1. Introduction to MITCH
Notions of innovation in healthcare services and products - Page (2014)
Changes in healthcare system: rising costs - demographic changes (getting older, which drives
demand for healthcare, and growing middle class) - changing in healthcare systems (from
hospital to home, focus on informal care and self-reliance, remote care) - technological
opportunities (focus on ICT, data monitoring) - privatisation and competition - COVID.
Innovation = anything from the way an idea is researched, manufactured, marketed and the
actual finished article with a change for the better (outcome (product), process and mindset) →
novelty + implementation = innovation.
→ novelty in different forms: new uses (original products positioned in new markets without any
significant changes) -> new category entries (new to the company, but not to the consumer) ->
new to the world (create a completely new market that previously did not exist).
→ characteristics: (a) can come in different forms (product, for individual or communities or as a
business) → (b) can produce growth and profit (for companies and governments) → (c) is best to
take place in areas of concentrated talent (universities and enterprise zones) → (d) has to have a
positive impact (has to aid the patient or help the healthcare professional in the process).
→ 6 forces that drive or kill innovation: (1) industry players (stakeholders with different interests/
agendas), (2) funding (finding investors, generate revenues, acquiring capital), (3) public policy
(regulations and rules), (4) technology (how and when to adopt or invest in new tech), (5)
customers (empowered and engaged consumers), (6) accountability (demands of customers and
regulating organisations for cost effectiveness) → can help innovation or create obstacles, so
important to acknowledge and manage them, BUT no total control over them.
Types of innovation:
- Service innovation = new elements introduced into an organisation consisting of mainly
intangible combinations of processes, skills and materials → characteristics: (a)
intangible, (b) heterogeneous, (c) perishable (no possibility of storage, return, sale or even
subsequent use), (d) inseparable (produced and consumed at the same time).
- Incremental innovation = dominant design is unchanged -> does not lead to a paradigm
shift -> low levels of uncertainty -> improvement of existing characteristics -> result of a
rational response or necessity (fill the gap) -> driven by market pull.
- Radical innovation = leads to a new dominant design -> can lead to paradigm shift ->
high levels of uncertainty -> introduces a whole new set of performance features ->
result of chance or R&D of policy (not necessity) -> driven by technology.
- Architectural innovation = new products or services use existing tech to
create new markets and/or new consumers → FEX. smartwatch.
- Disruptive innovation = type of innovation that displaces established
products/services with more affordable or simpler alternatives.
3 different types of innovations that can aid the healthcare system: customer-focused
innovations (the way in which customers purchase and use a product) ->
technology-based innovations (new products) -> business models (strategies).
→ innovation in healthcare is important due to rising costs, medical errors, gap between
knowledge and practice and organisation of healthcare (inefficient systems) → dependent on
acceptance (perceived ease of use + perceived usefulness) and diffusion (willingness to adopt).
→ to design and develop a product for use within the healthcare service, there is a series of rules
and regulations that have to be met → each product also fits into one of 3 categories:
1. products that patients use and interact with → FEX. walking sticks and crutches → easily
developed and innovated → BUT the impact and overall benefit for patients is limited.
, 2. products that pose a moderate risk to the patient → FEX. hearing aids, cardiac monitors
and catheters.
3. products that are invasive → FEX. pacemakers and breast implants → hard to innovate,
with obvious complexities involved with inserting products into the human body → a lot
of regulations and tests involved → BUT, provide a massive impact on patients’ lives,
which can ultimately have the potential to save lives.
Ideal triple aim = lower costs of care, improve patient experience and improve
quality of population health (at the same time) → picture left.
Social construction of technology (SCOT) = technological artifacts and systems
are shaped and influenced by the social and cultural contexts in which they are
created and used (techs are socially constructed) → interpretative flexibility.
Barriers to innovation: (a) a lack of funding (from large companies) -> (b)
academics not having enough time to engage in enterprise (even though the
government encourages companies to use innovation centres like universities) -> (c) the current
education system damages innovation in the youth of today (children have to specialise their
skills early on in life and therefore have a narrow horizon which hampers innovative
thinking/behaviour) -> (d) companies reluctant to innovate (easier to play safe than to innovate
in the tough industry).
e-Health in Vascular Diseases: Integrating Digital Innovation in Everyday Clinical Practice -
Lareyre et al. (2022)
Digital health = (e-health) the use of information and communication tech (ICT) to support the
management of healthcare, which encompasses a wide range of services and systems.
→ main domains: telemedicine/telehealth -> mobile applications (m-health) -> smart devices
(sensors and wearables) -> digital technology for the healthcare information system or the
development of integrated networks → all are potentially enhanced using AI techniques.
Digital tools for vascular diseases: can improve the patients’ individual health condition by
improving the control of vascular diseases and associated risk factors through the enhancement
of (a) treatment compliance, (b) adherence to behavioral changes, (c) education for
self-management and (d) patients’ empowerment.
→ from patient care (applications for detection, diagnosis, prognosis, treatment, follow-up or
prevention) to administrative tasks and the enhancement of medical information systems and
also for medical research and education.
→ telemedicine = remote diagnosis and treatment of patients through telecommunications
technology → benefits: (a) facilitates access to care, (b) reduces time and travel burden for
patients and (c) contributes to reducing disparities in distant regions or resource-limited areas.
→ AI and big data analysis: may help reveal new insights in the mechanisms underlying vascular
diseases, build predictive models and develop precision medicine and personalized care.
Limitations and challenges: scientific and medical concerns as well as legal, ethical, cultural,
technical and economic considerations.
- Is it working and safe? → difficult to generate evidence on clinical benefits due to the
lack of clear consensus and standardized methods and difficulties in organizing it at a
large-scale level.
- Can digital security, data protection and confidentiality be guaranteed? → implementing
digital innovations requires the definition of its intended use and the determination of
responsibilities, insurance coverage and reimbursement policies, which can widely vary
from one country to another.
, - How well is the digital health uptake among patients and professionals? → manufacturers
need to co-design their applications with all stakeholders.
2. Speeksee case
Aligning Concerns in Telecare: Three Concepts to Guide the Design of Patient-Centred E-Health -
Andersen et al. (2018)
Patient-centred e-health services = facilitate patient participation, self-management and
empowerment to increase access, promote quality and lower costs of care → patients as active
users with individual responsibility → FEX. patient-provider portals (e-visit and e-booking),
telehomecare platforms and PHRs (Personal Health Records) → problem: the majority is designed
from the perspective of medical experts rather than patients.
→ benefits: these services… (a) supplement existing relationships and forms of care, (b) improve
behavioural outcomes through tailored communication and increased interactivity, (c) create
favourable circumstances for improvements or strengthening patient participation, (d) ensure
more transparency and empowerment.
→ challenges/unintended consequences:
- Unanticipated practices: these services may disturb patient-clinician relations and lead
to more sick-work for the patients → might also create tensions between patients,
relatives and physicians because they are perceived as an intrusion to the family sphere.
- Discrepancies: between what patients want to share and what clinicians find useful →
may lead to miscommunication, unmet expectations and disappointment.
- Added responsibilities and extra costs for providers: costs that are often not covered by
existing reimbursement models.
- New expectations of patients: that clinicians cannot meet → clinicians may feel that their
professional practice is challenged or even undermined by the new technologies.
Decisive gap: between the way illness is experienced by patients and the way in which physicians
conceptualise disease in biomedical terms (two different realities) → medical phenomenology =
fundamental differences between patients and clinicians.
Patients’ perspective Physicians’ perspective
Illness illness as an immediate lived experience with focus on objective facts of illness, such as physical
physical or mental problems. signs, clinical findings and laboratory data.
Goal come to terms with their changed situation and diagnose the patient’s condition and provide reliable
develop effective coping strategies to curb their and effective treatment in accordance with accepted
anxiety and re-establish a meaningful life. practice standards.
→ patients’ and physicians’ concerns are not static, but change over time → concerns may vary
among patients and physicians → patients’ experiences of and strategies for coping with a
specific illness vary greatly (FEX. chronic patients are expert patients).
→ the difference in perspectives results in a systematic distortion = a fundamental distinction
between the lived experience of illness and its conceptualisation as a disease state.
Key challenges in aligning concerns between patients and physicians:
- What is a meaningful concern? → clinician and patient can have conflicting perspectives
on (a) which concerns are important and relevant for a consultation, and (b) what
constitutes a proper (re)action.
- physician: manages the consultation so that most important concerns from his
perspective are addressed.
