St. Petersburg clinics (departmental, private, state) to implement Internet of Things solutions in the provision of medical services. The results of the case studies are summarized as recommendations for the development of strategies for the implementation of the Internet of Medical Things in the activities of health care organizations.
Healfcare organizations and Internet of Things
Healthcare organizations
Outpatient clinics (city and district clinics; children's clinics; specialized clinics - counseling and diagnostics, dentistry, physiotherapy; paramedical and obstetric centers; centers - diagnostics, rehabilitation treatment for children, physical education and sports medicine, etc.; . outpatient clinics, hospitals );. Sanitary and epidemiological institutions (disinfection stations, pest control centers (stations), centers of state sanitary and epidemiological supervision in the subjects of the Russian Federation, cities and districts, administrative districts and districts of the city and others);
Business processes and strategic business units in healthcare organizations
Supporting administrative activities are the processes of professional operational daily organizing and regulating the influence on public relations, resolving general, group and private matters on the basis of and for the implementation of management decisions. The business processes that were defined were further used in the application of the value chain model to our cases in the third chapter of the study.
Value-added chain model
Basically, the majority of papers do not use the value chain model as a tool for strategic planning or development, but mention it superficially in the text. More importantly, there are no cases of the application of value chain models in healthcare with the Russian context.
Healthcare in the Russian Federation
- Organizational bases of healthcare in the Russian Federation
- Market overview
- Chosen healthcare organizations
Growth rate of the volume of the private healthcare market, M RUB Growth rate of visits. The undisputed leader in the field of comprehensive healthcare, providing medical services of the highest quality and of any complexity (EMC Clinic, 2020).
Internet of thing in healthcare
- Applications of IoT in health care
- Benefits and barriers that affect IoMT adaption in healthcare organizations
- IoMT market overview
- Wearable technologies
- Practices of IoT devices usage in healthcare organizations
As mentioned above, the emergence of Internet of Things technologies has led to exciting developments in the twenty-first century. The key players in the segment are Medtronic PLC (US), Royal Philips (Netherlands), Cisco Systems (US), IBM Corporation (US), GE Healthcare (US), Microsoft (US), SAP. Telemedicine is an interdisciplinary field related to the development and application of modern computer and telecommunication technologies in the health sector to monitor.
The table below shows the significant increase in the global number of patients using wearable devices from 2013 to 2018. Household appliances - the main users are patients and people who want to lead a healthy lifestyle;. Professional - the main users are athletes, security personnel, the military, firefighters, employees at remote drilling stations, drivers.
It coordinates therapeutic areas and will help bring information about the therapeutic solutions presented in the center to medical organizations. In the future, it is planned to expand the solutions presented at the center in other therapeutic areas (Skolkovo Foundation, 2019).
Research gap
Based on the value chain concept, the paper examines the activities of three clinics in St. Petersburg (departmental, private, state) for the implementation of IoMT solutions in the provision of health services. The results of the case studies are summarized as recommendations for the development of strategies for the implementation of the Internet of Medical Things in activities, which can be illustrated in the figure below.
How can the modified concept of value chain be applied to develop strategies for the implementation of Internet of Medical Things in the activities of Russian healthcare organizations.
Research methodology
- Research design
- Selection of methods and tools for organizations’ analysis
- In-depth interviews
- Coding
- Value chain concept application
- Context of the organizations based on interviews results
- NRCERM
- DRIEM
- EMC Clinic
- Finalization
Conducted in person or by telephone, if permitted by the nature of the marketing research;. Carried out on the basis of the guide guide, consisting of a list of topics to be disclosed during the interview;. Since the first mention of the value chain, the model has been applied to most of the industries.
In this way, we get a result independently of the person (the robot measures) and the person (nurse) does not get tired. The territory of NRCERM is huge and pipes cover almost the entire building. Mikhail believes that one of the main problems for further better adaptation of the Internet of Things is the low demand in Russia.
However, DRIEM was one of the first organizations to adopt telemedicine – there is a Baltic Telemedicine Center. Each of the health organizations received a list of recommendations for the development of a strategy for the implementation of IoMT in activities.
Application of developed framework to cases of organizations
NRCERM
- Value chain application
- Gaps in the primary and supporting activities’ strategies
- Recommendations
At the bottom of the model (light gray background) is the path of the patient in the SBU, at the top (white background) is the value for the patient in details. The patient is first brought to the waiting room, where their information is recorded and a wristband is printed. When the patient gets better, the pressure should be measured at the sister site.
After that, the patient stays in the hospital for another 3 days to see the reaction to the new drugs. If everything is in order (blood pressure is normal, there are no negative reactions from the body), the patient is discharged home. In our case, the patient must measure the pressure in the morning and evening and send the results via his personal account.
In addition, the patient can purchase a subscription for online monitoring and consultations (per month, quarter, year). There are portable versions of the EKG that can be used in an ambulance, so that the doctor can perform an electrocardiogram at the patient's home, on the way to the hospital or in hospital.
DRIEM
- Value chain application
- Gaps in the primary and supporting activities’ strategies
- Recommendations
Patients with iOS on their phone are a great part of NRCERM, so giving them access to a personal account is very important. In the case of NRCERM, the data will also be uploaded to a personal account and a unified internal information system, so that the doctor can monitor it and correct the treatment if necessary. He performs an initial examination, listens to heart sounds, measures pulse and respiration, determines blood pressure and oxygen concentration in the blood with a pulse oximeter, and performs an electrocardiogram (ECG).
When a patient is admitted to the hospital (before receiving the results of the analysis), he drips twice a day (dose and medication are agreed with the attending physician following the doctor's corrections if necessary). The day after the patient's admission, the doctor looks at the results of the blood tests, and the next day he looks at the results of the EKG and echo (echocardiogram). Monitoring and management (monitoring and management of the patient's condition, monitoring of compliance with therapy, monitoring of lifestyle modifications).
As a rule, the patient must return to the hospital after two weeks for a second examination (to check the progress of treatment, any adjustments to medications and dosage), and again six months later. It will help reduce the cost of offline consultations and create additional value from the services being explored to the patients. Moreover, it will create new services for customers.
EMC Clinic
- Value chain application
- Gaps in the primary and supporting activities’ strategies
- Recommendations
In addition, he asks the patient to measure his weight and track his daily physical activity. The doctor informs the patient of the results of the examination and prescribes treatment (eg balance of food, nutrients, medicine and etc.). The results of the monitoring are manually added to the personal account by the patient.
In order to improve the current strategy of the clinic and increase the value for the patient,. Today, most people already have "smart" scales and watches that measure physical activity and heart rate. Building an EMC application will increase engagement and add value (especially compared to competitors).
Analytics can easily be used to analyze weight and physical activity measurements collected from smart watches and scales. However, the results of larger tests can also be added to the analysis process.
Theoretical contribution and practical implication
Competitors are identified based on common activities in the chain (eg in the case of the study – NRCERM and DRIEM have similar value chains for a patient with hypertension, so in this case they can be defined as competitors). Strengths (weaknesses) of the SBU are internal organizational factors that ensure the SBU's advantage over competitors (competitors in relation to the SBE) by creating the value of the service provided and/or its production costs within the same value chain links. In this research, we defined the impact of the Internet of Things on the development of healthcare organization strategies - how IoT implementation affects functional strategies (marketing to connect with consumers, obtain information, channels, personnel, finance) and additional production strategies (range of technologies and services).
All phases of the provided service are examined in the process of the value chain model, which helps not to miss any of them. It helps perform a deep analysis of service delivery to improve it – reduce costs, improve quality, add value for customers. Specification of responsibility for the implementation of activities at each stage of service delivery.
In the process of applying the value chain model, all activities of the service provided are defined as primary activities (the activities of the division (SBU) being analyzed) or support activities (the activities of the entities of other providers). Therefore, it allows specifying responsibility for the implementation of activities (eg to the head of the division or other provider entities).
Limitations and direction for future research
To achieve the goal, the following research question was formulated – How can the modified concept of value chain be applied to develop strategies for the implementation of Internet of Medical Things in the activities of Russian healthcare organizations. The results of case studies are summarized as recommendations for the development of strategies for the implementation of Internet of Medical Things in the activities of, which can be generally illustrated in the Figure 12 below. Management in healthcare” (Graduate School of Management) and material from the master's thesis will be used for the upcoming publication.
Cybersecurity and the Internet of Things: Vulnerabilities, Threats, Intrusions, and Attacks //Journal of Cyber Security and Mobility. Big Data Analytics and the Internet of Medical Things Make Precision Medicine a Reality // International Journal of Internet of Things and Web Services. Internet of medical things: An overview of recent contributions on cyber-physical systems in medicine //IEEE internet of things journal.
The Internet of Medical Things: Architectural Model, Motivators and Barriers // 2018 15th Learning and Technology Conference (L&T). Internet of Things-IOT: definition, characteristics, architecture, enabling technologies, application and future challenges //International journal of engineering science and computing.
NRCERM. The Care Delivery Value Chain Hypertension Care
DRIEM. The Care Delivery Value Chain Hypertension Care
EMC Clinic. The Care Delivery Value Chain Longevity Department
