SEURO Project Coordinator, Dr John Dinsmore, on implementing large-scale digital health solutions for the self-management of patients with multimorbidities

To achieve this, SEURO will develop and evaluate three new digital tools for health services to improve their readiness to implement and evaluate digital health solutions in practice. The project will also test the effectiveness of a novel digital health solution called ‘ProACT’ which is designed to support individuals self-managing with multimorbidty at home. The SEURO project (2021-25) follows on from a previous Horizon 2020 project entitled ProACT, which developed and evaluated at a proof-of-concept level the above mentioned digital health platform. SEURO’s ambition was recognised when the project won the EU’s Silver Eco and Ageing Well International Award in Cannes, France in 2022.

SEURO and ProACT project coordinator, Dr John Dinsmore, is an Associate Professor in Digital Health and Integrated Care and Deputy Director of the Trinity Centre for Practice and Healthcare Innovation (TCPHI). He discusses the impact SEURO is having on the EU digital health landscape and how the solutions created in the project will help health services advance their ambitions for better community-centred care.

From a Trinity perspective, Dinsmore notes, ProACT and SEURO are pioneering digital health projects focused on user centred design and evaluation of multimorbidity self-management solutions across multiple EU member states. “Typically, EU health systems focus on single disease treatment, which do not adequately address the needs of individuals with multimorbidity. Innovations created in ProACT and SEURO provide services with the potential to augment their services for multiple disease management and care. It is one of the longest EU collaborations in this particular digital health area that I can think of, as we started the journey back in 2015. Certainly, we are grateful for the funding we have received every year since, which highlights the importance of the work we are advancing”. They also collaborate with some of the biggest organisations in Europe, including the European Association of Service providers for Persons with Disabilities (EASPD), the Association for the Advancement of Assistive Technology (AAATE) and IBM research Europe.

Establishing a Consortium and ProACT

Dinsmore’s consortium was first established a decade ago at the end of 2014, when he brought a team together to explore the issue of patients with multimorbidities. This is a societal group, he explains, for which care can be very inconvenient and ineffective: “they have to see multiple clinicians, multiple times, and repeat their medical history. We don’t have good mechanisms for sharing that medical history in our health service. It’s very complicated for people managing multiple different conditions to understand their symptoms and how to manage them. So we put together a plan to build a platform that would allow individuals with multiple conditions to better self-manage at home.”

Multimorbidity is also skewed towards an older demographic. Dinsmore and his colleagues therefore knew they needed to design a solution to cater for older adults. As you age, he explains, you’re more likely to have more than one chronic condition (such as diabetes, chronic heart disease/failure or chronic obstructive pulmonary disease). Once you get to 65, there is a 33% to 50% chance that you’ll have two or more chronic conditions. But when you get to 75 it’s anywhere between 55% to 75%. “We’re also an ageing population. So, we have a lot more people living with multimorbidity. And that’s putting a lot of pressure on our health systems.”

In 2015, the consortium received ProACT funding to build their first proof-of-concept platform. Working with a cohort of 165 people including older adults, GPs, pharmacists, healthcare professionals and family members, they designed and built a platform for multiple disease management. Following this, they ran a small pilot study with 120 people between Ireland and Belgium that showed promising results. According to Dinsmore, this was thanks to their interdisciplinary focus combining methods and approaches from behavioural science, human-computer interaction, health economics and artificial intelligence. “Results from our initial proof-of-concept trial showed high levels of engagement with the platform over time, with participants feeling it improved their ability to self-management. The nurses felt it also worked very well for them, improving their ability to triage and link in with patients. We also noticed that over twelve months alerts in terms of exacerbation of their conditions decreased.” Looking at the cost effectiveness within the HSE, he adds, “there could be substantial cost-savings from the introduction of the ProACT platform to the HSE, for example. If it was initially provided to 10,000 older adults living with multimorbidity it would lead to a reduction of 20% of hospitalisations at 79% platform effectiveness, which we have roughly seen in terms of our participant long term engagement with ProACT over 12 months. That could save the HSE €6 million per year. If then scaled to 100,000 patients the potential cost saving in terms could be €60 million.”

SEURO and Large-Scale Studies

Results from the ProACT project enabled the team to return to the European Commission to fund SEURO as a larger-scale study and further develop the platform. They received just under €4 million to test the potential effectiveness with 720 people in trials across 3 countries: Ireland, Belgium and Sweden. Outcomes will enable them to see the differences across different types of health services.

On top of that, they are also focusing on the health system itself: “If a health system is bringing a technology into play, how do they know they’re ready for it? How do they build a foundation? Our argument was, if the technology is really good but the system isn’t ready, the technology ends up being blamed as not effective.” To address this, SEURO have created three tools to support health services in getting ready to adopt digital health interventions. “These tools, called ProTransfer, ProBCF-C and ProInsight, support health services to understand and improve their readiness levels to implement and scale digital health interventions in practice. They also help services predict whether an intervention like ProACT would be effective for both patient outcomes and in reducing the cost of care.” The ambition is to help health services de-risk the selection, implementation and future roll out of a digital health solution at scale.

On-the-ground activity for the SEURO group is characterised by strong communication. Dinsmore typically has three meetings a week with the consortium, which cover the technical, research and spin-out developments emerging from their work. “There are approximately 50 to 60 people working on these projects across the EU, and my role as a lead is to know what everybody’s doing in each pocket of work and ensuring outputs link together to achieve the core aims and objectives of the projects.”

Their research to date has led to significant advances in state-of-the-art digital health solution development and implementation, with the delivery of well over a hundred peer-reviewed reports to the European Commission, as well as over 40 publications in the last 8 years. “One of the great things about this work is we’ve developed evidence-based platform and tools that could now be spun out of the project and used by health services to improve the delivery of care and lives of patients” Dinsmore observes. 

What challenges has SEURO encountered along the way? One big issue was recruiting patients. The health services have been so stretched that access to patients was considerably more difficult than initially expected. Ethics and regulations around technology are also very complex. A lot of new requirements came into play while they were developing the platform, which ended up delaying various aspects. “But we’re well through the SEURO trial now with the Irish and Belgian sites fully recruited and Sweden expected to complete recruitment this summer. There are always real-world problems, but a key part of successful research is figuring it out.”

Empowering Older Adults through Digital Health Interventions

Dinsmore highlights how these digital interventions can help empower their patient cohort. “One of the myths that we’ve debunked is the use of technology as a struggle for older adults. That hasn’t been the case here. The average age of the ProACT user is 73, our oldest was 93. Once they get trained, they’re using it very quickly. What we find is that as they use the application to check what their data means, they learn to interpret and understand how to act on changes to their health and well-being over time. With their health literacy increased their need to engage with the technology is reduced to what is essential for them, so it is not viewed as a burden. Additionally, the patient has their data across multiple conditions in one single platform, so they can just go into consultation and better explain to the healthcare professional what the problem is.”

“As you get older quality of life naturally declines. And our initial ProACT Horizon 2020 study showed that, compared to the general population, those in our trials have a potentially slower rate of decline. They’re self-managing better, which means they’re more likely to live at home longer, and the health services have a better oversight on patients. And if we also reduce hospital and GP admissions, the cost of care goes down. So, it’s a win for everyone.”

Looking at SEURO’s progress, the value of having an almost decade-long project becomes clear. “In the music industry, they’ll say you need ten years to be an overnight success. And it’s true here too. People say, ‘Wow! This is great,’ but they don’t realise it was a long journey. Often, people think technology development only works at speed. Sometimes that is true but sometimes we need more time, particularly when tackling complex health areas, we need to allow researchers the space to figure it out. The European Commission, which has primarily funded us has been fantastic. And when I talk to some of our industry partners, they would say to me, if you were in a company, you would never have got that time because they would want a product out asap. So having funding via the European Horizon programmes that will provide a longer runway to explore complex topic areas over time is a vital to ensure healthcare innovations such as ProACT, when ready, can be a long-term success and improve society”.

The Future of the ProACT platform and the SEURO project

High engagement with the ProACT platform isn’t just Irish-centric, Dinsmore notes. “It’s across all the trial regions we have implemented in so far, which is really reassuring for its potential transferability across Europe.” Currently, their aim is to conclude their recent large-scale trial within the SEURO project next year and generate their requisite evidence. The services that are using ProACT would like to continue using it, so the consortium will work directly with them on further implementation in their trial regions. “We’re also making the platform available for research, so we are currently exploring new collaborations to further advance our understanding of the use of ProACT for both multimorbidity and single disease management. The innovation doesn’t stop.”

SEURO partners TCD with Dundalk Institute of Technology (DkIT) which has also been trialling a version of ProACT as part of the Sláintecare Integration Fund project ‘SMILE’. This is an innovative new service led by Caredoc (as a SEURO partner) to enable Irish citizens to proactively self-manage their health and well-being from home supported by ProACT and nurse-led remote assessment and triage.

“We are currently supporting an exploration of the use of the SMILE service in the new HSE community hubs in the southeast of the country with triage nurses able to use the platform to support individuals managing multimorbidity in the community.” Results to date have been positive and there is the potential to expand the service to other community hubs nationally. “We will work with our partners and the HSE to try and understand better the requirements in terms of technology and staff, including training required to scale it up nationally.

“When we met health technology providers back in 2014-15 and explained our focus on multiple conditions in older adults, we were told it’s too difficult and risky, but we persevered,” Dinsmore reflects. “And looking at the market you have a lot of digital health solutions, but none have been solely developed with and for people with multimorbidity, particularly older adults. Thus we believe ProACT and the SEURO tools are a unique evidence-based offering that we have brought to the table.”

- Article written by Dr Sarah Cullen