Digital Technologies as a Catalyst for Change towards Integrated Care Delivery: Hype or Reality?

Introduction

The debate about integrated care is anything else but new. The call for better joined-up service delivery, particularly to those suffering from chronic conditions, traces back as far as into the 1950ies. Already 60 years ago, Burney (1954) argued that “Comprehensive programs, such as those directed to bring maximum benefit to persons with chronic diseases ..., require the coordination of the efforts of many individuals and agencies... The home care program clearly demonstrates the importance of the close integration of clinical, public health, and other services if the needs of chronic disease patients are to be met to a reasonable degree” (p.6). In the light of the recent debate on the future of long-term care within ageing societies, such a statement sounds remarkably modern (c.f. e.g. Leichsensring, Bilings & Nies, 2013; MacAdam, 2008). Perhaps most recently Rigby et al. (2014) have argued that “modern European society has created many services to help these citizens. But these services are split into organizational clusters such as Health, Social Care, Housing, and others, each in most settings separately organized, delivered and recorded by organizations and their staff who are separately funded, managed, and regulated. As a result, patients are surrounded by uncoordinated Islands of Excellence, when what is needed is Coordinated Care” (p.42). When it comes to the much-lauded paradigm shift towards person-centred and integrated care, it appears that the professional discourse has been turning in circles without much progress for more than half of a century (Stroetmann, 2013).

At the same time, information and communication technology (ICT) has frequently been ascribed the role of a key lever for integrated care (Nolte & McKee, 2008). Through its inherent functionalities ICT generally provides potentials for facilitating the transfer of information, eliminating redundant paperwork and monitoring of progress. Beyond this, telehealth and telecare solutions enabled closer and personalized management of chronic conditions and related personal risks. Against this background, the promotion of ICT-based solutions for long-term care has been regarded as a catalyst for the needs-driven seamless integration of typically separated care processes (Kubitschke & Cullen, 2005). From a health policy perspective, ICT has tended to be seen as presenting an opportunity for a ‘win-win-win’ outcome, whereby needs of care recipients are met in a high-quality manner, the costs of providing care and support are maintained at manageable levels for society, and new market opportunities open up for ICT-based products and services. For more than a decade, national governments and the European Commission have invested considerable amounts of financial resources into experimentation with ICT solutions for health and social care (Kubitschke & Cullen, 2010). However, wider mainstreaming of integrated e-Care solutions into day-to-day practice has yet to occur. Kubitschke & Cullen (2010) have for instance argued that “overall, there seems little indication that the traditional demarcation lines between health and social care have so far been overcome when it comes to implementation of ICT-based services to support independent living and homecare for older people. Whilst quite a number of RTD, pilots and trials take a more integrated, holistic approach, in reality, the majority of mainstreamed services tend to focus on one or other dimension and to be firmly located within one or other of either the social care or health care domains” (p.14).