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Project Acronym: INCAContract Number: CIP 621006

Starting Date: 01/01/2014Ending Date: 30/06/2016

Deliverable Number: D5.1Title of Deliverable: Market Overview

Work-Package of the Deliverable: Planning for SustainabilityDeliverable Type: R

Distribution: PUContractual Date of Delivery to the

CEC: 31/12/2014Actual Date of Delivery to the CEC:

Author(s):

Lars T. Berger, Miguel Alborg Farinos, Neofytos Gerosavva, Beatriz Martínez-Lozano Aranaga, Igor Ljubi, Alejandro Everria, Vicente Peñalver Camps, David Herrero Garcia (many more, order to be decided later, input is coming from ALL partners in the INCA consortium)

Contact point: [email protected]

Other Contributors: To be decided

Abstract: XXX insert

Project Co-ordinatorCompany Name: IDI EIKONName of representative: Miguel AlborgAddress: C/ Benjamín Franklin, 27

Parque Tecnológico de Valencia46980 – Paterna, SPAIN

Phone Number +34 96 112 40 00Fax Number: +34 96 112 40 54E-mail: [email protected] WEB site address: http://www.in3ca.eu

* (a) PR = PrototypeRE = ReportSP = SpecificationOT = Others

* (b) P = Public, for wide dissemination (public deliverables shall be of professional standard in a form suitable for print or electronic publication)

C = Confidential, limited to project participants. Irrespective of the status, all the reports and deliverables must be made accessible to the other project participants and responsible EC services.

ICT PSP D5.1v0.1: Market Overview INCA Nº 621006

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Copyrights

© 2014 The INCA Consortium, consisting of:

Investigación y Desarrollo Informático, Spain Ayuntamiento Quart de Poblet, Spain Interfusion Services, Cyprus Kenus Informática, Spain Especializada y Primaria L’Horta Manises (Hospital de Manises), Spain Dimos Geroskipou, Cyprus Ventspils Pilsetas Domes Socialais Dienests, Latvia Ziemelkurzemes Regionala Slimnica Sia, Latvia Hrvatski Zavod Za Zdravstveno Osiguranje, Croatia Grad Rijeka, Croatia Fundación para la Formación e Investigación Sanitaria de la Región de Murcia,

Spain

All rights reserved.

This document may not be copied, reproduced, or modified in whole or in part for any purpose without written permission from the INCA Consortium. In presence of such written permission, or when the circulation of the document is termed as “public”, an acknowledgement of the authors and of all applicable portions of the copyright notice must be clearly referenced. This document may change without prior advice.

For further information related to this Deliverable or to the INCA project please visit the project Web site http://www.in3ca.eu or contact the Project Coordinator [email protected].

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Document History

Version1 Issue Date Stage2 Content and changes0.1 31/03/2014 Draft Structure and contents defined by the WP5

Leader, the WP5 lead contributors and the Project Coordinator

1 Please use a new number for each new version of the deliverable. Add the date when this version was issued and list the items that have been added or changed. The ‘what’s new’ column will help the reader in identifying the relevant changes. Don’t forget to update the version number and date on the header.

2 A deliverable can be in either of these stages: “draft” or “final”. For each stage, several versions of a document can be issued. Draft: Work is being done on the contents. Final: All chapters have been completed.

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Executive SummaryThis is the 1st draft of D5.1. The main intention is to outline its contents and the work

strategy applied throughout the next 9 months until the due date of the final version.The detailed executive summary will be written once the document is mature and will

include:o document objectives

o main findings

o conclusions

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Table of ContentsCopyrights........................................................................................................................................2

Document History............................................................................................................................3

Executive Summary..........................................................................................................................4

1 Introduction and Context..........................................................................................................7

2 Integrated Care Trends..............................................................................................................8

3 Health System and Financial Flows in the Pilot Countries.........................................................9

3.1 The Spanish Health Care System..........................................................................9

3.1.1 General Overview......................................................................................................9

3.1.2 Organization...............................................................................................................9

3.1.3 Public Health Care....................................................................................................10

3.1.4 Private Healthcare...................................................................................................11

3.1.5 Spanish Health Care System Participants and Interrelationships.............................12

3.2 The Cyprus Health Care System..........................................................................12

3.3 The Croatian Health Care System.......................................................................12

3.4 The Latvian Health Care System.........................................................................12

4 INCA Predecessor and Companion Projects.............................................................................13

5 eHealth Literature Review.......................................................................................................15

6 Conclusions..............................................................................................................................16

References......................................................................................................................................16

Appendix – Online Databases and Resources.................................................................................17

Bibliographic Resources....................................................................................................17

Online Statistics Databases.............................................................................................17

Online Project Databases..................................................................................................17

Appendix – INCA Briefs: A D5.2 Preview (not in final D5.1)............................................................18

6.1 Product Hypothesis to Brief...................................................................................19

6.1.1 Product Features......................................................................................................19

6.1.2 Product Benefits.......................................................................................................19

6.1.3 Intellectual Property................................................................................................19

6.1.4 Dependency Analysis...............................................................................................19

6.1.5 Product Delivery Schedule.......................................................................................19

6.1.6 Total cost of Ownership/Adoption...........................................................................19

6.2 Customer Hypothesis to Brief...............................................................................20

6.2.1 Types of Customers..................................................................................................20

6.2.2 Customer Problems..................................................................................................21

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6.2.3 A day in the life of Our Customer (or a day in your live)..........................................22

6.2.4 Organizational Map and Customer Influence Map..................................................22

6.2.5 Return on Investment Justification..........................................................................22

6.2.6 Minimum Feature Set..............................................................................................23

6.3 Channel Hypothesis to Brief.............................................................................................23

6.4 Pricing Hypothesis to Brief...............................................................................................23

6.5 Demand Creation Hypothesis to Brief..............................................................................24

6.6 Market Type Hypothesis to Brief.....................................................................................24

6.7 Competitive Hypothesis to Brief......................................................................................26

6.8 Positioning Brief...............................................................................................................27

Appendix – Templates (not in final D5.1).......................................................................................28

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1 Introduction and ContextThe European project IN3CA (www.IN3CA.eu) deploys a multi-channel, patient centred,

integrated socio-sanitary care platform. Social services, medical organizations, patients, and private care givers are able to interact with each other through any device capable of running an Internet browser. Serving content from the Cloud allows access anywhere at any time.

INCA’s aim is to validate and to start a pragmatic initial deployment in Europe. The implementation of five pilot sites is foreseen the end of 2014. After having completed the implementation tasks, pilots will run for more than a year, followed by an evaluation to validate the implementation of the model and its impact as well as its replicability potential in other countries. INCA pilots target to impact more than 125.000 users and directly engaged with 1550 active users.

Achieving INCA Sustainability - the primary objective of WP5 - bears quite some parallels to problems startups face. Hence, among others when developing WP5 we consider key lean startup movement literature. Particularly, the interested reader might want to refer (Blank, 2013), (Ries,2011), (Maurya, 2012), (Furr & Ahlstrom, 2011) to get a more detailed understanding of the methodology applied throughout WP5.

An overview of all WP5 deliverables is given in Table 1-1. This pubic deliverable will mainly review publically available information related to the integrated care market and its savings potential. Further a review of predecessor and companion projects is provided baring some parallels to INCA. The deliverable is rounded off by a review of eHealth Reports and Literature.

Further, the INCA consortium internal deliverables reveal key strategic information on the quest to make INCA a sustainable and replicable business success. Sustainability, from a business point of view can at the same time be beneficial for society as whole and we strive to proof the positive impacts of INCA not only in terms of improved care quality but on society as a whole through a Socio-Economic Impact Assessment (SEIA) as detailed in D5.4. The SEIA will give decision makers information which they can use in weighing the potential positive and negative consequences of deploying INCA in their respective areas of influence.

TABLE 1-1: INCA WP5 DELIVERABLE OVERVIEW.

Deliverable Title Month Nature DisseminationD5.1 Market Trends Overview M12 report publicD5.2 Sustainability Strategies (public and private) M18 report confidentialD5.3 Business Plan Production M21 report confidentialD5.4 Socio-Economic Impact Assessment M28 report public

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2 Integrated Care TrendsWithin this section we are going to collect and present European statistics indicating inclusive

care trends. Especial focus will be put on peculiarities of the eHealth markets in the partners’ countries (SPAIN, CYPRUS, CROATIA, LATVIA).

Country specific information will shed light on existing eHealth services, technical infrastructure (percentage of citizens covered, broadband diffusion, percentage of elderly population, percentage of chronics, life-expectancy, growth domestic product, employment, sophistication level, user centricity, active age population, eHealth services usage vs age, number of specific patients per case (e.g number of cardiovascular patients in Cyprus, number of Diabetics/heart failure in Spain, mental health patients in Croatia and Rjeka), the number of the established initiatives per case.

Further, we are currently gathering:

Statistics regarding revenues spending from each country in eHealth (average figures for hospital admissions, average costs of admission)

Data about the expenditure of already established initiatives in Health social care (running costs labour/non labour, set up costs, costs carried over from previously existing services).

The severe budgetary constraints and at the same time what perspectives/potential exist or other solutions for savings and under what circumstances.

The eHealth market in EU in terms of maturity and readiness, the stakeholders, their respective penetration strategies for the roll out services

On a EU wide level we are collecting statistics on:

public health care expenditure in EU28 ICT Usage, ICT penetration Infrastructure covering Global telemedicine Market growth Number of enterprises working in Integrated Care in the country/region Estimated projections for elder population in EU between 2017-2021, based on the older

population growth trend from 2012 to 2030

Among others, helpful data sources with be:

Eurostat: Population structure and ageing (statistics of population projections of Eurostat for persons >65 years and for years 2020-2030) http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home/

eHealth Action Plan 2012-2020 - http://ec.europa.eu/digital-agenda/en/news/ehealth-action-plan-2012-2020-innovative-healthcare-21st-century

The 2012 Ageing Report: Economic and budgetary projections for the EU27 Member States (2010-2060) http://ec.europa.eu/economy_finance/publications/european_economy/2012/pdf/ee-2012-2_en.pdf

Innovative healthcare for the 21st century. EUROPEAN COMMISSION Brussels, 6.12.2012 COM(2012) final

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http://ec.europa.eu/economy_finance/publications/european_economy/2012/pdf/ee-2012-2_en.pdf

http://ec.europa.eu/economy_finance/publications/european_economy/2012/pdf/ee-2012-2_en.pdf

http://ec.europa.eu/digital-agenda/en/news/ehealth-action-plan-2012-2020-innovative-healthcare-21st-century

http://ec.europa.eu/digital-agenda/en/news/ehealth-action-plan-2012-2020-innovative-healthcare-21st-century

http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home/


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3 Health System and Financial Flows in the Pilot Countries

Unfortunately, Health Systems in Europe are very diverse, making it much harder for service providers to replicate their services. And not even within a country, structures and entities are homogeny, establishing a serious entry barrier for smaller players and SMEs. The following provides an overview of the general health system organization with service and monetary flows.

3.1 The Spanish Health Care System3.1.1 General Overview

The Spanish "National Healthcare System" is based on universal healthcare and provides health services to all Spanish residents. It is funded by Social Security contributions and combines public and private healthcare. The government sets the overall budget for the country, but each region takes individual responsibility.

To benefit from the Spanish National Healthcare system and medical assistance, residents must enrol with the General Social Security Fund (Dirección General de la Tesorería General de la Seguridad Social - TGSS). This gives access have access to free or low cost healthcare. Provincial social security offices are located throughout the country.

The Spanish National Health Service has an extensive network of health centres and hospitals throughout the country. The Health centres offer Primary Health Care Services (family/GP services, pediatrics and nursing, with availability of midwives, physiotherapists and social workers). If circumstances require, medical attention can be provided in the patient’s home. Hospitals offer specialized attention, with access via referral from primary healthcare services. Medication is obtained at pharmacies. Prescriptions are delivered by doctors, although some medications can also be obtained at pharmacies without prescriptions by paying their total cost.

The National Health insurance system covers medical treatment in a health centre and in (a public or private) hospital, contracted by Comunidades Autónomas or INGESA. The national health insurance system provides medicines, surgical prostheses, orthopaedic equipment and ordinary wheelchairs. It does not cover dental prostheses or eyeglasses. Citizens coming from European Union countries or from countries with bilateral health agreements with Spain, receive the same service as Spanish citizens.

3.1.2 OrganizationSpanish National Healthcare System is decentralized. The system consists of three organizational

levels:

1. Central (Organización de la Administración Central)The state's central administration agency is the Ministry of Health. This agency is in charge of issuing health proposals, planning and carrying out the execution of the government's health guidelines, and coordinating the activities aimed at reducing the consumption of illegal drugs.

2. Autonomous Community (Organización Autonómica)The territorial administration of health services is the responsibility of each of Spain's 17 Autonomous Communities (“Comunidades Autónomas”). Each Autonomous Community must offer integrated health services to the population through the centres, services and establishments of that community.

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3. Local (Áreas de Salud)The “Áreas de Salud” are the fundamental structures of the National Healthcare system and are responsible for the unitary management of the health services offered at the level of the Autonomous Community.

The “Áreas de Salud” are defined taking into account factors of demography (with a minimum of one “Área de salud” per region), geography, climate, socioeconomics, employment, epidemiology and culture. To increase operability and efficiency, the “Áreas de Salud” are subdivided into smaller units called “Zonas Básicas de Salud”.

3.1.3 Public Health CareIn Spain, registration with the Social Security service is compulsory. It is done once only, when the

person begins to work for the first time, and is valid for his or her entire working life. Once a person has registered s/he is given a registration card with his or her personal details and a personal social security identification number. This card is valid for his or her whole lifetime and is used for all dealings with the social security system, and so must be kept very carefully.

Social security contributions are calculated as a percentage (contribution rate) of the contribution base. These contribution bases and rates are determined by the government each year. The Social Security System in Spain has two levels or types of protection: the contributory system and the non-contributory system.

The Contributory system is further subdivided into:

a general scheme applicable to all employed persons who are not covered by special schemes, plus certain categories of civil servants; and

three special schemes, for: the self-employed, coal miners and sea workers (sailors and fishermen).

Students are covered by a special protection plan (school insurance). There is also a special contributory scheme for civil servants.

The Non-contributory system provides coverage to people who face a specific situation of need, and whose income is below a certain legally prescribed level, are eligible for non-contributory benefits. They may be entitled to this even if they have never paid social security contributions, or have done so but are not entitled to the resulting benefits under the contributory system.

Non-contributory benefits include:

medical assistance;

retirement and disability allowances;

special assistance for the unemployed (subsidio por desempleo);

family allowances;

non-contributory maternity allowance (subsidio por maternidad de naturaleza no contributiva) (not means-tested).

In addition, certain limited categories of persons may claim supplementary benefits from the central or local government. This social assistance is provided primarily to elderly and disabled persons.

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Access to health insurance is also provided to family members of insured persons as long as they reside in Spain, including, under certain conditions:

• the spouse of the person insured or the person co-habiting with the insured;

• those who are separated or divorced if they have the right to alimony;

• lineal descendants of the insured or his/her spouse, whatever their legal filiation, brothers and sisters of the insured person, and fostered children, younger than 26 or with a degree of disability of at least 65%.

Further, the Spanish system provides for the possibility of concluding special voluntary insurance agreements with the social security services for the purpose of maintaining, or in certain specific cases extending, an entitlement to social security benefits. In certain situations this may mean subscribing to the corresponding social protection scheme, depending on the person’s occupation. In such cases the insurance contribution is paid entirely by the subscriber.

3.1.4 Private HealthcareCare at private hospitals and clinics in Spain is either paid directly or, most often, through a

private insurance carrier. The main benefit of contracting private health insurance in Spain is to avoid the sometimes long wait times to see a doctor associated with the public healthcare system. Private healthcare companies also offer quicker service to patients and offer value-added services such as private rooms, express mailing of test results and keeping patients informed via email and SMS messages. Some of the most popular private medical insurance carriers in Spain are Sanitas and Mapfre.

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3.1.5 Spanish Health Care System Participants and InterrelationshipsSpanish health care system participants and their interrelations in terms of financial and service

flows are outlined in Figure 3-1. There are 17 regional health services to deal with.

FIGURE 3-1: THE SPANISH HEALTH SYSTEM AND ITS FINANCIAL FLOWS, ADAPTED FROM HTTP://WWW.MSSSI.GOB.ES/ORGANIZACION/SNS/DOCS/FLUJOSFINANCIEROS.PDF .

3.2 The Cyprus Health Care SystemUnder preparation

3.3 The Croatian Health Care SystemUnder preparation

3.4 The Latvian Health Care SystemUnder preparation

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4 INCA Predecessor and Companion ProjectsINCA does not exist in a vacuum. In this section we are reviewing key projects with a manifold set

of intentions. An interesting reading source in this respect is (B3 Action Group - Integrated Care,2013). Clearly, there is lots to be learned from available public deliverables and there is no need to reinvent the wheel. Further, a careful review will allow us to identify treats from competing consortia as well as spotting opportunities for strategic alliances and co-operation.

SMARTCARE is tying to understand how ICT and service processes can be improved to support higher quality and more integrated care to older people living at home in Europe, so enabling them to live more independent lives. The project will produce and document much needed evidence on the impact of integrated care, developing a common framework suitable for other regions in Europe. The common services will allow efficient cooperative care delivery and empower older people to take part in effective management of their health, wellness, and chronic conditions and maintain their independence despite increasing frailty.

epSOS (Smart Open Services for European Patients, www.epsos.eu) is the main eHealth interoperability project co-founded by the European Commission, formed by 47 beneficiaries. It focuses on improving medical treatment of citizens while abroad by providing health professionals with the necessary patient data. epSOS has been conceived as a large scale pilot A project, involving, in the second phase (2011-2013), 23 different European countries: 20 MS and 3 non-EU members (started in July 2008). The project will demonstrate that - based on European collaboration and the commitment of the Participating Nations - it is possible to improve the quality and safety of healthcare provided to patients outside their usual country of residence. In epSOS the primary objective is to gather information and evidence in order to facilitate and ensure subsequent sustainable and interoperable full deployment under near-market conditions. Furthermore, epSOS outcomes are among the most outstanding results, raising a lot of interest among other European eHealth Consortia because is paving a successful way to full eHealth deployments. The initial focus of epSOS is on cross-border access to Patient Summary and ePrescriptions data sets.

CALLIOPE (www.calliope-network.eu/) collaborates with epSOS with the eHEALTH INTEROP project launched by three European Standardisation organizations (CEN, CENELEC and ETSI) with the goal to enable the market to deliver interoperable solutions.

EU- network brings together experts and procurers interested in developing and implementing innovative procurements in the eHealth , Active Aging and Independent Living areas . The EU FP7 funded INSPIRE (International Network Supporting Procurement of Innovation via Resources and Education) -project presents an outstanding effort to create practical impact on the use of the Pre-Commercial Procurement (PCP) instrument and to strengthen forward looking procurement strategies in the domains of eHealth, Active Aging and Independent Living in partner Regions. Learnings will also be shared with other EU actors through an electronic platform where e.g. key analysis, PCP templates and webinars will be stored for future use.

United4Health - UNIversal solutions in TElemedicine Deployment for European HEALTH care. After nearly two years of worldwide research, the European MovingLife project (part of the 7th Framework Program) produced a roadmap for mobile health. It includes recommendations for technological research, clinical implementation practice and policy support. Its aim: to accelerate the establishment, acceptance and wide use of mobile eHealth solutions. What actions should be taken to secure a widespread uptake of mobile healthcare technologies? More info in the related document below and on the website www.moving-life.eu. Research results

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http://ec.europa.eu/digital-agenda/en/newsroom/all/research-results

http://ec.europa.eu/digital-agenda/en/newsroom/all/research-results

http://www.moving-life.eu/

http://ec.europa.eu/information_society/apps/projects/factsheet/index.cfm?project_ref=325215

http://ec.europa.eu/digital-agenda/en/news/new-network-ehealth-experts-and-procurers
























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A new EU research project, called PERSSILAA (PERsonalised ICT Supported Service for Independent Living and Active Ageing) has been launched and will run for the next three years. PERSSILAA aims at the development and validation of a new service model that addresses frailty in community dwelling for older adults. The validation will be done in two regions: the Enschede region in the Netherlands and the Campania region in Italy. PERSSILAA builds on activities within the European Innovation Partnership on Active and Healthy Aging and on the results of earlier European projects. More information

New project ALFRED: Personal Interactive Assistant for Independent Living and Active Ageing, News: 06/12/2013, ALFRED’s objective is to develop a mobile, personalized assistant for elderly people, which helps them stay independent, coordinate with carers and foster their social contacts.

ALFRED will be a mobile, personalized Butler, created using cutting edge technologies such as advanced speech interaction, so you can talk directly to him. ALFRED will be very easy to use and will provide 'context-sensitive services related to social inclusion, care, physical exercise and cognitive games.' The ALFRED research project aims to contribute to a society, where older people will be able to live at their own homes, independently and actively participate in economic and social life. More information

HAPPI is a project aiming at linking European health public procurers to work together in order to detect and purchase innovative and sustainable solutions which will improve ageing well. HAPPI - HA a priority for Europe"Ageing well" in health institutions is an area where innovation does not currently have a high profile, due to lack of promotion or lack of perceived value. Nonetheless, the stakes of ageing well are high, both for institutions and for manufacturers. The HAPPI project therefore seeks to establish the conditions for health institutions throughout Europe to collaborate in the purchase of "ageing well" and health innovative products, services and solutions for the long term. In order to achieve this goal it brings together an original consortium of 10 partners from 6 Member States of the European Union. http://www.happi-project.eu/abouthappi/about-happi

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http://www.happi-project.eu/abouthappi/about-happi

http://www.alfred.eu/

http://www.alfred.eu/

http://www.perssilaa.eu/

http://www.perssilaa.eu/


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5 eHealth Literature ReviewMuch can be learned from recent reports and studies in the field. As D5.1 is the first deliverable

in WP5, we dedicate this section to a review of “must read” literature on the quest to INCA sustainability. All partners are encouraged to suggest literature for inclusion into this section. However, please be selective when recommending. Further a subfolder “must_read_literature” has been created in the WP5 working area. All partners are encouraged to upload their contributions there. However, you are also encouraged to speak up if you think something is not worth to be included here.

Business models for eHealth (Valeri, Giesen, Jansen, & Klokgieters, 2010) National Evaluation of the Department of Health’s Integrated Care Pilots (Rand Europe,

Ernst & Young, 2012) Does Clinical Coordination Improve Quality and Save Money? Volume 1 and 2 (Øvretveit,

2011) Reflection process on modern, responsive and sustainable health systems (Subgroup 2 on

defining success factors for the effective use of Structural Funds for health investments,2013)

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6 ConclusionsWill be written at a later stage.

ReferencesYou can add references in the Reference Ribbon->Manage Sources->New

If you afterwards cite them in the text (via Insert Citation) then they will be automatically included in this reference section.

B3 Action Group - Integrated Care. (2013). A COMPILATION OF GOOD PRACTICES.

Blank, S. (2013). The Four Steps to the Epiphany.

Coram, B. (2012). Customer Development as a Design Squiggle. Retrieved from FIVE WHYS: http://fivewhys.wordpress.com/2012/07/03/customer-development-as-a-design-squiggle/

Furr, N., & Ahlstrom, P. (2011). Nail It Then Scale It.

Maurya, A. (2012). Running Lean. O'Reilly.

Øvretveit, J. (2011). Evidence: Does clinical coordination improve quality and save money? Health Foundation. Retrieved from http://www.health.org.uk/publications/does-clinical-coordination-improve-quality-and-save-money/

Rand Europe, Ernst & Young. (2012). National Evaluation of the Department of Health's Integrated Care Pilots. Retrieved from http://www.rand.org/content/dam/rand/pubs/technical_reports/2012/RAND_TR1164.pdf

Ries, E. (2011). The Lean Startup. Portfolio Penguin.

Subgroup 2 on defining success factors for the effective use of Structural Funds for health investments. (2013). Reflection process on modern, responsive and sustainable health systems.

Valeri, L., Giesen, D., Jansen, P., & Klokgieters, K. (2010). Business Models for eHealth. Rand Europe & Capgemini Consulting.

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Appendix – Online Databases and ResourcesBibliographic Resources The National Center for Biotechnology Information advances science and health provides

access to biomedical and genomic information http://www.ncbi.nlm.nih.gov/ Embase from Elsevier Life Science Solutions is the most comprehensive international

biomedical database for biomedical researchers http://www.elsevier.com/online-tools/embase

The Cochrane Library provides access to high quality, independent reviews, abstracts, clinical trials etc. www.wiley.com/cohcrane With reviews under www.cochrane.org/reviews.

The Database of Abstracts of Reviews of Effects (DARE) provides abstracts of systematic reviews focused on the effects of interventions used in health and social care. It is owned by the Centre of Reviews and Dissemination of the National Research Institute of Health Research of the NHS of the UK http://www.crd.york.ac.uk

CINAHL Journals database was originally an index to nursing literature but has now developed into a comprehensive bibliographic index and includes abstracts and full text materials from selected journals. http://www.cinahl.com/library/journals.htm and http://www.ebsco.com

Medscape features peer-reviewed original medical journal articles http://www.medscape.com/

Online Statistics Databases• Eurostat: http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home/• OECD: http://stats.oecd.org/index.aspx?DataSetCode=SHA)• Open Data Portals (overview): http://ec.europa.eu/digital-agenda/en/open-data-portals

Online Project Databases CORDIS Search Service: http://cordis.europa.eu/newsearch/index.cfm?

page=simpleSearch&js=1

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http://cordis.europa.eu/newsearch/index.cfm?page=simpleSearch&js=1

http://cordis.europa.eu/newsearch/index.cfm?page=simpleSearch&js=1

http://ec.europa.eu/digital-agenda/en/open-data-portals

http://stats.oecd.org/index.aspx?DataSetCode=SHA

http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home/

http://www.medscape.com/

http://www.ebsco.com/

http://www.cinahl.com/library/journals.htm

http://www.crd.york.ac.uk/

http://www.cochrane.org/reviews

http://www.wiley.com/cohcrane

http://www.elsevier.com/online-tools/embase

http://www.ncbi.nlm.nih.gov/


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Appendix – INCA Briefs: A D5.2 Preview (not in final D5.1)

The search for INCA sustainability has strong parallel with the phase of “Customer Discovery” in the “Customer Development Model” (Blank, 2013). You will find this idea reflected throughout WP5 activities. The main idea is to develop a profound understanding of the customers essential to achieve a validated product market fit. Important questions to be addressed are: “How well do we understand what problems customers have? How much will they pay to solve those problems? Do our product features solve these problems? Do we understand our customers’ business? Do we understand the hierarchy of customer needs? Have we found visionary customers/earlyvangelists, the ones who will buy our product early? Is our product a must-have for these customers? Do we understand the sales road map well enough to consistently sell the product? Do we understand what we need to be profitable? Are the sales and business plans realistic, scalable, and achievable? What do we do if our model turns out to be wrong?“ (Blank, 2013).

While there exists many similarities with a startup process, there are also key differences. The project consortium consists of 11 diverse private and public partners, i.e. in Spain, IDI Eikon (ICT SME), Manises Hospital, Kenus Informatica (ICT SME), Local Council of Quart de Poblet (Local Government) and Murcia Health Service (Foundation for Training and Healthcare Research of Murcia Region); in Croatia, Rijeka City and Croatian Health Insurance Fund; in Cyprus, Geroskipou Municipality and Interfusion (ICT SME); and, finally, in Latvia, Ventspils City Council and Slimnica Hospital. The private partners (SMEs) are having the key objective of making INCA a profitable business, and the public partners to deliver the best possible services to their citizens running on a limited budged. The EU project funding leads to the interesting situation where providers (private partners/SMEs) and beta-testers (public partners) are working closely together to achieve their goals. Public partners will take the role of visionary/earlyvangelists, providing valuable feedback to achieve a product market fit. Another important difference to a standard statup is that we are departing from several well established business with ongoing operations and revenue streams. This allows us to make use of existing industrial and commercial infrastructure adding INCA as an additional product to an existing portfolio. While EU funding, existing infrastructure, and provider-beta-tester collaboration are clearly working in our favour, difficulties may arise when different business interests have to be aligned and co-ordinated. In this respect we rely on the experienced co-ordination team as well as the rules laid out in the consortium agreement with the strong believe that a win-win-win situation can be achieved.

Explanation to the Partners: We are currently skimming down on several customer, product and market related hypothesis. In the envisaged customer development process (Blank, 2013) these hypothesis will be validated, refined or discarded to come to certainties summarised into several “Briefs”, which in turn with form the corner stones of a sustainable and scalable business model. All INCA consortium partners are supposed to contribute in form of filling out a detailed questionnaire. The following can be seen as a preview (first part) of the questionnaire we are currently preparing. Each partner is supposed to answer the following according to his role in the INCA consortium (potential business partner or potential customer).

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6.1 Product Hypothesis to Brief 6.1.1 Product Features

List which are, in your opinion, INCA’s top-five features and describe them using one/two sentences.

6.1.2 Product BenefitsList which are, in your opinion, INCA’s top-five benefits delivered to customers and describe them using one/two sentences

6.1.3 Intellectual PropertyWould you say INCA is a unique invention?

Do you know about other similar products/services which might be IP-protected?

6.1.4 Dependency AnalysisList which things you consider that need to change in the market for INCA to be a success and which are out of control of the INCA consortium in the following areas. Prioritize your selections, with the first one the most important. Try to list 5 items for each area:

Legal issues: Organizational issues (inside potential customer organization): Infrastructure / IT issues: Economic / Budgetary issues:

6.1.5 Product Delivery Schedule Do you consider INCA basic specifications and features are enough to start using the

product/service in your market (your daily work)?

List which are, in your opinion, the top-five features INCA is missing right now in its current prototype version and tell us if those features are “must have” or “nice to have”.

6.1.6 Total cost of Ownership/AdoptionList which, in your opinion, will be the costs your organization will need to face to effectively run INCA, apart from those of the product acquisition. Try, if possible, to quantify these costs [based on estimations]. Options of quantification are in terms of Euros, hours of work, etc. Please explain your quantification.

Additional IT or related infrastructure: investments in SW, HW or equipment needed to run INCA services

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Organizational changes: development of new ways of delivering care, of new multi-disciplinary groups and policies, of client champions groups…

Training needs: educational and training needs, estimated in hours… “duplicated efforts” [works that need to be duplicated or performed twice as two systems

are to be used]: Others: please describe and quantify, if possible

Category Item Description Estimated Cost (Euros, hours…)

IT / Infrastructure Item 1 Item 2

…

Item 1 cost Item 2 cost

…Organizational

Changes Item 1 Item 2

…


…Training Item 1

Item 2…


…“Duplicated efforts” Item 1

Item 2…


…Others Item 1

Item 2…


…Total Cost of Ownership / Adoption for INCA Sum of all

costs above detailed

6.2 Customer Hypothesis to Brief6.2.1 Types of CustomersList which will be, in your opinion the different types of “customers” INCA will need to address in the socio-sanitary market and briefly describe their role or position within a socio-sanitary organization

o End Users: who will use INCA on a daily basis? Inside and outside the socio-sanitary organization? Providers? Which ones? Patients? Caregivers?

o Influencers: who has “something to say” before INCA is finally acquired? Key medical personnel? IT people? Politicians?

o Recommenders: similar to influencers but with strong impact on the final buying decisiono Economic Buyer: who has the budget for INCA? Who needs to approve this expenditure?o Decision Maker: it can be the economic buyer or someone else. Who has the final

decision on buying INCA in the socio-sanitary organization/model?o Saboteurs: who could be threaten by INCA offering? Any individual? A department inside

the organization? Pre-existing providers?

Type of Customer Brief Description: why do you choose this profile? [1-

Position/Title in socio-sanitary organization /

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2 lines] model

End Users

Influencers

Recommenders

Economic Buyer

Decision Maker

Saboteurs

Can you organize the stakeholders in the table above in a diagram like the one proposed below [like a pyramidal organization chart] for a better understanding of the decision-making structure INCA will need to face?

Decision Maker€€€€€€€€

Economic Buyer€€€€€€€€

Recommenders

Influencers

End Users

6.2.2 Customer ProblemsList which are, in your opinion, top-five (maximum) problems in the INCA context for each ones of the stakeholders previously identified and classify those problems as:

o Latent Needs: customer has a problem and understands he has a problemo Active Need: if customer has a problem and is actively looking for solution, even when

not serious work on this issue has been done yeto Vision: if customer has a problem, is actively looking for solutions and has built some

type of home-made solution (or at least customer clearly knows what he wants and will pay for something better)

o At the end, this will help us to classify customers needs from “nice to have” to “have to have”

Customer Type Top-Five Problems Problem Type

End Users

Influencers

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Recommenders

Economic Buyer

Decision Maker

6.2.3 A day in the life of Our Customer (or a day in your live)A day in INCA customer’s life: please describe how “a day in your working life” is as a potential INCA customer. You may find it helpful to think of the following:

o Which products do you use? o How much time do you spend using them? o How would your life change after you have INCA?

6.2.4 Organizational Map and Customer Influence MapAs an INCA potential customer, can you provide a basic diagram of how end users are inter-related with other roles in your organization? How are our customer types positioned in the organization chart? Example:

Hospital General Manager

Primary CareGeneral Manager

Primary CareDoctors

Primary CareNurses

Primary CareSocial Workers

MedicalSpecialtiesManagers

IT SystemsMaintenance

Manager

HW staff

SW staff

Support staff

IT General Manager

End Users

Decision Maker

Economic Buyer

Influencer and/orSaboteur

Recommenders

Influencers

Influencers

Saboteurs

6.2.5 Return on Investment Justificationo What is the basic average cost of delivered care services? Routine Visit? Emergency

Visit? Hospital Admission? Hospital Stay per day?o You can use the set of indicators you are to deliver as the starting point scenario for your

pilots [pages 3 to 24 in the DOW]o We will use information you provide to build a table like the one below:

INCA Costs Generated Savings for Customers

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License Maintenance Fee Customization TOTAL

X% cost reduction estimation TOTAL SAVINGS

Indirect Costs New dedicated personnel Training Other costs TOTAL

Total Year One Costs Total Year One Savings

Payback in:

6.2.6 Minimum Feature SetAccording to your opinion, which is the minimum set of features every one of the stakeholders above identified will pay for?

Customer Type Minimum Feature Set to pay for

End Users

Influencers

Recommenders

Economic Buyer

Decision Maker

6.3 Channel Hypothesis to BriefHow do you think INCA should reach customers? Please provide your feedback in the table below, considering INCA Service complexity while doing so:

Channel Adds Value? Which one? Fits with pre-existing customer habits/practices? Why?

System Integrators

Direct Sales Force

Value-Added resellers

Dealers

Retail/Mass/Online

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6.4 Pricing Hypothesis to Briefo How much customers spend now on products similar to INCA?

o If they use no product like INCA; how much costs to customer doing something like INCA does using different means? How customers solve their problems using piece-part solutions from other vendors and how much does this cost them?

o Piece-part solutions from other vendors and how much does this cost them?

6.5 Demand Creation Hypothesis to BriefIn your opinion, how do customers learn about products that solve their needs?

Demand Creation Mechanism

Is this a commonly used mechanism in your market?

Which one is the most known one? Which are main references for each mechanism?

Advertising

Public Relations

Spam

Website

Word of Mouth

Seminars

Telemarketing

Other Partners

Trades and Fairs

In your opinion, which are the main influencers (outside from a potential customer organization) in this market?

o Market Analystso Presso Visionaries (medical leaders, IT leaders, political leaders…)o Which are market/industry main trends?o Main trade shows or events?o Main analysts and “opinion creators”?

6.6 Market Type Hypothesis to BriefIn your opinion, which type of market is INCA addressing:

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o Existing Market: well-defined, with a large number of customers, where our product does better something

o Re-segmented Market: well-defined, with a large number of customers, where your product is low cost or a unique product

o Fully New Market: undefined, with an unknown set of competitors

If you consider INCA addresses an Existing Market, try to answer the following questions:

o Who are competitors and who drives this market? o Can you at least “guess” about Competitors’ market shares? o Can you at least “guess” about MK and sales dollars competitors spend to compete

with you?o Can you estimate which is cost of entry against competitors? o Which are key performance attributes according to customers?o What is Competitor’s definition of the market? o Are there any market standards and an “agenda” for its evolution?o Are you embracing, extending or replacing those standards? o Can you build a Competitive diagram against main competitors: pick two key

attributes of your product/service and benchmark them against competitors (i.e. technology vs. feature; price vs. performance; channel vs. margin… please notice PRODUCT features are key to differentiate in this kind of market). Example:

High

Low

Low High

GeneratedSavings

For Customer

Socio-Sanitary ProvidersPerformance Control

INCA

DRGsDashboards

EMRsHIEs

If you consider INCA addresses an Re-Segmented Market, try to answer the following questions:

o What existing markets are customers coming from?o What are the unique characteristics of these customers?o What compelling needs of those customers are unmet by existing suppliers?

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o What compelling features of INCA will make customers abandon their current suppliers?

o Why existing suppliers cannot offer what INCA offers?o How long will it take to educate potential customers to buy INCA and to grow a

sufficient market size?o How do you think you need to educate the market?o What do you need to do to “create demand”?o Can you build competitive diagrams like the one above?o In addition, can you build a “market map” (a diagram detailing where customers for

INCA segment will come from). Example:

INCA

AbucasisOrion

Florence…

…

Google Health

MS HealthVa

ult

SIUSST-

Systems…

HIEs / EMRs Patient Portals

DRGs Dashboards Social Services Tools

If you consider INCA addresses a New Market, try to answer the following questions:

o What are adjacent markets next to INCA’s market?o What markets will potential customers come from?o What is the key compelling NEED to get customers?o What is the key compelling INCA FEATURE to get customers?o How long will it take to educate potential customers to buy INCA and to grow a

sufficient market size?o How do you think you need to educate the market?o What do you need to do to “create demand”?o What is the risk for you to develop the market and then having a “strong”

competitor taking it afterwards?o Can your product/service be defined either as re-segmenting a market or entering a

new market?

6.7 Competitive Hypothesis to Brief After allocating INCA in one type of market in the previous section, tell us how, in your

opinion, is competition defined in the chosen market?

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o Based on product/service attributes?o Based on critical features?o Based on prices/costs?

Why do you believe INCA proposal is different to others competitors? Why do you think customer cares about INCA proposal? Better features? Better

performance? Better channel? Better price? Who are INCA closest competitors today? In features? In performance? In prices? If no clear

competitor appears, how is customer solving their compelling needs using different alternatives in the market?

What is the key feature in competitor’s product/service? What is the key need competitor’s product/service solves?

6.8 Positioning BriefNot part of the questionnaire but one of its results. It will including SWOT analysis of the project.

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Appendix – Templates (not in final D5.1)The following shows you how to insert tables, figures and equations, which colours to

use and how the captions are inserted. This Appendix will be deleted from the final version.

FIGURE 0-2: EXAMPLE FIGURE - CUSTOMER DESIGN SQUIGGLE (CORAM, 2012).

TABLE 0-2: EVERY TABLE GETS A CAPTION WHICH IS TERMINATED BY A “.”.

A B

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