Health on a Cloud: Modeling Digital Flows in an E-health Ecosystem

Authors

  • Felix Lena Stephanie School of Communication & Information, Nanyang Technological University, Republic of Singapore
  • Ravi S. Sharma School of Communication & Information, Nanyang Technological University, Republic of Singapore

DOI:

https://doi.org/10.6000/2371-1647.2016.02.01

Keywords:

Cloud computing, electronic health, electronic medical records, value networks, patient-centric health

Abstract

A unified and well-knit e-health network is one that provides a common platform to its key stakeholders to facilitate a sharing of information with a view to promoting cooperation and maximizing benefits. A promising candidate worthy of being considered for this ponderous job is the emerging ‘cloud technology’ with its offer of computing as a utility, which seems well-suited to foster such a network bringing together diverse players who would otherwise remain fragmented and be unable to reap benefits that accrue from cooperation. The e-health network serves to provide added value to its various stakeholders through syndication, aggregation and distribution of this health information, thereby reducing costs and improving efficiencies. Because such a network is in fact an interconnected ‘network of networks’ that delivers a product or service through both competition and cooperation, it can be thought of as a business ecosystem. . This study attempts to model the digital information flows in an e-health ecosystem and analyze the resulting strategic implications for the key players for whom the rules of the game are bound to change given their interdependent added-values. The ADVISOR framework is deployed to examine the values created and captured in the ecosystem. Based on this analysis, some critical questions that must be addressed as necessary preconditions for an e-Health Cloud, are derived. The paper concludes with the conjecture that “collaboration for value” will replace “competition for revenue” as the new axiom in the health care business that could ideally usher in a fair, efficient and sustainable ecosystem.

References

Gubbins E. How telcos could conquer the cloud 2009. ConnectedPlanetOnline.com. Retrieved May 6, 2010 from http://connectedplanetonline.com/business_services/news/cloud-computing-telecom-service-providers-0401/

Narayanan HAJ, Günes MH. Ensuring access control in cloud provisioned healthcare systems. Consumer Communications and Networking Conference (CCNC) 2011; IEEE, 247-251. http://dx.doi.org/10.1109/CCNC.2011.5766466

Shimrat O. Cloud Computing and Healthcare: Bad Weather or Sunny Forecast? San Diego Physician 2009; 26-29.

Kuo AM-H. Opportunities and Challenges of Cloud Computing to Improve Health Care Services [Electronic Version]. Journal of Medical Internet Research 2011; 13(3): e67. http://dx.doi.org/10.2196/jmir.1867

Webb G. Making the cloud work for healthcare. (cover story). Health Management Technology 2012; 33(2): 8-9.

Wickramasinghe NS, Fadlalla AMA, Geisler E, Schaffer JL. A framework for assessing e-health preparedness. International Journal of Electronic Healthcare 2005; 1(3): 316-334. http://dx.doi.org/10.1504/IJEH.2005.006478

Hill JW, Powell P. The national healthcare crisis: Is eHealth a key solution? Business Horizons 2009; 52(3): 265-277. http://dx.doi.org/10.1016/j.bushor.2009.01.006

Black AD, Car J, Pagliari C, Anandan C, Cresswell K, et al. The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. PLoS Med 2011; 8(1): e1000387. http://dx.doi.org/10.1371/journal.pmed.1000387

Kellermann AL, Jones SS. What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Affairs 2013; 32(1): 63-8. http://dx.doi.org/10.1377/hlthaff.2012.0693

Dyer KA, Thompson CD. Medical Internet Ethics: A Field in Evolution. In V.L. Patel, R. Rogers & R.Haux (Eds.), MedInfo. Amsterdam: IOS Press 2001; pp. 1287-1291.

Bulgiba AM. Information Technology in Health Care – What the Future Holds. Asia-Pacific Journal of Public Health 2004; 16(1): 64-71. http://dx.doi.org/10.1177/101053950401600111

Tripathi M, Delano D, Lund B, Rudolph L. Engaging Patients for Health Information Exchange. Health Affairs 2009; 28(2): 435-443. http://dx.doi.org/10.1377/hlthaff.28.2.435

Parmar R, Mackenzie I, Cohn D, Gann D. The New Patterns of Innovation. Harvard Business Review 2014; 92(1/2): 86-95.

Wen HJ, Tan J. The evolving face of telemedicine & e-health: opening doors and closing gaps in e-health services opportunities & challenges. Proceedings of the 36th Annual Hawaii International Conference on System Sciences 2003. http://dx.doi.org/10.1109/hicss.2003.1174374

Clancy CM, Anderson KM, White PJ. Investing in Health Information Infrastructure: Can It Help Achieve Health Reform? Health Affairs 2009; 28(2): 478-482. http://dx.doi.org/10.1377/hlthaff.28.2.478

Eysenbach G. What is e-health? Journal of Medical Internet Research 2001; 3(2): 20. http://dx.doi.org/10.2196/jmir.3.2.e20

Baur A, Fehr J, Mayer C, Pawlu C, Schaudel F. Health care beyond medicine: Meeting the demand for new forms of care [Electronic Version]. Health International 2011; 56-63. Retrieved 02/04/2014, from http://www.mckinsey.com/ search.aspx?q=Health+care+beyond+medicine

Walker J, Pan E, Johnston D, Adler-Milstein J, Bates D, Middleton B. The Value of Health Care Information Exchange and Interoperability. Health Affairs 2005; 24: 10-18. http://dx.doi.org/10.1377/hlthaff.w5.10

Vishwanath A, Scamurra SD. Barriers to the adoption of electronic health records: using concept mapping to develop a comprehensive empirical model. Health Informatics Journal 2007; 13(2): 119-134. http://dx.doi.org/10.1177/1460458207076468

Ebel T, George K, Larsen E, Neal E, Shah K, Shi D. Strength in unity: The promise of global standards in healthcare [Electronic Version] 2012. Retrieved 02/04/2014, from http://www.mckinsey.com/insights/health_systems_and_services

Bandyopadhyay S, Ozdemir Z, Barron J. The Future of Personal Health Records in the Presence of Misaligned Incentives. Communications of the Association for Information Systems 2012; 31: 155-166.

Hill JW, Langvardt AW, Massey AP. Law, information technology, and medical errors: Toward a national healthcare information network approach to improving patient care and reducing medical malpractice costs. Journal of Law, Technology & Policy 2007; 2007(2): 159-238.

Raghupathi W, Kesh S. Designing Electronic Health Records Versus Total Digital Health Systems: A Systemic Analysis. Systems Research and Behavioral Science 2009; 26: 63-79. http://dx.doi.org/10.1002/sres.918

Blumenthal D, Tavenner M. The “Meaningful Use” Regulation for Electronic Health Records. New England Journal of Medicine 2010; 363(6): 501-504. http://dx.doi.org/10.1056/NEJMp1006114

Lohr S. Who Pays for Efficiency? The New York Times 2007. Retrieved September 23, 2009 from http://www.nytimes.com/ 2007/06/11/business/businessspecial3/11save.html?_r=1&ref=businessspecial3

Menachemi N, Collum T. Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy 2011; 4: 47-55. http://dx.doi.org/10.2147/RMHP.S12985

Catalino J. Software solutions can trim rising costs. Health Management Technology 2010; 10-11.

Osborne M, Rubinstein A. A course in game theory. Cambridge, Mass. [u.a.]: MIT Press 1994.

Myerson R. Game theory. Cambridge, Mass.: Harvard University Press 1991.

Luce R, Raiffa H. Games and decisions. New York: Wiley 1957.

Rapoport A, Chammah A. Prisoner's dilemma. Ann Arbor: Univ. of Michigan Press 1965.

Turocy TL, von Stengel B. Game Theory. CDAM Research Report LSE-CDAM-2001-09, October 2001.

Brynjolfsson E, Hitt LM. Beyond the productivity paradox. Communications of the ACM 1998; 41(8): 49-55. http://dx.doi.org/10.1145/280324.280332

Devaraj S, Kohli R. Information technology payoff in the healthcare industry: A longitudinal study. Journal of Management Information Systems 2000; 16(4): 41-67. http://dx.doi.org/10.1080/07421222.2000.11518265

Wiedemann LA. A look at unintended consequences of EHRs. Health Management Technology 2012; 24-25.

Adler-Milstein J, Bates D. Paperless healthcare: Progress and challenges of an IT-enabled healthcare system. Business Horizons 2012; 53(2): 119-130. http://dx.doi.org/10.1016/j.bushor.2009.10.004

Albanese R, Van Fleet D. Rational Behavior in Groups: The Free-Riding Tendency. Academy Of Management Review 1985; 10(2): 244-255.

Adar E, Huberman B. Free riding on Gnutella. First Monday, 2000; 5(10). http://dx.doi.org/10.5210/fm.v5i10.792

Arrow KJ. Uncertainty and the welfare economics of medical care. The American Economic Review 1963; LIII(5): 141-149.

Blomqvist A. The doctor as double agent: Information asymmetry, health insurance and medical care. Journal of Health Economics 1991; 10: 411-432. http://dx.doi.org/10.1016/0167-6296(91)90023-G

Shafer SM, Smith HJ, Linder JC. The power of business models. Business Horizons 2005; 48(3): 199-207. http://dx.doi.org/10.1016/j.bushor.2004.10.014

Bassi J, Lau F. Measuring value for money: a scoping review on economic evaluation of health information systems. Journal of the American Medical Informatics Association 2013; 20: 792-801. http://dx.doi.org/10.1136/amiajnl-2012-001422

Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, et al. Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine 2006; 144(10): 742-752. http://dx.doi.org/10.7326/0003-4819-144-10-200605160-00125

Fleming NS, Culler SD, McCorkle R, Becker ER, Ballard DJ. The Financial and Nonfinancial Costs of Implementing Electronic Health Records in Primary Care Practices, Health Affairs 2011; 30(3): 481-489. http://dx.doi.org/10.1377/hlthaff.2010.0768

Khan M. 14 predictions for healthcare in 2014. Health Management Technology 2014; 13.

Neupert P. Re-inventing Healthcare. Health Management Technology 2009; 30(3): 8-10.

Sharma RS. Towards A Strategic Tool For The Business Modeling Of IDM Startups - Implementing The ADVISOR Framework. International Journal of Applied Engineering and Technology 2011; 1(1): 68-79.

Sharma RS, Pereira F, Ramasubbu N. Assessing Value Creation and Value Capture in Digital Business Ecosystems. International Journal of Information Technology 2010; 16(2).

Charette R. EHRs: Electronic Health Records or Exceptional Hidden Risks? Communications of The ACM 2006; 49(6): 120. http://dx.doi.org/10.1145/1132469.1132495

Regan DB, Pusatli OT, Lutton E, Athauda R. Securing an EHR in a health sector digital ecosystem. Paper presented at the Digital Ecosystems and Technologies, 2009. DEST '09. 3rd IEEE International Conference on Digital Ecosystems and Technologies 2009. http://dx.doi.org/10.1109/dest.2009.5276739

Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence Based Medicine: What It Is And What It Isn't: It's About Integrating Individual Clinical Expertise And The Best External Evidence. BMJ: British Medical Journal 1996; 312(7023): 71-72. http://dx.doi.org/10.1136/bmj.312.7023.71

Jacob JA. Financial incentives are spurring growth of electronic health records BMJ 2013; 347: f4901. http://dx.doi.org/10.1136/bmj.f4901

Sittig DF, Singh H. Electronic Health Records and National Patient-Safety Goals. New England Journal of Medicine 2012; 367(19): 1854-1860. http://dx.doi.org/10.1056/NEJMsb1205420

Goldman D. Electronic health records: A check up 2009. CNNMoney.com. Retrieved October 29, 2009 from http://money.cnn.com/2009/07/02/news/economy/stimulus_electronic_health_records

Thomas K. Q & A. Healthcare Financial Management, 2013; 67(11): 64-68. Retrieved from http://search.proquest.com/ docview/1461712328?accountid=12665

Yellowlees PM, Marks SL, Hogarth M, Turner S. Standards-Based, Open-Source Electronic Health Record Systems: A Desirable Future for the U.S. Health Industry. Telemedicine and e-Health 2008; 14(3): 284-288. http://dx.doi.org/10.1089/tmj.2007.0052

Saleem JJ, Flanagan ME, Wilck NR, Demetriades J, Doebbeling BN. The next-generation electronic health record: perspectives of key leaders from the US Department of Veterans Affairs. Journal of the American Medical Informatics Association 2013; 20(e1): e175-e177.

Chang HH, Chou PB, Ramakrishnan S. An Ecosystem Approach for Healthcare Services Cloud, IEEE International Conference on e-Business Engineering (ICEBE ‘09) 2009.

Showell C, Nohr C. How Should We Define eHealth, and Does the Definition Matter? 2012. Retrieved 08/09/2014, from http://ebooks.iospress.nl/volume/quality-of-life-through-quality-of-information

Baur C. An Analysis of Factors Underlying E-Health Disparities. Cambridge Quarterly of Healthcare Ethics 2008; 17: 417-428. http://dx.doi.org/10.1017/S0963180108080547

Amatayakul MK. Electronic Health Records: A Practical Guide for Professionals and Organizations. Chicago, IL: American Health Information Management Association 2009.

Busch RS. Electronic Health Records: An Audit and Internal Control Guide. New Jersey: John Wiley & Sons, Inc. 2008.

Parente ST. Beyond The Hype: A Taxonomy of E-Health Business Models. Health Affairs 2000; 19(6): 89-102. http://dx.doi.org/10.1377/hlthaff.19.6.89

Joslyn JS. Healthcare E-Commerce: Connecting with Patients. Journal of Healthcare Information Management 2001; 15(1): 73-84.

Aggarwal AK, Travers S. E-Commerce in Healthcare: Changing the Traditional Landscape. Journal of Healthcare Information Management 2001; 15(1): 25-36.

Konrad W, Peter H. Balancing of Benefits and Disadvantages using IT-Integration to Support the Health Care value-added Chain. Paper presented at the European Conference on eHealth 2007, Oldenburg, Germany 2007.

Van Limburg M, Gemert-Pijnen V, Nijland N, Ossebaard HC, Hendrix RMG, Sevdel ER. Why Business Modeling is Crucial in the Development of eHealth Technologies. Journal of Medical Internet Research 2011; 13(4): e124. http://dx.doi.org/10.2196/jmir.1674

Bahga A, Madisetti VK. A Cloud-based Approach for Interoperable Electronic Health Records (EHRs). IEEE Journal of Biomedical and Health Informatics 2013; 17(5): 894-906. http://dx.doi.org/10.1109/JBHI.2013.2257818

Zahedi F, Song J. Dynamics of Trust Revision: Using Health Infomediaries. Journal Of Management Information Systems 2008; 24(4): 225-248. http://dx.doi.org/10.2753/MIS0742-1222240409

Broderick M, Smaltz DH. E-Health Defined. HIMSS E-Health SIG White Paper 2003. Retrieved October 11, 2009 from www.himss.org/content/files/ehealth_whitepaper.pdf

Morales-Arroyo M, Sharma RS. Deriving Value in Digital Media Networks. International Journal of Computer Science and Security 2009; 3(2): 126-137.

Mettler T, Eurich M. A “design-pattern” -based approach for analyzing e-health business models. Health Policy and Technology 2012; 1(2): 77-85. http://dx.doi.org/10.1016/j.hlpt.2012.04.005

Blumenthal D. Stimulating the Adoption of Health Information Technology. New England Journal of Medicine 2009; 360(15): 1477-1479. http://dx.doi.org/10.1056/NEJMp0901592

AbuKhousa E, Mohamed N, Al-Jaroodi J. e-Health Cloud: Opportunities and Challenges [Electronic Version] 2012. Future Internet, 621-645. Retrieved 12/09/2014, from http://www.mdpi.com/1999-5903/4/3/621

Sujith E. Cloud Computing in Healthcare. Frost & Sullivan Market Insight 2008. Retrieved 21/07/2010, from https://www.frost.com/sublib/display-market-insight.do?id=135578323

Lassetter JK. HIEs to Transform. Health Management Technology 2010; 18.

de Brantes F, Emery DW, Overhage JM, Glaser J, Marchibroda J. The potential of HIEs as Infomediaries. Journal of Healthcare Information Management 2007; 21(1): 69-75.

Yip W, Hsiao W. China's health care reform: A tentative assessment. China Economic Review 2009; 20(4): 613-619. http://dx.doi.org/10.1016/j.chieco.2009.08.003

Sunyaev A, Schneider S. Cloud Services Certification. Communications of the ACM 2013; 56(2): 33-36. http://dx.doi.org/10.1145/2408776.2408789

El Sawy O, Pereira F, Fife E. The VISOR Framework: Business Model Definition for New Marketspaces in the Networked Digital Industry. Center for Telecommunications Management, University of Southern California 2008.

Brandenburger AM, Stuart HW. Value-based Business Strategy. Journal of Economics and Management Strategy 1996; 5(1): 5-24. http://dx.doi.org/10.1111/j.1430-9134.1996.00005.x

Eisenmann TR. Managing Proprietary and Shared Platforms. California Management Review 2008; 50(4): 31-53. http://dx.doi.org/10.2307/41166455

Rappaport A. CFOs and Strategists: Forging a Common Framework. Harvard Business Review 1992; 70: 84-91.

Song J, Zahedi F. Trust in health infomediaries. Decision Support Systems 2007; 43(2): 390-407. http://dx.doi.org/10.1016/j.dss.2006.11.011

Hagel III J, Rayport JF. The Coming Battle for Customer Information. Harvard Business Review 1997; 75(1): 53-65.

Peters K, Niebling M, Slimmer C, Green T, Webb JM, Schumacher R. Usability Guidance for Improving the User Interface and Adoption of Online Personal Health Records 2009. UserCentric.com. Retrieved September 15, 2009, from http://www.scribd.com/doc/21811231/Usability-Guidance-for-Improving-the-User-Interface-and-Adoption-of-Online-Personal-Health-Records

Calvillo J, Román I, Roa LM. How technology is empowering patients? A literature review. Health Expectations 2013. http://dx.doi.org/10.1111/hex.12089

Burkhard R. Book Review: Patient-Centred E-Health [Review of the book Patient-Centred E-Health]. International Journal of E-Services and Mobile Applications 2009; 1(3): 79-81.

Powell PT, Laufer R. The promises and constraints of consumer-directed healthcare. Business Horizons 2010; 53(2): 171-182. http://dx.doi.org/10.1016/j.bushor.2009.11.003

Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: Definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association 2006; 13(2): 121-6. http://dx.doi.org/10.1197/jamia.M2025

Purcarea O. European Health Telematics Association (EHTEL) Symposium - A decade of dedicated support to eHealth in Europe. Microsoft EMEA Health Blog 2009. Retrieved November 05, 2009 from http://blogs.msdn.com/ms_emea_health_blog/archive/2009/10/23/ehtel-a-decade-of-dedicated-support-to-ehealth-in-europe.aspx

Ahern DK. Challenges and Opportunities of eHealth Research. American Journal of Preventive Medicine 2007; 32(5S): S75-S82. http://dx.doi.org/10.1016/j.amepre.2007.01.016

Couch JB. How to use electronic health records to achieve the quadruple aim. JAMA Internal Medicine 2013; 173(3): 250-250. http://dx.doi.org/10.1001/jamainternmed.2013.1620

Whitten P, Steinfield C, Hellmich S. Ehealth: Market Potential and Business Strategies. Journal of Computer-Mediated Communication 2001; 6(4). http://dx.doi.org/10.1111/j.1083-6101.2001.tb00129.x

Atkinson NL, Saperstein SL, Pleis J. Using the Internet for Health-Related Activities: Findings from a National Probability Sample. Journal of Medical Internet Research 2009; 11(1): e4. http://dx.doi.org/10.2196/jmir.1035

Kayyali B, Knott D, Van Kuiken S. The 'big data' revolution in healthcare: Accelerating value and innovation [Electronic Version] 2013. Retrieved 10/09/2014, from http://www.mckinsey.com/insights/health_systems_and_services/the_big-data_revolution_in_us_health_care

Payton FC. e-Health Models Leading to Business-to-Employee Commerce in the Human Resources Function. Journal of Organizational Computing and Electronic Commerce 2003; 13(2): 147-161. http://dx.doi.org/10.1207/S15327744JOCE1302_4

DeNardis. E‑health standards and interoperability 2014. Retrieved from https://itunews.itu.int/En/2472-E8209;health-standards-and-interoperability.note.aspx

Jones DK. The Fate of Health Care Reform - What to Expect in 2012. New England Journal of Medicine 2012; 366(4): e7. http://dx.doi.org/10.1056/NEJMp1114858

Goldstein J. Big Challenges Await Health-Records Transition. The Wall Street Journal 2009. Retrieved August 24, 2009 from http://online.wsj.com/article/SB124027664223937475. html

Miller RH, West C, Brown TM, Sim I, Ganchoff C. The value of electronic health records in solo or small group practices. Health Affairs 2005; 24(5): 1127-1137. http://dx.doi.org/10.1377/hlthaff.24.5.1127

Berthold J. Investing in EHRs pays off in paperless perks. ACP Internist 2008. Retrieved October 29, 2009 from http://www.acpinternist.org/archives/2008/02/ehrs.htm

Brailer DJ. Interoperability: The Key To The Future Health Care System. Health Affairs (Web Exclusive) 2005; W5-19. http://dx.doi.org/10.1377/hlthaff.w5.19

Brandenburger AM, Nalebuff BJ. The Right Game: Use Game Theory to Shape Strategy. Harvard Business Review 1995; 73(4): 57-71.

Brandenburger AM, Stuart HW. Value-based Business Strategy. Journal of Economics and Management Strategy 1996; 5(1): 5-24. http://dx.doi.org/10.1111/j.1430-9134.1996.00005.x

Dixit AK, Nalebuff BJ. The Art of Strategy: A Game Theorist’s Guide to Success in Business and Life. New York, NY: W.W. Norton & Company, Inc. 2008.

Grandori A, Neri M. The fairness properties of interfirm networks. In Grandori A, Ed. Interfirm Networks: Organization and Industrial Competitiveness. London: Routledge 1999; pp. 41-66. http://dx.doi.org/10.4324/9780203022481.ch0

Grandy C. Through a Glass Darkly: An Economic View of Fairness, Globalization, and States. In Dator JA, Pratt R, Seo Y, Eds. Fairness, Globalization, and Public Institutions: East Asia and Beyond. USA: University of Hawaii Press 2006; pp. 49-60.

Chesbrough H, Rosenbloom RS. The role of the business model in capturing value from innovation: evidence from Xerox Corporation's technology. Industrial and Corporate Change 2002; 11(3): 529-555. http://dx.doi.org/10.1093/icc/11.3.529

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2016-02-11

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Stephanie, F. L., & Sharma, R. S. (2016). Health on a Cloud: Modeling Digital Flows in an E-health Ecosystem. Journal of Advances in Management Sciences & Information Systems, 2, 1–20. https://doi.org/10.6000/2371-1647.2016.02.01

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