See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/356566577

Digital healthcare services

Article in Electronic Markets · November 2021

CITATIONS READS

5 529

3 authors, including:

Edith Maier Ulrich Reimer

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Ulrich Reimer on 29 November 2021.

The user has requested enhancement of the downloaded file.

PREFACE

Digital healthcare services

© Institute of Applied Informatics at University of Leipzig 2021

Digital healthcare services in transition medical staff spending more time with patients and less on
their PCs, for example, if information about patients were
Digitalization is playing an increasingly significant role in available seamlessly and the results of devices were trans-
practically all areas of society. The domain of healthcare has ferred directly into their health records. Digitalization is
been moving into the digital world relatively late and only actually a prerequisite of a patient-centered continuum of
recently has started with digitalizing processes and services care model, which has been considered the gold standard by
on a larger scale. Still, the potential for disruption in the health experts for years.
healthcare industry is enormous. Although approaches to Further, digital health services are available indepen-
healthcare financing and regulatory schemes differ greatly dently of time and location, encourage the empowerment of
between countries, it is generally recognized that current patients and enable shared decision-making. But although
healthcare systems are characterized by lack of transpar- the benefits of digital health services such as better accessi-
ency and inefficiencies and that digitalization of healthcare bility of care are widely recognized, there has been no large-
services can lead to improvements in quality, efficiency and scale integration into regular healthcare delivery. Rather,
accessibility of care. there is an abundance of successful pilot projects, which fail
We use the term “digital health” as an umbrella concept to be introduced into the regular healthcare delivery systems,
which subsumes eHealth, mobile or mHealth, telehealth or i.e. the so-called ‘first healthcare market’, which includes
telemedicine, among others. Digital health can be defined reimbursable products, medicines and services.
as “an improvement in the way healthcare provision is con- We assume that this discrepancy between expected
ceived and delivered by healthcare providers through the use benefits and actual implementation is primarily due to the
of information and communication technologies to moni- lack of viable business models. Such business models play
tor and improve the wellbeing and health of patients and to an important role in establishing sustainable service plat-
empower patients in the management of their health and that forms and promoting the uptake of digital health services
of their families” (Iyawa et al., 2016, p. 246). by health providers and patients. The healthcare market is
The COVID-19 pandemic, in particular, has shown how characterized by a complex multi-stakeholder environment,
much can be gained if health data were stored and processed fragmented decision-making processes as well as a lack of
digitally. A smart information system could even lead to incentives for cost-effectiveness (see e.g. Botti & Monda,
2020). Besides, healthcare products and services are heav-
ily regulated.
This is the Preface of the Topical Collection "Digital Healthcare
The motto “Move fast and break things”, which tech com-
Services".
panies use to describe the world as a playground for their
* Edith Maier creativity, does not fit hospitals. No advertising promise can
edith.maier@ost.ch be made without hard scientific evidence. Engineers in tech
Ulrich Reimer companies, on the other hand, are used to launching prod-
ulrich.reimer@ost.ch ucts early and then adjusting or stopping them. In medical
Nilmini Wickramasinghe technology, such an approach to product development would
nilmini.work@gmail.com be unthinkable. Moreover, the development process has to
1 be documented from the beginning according to official
Eastern Switzerland University of Applied Sciences,
St. Gallen, Switzerland guidelines.
2 There are two main routes into the healthcare market for
Swinburne University of Technology and Epworth
HealthCare, Hawthorn, Australia tech firms: 1) doing business with hospitals and healthcare

13
Vol.:(0123456789)
 E. Maier et al.

companies or professions in the existing system; 2) use their The authors conducted interviews with 50 long-term
various platforms to create entirely new channels through wearable users and analysed them on the basis of self-
which medical care or preventive interventions can be deliv- leadership theory. They have come to identify four use
ered. Channels may include smartwatches that use machine patterns that bring about different behavioral outcomes:
learning algorithms for health monitoring, smartphones for following, ignoring, combining, and self-leading. Their
use in clinical trials or apps that help people manage chronic study contributes to self-leadership research on individual
conditions such as diabetes. However, this will only work if health information systems and has practical implications
users can trust the devices and the channels through which for wearable and healthcare providers.
medical data can flow. The article on "Understanding the evaluation of mHealth
Based on the technology and the services provided by app features based on a cross-country Kano analysis" by
tech firms, other companies such as health insurance or tel- Gimpel et al. (2021) also deals with mobile health solu-
ecom companies, may enter the market with value-added tions but focuses on the effects of specific mHealth app
services. However, the impact of digital technologies and features on user satisfaction across different healthcare
associated services on the healthcare sector is not limited to system contexts. Their study uses personal health record
the emergence of new players, but also concerns the chang- (PHR) apps as an example and investigates how poten-
ing roles of the various stakeholders. tial users in Germany and Denmark evaluate a set of 26
app features taking into account four user characteristics,
namely privacy concerns, mHealth literacy, mHealth self-
Special issue papers efficacy, and adult playfulness. Based on survey data from
both countries, they subsequently evaluate PHR features
In this special issue of Electronic Markets, we can distin- to understand the underlying relationships between user
guish between two main categories of papers: those that characteristics and user perceptions of features. For this
relate to the relevance for and the use of digital health ser- purpose, they apply the Kano Model of Customer Satis-
vices by individuals and those that deal with economic and faction which classifies product attributes based on how
societal issues related to digital health services. Of course, they are perceived by customers and their effect on cus-
the boundaries between the two are not that clear-cut, tomer satisfaction. The results not only reveal significant
because a topic such as data protection, for instance, has differences between Germans and Danes with regard to
regulatory and thus societal as well as individual aspects, fourteen of the features but also demonstrate which of the
e.g. people’s concerns about the privacy of their health data. user characteristics best explain each of these differences.
Although most people like using Google and Facebook, Thus, they are able to show how the Kano method can
there is skepticism when these companies become active in be extended in terms of explaining subgroup differences,
the health sector. It is not hard to imagine that it would be which has implications for app providers and policymak-
a problem if personal health data fell into the wrong hands. ers.
The papers take up different aspects related to digi- In "Understanding continued smartwatch usage: the role
tal health services and discuss new approaches that may of emotional as well as health and fitness factors", Siep-
improve or will change the interaction and communication mann and Kowalczuk (2021) look at smartwatches, which
between patients, doctors, and other stakeholders. We first are widely considered to be the most popular wearable
present the papers that deal with the potential offered by devices. In recent years, the focus has shifted from finding
digital health services for individual users followed by those out what makes people adopt a smartwatch to understand-
papers that focus on economic and/or societal issues. ing factors that promote long-term usage. Based on self-
determination theory, their study investigates the impact
"Behavior change through wearables: the interplay of a person’s health and fitness as well as positive and
between self-leadership and IT-based leadership" by negative emotional factors that may encourage or impede
Lehrer et al. (2021) points to physical inactivity as a individuals to maintain the use of smartwatches over a
global public health problem that poses health risks to longer period of time. To this end, the authors extend
individuals and imposes financial burdens on already the expectation-confirmation model (ECM) to include
strained healthcare systems. The authors argue that emotional (device annoyance and enjoyment) as well as
wearables such as smartwatches have great potential to health and fitness factors (goal-pursuit motivation and
encourage regular physical activity and a healthy diet. self-quantification behavior). Based on 335 responses
However, studies have shown ambivalent results regard- from actual smartwatch users, they then use structural
ing the effectiveness of wearables in improving users’ equation modeling to validate the model. Results prove
health behavior. Therefore it is important to understand the applicability of the ECM to the smartwatch context
why some users change their behavior and others do not. and highlight the importance of self-quantification as a

13
Digital healthcare services

crucial construct for explaining goal-pursuit motivation, tal platforms might affect value creation with a particular
perceived usefulness, confirmation and device annoy- focus on Google, Apple, Facebook, Amazon, and Microsoft
ance. Not surprisingly, device annoyance proves to be an (GAFAM). To this end, they examine how GAFAM plat-
important barrier to continuous smartwatch use. forms introduce new value-creating roles and mechanisms
The paper by Fürstenau et al. (2021) on "Multi-sided in healthcare through their many and diverse products and
platform and data-driven care research - A longitudinal services. They then proceed to study the impact on health-
case study on business model innovation for improving care by scrutinizing the facilitators, activities, and effects.
care in complex neurological diseases" combines two cat- Their analyses show how GAFAM platforms discrupt con-
egories: on the one hand, the focus is on individualized ventional relationships and transform value creation struc-
care coordination for patients, on the other hand, it looks tures in the healthcare market.
at complex platform business models that may enable The last paper to be presented provides an interesting
such a continuum of care. In their longitudinal case study, example of a business model which is apparently not
the authors analyse the development of a platform for bound or restricted by the regulations normally faced
Amyotrophic Lateral Sclerosis, a severe neurological dis- by digital health services. The online service discussed
ease that requires the coordination of a diverse network of by Wu et al. (2021) is a direct-to-consumer model with
medical specialists, care and equipment providers as well no intermediary involved. Patients or clients pay for the
as the active involvement of patients. The authors then services out of their own pockets. In "How does service
establish two business models, namely, care coordination price influence patients’ decisions? An examination of the
and care research. Whilst the former aims at improving free-market pricing mechanism in online health commu-
patient care thereby creating immediate value for patients, nities" the authors introduce the reader to online health
the latter focuses on producing insights for long-term care communities (OHCs) in China, where physicians can pro-
improvements. The ongoing platform development care- vide online diagnostic services for which they apply free-
fully balances value generation for diverse stakeholders market pricing. By collecting publicly available patient
and economic sustainability. behavior data for three months from 7,726 physicians
"What to do after a data breach? Examining apology and (with 154,512 records) on an OHC in China, the authors
compensation as response strategies for health service investigate the influence of service price on patients’ deci-
providers" is a paper written by Masuch et al. (2021) sions with regard to search strategy, purchase, review and
addresses the issue of sensitive customer information review quality. As to be expected, scarcity of resources,
processed by health services. According to the authors, the risk of disease or whether a physician treats mild or
data breaches have become an everyday phenomenon. severe diseases affect a patient’s purchase decision apart
The challenge that health service providers face is to from the price of the service. To promote the continuous
find effective recovery strategies after data breaches to participation of physicians and patients, which is a pre-
retain customer trust and loyalty. They investigate how requisite for the growth of an OHC, the authors suggest
two widely applied recovery actions (apology and com- that the administrators of the OHC adopt a price recom-
pensation) affect customer reactions after a data breach in mendation system based on physicians’ ability, popular-
the specific context of fitness trackers. Drawing on expec- ity, reputation, medical title and other physicians’ prices
tation confirmation theory, they argue that the recovery for comparable services. Uniform pricing as practiced
actions derived from apology and compensation lead to in the traditional system cannot reflect the difference in
overall satisfaction with the recovery strategy, which in service quality and the value of physicians, the authors
turn positively influences customers’ attitudes and behav- argue. Besides, the pricing system should be dynamic and
ior. This is demonstrated based on data collected from adjustable to service demand.
fitness tracker users during a running event.
The paper published by Gleiss et al. (2021) can be assigned As can be seen from this brief overview, the papers
to the wider economic category. In "An apple a day – how included in this special issue raise a number of interesting
the platform economy impacts value creation in the health- questions with regard to possible business models and the
care market", the authors confirm that the healthcare indus- future financing of digital healthcare services.
try has been slow to adopt new technologies and practices.
As pointed out before, the recent COVID-19 pandemic has
shown the necessity of a fundamental digital transforma- Implications for healthcare
tion of the industry. But, the authors argue, whilst existing
research may discuss the relevance of digital platforms in The implications of the direct-to-consumer approach as pre-
this process, they fail to examine their economic impact. sented by Wu et al. would be profound and fundamentally
They intend to fill this research gap by exploring how digi- change the healthcare industry as it exists in most countries.

13
 E. Maier et al.

Whilst in the UK and most of Scandinavia healthcare is to become more effective and less bureaucratic and to open
mainly financed by the government or its agencies through up to the opportunities offered by digital health services.
taxation and implies a single-payer system, in countries
such as France, Germany, Belgium, Netherlands and Japan,
healthcare is partly paid for by the government through taxes References
and employers’ and citizens’ insurance and involves a multi-
payer system (Thomson et al., 2013). Providers of market- Botti, A., & Monda, A. (2020). Sustainable value co-creation and digi-
tal health: The case of trentino eHealth ecosystem. Sustainability,
priced health services would probably encounter widespread 12(13), 5263. https://​doi.​org/​10.​3390/​su121​35263​
reluctance or inability of patients to pay for digital health Fürstenau, D., Klein, S., Vogel, A., & Auschra, C. (2021). Multi-sided
services. platform and data-driven care research. Electronic Markets, 31(4).
While startups are hoping to compete on cost and choice, https://​doi.​org/​10.​1007/​s12525-​021-​00461-​8
Gimpel, H., Manner-Romberg, T., Schmied, F., & Winkler, T. J. (2021).
market-based financial considerations or choice may have a Understanding the evaluation of mHealth app features based on a
limited place in healthcare. If people are beset by a sudden cross-country Kano analysis. Electronic Markets, 31(4). https://​
health problem, they usually do not act like consumers. Even doi.​org/​10.​1007/​s12525-​020-​00455-​y
in a more market–based healthcare system as can be found Gleiss, A., Kohlhagen, M., & Pousttchi, K. (2021). An apple a day –
How the platform economy impacts value creation in the health-
in the US, where healthcare is paid for by employers and care market. Electronic Markets, 31(4). https://​doi.​org/​10.​1007/​
citizens, a different approach is currently pursued. In 2018, s12525-​021-​00467-​2
the Centers for Medicare and Medicaid Services introduced Iyawa, G. E., Herselman, M., & Botha, A. (2016). Digital health
changes to the 2018 Medicare Physician Fee schedule which innovation ecosystems: From systematic literature review to con-
ceptual framework. Procedia Computer Science, 100, 244–252.
allows practitioners to seek separate reimbursement for cer- https://​doi.​org/​10.​1016/j.​procs.​2016.​09.​149
tain digital health services such as remote monitoring (see Lehrer, C., Eseryel, U. Y., Rieder, A., & Jung, R. (2021). Behavior
Nixon & Gwilt, 2018). Unfortunately, such practices are not change through wearables: The interplay between self-leadership
yet widely disseminated although Covid-19 may have not and IT-based leadership. Electronic Markets, 31(4). https://​doi.​
org/​10.​1007/​s12525-​021-​00474-​3
only accelerated the digital transformation of the healthcare Masuch, K., Greve, M., & Trang, S. (2021). What to do after a data
system but also increased the willingness to pay for digital breach? Examining apology and compensation as response strate-
health services. For those interested in good healthcare at gies for health service providers. Electronic Markets, 31(4).
acceptable prices, it is therefore not bad news that tech com- Nixon, C., & Gwilt, R. E. (2018). CMS signals support for remote
patient monitoring with new reimbursement incentives. Telehealth
panies are getting involved in this area. and Medicine Today, 3. https://​doi.​org/​10.​30953/​tmt.​v3.​6
But whilst it is true that big tech companies as well as Siepmann, C., & Kowalczuk, P. (2021). Understanding continued
many health startups have been moving into the healthcare smartwatch usage: The role of emotional as well as health and
industry, their quest to disrupt healthcare has proven to be fitness factors. Electronic Markets, 31(4). https://d​ oi.o​ rg/1​ 0.1​ 007/​
s12525-​021-​00458-​3
exceedingly difficult. Google Health was discontinued in Thomson, S., Busse, R., Crivelli, L., Van de Ven, W., & Van de Voorde,
2013; IBM Watson Health was discontinued in spring 2021. C. (2013). Statutory health insurance competition in Europe: A
And to date Apple has emphasized wellness and prevention four-country comparison. Health Policy, 109(3), 209–225. https://​
by focusing on exercise, meditation, and sleep rather than doi.​org/​10.​1016/j.​healt​hpol.​2013.​01.​005
Wu, H., Deng, Z., Wang, B., & Gupta, S. (2021). How does ser-
on more impactful medical applications aimed at addressing vice price influence patients’ decisions? An examination of
chronic diseases. Beyond proving their value to consumers, the free-market pricing mechanism in online health com-
any tech company wanting to move into healthcare has a munities. Electronic Markets, 31(4). https://​doi.​org/​10.​1007/​
multitude of medical, ethical, and financial hurdles to over- s12525-​020-​00453-​0
come. Nevertheless, we consider it unlikely that medicine
Publisher’s note Springer Nature remains neutral with regard to
will undergo the kind of commodification that has already jurisdictional claims in published maps and institutional affiliations.
affected other industries such as transport or tourism. But
traditional healthcare providers may well feel the pressure

13

View publication stats