A Business Model for Digital Healthcare Environments: An Organic
Approach and a Use Case for Handling Cognitive Impairment
Andrea Pistorio
1
, Paolo Locatelli
2
, Federica Cirilli
2
, Luca Gastaldi
1
and Simona Solvi
1
1
Department of Management Engineering, Politecnico di Milano, Milan, Italy
2
Fondazione Politecnico di Milano, Milan, Italy
Keywords: Healthcare Services, Business Models, Service Models, Digital Solutions, Cognitive Impairment.
Abstract: Ageing has significant impacts on the organization of healthcare systems and on social inclusion—especially
for elderly people affected by Cognitive Impairment (CI). These people are significantly exposed to
undeniable risks that can affect their health and wellbeing (falling, malnutrition, hygiene issues, etc.) –
especially when living alone. This paper defines a Business Model (BM) allowing independent living for
elderly people affected by CI. This BM include: (i) an up-to-date, modular, flexible and scalable
organizational model describing the activities to be accomplished by regulators and service suppliers; and (ii)
a digital platform based on innovative and easy-to-replicate information and communication technologies.
The organic approach to the development of the BM is then focused in an Italian use case as a part of “DECI”,
a “Horizon 2020” project with four pilot projects in Israel, Italy, Spain and Sweden.
1 INTRODUCTION
The prevalence of Cognitive Impairment (CI) in
elderly patients is one of the key issues in Western
Countries since it involves loss of memory, cognitive
slow down, aphasia, apraxia, sensorial and movement
deficit, personality and mood disorders (Alexander et
al. 2015; Rizzi et al. 2014). The elderly people with
cognitive limits - especially those living in solitude -
are significantly exposed to undeniable risks for their
own safety: falling, malnutrition or unhealthy nutri-
tion, hygiene issues due to lack of mobility, isolation
and depression (Alzheimer’s Association 2016).
The needs of these patients range from daily aid
to dedicated medical assistance (Alzheimer’s
Association 2016; Miranda-Castillo et al. 2013).
Though digital technologies can be one key lever to
answer these needs, most of current solutions are
immature for mass implementation.
In this context, the goal of this paper is to define a
Business Model (BM) for supplying assistive services
to elderly people affected by CI. This BM will
include: (i) an up-to-date, modular, flexible and
scalable organisational model describing the roles
and the activities to be accomplished by policy
makers and service suppliers; and (ii) a digital
platform based on innovative and easy-to-replicate
Information and Communication Technologies (ICT)
streamlining and simplifying the flow of information
and the communication among the various key
stakeholders.
2 METHODS
This paper is based on DECI – Digital Environments
for Cognitive Inclusion – a project funded by the
European Commission under the Horizon 2020
program (grant agreement No 643588) that is aimed
at improving a healthy lifestyle for elderly people
affected by CI, passing through a system monitoring
vital signs, treating and managing diseases (Locatelli
et al. 2015).
DECI Consortium is led by Fondazione
Politecnico di Milano (Italy) and involves partners
from five different countries (Italy, Sweden, Spain,
Israel and The Netherlands). The consortium merges
academic and research competences, care and social-
care providers, healthcare authorities, ICT industry
and their broad network of stakeholders. Four pilots,
involving 100 to 250 patients each, will allow
assessing the feasibility, the effectiveness and the
potential economic benefits of the proposed measures
340
Pistorio A., Locatelli P., Cirilli F., Gastaldi L. and Solvi S.
A Business Model for Digital Healthcare Environments: An Organic Approach and a Use Case for Handling Cognitive Impairment.
DOI: 10.5220/0006168803400347
In Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2017), pages 340-347
ISBN: 978-989-758-213-4
Copyright
c
2017 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
within specific local healthcare systems and real-life
environments in Israel, Italy, Spain and Sweden.
The overall research process followed to develop
the BM as well as the related processes encompassed
three subsequent phases that are depicted in Figure 1
and described in the following paragraphs.
Figure 1: Research process.
2.1 First Phase
A literature review has been conducted to identify the
most relevant articles dealing with the state of the art,
good practices and trends related to the digital
solutions for assisting elderly people with CI. The
analysis of these articles allowed producing a general
BM to focus the main variables that increase the
likelihood of providing effective digital services.
Web of Science and Google Scholar have
been used to research the articles. The literature has
been analysed according to two complementary
frameworks.
Initially, we relied on the STOF framework
(Bouwman et al. 2008), which provides an overall
picture of a BM from four interrelated perspectives—
service, technology, organization and finance.
Next, we progressively deepened each insight
through the Business Model Canvas (BMC) frame-
work (Osterwalder and Pigneur, 2010), which
allowed focusing on key design elements.
2.2 Second Phase
The second phase of the research was based on two
steps that allowed to obtain, starting from the general
BM developed through the first phase, the BM
Canvases
and, then, the Service Models (SMs) depicted in
Figure 1. BM
Canvases
represent the Country-specific
subsets of the elements included within the general
BM. SMs contain configurations mainly focused on
value propositions in all the considered Countries–
with an emphasis on common aspects to be exploited.
The first step is made through two tools: (i) the
Business Model Environment (BME) (Osterwalder &
Pigneur 2010); (ii) a Coherence Matrix (CM). On the
one hand, these tools have been used to reduce the
multitude of elements proposed in the general BM.
On the other hands, they allow prioritizing the
required activities for the implementation of the pilot
projects—distinguishing among relevant and
irrelevant elements.
The BME organizes and describes the key
contextual variables useful to synthetically
characterize each Country involved in the research,
according to the four macro-areas: (i) key trends; (ii)
macro-economic forces; (iii) industry forces; (iv)
market forces.
The CM has been developed by the research
group and is characterized by the following five
dimensions: (i) country; (ii) customer segment; (iii)
functionalities; (iv) actions to address the needs of the
patient and of the overall system; (v) relevance of the
specific need. The CM describes the underlying
interrelations among these dimensions and allows
discerning between: (a) coherent and incoherent pairs
functionality-action to address the need (i.e. need of
the patient or of the overall system); (b) relevant and
not relevant pairs functionality-action to address the
need; (c) Country-specific and common among
Country pairs functionality-action.
The second step allows switching from BM
Canvases
to SMs. It reduces the complexity of the vast number
of elements of the BM
Canvases
focusing on the key
building blocks of value proposition and customer
segments. The path between BM
Canvases
and SMs
requires to select the common value propositions
among all considered Countries (general SM), and to
consider also the peculiar aspects of the contexts
(Country-specific SMs). All the functionalities,
related to the pairs functionality-action have been
clustered according to two levels: the main target of
the solutions (i.e. patient, care provider, care pathway
plan) and technological functionalities.
2.3 Third Phase
SMs are implemented within the third phase of the
research project following a Business Process
Reengineering (Hammer, 1990; Champy, 2002)
BM
General
BM
Canvases
BM
Environment
Coherence
Matrix
General
Service
Model
Specific
Service
Models
Application
of
Service
Models
Business
Pro cess
Reengineering
A Business Model for Digital Healthcare Environments: An Organic Approach and a Use Case for Handling Cognitive Impairment
341
approach that includes the following phases: (1)
design of the care process model, which firstly
defines the macro-phases of a general care process for
CI patients. (2) analysis of the AS-IS process models
in each pilot site; (3) design of the TO-BE process
models in each pilot site, underlining the difference
between AS-IS and TO-BE process models. Conside-
ring also digital solutions (Locatelli et al. 2014).
3 RESULTS
This paragraph describes the results of the research.
Firstly, the outcomes of the literature analysis and the
evidences related to the STOF framework are
grouped into the 9 building blocks of the BMC
framework. Secondly, the results related to the
application of the BME and CM are presented.
3.1 General Business Model
The general BM is characterized by the following 9
building blocks. For each of them we report the main
results of the analysis of the literature accomplished.
1. Customer segments are convenient set of clients
with common needs, behaviours or attributes. Follo-
wing Petersen (2004), the main customer segments to
be considered in CI are the following: (i) patients with
dementia; (ii) patients with amnestic Mild CI (a-
MCI); (iii) patients with non-amnestic Mild CI (na-
MCI).
2. Value proposition is the reason why a customer
chooses one product and/or service. In CI domain, a
tool adopted to assess the various needs is the
Camberwell Assessment of Need for the Elderly
model (CANE) (Reynolds et al. 2000). The
application of the model highlights that patients with
dementia have more care needs than MCI patients.
Furthermore, there are several solutions for the
various actors involved into the care process.
3. Channels are the interfaces used to interact with
the customers in order to deliver a value proposition.
Literature shows that the main channels by which
care services are delivered to elderly people with CI
are the following: (i) caregiver; (ii) general physician;
(iii) healthcare specialist; (iv) healthcare structure.
4. Customer relationships regards how relating
with customer segments. Patients suffering from CI
tend to communicate with their caregivers or social
workers. These two support patients in adopting and
using any digital solution for providing enhanced
services. From the viewpoint of the actors involved in
the care process, many companies maintain online
most of their relationships with caregivers.
5. Revenue streams deal with the cash generated
from every customer segment. Following Stroetmann
et al. (2003), the main revenues for a digital solution
in CI domain are the following: (i) service paid by
insurance funds; (ii) service paid by governments;
(iii) service paid by the patient or by his
relatives/caregivers through out-of-pocket expenses.
Three groups of people or organizations pay for the
digital solution: (a) Business to Consumer (B2C): the
service is sold directly to the patient or his caregiver.
(b) Business to Public (B2P): the service is sold to
public entities i.e. local authorities, NHSs and
housing associations; (c) Business to Business (B2B):
the service is sold to private companies and, in some
countries, most of them are private medical insurance
companies. Furthermore, there could be the following
types of transactions between the provider of digital
solutions and the healthcare organization: (1)
healthcare organization purchases the entire system
(one-time capital investment); (2) healthcare
organization pays a license fee for each patient
connected to the system.
6. Key resources are the essential assets necessary
to create and offer the value proposition. From the
perspective of the patient suffering from CI, human
resources that will be crucial in the establishment of
the BM are health professional and caregivers (or the
social worker if the patient has not relatives that
support her) (Robert et al. 2013). The human resource
that is vital in the establishment of the BM is the
specialist of digital services through which assisting
people with CI (Kapadia et al. 2015). From the
standpoint of physical assets required to provide the
service, technologies play a key role both for the
patient and for the overall system (Kerssens et al.
2015; Robert et al. 2013; Bharucha et al. 2009). Other
key resources are patents, licenses and copyrights.
7. Key activities are actions that have to be
performed in order to create and offer a value
proposition. From the patient standpoint, the key
activities are related to her involvement: (i)
engagement of the patient; (ii) maintenance of the
relationship with the patient. From the stand point of
the actors involved in the care process, key activities
are related to the creation and sustainment of the
relationships among these key actors: (a) create the
connection between healthcare specialist and
caregiver/social worker; (b) maintenance of the
relationship between healthcare specialist and
caregivers/social workers. Following Ógáin and
Mountain (2015), these activities can be supported
through the contributions of governmental actors in
terms of: (c) national/regional awareness campaigns;
(d) financial incentives to healthcare organizations;
(e) financial incentives to healthcare specialist for the
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342
diagnosis of MCI and dementia; (f) financial
incentives to healthcare specialists and healthcare
organizations for the adoption of digital solutions to
treat MCI and dementia. Following Robert et al.
(2013), the key activities in the BM related to the
technology adopted are the following: (1) production
of the equipment and sensors; (2) selection of the
most appropriate technology/sensor; (3) installation
of technologies in patients’ home; (4) calibration of
the sensors.
8. Key partnerships refers to the network of
suppliers useful to improve the BM. Literature on CI
suggests that some key partnership for the BM could
be: (a) government; (b) research center/university; (c)
local regional community (Kapadia et al. 2015); (d)
private organizations (König et al. 2015); (e)
networks between the providers of digital solutions
and healthcare organizations.
9. Cost structure deals with relevant costs
characterizing a feasible BM. Literature suggests that
the main costs for a digital solution in the CI domain
are the following (Kapadia et al. 2015): (i) training
costs; (ii) personnel costs; (iii) installation and
maintenance costs; (iv) purchasing and
manufacturing costs; (v) customer service costs.
3.2 Business Model Canvases
The next steps of the research allowed to move from
the general BM to BM
Canvases
through the BME and
CM. BME allows to describe the context in which
BM will be implemented, considering the following
4 macro areas:
1. Key trends: (a) national socio-healthcare
system overview; (b) general government
expenditure on health; (c) private expenditure on
health; (d) “Out-of-pocket” expenditure; (e) per-
capita total expenditure on health (WHO 2015);
2. Macro-economic forces: (a) payment
mechanisms; (b) policies regarding the sources of
revenue and financial flow;
3. Industry forces: (a) balance between public and
private healthcare; (b) centralization vs.
decentralization (c) main actors of the NHS; (d)
number of health and social care integration hospitals
per 100.000 population (e) number of psychiatric
beds per million population (WHO 2015);
4. Market forces: (a) percentage of population
aged > 60 years compared to the overall population;
(b) life expectancy at age 60 (WHO 2015); (c)
estimated prevalence of dementia per 1.000
population (OECD 2015; Prince et al. 2013); (d)
percentage of population living in urban areas (WHO
2015); (e) population ICT readiness; (f) tendency to
informal care (Lupianez et al. 2013).
In addition to BME, the implementation of the
CM returns different combinations of coherent,
relevant and Country-specific technological
functionalities and actions to address patients’ needs.
The tool allows highlighting the value propositions to
focus the attention on while designing BM
Canvases
. The
synthesis of the findings related to BME and CM
allows defining the BM
Canvases
. The latter, though
grounded on already established frameworks (e.g.
Business Model Canvas, BME, etc.), take advantage
of the flexibility of the tools adopted to build them,
thus making them adaptable to the various possible
contexts (i.e. specificities of the various countries) or
other patients’ clusters different from those adopted
in this research.
3.3 Service Models
In order to design a general SM able to encase a value
proposition common to all the four countries involved
in DECI, the needs marked by clinicians as extremely
relevant
have been highlighted and clustered as follow:
N
1
. Diagnosis and assessment: (i) overall medical
condition; (ii) behavior and mood; (iii) assess the risk
of malnutrition; (iv) Activities of Daily Living
(ADL); (v) risk for falls.
N
2
. Patient psychological needs: (i) cognitive
stimulation; (ii) online cognitive training.
N
3
. Clinical team needs: (i) coordination of care;
(ii) clinical team information sharing; (iii) improve
diagnosis method; (iv) advising on deciding course of
action; (v) better access to and relevance of non-
pharmacological therapies; (vi) standardized care
pathway.
N
4
. Follow-up: (i) monitoring overall condition;
(ii) measurement of adherence and compliance of
patients to treatment; (iii) assess timely changes
evolving needs for social care support.
Starting from these clusters, it is possible to
cluster also the technological functionalities that
allow meeting these needs, and which are common to
all Countries. Regarding the patient layer, the
following 5 clusters
have been identified
(technological functionality in brackets):
TFP
1
. Patient’s status (monitoring): (i) automatic
remote-based measurement of patient’s blood
pressure; (ii) automatic remote-based measurement
of patient’s O
2
saturation; (iii) automatic provision
and submitting of questionnaires (of various nature,
including patient’s health status and to support
change detection) to care-involved subjects; (iv)
gathering on non-structured information on patient’s
health status from informal caregivers or social
caretakers; (v) evaluation and monitoring of cognitive
A Business Model for Digital Healthcare Environments: An Organic Approach and a Use Case for Handling Cognitive Impairment
343
skills and monitoring of decay curves and other
trends.
TFP
2
. Patient’s status (alert): automatic provision
of feedbacks and alerts on patients’ progresses or
deterioration.
TFP
3
. Patient’s status (communication-cognitive
stimulation): (i) cognitive games/exercises to
stimulate patients to preserve cognitive/ executive
functions; (ii) tele-consultation (tele-presence)
functionalities allowing patients and professionals to
communicate to each other visually.
TFP
4
. Patient’s Activities (alert): (i) automatic
provision of remote real-time feedback on patients’
activities, including non-pre-scheduled activities; (ii)
automatic provision of remote real-time patient-
tailored motivational messages based on patients’
activities, including non-pre-scheduled activities; (iii)
automatic provision of remote feedback on patients’
activities, building on long-time data analysis on
patients’ status.
TFP
5
. Patient’s Activities (monitoring): activity
monitoring through accelerometer for elderly
monitoring (also outdoor, with batch data download
once reconnected to base station): stand / sit / walk /
steps + intensity of activity; GPS-based patient
monitoring and structured health-based data
gathering for outdoor step counting or activity
monitoring (including detection of falls); registering
of pre-scheduled activities performed by the patient
(who is monitored real-time by sensors when
performing the activity).
TFP
6
. Patient’s status (storage and sharing
information): (i) activity monitoring through
accelerometer for elderly monitoring (also outdoor,
with batch data download once reconnected to base
station): stand / sit / walk / steps + intensity of
activity; (ii) GPS-based patient monitoring and
structured health-based data gathering for outdoor
step counting or activity monitoring (including
detection of falls); (iii) Registering of pre-scheduled
activities performed by the patient (patient is
monitored real-time by sensors when performing the
activity).
Regarding the actors involved in the care process,
the following 4 clusters
have been identified:
TFS
1
. Care providers (communication): informal
communication (messaging) among various actors
(e.g.: family members and doctors);
TFS
2
. Care providers (teamwork): enablement of
multidisciplinary teamwork across care providers,
doctors and informal caregivers (or some of these);
TFS
3
. Care pathway/treatment plan (monitoring):
coherence check between clinical
guidelines/protocols and data gathered as part of care
activities;
TFS
4
. Care pathway/treatment plan (sharing
information): sharing of a treatment plan among
caregivers, doctors and family members (or some of
these).
Combining the clusters of common relevant needs
with the clusters of common relevant functionalities,
it is possible to point out the match between the two
as number of notable crossings, in order to highlight
packages of SM common to all four countries.
3.4 Italian Service Model
An example of the intersection between the two
clusters and of the specificities of a Country is
provided regarding the Italian context. Starting from
the value proposition common to all the 4 countries,
the general SM is enriched with further specificities
related to the Italian Customer Segments.
Given Italian specific needs, further specific
elements of the Italian SM are available: (i)
immobility detection for elderly monitoring at home
(indoor) for patient physical needs; (ii) fall detection
for elderly monitoring at home (indoor) for patient
physical needs; (iii) trend analyses performed on data
gathered from various patients’ monitoring activities
for diagnosis and assessment & for caregivers needs;
(iv) registering of pre-scheduled activities performed
by the patient (patient is formally required to provide
a yes/no answer) for patient environmental needs &
for patient physical needs; (v) automatic reminder to
patients for the performing of a scheduled activity for
patient environmental needs & for patient physical
needs; (vi) availability of personalized and adaptable
remote-based training programs automatically
tailored on individual patient’s characteristics for
patient physical needs; (vii) drug management for
patient physical needs.
The functionalities clusters are enriched, for the
Italian case, as follow:
Patient's status (monitoring): (i) Immobility
detection for elderly monitoring at home (indoor); (ii)
Fall detection for elderly monitoring at home
(indoor);
Patient's activities (monitoring): (i) Trend
analyses performed on data gathered from various
patients’ monitoring activities; (ii) Registering of pre-
scheduled activities performed by the patient (patient
is formally required to provide a yes/no answer);
Patient’s Activities (alert): (i) Provision of
automatic reminder to patients for the performing of
a scheduled activity; (ii) Availability of personalized
and adaptable remote-based training programs
HEALTHINF 2017 - 10th International Conference on Health Informatics
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automatically tailored on individual patient’s
characteristics;
Care pathway/Treatment plan (monitoring): drug
management.
These packages complete the general SM, shaping
the Italian specific one.
The other building blocks are grouped as follows:
upstream building blocks (Key partners, Key
activities and Key resources), downstream building
blocks (Customer Relationships, Customer Segments
and Channels), and cost and revenues (Cost Structure
and Revenue Streams). The main impacts are:
Upstream building blocks: (i) Italian clinicians
consider the diagnosis and assessment crucial (GPs
should be involved for an early detection); (ii) given
clinical team needs, it is important to provide the
technological functionalities to the local health
authorities to the municipalities and to the case
service providers; (iii) the monitoring of the patient’s
status and activities meet all the 7 clusters of needs;
(iv) to provide automatic reminders to patients for the
performing of a scheduled activity is important to
personalize the service; (v) from the point of view of
the actors involved in the care process, is crucial to
enable multidisciplinary teamwork across local
health authorities, municipalities, case service
providers, informal caregivers and voluntary
associations.
Downstream building blocks: (1) from clinical
standpoint, patient physical needs, caregiver needs
and the ones regarding the patient environment are
considered relevant; (2) the caregiver has a central
role and must be engaged and informed about the
evolution of symptoms and disease; (3) personal
assistance based on human interaction should be
preferred to meet the patient psychological needs.
Cost and revenues: (a) Revenue Streams should
be a B2P and B2C mix: (a.i) B2P: some
functionalities, for example the ones for the storage
and sharing to external EMR or other care
management tools, should be funded from general
taxation; (a.ii) B2C: some services should be sold
directly to the patient or his caregiver, for example
the ones for monitoring the patient’s status or for the
cognitive stimulation; (b) Considering the central
role of the caregivers, their training costs must be
considered also to meet their needs.
3.5 Application of the Service Models
This paragraph is focused on the application of the
SMs in the Italian pilot site, through three steps: (1)
the design of a general Care Process Model for
patients affected by CI; (2) the analysis of the AS-IS
Process Models in each pilot site, and finally (3) the
design of the TO-BE Process Models in each pilot
site, starting from the Service Model resulted from
literature analysis.
3.5.1 Design of the Care Process Model
The analysis highlighted four common phases to
every care process for people with CI (Figure 2).
Figure 2: Care Process Model for patients affected by CI.
A. Noticing Symptoms and First Detection: this
phase includes the access point of the patient with CI
in the care process and it considers the first
identification of the patient with suspected CI.
B. Assessment and Diagnosis: clinical activities
aimed at the assessment and diagnosis of the CI in the
patient identified in the previous phase. The phase
includes: a first basic assessment of CI that can be
owned by the GP, the socio-health care provider or
external specialized physicians; and then, a
comprehensive assessment that is usually owned the
socio-health care provider, although some of the
requested exams are provided by external physicians.
C. Treatment and Care Service Definition:
analysis of the patient needs, both clinical (emerged
from the clinical assessment delivered in the previous
phase) and social needs (usually analysed with the
patient and the family with a social assistant). When
needs are defined, the care service is designed.
D. Service Delivery and Maintenance: delivery of
the care service designed and continuous monitoring
of the patient’s status.
3.5.2 Analysis of the as-IS Process Models
We will describe in detail the Italian process model,
in Palazzolo Institute of Fondazione Don Carlo
Gnocchi Onlus in Milano, following the four macro-
phases.
A. Noticing Symptoms and First Detection: the
process starts though a first meeting between patients
and physicians, like a check-up visit, or after an acute
episode in a long term care facility. The visit can be
owned by the GPs or specialized physicians (both
within Palazzolo Institute as well as external). Once
patients with certain kind of characteristics have been
identified during a physician’s visit, their path
continues in the care process.
A Business Model for Digital Healthcare Environments: An Organic Approach and a Use Case for Handling Cognitive Impairment
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B. Assessment and Diagnosis: in case there are
symptoms of CI, a basic assessment can be
performed. Note that usually the GP points out the
patient to specialists (at Palazzolo Institute or
externally). This initial assessment consists of a basic
examination of the patient with suspected CI, aimed
at understanding more regarding patients’ health
conditions and social situation. In case the basic
assessment strengthens the initial suspicion of CI, a
comprehensive assessment follows. At Palazzolo
Institute, for a comprehensive assessment, patients
can be referred to a specialized geriatrics unit, which
starts the assessment protocol aimed at reaching the
diagnosis.
C. Treatment and Care Service Definition: in
Italy, it is common that patients’ relatives or
caregivers take the responsibility for organizing the
care pathway of the patient. The care pathway can be
managed through the activation of home-based and
facility-based services, whose activation is discussed
together with the family.
D. Service Delivery and Maintenance: Palazzolo
Institute delivers an integrated socio-healthcare
service to patients affected by CI. During the service
delivery the patient is continuously monitored by the
professionals of the Institute.
3.5.3 Design of the to-BE Process Models
As regards the TO-BE process models, we will
describe in detail the differences between the Italian
AS-IS and the TO-BE process model. The
fundamental differences from AS-IS and the TO-BE
process models are linked to some new technologies,
which ensure the sharing of information among the
various actors enabling independent living.
A. Noticing Symptoms and First Detection: during
the visit, physicians visualise the patient’s medical
records on the DECI platform connected with the
databases of local hospitals and GP.
B. Assessment and Diagnosis: data collected by
the specialized geriatrics unit are entered in a tablet
and immediately shared (through a cloud service)
with the other stakeholders of the care network.
C. Treatment and Care Service Definition: A first
needs analysis can be performed by the
patient/caregiver filling in on-line questionnaire on
the DECI platform. Then a visit could confirm the
results of the questionnaire.
D. Service Delivery and Maintenance: A
wearable sensor could be used to detect abnormalities
in the level of activity and send alert messages to
family members or assistance operator. The GP and
specialists can share the information collected
through the DECI platform and plan together a
revision of the medication and treatment plan, and
schedule visits. The program can alternate sessions in
physical presence of the physiotherapist with tele
rehabilitation sessions. Some cognitive stimulation
and rehabilitation exercises could be done also at
home through the online platform. The platform can
also be used by the case manager to communicate
with the patient or the caregiver.
4 CONCLUSIONS
The approach adopted to design the BM is relevant
because: (i) it adopts already established frameworks
(e.g. Business Model Canvas); (ii) it highlights
common traits and differences among the Countries
within the DECI project; (iii) it allows distinguishing
firstly between coherent and not coherent elements,
then between high-priority and low-priority ones; (iv)
it provides information about the impact of the
various digital solutions; (v) it is applicable in other
contexts (i.e. Countries) therefore it can overcome the
boundaries of the DECI project thanks to its
scalability; (vi) it supports decision-making processes
also after the pilot phases because, once the first most
relevant needs are addressed, it will be possible to
proceed with the actions to address the needs with a
lower relevance.
Furthermore, the approach was validated and
refined also through a Scientific Advisory Board with
the involvement of external stakeholders. Finally, the
approach is aimed to support the definition and
implementation of a comprehensive and multifaceted
BM in a complex and continuously evolving context.
The next steps of the DECI project are: (1) the
implementation of the Pilot site (Italy, Sweden, Israel
and Spain) adopting the proposed SMs and (2) the
evaluation of key performance indicators considering
different perspectives (e.g.: economics, social, etc.) in
order to highlight the potential benefits of the
designed approach.
ACKNOWLEDGEMENTS
The authors would like to thanks the whole
Consortium of the DECI project: Fondazione
Politecnico di Milano, Consoft Sistemi SpA,
Fondazione Don Carlo Gnocchi Onlus (Italy), Centre
for Healthcare Improvement – Chalmers University
of Technology, Västra Götalandsregionen (Sweden),
Hospital Universitario de Getafe - Servicio de
HEALTHINF 2017 - 10th International Conference on Health Informatics
346
Geriatría (Spain), Maccabi Healthcare Services
(Israel), Roessingh Research and Development (The
Netherlands).
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