Chesbrough emphasizes the importance of an implementation by stating that “a mediocre product with a good business model yields more value than a good product with a mediocre business model” [27
]. So, business modeling is crucial for the success of an eHealth technology. Through business modeling, the entire development becomes stakeholder-focused and value-driven. Stakeholders are asked early on what value drivers they expect regarding eHealth technology. These value drivers are relevant for both the design of technology as well as the design
of the implementation strategy that will determine effectiveness and sustainability of eHealth technology.
Business modeling is a value-driven process and, as such, it is not simply a business model but an extensive process through which early opportunities for an eHealth technology are explored, assessment is made of what is required, a case-specific business model is developed, and the said technology is accordingly implemented. As part of the roadmap, we stress that development is a continuum and thus requires ongoing research activities that include design, evaluation, and redesign. Making a choice based on facts today can be improper a week later when new facts emerge. Web technology in particular is notorious for being relentlessly progressive; thus, adaptability is crucial. Over time, stakeholders can come and go or their value needs change, and the implementation needs to be reevaluated and redesigned. In terms of business models, this is called business model erosion
], and due to this erosion, eHealth technology will be less sustainable and effective. So we need more sustainable methods to ground the eHealth development process and, for this, stakeholders need to be continuously involved in the development process and have their say in an implementation.
Our current approach to business modeling is to hold various workshops with relevant stakeholders to determine problems and opportunities in health care, which role technology can play, and which stakeholders are involved and what their importance is to the developed eHealth technology. Stakeholders at the workshops determine the role that the technology needs to fulfill in practice by forming an infrastructure and also determine what makes or breaks effectiveness and sustainability. All these elements are captured with a business model that can be detailed in a business case for further operationalization and deployment of the eHealth technology.
Value creation is central to business modeling. Obviously, in for-profit contexts, this value is mostly monetary, but other kinds of value drivers can be important too. Especially in the health care context, we often see extra attention paid to nonmonetary values, as health care is a special market. Intel’s health care information technology (HIT) value model breaks down value into three levels: monetary value, quantifiable value, and benefits, the latter being, for example, social value or certain qualitative values that are considered beneficial but are hard to express in concrete figures [29
]. In our business modeling approach, value drivers can be seen very broadly, that is, anything that a stakeholder considers critical to technology is a relevant value driver worthwhile to research. These values drivers form the basis for the development process and implementation.
Business modeling promotes a value-driven dialogue and promotes better understanding of what should be accomplished with eHealth technology [30
]. This value-driven approach allows stakeholders in eHealth technologies to better discuss and reflect on the intended value that technology has to offer to the health care setting. Value drivers can also be initially counterproductive, as, for instance, when a certain stakeholder loses money or influence, this stakeholder will then criticize the technology. These negative value drivers then must be compensated for elsewhere. Also, by determining the overall expected value before designing begins, the assessment will be more profound whether or not eHealth technology is worth the investment. Nevertheless, value
and value drivers
remain complex concepts. During the value specification, many values will appear and many will also conflict; hence, dialogue is very important. It can be an extensive task to assess and to clarify to stakeholders what value eHealth technology can create, but without looking into value drivers, exact gains of eHealth investments remain unclear a priori
, and it will be impossible to find a fitting implementation.
With business modeling, we aggregate all value needs bottom-up
from the stakeholders, and, through dialogue, we try to cocreate a fit between all the values that will become the overall expected value of the eHealth technology. Value becomes the focal point for technical design and also for the critical success factors [31
] required for implementation. In our workshops, we use custom mapping software, to elicit these values from stakeholders and to rank scores to their importance according to the stakeholders. This ranking acts as a way to quantify and prioritize values. (A common method for this is called the analytic hierarchy process [32
] that, in short, alters the initial scores given to the values by taking the hierarchy of these values into consideration.) These values are input for the design of an eHealth technology and are the basis for implementation. For example, if the value security
is given a high score by multiple stakeholders, then during implementation, all security-related choices (eg, collaboration with a good software security company) need to be given serious consideration; otherwise, certain stakeholders will not consider the technology valuable. This determination also influences the technology itself, that is, security-based features are apparently important, and thus designers and developers should thoroughly research what the security requirements are. Textbox 5
provides another example.
Example Case: How Value Drivers Can Influence Technical Design
During the problem analysis in the teledermatology project, it was found that there were many additional problems in the whole teledermatology process that the initial design of device did not reflect. In general, the device had to offer support regarding how health care professionals in home care can take pictures of wounds so that wounds can be better diagnosed. Consensus arose among stakeholders that it was necessary to provide standardized guidelines for using the technology. We determined what value drivers were relevant to these guidelines, as without these standardized guidelines, the device would be less useful and thus less valuable to the stakeholders. This process also resulted in technical design additions.