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Procuring innovative ICT for patient empowerment and self-management for type 2 diabetes mellitus

Periodic Reporting for period 2 - ProEmpower (Procuring innovative ICT for patient empowerment and self-management for type 2 diabetes mellitus)

Berichtszeitraum: 2017-08-01 bis 2020-09-30

Diabetes mellitus is a chronic, life-long, rising and very broad disease accompanied by many co-morbid conditions, complications and stages. Medical services for diabetes are available in all public and private sectors of healthcare systems, numerous medications have been developed, most importantly the body hormone insulin, and commercial support services back care providers’ efforts with products adapted to the needs of those living with the disease. Diabetes is also intensely researched and subject to health reporting in many industrialised countries, the majority of which also have national diabetes guidelines in place. Diabetes represents worldwide nevertheless an increasing burden on the cost of health care systems and the care offered is far from perfect. Usual care in most regions of Europe reacts to incidents rather than actively managing care. Diabetes care is also far from being fully integrated and further set back by the lack of interoperability across healthcare systems. The quality of many commercial internet-based services remains an issue and the focus on diabetes as a disease often fails to properly address social aspects in patients’ lives, such as retirement issues and the compatibility of diabetes and working.
ProEmpower is a pre–commercial procurement (PCP) project to buy R&D (research and development) services to improve the treatment and self-management of diabetes type 2 patients using a Personalised Diabetes Management Solution. The project brings together procurers from four regions in Europe. The regional health procurement bodies are supported by health provider organisations and consultancies.
The solutions are expected to improve the detection of type II diabetes and the treatment through person-centred and personalised care. This includes addressing the problems of the patients, improving their knowledge of diabetes, supporting them in communicating their treatment preference to physicians and facilitating a healthy lifestyle.
The project started by defining the procurers' common procurement requirements for an innovative diabetes management solution that will address their needs. Open Market Consultation workshops were organised in five different countries, as well as one webinar, to consult the supply side and validate and improve the requirements and to mobilise the supply side to participate in the call for tender. The ProEmpower tender was launched on 18 January 2018. A total of 15 tenders were received and evaluated in the period 22 March – 5 April 2018. 11 of them were joint tenders, and 4 single tender submissions. 13 tenders were led by SMEs, and 2 by large enterprises.Five tenders were selected to proceed to Phase 1 of the PCP: DM4All (Consortium led by GNOMON INFORMATICS S.A.) DiaWatch (Consortium led by Tech4Care srl), CarpeDiab (Consortium led by Health Insight Solutions GmbH), SHaDE (Consortium led by Hemosoft Bilisim ve Egitim Hizmetleri A.S) and a Consortium led by Linkcare Health Services. DM4All, DiaWath and CarpeDiab were selected to develop prototypes of their solutions in phase 2, and DM4All and DiaWatch were selected to fully develop and test their solutions with end users in phase 3 as part of a technology trial with 400 patients and 76 healthcare professionals. The trial resulted in overall improvement in clinical parameters. The use of the ProEmpower solutions was associated with significantly decreased glycated haemoglobin values. Secondary outcomes were characterised by decreased systolic blood pressure in diabetes patients with inadequate blood pressure control. There was an overall improvement in the patients’ quality of life after the use of the ProEmpower solutions and overall improvement in diabetes-related impact on the quality of life across all dimensions, however, not statistically significant.Patients considered that the ProEmpower solutions created a positive experience during the testing phase and increased their ability to manage their condition
The procurers have performed an analysis of their procurement process and implications for a large-scale procurement in the future and have detailed their ambitions towards such a procurement. Procurer-specific milestones have been identified towards that goal, which include:

• Turkey: The ProEmpower solutions are seen as a good choice for filling a current technological gap in MOH’s chronic disease management system, which currently does not have an interface for the patient and which does not come with a shared care plan as those in the two ProEmpower solutions. It is the mid-term plan of Ministry of Health of Turkey to integrate a patient interface into e-Nabız, personal health record system of Turkey, and connect the patient and their doctor on a shared care plan. As any public procurement of commercial solutions in healthcare needs to encompass the whole of Turkey’s target population (in this case more than 8 million type-2 diabetes patients), the procurement needs to be carefully planned during the course of 2021.
• Portugal: SPMS has identified the need for a fruther technical and clinical review to ensure that any solution procured from the outside is fully integrated into the SPMS ecosystem of apps and services, incl. the national EHR system. A further important step in the country is a strong political backing, which is expected to be solidified during the Portuguese Presidency of the Council of the EU (first half of 2021).
• Italy: The use of telemedicine services related to administrative and clinical-assistance procedures was activated in Federico II University Hospital (FOUND) due to the Covid-19 pandemic and following a regional emergency directive aimed at protecting the health of citizens with diabetes. However, reimbursement of telemedicine in the long run requires the implementation of a clinical trial to verify the effectiveness and safety of the ProEmpower solutions in order to make them available to public health organisations. FOUND is seeking opportunities to carry out such a trial in 2021-2022.
• Spain: SMS has acquired significant experience running PCP procedures that equally require high maturity in terms of legal, administrative and technical training.

In addition to procurer-specific milestones, some common milestones to large-scale procurement have been identified, such as further technological improvements following the pilot feedback, and the need for conducting a clinical trial to verify the solutions’ effectiveness and safety. Procurers SMS and FOUND have shown interest in pursuing a joint international collaboration focusing on those further improvements by participating in a Public Procurement of Innovation (PPI) project as a follow-up of ProEmpower. They are currently exploiring suitable PPI opportunities in the period 2021-2022.

Both the ProEmpower procurers and the two supplier consortia are committed to collaborate on the future procurement steps.
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