4 http://www.marketsandmarkets.com/Market-Reports/healthcare-it-252.html Ideally, e-health should encompass medical informatics, public health and business, and include within its purview health services and information that are delivered and enhanced through the Internet and related technologies (Eysenbach, 2001). With the integration of tele-health technologies with the Internet, e-health has the potential to enhance the quality and value of health services delivery through improved efficiencies and diminished costs thereby developing new markets (Wen & Tan, 2003; Baur, Fehr, Mayer, Pawlu & Schaudel, 2011). In essence, e-health comes with the promise of improved quality care, greater safety, reduced costs, reduced medical errors, increased efficiency of information flow and most importantly, empowerment of healthcare consumers in their healthcare decisions (Walker, Pan, Johnston, Adler-Milstein, Bates & Middleton, 2005; Vishwanath & Scamurra, 2007; Tripathi et al, 2009; Ebel, George, Larsen, Neal, Shah & Shi, 2012).
Although e-health envisages endless possibilities for the healthcare industry, there are several barriers to its adoption, the most significant ones being those that come from the healthcare providers’ perspective. Some of the major barriers are high investment costs (Reed, 2007), uncertain returns on investment (Steele, 2006), loss of productivity (Clarke & Meiris, 2006) and, most significantly, misalignment of incentives (Glaser, 2007). Overcoming these deterrents is crucial because healthcare providers are supposedly the harbingers of the future of e-health. If the barriers faced by them go unresolved, their participation and cooperation cannot be secured. As a result, the ideal of a patient-centric e-health system may not materialise.
Currently, healthcare providers may feel that they are unduly burdened with the responsibility of promoting e-health through investments in Electronic Health Records (EHR) systems. This may be because building such a system would obviously require huge investments and maintenance costs of equal magnitude. Further, costs may also come in the form of licensing and upgrading fees from time to time. Despite such investments, there is no guarantee of returns, however, owing to a lack of demonstrable evidence for the long term sustainability of an e-health system (productivity paradox). While the investment in EHRs is considerable - not only in terms of direct costs but also in terms of the time spent on staff training and the consequent loss of productivity, the returns on such investments may often be disappointingly low to warrant any justification.
To create a patient-centric e-health network, the combined power of technology and the Internet must be harnessed to foster a totally ’connected‘ health network that encompasses all the key stakeholders, and provides a common platform for interfaces and transactions among them, seamlessly connecting them in the process, for an exchange and reuse of health information. Since such a network is in fact an interconnected ‘network of networks’ that delivers a product or service through both competition and cooperation, it can be thought of as a ‘business ecosystem’. James Moore, who pioneered the concept in 1996, describes the ecosystem as being made up of “customers, market intermediaries (including agents and channels, and those who sell complementary products and services), suppliers, and of course, oneself” (Kandiah & Gossain, 1998, p. 29). In addition, such an ecosystem should be able to create value for its customers by providing additional information, goods, and services, through the use of the Internet and related technologies (Kandiah & Gossain, 1998). The type of patient-centric e-health network envisaged in this monograph may be said to have the attributes that characterize a business ecosystem and may henceforth be referred to as an “e-health ecosystem”.
Such an ecosystem may however be a difficult proposition in the current lopsided scenario where one stakeholder in particular, namely the healthcare provider, views itself as creating more value than it can capture from the network, with the other stakeholders benefiting more from the value created, a phenomenon known as the “tragedy of the commons”.
A patient-centric e-health network is also expected to reduce information gaps in the provider-patient relationship, benefitting patients and empowering them in their healthcare decisions and choices. Such an outcome may not be desirable for healthcare providers who have been traditionally leveraging this information gap (information asymmetry) to their advantage. And given the huge investments they need to make in order to progress into e-health, they may feel that it is neither logical nor reasonable to have to share the benefits of their investments with others including patients.
Even though some healthcare providers may seem willing to share their patients’ health data over the network, they may only want to do so within a private network. A private network is an arrangement entered into by players (strategic decision makers) for mutual benefits. Data is strictly shareable only within the network thus restricting patients’ healthcare choices to such players as are part of the network (information blocking).
Issues (dilemmas) such as the ones discussed above have not, as yet, been addressed and resolved to the satisfaction of healthcare providers. In this context, research has an important role to play inasmuch as it can establish the fact that a patient-centric e-health network may be feasible provided that certain conditions are met. To resolve these issues, appropriate trade-offs between conflicting notions such as fairness and efficiency must be achieved for every key player in the e-health network, particularly the healthcare provider. Fairness in this context would mean the pay-off received by a player proportionate to its contribution to the achievement of the total output, whereas efficiency would mean the benefits resulting from reduced information asymmetries.