European Specifications for Value-based Pre-Commercial
Procurement of Innovative ICT for Empowerment and
Self-management of Diabetes Mellitus Patients
Vincenzo De Luca
1 a
, Strahil Birov
2 b
, Ozan Beyhan
3 c
, Simon Robinson
2 d
,
Gorka Sanchez-Nanclares
4 e
, Maria Del Pilar López Acuña
5 f
, Adriano Fernandes
6 g
,
Reinhard Hammerschmidt
2 h
, Giovanni Annuzzi
1 i
, Guido Iaccarino
1 j
and Maddalena Illario
7 k
1
Azienda Ospedaliera Universitaria Federico II, via S. Pansini 5, Naples, Italy
2
empirica Gesellschaft für Kommunikations- und Technologieforschung mbH, Oxfordstr. 2, Bonn, Germany
3
Ministry of Health Turkey, Üniversiteler Mah. 6001. Cad. No. 9, Ankara, Turkey
4
Servicio Murciano de Salud, Central, 7 Edificio “Habitamia”- 5ª, 30100 Murcia, Spain
5
FFIS, Luis Fontes Pagán, 9. 1ª, 30003 Murcia, Spain
6
Misericordia of Amadora, Innovation Department, Estrada da Portela - Quinta das Torres, Amadora, Portugal
7
UOD Programmazione e Potenziamento Programmi di Health Innovation, Regione Campania,
Centro Direzionale Isola C3, Naples, Italy
Keywords: Pre-Commercial Procurement, ICT, Technical Specifications, Diabetes Mellitus, Management.
Abstract: Current demographic changes require a paradigm shift in the delivery of health and social services. Wide-
scale implementation of validated ICT support to clinicians and patients is essential to ensure the quality of
services to future generations of citizens. Healthcare providers from four European regions – Turkey,
Portugal, Campania and Murcia– have joined forces to procure an innovative ICT solution for patient
empowerment and self-management for patients with diabetes mellitus. The procurement is in the form of a
joint pre-commercial procurement (PCP) of Research & Development, with participation by EU industry in
competitive phases of development. The PCP is part of the EU-funded project ProEmpower, which is
currently in the prototype testing phase. The challenge faced by the procurers was to jointly define
specifications for the envisioned solution that reflect the needs of all four regions. After an intensive year of
consultations with procurers’ experts – clinicians, IT staff, procurement specialists – ProEmpower launched
a call for tender with the defined specifications, which reflect the unmet needs across the procuring regions
with regards to improving management of diabetes mellitus supported by ICT. This paper presents the
ProEmpower specifications, which can be easily adapted to the local conditions of any procuring region in
Europe and beyond. The specifications thus represent a valuable source for any new development of ICT-
supported diabetes management.
a
https://orcid.org/0000-0002-6115-931X
b
https://orcid.org/0000-0002-4575-0492
c
https://orcid.org/0000-0002-4337-3232
d
https://orcid.org/0000-0002-8572-3595
e
https://orcid.org/0000-0002-1797-9660
f
https://orcid.org/0000-0002-0986-3633
g
https://orcid.org/0000-0003-3644-7544
h
https://orcid.org/0000-0001-9460-2325
i
https://orcid.org/0000-0002-9324-6047
j
https://orcid.org/0000-0002-8997-835X
k
https://orcid.org/0000-0001-9834-6517
De Luca, V., Birov, S., Beyhan, O., Robinson, S., Sanchez-Nanclares, G., Acuña, M., Fernandes, A., Hammerschmidt, R., Annuzzi, G., Iaccarino, G. and Illario, M.
European Specifications for Value-based Pre-Commercial Procurement of Innovative ICT for Empowerment and Self-management of Diabetes Mellitus Patients.
DOI: 10.5220/0007638700190027
In Proceedings of the 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2019), pages 19-27
ISBN: 978-989-758-368-1
Copyright
c
 2019 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
19

1 INTRODUCTION
In Europe, a strong rise in the prevalence of chronic
non-communicable diseases is putting increasing
pressure on public expenditure for health services.
This can call into question the sustainability of
universal coverage models for health, underlining the
necessity of innovation in the field of health and care.
Innovative ICT solutions deployed in health and
care delivery can certainly help address these
challenges, in particular by tackling costs arising
from current inefficiencies. According to the
European Commission, improving the efficiency of
health care over the next 50 years can guarantee
provision of the necessary health and care resources
throughout Europe, despite the aging population,
demographic changes and increased demand for
services (European Commission, 2018).
Public procurement represents a huge market to
providers, and as such holds strong potential for
introducing innovative products and services.
Through public procurement, governments can
promote innovation at national, regional and local
level, resulting in a wide range of improvements
including productivity and inclusiveness (OECD,
2017). Public procurement is an important part of the
EU market, accounting for around 14% of the EU
Gross Domestic Product (GDP) (European
Commission, 2017). Horizon 2020, the EU
framework program for research and innovation, has
introduced two innovative forms of public
procurement: Public Procurement for Innovative
Solutions (PPI) and Pre-Commercial Procurement
(PCP). PPI is a procurement procedure in which
contracting authorities act as customers for launching
innovative goods and services that are not yet
available on a large-scale commercial basis. PCP
concerns public procurement of innovation, and
accordingly comprises the purchase of Research and
Development (R&D) services rather than finished
products. PPI and PCP engage industry players as
future vendors through all phases of development -
from research to the final product - and offer public
buyers the opportunity to influence the market,
stimulating vendors to develop solutions that respond
to well-identified needs.
Diabetes mellitus is a chronic disease with a broad
spectrum of severity, accompanied by many
concomitant conditions, complications and
development stages. Its prevalence is increasing
worldwide towards becoming a pandemic,
representing an ever greater burden on health care
systems (Bommer, et al., 2017). “Procuring
innovative ICT for patient empowerment and self-
management of type 2 diabetes mellitus”
(ProEmpower) is an European funded project under
Horizon 2020 programme, with the aim of purchasing
R&D services, through a PCP procedure, in order to
develop an innovative IT solution for early diagnosis
and management of diabetes, facilitating the lives of
people with type 2 diabetes, supporting them in their
daily lifestyle choices and giving healthcare
professionals access to the clinical data needed for the
management of the disease and its complications
(ProEmpower consortium, 2018). The project
involves four public procurers across Europe –
Turkey, Portugal, Campania (a region in southern
Italy with about 6 million inhabitants) and Murcia
(an autonomous community in south-eastern Spain
with a population of about 1,5 million). The
cooperation has allowed very significant synergies in
developing detailed specifications for new diabetes
management processes supported by fully integrated
ICT solutions. Work started with a thorough
investigation of requirements for service provision,
followed by specification work. This included an in-
depth analysis of opportunities to support end users
and care staff as well as of organisational resources
and legal/regulatory constraints.
In preparing the project proposal, the
ProEmpower consortium already felt that a most
important aspect to face was the current
fragmentation of solutions for professionals and
patients, which do not allow effective interaction
between the two. ProEmpower addressed this
shortcoming by calling for proposals to supply a
unitary continuous diabetes management system for
type 2 diabetes patients, centering on comprehensive
care pathways.
The joint PCP project addresses a demand for
innovation shared by many public procurers across
the EU, contributing to the sustainability of private
investment in research and development.
At the core of ProEmpower is a competitive R&D
process comprising two preparatory steps and three
phases:
▪ Open Market Consultations: dedicated workshops
organised by the procurers in their regions to
consult with vendors, inform the technical
specifications and set realistic, yet innovative
procurement objectives;
▪ Call for Tenders: an international tender launched
on the website of the Supplement to the Official
Journal of the EU
▪ PCP Phase I: Concept design, solution
architecture and technical specifications
▪ PCP Phase II: Development of prototype systems
ICT4AWE 2019 - 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health
20

▪ PCP Phase III: Development and testing of pilot
systems
Figure 1: ProEmpower PCP phases.
As the time of writing (November 2018), the
ProEmpower PCP is in phase II.
2 APPROACH
The approach to developing uniform technical
specifications for a diabetes mellitus management
solution involved the following aspects:
▪ Understanding the specific technical and clinical
environment at each health provider
▪ Engaging an interdisciplinary, international
working group with all relevant expertise to draft
the technical specification
▪ Involving end users (patients, informal care-
givers, healthcare professionals) in the co-design
process
▪ Jointly defining both functional and non-
functional requirements
▪ Describing appropriate use cases and
corresponding process models
2.1 Specific Health Provider
Environments
The specific technical and clinical environment in
each procurer health provider organisation was
analysed both to inform common specifications and
to identify any procurer-specific requirements, in
particular integration with diverse existing Electronic
Health Record systems.
For each procurer, the clinical, organisational,
technical and business environment was captured via
a series of interviews with key personnel – clinicians
and ancillary staff, IT staff, and hospital business
managers.
2.2 Co-design with End Users
There is ample evidence that health IT does not of
itself achieve better care, and can only contribute if
systems and solutions are properly embedded into
care processes, working routines and end-users’ day-
to-day life. Knowledge of the care experience, held
only by the patient, is particularly precious. This
knowledge is tapped by participatory design, where
the client is no longer passive recipient of a new
product crafted by experts, but is treated as active
contributor, integral to design and to the innovation
process as a whole.
The ProEmpower requirements were informed by
a selected set of end users (patients, informal
caregivers, professionals). 10 patients with diabetes
mellitus from each procurer region were first asked a
series of questions about possible solutions. Half of
them then participated in dedicated local focus
groups, fed by the information collected through the
questionnaires. User involvement is embedded into
the overall innovation process, with the plan to
involve users in subsequent phases to test and inform
the prototypes.
Example feedback by Turkish end users is
captured in the illustration below.
Figure 2: Feedback from ProEmpower professional end
users from the Turkish procurer.
2.3 Definition of Requirements
The process of eliciting user requirements in
ProEmpower included:
▪ development, administration and analysis of a
questionnaire capturing patients’ views on
possible system functionalities, and their wishes
for future support;
▪ development, administration and analysis of a
questionnaire for professionals in order to capture
a professional view of possible improvements to
SATISFACTORY
COMPLETE &
CORRECT
EASY ACCESS
FREE
INSTANT ACCESS TO
PATIENT DATA
SCIENTIFIC
INFORMATION FROM
AROUND THE WORLD
AVAILABLE
DIET & EXERCISE
PROGRAMS
FOLLOW-UP
DRUG AND DRUG USE
COMPLICATIONs
DIET & EXERCISE
TAKE INTO ACCOUNT
PATIENT‘S CHOICES
PSYCHOLOGICAL
TRAINING
ACCORDING TO
DISEASE PHASE
INCLUDE FAMILY
MEMBERS
SPEND MORE TIME
WITH PATIENTS
TRADITIONAL &
SOCIAL MEDIA
MONITORING
ALERTS
INFORMATION
SHARING
COMMON
PLATFORMS
Professional
Feedback
Turkey
Information
Nutrition &
exercise
Follow-up
SUPPORT
TRAINING
European Specifications for Value-based Pre-Commercial Procurement of Innovative ICT for Empowerment and Self-management of
Diabetes Mellitus Patients
21

delivering diabetes care in their respective
institutions;
▪ conducting interviews with experts on specific
topics, for example to obtain knowledge about
regulatory and business conditions.
The collected information was used to inform the
elaboration of functional, non-functional, legal and
regulatory requirements. Functional requirements are
key, as they capture details of the intended behaviour
of the system.
Each requirement was described using ID and
name, summary, and priority for implementation.
Table 1: An example of ProEmpower functional
requirements related to diabetes training.
ID and
name
Summary
Priority
R1.2.1
Training -
form
The ProEmpower solution shall
support training of diabetic
patients during physical meetings
and as offline follow up (e.g.
when the patient is at home).
9,5
R1.2.2
Training -
duration
The ProEmpower support
training of diabetic patients will
be designed in a way as to be able
to administer the physical training
session in modules, each lasting
from 15 to 45 minutes (depending
on personalisation and topics
covered).
7,7
2.4 Description of Use Cases and
Process Models
Based on the collected feedback, a set of use cases
and corresponding process models were developed
according to previously identified building blocks –
key aspects to be taken into account for delivering a
comprehensive solution in line with the Chronic Care
Model (CCM) (Stellefson, et al., 2013).
While PCP projects must define key requirements
and expectations in calling for R&D work, innovative
ideas should not be unnecessarily constrained, so as
to benefit optimally from expertise among suppliers
competing to carry out the necessary R&D.
In ProEmpower, the envisaged functionality is
described using use cases and process models. Use
cases represent a tabular description of the interaction
between a role and a system to achieve a goal. Each
use case has an ID, a title, a summary, actors (e.g.
patient, professional, system), parents and children
(to indicate relationships among use cases), pre-
conditions and post-conditions, and key
functionalities.
Process models represent a further generalised
version of use cases, also providing support and
guidance to the R&D work of suppliers. They are
developed as BPMN 2.0 process models.
Figure 3: Example process model in ProEmpower.
3 RESULTS
3.1 European Specifications for
Development of ICT Solutions for
Diabetes Mellitus Management
The ProEmpower procurers have compiled over 165
requirements for new ICT-enabled diabetes mellitus
management solutions for their regions, together with
a set of twelve use cases and process models. This
arguably represents a most comprehensive resource
for any European region or nation wishing to procure
innovative solutions in the field, as well as enabling
IT industry to innovate in line with their clients'
requirements.
The requirements are grouped into key topics
according to the Chronic Care Model, as shown in the
table below.
3.1.1 Functional Requirements
The four procurers requested the development of a
Shared Care Plan, accessible by patients and
healthcare professionals, to enable them to use a
common entity/document that uses relevant
information about the patient's diabetes management
and allows for scheduling events and reminders, such
as follow-up visits and regular tests. The Shared Care
Plan is to allow both patients and professionals to
enter data such as measurements, while giving each
specific rights to do so and integrating data captured
directly from devices.
ICT4AWE 2019 - 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health
22

Figure 4: ProEmpower diabetes management building
blocks.
The requirements associated with delivering
training to diabetic patients in various disease stages
include the topics of:
▪ Physical activity and exercise;
▪ Tobacco and alcohol consumption;
▪ Hygiene (mouth, feet);
▪ Complications from and prevention of diabetes;
▪ Hyper- and hypoglycaemia and blood glucose
self-control;
▪ Diet and nutrition;
▪ Insulin therapy and injectable drugs;
▪ Drug therapy;
▪ Life with diabetes;
▪ Sleep and stress avoidance.
Training to diabetic patients is to adapt to patients,
e.g. their age, sex, literacy level, emotional state,
working conditions, diagnosis (early stage, advanced,
etc), medication, weight trend, etc. Personalisation is
expected to motivate the patient to use the
ProEmpower solution effectively.
Measurement of parameters used by health
professionals and patients to manage the disease are
to be transferable to the main ProEmpower solution,
including automatic data transfer from sensors
complying with standards such as IEEE 11073 PHD.
It has been specified that a solution must be
compatible with at least two brands of glucometer
widely available in the markets of the four procurers.
The solution is furthermore to be able to deliver
messages to the patient, including messages
formulated by a professional and those automatically
generated through data analysis - notifications of
deviation from goals, tips for better management, etc.
Beyond messages, the solution is to provide
guidance/recommendations to the patient and/or
physician by using available patient data (e.g.
measured values, patient history, nutrition, physical
activity, etc) to estimate the short-term trend in blood
glucose.
ProEmpower procurers have requested a platform
capable of tapping neighbourhood and/or family
resources to deliver patients with co-operative
diabetes support. This online platform is also for
diabetic patients to communicate and be trained on
their disease. Professionals may also use it to
exchange ideas with colleagues and provide advice to
patients.
Requirements for early detection of diabetes
include requiring provision of the FINDRISK
questionnaire (Schwarz, 2011) in a public portal,
prompting the patient to contact a physician in case of
high risk. Furthermore, an algorithm is to use
specified clinical data to identify those individuals
who might have diabetes type 2 and/or other
complications.
3.1.2 Non-functional Requirements
A key area of requirements relate to the ease with
which a ProEmpower supplier can integrate new
processes with the procurers’ existing IT systems.
Suppliers bidding for R&D work were provided with
a comparative analysis of existing systems, and
requirements include that any solution must be
interoperable with the IT systems of the four
procurers. It is further required that at least five
languages (Italian, Spanish, Portuguese, Turkish and
English) be provided.
Existing electronic health records (EHR), local
data standards and existing software packages are
central to integration. In Campania, suppliers are to
conform with an Italian regulation to ensure
interoperability among the different regional IT
infrastructures which defines standards for
communication, the format of health and social care
documents and the encoding of clinical data
(Presidente del Consiglio dei Ministri, 2015).
Furthermore suppliers are made aware of the use of
MyStarConnect® diabetes data management by the
Azienda Ospedaliera Universitaria Federico II as
pilot site, and of AirDiabete®, a web service
supporting reporting on the participation of GPs in the
management of diabetic patients.
Murcia has a regional electronic health record
which aggregates in a central database medical
records from a range of information systems. Sources
ProEmpower
diabetes
management
building blocks
Glucose control
Patient-
professional
collaboration &
co-ordination
Interoperability
&
Integration
Quality &
outcome
reporting
Training
&
education
Devices
Early
detection
Healthier
lifestyle
Self-help & peer
support
European Specifications for Value-based Pre-Commercial Procurement of Innovative ICT for Empowerment and Self-management of
Diabetes Mellitus Patients
23

include hospital information systems, the Selene GP
information system, a patient identity database and
information systems for labs, radiology, etc. ETL
(Extraction, Transformation, and Loading)
procedures extract data from HIS and other systems
based, like the regional EHR, on an Oracle database.
Data are also obtained through HL7 message parsing.
Portugal's PDS health data platform reduces the
gap between health institutions by providing pointers
to patient clinical data in many locations. PDS also
provides a simple way of visualising the contacts a
patient has with the national health system, displayed
on a timeline. PDS provides patients with access to
their personal health record. A RESTful API® is
provided, and data is stored in a central database
along with pointers to other systems leaving most
clinical data held decentrally in hospitals or a primary
care centres.
In Turkey, E-Nabız® allows patients access to
their health record and enables them to add
information, such as daily exercise or blood sugar
measurements. The clinical information can be
accessed by a doctor if the patient gives permission,
possible through authentication mechanisms.
However, E-Nabız® is not intended to be a chronic
disease management system and provides no support
to doctors to communicate with the patient regarding
their condition. Currently, a doctor can only access
patient information in the clinical environment and
not out of business hours, even if the patient were to
consent. However, E-Nabız® is compatible with all
mainstream home-use medical devices, whose
measurements can be captured wirelessly.
3.1.3 Organisational, Staff and Business
Requirements
The four procurers specified that ProEmpower
solutions must fit their organisational models and
integrate with existing technological infrastructures.
The solutions are not to be technology-driven, but
clearly meet specific needs of patients and health
professionals in effective healthcare service delivery.
Common features of organisational models in
healthcare serving diabetes patients have been
identified. Analysis showed that the set of actors
involved in the process depends on the stage of the
disease. In early stages of diabetes the General
Practitioner and some cases a nurse are the only
actors, while in later stages many specialist doctors
from different clinics may be engaged. Generally,
actors are:
▪ General Practitioner, responsible for general
follow-up and dosage adjustments;
▪ Nurse, trains the patient in lecture-style sessions
and may demonstrate use of blood sugar devices;
▪ Dietician, advises on nutrition and, when so
instructed, on diet plans;
▪ Specialist doctor (cardiologist, ophthalmologist,
nephrologist, neurologist), organise advanced
medical tests.
A diabetologist plays a key role in some systems.
In Campania, diabetologists have a defined role in the
diabetes diagnostic and therapeutic pathway,
prescribing diagnostic tests, assessing
glycometabolic control and complications risk or
development, and making treatment interventions.
There, a diabetologist prescribes and reviews
medications and delivers tailored education to inform
lifestyle choices, including advice on physical
activity.
3.2 ProEmpower Use Cases and
Process Models
As shown in the diagram below, a set of 12 use cases
and corresponding process models was produced.
Generally, data-driven use cases are enablers for use
cases which deliver functionality.
Figure 5: ProEmpower use cases – key functionalities.
The ProEmpower use cases are:
▪ UC1: Enrolling users into ProEmpower
▪ UC2: Integrating data from different sources and
ensuring interoperability
▪ UC3: Capturing patients' level of knowledge and
capabilities
▪ UC4: Delivering personalised information using
data analysis, monitoring and continuous machine
learning
▪ UC5: Forecasting Daily blood glucose long-term
effects
Clinical data monitoring
Nutrition & Food data
Physical activity data
Blood glucose data
Shared Care Plan
FUNCTIONALITIES
Guidance &
Recommendations
Messaging
Device
interope-
rability
Other
physiological
data;
patient
knowledge
levels
Integrated
analysis and
delivery of
tailored
information
Training
Community
Undiagnosed patients
Integration
into existing
systems
Coaching
Doctor - patient
communication
and data
exchange
ENABLERS
ICT4AWE 2019 - 5th International Conference on Information and Communication Technologies for Ageing Well and e-Health
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▪ UC6: Enabling information exchange through
messaging
▪ UC7: Coaching on physical activity and nutrition
& food
▪ UC8: Providing diabetes training to patients
▪ UC9: Working with a Diabetes Shared Care Plan
(SCP)
o UC9-1: Setting and tracking targets
o UC9-2: Managing events
o UC9-3: Medication and dose management
o UC9-4: Generating, viewing and exporting
reports
▪ UC10: Participating in self-help and peer support
community
▪ UC11: Peer mentoring
▪ UC12: Flagging undiagnosed type 2 diabetes
patients
Two use cases and process models are described
in more detail in the following tables and figures –
one for coaching on physical activity (simplified) and
one on flagging undiagnosed patients.
Table 2: ProEmpower use case: Coaching on physical
activity and nutrition & food for diabetics.
ID
UC6 - Coaching on physical activity and
nutrition & food for diabetic patients
Summary
ProEmpower enabled patients will have the
opportunity to be coached on nutrition and
food choices and ideas which are suitable for
type 2 diabetic patients and in line with
personal preferences. Harmful effects (such
as intolerances and undesired food-drug
interactions) can be avoided and the patient
can receive comprehensive long-term
coaching. Similarly, patients will be coached
on activities to prevent and avoid a sedentary
lifestyle by receiving helpful and
comprehensive long-term coaching.
Actors
Physician, Patient, System, Nurse, Dietician
Key
functio-
nalities
Coaching relies on data provided by the
patient regarding physical activity and is thus
closely linked with UC2 and UC4. State-of-
the-art techniques shall be used to enable the
patient to record such data. Automatic
detection (e.g. type of exercise, duration,
distance, intensity, steps, floors, sleep, heart
rate) and recording are the preferred choice.
The system is able to:
- check whether the entered physical activity
is within recommended levels according to
the American Diabetes Association
recommended values
- propose duration and intensity of selected
physical activities appropriate to the patient
(e.g. based on latest recorded blood glucose
levels).
- give advice related to nutrition in
connection with meal intake (e.g. what foods
or drinks to take or not, before and after
exercise and in what quantity based on the
entered training duration and intensity).
- give suggestions, reminders & alerts for
exercise routine or walk routine (e.g. based
on the levels of sugar and the physical
conditions every day)
- provide physical activity lessons / tips for
the everyday routine.
- analyse the entries and patient parameters to
identify barriers to adherence to the physical
activity guidelines and suggests possible
actions to overcome them.
Continuously, the system provides positive
feedback to the patient and tracks goals. The
system gives out warnings to the patient (e.g.
poor activity daily, or physical condition
alert, excess of sedentary in activities of daily
living) in connection with UC4. The
physician and/or nurse can monitor entries
periodically (weekly or monthly) or view
summary reports and provide feedback to the
patient during visits. The physician can set
and adjust target goals for the different
activities and for different periods, which are
flagged as such and accompanied by notes
and explanations, and are reported by the
system to the patient.
Figure 6: ProEmpower process model: Coaching on
physical activity and nutrition & food for diabetic patients.
As can be seen from the descriptions, use cases
contain links to further functionalities and aspects that
are defined in other use cases.
All ProEmpower use cases and process models
can be downloaded from the ProEmpower website.
European Specifications for Value-based Pre-Commercial Procurement of Innovative ICT for Empowerment and Self-management of
Diabetes Mellitus Patients
25

Table 3: ProEmpower use case: Flagging undiagnosed type
2 diabetes patients.
ID
UC12 - Flagging undiagnosed type 2 diabetes
patients
Summary
The ProEmpower solution shall provide an
algorithmic module that uses available
existing patient data to identify those patients
which might have type 2 diabetes. Predictors
of diabetes could be age, body mass index,
prescribed medication, patient history
(family), etc. The identified patients will be
flagged, and a list/report provided to the
physician in charge of their care.
Alternatively, the physician may initiate a
request to run the module for a specific
patient (e.g. during a control visit).
Actors
Physician, Patient, System
Key
functio-
nalities
1. Identifying potential undiagnosed type 2
diabetes patients
The system reviews patient data continuously
using an algorithm to flag patients who might
have type 2 diabetes. Example parameters to
be used include:
- age
- body mass index
- prescribed medication
- patient history
The data analysis is possible if the patient has
provided consent for their data to be used in
such a way, which is the normal case for
those patients of physicians (GPs) which are
enrolled in ProEmpower.
2. Communicating results to the physician
The system provides a list of patients with the
results presented in a report format. The list
can be printed and provided to the
corresponding physicians in charge of the
patient's care.
Alternatively, physicians may wish to run the
algorithm during a patient session, in which
case the patient has provided consent for this.
Figure 7: ProEmpower process model: Flagging
undiagnosed type 2 diabetes patients.
3.3 Value-based Procurement
The ProEmpower specifications are part of a
comprehensive set of award criteria developed for
procurement of R&D services in ProEmpower, fully
aligned with value-based procurement. Weightings in
terms of points and thresholds were assigned to each
of the criteria. Depending on the phase, the
weightings are adjusted, both in terms of points and
thresholds, to reflect the characteristics of the PCP
phase. Selection of suppliers in each phase is based
on a price-quality formula:
Score for tender X = (Cheapest Price /
Price of tender X * 100 *
Price weighting of 30%)
*
Total quality score (out of 100) for all
award criteria of tender X *
Quality criteria weighting of 70%
(1)
A generic evaluation scorecard was configured for
ProEmpower and provided to the evaluation
committee, as shown in the figure below.
Figure 8: ProEmpower award criteria scorecard.
3.4 Extendibility
The ProEmpower specifications were designed with
extendibility in mind. The specifications are to
stimulate vendors to implement innovative solutions
Award criteria
Maximum
points
Threshold
Excellence of the proposed solution
Understanding of the ProEmpower domain
5
Extent to which the solution matches the ProEmpower vision
10
5
Extent to which the proposed solution meets the
requirements documented in the Call
15
8
Evidence of effectiveness
10
Total for excellence
40
20
Impact of the proposed solution
Value of benefits for patients
10
5
Value of benefits for procurers
10
5
Total cost of ownership
5
2
Sustainability of supplier business case
5
Soundness of the approach to integration with procurer
systems
10
5
Total for impact
40
20
Implementation of the proposed solution
Quality and completeness of the work-plan as well as detail
of task and result descriptions
5
Feasibility of plan and resources to meet the objectives
specified
10
5
Relevance of the proposed way to involve clinicians and
patients in design and development
5
Total for implementation
20
10
Overall total score for tender
100
60
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that meet requirements set. These reflect the Global
Guidelines for Diabetes type 2 (International
Diabetes Federation, 2012) and include the
requirement for interoperability with common
medical devices. Results are open to be used by
procurers worldwide, and can be extended to
complications such as kidney disease, and vendors
can use them as reference when developing their own
diabetes solutions.
The methodology applied in ProEmpower is
applicable to other chronic conditions such as
hypertension and chronic obstructive pulmonary
disease (COPD). ProEmpower procurers have
already adapted the approach for a PCP on innovative
hypertension management.
ProEmpower procurers have identified useful
synergies with other EU-funded projects. These
include EU project WE4AHA, further developing the
European “Blueprint on Digital Transformation of
Health and Care for the Ageing Society” (European
Commission, 2018). In work led by empirica GmbH,
twelve personas have been developed, intended to
represent the EU population. Personas are to inform
requirements and specifications and serve to ensure
that person-centred approaches are followed.
ProEmpower work informed persona development,
and personas with diabetes are currently being
validated by over 1,000 stakeholders of the European
Innovation Partnership on Active and Healthy Ageing
(EIP on AHA).
3.5 Progress of the ProEmpower
Suppliers
Three supplier consortia have been selected for phase
II of the ProEmpower PCP:
▪ DM4ALL – consortium led by Gnomon
Informatics SA (Greece)
▪ CarpeDiab – consortium led by Health Insight
Solutions GmbH (Germany)
▪ DiaWatch – consortium led by Tech4Care srl
(Italy)
Detailed information about the suppliers and their
approaches can be found on the ProEmpower
website.
4 CONCLUSIONS
The ProEmpower procurers have produced a
comprehensive set of specifications for value-based
pre-commercial procurement of innovative ICT for
empowerment and self-management of diabetes
mellitus patients. The requirements, use cases and
process models reflect the joint needs of four
European regions – Turkey, Portugal, Murcia and
Campania. They can be used by any procurer
interested in similar solutions, and can be extended
and used for other health conditions by procurers and
vendors alike.
ACKNOWLEDGEMENTS
The ProEmpower project has received funding from
the European Union’s Horizon 2020 research and
innovation programme under the Grant Agreement
No. 727409.
REFERENCES
Bommer, C. et al., 2017. The global economic burden of
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European Commission, 2017. Making Public Procurement
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European Specifications for Value-based Pre-Commercial Procurement of Innovative ICT for Empowerment and Self-management of
Diabetes Mellitus Patients
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