality and uncomfortable conditions, but they also tend to be less mobile and, thus, eventually spend a lot of time in confined spaces. What we think we know in terms of indoor air quality and comfort must be re-thought in light of these particular aspects relevant to this group of people. I believe this would be a great opportunity to address this issue. I would probablDear Bart. Thank you for your question. “AHA professional” are the people involved in the AHA health care system. Inside this huge group of people we have different types of AHA professionals with particular skills, responsibilities and study levels, e.g. doctors, nurses, formal care providers, researchers, hospital staff. (Amilcar – PROEIPAHA Team)Who is considered to be a 'AHA professional'?I feel this whole set of priorities is starting off on the wrong foot. To me the most important thing is to work out what care pathways will best enable people to age well, in their own homes. Only when those have been agreed should we start to think about researching the best technology to support those care pathways. Can we therefore please have a P0 of "identify the best care pathways to support ageing well then research the best technology to support them"I'm really pleased to see this topic included as a priority. Key issues are pretty much picked in the 4 sub-categories. Items 2 Maybe this sub-priority could find its place under the P3 priority as it is directly linked to patient/citizen empowerment. Furthermore, it's very similar to the P3-RIA3 sub-priotiry (Health literacy strategies)co-creation is an important process to established mutual understanding (related to awareness and acceptance) in both the development as well as the implementation and continuous refinementCohort and population study/monitoring in this respect might be quite different from the traditional (medical oriented) cohort studies. I feel unsure about the use of cohort studies to create a better awareness or improve the user experience: maybe only to obtain general principals for particular populations or to create reference or normative data sets. I think it would make more sense to promote monitoring of individuals who're using technology and use their experience and preferences to improve functionality on an individual level.I think that longitudinal studies are importante to monitoring individuals who are using technologyIt is important the use of appropriate tools, ckecklist to monitoring the improve of skills and knowledgeIt is important that solutions were developed with adequate, reliable and simple language I think it would be useful also to create lists, updated periodically, that identify providers that ensure data privacy. Some big names in cloud cannot comply with European regulations on data privacy. Maybe create a kind of badge that identify companies or tools that comply.Since there is a new EU regulation on data privacy, i think this paragraph should refer to it. When it says strategies that can ensure data privacy and protection, we can add that they have to comply with the new EU regulations. Anna ZacchiCo-creation covers not only awareness and acceptance but also the possibility to truly integrate the end users (patients, elderly, family members, care personnel)- into the development work as such. Thus strengthening the probability that the new service really solves problems and provides measurable evidence of its usefulness and positive impact on care quality, efficiency, costs etc.just noticed, that this is actually already said in the text box here :) I completely agree with the stated need to work directly with the private sector and bring in their skills to the development and deployment work of new AHA services. Permanent stuctured Testbed activity can be one way of doing this. Other way is to work in private-public partnership projects, with clear intention and established need to create new service(S)for the use of the public sector partner in the first place and for other potential (also private) markets in the second place. This requires strong and devoted partnerships.YOu have co-creation also in P 1. - is this the same focus here? In any case I would include the co-creation / service design aspect (i.e. User-Driven Innovation) much stronger in this paper. The usability, acceptance, value and outcomes of the new AHA services (that include technologies, digital solutions)are dependant of the having the real understanding of what works and what does not and why. This also makes it possible t evaluate the cost/effectiveness or cost/impact of the new deployed service - this is needed in a world of scarce resources where the payer wants to have "value for money"One tool is to approach the assessment is to use the Value / Outcome based method presented in PROEIPAHA WP 7 (Innovative procurement): i.e. the Value / outcome based service design and procurement method. This is a structured approach that can be applied also in situation where no procurement takes place. Its steps include 1. setting clear objectives for the service, 2. setting clear metrics linked to the objectives, 3. Evaluation method that is implementable and valid. The objectives can include financial / economic ones and care quality / user value based objectives.Maybe we should also include some information about sustainability of current solutions in this area in order to detect successes and errors with the aim of creating new evidences on the return on investment (as mentioned in the Domain Area 5 of this AG) (Paloma Jimeno - Hi-Iberia Ingeniería y Proyectos)Here is place for a multidisciplinary social innovation initiative, particularly mapping and identifying different useful tasks and services, which very well could be covered by different age groups with varying background and qualifications.A well tried out methodology is here EASW (European Awareness Scenario Workshop) Additional advantage is that all over Europe there are trained monitors to carry out such workshops. Many of them belonging to the age group 60 plus .As it was shown within the FP5 Innovation programme, the creation of one or more accompanying measures to stimulate an all European networking around good practices,can be a worthwhile investment.it's a very interessant topic but also very complicated, because standardisation should not be a constraint and a obstacle to developpement of personalized or customized solutions...it's important to find a balance Christophe MULLER, from Moselle Council (France)I would add "INTEGRATION OF lifestyle patterns..." Although I believe this approach is overall adequate and adjusted, I think it's missing a link. Not only users and carers need to learn and be informed about techniologies (even though there are already care organisations that have some knowledge and can be helpful here) but technical stakeholders aso need more field knowledhe (not only academic knowledge) on ageing. So, I would add, after"...informing the users and educate them about the most recent technologies in the AHA sector." that researchers and developers also need to learn about real-life needs and expectations of elderly and carers.We talk for a while about the triple or now quadruple helix of stakeholders but we still don't connect them all in both ways - learning and teaching. Only this exhange of knowledge can upgrade the technologies that may be developed and useful to the market.To achieve all these priorities what we need is to have more joint projects with the participation of all different actors. Although H2020 is very alligned with this, national funding programs (e.g. Portugal 2020) don't implement it - end users aren't eligible in research or development funding calls, for example - and only the experience of specific projects with all actors can bring more shared knowledge, awareness and more efectiveness of the proposed solutions.This is in fact an area that needs to be developed. Cáritas Coimbra is developing many of these activities during its participation on H2020 projects, but we see that there's still a very low participation, awareness and even knowledge on many social care organisations - the economic crisis and the subsequent lack of resources made real damage on NGOs and they have difficulties in investing in these areas, but their iputs are indispensable in orderto have the results we want - solutions that work, that are adjusted to their target and that can have market impact.Prevention has been very highlighte but not yet implemented as needed - I'm glad to see it here again.This is evidently a very important issue and I'm glad it's addressed. Maybe it could be a little more detailed and I dare to say, more ambicious. We may identify and promote good practices but what we need now, in fact, is not only a UE comitment but also a national commitment for all UE members that these will be priorities - in our national funding programmes there are no multidisciplinary interventions - and actually almost no social interventions - and we need here an actual call to action (not only declations of "good" intentions).very important indeedInstead of this title, i think it would be more adequate to have: IDENTIFICATION AND CREATION OF GUIDELINES AND TOOLS This obviously implies the collection of international good practices but goes beyond - just collecting practices doesn't seem to be enough considering the fast development of technologies - we should have a more serious and effective proposal, that would produce outcomes to be used in the future.I would adapt the text saying "This priority is connected to the need to ensure the adoption and implementation of ethical patterns, GUIDELINES AND TOOLS in RRI..." because I believe we already have the expertise to go beyond general patterns and can propose some specific methodologies on these issues - Cáritas Coimbra and other partners are publishing an article this year proposing a Verification Methodology on Ethical Compliance of PCR that I expect can go on this pathway.very, very importantthe use of mobile solutions is definitely one of the key topics but it is also linked with P9., data access, security and big data issues. Neither of these priorities can be discussed without the other.indeed a high priority topic since there are so less interventions focusing on holisitic aspects around europethis correlates with the P9-RIA2, because I think that it will be not an issue to collect huge amounts of data, but the important issue along big data will be how the data will be handled, managed an securely stored - and who will get access?I agree, that this topic is very very important, but be aware that education programs should be tailored depending on the target group (AHA professionals, general public an ddecision makers) and that education and training might be performed by an interdisciplinary team to meet the goals of a holistic approach to AHABut allocating more money would NOT solve all problems in policy-making and implementationwe argue that the major barrier (in addition to the others) is the unforeseen capacity of the middle management to face the urgent issues of the innovative models in integrated care. The complexity of the challenge requires to bring together cultures that were not yet accustomed to collaborate. See https://app.box.com/s/k2wlwu5s7zfddkiw6so8spbdvaswk2z0the political commitment is related to the awareness among the community. The spontaneous pilots aren't enough to raise a pervasive knowledge that can activate the policy makers. The field of AHA requires fully integrated care, supported by digital technologies, and it is too complex to be faced by easy solutions.Of course! (see above). However the cooperation is not yet there in most regions, and it must be one of the first challenges to be faced by a plan. We consider that ideally the deployment is performed through a local Roadmap made of a sequence of Local Initiatives. Each Local Initiative focusses on a particular health issue or on a managerial issue. Ideally a regional Action Plan should orchestrate the Local Initiatives and dealt with common systemic prerequisites and infrastructures. Ideally the regions and the localities should adopt a national/European vision. see the file SX04-TIMIC-F-TheFramework-v22 in the folder https://app.box.com/s/37tv45pdcnjfoknqv00pzgp1bxu76uuasee the file SX04-TIMIC-F-TheFramework-v22 in the folder https://app.box.com/s/37tv45pdcnjfoknqv00pzgp1bxu76uua in chapter 8 we outline a set of potential pragmatic mechanisms to promote scaling upin the file SX05-TIMIC-L-TheLanguage-v22 (always in the folder https://app.box.com/s/37tv45pdcnjfoknqv00pzgp1bxu76uua) we show how to develop a possible language to describe Action Plans, Local Initiatives and Tender Specifications in a comparable way and how to index them in a repository. yes. There is a need for funding a number of well focussed short-term concerted actions to accelerate the production of the sprints. A suitable committee should be entitle to select or provoke the sprint proposals, and to assign to them a reasonable amount of funds, with a simplified procedure. It happened for the Project Teams in CEN TC251; most of them were very effective.Overall there is huge amounts of funding channelled towards older people by state and non state actors at EU, national and local and regional level via health and social care, pensions etc. I think it will be very hard to justify shortage of funds alone as a barrier. However there may be a lack of funding for certain areas and also for innovative activitiesSilos also lead to a lack of connection and synergy in relation to policy as well as funding. Much policy relating to older people is driven by health and social care - understandably - defining older people as vulnerable and dependent. This means that addressing other needs becomes more difficultBetter integration is needed for sure and isolated pilot actions will need to be mainstreamed. Also more action which will prevent older people from becoming dependent through keeping them engaged as citizens and economic actors. This is about perception and image too Most also stress the role of the private sectior; individual businesses as well as business organisations in relation to the silver economy - providing goods and services, market testing, social innovation allowing wider benefits to be captured Not just smes, large economic players and all organisations offering employment Not just smes, large economic players and all organisations offering employment Not just smes, large economic players and all organisations offering employment Focus on businesses set up by older people - olderpreneurs - now an increasing trend, some building on hobbies and passtimes but others offering services that older people need. They will have health and well being as well as economic benefits and should be seen in terms of social innovation. Development agencies, business bodies etc can do more to support thisFocus on businesses set up by older people - olderpreneurs - now an increasing trend, some building on hobbies and passtimes but others offering services that older people need. They will have health and well being as well as economic benefits and should be seen in terms of social innovation. Development agencies, business bodies etc can do more to support thisDo not call people clients and users, call them citizens or customers (if relating to private sector) also important to involve all older people (depending on definition) including those who are not currently dependent or vulnerableDo not call people clients and users, call them citizens or customers (if relating to private sector) also important to involve all older people (depending on definition) including those who are not currently dependent or vulnerableThere is not so much of a mismatch between policy and funding as there is a mismatch between policy for personalized care and actual personalized care. Funding is needed for the latter, and if the former doesn't understand how money is spent by the latter, that's where the mismatch resides. The only way to solve is to create a detailed Information and Process view (done within EIP AHA A2) where policy makers, carers and seniors are identified with everything else in between. This is the only way to identify the common language, not just the common innovation language in the Blueprint.Again, Infornation and Process models are needed as an enrichment to Integrated Pathways models. Scalingup of good practices is just wishful thinking, no matter how good the practice is, unless pathways are accurately described. Funding lines must be connected (connecting the dots!), but pencil and paper won't do for modelling that connection. The EIP AHA scalingup model is hopelessly poor. Note also "silos of silos". There is the integration if primary and secondary care silo of silos, which strengthens the medical side, but does not help in creating integrated pathways for health and social care. If we continue to say "health always first, and social as required" we are making a huge mistake.Capacity building has been a buzzword for a long time, but we seem not to explain what it actually contains, in detail and in specific examples. A simple fact is that more severe health conditions are managed in home care environments as before, and this will increase. Moderate to severe dementia are quite common already in so called self-managed independent living. The competence picture for social work professionals needs adopt more nursing, and things like cleaning and shopping can no longer be formally part of social care. "Funding for capacity building" is thus quite tricky.In countries where politics and government is more bivalently left-right, ageing is also politically left-right. In countries where governments are more multiple coloured, ageing is one of the first issues where they try to agree. The way it becomes an economic issue is then dependent of this bivalence or multivalence. No. It's not a question about political commitment. Again, care teams take care of seniors. Politicians make policies based on their understanding of how that is done. But, of course, central government support helps. However, if they simply spray money all over, it's not going to help. It's like the flower. Its roots needs the water.That's it! And that requires the process model of integrated pathways, involving ALL stakeholders, professionals, and seniors Be more concrete. Germany is almost 100 million. It has states and they work independently. France, Italy and Spain are also "too large" in that respect. Ireland is way below 10 million, so the level below is their CHOs. Scotland, Austria and the Nordic countries are similar. So we have to be careful when we speak "inter", and "intra", across and within countries.This is key! Thanks to whoever wrote this! Geriatrics are very few, GPs more, and nurses and special workers even more than GPs. But seniors and their family is in a number that is exponentially larger. Even we train this group it has affect on other capacity building aspects as well. This is one of the most important points in the whole document. Self-management is achieved by this training.Ecosystem is good concept, but it must be further enhanced. A number of organizations, nobody named nobody forgotten, in Europe are "specialists" on ecosystems, but they need to know more about information and process aspects. Otherwise their ecosystem models remain shallow.The Blueprint indicates that Directorates start to talk to each other. That's good, and they should do that even more often. The same thing happens between ministers and ministries in countries. They seldom hook up for lunch to discuss joint matters. Don't forget deepening! The question is also which comes first. So far it has been "widening and [then] deepening", but it could now start to be the other way around?Why? Not engaging, but training the politicians.Yes, but technology validated also using health standards, not technology standards only. Otherwise we may have solutions where computers talk to computers, and it makes no sense.Again about information and process. Business models are about numbers and actions to achieve them. Business models must speak that common language which is native to all stakeholders, professionals and seniors The EIP AHA scaling-up model simplifies the WHO 2010 model, which in turn simplifies its own 2009 model. Why simplify and simplify? Europe has a population of 500 million. Simple models will not suffice. We might say that this is what we have, let us therefore use it. Nothing could be worse. If we do not have an elaborate scaling-up model, let us jointly create one!This is the quick and dirty approach to scaling-up which bypasses the need to respect national and regional circumstances. It's not scaling-up, it's simple replication. Simple replication is often not feasible even within regions.Efficiency in which sense? Impact assessment by MAFEIP is typical in this sense but MAFEIP does not embrace broad personalized assessment of health and social conditions. Indicators, KPIs, etc must not aim at being simple. Things like ICF were not created just for fun.This is important, and large companies with their health units are involved. They have the capacity to create the information and process pillars for themselves and for AHA as a whole. They can be seen as the engines in the Quadruple Helix model. Of course. No reason at all why not.... and requires information and process modelling underlying a detailed ecosystem model. They must not be disconnected. Ideally 1 1=3 but in a world of bits 1 1=0.More EU funding would be nice, but if we are totally unable to do anything without more and more funding, what is really going on? But indeed, a euro or two always helps.Efficient public/private cooperation, with the involvement of end users, is hard to be reached, mainly because of vertical rooted approaches of each interested party. Nonetheless, pilot actions can sometimes reveal the benefits each party can obtain when collaborating in innovative approaches. Concrete and measurable benefits can really help to affect policies and act against fragmentation Training is a key factor, but the way it is provided is crucial, either. Relying on on-line tutorials or ICT based training has revealed unsuccessful in most of the cases, when addressed to seniors.I'm not sure how this relates to the subsequent structure since there does not seem to be any list of Drivers or challenges in the way the Barriers are enumerated. I think there is something missing here - don't we need to list "Enablers" - we know the drivers in terms of costs, sustainability and quality of life (maybe those should be listed here?) but EIPonAHA is developing enablers (e.g. the good practice database) and there should be some assessment of those, ideas about new one and possible enablers to overcome the barriers listed?I think there are other Barriers: - inadequate characterisations of the ecosystems in different regions so it is hard to see key differences between regions. - training of professionals tends to reinforce traditional approaches. - practices are transferred by picking elements from several practices and recombining - not enough examples of successful transfer.This is a poor characterisation of the issue in my opinion. There is inadequate understanding of how to shift resources from responsive to proactive measures (e.g. prevention and anticipation). The key is how incrementally to decommission some services/activites in order to enable others. Without decommissioning resource will always be ploughed into current solutions rather than looking to solutions that shift the balance away from responsive measures. There is a very good NESTA report on this (entitled "The Art of Exit"): https://www.nesta.org.uk/sites/default/files/the_art_of_exit.pdfI'd say a key enabler here is an understanding of decommissioning and how to blend it with innovation in service delivery.It is not clear what this heading means. In order to further EIPonAHA strategy to spread the implementation of EIPonAHA inspired measures, it is important to make clear arguments about the economic benefits of the measures. This needs an evidence base in terms of the economic effects of a measure and on how best to utilise funding streams in the ecosystem to support transition. Perhaps there should be more emphasis on how to transition to a new practice as well as the description of the practice.A key enable that might help overcome this is data/evidence of the economic effects of new practice and case studies on the economic effects of the transition to new practice.We are aiming to evolve to a sustainable health and care system and I'd guess that in the current climate that means we do not want to see spending exceed current proportions of GDP. In this context we need to see EIP on AHA develop: - arguments for transitionary funding that will enable transition to a more sustainable system where the transitionary funding is not expected to continue indefinitely. - enablers that look at how funding can be reallocated incrementally as old services are decommissioned and new services are introducedIs this primarily a result of the fractured organisational structure that underpins health and care. Scotland has legal powers to drive integration but the cooperation of the different organisations is a long term issue that needs incremental models to achieve.An enabler is the development of approaches to inter-organisation cooperation and the development of incentives that drive cooperation towards sustainable health and care and avoid perverse incentives that encourage gaming and optimisation within single organisations. There are more resources than just funds. Is the primary issue that people are just too busy to innovate in delivery? There needs to be planning about how innovation can be built into everyday process. We need examples of this (is the West Lothian experience of decommissioning care homes and promoting independent living as part of the normal business of renewing care capacity a good example?) This would mean an enabler is how to take consideration of innovation into everyday planning for services.Change in a system inevitably means there will be closure of services and replacement with a new configuration. In health and care this almost inevitably results in protest and politicians react badly to this (e.g. in the UK it is hard to close a hospital). I think a key enabler here is the development of inclusive stakeholder groups that help understand the concerns of people and the need for transition. More generally there is the need for some sort of inclusive governance structure for change that takes account of the ideas of Ostrom on polycentric governance of common pool resources.Angelo makes a point earlier about middle management and organisational change. Effecting change in large, complex organisations with highly autonomous individuals (e.g. clinicians) is difficult. Top down change is effected by changing KPIs and understanding how to avoid perverse incentivisation - developing such patters of KPIs that help promote change through reward while avoiding unintended consequences would be a useful enabler. Enabling bottom up change is more concerned with training on how to identify innovation opportunities and being aware of new practice and how to transition.Should there be work on making practices more searchable and relevant to people involved in service delivery?The issue here is what incentives are there to engender cooperation. Achieving cooperation is a very significant issue. The systems we have at the moment often incentivise gaming and competition. The wider the stakeholder net the more complex this becomes because the value systems across different stakeholders become more difficult to align. This is not a measure it is an aspiration as it stands - there needs to be work put in to discover how to achieve this aspiration.Is the issue how we will enable the EIP on AHA ecosystem to become more productive of innovation that is adopted by other systems? In that case we need to have a range of scales of system represented and some element of subsidiarity in terms of responsibility for particular elements in the creation of innovation. For example, national scale is important when it comes to professional training - local level might be the right place to recognise innovative processes depending on levels of dependency to parts of the system that are planned and implemented at regional or national level.Here, I doubt that "accepting technologies" will have much impact. The key aspect is understanding how to achieve sustainable health and care in the first instance. Without this there will never be a switch to prevention and anticipation in our systems.Here Smart Specialisation is a key driver. Look to Vanguard Initiative. Not having read the comments, I think this section needs to be heavily edited to provide a clearer understanding. One element that is missing in the knowledge of AHA. Because healthy living does not begin at 60 - it begins the day you are born. In addition, in regards to barriers to policies then one barrier is the understanding of the field and the (sometimes) non-inclusion of the users and their requirements. Not having read the comments, I think this section needs to be heavily edited to provide a clearer understanding. One element that is missing in the knowledge of AHA. Because healthy living does not begin at 60 - it begins the day you are born. In addition, in regards to barriers to policies then one barrier is the understanding of the field and the (sometimes) non-inclusion of the users and their requirements. More so, the government should address the issue of ageing begins with prevention first and foremost! "Ageing issues" is not a problem". We all get there eventually so stop treating it like a disease but look at possibilites instead. Ecosystems and support systems. And it must be voluntary and based on regions/organisations' own abilities. How about "involving the users in co-creation processes" - just a suggestion. See previous comments. In regards to scaling-up, I suggest you look at great example from EU project, MASTERMIND, where transfer work-shops are being held. See "Market-place approach". Agree, but it is also important to get ownership from leadership on all levels, maybe a condenced newsletter sent out a couple of times a year and a toolkit to aid participants in informingtheir leaders could assist the process. This should have high priority and the sprints should in particular address this. This is not only about empowerment but about power structures, health literacy and digital health literacy. In particular interventions where the citizens and users of health care needs to be understood based on their capabilities and ressources. In this way we should not empower but educate and inform at all levels eg. schools and courses in collaboration with EIT health. Should also include research institutions! If possibleAlso project and evaluation models It should be stated specifically that it should be both citizens as recievers and collaborators as well as their formal and informal care givers that should be included. - agree with all that is mentioned re: funding - sometimes the problem is also the lack of a cohesive and comprehensive set of policies (not necessarily concerning funding issues, but policies in general that address or intend on addressin IC and/or AHA). The silos mentality is reflected not only on funding and funding policies but also in policy and decision-making in general. - ageing as an economic and financial priority (instead of only being a political priority). not sure if the argument will stick. Ageing is already one of the demographic changes considered by the H2020 program and a lot of money is being placed in research on the topic. To me the problem are the political options underlying the allocation of money (policies?): it is mostly directed to technology, pharmacology and biomedical factors. Much less attention is paid to IC or psychosocial dimensions of ageing - which are crucial for the understanding of AHA and its assertion as a real priority- I agree with a step by step approach. Not sure if the one described in the document is the best. My guess is that there is a lot we still don't know about how IC operates and/or is being implmented in Europe's regions/countires. Perhaps, first, we should come up with a mapping of IC in Europe's regions/countries (in line with what is intended by the B3MM and and the EUREGHA sprint), and then proceed to the design of a solution or strategy that is inclusive and goes beyond the "one size fits all" approach (which, I'm sure, is not what is intended with the proposal/approach in the document)I also think that reference sites could have a strategic relevance in this process that goes beyond its economic dimension or the economic opportunities they may represent. I think that reference sites could have a role in this processof bringin into light needs/resources, etc existing in a region and understanding which could be the best strategic approach to achieve engagement at all levels (local/community, regional, national) and the specific forms such engagement could assume- I would like to see more emphasis on the role of NGOs. There are many NGOs that already contribute to IC without often being aware of that. These organisations often lack training and financial resources, and they usually are unaware of what is out there and how they access it. Some discussions highlighting the issue were held at the June meeting of the B3AG.- I agree with what is said in the document - I also think that much more and more easily could be done if funding existed for assessing and testing/experimenting The methodology for processing the survey did not take into account relation of the answers and various countries in EU. Similarly, relation of healthcare and social systems and national AHA policies is not visible in the survey results. There is known issue of lower active participation of a number of EU countries (and regions) in EIP on AHA and RS and they also may have different response to incentives that may function in other regions that are more progressive in AHA. Other barriers may also exist and they were not revealed by the surey. We have dicsussed this in afternoon sesssion in BRU.Maybe at least remark in the survey related to the fact that different EU countries / different healthcare (social care) systems may need specific incentives to overcome their barriers could be useful. Dear Stuart thanks very much for your comment. You are right. You do not see the complete picture here. This is only an abstract of the document. The drivers/enablers are not discussed online. I would like to invite you to read the full report. Actually two: one that analysed the online survey on the drivers, barriers and challenges and the second one on the expert workshop that we organised in Brussels on 7th September. If you communicate your email address to me, I would be happy to forward those to you. Thanks very much for your comments! thanks very much, Stuart, David and Filomena. I have integrated your comments into the report. Thanks very much, Patrick and Eklund. Very good comments. Christina, I will look at your comment how to integrate it with a bit more explanation. We know Vanguard very well.thanks for the interesting comments on the separation of health and social care, Patrik. I also integrated the comment on the organisational fragmentation, Stuartthanks, Angelo and Stuart. I have integrated your comments about capacity building and embedding innovation in everyday practices thanks, Angelo and Stuart. I have integrated your comments about capacity building and embedding innovation in everyday practices Thanks, Damir!This sentence was more about the skills to apply for funds, not necessarily about the skills for the care staff but I will try and look for a place to insert this comment, Patrik. ThanksDear Christina, I understand that it is not easy to grasp the whole picture by these small paragraphs that we put forward for comments. If you provide me with your email address, I can forward you the whole report. Yet, your comment about the engagement of the users I will try and integrate in another chapterDear Patrik. thanks very much. Integrated as a whole. Interesting observation, indeed!Dear Stuart, your suggestion for an inclusive stakeholder group has been accepted to include in the textDear Christina, absolutely, that is what we suggest: ageing is an opportunity in many waysDear fiomena, I have inserted your comment. Good point! although not here but in the funding part. thanks!Dear Angelo and David, very faire points. I have taken them up. dear Lars, thanks very much. you are right, indeed about the ownership. I have inserted your commentdear Lars, thanks very much. you are right, indeed about the ownership. I have inserted your commentthanks very much for all: Angelo, Patrik, Francesca, Lars and Stuart. I liked all your comments. They touch upon different aspects of cooperation but support the original idea. I have included all the comments in the report.Angelo, this is an interesting observation. I will take it up but in another chapter. Thanks!thanks very much. Very interesting and very much in line with what we stated. I have integrated this evidence as you statedStuart, very good point. I have inserted he distinction between the issues.Thanks for all your excellent comments. I had to mix them a bit to extend this paragraph.thanks, Christina and Patrik. I have included your commentsDear Christina, the full text does include the involvement of citizens right from the beginning. Yet, I have included that "through co-creation processes". Thanks!thanks, Patrik. I have added this comment on Blueprintsurely, we mean that all stakeholders, LarsPatrik, actually participants at the workshops rather highlighted deepening, not wideningthanks, David. Changed the term to a broader category as you suggested. thanks, Patrik. Good point. I inserted this comment but elsewhere because in this chapter we refer to tools rather than solutions.thanks, Filomena. I have included the NGOsthanks, David. Included the comment but not exactly in this chapter but below in the chapter about investments.thanks, Patrik. I have included the comprehension aspectthanks, David. I have changed the term into citizens and customersthanks for all three of you. I have included your comments in the chapterAccording to a Pilot Survey for Older Adult Patients entitled "Health literacy of Functional Decline and Frailty related to Ageing", the most trusted sources of information were: doctors (79.4%), health broadcasts, nurses, pharmacists and magazines. Therefore the professionals should first be trained to have the right skills in order to train the citizens to become "ageing literate". Relying on on-line tutorials or ICT based training has revealed unsuccessful in most of the cases, when addressed to seniors. Therefore health literacy should be mandatory in the curricula of medical schools.I would be fine to include the W3C Consortium as International Standarization Organization, as well.Maybe should be more appropiate to collaborate with existent workgroups in interoperability standards such as "Web of Things" instead of develop a brand new standardis it possible to promote WHO methodology related to age-friendly cities and communities as a standard in the EU? otherwise, there will be plenty various "age-friendly" standards that will not fit to each other...should not this be moved to "Independent living and age-friendly environments proposals"?can we literally indicate housing and public spaces?cities and communities?I believe environmental quality of spaces occupied by elderly people is of the utmost importance! It has not only a huge impact on their quality of life but also very big implications in terms of costs for the health care system. We can't forget how sensitive and frail many of us can be at this age and, thus, particular attention must be put on this issue!1. The list of very high priority proposals feels relatively long, whilst the list of high priority proposals is relatively short. 2. We would suggest to focus on just a few proposals that are very high priorityWe agree that this should be a very high priority.We agree that this should be a very high priority.We agree that this should be a very high priority.We would like to suggest another topic for high priority - Accessibility of products and services under a Design for All approach. We need to be aligned with the BS 8878 Web accessibility Code of Practice.We fully endorse this proposal as we have a Scottish strategic priority focussed on medicines reconciliation.We would like to suggest a new high priority proposal that focusses on merging or extending standards to support integrated health and social care. We have the impression that eHealth standards are focussed on the health domain, which is no surprise. However, in relation to the integrated care ambitions of Scotland, this leaves a gap when dealing with other types of datasets and different semantics related to social care and other services. The above could be achieved by merging or extending other standards to encompass 'integrated health and social care'. These are very relevant in the context of person centred care and the direction that we are taking in Scotland: a. Cognitive accessibility of ICT products and services. b. Accessibility and integration of mobile applications, including those that support independent living.We are not convinced that this needs any standardisation. It is a question of making a good level of network connectivity available in remote and rural areas. The rest will then fall into place.We believe this should be a high priority, not medium. We would recommend to elevate this to at least medium priority. Quality matters to get adoption and it would be good to have an off-the-shelf reference.We would suggest raising the profile of this proposal to at least medium. We should be more consistent with this support and not have citizens being disadvantaged by where they live.We would suggest to elevate this to a medium, or even high, priority given that we generally place a higher value on usability. I agree with the previous comment.I asume it will be considered to coordinate or use current standards on health data. (HL7, SNOMED, LOINC)Standarization on Social History (Electronic Social Record) needed. Information on social services, rehabilitation carried out by the third sector, social needs and support, ... Totally agree with previous comments. Social care in the scope of integrated care is needed.I also agree...maybe some can be set as lower priority to focus in a achievable subset.I think SNOMED and HL7 may also be contacted as most proposals are around semantic interoperabilityI agree alsoAbsolutely support this topic (as stated previously). The more standardised care interventions the easier to adopt in a certain case of useFrailty and dependency scales and assessment should be par of the standardizationBest practices gathering should be done as long as attached to outcome evaluation An entire smart ecosystem What about smart nets ? - so many elderly are left far from the cities! What about smart nets ? - so many elderly are left far from the cities! Expansions to cover social care records necessary, as mentioned in other comments.Results of OpenMedicine project should be utilized.In agreement with former comments. Absolute necessity and not yet a priority in many EU MS.It would be more appropriate to propose standardization of fall prevention practices, rather than services.Both assessment of the different dimensions of frailty and the next proposal on interventions for different frailty risk categories would be more appropriately placed at least as 'High' (if not very high) priorities, since frailty is a comprehensive measure of a person's health and well-being status. Completely agree with D. Henderson's comment. As it has been brought up in several points, the social care aspects need to be reflected on all levels - not just the healthcare perspectiveThe formulation of this proposal is unclear. Does it mean standardization of information describing cognitive impairment or standardization of information to be provided e.g. to persons with cognitive impairment? Either way, it should be of higher priority.There is a lot to be learned and taken up from Design for All- principles and experiences, therefore it should be raised to a considerably higher priority status.I believe that an environment incorporating in its design principles the knowledge on human physiology and perception and especially the physiology and perception of people across the lifespan, where multi-morbidities such as frailty and Alzheimer’s might occur, is beneficial for all other aspects of care and everyday life and acts as their multiplier. The transfer of knowledge and upscaling for frailty and fall-prevention through design technologies as well as the integration of healthcare facilities via holistic approaches is of great importance.Inclusion of new design paradigms for environments of the care and treatment of people and for sustaining healthy societies