December2013,IDCHealthInsights#IDCWP37V

WHITE PAPER
Enabling Sustainable and Healthier Living in the Urban
Era: The Healthier Cities Maturity Model
Sponsoredby:Microsoft
SilviaPiai MassimilianoClaps
December2013
IN THIS WHITE PAPER
IDC Health Insights Opinion
Healthierlivingisakeyfactorforacity'slong-termcompetitivenessandsustainability.
Stakeholdersandprocessesinvolvedinensuringsustainableandhealthierlivinggobeyond
traditionalhealthecosystems.Citiesthereforeneedtoembraceaholisticapproach,changingthe
legacymanagementculturebuiltaroundsiloedbudgetingprocesses,localbylawsandgovernance
structures,andoutdatedwaysofmeasuringsuccess.
Tohelpcitiesfindtherightapproachandunderstandinvestmentandotherfactorsthatenableor
inhibitprogress,IDCHealthInsightshasdevelopedthisHealthierCitiesmaturitymodel.This
modelisintendedtobeusedtodevelopclarityofvision,acommonlanguage,andastrategicroad
mapwithkeyleadersandinnovatorsinthecity'secosystem.Itisimportantforthecitytowork
towardabalanceinmaturityacrossallmeasuresdescribedbythemodel.Asmanyoftheissues
arerelatedtopeople,processes,andculture,toprogresstowardstheoptimizedstageofthe
model,IDCHealthInsightsrecommendsthatcityleadersshould:
Aimforasystemicvisionpoweredbydynamicmultistakeholdergovernance.
Focusontheempowermentofcitizensandprofessionalsandmeasurementofresults,so
thatcollaborationandinnovationcontributetocontinuousimprovementofbusiness
processefficiencyandeffectiveness.
Harnessthepowerofthird-platformtechnologies'nexus,leveragingopenandsecuredata
topreemptandadapttohealthierlivingneedsneeds.
Executive Summary
The21stcenturyischaracterizedbythe"citiesmomentum."Themajorityoftheworldpopulation
livesincitiesandurbanizationisgrowingrapidly.Thehealthstatusofthepopulationisanaspect
thatcannotbesidelinedasithasadirectimpactonacity'slong-termsustainabilityand
competitiveness.Inatightlyknitenvironmentlikeacity,thewide-reachingimplicationsofahealthy
(orunhealthy)populationmakeachievingahealthiercityvisionateamgamethatgoesbeyondthe
traditionalhospitalsetting.Servicesneedtobeintegratedalongthecarecontinuum,withthe
integrationofsecondaryandprimarycarewithsocialservicesandatotherimpactfulaspectsofthe
cityadministration,suchaspublictransport,publichealthpoliciesandinitiatives,education,and
urbanplanning.
2013IDCHealthInsights #IDCWP37V 2
TosupportcitiesintheirjourneytowardssustainableandHealthierLiving,IDCHealthInsights
developedtheHealthierCitiesmaturitymodel,withfivestagesoutliningtheprogressionofthecity
inthisjourney.ThefivestagesAdHoc,Opportunistic,Repeatable,Managed,andOptimized
aremeasuredagainstfivedimensionsStrategy,Culture,Process,Technology,andData
basedonthepeople-process-technologytrinomial.Eachdimensionwillevolvealonga
fragmentation-integrationaxis,drawingthelinesbetweensuccessfulcitiesthatoptimizeforhealth
andsustainabilityandthosethatremaininthelowerstagesofthematuritypathway.Themodelis
meanttobeusedtodevelopclarityofvision,acommonlanguage,andastrategicroadmapwith
keyleadersandinnovatorsinthecityecosystem.Onthejourneytowardtheoptimizedstage,the
MaturityModelcanhelpto:
Baselinecompetencyineachofthefivemeasuresofthemodel
Compareagainsttheindustrybenchmarktoidentifygapsandthedesiredstatuswithina
giventimeframe
Comparematurityassessmentsandidentificationofmaturitygapsamongbusinessgroups
(e.g.,GPs,communitycare,agencies)andbetweenbusinessandITwithinasingle
organization
SITUATION OVERVIEW
Why Cities Need a Healthier Living Strategy
Whilethe20thcenturywastheageofnations,the21stcenturyisoftenreferredasthe"ageof
cities".Forthefirsttimeever,themajorityoftheworld'spopulationlivesinacity,andthis
proportioncontinuestogrow.Onehundredyearsago,twooutofeverytenpeoplelivedinanurban
area,butasof2010,morethanhalfofallpeoplewerelivinginanurbanarea.By2050,this
proportionwillincreasetosevenoutoftenpeople.Bothinmatureandemergingcountries,citiesof
mediumtolargesizewillcontinuetoattractpeoplelookingforneweconomicopportunitiesandthe
intellectualchallengebroughtaboutbyculturalevents,high-techindustries,andcompanies
seekingtalentandopportunitiestopartnerandcompetewithotherbusinessesinordertoinnovate
andincreasetheirvalue.
Insuchadynamicenvironment,sustainableandaffordablehighqualityoflifecanbesuperseded
intheshort-term,whileeverybodyenjoysthelower-hangingfruitsofrapideconomicgrowth,but
cannotbeneglectedinthelong-run.Qualityoflifeishighlydependentonthehealthconditionsof
thepopulation.Thesheernumberandincreasingproportionofpeoplelivinginanurban
environmentnecessarilyimpliesthaturbanhealthproblemsdirectlyaffectmorethanhalfofthe
worldpopulation.Thehealthoftheurbanpopulationdeterminesthesustainabilityand
competivenessofcitiesaroundtheworld.
Ahealthypopulationthatcanaccessgoodhealthservicescanworkproductively.Ahealthy
populationthatcanaccessgoodsocialservicesthatmakecareaffordablecanplantostayand
contributetoeconomicgrowthinthefuture.Unhealthypopulationsthatcannotcountonservices
thatmakestayinghealthyfinanciallysustainablewillcontributelessproductivelyandeventually
seekopportunitiestogoelsewhere.Mostimportantly,inatight-knitenvironmentlikeacity,itisnot
justthehealthcareservicesdeliveredinhospitalsanddoctorofficesortheadultcareofferedin
nursinghomesthatcounts;thesystemiceffectofthequalityofairandwater,theabilitytotravel
safelyandwithoutlongwaitingtimes,theavailabilityofgreenspacesandsoforthallimpacton
makingacityhealthier.
2013IDCHealthInsights #IDCWP37V 3
Policy-makersmustbeawareofthescaleandcostofthelostopportunity(i.e.thebenefitsforgone)
ofdoingtoolittletopreventandmitigatehealthrisksthataretypicalofacityenvironment:
Infectiousdiseasesandpandemics.Denselypopulatedareashavetraditionallyhadto
dealwithcommunicablediseasescausedbypoorsanitationandthepollutionofwater,air
andfood.Cityexecutivesneedtoinvestcontinuouslytopreventandmitigatethesepublic
healthrisks,whiledealingwithnewerrisksgeneratedbytheriseinglobaltradeand
growinginfluxoftouristsandmigrantsthatintensifiesthescaleandvelocityatwhich
epidemicsandpandemicscanspread.
Injuriesandviolence.AccordingtotheWHO,about5.8millionpeopledieeachyearasa
resultofinjuryandviolence,suchasroadtrafficaccidents,suicideandhomicide,
accountingfor10%oftheworld'sdeaths.Infact,inmanycountriestheincreasedtrafficin
citieshasnotbeenmetwithadequatetransportinfrastructures,newtrafficregulations,or
measurestoensureimprovedroadsafetyandtodecreasecongestion.Urbanviolence,
meanwhile,needstobeanalyzedandtackledinthecontextofcontributingfactors,such
associalexclusion,poverty,unemployment,andpoorhousing.
Non-communicabledisease.Theincidenceofillnessessuchaschroniccardiovascular
andrespiratorydiseases,cancer,andmentalillness,isexacerbatedincities,where
peoplelivemoresedentarylives,aremoreaffectedbyairpollution,eatunhealthyfood,
andaremoresubjecttostressrelatedtounemployment,trafficandotherissuesthatcan
leadtodepressionandothermentalillness.AccordingtotheWHO,non-communicable
diseasesareexpectedtomakethebiggestnegativeimpactonpeople'shealthylifeyears
andonthecostofdeliveringcareservices.Theyshouldthereforebeaprimaryfocusfor
cityadministratorsacrossbothemerginganddevelopedcountries:preventingsomeof
thosecostsandproductivitydecreasesbyensuringthe"healthyyears"ofthecity
populationlastlonger,andremediatingthetrade-offbetweencaringfortheproductivityof
healthyworkersandensuringtheelderlyhaveagoodqualityoflife.
Finding Real Impact Beyond the Hospital Setting
Today'scitypopulationenjoysbetterhealththantheirruralpeers.Butamoregranularlook
systematicallyrevealsharshhealthinequalitieswithinthecityenvironment.Urbanhealth
inequalitiesshowaconsistentpatternacrossthepopulationdependenttosocioeconomicstatus
(work,age,education,thehealthsystemandservicestheycanaccess)orgeographicallocation
(natural,socialandbuiltenvironments,aswellasaccesstoservices).Forexample,2010research
fromthePublicHealthIntelligenceteamofNHSCentralLancanshire(UK)showedthatlife
expectancyvariesby14.7yearsformenand10yearsforwomenbetweenthemostaffluentand
mostdeprivedareas.
Theneedforacoordinatedapproachtoreducetherisksandcostsofcommunicablediseasehas
beenunderstoodforalong-time.Water,wastetreatment,transportandotherauthorities(and
corporations)worktogether,ensuringthequalityofwater,air,andfood,publichealthdepartments
inlocalgovernmentscontrollingthesafetyoftheenvironment,andfirstresponders,including
emergencyandinfectivecareunitsinhospitals,takingcareofacuteepisodestominimizethe
spreadofdisease.Butitisbecomingincreasinglyevidentthatcoordinationacrossthecontinuum
ofcareisalsoparamountfornon-communicablediseases.Hospitals'highlyspecializedservices
canappropriatelyaddresstheacutephaseoftheseillnesses,buttheirlong-termmanagement
requiresaconstantmonitoringofthepatientandfollowupsthatcannotbeeffectivelydeliveredin
thehospitalsetting,becauseofhospitalizationcosts,patientexperienceandcaresafetyissues.A
coordinatedapproachisthereforeneeded,includingarangeofservicesfrompreventionto
diseasemanagement.Effectiveurbangovernancethatincludesgovernment,education,private
sector,civilsociety,andcommunitygroupswillhelptoreducethebreadthofhealthinequalities
2013IDCHealthInsights #IDCWP37V 4
andthustheincidenceofchronicdiseases.Infact,reducingpollution,educatingchildrentoeat
healthierfood,ormakingpublichealthyspacesavailable,cancontributetopreventingresidents
contractingcardiovascularandrespiratorydiseasesaswellascancer.Similarly,forthose
residentsthatareaffectedbythesediseases,socialservices,suchashousing,occupational
therapy,meals-on-wheels,rehabilitationandpsychotherapymustbecoordinatedbylocal
governments'adultandchildcaredepartmentsandprimarycare,afterhospitaldischarge.City
administrationmattersencompassingcrisismanagement,environmentalprotectionregulation,
urbanplanninglaws,education,andpublictransportmustbeaddressed.
A Healthier City is a Team Game
Thehealthcaresectorcannottacklethevarioushealthcarechallengesinthecityenvironment
alone.Thewide-reachingimplicationsofahealthy(orunhealthy)populationmakeachievinga
healthiercityvisionateamgame.Cityadministratorsshouldtaketheleadbydefiningastrategy
thatleveragesonthepowerofcoordination.Collaborativegovernancewillhelpmakesurecity
departmentsandagenciesandnon-governmentpartnersunderstandwhattheintendedoutcomes
areandthemayorandtheirstaffcankeeptrackoftheirprogressintheenterprisecontext.
Communityparticipationhasbeenfundamentaltotheimplementationofthenine
NeighborhoodHealthPlansinthecityofBarcelona.Thepublichealthagencyof
Barcelonaisresponsiblefororganizinginterventions,butreliesontheongoing
supportofprimarycare,theregionalDepartmentofHealthofCatalonia,thecity
councilwithitsadministrativedistricts,andtheircommunityworkers.Acommunity
groupisformedineachparticipatingneighborhoodandwiththesupportofarange
localpartnersisresponsibleforallaspectsofplanningandimplementationof
initiativesaimedatreducinghealthcareinequalities.
Thekeystepsthatcityadministratorsshouldconsidertofostersuchacollaborativeecosystem
are:
Designingandclearlycommunicatingaconcisesetofstrategicgoals
Changingregulations,organizations,processesandskillstoalignstakeholders
Allocatingfundsandaligningthemwithstrategicgoalstokick-startinitiatives,butalso
incentivizeotherstakeholderstocontributesothatthefinancialsustainabilityofthe
programisstronger
Settingupandnurturingcross-boundarycommitteesandempoweringthemtotake
decisions
Managingperformanceforcontinuousimprovement
Collaboratingwithbusinesses,boththosewhoseactivitiesdirectlyaffecthealth,suchas
transportationcompanies,utilities,orcompanieswithfactoriesemittingthemostdangerous
pollutants,andothersthatcanimplementorganizationalchangesforasaferworkingenvironment,
forinstancereducingdemandsthatworkerstraveltotheofficeatpeakhoursorprovidinghealthy
foodinacanteen,isequallyimportantinpursuingHealthierCitygoals.
2013IDCHealthInsights #IDCWP37V 5
THE APPROACH
A Maturity Model for an Integrated and Sustainable Healthier City
MainstreamingHealthierLivingpolicies,services,andprocessesrequirestheadoptionofaholistic
approachthatchangesthelegacymanagementculturebuiltaroundsiloedbudgetingprocesses,
localbylawsandgovernancestructures,andoutdatedwaysofmeasuringsuccess.Tohelpcity
executivesintheirprogressassessment,IDCHealthInsightsdevelopedamaturitymodelthat
identifiesfivestages,describingaroadtotheintegrationofHealthierLivingpoliciesintothewider
andlong-termcityvision.Eachofthesestagesismeasuredagainstfivedimensions.Every
dimensionevolvesthroughthefivestages,alongafragmentation-integrationaxis,drawingthe
linesbetweensuccessfulcitiesthatoptimizeforhealthandsustainabilityversusothersthatwill
remaininthelowerstagesofthematuritypathway,becausetheyoperateinsiloesanddonot
leveragethepowerthatsitsatthenexusofthird-platformtechnologies(cloudcomputing,social
business,mobility,BigData,andanalytics)tooffermoreagileresponsestoemergingbusiness
andpolicyneeds.
Five Maturity Stages to Healthier Living
ThefivestagesandthekeyattributesofeachstageidentifiedbyIDCtodescribeprogressphases
are:
AdHoc:Thisstageisthetraditionalmodusoperandiwithadhocprojects,department-based
planning,anddiscreteprojects.
ThegoaloftheAdHocstageistobegintoprovethevalueoftheHealthierCityconcept
anddevelopthebusinesscaseviademonstratedROIfrompilotprojects(proofofconcept).
Opportunistic:Opportunisticprojectdeploymentsresultinproactivecollaborationwithinand
betweenhealthcareprovidersandothercitydepartments(e.g.socialservices).
ThegoalattheOpportunisticstageistoengagekeystakeholdersandgettheirbuy-inand
alignmentasthestrategyandroadmaparedeveloped.Inthisphase,leadersneedto
identifygoodpracticesandcommonlanguagestoenablebusinessprocesschangethat
willhelpwithscalabilityandrepeatability.
Repeatable:Atthisstage,recurringprojects,events,andprocessesareidentifiedforintegration.
Formalcommitteesdocumentdefinedstrategies,processes,andtechnologyinvestmentneeds
withstakeholderbuy-in.
ThegoaloftheRepeatablestageofmaturityisimprovedoutcomesandservicedeliveryas
aresultofrepeatablestandardprocessesforHealthierCityprojectsandtheircoordination
beyondthesingledepartment/singleorganizationlevel.Moreformalizedprocesses
developmeasuresofbothoutputsandoutcomestodeterminesustainabilityofthe
initiatives.Specificinitiativesandrelatedgovernancemodelsarescaledandintegration
begins.
Managed:Formalsystemsforwork/dataflowsandleveragingtechnologyassetsareinplaceand
standardsemerge.Outcomesbasedperformancemanagementshiftsculture,budgets,IT
investment,andgovernancestructuretoabroadercitycontext.
2013IDCHealthInsights #IDCWP37V 6
ThegoaloftheManagedstageofmaturityisforcitiestobeabletopredictthehealthcare
needsoftheirresidentsandprovidepreventativeservicesbeforeproblemsarise.Thanks
toasharedunderstandingofperformancemetricsandacommoninformationframework,
cityleadersandstakeholdersareabletopredictandpreventnewevolutionsofcareneeds
throughacoordinatedandefficientapproach
Optimized:Aholisticcitywideplatformisinplace.Superioroutcomesdeliverdifferentiationfrom
othercities.
TheultimategoaloftheOptimizedHealthierCityisintegrationofHealthierLivinginthe
long-termcityvision.Agilestrategy,IT,andgovernanceallowforautonomywithinan
integratedsystemofsystems,andcontinuousimprovementsguaranteesustainability.The
HealthierCitiesapproachismature.HealthierCitieswillattractinvestments,visitors,and
citizensbecausetheyprovideaffordableintegratedhigh-qualityservicesandofferahigher
andhealthierqualityoflife.
Five Dimensions for Enabling Healthier City
Eachofthestagesdescribedaboveismeasuredagainstfivedimensions(strategy,culture,
process,technology,anddata)thatneedtobeaddressedinordertomainstreamtheHealthierCity
conceptandmakeitfullyoperational.Manyofthesearenottechnology-relatedmeasuressince
thegreatestchallengesthatcitiesfacearerelatedtopeopleandprocess(seeFigure1and
Annex1)
FIGURE 1
Healthier Cities Maturity Model: A Five-Stage Evolution

Source:IDCHealthInsights,2013
Ad hoc
Opportunistic
Repeatable
Managed
Optimized
Strategy
Culture
Process
Technology
Data
No strategy in
generalizing Healthier
Living aligned to
citizens needs.
No f ormal process to
engage with new
ideas within risk-
averse culture.
Health and care
processes are
managed at single
department/ agency
level
Enterprise
architecture is
f ragmented
Data is underutilized
and housed in
disparate systems
Strategy begins at city
department level,
starting with pilots
engaging diverse
healthcare
stakeholders.
City experiments with
citizen/patient
engagement, but on a
limited and purely
transactional basis
City leaders start
analyzing specif ic
citizens' needs and
processes f or
coordinated f ulfillment
City moves toward a
broader adoption and
build-out of
collaborative tools
City's stakeholders
start to open as
collaboration and big
data and analytics
projects are launched
A city's vision f or
cross-department
strategic outcomes is
stated in a f ormal
document
City proactively
engages citizens,
though partially
personalized
innovative processes
City leaders def ine
key services,
processes and
governance f or
integration on a
broader scale
Collaborative tools
are integrated with
business applications.
SOA is adopted as an
open platf orm
City's stakeholders
start to develop a
more holistic
approach to
integrated data
management
The strategy involves
players beyond city
administration, and
healthcare providers
Citizens engage with
the city through
multiple, customized
channels
Inf ormation is shared
and service delivery
processes are
coordinated in
alignment with wider
city long-term vision
Smart devices and
embedded analytics
lead to dynamic data
supporting Healthier
Living
Data made available
in open f ormats to
provide actionable
insights to f urther
Healthier City goals
Governance enables
continuous evolution
and improvement of a
holistic strategy f or
healthier living
Citizen/patient
experience is
inclusive,
personalized, and
collaborative
Processes are
continuously
improved and re-
conf igured to achieve
strategic healthier
living outcomes
3
rd
platf orm, IoTand
legacy are integrated
supporting a secure,
intuitive and outcome
driven environment
Data are liquid,
secure and
personalized to pre-
empt and adapt to
healthier city needs
2013IDCHealthInsights #IDCWP37V 7
Strategy: Defining a City's Intent for Healthier Living
Thestrategydimensionisaboutacity'svisionforhealthcare,howthehealthierlivingapproachwill
bemainstreamedandembeddedinthecity'sgeneralstrategy/identity.Inthisdimensionthecity
identifiesitssustainable"HealthierLiving"objectives.Thestrategycanbeanalyzedalongthree
lines:
Astrategiccityplan,definingthedesiredhealthcarevision,missionandgoals;identifying
howthecity'sstrengthsandweaknesseswillbeleveragedandaddressed.
Developmentofthebusinesscase:toensurelongtermsustainabilityoftheinvestment
plans.
Leadership:forthepromotionofthecityvisionandcommunicationofthebenefits.Leaders
typicallyincludemayors,CIOs,and/orcommunityandbusinessleaders.
Culture: Enabling a Culture of Innovation and People Engagement
Whenitcomestopeople'shealthcareconditionsinparticular,cityleaderstendtoberiskaverse,
becauseresourceconstraintsandfailuresthatimpactcitizens'livescannegativelyimpactcity
executives'reputationsandcareers.Thisriskaversionmakesitmoredifficultforcitiestotake
advantagethetalentandideasofcitizensempoweredbythirdplatformtechnologies(including
communityandbusinessleaders).21stcenturysocietyismovingfromwelfarestatevalues(aimed
atassuringthesamelevelofservicestoallcitizensandfollowingaonesizefitsallconcept)
towardtheempowermentofindividuals.Thankstotheimpactofthird-generationplatform
technologies(cloud,BigDataandanalytics,socialmedia,andmobile),citizenswanttoadaptand
personalizeservicesaccordingtheirneeds.Itisnotanideologicalquestionaboutmoreorless
state:itisaboutenablingchoice.Itisasocietalchangeandthird-generationtechnologiesapplied
tohealthcareandgovernmentareforward-lookinginstrumentstoenablethischange.Ata
Europeanlevel,theMalmMinisterialDeclarationintroducedtwoimportantconcepts:
Theempowermentofcitizensandbusinessesthroughtechnologiesthatinvolvethemin
thedesignandoperationofservices.
Themaximizationofpublicvaluesthroughthejointproductionofservicestothepublicby
governmental,private,andcivilparties.
Culturalchangeisneededtomakesurethecitycapitalizesontheresourcesofcitizensand
engageswiththembybecomingmoreexperimentalandinnovativeintheuseofemerging
technologiesandnewideastosolvelong-standinghealthcareproblems.
Process: Governance for an Extended Ecosystem
Theprocessmeasurestheabilitytointegratebusinessworkflows,information,andpartnerships.
Thisdimensioniskeyforlong-termoperationalsustainabilityofaHealthierCity.
Processintegration.Citystakeholdersneedtounderstandhowservicesaredelivered,
whattypeofinformationisneededandproducedineachprocess,andwhichstakeholders
areinvolved.InaHealthierCity,careprocessesandinformationneedtobeintegratedand
optimizedwiththecitizens'needsandbehaviorinmind.Analyticaltoolsincreasinglyblur
theboundariesbetweentransactionalandcollaborativeprocesses.
Partnershipcapabilityinfluencesthegovernanceoftheextendedecosystemsthata
HealthierCityrequires.Solidcollaborationframeworkswillrequiretheinclusionof
healthcareandpublicadministrationwithexternalpartnerssuchasacademia,private
industry,ICTvendors,andcitizengroups.
2013IDCHealthInsights #IDCWP37V 8
Technology: The Healthier City Technology Architecture Framework
TechnologymeasurestheadoptionandpenetrationofICTinfrastructureandrelatedtechnologies
aswellasthedevelopmentoftheHealthierCitytechnologyarchitectureframework.Arobust
telecominfrastructureisthebackboneonwhichtheHealthierCitywillgrow.Tocovertheextended
ecosystemsofinstitutionsandpeopleinvolved,ICTneedstosolidlysupportdataproduction,
consumption,andsharingindifferentcarecontexts(atthepatient'shome,inthepractice,at
school,atwork),throughthemostappropriatedevice(e.g.,desktopandmobile).Informationis
createdandusedthrough:
Healthandsocialcare-specificapplicationssupportingtheworkofhealthandsocialcare
professionals.
Socialmedia,mobileapps,andotherend-userinterfaces,suchasportals,enablingthe
participationofcitizensandtheprivatesectoraswellascityandhealthcareprofessionals.
Advancedandintelligentsensors,cameras,medicaldevicesandotherappliancesusedas
datacollectionpoints,aswellastriggersofevent-drivenworkflows.
Cityleadersneedtothinkabouothowtheywillensureinteroperabilityandsystemconsolidation
acrossthird-platformtechnologies,legacysystems,andtheInternetofThings;forexampleviaa
serviceorientedarchitecture,coherentandreliabledatacenters(managingdataforappsand
applicationsaswellasforadvancedanalyticsfunctionalities)andsharedcollaboration
infrastructures.
Data: Increasing Accessibility for Transparency, Collaboration and Insights
Thedatadimensionmeasureshowdataisusedandaccessed.Citieshaveawealthofdataintheir
currentsystemsaswellasafloodofnewdatacomingintosystemseveryday,asforexamplereal
timedataproducedbymobiledevices,wearabletechnologies,sensorsandsocialmedia.Data
accessibilityisparamounttobetterinformandengagecitizensandautomateprocesses.Increased
opennessandadvancedanalyticalcapabilitieswillbekeyenablersfortheHealthierCityvision
providing:
Acoherenttechnicalandsemanticframework,enablingcollaboration,citizenengagement
andtransparency
Areferenceforcrowd-sourcingandco-production,involvingtheprivatesectorandthe
communityanddrivinginnovation(forexampleinareaslikenewmobileappdevelopment)
Thenumberofgovernmentsadoptingopendataplatformsisrapidlyincreasing, inspired by
principles such as transparencyandaccountabilityofinstitutions.Thevalueofopendataisnot
limitedtogreatercapabilitytocontroltheconductofpublicinstitutions,however.Achieving
HealthierLivingobjectivesrequiresnotonlydefiningandreportingacity'shealthproblems,but
alsoturninginformationintoactionableinsights.Inaninformation-dependentsectorlike
healthcare,"liquid"datacombinedwithBigDataandanalyticscanunlockrealvalueinareassuch
asservicespersonalization,processefficiencyandnewcaredeliverymodeleffectiveness.
HealthierCitiesrestonusingBigDataandanalyticstominedataforpredictiveandpreventative
resourceallocationsandplanning.BigDatarequiresanewapproachtodataaccessibility,
accuracy,anduse.Opendatamodelswillbetiedtoculturearoundinnovation,dataprotection
legislationevolution,andcitizenengagement.MostoftheBigDataandanalyticsolutionsdeployed
willincorporatemulti-structureddatafrommultiplesources.Therefore,asignificantportionofthe
datamanagementbudgetwillbededicatedtoinformationmanagement,security,andprivacy
protection
2013IDCHealthInsights #IDCWP37V 9
FUTURE OUTLOOK
Healthier Cities: The Reality and the Promise
ThepathtotheOptimizedstageisalong-termeffortthatwilltakeyearsratherthanmonthsto
achieve.TodaythereissporadicadoptionofHealthierCitysolutionsacrosscities,withonlya
handfulofcitiesworldwideactivelyintheOpportunisticorRepeatableimplementationstages.Most
citiesarefocusedonresearchingandevaluatingusecasesandtechnologycapabilitiesalongwith
definingtheirvisionofaHealthierCityandidentifyingbarrierstoadoption.Citiestodayshowa
morematureapproachintheStrategyandtheTechnologydimension(seefigure2).Data,
process,andculturearetheareaswherecitystakeholderstodayneedgreaterimprovementto
movetowardtherepeatableandmorematurestages.
FIGURE 2
Average Maturity of Healthier Cities in 2013

Source:IDCHealthInsightsEstimate,2013

Thefivedimensionsarecloselyinterwovenandinterdependent,thereforetoprogresstowardthe
moreadvancedstagesofthemodel,citieswillneedpartnersabletounderstandthecomplexity
andbreadthofaHealthierCity.Cityleaderswillneedtolookforsolutionplatformsand
ecosystemssupportingnotonlythetechnologicalanddata-relatedaspects,butalsoprocesses
andstrategies,suchas,forexample,theMicrosoftCityNextframeworkandinparticularwiththe
HealthierCitiesCoalitionofpartners.
Ad hoc
Opportunistic
Repeatable
Managed
Optimized
Strategy
Culture
Process
Technology
Data
No strategy in
generalizing Healthier
Living aligned to
citizens needs.
No f ormal process to
engage with new
ideas within risk-
averse culture.
Health and care
processes are
managed at single
department/ agency
level
Enterprise
architecture is
f ragmented
Data is underutilized
and housed in
disparate systems
Strategy begins at city
department level,
starting with pilots
engaging diverse
healthcare
stakeholders.
City experiments with
citizen/patient
engagement, but on a
limited and purely
transactional basis
City leaders start
analyzing specif ic
citizens' needs and
processes f or
coordinated f ulfillment
City moves toward a
broader adoption and
build-out of
collaborative tools
City's stakeholders
start to open as
collaboration and big
data and analytics
projects are launched
A city's vision f or
cross-department
strategic outcomes is
stated in a f ormal
document
City proactively
engages citizens,
though partially
personalized
innovative processes
City leaders def ine
key services,
processes and
governance f or
integration on a
broader scale
Collaborative tools
are integrated with
business applications.
SOA is adopted as an
open platf orm
City's stakeholders
start to develop a
more holistic
approach to
integrated data
management
The strategy involves
players beyond city
administration, and
healthcare providers
Citizens engage with
the city through
multiple, customized
channels
Inf ormation is shared
and service delivery
processes are
coordinated in
alignment with wider
city long-term vision
Smart devices and
embedded analytics
lead to dynamic data
supporting Healthier
Living
Data made available
in open f ormats to
provide actionable
insights to f urther
Healthier City goals
Governance enables
continuous evolution
and improvement of a
holistic strategy f or
healthier living
Citizen/patient
experience is
inclusive,
personalized, and
collaborative
Processes are
continuously
improved and re-
conf igured to achieve
strategic healthier
living outcomes
3
rd
platf orm, IoTand
legacy are integrated
supporting a secure,
intuitive and outcome
driven environment
Data are liquid,
secure and
personalized to pre-
empt and adapt to
healthier city needs
2013IDCHealthInsights #IDCWP37V 10
Thefollowingparagraphsdescribehowthe5dimensionsoftheMaturityModelwillbelikelyto
evolveintheshortandinlongerterms,highlightingkeyinhibitorsanddrivers.Inthejourneytoward
theoptimizedstage,theMaturityModelcanhelpto:
Baselinecompetencyineachofthefivemeasuresofthemodel
Compareagainsttheindustrybenchmarktoidentifygapsandthedesiredstatuswithina
giventimeframe
Comparematurityassessmentsandtheidentificationofmaturitygapsamongbusiness
groups(e.g.,GPs,communitycare,andagencies)andbetweenbusinessandITwithina
singleorganization.
Strategy
There are examples of Healthier Living thought leadership in many cities also thanks to
internationalinitiativesliketheWHOEuropeanHealthyCitiesNetwork.Intheshortterm,moreand
morecityleaderswillopenlystatetheirplanstocreateaHealthierCity;however,thespecificsof
the vision may not be fully developed. The vision of city innovators will be frustrated by the
slowness of progress for a variety of reasons, mainly around internal risk-averse cultures,
governanceissues,andtherigidityofengagementmodelswithexternalpartnerssuchascitizens
andtheprivatesector.
In the longer term, as these elements become more flexible and city constituents become more
awareofHealthierLivingbenefits,citieswilldeveloptheirownHealthierCityvisionthathighlights
theiruniquestrengthsandhowtheyaremainstreamedinthecity'sgeneralidentity.Areasthatmay
havepreviouslybeenhandleddistinctly,suchaspublictransport,education,andsafety,willbegin
to be coordinated, especially where business groups and citizen groups of interest are engaged
withcityleaders.
Forexample,thecityofManchester(UK)isworkingonabroadreformof"peopleservices"(Health
andsocialcareintegration,TroubledFamilies,EarlyYears,TransformingJustice,Worklessness
andlowskills)focusingongreatercollaborationamongdepartmentsandarenewedapproachto
datacollectionandanalysis.Inparticular,theEarlyYearsinitiative(addressinghealthand
educationwiththeaimthatallchildrenarereadyforschoolsoastoreducedependencyand
improvelifechances)isfocusedonharmonizingdataaboutchildrenof05years,collectedand
managedbyanumberofprofessionals(commissioners,socialworkers,carers)aswellasparents.
Anewdatamanagementframeworkwillallowacomplete,transparent,andprogressiveviewofa
child'sneeds,appropriatelytriggeringandmeasuringinterventions,self-referrals,viewing
assessments,knowledgeofcontacts/who'sinvolved,gettinghelpfulinformation/guidanceand
generalcasemanagementsolutionsandenablingmoreaccuratestrategicplanningofuniversal
andtargetdfamilyservices.
Culture
Intheshortterm,onlyasmallnumberofcitieswillreallybepushingtheHealthierCityconceptand
adoptinginnovativeframeworksandsolutions,settingbestpracticesandidentifyingsuccess
factors.Civicinnovationmodelswillspreadandcitizenengagementwillcontinueintermsof
bringingideasinfromthecommunityorusingcitizen-developedhealthapps.Withtime,citieswill
approachservicesevolutioninamoresystematicway,creatingandsupportingframeworksfor
innovation(regularhackdays,incubators)andprivatepublicpartnershipstofurtherdevelopthe
healthcareeconomy.
2013IDCHealthInsights #IDCWP37V 11
Citizenengagementwillhaveasteepgrowthcurve,butitmayruntheriskofbackslidingifcities
don'tstrivetokeepengagementupwithfreshapps,challenges,andopendatasets.Emerging
citieswillstrugglewithhowmuchtoengagecitizens,giventheinitialhighcostofeducatingthe
publicontheuseofsomeservicesaswellasthehighcostofengagement(i.e.,callcentercalls
increasingasengagementincreases).
Process
Advancesinprocessoptimizationwillmaterializeaspartnershipandcooperationmodelsevolve.
Businessprocessoptimizationwillbelimitedtosupportinginitialfocusedprojects,butthe
experiencedevelopedinthesesettingswillbuildasolidreferenceframeworkasthecitystrategy
advances.Tofindfundsthatcanhelpscaleprojects,citieswillalsoneedtogetresourcesfromthe
privatesector,aschangestoexistingbylawsorstructurestakemuchlonger.
Cityleaderswillhavedifficultymanagingtheextendedecosystem.Thecreationofcollaboration
schemessharedandacceptedbyallparticipantsaswellastheuseofdashboardsandindicators
toensurethatprocessesareoptimizedandreconfiguredconditionsandpopulationneedschange,
andthatthecontributionofthevariousplayersisappropriate,willbekeyfortheviabilityofthe
HealthierCityinthelongterm.
Technology
Currentmaturityinthetechnologydimensionistheresultofthemanyinitiativesandpilots
launchedintheareaofdiseasemanagement,especiallyforchronicpatients,andpopulation
healthmanagement.The3
rd
generationplatformisemergingastheplatformforsmarterhealthand
caredelivery.Technologyadoptionisgrowingrapidly,especiallyinBigData,analytics,and
mobility.Citiesthatarecapableofharnessingthevalueatthenexusofcloud,social,mobile,and
BigDatawilltaketheleadandrapidlybuildcollaborationinfrastructureandsolutionsthatcanalso
capturedatafromdeviceslikecamerasandsensors.Citieswithhighertechnologyadoptionand
penetrationwillstarttotakeinventoryofassetsandthinkhowtheycanbeleveragedacross
multipleprojectsand/ordepartments.
Inthelongerterm,citieswillbegintomakeimprovementsinharnessingtherapidlygrowing
informationproduction.BigDataapplicationswillensurethatanalyticfunctionalityismade
availabletothehighestpossiblenumberofstaffandexecutives,supportingtheshifttoward
evidence-basedservicedeliveryandassessment.Openandconsensus-setstandardswillevolve
andemergetomitigatetechnologyrisksandtoimproveinteroperabilityacrossthestackand
acrossvendorsolutions.Citieswillasktechnologyvendorstoprovideplatformsforadd-on
developmentbypartners,citizens,andcitiesthemselves.Todoso,pointsolutionswillnotbe
enough,itwillbemoreimportanttodeploysolutionframeworksthatenabletheuseofan
interoperabilityandcollaborationlayerontopofsiloedapplications;forexample,byenablingCRM
systemstobesharedacrossdifferentdepartmentstoenablegreatpersonalizationofservices.
Mobileandsocialmediawillbeincreasinglyusedaschannelsforinteractivepreventionand
diseasemanagementcampaigns.Increasedstrategicvalueofdataasanassetwilladdadditional
pressureandscrutinyofatechnology'scountryoforigin(especiallywhenconsideringcloud
serviceanddatacenterlocation)astheriskofdatalossorcontaminationincreases.
Data
Data"liquidity"willbetiedverymuchtoculturearoundinnovationandcitizenengagement.Evenif
morecitiesadoptedopendatastrategies,availablehealthdatasetsarelimitedandarenot
2013IDCHealthInsights #IDCWP37V 12
presentedinrealtime.Mostlegacyhealthcareinformationsystemsstillproducedatainproprietary
format,hinderinghealthinformationexchangeandanalysis.Healthcaredecisionmakersare
increasinglylookingatstandardsandinteroperabilityintheprocurementofnewsystems.Inthe
nexttwoyears,manyIT-ledBigDataandanalyticsprojectswilllackaconnectiontoHealthierCity
goals,becauseofthelackofsufficientITandbusinesscollaboration.Thismisalignmentwillleadto
slowadoptionofsolutionsanddifficultyinsecuringadditionalroundsofprojectfunding.Inthe
longerterm,programmanagersandcityexecutiveswillbecometheleadfordataandanalytics
initiatives,reducingtheriskofmisalignmentofITandlineofbusinesspriorities.
Increasingdataavailabilitywillspurbottom-upinnovationascitizensandhealthcareprofessionals
inventnewappsforspecificcareandwellbeingservices.Withtime,agrowingpercentageofthe
populationwillopttosharebehavioral,demographic,purchasing,financial,andotherpersonal
data,thoughtherewillbeabacklashinsomecitiesoverthenon-voluntarydatacollectionof
information,especiallyiftherearedataleaksormisuse.Privacyregulationwillcontinueto
influenceanincreasingportionofthedatamanagementbudgetinthelongerterm,asexecutivesin
bothlocalgovernmentandhealthcareunderstandthatintegratedandsecureaccesstodatais
paramount(seeFigure3).
Itisworthnotingthatprogressinthismaturitymodelisnotasteadyandconsistentmarchfromone
stagetothenext.ThemovefromAdHoctoOpportunistictakeslesstimeandeffortthanthe
progressionfromOpportunistictoRepeatable,whichrequiressignificantefforttoaddresshowto
scaleandfundprojects.Similarly,movingfromRepeatabletoManagedisalongerprocess,with
processissuesattheforefront,butgoingfromManagedtoOptimizedmaytakelesstimebecause
allofthefoundationalstrategic,process,andculturalissueswillhavebeenlargelyresolved.

2013IDCHealthInsights #IDCWP37V 13
FIGURE 3
Top IT priorities
Q. Using a scale ranging from 1 to 5 where 1 = 'Not at all Important' and 5 = 'Extremely Important'
how important would you rate each of the following objectives for your IT organization?

Source:IDCHealthInsights,2013
BUILDING A ROADMAP FOR HEALTHIER CITIES
CityleaderslookingtoestablisharoadmapfortheirHealthierCityvisionneedtoconsiderthe
differentrolesthatwillbeplayedbythevariousstakeholdersandthedifferentscenariosfrom
whichtheymightstarttheirjourney.
Which Role for the Healthier City Stakeholders?
AHealthierCityisateamgamethatincludesalargeandvariablenumberofstakeholders,
dynamicallycombiningtheircapabilitiestoimprovequalityoflife.Thisdynamicecosystem
includesthecitizenwhoisactivelyengagedinhis/herhealthchoices.Thedifferentroleof
educationinstitutions,primaryandsecondarycareprovidersandlocalgovernmentservicesis
functionalinthiscitizen-centricview,anditwilldriveinvestmentinspecifictechnologiesthatwill
supporttherequiredorganizationalandculturalchanges.Thefollowingsectionsidentifytherole
thatkeystakeholderscitizens,education,primarycare,socialservicesandothercityservices,
andhospitalswillplayintheHealthierCity.
Citizens Will be Enabled to be Actively Engaged in Prevention and Disease
Management
Publichealthauthorities,healthcareproviders,payersshouldengagecitizensbyempowering
themtotakeamoreactiveroleby:
4.10
4.01
3.92
3.90
3.90
3.88
3.86
3.84
3.73
4.05
4.02
3.84
3.87
3.79
3.83
3.90
3.94
3.73
Proven data privacy protection
Integrated and secure access to data and
applications
Speed and cost of regulatory compliance
adaptation
Improve the quality of IT skills within the
organization
Improve IT governance
Lower costs of IT
Align IT projects and build Flexible IT systems to
support strategic business priorities
IT systems consolidation
Real-time monitoring of business performance
Local government Healthcare providers
2013IDCHealthInsights #IDCWP37V 14
Promotingtheusageofmobileappsandonlineservicesthatallowpatientstotransmit
datafrompersonalmedicaldevicessuchasglucosemonitorstotheirdoctors.
Disseminatinginformationonnutrition,wellness,andavailabilityofservicesandcare
providersbyengagingwithcommunitysocialmedia,orpromotinggamingapps.
Developinguser-friendlyonlinetoolsandplatformsaimedatorganizingandmanaging
healthinformationcomingfromthevariousproviders.
Forexample,NHSChoice,theUK'slargesthealthinformationwebsite,in
collaborationwith3chillies,hasdevelopedthe"HealthChoices"app,which
optimizesinformationonNHSproviders'accessinamobileenvironment.The
appscanbeintegratedwithMicrosoftHealthVault,addingtheabilitytosave
conditionandNHSserviceinformationlinkedtoasecurepersonalaccount.
Theroleofeducationalinstitutionsisfundamentaltoappropriatelyempoweringcitizensontheir
healthchoicesfromtheirearliestyears.Educatingandinformingchildrenandadolescentsabout
healthierbehavior(forexampleonthebenefitsofabalanceddietandphysicalexerciseandthe
risksassociatedwithsmoking,alcohol,andasedentarylife).Tothisend:
Theuseofsocialnetworkscanbefunctionalinsupportingkeymessagesaround
preventionofdiseases,increasingawarenessofavailableservices,andgettingfeedback
fromchildrenandadolescentsabouttheirhabits,howtheywouldliketoaddresscertain
issues,etc.
Onlinegamescanbeusefultoolsforincreasingawarenessabouthealthybehaviors,such
asforexample,theuseofaversionofthepopulargame"AngryBirds"aimedatexplaining
andfightingthecausesofchildobesity.Gaminghasalsobeenusedinmentalhealth(for
example,forcognitivetests)andinrehabilitationactivitiestomakeexerciselessboring
ensureitisdonecorrectly.
Schools and Higher Education Will Provide Health Professionals With New Skills
Onthecareproviders'side,professionalschoolsanduniversitiesalsohaveafundamentalrolein
trainingnewhealthandsocialprofessionals,helpingthemtodevelopnewexpertiseandskills.The
wideradoptionofclinicalinformationsystems,aswellasthedevelopmentofgenomics,
proteomics,microbiomics,andgeneticengineeringatthecrossroadbetweenmedicalstudiesand
computersciencemeansITskillsarefundamentaltoleveraginginformationsystemsthatenablea
coordinatedcareapproach.EducationinstitutionsneedtotackleITskillsgapsacrossgenerations
ofhealthprofessionalsandatthesametimeleveragingandencouragingknowledgeandtalent
withinhealthandcity'sorganizationsthroughinitiativessuchasNHShackdays.Asthe
implementationofaHealthierCitystrategyimpliesmanagementchange,cityleadershaveto
cooperatewithcliniciansandnursesassociationstopromoteanddelivertrainingandrelated
activities.Tothisend,theuseofonlinelearningplatformscaneffectivelysupportonthejob
training.Onlinelearningplatforms,whichcanbeaccessedthroughdifferentdevices,canflexibly
supportthecontinuouseducationofhealthprofessionals,withoutinterferingintheirbusy
schedules.
Primary Care Professionals Need to Be the Patient's Trusted Coach
Primarycareprofessionals,suchasGPsandpediatricians,andcommunitycareprofessionals,
suchasfieldnursesandmidwivesshouldavoidbeingcorneredasgatekeepersandinsteadcoach
patientstotakeadvantageoftheircollaborationwithhospitalsandothercareandwellness
providers.Thiswillensurethatthemostappropriateandaffordabletreatmentisdeliveredthrough
adequatereferralswhenacuteepisodesoccur,andthatfollowupsarebuiltaroundthepatientto
2013IDCHealthInsights #IDCWP37V 15
avoidreadmission.Citiesaimingtoachievehealthierlivinghavetosupportthepivotalroleof
primarycareandenableseamless:
Sharingofmedicalinformation(prescriptions,images,videos,referrals,laboratorytests,
diagnosis,etc.)throughsolutionslikeEHR,ePrescriptionsystemsandHealthInformation
Exchangeplatforms
Collaborationwithothercareprovidersandthepatientthroughsolutionsthatinclude
secureemail,videoconferencing,instantmessaging,andapps.
Forexample,inTheHague(Netherlands)primarycareproviderFlorence
deployedacloud-basedcollaborationIntranetportalincollaborationwithMicrosoft
andRapidCircle.Thenewportalallowsstafftosecurelyaccesspersonal
mailboxesanddevelopahubtomanagecollaborativecareprojects.
Deliveryofpatient-centricservicesthroughrelationshipmanagementsolutions,supporting
followupthroughautomatedprocesses,pre-plannedreminders,andtailoredreportsand
onlineportalandappsallowthepatienttoaccesstheirdataandcareplan.
Social Services and Wider City Services Will Act on Health Inequality
Citygovernmentsocialcaredepartmentsshouldmonitorsocialdeterminantsofhealthsuchas
demographics,education,employment,housingconditions,safetyandsecurity,andgender
equality.Andtheyshouldcollaboratewithcommunityandprimarycareproviders,aswellaswith
educationinstitutions,toremoveinequalitiesthatcanimprovethehealthstatusofacity's
inhabitants,particularlyfortheelderly,mentalhealthpatients,childrenandthedisabled.ICTcan
easethebureaucraticburdenofsocialcareworkers,andconsequentlyfreeuptimeforservices
delivery.Inparticularitwillenablefastercasemanagementthrough:
SharedCRMsystems
Documentandcontentmanagementsolutions
Thesesolutionswillmanageallstructuredandunstructureddataandsupportsocialworkersin
repetitiveprocessessuchasformsandreportssubmission.Thesametechnologiesofferinga
completeviewofthecitizen'scasecan:
Streamlineclaimsmanagement,allowingfasterresponsetocitizens'expectations
Supportfrauddetectionmakingsurethattherearenoabusesandmisallocationof
resources
Alongwithsocialservices,anumberofothercityservicessuchasutilitiesmanagement(waste,
water,gas,electricity),transport,andurbanplanningwillcontributereducinghealthinequalities
providingdataonservicesusage,mobility,etc,givinginsightstofurtherdimensionsofcitizens
socialandcareneeds.
Hospital Services Use Will be Driven by Principles of Appropriateness
Hospitalsmustensuretheappropriatenessoftheirinpatientandoutpatientcareservicestoreduce
therateofreadmissionandthenumberofunnecessaryday-hospitaladmissionsandtestsfor
chronicallyillpatientsandslashwaitingtimesforpatientswithinjuriesoraffectedbypandemics.
Thefocusonappropriatetreatmentwillnotonlyimprovepatientsafety,butalsoincrease
productivity,becausehospitalswillbeabletooperatewithfewerbeds,fasterpatientturnover,and
moretimelyallocationofassets,supplies,andpeople.
2013IDCHealthInsights #IDCWP37V 16
Toachievetheseobjectives,hospitalswillhavetocollaboratecloselywithprimaryandcommunity
caretooptimizereferrals,soasnottocreatebottlenecksforthemosturgentadmissionsandto
followuponpatienttreatmentafterdischarge.Cityleadersshouldincludehospitalsincoordinated
careinitiativesandsupportinvestmentinsolutionssuchas:
EHR,eprescriptionsystems,andhealthinformationexchangeplatforms
Collaborationsuites(secureemail,videoconferencing,etc.)forcommunications,
consultationsandreferralstoprimarycareandsocialservices
EnablingCollaborationbetweenPrimary,SecondaryCareandMunicipalSocial
Services:theRegionSkane(Sweden)example:
BuildingontheexperienceofCareOptmizer(aprojectfocusedonimprovingthe
handoverandcareplanningforelderlyandfragilepatientsatthengelholm
hospital,coordinatinghospitalandmunicipalservices),RegionSkaneandthe
municipalityofngelholmstartedanambitiousandvisionaryproject,
"Hlsostaden"(HealthCity),aimedatfurtherintegratinghealthandcareservices
withinthearea.Thefirstpilotprojectwilllastforthenextthreeyearsandisaimed
atimprovingtheappropriatenessofcareservices,avoidingunnecessaryhospital
staysbyprovidingcareattherightlevelandattherighttimethroughgreater
interactionbetweenhealthcareandsocialcare,increasingtheavailabilityof
serviceandpatientsafety,whilebetterallocatingthefinancialandhuman
resourcesofthemunicipalityandcareproviders.Thecooperationwillincludethe
creationofaneworganizationwith600employees(comingfromthethree
organizations)locatedinthehospitalorinanadjacentstructurethatwillcover
someoftheregion'sactivitiesatngelholmhospitalandpartofthemunicipality's
socialservices.Servicesundertheremitofthisorganizationwillincludethose
providedby:(1)primarycareandsocialcareservices,suchastheintegrated
primarycarehealthcenter(Laxen)andtheprimarycarecallofduty(available7/7)
thecareplanningunit,theintegratedhomecareservicesandthehomevisitteam
(deliveringspecialistcare);(2)Hospitalcare,throughtheshorttermstayservices,
thedepartmentofmedicine(outpatient/inpatient)andtherehabilitation&geriatric
departments.TheprojectleadersareworkingwiththeirICTpartnersonthe
developmentofinformationsystemsthatwillintegratedocumentsandinformation
comingfromfragmentedlegacysolution.Buildingontheexperienceof
CareOptimizer,developedbyCapgeminiinpartnershipwithMicrosoft,thesystem
isexpectedtohelpautomateandstreamlineprocesses,avoidingunnecessary
duplicationofservices,easingthebureaucraticburdenofhealthstaffand
reallocatingresourcesmoreeffectively.Projectleaderswantthisprojecttobe
integratedwithnationalinfrastructuressuchasthefutureSwedishcarerecord(the
NPO)toaccompanycitizens'carepathinacompleteway.
Scenarios at the Nexus of the Health Value Chain
ThejourneytowardanoptimizedHealthierCityseesacombinationofprocess,peopleand
technologyevolvingwithcitizenexpectationsandneeds.Thefollowingsectionpresentsaseriesof
scenariosfromwhich,accordingtothecity'svisionandmission,cityleaderscanstarttheir
HealthierCitystrategy.
2013IDCHealthInsights #IDCWP37V 17
Remote Care and Case Management
Theincreasingincidenceofchronicdiseasesandtheneedsofanagingpopulationdrivecitiesand
healthcareproviderstorethinkthepointofcare;movingitawayfromthehospitalsettingtoget
closertopatients'hometomeettheirexpectationsaboutqualityofcareandalsotocontaincosts.
Theuseofmedicaldevicesandmobilesolutionspoweredbycloud-basedsharedinfrastructures
andcollaborationplatformsmakeitpossibletomovethepointofcaretothemostappropriatelevel
whetherathome,incommunitycenters,orintheworkplacewithoutaffectingthequalityofcare
andpatientsafety.Thesetechnologiesincreaseaccesstohealthcareandallowamore
autonomousandengagedparticipationofthepatientintheirhealthcarepath.Forexample,many
rehabilitationfacilitiesalreadyusetechnologiessuchasKinectandothergamingcapabilitiescan
helppatientsdophysicaltherapyorcognitiverehabilitationalsoathome.
Bycombiningmedicaldevices,mobilephones,videoconferencingtools,CRMandcontent
management,careteamscancollaborateregardlessoftheirlocationtoproviderapidand
specializedcare.
LocalaCommunityPartnershipsisasocialenterprisethatprovidescommunity
healthcareservicessuchasdistrictnursing,healthvisiting,schoolnursing,
communitydentistry,podiatry,stoppingsmokingsupportandcontinenceservices
inKirkleesinWestYorkshire(UK).Localawasoneofthefirstorganizationsinthe
UKtoestablishCommunityCareTeamsinwhichhealthandsocialcareteams
worktogethertosupportpatientswithlong-termconditionstostayintheirown
homes.Tosupportthisproject,Localaisimplementinganewhybridcloud-based
servicethatwilldelivercriticalclinicalandadministrativeinformationatthepointof
careonthemove.Thenewservice,implementedbyDell,willconnectstaffwithall
theirrequiredclinicalapplicationsaswellastheNHSN3network,MicrosoftOffice
365,andMicrosoftLync.ViatheInternet,staffwillbeabletoaccessallrelevant
patientinformation,corporatesystems,andunifiedcommunicationstools,
ensuringamoreefficient,agileworkforce.
Pandemic and Emergency Management
Migration,tourism,andinternationaltradeareexposingcities,regions,andentirenationsto
emergencyepisodes,suchasoutbreaksofinfluenzaandfoodalerts,thatrequirereactiveand
flexibleemergencyandpandemicmanagement.Localemergenciesalsomakeitimperativefor
cities,headsofhospitals,andotherdecision-makerstotakeadvantageofBigDataandanalytics
solutionsthatrapidlyhelprecord,classify,group,analyzeandvisualizeinformationrelatedto
emergencypatternsandsupportrapiddecisionmakingtoprovidetherightresourcesandprevent
recrudescenceorcomplications.Ashospitalemergencydepartmentsinthesesituationsrapidly
reachfullcapacity,itisnecessarytoempowerfieldworkersandenablingthemtoprovide
substantialcareonthespotbyprovidingthemwithmobilitysolutionsandapplicationsthattrack
incidentsandallowconsultationwithhospitalspecialiststoimmediatelyrunthetriageprocess.
Emergencyservices'logisticalrequirementsneedtobeincludedinpublictransportandmobility
plans,providingeasiermovementofcitizensandhealthprofessionalswithinthecity,therefore
intelligentsystemsregulatingtrafficflowandpublicservicesusagehavetobepartofthewider
emergencymanagementstrategy.
2013IDCHealthInsights #IDCWP37V 18
Population Health Management
Urbanhealthisnotahomogeneouslandscape.Citiesaretheplaceswherehealthcareinequalities
anddifferencesinhealthconditionsbetweendifferentsocialgroupsrichandpoor,youngand
old,menandwomen,immigrantsorlongtermresidentsareexacerbated.Cityleadersare
thereforeaskedtoimprovetheconditionsofspecificgroups.Inordertoso,abroadrangeof
informationrelatedtosocialdeterminantsneedstobedisaggregatedandanalyzedatagranular
level.Citiesneedsolutionsabletocopewithalargeamountofstructuredandunstructureddata
comingfromdifferentsourcesthatincludehospitalinformationsystemsaswellassocialmedia
andsearchengines.
LeedsTeachingHospitals,forexample,havebeenusinganewsyndromic
surveillanceproofofconceptthatcreatesastandardizedapproachtohealthcare
dataanalysistosupportemergencypreparednessandserviceplanning.The
systemwasdevelopedbyAscribe,Two10Degrees,andMicrosoft.Itconsistsofan
end-to-end,cloud-basedBigDatasolutionwithbusinessintelligencetoolsthat
analyzesLeedsA&Erecords.Leedsgeneratesuptohalfamillionrecordseach
yearandapproximatelyonemillionunstructuredcasefileseachmonththroughits
AccidentandEmergencyDepartmentsystem(Symphony).Usingthesystem,
LeedsTeachingHospitalwasabletolookatpatternsinthedatatoidentify
potentialoutbreaksofinfectiousdiseaseandeffectivenessofvaccination
programs,aswellastrendsthataretypicallymoredifficulttoanalyze,suchas
alcohol-relatedvisitstotheemergencyroomandinjuriesfromaccidentsinthe
home.Symphonyhasalsobeenoptimizedforthemobileenvironmentenabling
moreaccurateandreal-timecollectionofpatientdata.
HEALTHIER CITIES: A CALL FOR ACTION
Starting the Journey Toward the Optimized Stage
IndependentofthescenariochosentostartbuildingaHealthierCity,attheveryearlystageitis
importanttousethemodelwedescribedinthispaper,todevelopclarityofvision,acommon
language,andastrategicroadmapwithkeyleadersandinnovatorsinthecityecosystem.
Asmanyoftheissueswithcitiesarerelatedtopeople,process,andculture,itisimportanttowork
towardabalanceinmaturityacrossmeasures,sincetheinhibitorstowardfullyoptimizedbenefits
arerelatedtoslowermaturityinprocessandculture.ToprogresstowardstheoptimizedstageIDC
HealthInsightsrecommends:
Strategy:aimforasystemicvisionpoweredbydynamicmulti-stakeholdergovernance
Culture:empowercitizensandprofessionalstoengageinacollaborativeandinnovative
experience
Process:continuouslyimprovebusinessprocessconfigurationandoperationstoachieve
long-termoutcomes
Technology:harnessthepowerofthird-platformtechnologies'nexus
Data:makedataliquidandsecuretopre-emptandadapttohealthiercityneeds
2013IDCHealthInsights #IDCWP37V 19
Moreover,althougheachofthefivevariableshasitsspecificdevelopmentpatternsfromthead
hoctotheoptimizedstages(seeappendix),itwillbeimportantforcityleaderstosetspecific
timelinesinordertomaximizethebenefitoftheHealthierCityMaturityModel.Inparticular:
Now:AssessthebusinessandITHealthierCitysituation"asis".Identifyopportunitiesto
useexistingdata,technology,workers,andcitizensinnewways.Exploreopportunitiesto
experimentwithcloudandopensourceoptionsastheyemerge,includingcitizensourcing
ofappdevelopment.
Inthenextonetotwoyears(thenextbudgetcycle):Useearlyquantifiablewinsto
demonstratepotentialandjustifybudgetallocations.Assessarchitectureandskillsgaps
andplantoacquirecapabilities.Identifybusinesssponsorsandchampionsthatwill
supportandpromotescalingofHealthierCitypilotprojectstohelpdefinearchitectural
standards.Begingovernanceandperformancemanagementdiscussions;byusingaset
ofKPIsorperformancemeasurestodefinethesuccessofeachstage(forinstance,WHO
hasdevelopedUrbanHEART-UrbanHealthEquityAssessmentandResponseTool)

2013IDCHealthInsights #IDCWP37V 1
APPENDIX
TABLE 1
Evolution of the Five Dimensions in the Five Healthier City Maturity Stages
Ad Hoc Opportunistic Repeatable Managed Optimized
Strategy No strategy in place.
Population health needs
are not addressed in the
general policies of the city
Investments are focused on
discrete and scattered
areas (for instance, limited
telemonitoring projects run
by the city hospital as
research projects) with no
business case for
generalizing Healthier
Living initiatives.
City leaders do not engage
with healthcare process
stakeholders: healthcare is
still perceived as outside
the city's remit.
Strategy begins to take form at
the individual city department
level.
Healthcare needs are
analyzed and the definition
of desired outcomes
begins.
Pilot projects are
instrumental to
demonstrate ROI. Data
collected at the ad hoc
stage is formalized into
business cases and
methodologies informing
investment management
decisions, and
corroborating the business
case for a future scaling of
the solution.
City leadership starts
engaging with healthcare
stakeholders, but not in a
structured way.
Strategy begins to span the
borders of the single
department and involves
multiple organizations.
Application of a common
business cases and expand
it to new, but related,
initiatives.
City's vision with expected
outcomes is stated in
formal documentation.
Leadership and key
stakeholders invest in
projects with vision of long-
term scalability (for
example, starting
identifying possible funding
within the involved
organizations' budgets on a
case by case scenario)
Strategy involve a vast array
of players across city
administration and healthcare
providers and beyond the
public sector.
Objectives are clearly
communicated and
accepted citywide
Value for money,
developed at the
opportunistic stage and
then standardized at the
repeatable stage, is used
for benefits realization to
manage performance
against strategic objectives.
Leadership provides
dedicated budgeted funding
mechanisms.
A governance system allows
continuous evolution and
improvement of the strategy.
The leadership is engaged
into a holistic and broad
scale transformation of
processes, culture, and
operations.
Strategy evolves based on
continuous feedback
enabling a continuous
progress on KPIs against
mission-based
performance.
Healthier living objectives
are embedded within
overall city strategy
Culture No formal process to engage
those with new ideas inside or
outside healthcare related
initiatives. Pockets of
innovation exist within a risk-
averse culture (impromptu
City experiments with
citizen/patient engagement on
healthcare related initiatives
via social networks and mobile
apps as a new channel.
In this phase, the
City proactively engages
citizens through partially
personalized direct
communications.
New services enabled and
driven by the interaction of
Citizens independently engage
with the city through multiple
channels according to their
needs.
The City provides a broader
range of services in new,
City has cultivated
engagement models that are
inclusive, personalized, and
multidirectional ongoing
collaborations.
The personalization of
2013IDCHealthInsights #IDCWP37V 2
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Evolution of the Five Dimensions in the Five Healthier City Maturity Stages
Ad Hoc Opportunistic Repeatable Managed Optimized
"rogue innovators" within city
departments), with no specific
programs aimed at supporting
the work of innovators and
new entrepreneurs.
interaction with citizens is
still limited and purely
transactional.
Social media used to
increase awareness of
service availability and get
instant feedback on single
initiatives (e.g., more
advanced techniques such
as social sentiment
analysis are not in use).
Innovation is supported
through specific and time
limited initiatives, generally
at a department-level,
where city employees start
innovation initiatives agreed
with management.
citizens via mobile, sensors
and social network
interactions (for instance,
prevention campaigns
delivered via social media
integrating location based
and personalized advice or
through online gaming
activities).
Innovation culture
supported by processes
that allow risk.
New initiatives that
capitalize on 3rd platform
technologies (cloud,
mobile, Big Data, and
social media) are funded
and/or city starts providing
resources and
infrastructures to different
public and private
organizations to incubate
and test new projects.
easier, more accessible
and affordable ways,
engaging with citizens on
their terms (for example,
with health and social
services mobile apps that
are available 24x7).
The experience is
customized for every
interaction regardless of
channel. Social media is an
established channel to
reach citizens with healthier
living initiatives, and is used
as the personalized
connecting hub for an
extended variety of
services aimed at
interactively mainstreaming
healthier behavior ( such as
health education and
fitness programs delivered
through online games).
The city has established
permanent mechanisms
and infrastructures to
leverage ideas from
citizens, healthcare and
government workers, non-
profit organizations, and
business.
services and the education
activities on Healthier
Living include not only the
interactions between the
city departments and
citizens, but also, on a
voluntary basis, the
interactions that citizens
have with one another ( for
example interactions
between patients and their
families), adding a further
dimension to engagement.
Healthier living policies are
assessed and adjusted in
almost real time, leveraging
network analysis and Big
Data capabilities. Health
and social care innovation
is institutionalized and
managed within the whole
city paradigm. Innovation
policies are aimed at
involving the whole
Healthier Living value chain
(prevention, cure and care).
Impact of innovation
policies is continuously
assessed and approaches
adapted.

Process Health and care processes are
managed at single
City leaders start analyzing
citizens' specific needs and
City leaders identify key
services categories for
The various processes are
coordinated at the program
Processes are continuously
improved and re-configured
2013IDCHealthInsights #IDCWP37V 3
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department/single institution
level, budgets are siloed and
decision making is
fragmented. Where present
partnerships are managed in a
traditional one to one
relationship and have a very
limited span.
which processes support their
fulfillment. Several initiatives
are launched with ad hoc
process rationalization and
optimization.
Project base multi-
department initiatives as
well as new models of
engagement with external
partners are tested, but
shared processes, budget
and decision making still
have very limited time
span.
Typical areas where
collaboration is tested
include care of the elderly
and children. A small
number of organizations or
departments is involved in
these coordinated care
initiatives.
integration on a broader scale.
Formal committees
representing stakeholders
define and document
process needs for
optimization and
standardization.
Specific initiatives begin to
be scaled and real
integration begins. Better
use of information and the
processes in place to
respond to events drives
improved outcomes and
service delivery.
Process sustainability
through dedicated funding
models becomes a focus.
The maturity of the
relationship with partners
evolves to include benefits
sharing and co-
development of solutions.
level and integrated in the
wider city vision.
Information flows are
standardized and shared.
Collaborative processes
are a key component of
stakeholders' mission.
Accountability and
performance management
is for end-to-end
processes, not limited to
organizational units.
Program budgets cut
across departments and
multiyear planning and
budgeting for common
programs, services, and
infrastructures is in place.
Partnerships are
increasingly aligned with
the Healthier City long term
vision and multiple
stakeholders' roles are
defined and coordinated.
depending on what's needed
to achieve strategic outcomes
and their impact on the whole
city.
Decisions about processes
optimization and
reconfiguration are
outcome-driven, and no
longer driven by the single
organization logic.
People and organizational
units' participation depends
on their capabilities to
contribute to outcome, not
on their hierarchical role.
Technology The overall ICT environment
presents function and
integration gaps.
Broadband/wireless
infrastructure adoption and
use is inconsistent.
Enterprise architecture is
fragmented and transaction
between systems is based
City moves toward a broader
adoption and build-out of
wireless broadband to support
the launch of specific projects,
such as remote monitoring of
chronic patients, using
sensors, cameras, medical
and mobile devices.
The involvement of different
Collaborative tools are
integrated with the business
process applications in use.
SOA is pervasively adopted
as an open platform on
which data, business logic,
and presentation layers are
separated for more flexible
management.
Shared infrastructural and
back-office solutions create
the conditions to leverage on
common data sets and
processes.
Ubiquitous broadband
network, leveraging an
extended ecosystem of
smart devices and sensors,
A sustainable city "technology
platform" is in place. Third
platform technologies and IoT
(Internet of Things) are fully
interoperable with legacy
systems and open to new
developments such as in
BYOA, allowing agile
configuration of new
2013IDCHealthInsights #IDCWP37V 4
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Evolution of the Five Dimensions in the Five Healthier City Maturity Stages
Ad Hoc Opportunistic Repeatable Managed Optimized
on duplication.
Health and social care
professionals use
fragmented applications
supporting separate
transactional processes in
each unit.
Social media and app
usage is very limited.
organization units spurs the
adoption of collaboration
and health information
exchange platforms that
need to be available on
different devices.
Processes continue to rely
on dedicated transactional
systems, but IT
departments across the
various units start adopting
a service-oriented
architecture (SOA)
approach to enable
consolidation.
Access to information and
security policies is still
managed in isolation at
single organization level.
User-friendly interfaces and
apps are developed to
support health and social
professionals and to give
citizens involvement in their
care path.
IT decision makers embark
on datacenter
rationalization and
consolidation to support
long-term multi-
organization projects.
Data is collected and
organized to inform
performance management
across organizational units.
ID management starts to be
standardized at the
enterprise level. As the role
of mobile technology
becomes essential to
services delivery, the
adoption of comprehensive
device management
strategy becomes
paramount.
ICT departments start
exploring the opportunity
offered by cloud as they
focus on accelerating
services deployment and
on decreasing maintenance
and compliance costs.
leads to real-time dynamic
data output to support
Healthier Living services.
Datacenter harmonization
and cloud services enable
the setup of shared back-
office systems such as
ERP and CRM, allowing a
more efficient and
comprehensive allocation
of resources and
understanding of citizens'
needs.
Addressing mobility,
greater adoption of cloud
services drives IT
departments to embrace
the BYOD paradigm,
focusing more on access
and ID management.
Collaboration processes
start to leverage the inputs
from social media, although
information flux is still
mainly one-way.
collaborative processes.
Compliance with data
security and privacy
regulation is delivered
through a federated identity
management system.
Contextual information of
IoT, mobile, and social are
used to nurture two-way
collaboration between
public servants and
empowered citizens.
The enormous amount of
data produced, along with
greater standardization of
data sets and an efficient
datacenter management
drive larger adoption of Big
Data and analytics
Data analysis includes
different contexts and
purposes (public health
policy efficacy, chronic
disease management,
definition of optimal
treatment pathways, spend
management, fraud
detection, etc), contributing
to the transformation of the
city information systems
into an intuitive and
performance driven
environment.
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Evolution of the Five Dimensions in the Five Healthier City Maturity Stages
Ad Hoc Opportunistic Repeatable Managed Optimized
Data Data is underutilized and
housed in disparate systems
with proprietary specifications
that limit information exchange
capabilities.
The secondary use of
citizens' health data is
limited to a specific data set
and for very specific
initiatives.
Access to and use of data
is limited to single
organizations because of
issues with data integrity,
privacy/security and
integration.
The city's stakeholders start to
address data integrity and
data interoperability as
collaboration and Big Data and
advanced analytics projects
are launched.
Some data sets are opened
to public. Data becomes
more widely shared across
departments, although
sharing is limited to single
initiatives.
At this stage, whether they
are technically solid or not,
many data and analytics IT-
led projects will lack a
connection to business
goals, and a continued lack
of sufficient IT and
business collaboration will
lead to slow adoption of
solutions and difficulty in
securing additional rounds
of project funding.
City's stakeholders start to
develop a more integrated
approach to data
management.
Progress is made in
accuracy and semantic
consistency as datacenter
rationalization initiatives are
launched and
interoperability standards
become an almost
mandatory element in the
selection of line of business
solutions.
Formal systems for data
flow between different
organizations are set up.
Data use is focused on
maintaining quality for Big
Data and analytics use
cases, that are increasingly
led by business leaders
rather than IT departments.
Open data becomes
strategic to start leveraging
skills and ideas from many
organizations and citizens'
community groups.
Data is used to provide
actionable information to
further Healthier City goals.
The shift toward a
performance management
model based on outcomes
puts advanced data
analysis in the spotlight.
Data is produced and
available in open and
standard formats, enabling
M2M communication and
fully operational data
sharing among
organizations and
individuals inside and
outside of the public sector
health and care providers.
Context aware data access
and use enable greater
personalization of cure and
care services.
Rules on data security,
privacy and analytic
governance standards are
accepted and shared by the
extended Healthier City
environment.
Data is used for predictive
models for improved services.
Information is ubiquitous,
open, and personalized.
The availability of data in
real-time combined with
analytical capabilities and
shared business processes
enables city leaders to
predict most of the needs of
their residents and provide
preventative services
before problems arise.
Real-time data is displayed
using dashboards, GIS,
and other visualization tools
for improved decision
making, allowing faster
response for non
predictable events.
Big Data and analytics help
city's decision makers to
prevent inefficiencies and
adapt workflows for
improved outcomes.
Citizens use data to make
more informed choices
about their health, to
manage their care path in
coordination with care
services providers.
Source:IDCHealthInsights2013

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