the digital transformation in healthcare services is...

THE DIGITAL TRANSFORMATION IN

HEALTHCARE SERVICES IS

CHALLENGING NEW BUSINESS MODELS

Luís Velez Lapão, PhD, MSc

15th June 2016

Environmental

Data

Life Signals

INTEGRATED HEALTHCARE RECORDS

Biosensors

Genomic data

Biochips

DIGITAL TECHLOGY IS PUSHING HEALTHCARE...EUROPEAN COMMISSION STRATEGY IS BASED ON AN INTEGRATED NETWORK

OF SENSORS AND INFORMATION SYSTEMS

NEW EQUIPMENTS ARE ARRIVING… AND THEY ARE LEVERAGING THE CAPACITIES OF HEALTH PROFESSIONALS

LV Lapão 2014

…Professionals are also

changing behaviour

THE EFFECT OF DIGITALIZATION IN HEALTHCAREBudget limitations and the lack of a proper business-models are primary

reasons for unsuccessful implementation

For many decades most telemedicine/eHealth projects were mainly deployed

as pilot/research programs.

Although the hype and the proven fact that it adds both clinical and economic

value, the reality is that most cases did not reach routine-care, i.e.

transformation. Several reasons are recognized as being responsible for

that. Budget limitations and the lack of a proper business-models are

the primary.

The Momentum project, a thematic-network partially funded by the

European-Commission, coordinated by EHTEL, and with the involvement of

EHMA, has addressed this problem.

There is a need to developed new

business-models that better address the

digital transformation challenges of today.

Digital Technologies

Management/PatientKnowledge

Health Professionals’

Skills

SOCIETY CHANGE

HEALTHCARE SERVICES DIGITAL TRANSFORMATION

LV Lapão 2015

TELEMEDICINE’S WAVES OF DEVELOPMENT

First Wave Second Wave Third Wave

Timeframe

Emphasis

Scope

Nature

60’s-70’sEarly 90’sto present

Coming

decade

FeasibilityClinical

DevelopmentServices

Integration

Very limitedFringe

populationsMainstream

Care Delivery

Video links + Instrumentation + Informatics

&

Business Models

Product centred model…

…Patient centred model

HEALTHCARE SERVICES: PARADIGM CHANGE

mHEALTH MARKET IN 2015: 500 MILLION PEOPLE ARE

USING HEALTHCARE SMARTPHONE APPLICATIONS

AAL HEALTHCARE SERVICES MODEL

- Socio-Technological Systems

PEOPLE/CHRONIC PATIENTS

… Other Channels

Sensors 2.0

Interactions/Usability

Cloud

Automatic

Systems

Operador,

Nurse

Physicians

Service Management: QoS & SLA

Health Managers

Service Organization

Sales/Marketing/Financing/Cost Modelling

- Home assessment

& installation

- Help desk

(different clients)

Health Units

- IT Support &

Management

- Maintenance

- HR Qualifications

- Services Integration

- EHR Integration

- Services

Organization

- Clinical Governance

THE PROJECT “MOMENTUM”

A CIP ICT-PSP thematic network

Running from February 2012 until January 2015

The consortium: 21 organisations

Telemedicine associations / competence centres from

Denmark, United Kingdom, Estonia, Norway, Spain, France,

Sweden, Germany, Greece, Poland, Portugal and Switzerland

European stakeholder associations representing

Health professionals and health care organisations, health

insurers, technology vendors

A growing network of partners

15

16

BUSINESS MODELS AND ORGANIZATION ARE KEY GO

FROM PILOT TO ROUTINE CARE …

A European Telemedicine

deployment Blueprint

THE CHALLENGE FOR DEVELOPING

eHEALTH AND TELEMEDICINE SERVICES

This is about changing from

Data to services

Data collection to data integration in processes

Tools to process redesign / new care pathways

If not, then one get the equation:

New Technology + Old System = New Old System

17

TOOLS AND METHODS ARE REQUIRED FOR

DEPLOYING SERVICES

Impact assessment framework

The results and lessons learned from Renewing Health

The approach of United4Health and Engaged

Guidelines for large scale deployment

The blueprint of Momentum

Business development tool kit

Innovation Governance

…18

MOMENTUM STUDY DIMENSIONS

Strategy

& Management

Legal,

Regulatory&

Security

Organisation &

Change Mgmt.

Technical

&

Market relations

CRITICAL SUCCESS FACTORS

CRITICAL SUCCESS FACTORS FOR

DEPLOYMENT STRATEGYStrategy

& Management

Legal,

Regulatory&

Security

Organisation &

Change Mgmt.

Technical

&

Market relations

21

1. Ensure leadership through a champion.

2. Create a community consensus on the

compelling need to address.

3. Define & Develop Business Model and Plan.

4. Put together the resources needed for

deployment.

CRITICAL SUCCESS FACTORS FOR

ORGANIZATIONAL CHANGE

5. Involve health care professionals and decision-

makers.

6. Involve patients: “Patient at the centre of the

service”.

7. Prepare and implement a change management plan.

Strategy

& Management

Legal,

Regulatory&

Security

Organisation &

Change Mgmt.

Technical

&

Market relations

22

Strategy

& Management

Legal,

Regulatory&

Security

Organisation &

Change Mgmt.

Technical

&

Market relations

CRITICAL SUCCESS FACTORS FOR LEGAL,

REGULATORY AND SECURITY COMPLIANCE

8. Establish the conditions under which the service

is legal, ethical, privacy and security experts.

9. Seek for relevant legal and security operational

guidelines to help setting the service up

23

Strategy

& Management

Legal,

Regulatory&

Security

Organisation &

Change Mgmt.

Technical

&

Market relations

CRITICAL SUCCESS FACTORS FOR

TECHNOLOGY DECISIONS AND PROCUREMENT

10. Ensure that the IT and eHealth infrastructures

needed are in place;

11. Ensure that the technology is user-friendly,

using processes required to monitor the service.

12. Guarantee that the technology has the potential

for scale-up (i.e., “think big”), maintaining good

procurement practices.

24

• Business plan will help to define clearly the TM service objectives and value for each stakeholder.

- All the costs are also analyzed and a cost-benefit analysis is done to check for the validity of the investment required;

- Additionally a timetable is defined and validated by all stakeholders (including patients and health professionals);

HYPOTHESIS:

PREPARE AND IMPLEMENT A BUSINESS PLAN

IS THE MOST SIGNIFICANT CRITICAL SUCCESS

FACTOR FOR TELEMEDICINE TO GO

FROM PILOT TO ROUTINE CARE

26

CHARACTERISTICS OF A BUSINESS PLAN

Written business plan describes:

new telemedicine service (access, information flow,

people required, patients, etc.),

business model (resources used, payments, incentives,

service levels, etc.),

Competition analysis,

projections and milestones, and

analysis of the market

Engage health professionals, managers, technicians,

and patients (e.g., testing usability and validating

requirements)

28

BUSINESS PLAN: What is It?

• Still many AAL/telemedicine ventures fail to grow beyond the initial

pilot stage.

• It is important to study the business models of successful telemedicine

ventures can help develop business strategies for upcoming ventures.

• We use Osterwalder's "Business Model Canvas” to describe business

models.

• The business models can be compared to draw inferences and

lessons regarding their business strategy and contextual factors that

influenced it.

• A business strategy is clearly necessary for the development of the

next generation of AAL/telemedicine ventures to be economically

sustainable and to successfully address local healthcare challenges.

AAL/TELEMEDICINE BUSINESS MODELS

Business Model Canvas

THE MOST FREQUENT AAL/TELEMEDICINE

FAILURE REASONS WERE IDENTIFIED

• Lack of clear objectives (confusion between services and

technology);

• Lack of leadership and coordination;

• Lack of proper business and service training;

• Lack of business models (benefits estimation, incentives,

reimbursing schema, etc.);

• Lack of integration with the routine services.

Additionally, it was found that this is both a private and public

health services phenomenon, as it is an European problem.

• From the successful cases analysed there are mainly two

different situations:

• the TM services is the continuity of previous services: only using

TM to extend it, like radiology/haemodialysis; or,

• TM services is integrated in healthcare networks simply

assumed as beneficial. The existence of a business plan or

reimbursing schemes supporting the decisions are rare;

• Most of the TM project coordinators believe in their “non-

existent” business-models, probably feeling that with

more time and experience an “innovative business-model”

will emerge

HOWEVER, I ALSO FOUND SOME MISSLEADING

INTERPRETATIONS OF THE REALITY

MOMENTUM HAVE SHOWN THE IMPORTANCE OF

MANAGEMENT, LEADERSHIP AND BUSINESS MODELS

IN THE DEVELOPMENT OF TELEMEDICINE SERVICES

- However, are we sure to have the managers with the

right skills to address the challenges of launching

TM services?

- Are business-models incorporating real value?

- How can TM make it possible?

Discussion

IN CONCLUSION

• We are learning a lot about telemedicine deployment from the information collected through questionnaires and from the stakeholder groups

• But we still lack more information to know if the highlights are correct

• The MOMENTUM Blueprint will not be the solution that truly escalates telemedicine deployment, but the MOMENTUM blueprint will be a…

valuable contribution and tool to maximise the current “momentum” for telemedicine deployment in Europe.

35

Strategy

& Manageme

nt

Legal,

Regulatory&

Security

Organisation &

Change Mgmt.

Technical

&

Market relations

Thank you!

Obrigado!

luis.lapao@ihmt.unl.pt

WHO Collaborating Center for Health Workforce, Policy and PlanningInstituto de Higiene e Medicina Tropical

Universidade Nova de Lisboa