ict in healthcare delivery a multi dimensional business model er swamil patni,dr. arpita

8/3/2019 ICT in Healthcare Delivery a Multi Dimensional Business Model Er Swamil Patni,Dr. Arpita

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ICT in Healthcare delivery a multi dimensional Business Model Analysis

Er. Swamil Patni

Health Information Technology

Institute of Healthcare Management

Research

Delhi, India

[email protected]

Dr. Arpita

Hospital Management

Institute of Healthcare Management

Research

Delhi, India

[email protected]

AbstractAs we all know that in of-late world

prevalence of various diseases is mushrooming

due to various reasons. Also people are getting on

heels in their day to day activities as they dont

have enough time to be in pink of their health.

Therefore, a need arises of the trained physicians

throughout the society, which has become

paucity. In order to find solution to such problems

we have tried to design a business model using

ICT as a support system to assist patients and help

physicians to treat them in best possible way and

save time too. In this model we have used m-

health as well as e-health basics along with

telemedicine to provide quality care to the patients

while keeping in mind their concerns like properand timely care, personal information security etc.

This is a multidimensional model in which there

is use of applications like Health Information

System, Cloud computing, Computerized Patient

Record etc. Also it can be expanded or

compressed according to organization

requirements and can also be used in accordance

with the already existing methods of care via ICT

that the organizations are currently using. We can

also workout on the financial matters according to

the financial condition of the organization.

Keywords- m-health, e-health, telemedicine,

Health Information System, Cloud Computing,

Computerized Patient Record

I. INTRODUCTIONAs we all know that Transforming Healthcare

via ICT needs involvement of multiple

stakeholders (Figure-1) that enables or oversees

the business and legal issues involved in the

maintenance, exchange and use of health

information, in a secure manner, for the purpose of

promoting the improvement of healthcare delivery


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which helps to maintain better health quality,

safety and efficiency.

Over the past few years many initiatives have

cropped up attracting large number of public and

private funding, but unfortunately ,there is no such

sustainable model seen or designed which can be

universally applied to entire Healthcare Industry as

yet. Recently, the healthcare industry has shown a

paradigm shift and hence there is further evolution

of e-health business model (Figure-2).

The health care industrys ability to enable tele-

health and tele-medicine via health information

systems interconnectivity and interoperability that

telecommunication offers, the potential to

transform the health care market place through

increased communication and collaboration,

improved care quality, will provide timely care

and reduced medical errors, operational

inefficiencies and duplicate services.

Figure-1:- Health Industry main stake holders

Figure-2:- Evolution of e-Health Business Model

We have tried to design such a model

which could be universally applied in the entire

healthcare system and this model has been

analysed on the basis of Health Information

Exchange (HIE) Business Models as produced by

the Deloitte Centre for Health Solutions. We all

are aware of the fact that Information and

Communication Technology (ICT) is making a

deep impact in our healthcare delivery system, few

examples where ICT is working successfully are

Electronic Health Record, Telemedicine, e-

prescribing, push services, radiology images etc;.

It is expected that each community will explore

the different types of health ICT business models

and pick the one(s) that offers them maximum

benefit, returns and easy sustainability.

Figure-3:Health-ICT business model


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The following four general categories of emerging

Health-ICT business model demand attention are:-

Non-Profit The non-profit Health

organizations are driven by their charter to help

the community and the patients. They will be

benefited by standardizing their healthcare

services via ICT. This model can facilitate them

in achieving their objective.

Public Utility This Health-ICT model can

prove very handy as a public utility kit too, it

will help government and other such public

organizations to create and maintain universal

health records and provide basic healthcare

facilities at the doorsteps even in remote

locations. This will help them to achieve their

motive of providing basic healthcare at cheaper

rates and at door steps.

Physician and Payer Collaborative This

Health-ICT model is created for/by allphysicians and payers, so that they can

provide/access healthcare records and services

irrespective of their location. These collaborative

can be either for-profit or not-for-profit purposes

or as Public Private Partnership (PPP); however,

the key to this collaboration between

participating payers and physicians is their

mutual benefits.

For-Profit This Health ICT model is created

in such a manner that even those organizations

whose objective is to make profit can invest in it

and they will have good Return on their

investments (ROI). These organizations look to

reap financial benefits from their transactions

and have solid start-up funding.

Fig-4:-Health-ICT governance and characteristics

explanation

Evaluating Health-ICT Business Models

Understanding the governance and

operational characteristics that drive creation of

Health-ICT is an important first step to identifying

a sustainable business model. These characteristics

can be grouped into four categories: Value of Services A Health-ICT model is

motivated by the perceived value of the services

that it anticipates to provide to its consumers. All

benefits may not be tangible; however, it will

provide value.

Governance A Health-ICT models

organizational and hierarchical composition sets

governance and defines policies and processes.

Architectural A Health-ICT model is

structured around the business and technical

architecture that facilitates Healthcare operations


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via ICT, as well as provide basic healthcare

facilities that healthcare service seekers need.

FinancialA Health-ICT model is driven by the

financial agreements that generate its revenue

stream and capital. This is crucial, as it can

indicate the Health-ICTs potential sustainability.

Using these characteristics for assessing a

successful Health-ICT model, the next step is to

evaluate the characteristics against the most

prevalent Health-ICT model categories. Figure 4

details characteristics that can be blended to create

a Health-ICT model that matches the needs of its

community.

Characteristics of a successful Health-IT

Model

The Using the information in Figure 3 for

guidance, the following analysis of this Health-

ICT model points to characteristics that typify

successful business models:

Value of Services

High-performing Health-ICT application can

bring together multiple stakeholders , interact and

exchange data in a collaborative manner that

improves quality of care, reduces errors, and

provides better patient outcomes and value-added

services. Successful Health-ICT models have

created solutions that meet the needs of various

stakeholders. For example, Telemedicine, CPRS,

m-health, e-health are some good examples via

which hospitals, clinics, and physicians can

exchange health information to improve care for

patients. They all are there in our model, this type

of ICT applications helps create standard treatment

protocols and improved patient health outcomes.

While financing and ROI issues often receive

a disproportionate share of stakeholder attention,

successful Health-ICT models keep their purpose

and mission at the forefront. This, in turn, helps

the Health-ICT better meet operational milestones

by keeping their target in sight. For example, the

Hospital Information System (HIS) turned out to

be such an important part of most of the hospitals,

HIS has not only reduced their operational cost but

it has also benefited them by smoothening and

standardizing their workflow. With this business

model we can cover patients even from distant

locations; also the ROI will be better since we can

use the already established infrastructure initially

by various tie-ups hence our initial investment cost

will be low.

Successful Health-ICT models implement

their vision and plan in several smaller phases,

rather than all at once. This approach reduces risk

and provides flexibility to address ambiguous

constraints, and also enables better planning. As

the HIS which we see in most of the hospitals

today is simply a combination of various modules

of different departments and not only this it is also

be modified according to the needs of the

organization. Similarly this Health-ICT model can

be divided into several modules and can be


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implemented step by step. Its three important parts

e-health, m-health and tele-health can be used in

collaboration as well as independently as per

situation. This can be used by an organization

individually and can work in tie-ups.

Effective Health-ICT applications utilize

physicians, payers and other stakeholders to bring

best practices together to achieve a wired health

care model. In this Health-ICT model, physicians

can have access to patients even in distant places

being at their workplace, while Payers and other

stakeholders are happy with the related benefits

that this model offers, which include easy set-up,

quality care and quantifiable financial gains.

Top Health-ICT models strive to understand and

provide incentives for all their stakeholders. These

Health-ICT models facilitate improved quality of

care by providing physicians and other clinical

staff with patients most accurate health

information at the point of care. This Health-IT

model has all such qualities incorporated in it,

hence it will prove beneficial to all those who will

be linked to this Health-ICT model.

Governance

The governance of various Health-ICT models

mainly depends on the motive for which it is

structured to accomplish. Various motives might

be to earn profit, provide better services and serve

community etc. This model can be proved

beneficial in accomplishing most of the objectives

of the governing body.

Effective Health-ICT models tries to link

public health organizations, the health care

community, physicians and payers that bring

together respective strengths and best practices to

achieve shared benefits. A large number of

companies have come up and are trying to develop

various tools that can help to provide better

healthcare facilities depending on the mode of

governance. This model being multidimensional

can facilitate all types of governing bodies to

fulfill their motive. This model also extends their

reach and impact by collaborating with its multiple

stakeholders. This provides more resources to

create and operate an end-to-end solution.

Architectural

Effective Health-ICT model clearly define data

standards for stakeholders and across industries. A

huge amount of patient data will be accessed

through this model, and hence standards must be

in place. Although there have been various Health-

ICT applications in market but there are no

specified standards for Health-IT applications yet,

each Health-ICT application may have a unique

set of standards, the industry as a whole must

conform to uniform set of rules for all Health-ICT

applications in order to make it uniform..

Best-practice Health-ICT applications use EHRs

and, to a lesser extent, PHRs, to build a solid

foundation for sharing data, to increase outreach

and adoption rates, and to obtain tangible ROI in a

short amount of time. In this model maximum


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standards that we have used are generally applied,

so that they can be applicable universally.

While long-time health care industry players

have leveraged existing relationships to promote

the development of various types of Health-ICT

applications, several new market entrants are

developing strategies to apply best practices and

lessons learned from other industries to health

care. This model is having the combination of both

so as to make impact for changing market

dynamics.

High-performing Health-ICT applications

leverage best-in-class technologies and

customized, scalable, comprehensive solutions that

meet stakeholders needs while effectively

managing its costs. This model will allow all

stakeholders with different systems of all sizes and

maturity levels to participate in the network.

Philosophically, ICT involving e-health, m-health,

telemedicine etc. are the building blocks of this

Health-ICT model. Therefore, it can also be

successfully merged with all those previously

existing Health-ICT applications in the market.

Successful Health-ICT applications can help

us achieve consistent and standard operational,

data and technical workflows with a single,

interoperable system. This model links different

methods of Healthcare delivery system which can

have a shared framework and will help us to

achieve economies of scale for technology-related

costs and assist in defining common rules,

platform and workflows.

Financial

Successful Health-ICT applications should havea clear plan for sustainability, even if their initial

funding source will eventually become depleted.

This model can be broken down into different

phases and can be brought to action one after the

other. Its initial cost is comparatively less,

operational cost is even lesser and also it can be

combined and used with existing Health-ICT

applications.

High-performing Health-ICT applications that

have been implemented gradually, starting with

easier projects that deliver quick hit results.

These smaller, successful milestones also help

build a stronger case to secure additional funding.

Just as we see the most common HIS application

is simply a combination of various individual

modules. Similarly, this Health-ICT model can be

initiated with a part of it first to provide quick-hit

solutions and then implement system

enhancements. Also we can initiate it in a specific

geographical area, see its impact and then consider

its expansion.

A common operational model for many Health-

ICT application combines earned and contributed

income. The earned income can be further

invested in ongoing value-creation initiatives.

Additionally, this Health-ICT model will seek

contributed income from various stakeholders to


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support its financial needs and grow its

capabilities.

At best-practice in most Health-ICT

applications, a strong initial investor is secured to

provide funds for the first few years without

expecting or requiring a monetary ROI. Setting

realistic expectations is important. Most of the

returns at least in the short-term will be

intangible ones around improving health care

quality and processes. Government is often good

initial investor, as they are advocates of patient

safety, quality, and community health.

Additionally, payers can be a good investment

source.

Challenges and Suggested Strategies

As various Health-ICT applications evolve and

expand, their responsibilities, roles and influence

within the health care industry will evolve.

Following are a list of current and potential

challenges, as well as suggested strategies for

success:

Align Incentives

To increase stakeholder participation, this

Health-IT model needs to align incentives to the

stakeholders and stand up-to their ROI

expectations. Each stakeholder has different

reasons and expectations for joining/ aligning with

Health-ICT and they need to be taken into

consideration.

Consider establishing a governance structure in

which this model is steered by classes of

stakeholders possibly with differentiated voting

rights designated by their level of involvement

and/or investment.

Secure FundingWhile a few Health-ICT applications have been

in use by various organizations but they are

implemented on small scale, while we want to

carry out this model on a large scale which require

adequate amount of funding also the concept is

still maturing and the current business models

have yet to stand the test of time. To survive, this

model must secure both start-up funding and a

sustainable plan for meeting ongoing operating

costs.

Initially this model can be funded by

government and other organizations but once it

comes into process it is capable of generating

enough revenue to manage its day to day processes

via the registration fees and other processing

charges that its users will have to pay.

For most Health-ICT applications, the

membership/subscription model, enhanced by

transaction fees, appears to be the most effective

means to achieve sustainability. Other innovative

sources of income can be tapped by various

initiatives; examples include fees for online record

maintenance, m-Health, telemetric medicine,

training programs etc.

Boost Adoption Rates

Current Health-ICT adoption rates are low

especially in backward areas. To prosper, our user


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numbers and geographic reach must grow. This

model can encourage and support the growth by

facilitating patient at their door step and providing

them their medical information 24/7, such as

providing an EHR, m-Health facilities to any

location a patient may travel.

The way Health-ICT is booming it clearly

demonstrates the benefits of participating in this

model. In this there is higher potential for ROI

(both tangible and intangible) for everyone.

Define Data Standards

As there are numerous Health-ICT applications

in the market, the data being transferred varies.

There should be a clear definition or

understanding of data standards among all

stakeholders. Government and other stakeholders

can assist in establishing national standards and

driving interoperability requirements. Recently

government has laid down some norms pertaining

to it.

Conclusion

Health Information Technology offers

tremendous potential to improve the quality of our

health care delivery system. Patients, providers,

and payers will be benefitted from standard and

timely care. Communication and patient data

exchange becomes simple. This will result in

meeting an overarching goalimproved quality of

care, reduced medical errors, and better outcomes

for patients. Certainly, Health-ICT evolution faces

technical, financial and operational challenges;

however, public and private support for the

movement will assist in Health-ICT development

and adoption.

Sustainability is the major challenge for

Health-ICT and there are some best practices

around this concept. However, Health-ICT needs

to continuously work at self-improvement and

should provide services to its stake holder as well

as meet the data needs of its customers and could

serve as a model for the health care industry.

Health-ICT stakeholders need to develop

and operate under a business model that enables

long-term financial self-sufficiency. Another

major challenge for Health-ICT applications is

data security, which is necessary to keep in mind

while carrying out any process. Currently, a lot of

thought is going on about making data universally

accessible without compromising with data

security. Government must adopt a common set of

standards to link the Health-ICT applications with

a common goal, and establish a regulatory

environment in which the Health-ICT can flourish.


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