building a telemedicine program

Telemedicina e eSaúde

Telemedicine Building 1

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Building a Telemedicine ProgramTelemedicina e e-Saúde

2019/20

Pedro Brandão

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References

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

• Inside citations will be From: CitationSource

TeleSaude 19/20 - Telemedicine Building - pbrandao

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Business Models for eHealthEU ReportBuilding 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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Business Models for eHealth EU Report

• Report that discuss business models for eHealth within the EU context (from 2010)o Analyses 5 successful case studies


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https://ec.europa.eu/digital-single-market/en/news/business-models-ehealth-study-report



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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 insuranceo Ireland

• Out-of-pocket

o Not used in Europe


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See this article and other

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Fin

anci

al

ClientsOfferResources

Building blocks of the business model


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Key Partners

What can partners do to leverage

your eHealthsystem/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?

ChannelsThrough which means do your clients want

to be reached to

leverage eHealthcareand 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 eHealthsystem/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]

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

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



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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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Recommendations II [EUREP]

• Clear and precise understanding of the specific needsof 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 safetyo Use of appropriate regulations and protocols

o Incorporate them in the design process


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ValueHealth Project

• “will demonstrate how interoperability of health information can consistently create, deliver, and capture value for all stakeholders, in order to justify sustainable investments in scaling up interoperability across Europe.”

• Project ended 6/June/2017

• Deliverables


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CEF - Connecting Europe Facility

http://www.valuehealth.eu/

http://www.valuehealth.eu/index.cfm/deliverables/



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ValueHealth Project - Initial use-cases


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From the Project’s D1.2 Prioritised Use Cases

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ValueHealth Project - Initial use-cases


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From the Project’s D1.2 Prioritised Use Cases

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http://www.valuehealth.eu/ValueHealth/assets/File/VALUeHEALTH_D1_2%20Prioritised%20Use%20Cases.pdf






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Using COTS SystemsBuilding a Telemedicine Program


TelemedSupplies

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Using COTS System

• Commercial Off The Shelf

• When cost and requirements can be simultaneous meto Assume some customization needed

• Differences to a “customization approach”o Minimal custom coding/programming;

o Flexible requirements to meet market’s offers;

o Flexible business process to adapt to COTS.


From [COTS]

T e le me d

S u p p l i e s 14



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Integration Life-Cycle


15Image from [COTS]

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COTS – Steps I

• Determine the Organizational Fit

o Incorporate Multiple Views of Requirements;

o Make requirements definition and design interactive.

• Consider Selecting a System Integrator

• Don’t Rely on the Vendor for Everything

• Identify gaps

• Data schema changes


16From [COTS]

T e le me d

S u p p l i e s



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COTS – Steps II

• Have a Complete Set of Selection Criteriao 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


17From [COTS]

T e le me d

S u p p l i e s

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SummaryStepsBuilding 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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The triple constraint


QualityTime

Cost/Resources

From [PAPLE]19

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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


20From [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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B . Plan the service (cont.)

C. Develop healthcare team

o Remote team and Hub team

o Train and support

D. Market the program/serviceo To clinicians in the planning phase


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E. Evaluation

• Safetyo 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 ofTelemedicine 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

• [MAST] Model for ASsessment of Telemedicine, EU project to define atoolkit for telemedicine assessment


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https://ec.europa.eu/digital-single-market/en/news/business-models-ehealth-study-report

https://cimt.dk/gb/mast-model-for-assessment-of-telemedicine/



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Acronyms – Building

• CEF – Connecting Europe Facility

• COTS – Commercial Off The Shelf


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building a telemedicine program

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