Apache Asia Roadshow 2009

ViduSuwa

This solution bagged the award in the eHealth & Environment category at eSwabhimani 2009. The solution was successfully implemented by University of Colombo School of Computing along with the Ministry of Health & Nutrition (where the client institutes were Base Hospital Marawila and District Hospital Dankotuwa) under the patronage of Information and Communication Technology Agency (ICTA), Sri Lanka !!!

Glad I was part of it =)

ViduSuwa also won the Mantha Award !!! (http://www.manthanaward.org/section_full_story.asp?id=839)

Global Perspective on the Business Models in Medical Information Systems

Abstract

A healthy life style paves way to a successful livelihood making people utilize and expedite their natural talents and develop new skills, leading to a well-off living. Apparently, in the current global context; one has to spend a considerable amount of capital to lead a healthy life. People living in the developed country context are less fortunate in accessing specialized health services due to various reasons (e.g. financial difficulties of patients, geographical dispersion of health institutes and, etc.). Nevertheless, the increasing number of innovative technologies has started to bring the human living standards into a new sophisticated era. Consequently, many institutions and organizations prefer to exploit computing power to improve and enhance various sectors. Accordingly, health services can also be increased and enhanced to improve the living standards of the developing regions using IT. This article hence presents a comprehensive coverage of Business Models used in the field of Medical Information Systems which will sustainably stabilize the Medical Information Systems and their services.

Introduction

THE vision of the Ministry of Healthcare & Nutrition in Sri Lanka is to preserve “A healthier nation that contributes to its economic, social, mental and spiritual development” [1]. Therefore, the concept of empowering people, via healthy lifestyles should be promoted throughout the island. As a developing country it has been quite chaotic to give room to health related projects within the National Budget. Yet, the government of Sri Lanka has taken measures to increase the provisions for the health sector [2].

According to the World Health Organization (WHO), by the year 2020, 20% of Sri Lanka's population will reach 60 years of age or over [3]. Old age pave way to an array of ailments. This fact hence is a serious indicator of the number of ailing people that might exist within another decade’s time. Thus, it makes a crucial point to make necessary steps in bringing the local Hospital System to a more stable and a smoothly functioning organization before it is too late.

Application of electronic infrastructure in the face of Medical Information Systems can create dramatic changes in the health sector in both developing and developed countries. Yet, to improve the sustainability of such systems with a minimal of down-time, matured Business Models need to be incorporated.

Therefore, this paper will provide a comprehensive study of the Business Models used in the field of Medical Information Systems which will sustainably stabilize the Medical Information Systems and their services.

References

1. Ministry of Healthcare & Nutrition Sri Lanka, Viewed on 10th October,
2. Aussie Indo Lanka, Sri Lanka - Health status of Lankans on par with developed nations, Viewed on 10th October,
3. World Health Organization, Sri Lanka, Viewed on 10th October,
4. Europe’s Information Society, Business Models for eHealth, Viewed on 23rd December 2008, < item_id="4108">
5. Stroetmann ,V.N., Jean-Pierre Thierry, Stroetmann, K. , Dobrev, A., eHealth for Safety Impact of ICT on Patient Safety and Risk Management, Viewed on 23rd December 2008,
6. National eHealth Program, Viewed on 24th December 2008, http://www.ehealth.scot.nhs.uk/wp-content/documents/ehealth-procurement-strategy-template-v1-01.doc
7. Encouraging Innovation-Friendly Procurement in eHealth, eHealthNews.eu, Viewed 24th December 2008, http://www.ehealthnews.eu/content/view/1097/27/
8. An Examination of How Broadband Services Enhance Health Care In America, eHealth and America’s Broadband Networks, US Internet Industry Association, August 14, 2007, Viewed on 24th December 2008, http://www.usiia.org/pubs/eHealth.pdf
9. eTELEMED 2009; International Conference on eHealth, Telemedicine, and Social Medicine, February 1-7, 2009 - Cancun, Mexico, Viewed on 23rd of December 2008, http://www.iaria.org/conferences2009/eTELEMED09.html
10. Building eHealth Services in Developing Countries, Asia Pacific Telemedicine Initiative, 21st Pacific Science Congress, Okinawa Japan, 16 June 2007, Viewed on 24th of December 2008, http://www.pacificscience.org/pdf/APTdeclarationPSC21.pdf
11. eHealth for Safety, Impact of ICT on Patient Safety and Risk Management, Viewed on 23rd December 2008, http://www.ehealth-for-safety.org/
12. eHealth Initiative, Welcome to Initiative’s Connecting Communities Toolkit, Viewed on 23rd December 2008, http://toolkits.ehealthinitiative.org/
13. Ognianov A., Report in the framework of the eHealth ERA project, eHealth strategy and implementation activities in Bulgaria, Bulgarian National Health Insurance Fund, 7 January 2007, eHealth ERA Towards the Establishment of a European e-Health Research Area, Viewed on 24th December 2008, http://www.ehealth-era.org/database/documents/ERA_Reports/Bulgaria_country_report_final_07-03-2007.pdf
14. eHealth in Eastern Mediterranean, Regional Telemedicine Workshop: From Telemedicine to E-Health- Information and New Telecommunication Technologies as a Tool to Improve the Health Services in Developing Countries, (Cairo, Egypt 18-20 December 2001), http://www.emro.who.int/his/ehealth/Meetings-ITU.htm
15. Whitten P., Steinfield C., Hellmich S., eHealth: Market Potential and Business Strategies, Department of Telecommunications, Michigan State University, USA, Viewed on 23rd December 2008, http://jcmc.indiana.edu/vol6/issue4/whitten.html
16. ICT Results, Getting eHealth to live up to its promise, Viewed on 23rd December 2008, <>
17. eHealth Risk, eHealth Business Risk, Viewed on 23rd December 2008,
18. eHealth, New HER Business Model, Viewed on 23rd December 2008, <>
19. Lin C., Wireless Differentiates eRemote Home Health Care, 2006 eHealth Forum 2006-Building a Healthy Tomorrow Using IT, Viewed on 24th December 2008, http://www.ehealth.org.hk/Speaker/Dr%20CHIH%20Lin%20I.pdf
20. eHealth Impact, Study on Economic Impact of eHealth, Viewed on 23rd December 2008, <>
21. Europe’s Information Society, Studies on eHealth Issues, Viewed on 23rd December 2008, http://ec.europa.eu/information_society/activities/health/studies/index_en.htm
22. Europe’s Information Society, Ongoing Studies on eHealth Issues, Viewed on 23rd December 2008, http://ec.europa.eu/information_society/activities/health/studies/ongoing/index_en.htm
23. eHealth Study of the Month, Legally eHealth, February, 2007, Making clear the legal and regulatory context of eHealth, viewed on 23rd December 2008
24. Wickramasinghe Y, et al (2009) BudhuDas: An eHealth Business Model for Emerging Countries
25. Dinusha V, et al (2009) A Mobile eHealth Solution for Patients in Emerging Countries
26. Wijethilake D, et al (2009) A Change Management Methodology for eHealth Applications in the Developing World.

Risk Analysis for the London Ambulance Service's Computer Aided Dispatch System (LASCAD)

Overview

By mid-morning October 27th 2002 LASCAD became the top story of BBC. The cause for this was the LASCAD failed to process the telephone calls that sought immediate ambulatory assistance to get the patients to hospitals. The reports said, many patients were in a moribund state by the time the ambulances reached them. And some even had to experience the irrecoverable loss - the unfortunate demise.

So the reason for such a disastrous situation was the authorities failed to incorporate popper Risk Management, Contingency Planning and Disaster Recovery Strategies. This, post would hence provide an overview of the LASCAD phenomena in the Risk Management Perspective.

Fundamentally, any project is recommended to consider Risks in terms of:

• Risk Identification
• Risk Analysis
• Risk Planning
• Risk Trackging
• Control Measures
• Communication

Let us now see how LASCAD system would have prevented such a disastrous situation being realized in terms of Risk Management, Impact Analysis and Disaster Recovery.

Risk Management

In the Risk Management the rule of thumb is to first identify the Assets, Threats and Vulnerabilities associated with the organization and its Business Processes.

A. Asset Identification

• Information Assets - Medical Data, Caller Details, Ambulance Details, etc
• Paper Documents - Disclaimers, etc
• Physical Assets - Medical Equipment, Ambulances, etc
• Software - IS
• People- Patients, LAS Management, Headquarter Staff (esp. people in the Control Room) and Ambulance Staff
• Reputation - Reliability of LASCAD, Medical Data Protection

B. Threat Identification

• Technical - Hardware and Software
• Human - Sabotage, Human Error, Hostility towards the IS, Friction between the Management and the subordinates, Vague Objectives, Personal Agendas, etc
• Natural - Flood, Thundering, etc

C. Vulnerability Identification

• Absence of Medical Staff
• Unstable Network Connectivity
• Transmission over unprotected Communication Channels
• Budgetary Mishaps
• Natural Disasters

Impact Analysis

It is noted that when the LASCAD failed, they had a lot of trouble in switching to their backup system. There they failed to continuer their organizational operations smoothly. According to the Risk Assessment Framework by Wilcocks and Margettes 6 elements had been taken into consideration in the LASCAD failure.

• History: Prior Organizational Developments (Prior IS Success/Failure)
• Outer Context: Government, the Economy, Markets, etc
• Inner Context: Characteristics of the Organization (Strategy, Structure, Reward System)
• Content: Changes involved (Size of Project, Difficulty)
• Processes: How things are done and possible issues (Project Management, Staffing, Change Management Practices)
• Outcomes: Planned or unanticipated (Cost, Time, etc)

Business Continuity Management (BCM)

The developers of the LASCAD would have considered the following points in BC in the face of a disaster.

• Options (Cost to Implement,MTPoD, Consequences in Interruption, etc)
• People (Patients, LAS Staff, etc)
• Premises (Ambulance Depot, Control Centers, etc)
• Technology (IS, OROIN Standards over Project Management (PRINCE) )
• Information (Call Taking, Resource Identification, Resource Mobilization, Resource Management and Management Information)
• Supplies (multiple suppliers that can compensate amongst each other)
• Stakeholders (Patients, Staff, Media, etc)

Further, they would have crafted a comprehensive BCM response strategy that they should have periodically exercised and tested so as to improve their BCM response. So they would have easily switched over to their backup system when the LASCAD phenomena occurred.

Disaster Recovery

In conclusion they should have practiced the following strategies in quickly recovering from such a scenario:

• Properly documented Disaster Recovery Strategy
• Periodic Execution and Review of the Disaster Recovery Strategy
• Monitoring and Updating the executions
• Going up in the disaster recovery learning curve

BudhuDas: An eHealth Business Model for Emerging Countries

This Business Model was designed to identify the possibility of connecting a patient with his/her Consultant at a Health Institute (with close proximity to the patient’s residence) via internet. Thus, the consultant could be referred as an eConsultant where as the patient would be the ePatient. In this model the consultant would be given the privilege of choosing his location while conducting an eConsultation session. Further, BudhuDas will verify health institutes (or any other location) that can incorporate an eHealth solution so that the quality of service rendered by these health institutes can be enhanced to a greater extent.

BudhuDas will focus on mainly, technological economical, anthropological, legal, and stakeholder incentive-based (e.g. Patients, Doctors, Government, etc.) aspects in order to establish a sustainable eHealth model, in terms of an eCare Clinic (in the periphery) associated with an eConsultation Clinic (conducted by a Consultant). Consequently, this research was performed as an action research by collaborating with the Base Hospital, Maarawila SL, and District Hospital, Dankotuwa SL. Thus, this research was backed-up by a participatory approach.

A. Background Analysis

The background analysis is performed to verify, whether the selected health institute is capable of functioning as an eClinic or an eConsultation in terms of the Institute and its stakeholders based on the criteria defined in the Table 1.

Depending on the Background Analysis, it can be decided whether the selected Health Institute is capable of functioning as an eClinic or an eConsultation Center.

B. Sustainability Check

Next, the institute should be subject to an investigation (Table 2) to measure how capable the health institute is to implement the selected eHealth Institute Structure. This has to be done in four major factors namely:

· Economical – In order to get the eConsultation System running smoothly there should be financial support that needs to provide the Hardware, Software and Connectivity Support.

· Anthropological - Humans are by nature reluctant to change. Thus, before instigating any venture for the first time, you need to critically think through the Risks and Issues that rise in terms of the human aspect.

· Technological – There should be adequate technological support to commence an eConsultation Center and an eClinic in Health Institutes in terms of

o Hardware – Depending on the Financial Provisions and Quality of Service needed there is an array of hardware solutions that can be used to connect the Consultant/Doctor to the system via internet specified in the Table 3

o Software – It is advisable to use open source technologies for both system and application software as this model emphasizes on Emerging Country Contexts, where lack of financial support persists in acquiring and maintaining Licensed Software.

o Internet Connectivity – In order to connect the eConsultant (eConsultation Center/a place defined by the Consultant) with the ePatient (eClinic) there could be various technologies that can be used with at least 512Mbps Downlink and an Uplink

· Legal - In order to implement a patient safety system, the legal implications should be given a comprehensive attention. These can be performed by crafting a Policy, Terms & Conditions that should be considered when using the system and the Disclaimers for the System Users as well as Patients that would be registered in the system.

After considering all the factors mentioned above, you can decide the applicability of an eConsultant and an ePatient in a selected environment.

Table 1 : Selection of a location as an eClinic/eConsultation Center

Background Category	Criterion	eClinic	eConsultation Center
Institution	Location	District Hospital or below	Base Hospital or above*
	Hospital Infrastructure	A room to conduct the eClinic, Table Chairs (for Doctor and Patient), Bed, & Medical equipment	A room to conduct the eConsultation Center, Table and a Chair (for the Consultant)
	Draining Area of the health institute	An exclusive coverage	A coverage that can be compensated by nearby secondary health institutes
	Neighboring Health Institutes and their corresponding health institute categories	The presence of Higher level Health Institutes	The presence of Lower level Health Institutes
Stakeholder(s)	The head of the institute	Supportive	Supportive
	Staff and the organizational structure of the institute	Presence of Doctors willing to assist patients during an eConsultation Session	Presence of a Consultant willing to provide a consultation via the internet
	Designations above the head of the institute	Supportive	Supportive
	Partners of the Institute	Supportive	Supportive
	Pharmacies and Laboratories that operate outside the health institute	Better	Not Applicable

*An eConsultant could choose a location that he would be comfortable in conducting an eConsultation session

Table 2 : Selection of eClinic/eConsultation Center

Sustainability Factor	Criterion	eClinic	eConsultation Center
Economics	Provisions to buy one of the options mentioned under the Table 3	Major	Major
	Provisions to maintain computer equipment used for the eConsultation Session	Moderate	Moderate
	Provisions to receive internet connection	Major	Major
	The average cost reduction of an existing patient in opting to come to an eClinic	N/A	Major
Anthropological	Fear of losing existing occupation	Major	Major
	Fear of using Computers at work
	Feeling inferior in using Computers (compared to individual expertise)	Moderate	Moderate
	The fear of losing the dignity in case of a system implementation failure	Major	Major
	Feeling superior to professionals in other domains, thus decline to support the initiative	Moderate	Moderate
	Dissuade superiors, colleagues and subordinates in supporting the system	Moderate	Critical
	Pessimism of the Organizational Head	Major	Major
	Reject adopting to new methods to perform day-to-day tasks	Minor	Minor
Technological	Managing Hardware Failure	Moderate	Moderate
	Managing Hardware being Outdated	Minor	Minor
	Managing Software Failure	Major	Major
	Managing Software being outdated	Moderate	Moderate
	Managing Connectivity Failure	Major	Moderate
	Managing Connectivity Upgrades	Moderate	Minor
Legal	eHealth Policy to use the system and conduct eConsultation	Major	Major
	Terms & Conditions to use the system and conduct eConsultation	Major	Major
	Disclaimer form for the System Users	Major	Major
	Disclaimer form for the Patients in safeguarding Medical History	Major	Major

Table 3 : Hardware Solutions

Quality	Hardware Solution	Cost Effectiveness
	Personal Digital Assistant (PDA)
	Atom Computer
	Notebook
	Single Monitor - Single Machine (with a Webcam, a Sound System and a Microphone)
	Twin Monitor – Single Machine (with a Webcam, a Sound System and a Microphone)
	Single Monitor – Twin Machines (with a Webcam, a Sound System and a Microphone)
	Single Machine with 21” Flat Panel