Services Engineering and Management Summer School, Helsinki University of Technology, August 28-September 2

This digest was created in real-time during the meeting, based on the speaker's presentation(s) and comments from the audience. The content should not be viewed as an official transcript of the meeting, but only as an interpretation by a single individual. Lapses, grammatical errors, and typing mistakes may not have been corrected. Questions about content should be directed to the originator. The digest has been made available for purposes of scholarship, posted on the Coevolving Innovations web site by David Ing.

Karita Ilvonen, Helsinki University of Technology

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(Came in a few minutes late, a few slides in)

Started studying Palo Alto Research Foundation

• Do patients get more out of ICT in primary care?
• The current healthcare paradigm has been to add resources, and now there is no more resources to add
• Can ICT help create new system of innovation?
• What part of healthcare can be taken online?

Drivers for online healthcare

• Electronic Healthcare Records in the USA
  • State levels: Regional Healthcare
  • Local and regional have done EHRs
• Personal records locking onto one part of a regional record
• Connection to 
• Hurricanes Katrina and Rita, had to take the patients out, but most of the servers were in the lower floors, and then don't have records, and they're only in one place.
• A case for servers on the Internet

U.S. health care is 13.6% (compared to 7% in Finland with good health care), will to go to 23% by 2010

• Some reduction in costs, but aging, and obesity with increasing number of diabetics
• Consumerism and medical breakthroughs are expensive, they like newest technology
• Want to lower costs

Healthcare Operations Management

• Analysis, planning and control
• Products can be defined by specialty of patients, e.g. outpatient care
• Further subdividing: diabetics
• Gaze: consultation

Healthcare processes by Paul Lillrand

• Care episodes

Online service delivery in healthcare

• Internet is almost everywhere in the U.S.
• Including rural, will be in almost every library.
• Few access via mobile phone, different from Finland.
• Lots of health care data, but currency/date and source are not notated, concerns on quality.

Patient Health Records

• An electronic application, wher eindividuals can access themselves
• Similar to banking, except doctor's visits, results from lab
• Messaging: secure, encrypted e-mail over a specific application
• Also link remote patient technologies: diagnostics, monitoring, consultation (videoconferencing, avoiding phone tag)
• Non-clinical support functions, e.g. online appointment scheduling

There are different models for PHR, talking about PHR out of EHR

• There's also models where you write it up yourself, or your health insurance company keeping records.

PHRs:

• More informed, more empowered patients.
• Typical way of providing messages: where specific words are highlighted, e.g. diabetes with a link to trusted information
• Safer than e-mail through work or Hotmail accounts
• Still lacking a business case, not incentive for Finnish or European use, as not access to health outcomes
• Study by Mayo Clinic that show that people leaving a hospital, 62% don't know the use of their prescriptions, 86% don't know side effects, 58% didn't know their diagnosis.
  • PHR could provide all of this
• Found that the older people do use the Internet, up to 80 years old
• Palo Alto, average patient using is 64
• Messaging can be async, that allows doctors to reply when they have time
  • If a patient takes 10 minutes of a 20 minute appointment, have time
  • Only non-urgent information
• PWC 1999 study says access to e-mail would reduce in-office visits by 20%
  • Doctors could be reimbursed for online messages
  • Why would you want to spend time with patients that don't need urgent care?

Palo Alto patients pay $60, doctors in the study did it out of goodwill

Lillrand: Most businesses would like to increase demand. Health care is different. Fixed costs might cause overconsumption.  But pay as you go raises equity issues.

• Alok: Delco cost per employee is about $65.  Employee gets $28/hour, health care provider gets $25.

Had data on 15,000 patients, chose diabetic patients of 127 for 12 months before and 12 months after intervention

• Control: patients that don't have Internet
• Second group: some that have access, but not messaging
• Heavy users

Messaging patients have more chronic patients, need the service more, potentially replacing visits with messaging

• Number of visits flatten out, at a higher level, rather than continuing to trend up
• Messages: after intervention, have a kick the tire effect, initially higher demand for the first 4 months, then goes down to one message per month

Physician survey

Asked physicians for estimates on how long it takes them to do a function

• On average, phone call takes 5 to 7 minutes or above
• Online results or prescriptions could be done in a minute or less
• Messaging improves quality of care: better access to health care, better lab results, better disease management

Today and future

• Static health content --> Test results
• Appointment requests --> direct scheduling, like airlines
• --> more information online
• Possible for someone to take photos of everything that they've eaten that day
• Asynch advise --> real time chat
• Unstructured e-mail --> Patient-physician messaging
• Generic content --> personal illness content

Future:

• Need to be able to migrate, as people move
• Automatic algorithms to devices in home
• Aim to increase national security

[Question]

Service innovaiton. Driver?

• Started before born
• Demand driven, by people who want to get better access to providers

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