telemedicine building systems

Telemedicina e e-Saúde 2010/2011

Telemedicine Building Systems 1

Telemedicine Building

Telemedicina e e-Saúde

2010/11

Pedro Brandão

References

Sources are indicated by [RefSource] where the complete citation will be at the end

Insite citations will be From: CitationSource

Telemed 10/11 - Telemedicine Building - pbrandao 2



BUILDING A TELEMEDICINE PROGRAM


BUSINESS MODELS FOR EHEALTH EU REPORT

Building a Telemedicine Program Based on Lorenzo Valeri, Daan Giesen, Patrick Jansen, Koen Klokgieters “Business Models for eHealth Final Report”, ICT for Health Unit DG Information Society and Media European Commission, Feb 2010

Telemed 10/11 - Telemedicine Building - pbrandao

http://ec.europa.eu/information_society/newsroom/cf/itemdetail.cfm?item_id=5863






Business Models for eHealth EU Report

Report that discuss business models for eHealth within the EU context

o Analyses 5 successful case studies


Motivation

European eHealth market estimated at EUR14.269 million in 2008

Projected to EUR15.619 million by 2012,

o compounded annual growth rate of 2.9%.

Major European eHealth markets:

o France, Germany, Italy, Spain and United Kingdom


From [EUREP]

Based on an analysis undertaken by Capgemini Consulting in the context of the report



EHealth European Market


From a study from CAPGEMINI in [EUREP]

2012 2008

Market composition in Europe


Market Composition in 2008

Clinical Information System (CIS) 22.50%

Secondary Usage Non-clinical Systems (SUNCS)

71.60%

Telemedicine 0.90%

Integrated Health Clinical Information Network (IHCIN)

5.00%




Expect Growth



eHealth market Compounded Annual Growth Rate (CAGR) (2008-2012) per market sector

Social Insurance financing models Centred on public taxes (Beveridge Model)

o UK, Spain, Portugal, Italy, Greece

Compulsive Social Insurance (Bismarck Model)

o Germany, France, Netherlands, Switzerland

Voluntary private insurance + standard social insurance

o Ireland

Out-of-pocket

o Not used in Europe


See this article and other

http://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php

http://www.finfacts.ie/irishfinancenews/article_1011335.shtml



Fin

anci

al

Clients Offer Resources

Building blocks of the business model


Key Partners

What can partners do to leverage your

eHealth system/service

(better, at lower cost)?

Key Activities

What key activities do you need to perform

and how easily can you do this?

Key Resources

What key resources does your eHealth

system/service requires?

Value Proposition

Which of your clients (patient/doctor/

user) problems do you solve and which needs are satisfied

Relation

What kind of relations does your

patient/doctor/user expect and which do

you maintain?

Channels

Through which means do your clients want to be reached to leverage eHealthcare and which means do you utilise?

Patient/doctor/ user segments

What are your

patients’, doctors’, users’ needs,

problems desires and ambitions?

Cost structure

What is the cost structure of your eHealth system/service and is this in line with the core values of the business

model?

Revenue streams

What value are your clients willing to pay for and what is the preferred payment mechanism?

From [EUREP]

Recommendations I [EUREP] Identifications of stakeholders is key

o Their role and value

Business model flexible and adaptable to new situations o phased step-by-step approach involved actors can

adapt/adjust.

Stable financial support. o long time until return on operational and financial

results. o Senior management key to insure constant funding, o Allocate funding to cover staff time for their

involvement




Recommendations II [EUREP]

Clear and precise understanding of the specific needs of patients. o Directly or indirectly involve them in designing

the functionalities.

o Operational process for capturing these evolving needs

Use of open standards and applications (not necessarily open source software). o Prepare for integration with current and future

systems


Recommendations III [EUREP]

Use of regular operational assessments while system is developed and/or delivered o Internal and external reviews;

o Intangible benefits

o Evaluate internal and external benefits;

o Evaluate financial and socio-economic gains

Security, privacy, data protection and safety o Use of appropriate regulations and protocols

o Incorporate them in the design process




USING COTS SYSTEMS Building a Telemedicine Program


Telemed Supplies

Using COTS System

Commercial Off The Shelf

When cost and requirements can be simultaneous met

o Assume some customization needed

Differences to a “customization approach”

oMinimal custom coding/programming;

o Flexible requirements to meet market’s offers;

o Flexible business process to adapt to COTS.


From [COTS]

Telemed Supplies

16



Integration Life-Cycle


Image from [COTS]

COTS – Steps I

Determine the Organizational Fit

o Incorporate Multiple Views of Requirements;

oMake requirements definition and design interactive.

Consider Selecting a System Integrator

Don’t Rely on the Vendor for Everything

Identify gaps

Data schema changes


From [COTS]

Telemed Supplies



COTS – Steps II Have a Complete Set of Selection Criteria

o Functionality o Architecture o Life-cycle costs o Vendor/product stability o Vendor

• Licensing (model, approaches) • Vendor assumptions • Additional vendor services

o Infrastructure and training needed

Consider Test installation


From [COTS]

Telemed Supplies

SUMMARY STEPS

Building a Telemedicine Program Based on “Defining the needs of a Telemedicine Program”, Gray Doolittle and Ryan Spaulding; “Successffuly Developing a Telemedicine System”, Peter Yellowlees; “Evaluating Telemedicine Services and Systems” Paul Taylor from the book “Introduction to Telemedicine” 2nd Ed, Edited by Richard Wootton, John Craig, Victor Patterson




The triple constraint


Quality Time

Cost/Resources

From [PAPLE]

21

7 imperatives for success 1. Strong commitment from administration to

change. 2. Ownership by end-user of system design,

implementation and standardization 3. Establish and communicate realistic goals and

expectations 4. Clinician’s involvement 5. Internal marketing from physician champions 6. Process redesign is more effort than system

design 7. Learning as continuous process


From [PAPLE]



A. Define what is the need

Involve stakeholders/users

o Local support (willingness) of clinicians

Needs assessment:

o Clinical

o Economic

• Equate remote site economic responsibilities;

• Funding sources.

o Technology


B . Plan the service

Responsible team involving all sectors (physicians, nurses, technicians, information technologists, administrators);

o Program champions

Involve local clinicians;

Business plan

User-friendly technology




C. Develop healthcare team

o Remote team and Hub team

o Train and support

D. Market the program/service

o To clinicians in the planning phase


E. Evaluation

Safety o Information is available/usable without any

degradation

o Patient care is same or better than conventional

Feasibility

User satisfaction

Clinical outcomes

Randomized controlled trials

Cost-effectiveness (compare to absence of) o Remember cost analysis




END OF TELEMEDICINE BUILDING


Referências – Building [COTS] C. Todd Couts and Patrick F. Gerdes,

“Integrating COTS Software: Lessons from a Large Healthcare Organization”, IEEE IT Pro March/April 2010

[EUREP] Lorenzo Valeri, Daan Giesen, Patrick Jansen, Koen Klokgieters “Business Models for eHealth Final Report”, ICT for Health Unit DG Information Society and Media European Commission, Feb 2010

[PAPLE] Keith Shelman, “Changing from Paper to Paperless Hospitals in Busy Academic Centres”, Chapter from “Current Principles and Practices of telemedicine and e-Health”, ed Rifat Latifi, 2008 IOS Press









Acronyms – Building

CAGR – Compounded Annual Growth Rate

COTS – Commercial Off The Shelf

CIS – Clinical Information System

IHCIN – Integrated Health Clinical Information Network

SUNCS – Secondary Usage Non-clinical Systems


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