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