As technologies penetrate our entire society, they profoundly change our worldview and our individual and collective behavior. This is particularly true in the field of health in the broad sense, including but not limited to medicine. While our awareness of these technologies’ contributions to our lives and knowledge is acute, their financing is beginning to pose a problem because our economy is in crisis.

To support older adults with age-related or chronic diseases living in the community, suppliers are increasingly turning to Personal Health Systems (PHS) for remote care delivery. Despite the advantages of PHS, implementing these systems brings on several challenges on the technical level, but also related to the diversity of end-users, the characteristics of the ecosystem, the innovation process itself, regulatory and social aspects. To discuss these issues, we study two different PHS currently under implementation and deployment by two French companies: a telehealth service for frail older adults living at home and a GPS-based monitoring service to deal with wandering and disorientation of persons with dementia. We describe and compare problematic situations faced by these companies on three levels - demand, supply, and context- and explain why they decided to evolve towards a Living Lab approach to improve technology acceptance and social and economic return on investment.

Designing new technological products or services for improving health care raises many challenges today, namely improving the innovative care process, bringing health actors to develop new value propositions and reconciling the logic of business and the logic of social economy around health. The health ecosystem is not the only sector in which such an issue emerges. Indeed, the question of the management of an industrial ecosystem arises today in many sectors seeking a renewal of their capabilities for innovation. In such situations, empirical and theoretical studies show the emergence of new actors—innovation intermediaries—who aim to influence the innovation process. Recently, scholars have enriched the description of the diversification of the role of such actors, showing how those actors can take a more active role within the innovation process. Our goal in this paper is to examine the role that Living Labs can play in the health ecosystem as architects of the unknown, i.e., innovation intermediaries acting to improve the innovation capabilities of other stakeholders. Building on both a description of the contemporary stakes of innovating in the health ecosystem and the literature on innovation intermediaries, we examine a case study in the Rhône-Alpes region in France in which we show how structures like Living Labs can act as architects to stimulate innovation and to help new concepts to emerge. This article therefore contributes to deepen the emerging stream of research that studies the concept of Living Labs and enriches our understanding of the activities that innovation intermediaries can undertake within the health ecosystem.

Many technology-based products and services have proven to be successful in supporting older adults with cognitive disorders in regard to health and social care, safety, and independent living. However, several barriers to effective design, assessment and provision of assistive technologies in this context have been identified over the last years (e.g., technology acceptance and usability issues, methodological limitations in the assessment process, difficulties to balance the interests of different stakeholders, fragmentation in the field, lack of appropriate models for including assistive technology in global care plans). These barriers are associated either to micro-level factors, pertaining to the individual user, or to macro-level factors, related to a variety of stakeholders and the socio-economic, organizational and infrastructural characStudia Informatica Universalis. Contribution of the Living Lab approach... 35 teristics of the ecosystem. This paper discusses how Living Labs in the sector of healthcare, by promoting user-centered approaches, open-innovation, multi-stakeholder alliances and real-life experimentations, offer the infrastructure, knowledge, services and flexibility to address these issues. After summarizing main barriers to the use of assistive technology by older adults with cognitive disorders, we provide a general description the Living Lab concept and some examples of related national and regional initiatives. Then, we present LUSAGE, a French Living Lab engaged in the design, assessment and deployment of assistive technology solutions for older adults with cognitive impairment, such as Alzheimer’s disease and related dementias. LUSAGE’s scope and activities are described in terms of the identification of micro and macro level factors that influence AT development, assessment and provision in this context. Finally, we suggest some promising directions for further development of Living Labs in the field of aging and independent living.