Business models sustainability
IHE Australia Worhshop – July 2011
Peter MacIsaac & Paul Clarke
1
What IHE Delivers
Blair Butterfield – eHealth Initiative
2
18/07/2011
Blair Butterfield – eHealth Initiative
3
Connecting standards to reality and care
delivery
Care providers, authorities and IT professionals
work with solutions developers to coordinate
the implementation of standards to meet their
needs
 Care providers identify the key interoperability problems
they face
 Drive industry to develop and make available standardsbased solutions
 Implementers follow common guidelines in purchasing
and integrating systems that deliver these solutions
More than 300 IHE members/stakeholders work together
in an open and transparent way to advance practical interoperability
4
Sharing Records: simple but powerful: IHE-XDS
Community or
sub-network
Hospital Record
Repository of
Documents
Clinical IT System
Clinic Record
1-Reference
to records
Specialist Record
Repository of
Documents
Index of
patients records
Sharing System
Clinical Encounter
5
6
7
Point-to-Point plus Search : IHE-XDS
Community or
sub-network
Clinic Record
Hospital Record
Repository of
Documents
Repository of
Documents
3-Records
Returned
4-Patient data
presented to
Physician
Clinical IT System
Aggregate
Patient Info
Clinical Encounter
1-Reference
to records
Specialist Record
Index of
patients records
Sharing System
2-Reference
to Records
for Inquiry
8
Information Sharing
- Business Approach and Options (1)
•
Adopt a collaborative partner model
-
Governance model
RHIO or other legal entity collaborative
Amortise operational costs across participant services
Capital funding / equity arrangements
Cooperative model to manage infrastructure and service
provision
Partners may include key vendor and/ or service provider
organisations ( eg. Hosted services providers)
Contractual framework and service level agreements
JamPac
9 Delivers
What IHE
Information Sharing
•
Focus on achieving “regional” sustainability
- Business
Approach
and
Options
(2)
- Consider provider / user demography and geography
when defining the “region” to be serviced – need to
consider ALL boundaries, constraints, critical mass of
users required, existing services and provider / user
needs
- Baseline modelling of uptake by users (providers /
consumers) should be conservative over a 3-5 year
period
- Incentive to increase / accelerate uptake / connectivity to
services (beyond the baseline model) – decrease service
provision costs and potentially subscription or
transactional fee costs to providers
- Determine the critical number of users required to
provide sufficient revenue generation to enable selfsustainable operations to be achieved in a short (but
realistic) timeframe
JamPac
10 Delivers
What IHE
Information Sharing
- Business Approach and Options (3A)
•
Fully consider Business model requirements and
constraints
-
-
-
Need to establish business case for investment by partners
Capital cost requirements – partner funding /equity
model, external funding sources
Partner equity considerations – benefits flow, contribution
to solution and services provision, capacity of business to
make the investment
Not-for-profit or commercial business model ?
Benefits flow to participant providers / users - quantum
and timing is important
Provider / user Subscription Vs transactional fee based
model – consider capacity to pay, business value and
benefits flow
Staged, incremental implementation of services /
functionality Vs “big bang” approach – risks / benefits
JamPac
11 Delivers
What IHE
Information Sharing
- Business Approach and Options (3B)
•
Fully consider Business model requirements and
constraints
-
-
-
-
Incremental adoption curve – differential curves for specific user
types based on ability to access the services, impact on user
workflows, benefits, capacity to pay (e.g. is there a need to
discount subscription / transactional fees over an initial or longer
term period to increase adoption rate) implementation roll-out
timeframe
Minimise changes required to user applications and ensure
information sharing services support rather than require
significant redesign of user business processes where possible
ROI will require achieving a critical mass for adoption of services
in as short (but realistic) as possible timeframe – short-term
discounting of service fees may be an option but will require
monitoring and review to assess impacts
Some Partner organisations may conceivably be (or represent)
providers or users – hence benefits / equity / cost considerations
may become more complex
JamPac
12 Delivers
What IHE
Information Sharing
•
Maximise opportunities to enhance stakeholder
- Business
benefits andApproach
minimise costs and Options (4)
-
-
Look at opportunities to extend or enhance the scope of
services to achieve economy of scale
Can regional coverage be extended to increase the number
of connected users ?
Consult with users to determine the business and functional
requirements for the proposed services – identify the critical
(must have), expected (baseline functionality) requirements
and look at benefits of staging incremental service delivery
functionality to meet differential user requirements (i.e. not
all users require the same functions at the same time) –
delivery of enhanced functional scope of services over time
Information sharing must support business workflow and
care delivery processes – adoption will be impacted if
information sharing greatly impacts on existing processes –
need to consult widely with all users / stakeholders
JamPac
13 Delivers
What IHE
Information Sharing
- Business Approach and Options (5)
•
Performance based hosted technology services
model to minimise service delivery costs
Hosted services model avoids capital investment in
technology infrastructure (with a high obsolescence
factor, significant maintenance requirements, and
minimal asset value after 2 years)
- Adopt a performance based contractual agreement with a
selected technology partner(s) over a fixed 3-5 period to
underpin system performance and enable technology and
support costs to be capped across the contractual period
(and tied to performance guarantees)
-
JamPac
14 Delivers
What IHE
Information Sharing
- Business Approach and Options (6)
•
Standards based interoperability approach to
reduce technology obsolescence and maximise
information sharing capabilities
Adopt standards based IHE interoperability approach
- Impact of standards adoptions on provider / user systems
(e.g. changes required to user systems) and workflows
needs to be fully assessed and addressed
- Consider cross-community information sharing
requirements (e.g. between RHIOs using IHE XDS or
XCA protocols)
-
JamPac
15 Delivers
What IHE
16
What IHE Delivers