This short report on Test Beds in health care in the United States, Canada and Japan has been commissioned by VINNOVA and in turn relates to a commission from the Swedish government to VINNOVA. The purpose of the report has been to describe any national strategies relating to test beds in health care as well as to describe good examples.

National strategies for promoting the creation of test beds in  health care have not been found neither in Canada nor the United States,  and the term is not commonly used. However, test beds  with  the definition used for this study;  A test bed is a physical or virtual environment where companies in cooperation with stakeholders in health care can test, develop and introduce new products, services, processes, organizational solutions and business models,  exist in both countries and are often supported by national or federal funding programs. Clearly, academia plays central roles in most of the initiatives found.

In the United Stated, the Agency for Healthcare Research and Quality (AHRQ) as well as the National Institutes of Health (NIH)  are important for test beds, in particular through their funding programs. In the case of NIH, which consists of 27 individual institutes and centers, the National Center for Research Resources (NCRR) is of particular importance through  its funding of grants and infrastructure to support clinical and translational research.  Furthermore, the newly formed National Center for Advancing Translational Sciences (NCATS) will most likely play a central role in the future. However, it is not only the biomedically and health care oriented agencies that are important for test beds in health care. One important example is the i6 Challenge Competition led by the Department of Commerce (DOC) and its Economic Development Administration (EDA). The  i6 Challenge was designed to stimulate innovative new ideas that will accelerate technology commercialization in the United States.

In Canada, Industry Canada (IC-the commerce department), as well as agencies such as the Canadian Institute of Health Research (CIHR), the Canadian Agency for Drugs and Technologies in Health (CADTH) and some other research councils play central roles in supporting test beds. A number of funding schemes are available that could be used by test bed initiatives.

The study has identified a number of different types of test beds of which most are nonprofit organizations while others are more commercially oriented. In Canada, all examples described are non-profit organizations that to various degrees are federally funded. In the United States, more diverse examples were found. It should, however, be kept in mind while reading this report that the available time for the project has not allowed a thorough mapping of all existing initiatives.

Interestingly, all but one of the test beds in this report  have academic components no matter if  they are motivated by commercial or research interests. Furthermore, all the studied initiatives are in some way discipline- or purpose-oriented. While some are directed towards the testing of physical infrastructure, others  involve  services for the elderly, advanced medical technologies, hospital/care services or biotherapeutics. For many of the test beds, a connection to a hospital is considered to be crucial for operations.

In the more academically motivated cases, the business models are often somewhat unclear and research interests are frequently mentioned as a driver of the activities. Even in cases where companies or other organizations are charged for services the test beds depend on public funds. In addition, the test beds are often not interested in pursuing the intellectual property (IP). The more commercially oriented examples have  more clearly defined business models. In the case of the Pfizer/Academic Medical Centers (AMC) test bed, the major driving force is to commercialize research results from the AMCs and to accelerate the development pipeline. At Kaiser Permanente´s Garfield Health Care Innovation Center real-world scenarios and  activities are used to innovate and examine many aspects  of delivering health care.

During this short project, we have not been able to find any test bed initiatives for health care in Japan adhering to the definition used. However, innovation for the elderly is clearly important in the country which has one of the largest proportions of elderly citizens in the world. Although test beds have not been found, there are a number of different initiatives relating to health care including the building of communities for the elderly and various research programs. Life Science research and innovation including translation of research results to the clinic is in focus in Japan. Clinical trials take a very long time in Japan and are costly. Therefore efforts are underway to remedy the situation.

For the development of a future Swedish test bed system, the above initiatives are of interest as examples of how various types of test beds may function and be funded. Three identified success factors appear  to be; the proximity to a hospital and/or other care providers, the formation of academic-private partnerships and that each test bed focuses on a specific service or type of service, often within  a  technological or therapeutic area. However, a more comprehensive mapping of test beds in the United States and Canada would be of interest  as well as an in-depth study of the effects  of test beds on its “customers”.