Abstract
An aging population and new illnesses are contributing to increasing incidences of chronic diseases, multi-pathologies, and new syndromes. This jeopardizes the sustainability of worldwide National Healthcare Systems (NHSs), which are involved in providing high-quality healthcare under cost containment. To address this challenge, especially in the post-pandemic context, OECD countries have recognized digital technologies as a critical factor to deliver adequate care while reducing contact among individuals. Accordingly, the Italian Recovery & Resilience Plan (PNRR), as encapsulated within the Next Generation EU funds, focuses on digital health to enhance the protection of health as a fundamental public right. Within the sphere of digital transition of NHSs, coherently with the Value-Based Healthcare principles and user-centric innovation theories, telemedicine can be considered as able to increase access to healthcare and to reduce its related resource consumption. Nevertheless, despite its high potentialities, diffusion of telemedicine is struggling to gain access current practices of healthcare institutions. Notwithstanding the copious technology availability, this seems to be due to the organizational changes (operational assets, know-how, and operative processes) needed to adopt an innovation that requires a radical modification of cost and organizational structure for healthcare providers. Thus, the analysis of processes and resources involved in this modernization of healthcare supply structures is a prerequisite for its improvement and implementation. Based on the literature background (both peer-reviewed and technical reports) in the field of eHealth, this chapter wants to sketch features (actors, roles, responsibilities, and flowcharts) for designing human-centered services based on telemedicine. By formalizing both an operational definition of telemedicine and designing a general model for its operation, this contribution aims to support healthcare organizations’ decision-making about implementation of investment in telemedicine infrastructures by fostering awareness of management about financial and organizational issues, related to the necessary changes, connected to the intervention.
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References
Afzal, M., Islam, S. R., Hussain, M., & Lee, S. (2020). Precision medicine informatics: Principles, prospects, and challenges. IEEE Access, 8, 13593–13612.
Alonso, S. G., de la Torre Díez, I., & Zapiraín, B. G. (2019). Predictive, personalized, preventive and participatory (4P) medicine applied to telemedicine and eHealth in the literature. Journal of Medical Systems, 43(5), 1–10.
Amatucci, F., & Mele, S. (2011). I processi di acquisto di beni e servizi nelle aziende sanitarie: elementi di innovazione e modelli di accentramento. Milan, Italy: EGEA.
Anderson, S., Nasr, L., & Rayburn, S. W. (2018). Transformative service research and service design: Synergistic effects in healthcare. The Service Industries Journal, 38(11–2), 99–113.
Banta, H. D., Behney, C. J., & Willems J. S. (1981). Toward rational technology in medicine: Considerations for health policy (Vol. 5, No. v–xiv, pp. 1–242). Springer Series Health Care Society.
Bäuerle, A., Teufel, M., Musche, V., Weismüller, B., Kohler, H., Hetkamp, M., Dörrie, N., Schweda, A., & Skoda, E.-M. (2020). Increased generalized anxiety, depression and distress during the COVID-19 pandemic: A cross-sectional study in Germany. Journal of Public Health, 42(4), 672–678. https://doi.org/10.1093/pubmed/fdaa106
Bellè, N. (2015). Performance-related pay and the crowding out of motivation in the public sector: A randomized field experiment. Public Administration Review, 75(2), 230–324.
Bergmo, T. S. (2015). How to measure costs and benefits of eHealth interventions: An overview of methods and frameworks. Journal of Medical Internet Research, 17(11), e254.
Bharadwaj, A., El Sawy, A. O., Pavlou, A. P., & Venkatraman, N. (2013). Digital business strategy: Toward a next generation of insights. MIS Quarterly, 37(2), 471–482.
Bick, A., Blandin, A., & Mertens, K. (2020). Work from home after the COVID-19 outbreak. CEPR Discussion Paper No. DP15000.
Binci, D., Palozzi, G., & Scafarto, F. (2021). Toward digital transformation in healthcare: A framework for remote monitoring adoption. The TQM Journal. Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/TQM-04-2021-0109
Black, J. T., Romano, P. S., Sadeghi, B., Auerbach, A. D., Ganiats, T. G., Greenfield, S., Kaplan, S., Ong, M. K., & The BEAT-HF Research Group. (2013). A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: Study protocol for the better effectiveness after transition-heart failure (BEAT-HF) randomized controlled trial. Trials, 15(1), 124.
Bouckaert, G., & Halligan, J. (2007). Managing performance: Internaconal comparisons. Routledge.
Bradford, N., Caffery, L., & Smith, A. (2016). Telehealth services in rural and remote Australia: A systematic review of models of care and factors influencing success and sustainability. Retrieved July 25, 2022, from www.rrh.org.au/journal/article/3808
Bryson, J. M. (2015). Strategic planning for public and nonprofit organization: A guide to strengthening and sustaining organizational achievement. New York, USA: Wiley.
Burri, H., Heidbuchel, H., Jung, W., & Brugada, P. (2011). Remote monitoring: A cost or an investment? Europeace, 13(2), 44–48.
Carosi, G., Cauda, R., Pession, A., & Antonelli, G. (2021). La pandemia di COVID-19 in Italia. Harrison Principi di Medicina interna 20a edizione-2021. CEA-Casa Editrice Ambrosiana-Rev.
Cavaleri, E., & Ferraris Franceschi, R. (2005). Economia Aziendale, Vol. 1, Attività aziendale e processi produttivi, Giappichelli, Turin, Italy.
Cavallo, M. C. (2008). Le tecnologie sanitarie e il loro ruolo nella tutela della salute: i dispositivi medici in una prospettiva Europea. Milan, Italy: EGEA.
Cavallone, M., & Palumbo, R. (2020). Debunking the myth of industry 4.0 in health care: Insights from a systematic literature review. The TQM Journal, 32(4), 849–868.
Cepiku, D., & Giordano, F. (2014). Co-production in developing countries. Insights from the community health workers experiences. Public Management Review, 16(3), 317–340.
Cepiku, D., Giordano, F., Bovaird, T., & Loeffler, E. (2021). New development: Managing the Covid-19 pandemic—From a hospital-centred model of care to a community co-production approach. Public Money and Management, 41(1), 77–80. https://doi.org/10.1080/09540962.2020.1821445
Cornwall, A., & Gaventa, J. (2000). From users and choosers to makers and shapers repositioning participation in social policy1. IDS Bulletin, 31(4), 50–62.
Dávalos, M. E., French, M. T., Burdick, A. E., & Simmons, S. C. (2009). Economic evaluation of tele-medicine: Review of the literature and research guidelines for benefit–cost analysis. Telemedicine Journal and E-Health, 15(10), 933–948.
Demaerschalk, B. M., Miley, M. L., Kiernan, T. E. J., Bobrow, B. J., Corday, D. A., Wellik, K. E., & Koch, T. C. (2009). Stroke telemedicine. Elsevier. Mayo Clinic Proceedings, 84(1), 53–64.
Deming, W. E. (1994). The new economics: For industry, government, education. MIT Center for Advanced Engineering Study (2nd ed.). Cambridge: MIT Press.
Driessen, J., Bonhomme, A., Chang, W., Nace, D. A., Kavalieratos, D., Perera, S., & Handler, S. M. (2016). Nursing home provider perceptions of telemedicine for reducing potentially avoidable hospitalizations. Journal of the American Medical Directors Association, 17(6), 519–524.
du Toit, M., Malau-Aduli, B., Vangaveti, V., Sabesan, S., & Ray, R. A. (2017). Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: A systematic review. Journal of Telemedicine and Telecare, 25(1), 3–16.
Elrod, J. K., & Fortenberry, J. L. (2017). The hub-and-spoke organization design: An avenue for serving patients well. BMC Health Services Research, 17(1), 457.
European Commission. (2004). Libro bianco sui servizi di interesse generale. COM. 374. Eurpean Commision.
European Commission. (2008). Telemedicine for the benefit of patients, healthcare systems and society. COM (689). European Commision.
Farooq, A., Laato, S., Islam, A. N., & Isoaho, J. (2021). Understanding the impact of information sources on COVID-19 related preventive measures in Finland. Technology in Society, 65, 101573.
Ferreira, A., & Otley, D. (2009). The design and use of performance management systems: An extended framework for analysis. Management Accounting Research, 20(4), 263–282.
Fotheringham, A. S., & O’Kelly, M. E. (1989). Spatial interaction models: Formulations and applications. Norwell, MA: Kluwer.
Gabbrielli, F. L. G. M., Bertinato, L., De Filippis, G., Bonomini, M., & Cipolla, M. (2020). Interim provisions on telemedicine healthcare services during COVID-19 health emergency. Version of April, 13(2020), 1–32.
Gagnon, M.-P., Desmartis, M., Labrecque, M., Car, J., Pagliari, C., Pluye, P., Fremont, P., Gagnon, J., Tremblay, N., & Legare, F. (2012). Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. Journal of Medical Systems, 36(1), 241–277.
Garshnek, V., Logan, J. S., & Hassell, L. H. (1997). The telemedicine frontier: Going the extra mile. Space Policy, 13(1), 37–46.
Green, S., & Vogt, H. (2016). Personalizing medicine: Disease prevention in silico and in socio. HUMANA.MENTE Journal of Philosophical Studies, 90(30), 105–145.
Griffiths, K. M., & Christensen, H. (2007). Internet-based mental health programs: A powerful tool in the rural medical kit. Australian Journal of Rural Health, 15(2), 81–87.
Hasan, A., & Paul, V. (2011). Telemonitoring in chronic heart failure. European Heart Journal, 5(32), 1457–1464.
Hess, D. C., Wang, S., Hamilton, W., Lee, S., Pardue, C., Waller, J. L., Gross, H., Fenwick, N., Hall, C., & Adams, R. (2005). REACH: Clinical feasibility of a rural telestroke network. Stroke, 36(9), 2018–2020.
Hood, L., & Friend, S. H. (2011). Predictive, personalized, preventive, participatory (P4) cancer medicine. Nature Reviews Clinical Oncology, 8(3), 184–187.
Huddleston, P., & Zimmermann, M. B. (2014). Stroke care using a hub and spoke model with telemedicine. Critical Care Nursing Clinics, 26(4), 469–475.
ISTAT - Italian National Statistical Institute. (2021). Conti economici Nazionali. Anni 2018–2020. Prodotto interno lordo e indebitamento netto delle Amministrazioni pubbliche. Retrieved November 04, 2022, from https://www.istat.it/it/files//2021/09/CS_Conti-economici-nazionali_2020.pdf
Italian Ministry of Health. (2014). Telemedicina–Linee di indirizzo nazionali. Retrieved July, 23, 2022, from http://www.salute.gov.it/imgs/C_17_pubblicazioni_2129_allegato.pdf
Italian Ministry of Health. (2020). Indicazioni Nazionali per l’erogazione di prestazioni in telemedicina. Versione, 4, 27. Italian Ministry of Health (Ed.), Italy.
Jung, C., & Padman, R. (2015). Disruptive digital innovation in healthcare delivery: The case for patient portals and online clinical consultations. In R. Agarwal, W. Selen, G. Roos, & R. Green (Eds.), The handbook of service innovation (pp. 297–318). London: Springer.
Kaplan, R. S., & Porter, M. E. (2011). How to solve the cost crisis in healthcare. Harvard Business Review, 89(9), 46–64.
Kaplan, R. S., & Norton, D. P. (2001). The strategy-focused organization: How balanced scorecard companies thrive in the new business environment. Watertown, Massachusetts, MA: Harvard Business School Press.
Kemm, J. Parry, J., & Palmer, S. (2004) Health impact assessment. Oxford, NY, USA: Oxford University Press. ISBN 978-0-19-852629-2.
Kieweg, P. H., Schöberl, S., & Palozzi, G. (2021). The role of communication in COVID-19 crisis management: Findings about information behavior of German and Italian young people. International Journal of Business Research and Management (IJBRM), 12(5), 263–288.
Kim, Y., Lee, H., Lee, M. K., Lee, H., & Jang, H. (2020). Development of a living lab for a mobile-based health program for Korean-Chinese working women in South Korea: Mixed methods study. JMIR MHealth UHealth, 8, e15359.
Kroenke, K., Theobald, D., Wu, J., Norton, K., Morrison, G., Carpenter, J., & Tu, W. (2010). Effect of telecare management on pain and depression in patients with cancer: A randomized trial. JAMA, 304(2), 163.
Kyle, E., Aitken, P., Elcock, M., & Barneveld, M. (2012). Use of telehealth for patients referred to a retrieval service: Timing, destination, mode of transport, escort level and patient care. Journal of Telemedicine and Telecare, 18(3), 147–150.
Mettler, T., & Pinto, R. (2018). Evolutionary paths and influencing factors towards digital maturity: An analysis of the status quo in Swiss hospitals. Technological Forecasting and Social Change, 133, 104–117.
Moffatt, J. J., & Eley, D. S. (2010). The reported benefits of telehealth for rural Australians. Australian Health Review, 34(3), 276–281.
Mueller, K. J., Potter, A. J., MacKinney, A. C., & Ward, M. M. (2014). Lessons from tele-emergency: Improving care quality and health outcomes by expanding support for rural care systems. Health Affairs, 33(2), 228–234.
OASI Report. (2018). Osservatorio sulle Aziende e sul Sistema sanitario Italiano. Retrieved July 24, 2022, from https://cergas.unibocconi.eu/sites/default/files/files/Capitolo-2-OASI-2018.pdf
OASI Report. (2021). Osservatorio sulle Aziende e sul Sistema sanitario Italiano. Retrieved July 24, 2022, from https://cergas.unibocconi.eu/observatories/oasi_/oasi-report-2021
OECD. Elderly population (indicator). (2019). Organisation for Economic Co-operation and Development (OECD, Ed.) Retrieved July 24, 2022, from https://data.oecd.org/pop/elderly-population.htm#indicator-chart. https://doi.org/10.1787/8d805ea1-en
OECD. (2021). Strengthening the frontline: How primary health care helps health systems adapt during the COVID-19 pandemic POLICY BRIEFS, Organisation for Economic Co-operation and Development (OECD, Ed.). Retrieved July 24, 2022, from https://read.oecd-ilibrary.org/view/?ref=1060_1060243-snyxeld1ii&title=Strengthening-the-frontline-How-primary-health-care-helps-health-systems-adapt-during-the-COVID-19-pandemic
O’Kelly, M. E., & Miller, H. J. (1994). The hub network design problem: A review and synthesis. Journal of Transport Geography, 2(1), 31–40.
Osborne, S. P., Radnor, Z., & Strokosch, K. (2016). Co-production and the co-creation of value in public services: A suitable case for treatment? Public Management Review, 18(5), 639–653.
Osborne, S. P. (2006). The new public governance? Public Management Review, 8(3), 377–387. https://doi.org/10.1080/14719030600853022
Osborne, S. P., & Strokosch, K. (2013). It takes two to Tango? Understanding the co-production of public services by integrating the services management and public administration perspectives. British Journal of Management, 24(S1), S31–S47. https://doi.org/10.1111/1467-8551.12010
Ostrom, E. (1996). Crossing the great divide; Co-production, synergy, and development. World Development, 24(6), 1073–1088.
Palozzi, G., Binci, D., & Appolloni, A. (2017). e-Health & co-production: critical drivers for health diseases management. In M. A. Pfannstiel, & C. Rasche (Eds.). Service business model innovation in the healthcare and hospital management; Models, strategies, tools (pp. 269–296). Cham: Springer Nature. https://doi.org/10.1007/978-3-319-46412-1
Palozzi, G., Chirico, A., Falivena, C., & Calò, L. (2018). How information availability changes healthcare chronicity management: Findings from a pilot case study. In International Forum on Knowledge Asset Dynamics (IFKAD) Proceeding, e-Book. ISBN 978-88-96687-11-6, ISSN 2280-787X
Palozzi, G., Chirico, A., & Gabbrielli, F. (2020a). Cost analysis of telemedicine implementation in the lens of healthcare sustainability: A review of the literature. In EAI International Conference on Smart Cities within SmartCity 360° Summit (pp. 451–469). Cham: Springer Publishing.
Palozzi, G., Schettini, I., & Chirico, A. (2020b). Enhancing the sustainable goal of access to healthcare: Findings from a literature review on telemedicine employment in rural areas. Sustainability, 12(8), 3318.
PNRR - Piano Nazionale di Ripresa e Resilienza. (2021). Italian Government, Rome, Palazzo Chigi, 25.
Porter, M. E. (1991). Towards a dynamic theory of strategy: Special issue. Strategic Management Journal, 12(51), 95–117.
Porter, M. E. (1997). Competitive strategy. Measuring Business Excellence, 1(2), 12–17.
Porter, M. E. (2008). Value-based health care delivery. Annals of Surgery, 248(4), 503–509.
Porter, M. E. (2010). What is value in health care? The New England Journal of Medicine, 363(26), 2477–2481.
Porter, M. E., & Teisberg, E. O. (2006). Redefining health care: Creating value-based competition on results. Boston, MA: HBSP.
Preston, J., Brown, F. W., & Hartley, B. (1992). Using telemedicine to improve health care in distant areas. Psychiatric Services (Washington, DC), 43(1), 25–32.
Quattrociocchi, L., Tibaldi, M., & Caputi, M. (2020). Invecchiamento attivo e condizioni di vita degli anziani in Italia. Italian national statistical institute—ISTAT, Italy.
Razmak, J., & Belanger, C. H. (2017). Connecting technology and human behaviours towards e-health adoption. International Journal of Information Systems and Change Management, 9(3), 169–192.
Renedo, A., Marston, C. A., Spyridonidis, D., & Barlow, J. (2015). Patient and public involvement in healthcare quality improvement: How organizations can help patients and professionals to collaborate. Public Management Review, 17(1), 17–34.
Rghioui, A., & Oumnad, A. (2018). Challenges and opportunities of Internet of Things in healthcare. International Journal of Electrical and Computer Engineering, 8(5), 2088–8708.
Roine, R., Ohinmaa, A., & Hailey, D. (2001). Assessing telemedicine: A systematic review of the literature. Canadian Medical Association Journal (CMAJ), 165(6), 765–771.
Rosenberg, C. N., Peele, P., Keyser, D., McAnallen, S., & Holder, D. (2012). Results from a patient-centered medical home pilot at UPMC health plan hold lessons for broader adoption of the model. Health Affair, 31(11), 2423–2433.
Sampietro Colom, L., Lach, K., Haro, I. E., Sroka, S., Cicchetti, A., Marchetti, M., Iacopino, V., Kidholm, K., Ølholm, A. M., Birk Olsen, M., Pasternack, I., Roine, R. P., Halmesmäki, E., Fure, B., Arentz Hansen, H., Frønsdal, K. B., Rosenmöller, M., Ribeiro, M., Garcia, E. V., Wild, C., Patera, N., Fischer, S., Kisser, A., Kahveci, R., Tutuncu, T., Yuksek, Y. N., Kucuk, E. O., Wasserfallen, J. B., Pinget, C., Kiivet, R. A., & Ulst, M. (Eds.). (2015). The AdHopHTA handbook: A handbook of hospital-based Health Technology Assessment (HB-HTA). Public deliverable, The AdHopHTA Project (FP7/2007-13 grant agreement nr 305018), Barcelona, Spain.
Sankaran, S., Luyten, K., Hansen, D., Dendale, P., & Coninx, K. (2018). Have you met your METs?—Enhancing patient motivation to achieve physical activity targets in cardiac tele-rehabilitation. In Proceedings of the 32nd International BCS Human Computer Interaction Conference (Vol. 32, pp. 1–12). Retrieved July 24, 2022, from https://doi.org/10.14236/ewic/HCI2018.48
Segrelles-Calvo, G., López-Padilla, D., Chiner, E., Fernandez-Fabrellas, E., & de Granda-Orive, J. I. (2017). Acceptance of telemedicine among respiratory healthcare professionals. European Research in Telemedicine/la Recherche Européenne En Télémédecine, 6(3–4), 147–155.
Shaw, S. L. (1993). Hub structures of major US passenger airlines. Journal of Transport Geography, 1(1), 47–58.
Skorin-Kapov, D., & Skorin-Kapov, J. (1995). On hub location models. Journal of Computing and Information Technology, 3(3), 183–192.
Solberg, E., Traavik, L. E., & Wong, S. I. (2020). Digital mindsets: Recognizing and leveraging individual beliefs for digital transformation. California Management Review, 62(4), 105–112.
Spano, A., & Aroni, A. (2018). Organizational performance in the Italian health care sector. In E. Borgonovi, E. Anessi-Pessina, & C. Bianchi (Eds.), Outcome-based performance management in the public sector (pp. 25–43). Cham, Switzerland: Springer International Publishing.
Stensland, J., Speedie, S. M., Ideker, M., House, J., & Thompson, T. (1999). The relative cost of outpatient telemedicine services. Telemedicine Journal, 5(3), 245–256.
Switzer, J. A., Demaerschalk, B. M., Xie, J., Fan, L., Villa, K. F., & Wu, E. Q. (2013). Cost-effectiveness of hub-and-spoke telestroke networks for the management of acute ischemic stroke from the hospitals’ perspectives. Circulation: Cardiovascular Quality and Outcomes, 6(1), 18–26.
Tarricone, R. (2004). Valutazioni economiche e management in sanità. Applicazioni ai programmi e tecnologie sanitarie (Vol. 1). Milan, Italy: McGraw-Hill.
Taylor, M., Caffery, L. J., Scuffham, P. A., & Smith, A. C. (2018). Economic modelling of telehealth substitution of face-to-face specialist outpatient consultations for Queensland correctional facilities. Australian Health Review, 42(5), 522–528.
Terry, N. P. (2016). Will the Internet of Things transform healthcare? Vand. J. Ent. & Tech l., 19(2), 327–352.
Tresp, V., Marc Overhage, J., Bundschus, M., Rabizadeh, S., Fasching, P. A., & Yu, S. (2016). Going digital: A survey on digitalization and large-scale data analytics in healthcare. Proceedings of the IEEE, 104(11), 2180–2206.
Uphoff, M. E., & Krane, D. (1998). Hospital-based health technology assessment: Essential questions and an operational model. Public Productivity and Management Review, 22(1), 60–70.
Wang, K., Wong, E. L.-Y., Ho, K.-F., Cheung, A. W.-L., Yau, P. S.-Y., Dong, D., Wong., S. Y.-S., Yeoh, E.-K. (2021). Change of willingness to accept COVID-19 vaccine and reasons of vaccine hesitancy of working people at different waves of local epidemic in Hong Kong, China: Repeated cross-sectional surveys. Vaccines, 9(1), 62. https://doi.org/10.3390/vaccines9010062
World Health Organization. (1998). A health telematics policy in support of WHO’s Health-For-All strategy for global health development: report of the WHO group consultation on health telematics, 11–16 December 1997, World Health Organizcation (WHO, Ed.), Geneva.
World Health Organization. (2021). Coronavirus disease (COVID-19) advice for the public. World Health Organizcation (WHO, Ed.). Retrieved July 23, 2022, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
Yilmaz, S. K., Horn, B. P., Fore, C., & Bonham, C. A. (2019). An economic cost analysis of an expanding, multistate behavioural telehealth intervention. Journal of telemedicine and telecare, 25(6), 353–364.
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Palozzi, G., Ranalli, F. (2023). Telemedicine Implementation Between Innovation and Sustainability: An Operating Model for Designing Patient-Centered Healthcare. In: Pfannstiel, M.A. (eds) Human-Centered Service Design for Healthcare Transformation. Springer, Cham. https://doi.org/10.1007/978-3-031-20168-4_21
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