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CHAPTER 4 - THE PROCESS OF ANALYSIS
The business model framework consists of five base pillars, eleven components considered to be decision areas, and three increasing levels of decision making. By adopting this framework, we hope to help NTUH successfully deploy e-health ser-vices. We use the case study methodology for our two-part research framework. The first part takes place on the foundation level to identify general decisions about e-health services in the healthcare industry. In this part, we search for related repre-sentative cases of e-health services in Taiwan and analyze their common properties and distinguishing features. The second part includes the proprietary and rules level that helped develop competitive NTUH e-health services. In this part, we determine the advantages and differences of NTUH and then propose some feasible ideas for e-health services that present a good fit for NTUH. Then, we evaluate these ideas through interviews, questionnaires, analysis and reports. After making a series of de-cisions, the business model for NTUH e-health services will be drawn up. See Figure 8.
Figure 8 The research roadmap 4.1 Case background: NTUH e-health services
NTUH is a top teaching hospital, and it is well known not only domestically but
Business model framework Five pillars and eleven components Three levels of decision making
The business model for NTUH e-health services Industry analysis
Search for related representative cases of e-health services and analyze them
Foundation level
Define general decisions of e-health services in the healthcare industry
Case analysis: NTUH e-health services Collect data from NTUH and determine its advantages and differences
Proprietary and rules level Evaluate the feasibility of unique decisions through interviews, questionnaires and reports
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also internationally. It focuses on teaching, research, educational systems, diagnostic and treatment techniques, as well as innovative research and development. NTUH contributes to the development of medical treatment and plays a leading role in the healthcare industry. E-health service is an emerging and important area in the medical field, and it also attracts the investment of healthcare organizations. NTUH always pursues innovation and advancement to promote human health, and it consequently has sought to develop e-health services.
NTUH is currently developing a project in hopes of developing a sustainable e-health services operation. The project seeks to construct a continuous, integrated personalized healthcare platform. Through the platform, each patient acquires e-health services at home, obtains immediate and continual care and consultation from case managers, and receives medical care and treatment in case of emergency situations. In addition, the mobile platform allows patients to receive e-health services regardless of time and location (see Figure 9). The goal of the project is to improve patients’ physi-ological condition and their quality of life, to promote favorable medical outcomes for NTUH, to help people lead healthy lives and to demonstrate a successful case for the healthcare industry in Taiwan.
Figure 9 The Continuous, Integrated Personalized Healthcare Platform framework 4.2 Data collection
We collected data from interviews, questionnaires, related extant literature, in-dustry reports, final reports of pilot projects, and newspaper and magazine reports.
The first part of the study is to execute an industry analysis through searching for
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related representative cases of e-health services in Taiwan and to analyze their com-mon properties and distinguishing features:
Case Study
We choose the following cases to conduct an industry analysis: National Taiwan University Hospital (NTUH) Telehealth Center, Changhua Chris-tian Hospital (CCH) Long Distance Health Management Center, Far East-ern Memorial Hospital (FEMH) and Far Eastone Telecommunications (FET), Cheng Hsin General Hospital (CHGH) Telecare Services Center and Min-Sheng Healthcare (see Table 11).
Table 11 The case study list
Case Description
NTUH Telehealth Center2
The center offers a personalized Telehealth platform and services enabling patients to receive care at home. It targets patients with chronic or cardiovascular disease or people who want to become healthier.
CCH Long Distance Health Management Center34
It is the leading hospital for diabetes care in Taiwan. It focuses on offering diabetes care and management for individual users, communities, and institutions.
FEMH and FET 880 Mobile Care Services5
It targets cardiovascular disease patients and offers mobile care services on the basis of the medical advantage of FEMH and the telecommunication services platform of FET.
CHGH Telecare Services Center6
It is the first hospital to adopt a round-the-clock Telecare System in Taiwan to provide patients with cardiovascular or chronic diseases with heart disease care and chronic care.
Min-Sheng Healthcare78
It focuses on offering postoperative care for the base customers of Min-Sheng Healthcare through its medical resources combined with the remote medical technology of Smart Care.
For the second part of the study, we interviewed administrators, physicians and case managers from different viewpoints of related stakeholders to determine the fea-sibility or possible difficulties of developing NTUH e-health services. In addition, to
2 http://telehealth.ntuh.gov.tw/ [Accessed on July 23rd, 2013]
3 http://www.cch.org.tw/home.aspx [Accessed on July 23rd, 2013]
4 http://www2.cch.org.tw/bsdm/slim_distancecare.html [Accessed on July 23rd, 2013]
5 http://depart.femh.org.tw/cardiology/service10.htm [Accessed on July 23rd, 2013]
6 http://home.chgh.org.tw/chgh/passport/index.jspx [Accessed on July 23rd, 2013]
7 http://www.e-ms.com.tw/homepage.aspx [Accessed on July 23rd, 2013]
8 http://www.smart-care.com.tw/ [Accessed on July 23rd, 2013]
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develop the e-health business model, it is necessary to understand the customer’s ex-act needs, so we also used a questionnaire survey to understand the patients’ expecta-tions for e-health services:
Interview
The primary data sources were interviews conducted from April 2012 to January 2013. Each interview was limited to about 1 hour. The interview questions were designed according to each component. The notes were summarized at the end of each interview, and interview content was ex-tended and corrected in the next interview. The details regarding the inter-viewees, the schedule and the interview questions are listed below. See Ta-ble 12 and Appendix A - The Interview Questions.
Table 12 The interview list
Role Description Interviewee
Administrator
From the administrators’
viewpoint, we want to know the business problems and so-lutions that are needed to de-velop an e-health services model.
Project director
Director of Telehealth Center, NTUH
Physician
From the professional physi-cians’ viewpoint, we want to study the feasibility of e-health services for areas such as dia-betes, metabolism or endocri-nology.
Doctor A, Department of Internal Medi-cine, NTUH
Doctor B, Department of Family Medi-cine, NTUH
Doctor C, Department of Family Medi-cine, Jin-Shan Branch Hospital (JSH)
Doctor D, Department of Family Medi-cine, Jin-Shan Branch Hospital (JSH)
Case manager
From the case managers’
viewpoint, as an e-health ser-vice provider on the front line, we want to understand key factors in the process of deliv-ering e-health services.
Case Manager A
Case Manager B
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Table 13 The interview schedule
Interviewee Time Position
Case Managers A and B April 24th, 2012 NTUH Original Building Project director October 8th, 2012 NTUH Main Building Doctor A, Department of Internal
Medicine, NTUH October 22nd, 2012 NTUH Main Building Doctor B, Department of Family
Medicine, NTUH October 23rd, 2012 NTU Medical College Director of Telehealth Center, NTUH October 25th, 2012 NTUH Telehealth Center Doctors C and D, Department of
Family Medicine, JSH January 1st, 2013 JSH
Questionnaire
The subjects were people who had already joined the project and used the e-health platform. The questionnaire was designed to explore users’ satis-faction with e-health services and to investigate the potential e-health ser-vices that users expect in the future. (See Appendix B - The Questionnaire) From 2012/4/25 to 2012/9/24, we administered anonymous questionnaires in the e-health platform. After logging in, users could freely choose to fill out questionnaires. During that time, we sent the questionnaires to 108 users who joined the project and received 49 questionnaires. The response rate was 45%.
After finishing the case study in the first part as well as conducting the interview and questionnaire in the second part, related extant literature, industry reports, final reports of pilot projects, newspaper and magazine reports and so on were also gath-ered and examined for cross-reference. The information collected was arranged into a table to define general decisions at the foundation level, competitive decisions at the proprietary level and executing guidelines at the rules level to eventually capture an e-health business model for NTUH. An example of the decision making in the organ-ization was analyzed with the proposed research framework presented in Table 14. In addition, to ensure construct validity, internal validity, external validity and reliability, we followed the recommended case study tactics (Yin, 2003). See Table 15.
Table 14 An analysis example of the component: Organization
Foundation level
Missions of Home Care:
Establish a people-centered and integrated care model
Apply information and communication technology
Improve the quality of e-health services
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Promote accessibility in e-health services
Integrate medicine, care and life concepts into an e-health business model
Proprietary level
NTUH’s culture:
Not taking your money, but making you healthy NTUH’s missions:
Bring patients health and life
Improve medical and care outcomes
Innovation in medicine, teaching, research, service, etc.
Provide a contact channel for people in need
Offer continuous monitoring and care
Provide early intervention therapy
Rules level
NTUH’s objectives:
Reduce the number of outpatient visits, hospitalizations, etc.
Contribute to marginal benefits for NTUH
Have the ability to independently balance revenues and costs NTUH’s goals:
Short-term:
Incorporate the project’s diabetes care into the NTUH Telehealth Center
Medium-term:
Become a routine, comprehensive and independent department
Long-term:
Become an important department to maintain people’s health Table 15 Validity and reliability tests
Tests Tactic (Yin, 2003) Implementation in this study
Construct validity
Use multiple sources of evi-dence in the data collection phase
The primary data sources were collected from case studies, interview contents and survey results.
Other information from related extant literature, industry reports, final reports of pilot projects, and newspaper and magazine reports were considered simultaneously.
Reliability Use case study protocol in the data collection phase
Interview questions were designed according to each component. The interview included several open format questions to provide participants flexibility in their responses. The questionnaire was designed to investigate users’ characteristics and attitudes toward the e-health platform, and the potential e-health services that users expect in the
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future.
External validity Use replication logic in the research design phase
Each case applied the same theoretical framework for the analysis (Figure 5), and these replications in the theoretical framework could be considered as general decisions on the foundation level.
Internal validity Build explanations in the data analysis phase
A series of literary works were conducted to ex-amine the framework, leading to the three-level analysis in our case study.