Business models - sustainability

1. Business models - sustainability IHE Australia Worhshop – July 2011 Peter MacIsaac & Paul Clarke

2. Blair Butterfield – eHealth Initiative

3. Blair Butterfield – eHealth Initiative

4. 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 standards-based solutions • Implementers follow common guidelines in purchasing and integrating systems that deliver these solutions More than 300 IHE members/stakeholders work togetherin an open and transparent way to advance practical interoperability

5. Hospital Record 1-Reference to records Clinic Record Specialist Record Index of patients records Clinical IT System Sharing System Clinical Encounter Sharing Records: simple but powerful: IHE-XDS Community or sub-network Repository ofDocuments Repository ofDocuments

8. Hospital Record 1-Reference to records Clinic Record Specialist Record 3-Records Returned 4-Patient data presented to Physician Aggregate Patient Info Index of patients records Clinical IT System Sharing System 2-Reference to Records for Inquiry Clinical Encounter Point-to-Point plus Search : IHE-XDS Community or sub-network Repository ofDocuments Repository ofDocuments

9. JamPacHealth Informatics Consulting 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

10. JamPac Health Informatics Consulting Information Sharing - Business Approach and Options (2) Focus on achieving “regional” sustainability 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 self-sustainable operations to be achieved in a short (but realistic) timeframe

11. JamPac Health Informatics Consulting 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

12. JamPac Health Informatics Consulting 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

13. JamPac Health Informatics Consulting Information Sharing - Business Approach and Options (4) Maximise opportunities to enhance stakeholder benefits and minimise costs 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

14. JamPac Health Informatics Consulting 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)

15. JamPac Health Informatics Consulting 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)