Meyer I,Müller S and Kubitschke L,Achieving effective integrated e-care beyond the silos

Reviewed by: Hubertus JM Vrijhoef, National University of Singapore and National University Health System, Singapore; Tilburg University and Maastricht University Medical Center, the Netherlands; Vrije Universiteit Brussels, Belgium; Editor-in-Chief International Journal of Care Coordination

In reviewing this book for the International Journal of Care Coordination, I asked myself the following two related questions: (1) Is integrated E-Care different from integrated care? (2) Can one meaningfully focus on information and communication technologies (ICT) and pay less attention to other parts of the integrated care puzzle?

Besides, I reviewed this book by assessing how well authors managed “to take stock of what already exists in the area of integrated eCare” (pp. xvi). Before I go, please note that the authors talk about “E-Care” in the title and “eCare” in the remaining of the book. Should the reader care about this?

Section 1 consists of the first three chapters and looks at the conceptual approaches to integrated eCare. In brief, it shows that integrated care is anything but new, has several meanings, and ICT is at least conditional to successfully solve the puzzle. It is pointed out that the European Commission is highly committed to ICT-supported integrated care by referring to one of its action groups. The authors realistically balance their enthusiasm for ICT as a component of integrated care with the many challenges that both ICT innovations and the reform of care systems are facing.

In Section 2, the authors discuss technologies for integrated eCare in, again, three chapters. They emphasize ICT, in its multiple forms, should be viewed as an important enabling factor for the integration of social and health care. I truly hope readers do not stop reading after Chapter 4. Just before one starts to think that after all ICT is not the hardest piece of the puzzle, the book continues with a plethora of challenges related to informatics and socio-technical issues when designing solutions for integrated eCare.

It is interesting authors talk about “solutions” in Section 2, where Section 3 presents different tools and methods for the evaluation of integrated eCare services and the development of business models. Apparently, the jury is still out. On another note, I would have welcomed when authors had discussed a research agenda here. Notwithstanding the relevance of research addressing the question if integrated eCare services are effective and efficient, research is needed to understand why this is or isn’t, who benefits from it and in what context?

Section 4 is probably the part of the book most readers have an appetite for: real life implementation of integrated eCare services in different parts of Europe, all captured in seven chapters. Palliative care, care for frail older people, the intersections of social and health care, population health management, and dementia care are the selected practices. Despite no clarification being provided for the selection of cases, Section 4 does provide an interesting mix of eCare services, target populations, integrated care settings, and research or evaluation methods and findings.

In Section 5, where authors critically discuss the main insights, the added value of their book and the present recommendations are lacking. One wonders whether the authors leave this up to the reader or that they found this a tricky exercise. This is certainly a missed opportunity. After all, stock-taking is only meaningful when stock valuation follows.

As often, the strength of this book is its weakness. I tend to believe that the authors distinguish integrated E-Care from integrated care. But doesn’t this introduce a fragmented view on integrated care? By focussing on ICT, the authors look primarily from the inside. This is insightful in better understanding the “do’s and don’ts” of eCare services.

However, for making sense out of the puzzle of integrated care, much more is needed. One has to master looking from the inside out and from the outside in in order to connect ICT to other enabling factors, transformation strategies and ultimately to understand the big picture. Perhaps a series of books in the field of integrated care with this book as an important and valuable first issue is how we can connect the silos.