Medicine2.0'10: Business Modelling to advance the development and implementation of eHealth...

Business Modelling to advance the development and implementation of eHealth technologies

Maarten van Limburg, MSc, BEngElly Kloeze, MSc

30 November 2010, Maastricht

06/12/2010Business Modelling in eHealth 2

MAARTEN VAN LIMBURG, MSC, BENG

Background in Business IT and Innovation Management

MSc project: Business model for a Dutch PHR service

PhD Student: “eHealth Business Modelling” Eursafety Health-net project


IN THIS TALK

Why the implementation requires attention Explanation on business models and business modelling Why business modelling in eHealth Introduction of CeHRes Roadmap

Example case: Business Modelling for a teledermatology project

Current projects and future research

More focus on how to improve eHealth technologies

User-/Human-Centered Design Involving the users of the technology Improving usability eHealth technologies reflect users needs and behaviour better Persuasive technology

06/12/2010 4

IMPROVING eHEALTH TECHNOLOGIES

Business Modelling in eHealth

06/12/2010 5

IMPLEMENTATION OF eHEALTH TECHNOLOGIES

Implementation of eHealth technologies still problematic: eHealth technologies don’t catch on in practice Lacking support from insurance companies, health professionals, etc No self-sustaining revenue model Fragmented – difficult to scale up Too technology-driven


06/12/2010 6

STAKEHOLDERS

There are a lot more parties involved than just users For the implementation the stakeholders are relevant

- health insurance companies- healthcare organizations- healthcare professionals- government- ...


06/12/2010 7

STAKEHOLDERS

Stakeholders aren’t neccesarily users of the technology “Anyone who affects or gets affected by the technology” (Freeman)

Stakeholder types: policymakers, vendors, insurers, healthcare organizations and providers, home care, employers and patients (Cain)

Every eHealth technology will have its own, specific stakeholder network(sometimes also refered to as ecosystem)


06/12/2010 8

STAKEHOLDERS EXPECT VALUE

Stakeholders expect certain benefits in return for participating in the eHealth technology. “one good turn deserves another” (Proverb) Something valuable

How can we make the implementation value-driven?


06/12/2010 9

BUSINESS MODELS

“a business model is the rationale of how an organization creates, delivers and captures value” (Osterwalder)

Used in strategic management to assess innovations Basis for implementing an eHealth technology: Assessing the implementation a priori Guideline for operationalizing the technology in practice


06/12/2010 10

COMPOSING A BUSINESS MODEL: CANVAS


06/12/2010 11

BUSINESS MODELLING

Involving stakeholders in composing the business model, they need to accept the implementation after all. Discovering what value they want Consensus, finding a fit (HOT-fit) Co-creation Continuous process



SO WHY BUSINESS MODELLING IN EHEALTH?

As said, it can help the implementation: Sustainability Cost-effectiveness

Holistic approach Value-driven Co-creation and collaboration Flexible and reflective


DEVELOPING IS IMPLEMENTING

Makes the whole development process value-driven If stakeholders find something valuable, make it, implement it And if they don’t, don’t!

Implementation influences development Development influences implementation

The environment determines, not only one party (outside-in)


DEALING WITH MULTIDISCIPLINARITY

eHealth is multidisciplinary (Pagliari) Brings different types of stakeholders together Diverse values “Value” can act as a common ground: # of patients $$$ Quality

Work to a consensus or fit


STAKEHOLDER NETWORK BECOMES A PLATFORM

Multidisciplinary nature means that collaboration is important

Getting the group who need to eventually collaboration together whilstimplementing If it doesn’t work now, it won’t work later either Finding the context of the problem


OPENNESS

Collaboration requires openness Open business models (Chesbrough) Disease Management -> Organizational barriers fade

Willingness to co-create Using standards

Avoid problems from fragmentation


FLEXIBILITY AND EVALUATION

Formative evaluation A business model grows: Discovery driven (McGrath) Evaluate assumptions

Environment is dynamic

Summative evaluation Technologies and implementations aren’t forever Still feasible/sustainable/cost-effective? Or re-design?


CEHRES ROADMAP


CEHRES ROADMAP - INSTRUMENTS


BUSINESS MODELLING INSTRUMENTS


ELLY KLOEZE, MSC

Background in Health Science & Policy

MSc project: Business model for a Teledermatology project

Researcher on business modelling for diabetic foot care and Pal4.


EXAMPLE CASE: Teledermatology

Using CeHRes Roadmap for a teledermatology (TD) eHealth technology Tele-diagnostic device chronic wounds Automated diagnosis Wound evolvement

Problem identification

Stakeholder-mapping

Stakeholder analysis

Values

Functional requirements

Design requirements

Technical feasibility

Scenarios Infrastructure wound care

Business model

CONTEXTUAL INQUIRY

First indication stakeholders Focus group

Problem statement (step 1) General solutions (step 2) Contribution of technology (step 3)

Business Modelling in eHealth 06/12/2010 23

VALUE SPECIFICATION

Definitive stakeholders project Stakeholder interviews (n=11): Determine values A value = “something that is beneficially and desirable for a

stakeholder.” Determine attributes (how to realize values?) and requirements

(specification of attributes) Rank the values, attributes and requirements (1-5)


ATTRIBUTES & REQUIREMENTS

Example of scored attributes and requirements

Nine overview schemes per stakeholder

Program of functional stakeholder requirements

25Business Modelling in eHealth 06/12/2010

ATTRIBUTES & REQUIREMENTS

Example of scored attributes and requirements

Nine overview schemes per stakeholder

Program of functional stakeholder requirements


Functional requirements

27

high performance quality camera and technical system

objectifying shape, surface, depth, color, total size under leg, temperature, wound edge conditions

providing images

involve patient by technique and results

sharing a portal between health care providers

more alignment chain of care

transparency and uniformity of communication

financial support

integration with wound score sheets

store history and additional disorders patient

work on behalf of standard protocol

Business Modelling in eHealth 06/12/2010

DESIGN

More specific information about the characteristics of the design and format of the TD device Examples: handy, disinfection option, stand alone device etc.

Match stakeholder requirements with technical requirements


OPERATIONALIZATION

Different scenarios: Role of the TD service provider Scenario 1: the General Practioner (GP) takes an image of the wound

and sends the image to the dermatologist Scenario 2: the home care nurse takes an image of the wound and

send the image to the GP

Interaction networks Who pays for which service? Who benefits? Who have a contract with

whom?


WHICH SCENARIO SUITS BEST?

Validation of the interactionnetworks: Different stakeholders Brainstorm session technology

provider TD device Scenario 2 is preferable: the economics of scale wound care structure

improves: nice tool for communication


BUSINESS MODEL FOR SCENARIO


BUSINESS MODEL FOR SCENARIO

How technology fits inbusiness model of partner(Openness)


SUMMATIVE EVALUATION

Can take place after the TD device is deployed

Test first prototype in clinical setting Test advanced prototype Results unknown for now Robustness roadmap Reflect on participatory development process Cost effectiveness


CURRENT PROJECTS AND FUTURE RESEARCH

Different case settings: Eursafety Health-net Personal Assistant for life (PAL4) Diabetes Interactive Education Program (DIEP)

Refine and test roadmap, improve robustness

Added value for the development of eHealth technologies


THANK YOU

E-mail : [email protected]: [email protected]

www : www.ehealthresearchcenter.org


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