Electronic communities of care - Measuring the benefits

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UNIVERSITY OF SOUTHERN QUEENSLAND

“Electronic Communities of Care -

Measuring the Benefits”

A Dissertation submitted by

Frank Whittaker, MBA

For the award of

Doctor of Philosophy

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ABSTRACT

Collaborative technologies including web, mobile applications, social media and smart devices are driving new models of healthcare where providers and consumers can connect together in virtual communities that facilitate real-time communications and encourage consumers to take a greater role in the management of their health. As technology enabled care models evolve, it will become imperative for program researchers and evaluators to quantify their impacts and to answer the many efficiency and effectiveness questions that different stakeholders are likely to pose. The primary aim of this study was to develop a framework that would enable the health and socio-economic benefits of technology enabled health care (e-Healthcare) models to be evaluated from the perspectives of providers, recipients and funders. To achieve this aim, a multi-dimensional framework, incorporating Information Systems and Health Economics theory, was developed and refined through input from multiple case studies. These studies included an Australian Research Council (ARC) case using Health technologies to minimise unnecessary hospitalisation of elderly patients; an Australian E-Health Research Centre (EHRC) case using Tele-Health to deliver cardiac rehabilitation services; and a regional Australian care collaboration case involving multiple care providers from different disciplines. In each of these cases, the positive impacts of e-Healthcare models were clearly evident, with outcomes including increased access to services, increased participation, better health outcomes, improved safety and quality and more cost-effective use of resources.

The learnings from this study are many, including that even where it can be clearly demonstrated that the e-Healthcare model can provide significant benefits and is a preferred choice by users that this does not guarantee its continued operation and main stream uptake.

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CERTIFICATION OF DISSERTATION

I certify that the ideas, experimental work, results, analyses, software and conclusions reported in this dissertation are entirely my own effort, except where otherwise acknowledged. I also certify that the work is original and has not been previously submitted for any other award, except where otherwise acknowledged.

Frank Whittaker

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Signature of Candidate Date

ENDORSEMENT

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Signature of Supervisor/s Date

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ENDORSEMENT

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Signature of Supervisor/s Date

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ACKNOWLEDGMENTS

Firstly, I dedicate this dissertation to my wife Sharon and our five beautiful children to whom I am so grateful for enduring this journey with me and allowing me to work away over the past five years.

Secondly, I dedicate this dissertation to my mum, who sadly passed away before I finished, but who encouraged me immensely through her poetry and writings.

Sincere thanks to my supervisors, Dr Jeffrey Soar and Dr Trudy Yuginovich, of USQ, who have endured my struggles and doubts, but have always been there to give a word of encouragement and provide the advice I needed to complete this undertaking.

Thanks to Dr Victoria (Tori) Wade, for clarity, when I was trying to pull all the pieces together and also, to Jeremy Hamlyn for your support and belief in me. To my dear friend Ben; thank you for listening to me continuously and encouraging me along the way. Hopefully this work will provide a springboard for helping organisations to provide care to where it is needed most.

My appreciation to the Australian Research Council and the partner organisations in the Minimisation of Avoidable Hospital Admissions project; the University of Southern Queensland, Queensland Health and Nexus Online, for the opportunity to participate in an exciting project and the scholarship provided. Memorable thanks to Moya Conrick (deceased), who was pivotal in obtaining the ARC grant and an inspiration to many of us!

My appreciation to Gary Sawyer of the Murray Mallee Aged Task Force, the Aged Care Assessment Team and the representatives of the care providers who participated in the trial of the Community Waiting List.

My appreciation to Dr Mohan Karunanithi, Research Team Leader, at the CSIRO Australian E-Health Research Centre (AEHRC) and for the opportunity to work on the Tele-Health cardiac rehabilitation project (CAP2) and the scholarship contribution.

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APPENDICES

Appendix A - Letter to Participants ... 218

Appendix B - Consent Form ... 219

Appendix C - AT Solutions Investigated ... 220

Appendix D - Measurement Tools used to measure Costs and Benefits ... 224

Appendix E - CWL – Interim Evaluation Survey ... 225

Appendix F - ARC – Business Processes ... 230

Appendix G - Statistical Data Sources ... 236

Appendix H - Cardiac Rehabilitation Assessment ... 239

Appendix I - CSIRO Resource Allocation ... 241

Appendix J - Cap2 Outcomes Benefits and Measures ... 242

Appendix K - Cap Technology Questionnaire... 252

Appendix L - Conference Presentations ... 264

Appendix M - Journal Articles / Conference Papers ... 265

Appendix N - Other Presentations ... 267

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LIST OF FIGURES

Figure 1-1 Case Study Method adapted from Yin (2003) ... 5

Figure 3-1: General evaluation framework of E-health (Quynh, 2007 pg. 4) ... 44

Figure 3-2: Updated D&M (IS) Success Model ... 46

Figure 3-3: Combining technology, service and information to provide services to consumers ... 48

Figure 3-4: E-Communities of Care Image (ref) ... 49

Figure 3-5: Program Cost Benefits Decision Tree ... 50

Figure 3-6: Initial adaptation of the DeLone and McLean (IS) Success Model for evaluation of e-Healthcare service models. ... 51

Figure 3-7 Kaplan Balanced Scorecard ... 52

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Figure 4-1 Case Study Method adapted from Yin (2003) ... 71

Figure 4-2 Case Study Process - Stage 1... 72

Figure 4-3 Activity Based Costing Model developed by (Whittaker, 2008) ... 83

Figure 4-4 Using CDs to trace activity costs to two different programs ... 92

Figure 5-1 Stage 2 - Case Study 1 ... 99

Figure 5-2 - Community Waiting List Logon ... 102

Figure 6-1 Stage 2 - Conduct Case Study 2 ... 123

Figure 6-2 Total incidents (SAC 1, 2 and 3) 2008-09: Total incidents by harm ... 130

Figure 6-3 Electronic Community of Care ... 137

Figure 6-4 ARC - Technology Infrastructure ... 138

Figure 7-1 Stage 2 - Case Study 3 ... 150

Figure 7-2 CAP2 Model ... 151

Figure 7-3 Process flow of participants through each program ... 155

Figure 8-1 Case Study Construct ... 181

Figure 8-2Case Study Construct - Modify Theory ... 190

Figure 8-3: Updated D&M IS Success Model ... 190

Figure 8-4 Adapted Version of the McLean IS Success Model ... 192

Figure 8-5 Cost Benefits Scorecard ... 193

Figure 8-6Case Study Construct - Cross Case Report ... 194

Figure A0-1 Overview of the Telcomed Telemedicine surveillance system and Medical Monitoring Centre ... 221

Figure A0-2 Overview of the Corscience Deployment ... 222

Figure A0-3 Tunstall Tele-Health Monitor ... 222

Figure A0-4 Intel Healthguide ... 223

LIST OF TABLES

Table 3-1 e-Health Frameworks Investigated ... 41

Table 3-2 CBS Program Outcomes ... 56

Table 3-3 – Collaboration; A Nebulous Term ... 57

Table 3-4 CBS Key Benefits, Grouped by Program ... 58

Table 3-5 CBS Measure Types ... 59

Table 3-6 Cost-Benefits Scorecard (CBS) Measures ... 59

Table 3-7 Impact Measurement Tools ... 63

Table 4-1 Outcomes and Benefits ... 81

Table 4-2 Identification of High Level Activities for example, a Medication Monitoring Program... 85

Table 4-3 Sample Resource Allocation for 2 FTE RNs over a 4 week period ... 87

Table 4-4 Calculating the activity cost of personnel ... 88

Table 4-5 Other Resource Costs Traced to Activities ... 89

Table 4-6 Total Activity Cost of Personnel and Other Resources, with Admin Activities Allocated ... 91

Table 4-7 Activity Costs Traced to each Service Model ... 92

Table 4-8 Key Benefits of a Technology Enabled Tele-Health Program ... 94

Table 4-9 Measures Terminology ... 95

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Table 4-11 - Assessment Tools ... 96

Table 4-12 Examples of Effectiveness Measures used in Cost-Effectiveness Analysis ... 97

Table 4-13 Cost-Benefits Framework Comparing 2 Service Models ... 98

Table 5-1 Definitions, acronyms and abbreviations ... 100

Table 5-2 Terminology ... 100

Table 5-3 Actors ... 100

Table 5-4 Stakeholder Groups ... 103

Table 5-5 - Participant selection ... 104

Table 5-6 Key Objectives ... 105

Table 5-7 Outcomes ... 105

Table 5-8 Outcomes Benefits ... 106

Table 5-9 Key Processes ... 108

Table 5-10 CWL Outcome Benefits ... 118

Table 5-11 CWL Questions and Results ... 120

Table 5-12 CWL Cost Benefit Scorecard ... 121

Table 6-1 Definitions, Acronyms and Abbreviations... 124

Table 6-5 Participant Selection ... 132

Table 6-6 Key Objectives ... 134

Table 6-7 Outcomes ... 134

Table 6-8 Outcomes Benefits ... 135

Table 6-9 Process Outlined ... 139

Table 6-10 Core Activities Involved in Delivering the TACCT Service ... 143

Table 6-11 Allocation of Personnel to Activities ... 143

Table 6-12 - Calculate Staff Costs... 144

Table 6-13 Estimated Technology Costs ... 144

Table 6-14 Summary of Costs ... 145

Table 7-1 Definitions, Acronyms and Abbreviations... 152

Table 7-5 Participant Selection ... 157

Table 7-6 Core Activities involved in a Cardiac Rehabilitation Service ... 160

Table 7-7 Allocation of Personnel to Activities - CR ... 161

Table 7-8 Mentoring Activities ... 162

Table 7-9 Management Services Costs ... 163

Table 7-10 Technology Staff Resource Time Traced to Activities ... 164

Table 7-11 Technology Costs ... 165

Table 7-12 Mentoring Activities ... 165

Table 7-13 Summary of Comparative Costs ... 166

Table 7-14 Uptake of Services for each Program ... 166

Table 7-15 - CAP2 Program Objectives ... 167

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INTRODUCTION

Table 7-17 Gender Breakdown ... 170

Table 7-18 Participant Breakdown ... 170

Table 7-19 Process Flow of Participants through each Program ... 171

Table 7-20 Participation Benefits ... 172

Table 7-21 Readmissions within 12 months of Commencing Rehabilitation ... 173

Table 7-22 CR Assessments and Descriptions ... 174

Table 7-23 Change in QoL GMean ... 175

Table 7-24 Incidents ... 175

Table 7-25 Participant Preference for Service Model ... 176

Table 7-26 Cost Efficacy Cost Comparison for IT and Non IT Service Models ... 177

Table 7-27 Participant Costs ... 177

Table 7-28 Cost Benefits Scorecard ... 178

Table 7-29 – Extrapolated Cost-Benefits Scorecard ... 178

Table 8-1 CWL Benefits Scorecard ... 182

Table 8-2 ARC Benefits ... 185

Table 8-3 CAP2 Cost Benefits Scorecard ... 186

LIST OF EQUATIONS

Equation 1 - Activity Costs Calculation ... 87

Equation 2 - Calculation of Activity Costs ... 87

Equation 3 - Apportion Consumable Costs to Activities ... 89

Equation 4 - Apportion Facility Costs to Activities ... 89

Equation 5 - Apportion Technology Costs to Activities ... 90

Equation 6 - Apportion Travel Costs to Activities ... 90

Equation 7 - Apportion Corporate Costs to Activities ... 90

Equation 8 - Tracing Overheads to Activities ... 91

Equation 9 - Calculate Activity Costs... 161

Electronic communities of care - Measuring the benefits

UNIVERSITY OF SOUTHERN QUEENSLAND