The HSMonitor consortium brings together leading healthcare providers (ministries of health, hospitals and healthcare centres) from four countries – Italy, Turkey, Sweden and Croatia. Together they want to procure, or to buy, innovative solutions for hypertension management. They have looked at available solutions on the market and decided that they do not meet their needs. This is why the HSMonitor procurers are investing money, with the support of the European Commission, in further Research and Development (R&D) so that new solutions are developed which address the procurers’ needs. The procurers do not develop the solutions on their own, but seek to partner with leading developers from Europe – suppliers.

In the spirit of the European Union, innovation should be shared as widely as possible. Many EC funding instruments require a minimum number of participants from different EU Member States to apply together. In addition, the healthcare sector is not as consolidated and as centrally coordinated across Member States as, for example, the financial sector. Different Member States have different healthcare systems, rules and approaches. Developing solutions which, from the start, are applicable to multiple healthcare systems is therefore very beneficial for the suppliers, as their solutions can be used in different national markets. For the procurers, joining forces in international procurement means that they become more attractive to European suppliers and will receive a bigger variety of potential solutions to chose from. The procurers will also dictate the approach, instead of letting large healthcare enterprises offer them a ready solution which is not tailored to their expectations.

Hypertension, or having high blood pressure, is a very common long-term condition. Up to one third of the EU adult population has hypertension. It is a major risk factor for coronary artery disease, stroke, heart failure, atrial fibrillation, etc. At the same time, most hypertension cases are detected late, because hypertension can present no or few symptoms, thus contributing to low awareness among the population. This has led to hypertension being referred to as the “silent killer”.

The HSMonitor partners are looking to improve the prevention and management of hypertension. Using Information and Communication Technology (ICT), new solutions can be more effective in supporting citizens, patients and healthcare professionals and reduce the burden of hypertension and its complications.

HSMonitor is a pre-commercial procurement project, which is a type of project that involves the procurement of solutions from multiple suppliers in competitive phases. Because suppliers are developing solutions which do not currently exist, the procurers do not want to have just one winning solution, because the supplier of that solution will have a monopoly. Through competitive PCP phases, procurers ensure that different innovative ideas are developed, leading to at least two solutions in the final phase.

Based on their needs, the HSMonitor procurers have defined a challenge for the suppliers, by specifying the scope and ambition of the types of solutions they wish to procure. They, however, have not defined every single detail of the envisaged solutions, but have rather focused on what the solutions should be able to do. How it should be achieved (technically, organisationally) is not always specified, leaving suppliers room to propose innovative approaches. This results in solutions being developed by the suppliers, which have a common goal, but may look very differently, each having pros and cons. Between the phases, the offers are evaluated based on the new results of the last phase, and the best suppliers’ offers are selected to proceed to the next phase.

The HSMonitor project is organised into the following project phases:

• Phase 0: Curiosity driven research. In this phase the procurers work on defining the challenge and scope of the procurement. They use their experts to do this, but also carry out public dialogue with potential suppliers (Open Market Consultations) to ensure that their vision is informed by the latest developments on the market, that it is realistic within the envisaged timeframe of the project, and that there is enough interest from potential suppliers to ensure a competitive process.
• Call for tenders: in this phase the procurers launch a world-wide call for suppliers to submit offers that can address the challenge. The offers are assessed by the procurers, and the suppliers of the best ideas are selected to proceed to phase I. Suppliers can be individual organisations or a group of organisations (consortia).
• Phase I: Solution designs. In this phase the selected suppliers develop their ideas further based on the input of the procurers’ evaluation of the call for tenders. In HSMonitor seven suppliers are taking part in this phase.
• Phase II: Prototype development. In this phase the selected suppliers move from concepts to developing prototypes which are tested with end users (patients and healthcare professionals). In HSMonitor it is expected that up to three suppliers take part in this phase.
• Phase III: Original development of limited volume of first products/services. In this phase the suppliers perform pilot testing: a small-scale continuous testing of their solutions over several months. The end users receive all the necessary equipment needed for the solutions to work (e.g., a smartwatch, an app). Certain clinical and non-clinical parameters are monitored throughout the pilot to be able to assess whether the solutions are effective. In HSMonitor it is expected that up to two suppliers take part in this phase.

The HSMonitor procurers know that in order to improve hypertension management, the end users need to be empowered to do so. For citizens and patients, this means giving them appropriate tools and knowledge to be aware of hypertension, the risks it carries, and how to best address it early on. For healthcare professionals, this includes giving them the right information at the right time in order for them to make the best decisions regarding treatment options for their patients.

The HSMonitor procures have involved end from the start of the project. End user representatives from each procurer were surveyed about their expectations and needs from the future solutions, which helped inform the procurers’ challenge definition and scope. End users will be involved in the subsequent phases, e.g., to test and provide feedback on the prototype solutions in phase II, and to fully test the mature solutions for an extended period in phase III.

Any change, even for the better, involves uncertainty and hesitation, which is why the HSMonitor project has a change management work strand at its core to ensure that end users are continuously informed about the developments in the project and encouraged to participate in the various phases, by providing input, feedback and advice.

The HSMonitor project is expected to result in at least two solutions for hypertension being fully developed and close to the market, which have been tested with real end users and assessed for clinical and non-clinical benefits. The piloting with use healthcare facilities of the procurers (hospitals, healthcare centres), which will recruit more than 300 end users.  The results of the piloting will be assessed, helping the procurers to make a decision about which solution shows better results and can be scaled up beyond a pilot. The suppliers of the solutions will have developed solutions which fully meet the requirements of their procurer clients, making for attractive markets which suppliers can enter and starting discussions about large scale-up activities.