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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
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Telemedicina e e-Saúde 2010/2011
Telemedicine Building Systems 2
BUILDING A TELEMEDICINE PROGRAM
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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
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Telemedicine Building Systems 3
Business Models for eHealth EU Report
Report that discuss business models for eHealth within the EU context
o Analyses 5 successful case studies
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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
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From [EUREP]
Based on an analysis undertaken by Capgemini Consulting in the context of the report
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Telemedicine Building Systems 4
EHealth European Market
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From a study from CAPGEMINI in [EUREP]
2012 2008
Market composition in Europe
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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%
From a study from CAPGEMINI in [EUREP]
Telemedicina e e-Saúde 2010/2011
Telemedicine Building Systems 5
Expect Growth
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From a study from CAPGEMINI in [EUREP]
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
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See this article and other
Telemedicina e e-Saúde 2010/2011
Telemedicine Building Systems 6
Fin
anci
al
Clients Offer Resources
Building blocks of the business model
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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
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Telemedicine Building Systems 7
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
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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
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Telemedicine Building Systems 8
USING COTS SYSTEMS Building a Telemedicine Program
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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.
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From [COTS]
Telemed Supplies
16
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Integration Life-Cycle
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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
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From [COTS]
Telemed Supplies
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Telemedicine Building Systems 10
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
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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
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Telemedicine Building Systems 11
The triple constraint
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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
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From [PAPLE]
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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
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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
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Telemedicine Building Systems 13
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
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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
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END OF TELEMEDICINE BUILDING
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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
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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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