How can health care organizations create value? : business model explorations

Background: The Triple Aim posits that health care should strive to improve patient experience, improve population health, and maintain or lower costs. However, most organizations are not organized to achieve the Triple Aim. Attempts to improve the ability of health care organizations to deliver increased value through the introduction of management concepts, most recently Value-based Health Care (VBHC), have led to the emergence of a pattern of pseudoinnovation, where concepts are frequently replaced with similar content, but in new “packaging”. This suggests that organizations and their ability to adapt to their environment and integrate new management concepts could potentially be explored by looking at how the concepts themselves are understood and at how organizations deliver care. In management terms, the latter can be described as the business model (i.e., how an organization creates, delivers, and captures value). Aim: The overall aim of this thesis is to understand how management concepts about value are understood and to explore how health care organizations in a publicly financed health care system are organized so that they create, deliver, and capture value. Methodology: In Study I, citation registry data and literature were sequentially analyzed qualitatively and quantitatively to assess diffusion and understanding of VBHC as a nascent management concept in the literature. Study II, a systematic review, employed an explanatory synthesis approach to understand how business model frameworks have been applied in health care. Studies III and IV apply the Business Model Canvas (BMC) framework in a deductive content analysis of interviews with top managers (Study III) and with multiple data sources (Study IV) to conceptualize a hospital business model and to compare perinatal clinics’ business models in a publicly financed, Swedish health care setting. Findings: VBHC and business model frameworks are commonly and increasingly used to improve value in health care. VBHC is superficially understood in the literature (Study I). Business model frameworks are primarily applied in e-health. They include a broad range of elements and have been used to identify essential elements, assess finances, and classify, analyze, develop, and evaluate organizations (Study II). Managers conceptualized the hospital business model differently, primarily related to customer segments. A tension between espoused and de facto value propositions was identified (Study III). Four distinct perinatal business models were identified within the same regional health system (New Thinkers, a Local Service Provider, Continuous Capacity Keepers, and a Hybrid) (Study IV). Conclusions: The superficial understanding of VBHC and the ambiguity and lack of empirical data in business model applications risk diluting the potential benefits of both these management approaches. The multiple, co-existing business models within the same organization or health care system raise questions about how organizations are aligned and how we should view the role of different stakeholders in creating, delivering, and capturing value

Arquiteturas federadas para integração de dados biomédicos

Doutoramento Ciências da ComputaçãoThe last decades have been characterized by a continuous adoption of IT solutions in the healthcare sector, which resulted in the proliferation of tremendous amounts of data over heterogeneous systems. Distinct data types are currently generated, manipulated, and stored, in the several institutions where patients are treated. The data sharing and an integrated access to this information will allow extracting relevant knowledge that can lead to better diagnostics and treatments. This thesis proposes new integration models for gathering information and extracting knowledge from multiple and heterogeneous biomedical sources. The scenario complexity led us to split the integration problem according to the data type and to the usage specificity. The first contribution is a cloud-based architecture for exchanging medical imaging services. It offers a simplified registration mechanism for providers and services, promotes remote data access, and facilitates the integration of distributed data sources. Moreover, it is compliant with international standards, ensuring the platform interoperability with current medical imaging devices. The second proposal is a sensor-based architecture for integration of electronic health records. It follows a federated integration model and aims to provide a scalable solution to search and retrieve data from multiple information systems. The last contribution is an open architecture for gathering patient-level data from disperse and heterogeneous databases. All the proposed solutions were deployed and validated in real world use cases.A adoção sucessiva das tecnologias de comunicação e de informação na área da saúde tem permitido um aumento na diversidade e na qualidade dos serviços prestados, mas, ao mesmo tempo, tem gerado uma enorme quantidade de dados, cujo valor científico está ainda por explorar. A partilha e o acesso integrado a esta informação poderá permitir a identificação de novas descobertas que possam conduzir a melhores diagnósticos e a melhores tratamentos clínicos. Esta tese propõe novos modelos de integração e de exploração de dados com vista à extração de conhecimento biomédico a partir de múltiplas fontes de dados. A primeira contribuição é uma arquitetura baseada em nuvem para partilha de serviços de imagem médica. Esta solução oferece um mecanismo de registo simplificado para fornecedores e serviços, permitindo o acesso remoto e facilitando a integração de diferentes fontes de dados. A segunda proposta é uma arquitetura baseada em sensores para integração de registos electrónicos de pacientes. Esta estratégia segue um modelo de integração federado e tem como objetivo fornecer uma solução escalável que permita a pesquisa em múltiplos sistemas de informação. Finalmente, o terceiro contributo é um sistema aberto para disponibilizar dados de pacientes num contexto europeu. Todas as soluções foram implementadas e validadas em cenários reais

Quality framework for semantic interoperability in health informatics: definition and implementation

Aligned with the increased adoption of Electronic Health Record (EHR) systems, it is recognized that semantic interoperability provides benefits for promoting patient safety and continuity of care. This thesis proposes a framework of quality metrics and recommendations for developing semantic interoperability resources specially focused on clinical information models, which are defined as formal specifications of structure and semantics for representing EHR information for a specific domain or use case. This research started with an exploratory stage that performed a systematic literature review with an international survey about the clinical information modelling best practice and barriers. The results obtained were used to define a set of quality models that were validated through Delphi study methodologies and end user survey, and also compared with related quality standards in those areas that standardization bodies had a related work programme. According to the obtained research results, the defined framework is based in the following models: Development process quality model: evaluates the alignment with the best practice in clinical information modelling and defines metrics for evaluating the tools applied as part of this process. Product quality model: evaluates the semantic interoperability capabilities of clinical information models based on the defined meta-data, data elements and terminology bindings. Quality in use model: evaluates the suitability of adopting semantic interoperability resources by end users in their local projects and organisations. Finally, the quality in use model was implemented within the European Interoperability Asset register developed by the EXPAND project with the aim of applying this quality model in a broader scope to contain any relevant material for guiding the definition, development and implementation of interoperable eHealth systems in our continent. Several European projects already expressed interest in using the register, which will now be sustained by the European Institute for Innovation through Health Data