Telemedicine in Europe: Are we Addressing the Right Business Models?

Transcription

1 EHMA Annual Conference, Birmingham June 2014: Leadership healthcare: from bedside to board Telemedicine in Europe: Are we Addressing the Right Business Models? Prof. Luís Velez Lapão MOMEMTUM Team 24 June 2014

2 AGENDA The challenge: steering telemedicine from pilot to routine Momentum project Momentum Critical Success Factors To have a Business plan or not: that is the question Conclusion

3 For decades many telemedicine projects, mainly within pilot or research context, were deployed Although the hype and the proven fact that it adds both clinical and economic value, the reality is that most cases did not reach routine care There are many reasons, most often due to the lack of a proper business-model The MOMENTUM project, a thematic-network partially funded by the European-Commission, coordinated by EHTEL, and with a deep involvement of EHMA is addressing this problem

4 TELEMEDICINE S WAVES OF DEVELOPMENT First Wave Second Wave Third Wave Timeframe 60 s-70 s Early 90 s to present Coming decade Emphasis Feasibility Clinical Development Services Integration Scope Very limited Fringe populations Mainstream Care Delivery Nature Video links + Instrumentation + Informatics Business Models

5 HEALTHCARE SERVICES: PARADIGM CHANGE Product centred model Patient centred model

6 The methodology - Literature Review - The survey was applied in almost all European countries to identify Telemedicine development barriers and opportunities - A set of good examples was chosen for further study, with the focus on business-models issues. - Business-models used by these cases were analysed to enable proper analysis; and - to identify barriers and the necessary steps required to support the leap to routine care.

7 THE CHALLENGE FOR DEVELOPING ehealth AND TELEMEDICINE SERVICES This is about changing from Data to services Data collection to data integration in processes Tools to process redesign / new care pathways If not, then one get the equation: New Technology + Old System = New Old System 7

8 TOOLS AND METHODS ARE REQUIRED FOR DEPLOYING SERVICES Impact assessment framework The results and lessons learned from Renewing Health The approach of United4Health and Engaged Guidelines for large scale deployment The blueprint of Momentum Business development tool kit Innovation Governance 8

9 THE PROJECT MOMENTUM A CIP ICT-PSP thematic network Running from February 2012 until January 2015 The consortium: 21 organisations Telemedicine associations / competence centres from Denmark, United Kingdom, Estonia, Norway, Spain, France, Sweden, Germany, Greece, Poland, Portugal and Switzerland European stakeholder associations representing Health professionals and health care organisations, health insurers, technology vendors A growing network of partners 9

10 THE SECRET? FROM PILOT TO ROUTINE CARE A European Telemedicine deployment Blueprint 10

11 Highlights FOR DISCUSSION Legal, Regulatory Security Strategy Manageme nt Organisati on Change Mgmt. Technical Market relations The initiative is local and the initiating body is responsible for the whole process. Success is greater when healthcare value is perceived. Legislation or lack of it does not seem to be a critical success factor. Presence or absence of national policy does not seem to be a critical success factor. It is important to determine what the critical success factors are. 11

12 Manageme Highlights FOR DISCUSSION nt Organisati on Change Mgmt. Legal, Regulatory Security Strategy Technical Market relations It is about innovative people, not organisation. It is about the service, not technology. The success depends more on the involvement of department management team than top-level management team. Involvement of doctors and nurses is a key factor. There should always be present an alternative for telemedicine. 12

13 Manageme Highlights FOR DISCUSSION nt Organisati on Change Mgmt. Legal, Regulatory Security Strategy Technical Market relations Legal limitations are exaggerated. Lack of clarity concerning reimbursement is the real problem. Consent: Telemedicine services are so special that a separate consent is necessary in addition to the general consent to medical treatment given from the patient Data security: Skills in privacy and information security are not good enough when so many of the respondents are unaware of who is responsible for data security of their telemedicine service. 13

14 Manageme Highlights FOR DISCUSSION nt Organisati on Change Mgmt. Legal, Regulatory Security Strategy Technical Market relations The core infrastructure alone is not enough to ensure effective service delivery. Majority of current systems have no integration with other systems". Interoperability was cited as a barrier by 47% of the case studies (literature) and > 50% in MOMENTUM Integrated care: IDs valid across organisation borders only in 6 cases 14

15 CRITICAL SUCCESS FACTORS Strategy Management CRITICAL SUCCESS FACTORS FOR DEPLOYMENT STRATEGY Legal, Regulatory Security Organisation Change Mgmt. Technical Market relations 1. Check that there is cultural readiness towards telemedicine and the need to change the way to care. 2. Ensure leadership through a champion. 3. Create a community consensus on the compelling need to address 4. Put together the resources needed for deployment. 15

16 CRITICAL SUCCESS FACTORS Strategy Management CRITICAL SUCCESS FACTORS FOR ORGANISATIONAL CHANGE Legal, Regulatory Security Organisation Change Mgmt. Technical Market relations 5. Address the needs of the primary client(s). 6. Involve health care professionals and decisionmakers. 7. Prepare and implement a financial plan. 8. Prepare and implement a change management plan. 9. Put the patient at the centre of the service. 16

17 CRITICAL SUCCESS FACTORS CRITICAL SUCCESS FACTORS FOR LEGAL, REGULATORY AND SECURITY COMPLIANCE Legal, Regulatory Security Strategy Management Organisation Change Mgmt. Technical Market relations 10. Establish the conditions under which the service is legal. 11. Seek for advice from legal, ethical, privacy and security experts. 12. Seek for relevant legal and security operational guidelines to help setting the service up 13. Ensure that telemedicine doers and users have privacy awareness. 17

18 CRITICAL SUCCESS FACTORS Strategy Management CRITICAL SUCCESS FACTORS FOR TECHNOLOGY DECISIONS AND PROCUREMENT Legal, Regulatory Security Organisation Change Mgmt. Technical Market relations 14. Ensure that the IT and ehealth infrastructures needed are in place. 15. Ensure that the technology is user-friendly. 16. Put in place the technology and processes required to monitor the service. 17. Maintain good procurement practices. 18. Guarantee that the technology has the potential for scale-up (i.e., think big ). 18

19 HYPOTHESIS: PREPARE AND IMPLEMENT A BUSINESS PLAN IS THE MOST SIGNIFICANT CRITICAL SUCCESS FACTOR FOR TELEMEDICINE TO GO Business plan FROM will PILOT help to TO define ROUTINE clearly CARE the TM service objectives and value for each stakeholder. - All the costs are also analyzed and a cost-benefit analysis is done to check for the validity of the investment required; - Additionally a timetable is defined and validated by all stakeholders (including patients and health professionals); 19

20 BUSINESS PLAN: What is It? A written document (the result from careful analysis of data) describing the nature of the planned telemedicine service: the service/sales and marketing strategy, The team and skills required, the financial background, containing a projected profit and loss statement Business plan for the new service has to be in place also in case the service is provided by the non-profit or governmental organisations 20

21 CHARACTERISTICS OF A BUSINESS PLAN Written business plan describes: new telemedicine service (access, information flow, people required, patients, etc.), business model (resources used, payments, incentives, service levels, etc.), Competition analysis, projections and milestones, and analysis of the market Engage health professionals, managers, technicians, and patients (e.g., testing usability and validating requirements) 21

22 WRITING A BUSINESS PLAN IS A HARD BUT A NECESSARY EXERCISE Demand estimation Healthcare professional cost Costs Telemedicine provider cost Device cost Logistic commercial cost Interoperability cost Device supplying Our assumptions Revenues from each service Investments Profit Loss Cash Flows

23 THE MOST FREQUENT TELEMEDICINE FAILURE REASONS WERE IDENTIFIED Lack of clear objectives (confusion between services and technology); Lack of leadership and coordination; Lack of proper business training; Lack of business models (benefits estimation, incentives, reimbursing schema, etc.); Lack of integration with the routine services. Additionally, it was found that this is both a private and public health services phenomenon, as it is an European problem.

24 HOWEVER, I ALSO FOUND SOME MISSLEADING INTERPRETATIONS OF THE REALITY From the successful cases analysed there are mainly two different situations: the TM services is the continuity of previous services: only using TM to extend it, like radiology/haemodialysis; or, TM services is integrated in healthcare networks simply assumed as beneficial. The existence of a business plan or reimbursing schemes supporting the decisions are rare; Most of the TM project coordinators believe in their nonexistent business-models, probably feeling that with more time and experience an innovative business-model will emerge

25 Discussion MOMENTUM IS SHOWING THE IMPORTANCE OF MANAGEMENT, LEADERSHIP AND BUSINESS MODELS IN THE DEVELOPMENT OF TELEMEDICINE SERVICES - However, are we sure to have the managers with the right skills to address the challenges of launching TM services? - Are business-models incorporating real value? - How can TM make it possible?

26 IN CONCLUSION Legal, Regulatory Security Strategy Manageme nt Organisati on Change Mgmt. Technical Market relations We are learning a lot about telemedicine deployment from the information collected through questionnaires and from the stakeholder groups But we still lack more information to know if the highlights are correct The MOMENTUM Blueprint will not be the solution that truly escalates telemedicine deployment, but the MOMENTUM blueprint will be a valuable contribution and tool to maximise the current momentum for telemedicine deployment in Europe. 26

27 THANK YOU! You want to know more: You have implementation experience to share: You want to follow-up our activities: 27

28 WHO Collaborating Center for Health Workforce, Policy and Planning Instituto de Higiene e Medicina Tropical Universidade Nova de Lisboa Obrigado! luis.lapao@ihmt.unl.pt