CHAPTER 6 - DISCUSSION
After proposing the e-health business model for NTUH, we must actually assess this model to investigate whether NTUH currently has the conditions or capabilities recommended by the model or the recommendations for the future direction for NTUH. The assessment results are shown in Table 27.
Table 27 Assessment of the NTUH e-health business model
Suggestion or Ideal planning Assessment
Organization NTUH’s objectives
1) Reduce the number of outpatient stays, hos-pitalizations, ED visits, etc. to contribute to marginal benefits for NTUH
2) Have the ability to independently balance revenues and costs
1) Underway: NTUH has tried to verify that e-health may improve outcomes not only for patients but also for NTUH by conducting various pilot plans.
2) Not yet: Far from this stage NTUH’s goals
1) Short-term: Incorporate the project’s diabetes care into the NTUH Telehealth Center
2) Medium-term: Become a routine, compre-hensive and independent department
3) Long-term: Become an important department to maintain people’s health
1) Underway: Now it is in the consolidation process.
2) Not yet: Far from this stage 3) Not yet: Far from this stage
JSH’s goals
1) Short-term: Extend the types of disease care, ranging from diabetes to heart diseases or hypertension
2) Medium-term: Promote this model to the community
1) Not yet: Currently mainly focusing on diabe-tes or other chronic diseases
2) Underway: JSH has set up Health Stations to build a positive relationship with the com-munity as well as actively execute home vis-iting to keep in touch with patients.
Customer Segments An e-health business model between the two
extreme markets
1) Crisis Management as the exclusive market:
patients with Type 1 diabetes, severe cardiovascular diseases, or complications, hereditary, complex or long-term diseases
1) Finished: NTUH has offered related care for patients with Type 1 diabetes and severe cardiovascular diseases, which is
differentiated from most hospitals operating
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2) Health Management as the mass market:
people who feel healthy but hope to become healthier may also participate or who feel unwell but hope to return to their original healthy states may participate
for chronic care. As for patients with complications, hereditary, complex or long-term diseases, there are some issues facing the capability of e-health platforms, the difficulty of commercial operations and the integration of each department.
2) Finished: NTUH Telehealth Center has targeted the customer groups and offered services.
Service Proposition Integrated services
1) Integrate platforms: Including patients’ elec-tronic medical records, physiological value, medical information platforms, etc.
2) Integrate services: Related services of each department
3) Progressive development: As e-health gradu-ally expands, more and more disease care will be contained in integrated services; all departments will eventually participate, like tele NTUH.
3) Underway: Begin first with cardiovascular disease, which is more urgent and patients would be more willing to pay for it; diabetes care will also be included. Liver disease, kidney disease or postoperative patients are also prone to accept short-term care; addi-tionally, some relevant departments or ser-vices, such as weight loss, sleep or rehabilita-tion, have also expressed interest.
Health management services
1) Design services focused on satisfying the basic necessities of life of diabetes patients to combine life care with e-health services 2) Cooperate with affiliate stores, such as a
fit-ness center. For example, after assessing a patient’s situation, NTUH could choose a fitness center and suggest that patients follow a particular diet or exercise plan
1) Not yet: Although there are related services in the platform, such as Diet records, it is still far from this type of service
2) Not yet: No related cooperation now
Offer basic and value-added services
1) Distinguish services at several levels to form basic and value-added services, making op-tions more flexible
1) Underway: Currently we know users' demands and their priority of each service through the questionnaire survey, which can
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be a reference for development in the future JSH’s e-health services
1) Design life care services for the elderly 1) Not yet: Besides home visiting, there are no related life care services at the present time Service Encounter
The development of CDSS
1) Establish CDSS to automatically diagnose cases’ status to reduce the burden on service personnel
1) Underway: Ongoing
The development of an online patients associa-tion
1) Let patients share information or provide emotional support in an online patients asso-ciation
1) Not yet: The project has an initial idea, but has not yet implemented it.
Service Delivery
Key Resources Improvement suggestions for the platform
1) User-friendly interface and improved fluency 2) More information after arranging
3) Quickly browse and query key information 4) New record field
5) Arranging function 6) More integrated 7) More useful indicators
8) Record temporary and acute changes 9) View data, process and make decisions
1) Not yet
2) Underway: Continuing to improve 3) Underway: Continuing to improve 4) Finished
5) Underway: Continuing to improve 6) Underway
7) Not yet 8) Not yet 9) Not yet Improvement suggestions for JSH’s
instruments
1) Personal identification feature
2) User-friendly / graphical interface design for the elderly
1) Finished 2) Not yet Resident physicians
1) When the e-health center reaches 1,000 or 2,000 cases, there must be resident
physicians to stand by in the center.
1) Not yet: Far from this stage
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Design a scalable architecture1) When the front-end auto filter discovers a problem, directly pass it to the back-end service group to handle it. Only the center has the ability to operate the back end, it could run the front end.
1) Finished: NTUH currently employs the scaled-up architecture to balance the burden of the telehealth group and provide services to more patients
Education and management of the e-health team
1) Offer case manager training
2) Cultivate a professional e-health team
1) Not yet: Because the number of cases currently does not reach a critical mass, it is difficult to plan related training.
2) Finished: NTUH has participated in various exchanges, certification and competitions to earn patients’ trust.
Key Partners Cooperate with institutions, communities or
branches
1) The community hospital, JSH, is responsible for the first line of treatment. By using the e-health system, it can screen relatively stable patients and pass severe cases to NTUH to accept treatment.
2) Through e-health, NTUH or JSH can offer some medical guidelines and consultation for the nursing facility, and the nursing facility can provide better care to patients and improve the quality of care.
3) The cloud can be used to filter patients to the center, so more manpower will not need to be added.
1) Finished: The mechanism is preexisting in general medical use and can also be applied in the e-health area.
2) Not yet: Although NTUH has such aims, it has not yet discussed a cooperative model with any nursing facilities .
3) Underway: NTUH and JSH both hope to realize this method in the future. Perhaps through e-health, as long as someone local can implement the doctor's orders, it is not necessary to set up an e-health team locally, which saves manpower and personnel costs.
Government: policies & regulations
1) In terms of legislation or health care, require patients to upload data to the platform;
consider the rights and obligations of patients with Type 1 diabetes
2) Using the FFS model, for example, NHI can determine whether patients’ HbA1c value is
1) Not yet: The policies need to be provided to the relevant government agencies to
deliberate.
2) Not yet: Through government grants and patient exam fees, it is difficult to grant patients even an instrument fee.
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higher than 8%; NTUH can thus open medical orders to allow patients to use the instruments. Moreover, the instruments can be provided here by the NHI Bureau.
3) Using the Case payment model in the future, NTUH should research and verify that e-health indeed improves patients’ health. If NTUH finds that e-health may decrease medical expenses, it will have more incentive to offer e-health service for free.
3) Underway: Various pilot plans conducted by NTUH and JSH are trying to confirm that Case payment can actually reduce medical costs and improve patients' health.
Financial Value Technology Transfer Fee
1) If the e-health business model can reach successful duplication and diffusion, NTUH is expected to earn technology transfer fees totally approximately $2,000,000 NTD.
1) Not yet: The model still has not reached the necessary size.
Customer Value
Operating Value