The healthcare system is in many countries operated by the governments, and interaction with the healthcare system is one of the most frequent interactions between citizen and government. Demographic, medical, and technological changes are likely to bring new aspects of connectedness into the everyday life of people and place healthcare and homecare professionals in new roles. A transformation is taking place where hospital best practices are constantly reducing patient’s in-hospital stays to alternative, less-costly care—notably at home. Telemedicine, telehealth, eHealth, home monitoring, and self-care are essential aspects of this transformation. Many issues are influencing this transformation, and new barriers are showing up where others are removed. A broadly oriented enterprise architecture effort is presented for the underpinning of the change process. The architectural approach encompasses views of the citizen, the healthcare system, the information infrastructure, and the citizen-oriented technology. A case of telemonitoring and self-care is presented using mobile hypertension measurement on a large-scale population cohort. Evaluation of the acceptance and success of the solutions is done within a combined understanding including technology, economy, organization, and culture.
TopIntroduction
Telemedicine, TeleHealth, eHealth, telehomecare, and similar ICT-based systems are assumed to be critical in providing healthcare solutions in the future with ageing population, healthcare system under financial pressure, and with the “epidemic” in life-style chronic diseases (Kun, 2001). Traditionally, healthcare in industrialized societies has been built upon a physical, direct contact between healthcare professional and the citizen (patient). Physical interaction has put a linear-to-exponential load on the healthcare system. With new, smart electronic solutions, it is the belief that home-monitoring and self-care solutions will reduce the load by the individual patient with the distinct medical conditions on the healthcare system (Bellazzi, 2001). Interhuman interaction within the physical rooms of the healthcare system could be shifted into virtual rooms where none of the parties are limited in space and—in some case—also time. The logistics of patients, nurses, and doctors could be replaced by a logistics of information.
Many projects in this area are, however, still at an experimental level and narrowly technologically focused projects tend to overlook economic, social, and organizational issues like cases found in Savel et al. (2010) and MacFarlane et al. (2006). Even technologically oriented projects tend to focus on patients and “gadgets” and overlook infrastructure, and infrastructure might relate to hosts of new issues such as repositories, communication protocols, equipment, patient-doctor information logistics, embedding of new data into existing hospital systems, etc. This chapter is based on two case studies aimed at creating benefits of telemedicine both at the local and national level with a critical focus on the cross-organizational collaboration and communication. The chapter argues from the first of the projects that are looking at founding telehomecare as a cross-organizational phenomenon and the establishing of organizational constructs as the key transitional element from having experimental telehomecare and into operational telehomecare.
The lens used for this chapter is the investigation of the prerequisites in obtaining valuable connectedness between citizen and government, the technological, social, economic and organizational architecting necessary to make such a connection meaningful and create sound (business) cases. The disciplines of enterprise architecture and partially information systems are the bearing theoretical viewpoints each having its embedded paradoxes. Even if new public management strongly influences in governmental healthcare services, and a regime of business terminology is widespread, then medicine, people, and politics dominate are the main driving forces. Consequently, the strategic management objectives driving enterprise architectures might come from anything else than traditional market-driven profit-potentials.
The aim of the chapter is to illustrate a requirement for a flexible, well-defined architectural approach with a strong focus on engineering of organization, professional and clinical acceptance, user orientation, intra-/inter-organizational interfaces, and infrastructure more than technology itself.