國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
CHAPTER 7 - CONCLUSION
This study aims to successfully deploy NTUH e-health services, sustainably op-erate and permanently offer e-health services, and improve other management con-cerns. After a series of analyses and derivations, we propose the e-health business model for NTUH. Using five main pillars to describe our model, our findings and recommendations are as follows:
1. Identify the service position to design services competitively:
First, a service provider should define its service position to emphasize its own strengths and develop service characteristics differentiated from other service providers. NTUH is a top teaching hospital with a complete medical system and an outstanding medical team that offers patients complete med-ical care and treatment. To have the ability to independently operate e-health, NTUH can choose between two extreme disparities: the exclusive market “crisis management” and the mass market “health management” to balance its costs and revenues. Therefore, NTUH can target patients with complications, hereditary, complex or long-term diseases to offer e-health services, which distinguishes it from other community hospitals or institu-tions focusing on long-term care for elderly patients. Additionally, NTUH can also offer health management services to people who feel healthy or unwell and emphasize that prevention is better than a cure by connecting care services with patients’ daily lives, such as exercise and diet. NTUH needs to first develop a successful model, and then extend it to other areas of disease care to realize its movement from Cloud Ward to Cloud Hospital.
2. Customer-oriented service design:
Before developing e-health service propositions, it is necessary first to un-derstand target customers' demands to ensure customers would be satisfied with the services. Take NTUH as an example. Most users had Type 1 dia-betes, were aged 35-65, young and middle-aged, and had a long-term histo-ry of disease. Therefore, how to design services to let the customer groups control their physical conditions easily and carry on their normal life and leisure will be the service propositions. The customer groups thus show in-terest in Mobile care services (e.g., reminder services by cell phone text messages) and Health management services (e.g., Calculating, recording and chart tracking of calories per meal). Life care service for the elderly seems unsuitable for such customer segments because the service design for
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
these target customers would result in a waste of resources. Additionally, for future e-health services, users prefer Priority registration, Health man-agement and Consulting remote physicians. These results show that users expect to conduct some self-health management as well as obtain medical resources more easily to improve their health.
3. Create delivery processes to interact with customers:
In this section, we focus on how to interact with customers and how to exe-cute each process. Through the e-health center, platform and instruments, NTUH makes e-health services continually accessible to customers. Addi-tionally, NTUH can develop CDSS to monitor patients' situations to ease the burden on service providers as well as create online patients associations to promote more experience sharing among patients. At NTUH, case man-agers are the main service personnel that give patients health consultations, build patients’ personal health records, offer monthly health reports, and provide urgent care consulting; physicians would then assess patients’ con-ditions in a timely fashion. Additionally, with physicians promoting the ser-vice, the patients’ willingness to participate in e-health services will be higher, which is a channel that NTUH can consider.
4. Build supporting processes to enable the offering of e-health services:
The realization of service propositions and the quality of service delivery depend on perfect service support. Therefore, a hospital must view its available resources, determine how to execute and consider how to cooper-ate with partners. NTUH needs to integrcooper-ate relcooper-ated resources and each de-partment to develop an integrated e-health service and platform. First, the platform must concern not only the inputting and viewing of patient data but also the ease of case managers’ and physicians' inspection and diagnosis.
Additionally, NTUH needs to offer service personnel superior training to enable them have the ability to offer service to patients. To expand the scope of enrollment, NTUH can consider working with institutions or communities. As for government units, NTUH should consider various ways to offer e-health services in response to different policy directions.
5. Generate value:
The generation of value can be viewed from three aspects. The financial value includes economic benefits brought to hospitals as well as prices the patients are willing to pay for this service, namely revenues and costs. The
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
customer value refers to the degree of users' health improvement and satis-faction with the service and platform. It affects whether customers would keep participating in the e-health service. Therefore, in addition to actually improving the value of patients’ health, NTUH still needs to think of how to make customers feel the value that e-health services bring. The operating value can be observed in terms of management and personnel. From the perspective of management, some marginal benefits that e-health services bring can contribute to NTUH. For example, e-health would improve bed turnover rates, so the number of patients treated simultaneously is increased.
From the perspective of service personnel, because case managers and phy-sicians play important roles in e-health services, it is critical to enhance physicians and case managers’ willingness to participate.
We hope the proposed model can be a reference for NTUH, other potential hos-pitals, and even governments. In the future, if any service providers want to develop e-health services, we offer a successful case and methods to address other problems, such as integration, laws, fees, and finance imbalances. The most important aspect of successfully delivering e-health services is helping people to lead healthy lives. In conclusion, it is of great value to successfully implement e-health services by adopt-ing the business model method.
Also, there are other challenges, including the limitation of the Physicians Act and Personal Information Protection Act, the future policy direction of NHI, the dif-ficulty in charging for e-health services, seeking appropriate environment to develop e-health, the relationship between automation systems and personalized medicine. We propose the above questions as references for the potential e-health service providers.
As for the future research, we suggest that two additional issues can be included into an e-health business model. The first one is regarding risk management. Risk management refers to potential threats about finance, legislation, personnel, health and safety or environment, which is an important issue upon developing a business, and especially for the business concerning the medical industry. As a result, we con-sider that risk management is also a critical factor when fostering an e-health business.
The second one is cost reduction through resource management. As we mentioned earlier, now e-health has a difficulty in financial imbalance, accordingly how to use limited resources and costs to reach the most effective outcomes is an imperative is-sues. For a developing business, namely e-health, finance and resource issues should absolutely be considered. As a consequence, we recommend that future research di-rections can be conducted toward risk management as well as cost reduction in the hope of a sustainable business model for e-health services.
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
REFERENCE
Afuah, A., & Tucci, C. L. (2001). Internet Business Models and Strategies. Boston, MA: McGraw Hill.
Amit, R., & Zott, C. (2001). Value creation in ebusiness. Strategic Management Journal, 22(6-7), 493-520.
Applegate, L. M. (2001). Emerging E-Business Model: Lessons from the Field. Bos-ton, MA: Harvard Business School Press, HBS No. 9-801-172.
Barker, G. P., Krupinski, E. A., McNeely, R. A., Holcomb, M. J., Lopez, A. M., &
Weinstein, R. S. (2005). The Arizona Telemedicine Program business model.
Journal of Telemedicine and Telecare, 11(8), 397-402.
Bateson, J. E. G. (1985): Perceived control and the service encounter. In J. A. Czepiel, M. R. Solomon, & C. F. Surprenant (Eds.), The service encounter (pp. 67-82).
Lexington, MA: Heath and Company.
Broens, T.H.F, Huis in’t Veld, M.H.A., Vollenbroek-Hutten, M.M.R, Hermens, H.J, Halteren, A. van & Nieuwenhuis, L.J.M. (2007). Determinants of successful telemedicine implementations: a literature study. Journal of Telemedicine and Telecare, 13(6), 303-309
Brown, S.W. (1997). Service Recovery Through IT. Marketing Management, 6(3), 25-27.
Brown, S.W. (2000). Practicing best-in-class service recovery. Marketing Manage-ment, 9(2), 8-9.
Brown, S.W., Fisk, R.P., & Bitner, M.J. (1994). The Development and Emergence of Services Marketing Thought. International Journal of Service Industry Man-agement, 5(1), 21-48.
Carlzon, J. (1987). Moments of Truth. Cambridge. MA: Ballinger Publishing Co.
Chase, R. B., & Dasu, S. (2001). Want to perfect your company’s service? Use be-havioral science. Harvard Business Review, 79(6), 78-84.
Chase, R.B. (1978). Where does the customer fit in a service operation? Harvard Business Review, 56(6), 137-142.
Chase, R.B. (1981). The Customer Contact Approach to Services: Theoretical Bases and Practical Extensions. Operations Research, 29(4), 698-706.
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Chase, R.B., & Tansik, D.A. (1983). The customer contact model for organization design. Management Science, 29(9), 1037-1050.
Chesbrough, H.W., & Rosenbloom, R.S. (2002). The role of the business model in capturing value from innovation: Evidence from Xerox corporation’s technology spin-off companies. Industrial and Corporate Change, 11(3), 529-555.
Congram, C., & Epelman, M. (1995). How to describe your service. International Journal of Service Industry Management, 6(2), 6-23.
Cook, D.P., Goh, C.H., & Chung, C.H. (1999). Service Typologies: A State of the Art Survey. Production & Operations Management, 8(3), 318-338.
Cook, L.S., Bowen, D.E., Chase, R.B., Dasu, S., Stewart, D.M., & Tansik, D.A.
(2002). Human issues in service design. Journal of Operations Management, 20(2), 159-174.
Cronin, J.J., & Taylor, S.A. (1992). Measuring service quality: A reexamination and extension. Journal of Marketing, 56(3), 55-68.
Dabholkar, P.A., & Overby, J.W. (2005). Linking process and outcome to service quality and customer satisfaction evaluations: An investigation of real estate agent service. International Journal of Service Industry Management, 16(1), 10-27.
Dean, A.M. (2004). Service delivery and operations objectives: listening to call cen-tre customers. Retrieved from
http://www.buseco.monash.edu.au/mgt/research/working-papers/2004/wp34-04.
Elnaghi, M., Al Shawi, S., Irani, Z., & Seitanidi, M.M. (2008, May). Towards De-signing a Sustainable IS-Enabled Service Delivery System. Paper presented at the European and Mediterranean Conference on Information Systems 2008, Dubai.
Abstract retrieved from
http://www.iseing.org/emcis/EMCIS2008/proceedings/refereed%20papers/contri butions/c%2079/emcis%202008%20paper%20v2.pdf
Fitzsimmons, J.A., & Fitzsimmons, M.J. (2001). Service Management: Operations, Strategy, and Information Technology. New York: McGraw-Hill.
Fleming, C. (2010, February 2). Global E-Health Is Focus Of New Health Affairs Is-sue. Retrieved from
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
http://healthaffairs.org/blog/2010/02/02/global-e-health-is-focus-of-new-health-a ffairs-issue/
Goldstein, S.M., Johnston, R., Duffy, J., & Rao, J. (2002). The service concept: the missing link in service design research? Journal of Operations Management, 20(2), 121-134.
Gouillart, F.J., & Sturdivant, F.D. (1994). Spend a Day in the Life of Your Customers.
Harvard Business Review, 72(1), 116-125.
Grönroos, C. (2000). Service Management and Marketing: A Customer Relationship Management Approach (2nd ed.). Chichester, England: John Wiley & Sons.
Gummesson, E. (1994). Service Management: An Evaluation and the Future. Interna-tional Journal of Service Industry Management, 5(1), 77-96.
Hamel, G. (2000). Leading the revolution. Boston, MA: Harvard Business School Press.
Hart, C.W.L., Heskett, J.L., & Sasser Jr., W.E. (1990). The Profitable Art of Service Recovery. Harvard Business Review, 68(4), 148-156.
HERO Network LLC (2013, March 22). About Us [Online official information]. Re-trieved from http://hero-network.com/
Heskett, J. L., Sasser Jr., W. E. & Hart, C. W. L. (1990). Service Breakthroughs:
Changing the Rules of the Game. New York: The Free Press.
Heskett, J.L. (1987). Lessons in the service sector. Harvard Business Review, 65(2), 118-126.
Hoy, Wayne K., John Tarter, C., & Kottkamp, Robert B. (1991). Open Schools/Healthy Schools. London, England: Sage Publications.
Intel-GE Care Innovations (2012, November 25). About Us [Online official infor-mation]. Retrieved from http://www.careinnovations.com/about-us
Johnston, R., & Clark, G. (2001). Service Operations Management. London: FT Pren-tice Hall.
Kim, H.W., & Kim, Y.G. (2001). Rationalizing the customer service process. Busi-ness Process Management Journal, 7(2), 139-156.
Leunissen, R.M.J. (2009, January). The validation of an e-health service business model. Paper presented at the 10th Twente Student Conference on IT, Enschede,
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Netherlands. Abstract retrieved from
http://referaat.cs.utwente.nl/conference/10/paper/6931/the-validation-of-an-e-hea lth-service-business-model.pdf
Lovelock, C., & Wirtz, J. (2004). Service marketing: People, technology, strategy (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Lynch, R., & Cross, K. (1995). Measure up! Yardsticks for continuous improvement.
Cambridge, MA: Basil Blackwell.
Mayer, K.J., Bowen, J.T., & Moulton, M.R. (2003). A proposed model of the de-scriptors of service process. Journal of Services Marketing, 17(6), 621-639.
McLaughlin, C.P., Pannesi, R.T., & Kathuria, N. (1991). The Different Operations Strategy Planning Process for Service Operations. International Journal of Op-erations & Production Management, 11(3), 63-76.
Medi-Compass (2013, March 22). Who We Are [Online official information]. Re-trieved from http://www.medi-compass.com/who-we.php
Metters, R. D., King-Metters, K. H., Pullman, M., & Walton, S. (2006). Successful service operations management (2nd ed). Mason, Ohio: Thomson
South-Western.
Mintzberg, H. (1989). Mintzberg on Management: Inside our Strange World of Or-ganisation. New York: Free Press.
Mitchell, D., & Coles, C. (2003). The Ultimate Competitive Advantage of Continuing Business Model Innovation. The Journal of Business Strategy, 24(5), 15-21.
Mohr, L.A., & Bitner, M.J. (1995). The Role of Employee Effort in Satisfaction with Service Transactions. Journal of Business Research, 32(3), 239-252.
Morris, M., Schindehutte, M., & Allen, J. (2005). The entrepreneur’s business model:
toward a unified perspective. Journal of Business Research, 58(6), 726-735.
Mun, S. K., Tohme, W. G., Platenbergw, R C., & Choi I. (2005). Teleradiology and emerging business models. Journal of Telemedicine and Telecare, 11(6), 271-275.
National Taiwan University Hospital (2013, Feburary 5). About us: Future Prospects [Online official information]. Retrieved from
https://plus.google.com/u/0/stream/circles/p2a16a48f8eee0197
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
National Taiwan University Hospital (2013, July 24). Introduction[Online official in-formation]. Retrieved from http://www.ntuh.gov.tw/ntuh.aspx
National Taiwan University Hospital Telehealth Center (2013, March 21). About us:
About Our Center [Online official information]. Retrieved from http://telehealth.ntuh.gov.tw/html.php?id=10
National Taiwan University Hospital Telehealth Center (2013, March 21). Service:
Enrollment Targets [Online official information]. Retrieved from http://telehealth.ntuh.gov.tw/html.php?categoryid=1&id=1
Osterwalder, A. (2004). The Business Model Ontology- A Proposition in the Design Science Approach (Unpublished doctoral dissertation). University of Lausanne, Lausanne, Switzerland.
Osterwalder, A., Pigneur, Y., & Tucci, C.L. (2005). Clarifying business models: Ori-gins, present and future of the concept. Communications of the Association for Information Science (CAIS), 16(1), 1-25.
Osterwalder, A., Pigneur, Y., Smith, A., & Clark, T. (2010). Business Model Genera-tion: A Handbook for Visionaries, Game Changers, and Challengers. New York:
John Wiley & Sons Inc.
Paul Y. Takahashi, MD, MPH; Jennifer L. Pecina, MD; Benjavan Upatising, MSIE, PhD; Rajeev Chaudhry, MBBS, MPH; Nilay D. Shah, PhD; Holly Van Houten, BA; Steve Cha, MS; Ivana Croghan, PhD; James M. Naessens, ScD; Gregory J.
Hanson, MD. (2012) A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency de-partment visits. Arch Intern Med, 172(10), 773-779.
PHRsToday (2012, November 25). PHR Reviews: MediCompass [Web blog mes-sage]. Retrieved from http://www.phrstoday.com/medicompass.html
Pine, B.J., & Gilmore, J. H. (1999). The Experience Economy. Boston, MA: Harvard Business School Press.
Piotti, B., & Macome, E. (2007). Public healthcare in Mozambique: strategic issues in the ICT development during managerial changes and public reforms. Interna-tional Journal of Medical Informatics, 76(1), 185-194.
Ponsignon, F., Smart, P.A., & Maull, R.S. (2007, July). Service delivery systems: a business process perspective. Paper presented at the Production and Operations
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Management Society (POMS) Conference, London Business School. Abstract retrieved from http://www.poms.org/conferences/cso2007/talks/44.pdf
Porter, M.E. (1985). Competitive advantage. New York: Free Press.
Reichheld, F.F., & Sasser, E.W. (1990). Zero defections: Quality comes to services.
Harvard Business Review, 68(5), 105-111.
Roth, A.V., & Menor, L.J. (2003). Insights into service operations management: a re-search agenda. Journal of Production Operation Management, 12(2), 145-164.
Sampson, S. E., & Froehle, C. M. (2006). Foundation and implication of a proposed unified services theory. Production and Operations Management, 15(2), 329-343.
Scheuing, E.Z., & Johnson, E.M. (1989). A proposed model for new service devel-opment. Journal of Services Marketing, 3(2), 25-34.
Schlesinger, L. A., & Heskett, J. L. (1991). The Service-Driven Service Company.
Harvard Business Review, 69(5), 71-81.
Schwartz, H.M. & Davis, S.M. (1981). Matching Corporate Culture and Business Strategy. Organizational Dynamics, 59, 33.
Shieff, D., & Brodie, R. (1995). Customer service mapping: How to make customer satisfaction research deliver actionable results to managers. Australian Journal of Market Research, 3(1), 31-37.
Shostack, G. (1985). Planning the service encounter. In J. Czepiel, M. Solomon, & C.
Surprenant (Eds.), The Service Encounter. Lexington, MA: Lexington Books.
Shostack, G. L. (1987). Service positioning through structural change. Journal of Marketing, 51(1), 34-43.
Shostack, G.L. (1982). How to Design a Service. European Journal of Marketing, 16(1), 49-63.
Shostack, G.L. (1984). Designing services that deliver. Harvard Business Review, 62(1), 133-139.
Slack, N., Chambers, S., Johnston, R. (2004). Operations management (4th ed.). Har-low, England: Financial Times/Prentice Hall.
Slywotzky, A.J. (1996). Value Migration: How to Think Several Moves Ahead of the Competition. Boston, MA: Harvard Business School Press.
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
Solomon, M. R., Surprenant, C. F., Czepiel, J. A., & Gutman, E. G. (1985). A Role Theory Perspective on Dyadic Interactions: The Service Encounter. Journal of Marketing, 49(1), 99-111.
Spil, T., & Kijl, B. (2009). E-health Business Models: From Pilot Project to Success-ful Deployment. IBIMA Business Review, 1(5), 55-66.
Stewart D.W., & Zhao, Q. (2000). Internet marketing, business models, and public policy. Journal of Public Policy and Marketing, 19, 287-296.
Stroetmann, K.A., Jones, T., Dobrev, A., & Stroetmann, V.N. (2006). eHealth is Worth it: The economic benefits of implemented eHealth solutions at ten Euro-pean sites. EuroEuro-pean Commission (Ed.). Luxembourg: EuroEuro-pean Communities.
Takahashi, P.Y., Pecina, J.L., Upatising, B., Chaudhry, R., Shah, N.D., Van Houten, H., Cha, S., Croghan, I., Naessens, J.M., & Hanson, G.J. (2012). A randomised controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits. Archives of Internal Medicine, 172(10), 773-779.
Timmers, P. (1998). Business Models for Electronic Markets. Journal on Electronic Markets, 8(2), 3-8.
van Looy, B., Van Dierdonck, R., & Gemmel, P., (1998). Services Management An Integrated Approach. Harlow, England: Pearson Education Limited.
Verma, R., Fitzsimmons, J., Heineke, J., & Davis, M. (2002). New issues and oppor-tunities in service design research. Journal of Operations Management, 20(2), 117-120.
Victorino, L. (2008). Scripting the Service Encounter: An Empirical Analysis. Cali-fornia: BiblioBazaar LLC.
Willings, B. (2010). Sustainable e-health business models in Sub-Saharan Africa (Master Thesis, Athens Information Technology). Retrieved from
http://www.aitdspace.gr/xmlui/handle/123456789/286
Zeithaml, V.A., Bitner, M.J., Gremler, D.D. (2006). Services marketing: Integrating customer focus across the firm (4th ed.). Boston, MA: McGraw-Hill/Irwin.
北區遠距健康照護區域服務中心(2012)。服務內容。2013 年 07 月 24 日取自 http://www.telecareservice.org.tw/TRSCPortal/index.aspx
‧ 國
立 政 治 大 學
‧
N a tio na
l C h engchi U ni ve rs it y
宅學習 - Social Learning Space (2011)。A.2.3 臺大醫院遠距照護中心。2013 年 07 月 24 日取自 http://sls.weco.net/node/15915
亞東紀念醫院心臟血管內科(2013)。遠距醫療(安心照護)。2013 年 07 月 24 日取 自 http://depart.femh.org.tw/cardiology/service10.htm
林東正、徐筱雯(2008 年 12 月)。遠距醫療之探討：商業模式觀點。第十四屆資 訊管理暨務實研討會，東吳大學。
金山分院(2013)。醫院簡介。2013 年 07 月 24 日取自 http://www.jsh.org.tw/
南區遠距健康照護區域服務中心(2012)。服務內容。2013 年 07 月 24 日取自 http://healthcare.uho.com.tw/
振興醫院 遠距照護中心(2010)。振興醫院遠距心臟照護管理執行經驗與分享。
2013 年 07 月 24 日取自
http://doh.telecare.com.tw/Upload/Activity/20101110%E7%A0%94%E8%A8%
8E/%E7%B6%93%E9%A9%97%E5%88%86%E4%BA%AB_%E6%8C%AF%
E8%88%88%E9%86%AB%E9%99%A2-%E6%AE%B7%E5%81%89%E8%B3
%A2%E4%B8%BB%E4%BB%BB.pdf
振興醫院 遠距照護中心(2013)。服務說明。2013 年 07 月 24 日取自 http://home.chgh.org.tw/chgh/passport/index.jspx
國立台灣大學生醫電子與資訊學研究所（2011）。連續性個人化健康照護整合平 台。行政院國家科學委員會專題研究成果報告（編號：NSC 100-2219-E-002 -032），未出版。
國立台灣大學生醫電子與資訊學研究所（2012）。連續性個人化健康照護整合平 台。行政院國家科學委員會專題研究成果報告（編號：NSC 101-2219-E-002 -024），未出版。
敏盛醫療體系(2013)。認識敏盛。2013 年 07 月 24 日取自 http://www.e-ms.com.tw/homepage.aspx
智能醫學科技(2013)。服務方案。2013 年 07 月 24 日取自
智能醫學科技(2013)。服務方案。2013 年 07 月 24 日取自