ObjectivesTo identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus.SettingOne health care sector in Spain (Barcelona) (n = 11.382); six municipalities in Norway (Trondheim) (n = 450); and one hospital in Greece (Athens) (n = 388).MethodThe four services were: (i) Home-based long-term maintenance of rehabilitation effects (n = 337); (ii) Enhanced Care for frail patients, n = 1340); (iii) Home Hospitalization and Early Discharge (n = 2404); and Support for remote diagnosis (forced spirometry testing) in primary care (Support) (n = 8139). Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted.ResultsThe project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05); (iii) Reduced in-hospital days for all types of patients (p < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (p < 0.01) for patients with respiratory symptoms in Support, with marked differences among sites.ConclusionsThe four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.

In this position paper we present IT-centered challenges that lie in designing an architecture for a flexible, open, transferable, and replicable smart city ecosystem spanning a plethora of suppliers and systems. The background is the smart city and energy project +CityxChange. Its vision is to enable the co-creation and development of Positive Energy Blocks in smart sustainable cities. It will include the development of a framework and supporting tools to enable a common energy market, supported by a connected community and city integration. It will explore influences of the energy transition into city operations and urban planning, the integration of e-Mobility as a Service (eMaaS) into positive energy communities, and the growth of local trading markets and new business models. Digitalization, open architectures, and open data need to support these processes for open urban innovation in the ICT-enabled city.

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