Document Status: Finished
Inspected by: Filip Nyberg (Quality Coordinator)
Contact Person: William Bergekrans (Lead Analyst)
Written by: Agnes Öberg (Analyst), Alve Rybom (Analyst)
Manager: William Bergekrans (Lead Analyst)
| Date | Version number | Description | Changes made by |
|---|---|---|---|
| 2020-12-08 | 2.2 | Inspection performed. Final version | Filip Nyberg |
| 2020-12-01 | 2.1 | Fixed Table of Contents | Agnes Öberg |
| 2020-12-01 | 2.0 | Added USP and rewrite other parts | Agnes Öberg |
| 2020-11-06 | 1.0 | Original version | Agnes Öberg, Alve Rybom |
For each individual digitization in health care means completely new opportunities for independence, participation and influence regarding their own situation. The development of various digital healthcare services has been rapid in recent years, also for various home monitoring systems. Home monitoring means that the patients are able to perform their measurements at home and then send their results directly to a care unit from, for example, a phone or a tablet. This enables the patients to avoid physical visits at the hospital every single day and the patients can be more flexible regarding when to perform their measurements. The patient can also receive a closer follow-up and in the long run receive faster treatment if there are signs of deterioration.
For home monitoring to be a successful alternative it is essential that the patient is motivated enough to perform their measurements. In order to keep up their motivation it is preferable that the system is easy to use and easy to understand, especially for the aging population that continuously grows in Sweden. According to Region Östergötland, a possible outcome from home monitoring is that the patient gets more involved in their own disease – which has led to more knowledge and a more preventive thinking regarding their situation. Therefore, developing a system that facilitates the whole procedure while home monitoring is a matter of course to ensure the patient’s motivation and involvement remains intact. Another problem identified is that home monitoring provides a lack of face-to-face contact, which takes us to another vital part to have in mind when developing a system for home monitoring.
This project introduces a chatbot as an additional feature in the patient's home monitoring system. Using this chatbot the patients can, through a common chat-interface, perform all their measurements, follow guides, ask questions, book consultations, check symptoms and receive notifications. This solution is simple enough for everyone to use and is a complementary way of using the current home monitoring system.
This solution does not only make it easier for the patients, it is also a facilitating solution for the caregivers as their workload probably will be decreased. As the chatbot can answer questions from patients it implies that less questions will be asked directly to the caregivers. Therefore, this is a solution that also helps caregivers to monitor many patients simultaneously.
This solution offers a unique combination of services by concentrating the functionality within the chat. The patients no longer need to navigate around on a web application for every single purpose, which improves the overall simplicity and understandability of the complete home monitoring system.
Furthermore, this solution offers a high level of service that copes with the lack of face-to-face contact the home monitoring system otherwise provides. Using this chatbot the patients shall get a feeling of human interaction that shall have a further impact on the trust and familiarity towards the system. Also, including a chatbot differentiates this solution from other home monitoring systems since instant service always will be provided. Receiving help instantly from the chat will imply lesser calls than usual from patients to caregivers and therefore decrease the caregivers total workload.
The affected stakeholders of the project are mainly internal. However, if the project isn’t successful, it can have a negative effect on the trust the external stakeholders have on Region Östergötland. The wants of each identified stakeholder is summarized below.
- Patient: uses the chatbot in order to preform measurements, book consultations, ask questions.
- Caregiver: wants decreased administrative workload, working in the new system should not result in more work for them.
- Region Östergötland: owner of the system, wants ability to follow up on patients.
- Community: citizens, local interest groups. Affects their trust towards health care in general.
- Government: political, legal system. Want to implement the system in more regions if it’s good.
Pestle is a framework for describing macro-environmental trends. Pestle is an initialism of the factors that are analyzed: Political, Economic, Social, Technological, Legal, and Environmental. The analysis is helpful in finding an appropriate approach in marketing and creates a solid foundation for external factors in a SWOT analysis (see below).
Demographic change: According to SCB, the population of Sweden is ageing. 20 percent of Sweden’s population is now 65+ years old, compared to 14 percent in 1970. This development means that age-related chronic conditions, such as diabetes, cancers, and cardiovascular diseases will become more common. As a benefit of self-monitoring is improving the lives of those living with chronic conditions, the need for self-monitoring services will grow. [1]
Possible political incentive: The development described above will necessitate an increase in public spending on health care. A goal with self-monitoring is to decrease the workload per patient, which can partially mitigate the need to spend more. The ambition to provide the same care for less tax money will likely mean political incentive to introducing self-monitoring services in more areas of healthcare.
Small impact from the economic cycle: As Sweden’s healthcare is funded by tax money, the self-monitoring project is less sensitive to being shut down due to poor economic conditions than if the project was privately funded. Furthermore, the project seeks to decrease the cost per patient, there will likely be no ambition amongst stakeholders to shut it down as a cost saving measure.
Economic threshold: To be a part of the self-monitoring project, one needs access to the internet and a compatible device. Not everyone can afford an internet plan and a compatible device and the proportion of the population who has access to the internet and a smart-phone/tablet/computer is lowest among old people. As older people are more likely to have the types of diseases that could be improved with self-monitoring, it is vital that the project finds a solution for them too.
Digitalization of society: Today we can see a clear change into a more digitalized society that has affected people’s overall norms, values, and traditions. The solution of using a chatbot for home monitoring can probably take advantage of that the society has become more mobilized which increases the attitude towards technical solutions. Through platforms, like social media for example, it will be easier to find different target groups and there improve the user’s attitude towards the system. For this project it is vital that the users find the solution socially accepted to use.
Hesitance to change: A shift to self-monitoring will entail big shifts for the patients. Some may be averse to changing their routines and many probably prefer face to face meetings with their caregivers. The project will never be fully realized unless patients are on board – it’s essential that the benefits are communicated effectively and that the transition to self-monitoring is smooth.
Target demographic of elderly persons may have a hard time adapting to rapid technological advances, the service provided must ensure that the technical load is bearable for the demographic. The service must be prepared to provide some form of education in such cases.
Possible source of user resistance: In cases where technical solutions have been introduced with lackluster education and introduction user resistance to the solution has been most prevalent. By introducing the product with a solid tutorial, we can minimize the risks of user resistance.
High-risk information: Information stored within and around the solution will be sensitive, therefore there is a tangible risk that the system becomes a target for malicious individuals or groups. The system must keep a high security standard, security solutions like two-factor authorization and encryption of data should be explored by the project.
Benefits from technological development: The healthcare team’s workload can be reduced more as machine learning and artificial intelligence matures. These technologies can be used to improve the bot and give it new capabilities: for example, it can enable image recognition to evaluate pictures of a patient’s skin changes and schedule a skin cancer screening if need be. It could also analyze data from patients and discover trends in how treatment effects measured values and if deviations in values could serve as a warning signal.
GDPR: Compliance with GDPR is a must since the proposed system will be safeguarding sensitive patient data. GDPR creates some challenges as the right for individuals to have their data removed is strengthened.
Other legislation: Apart from GDPR the project can be affected by other legislations that may affect what or how much the system can offer the patient. A change in the discrimination law, for example, can imply that the format of home monitoring system this project provides is no longer accepted. Being monitored by the bot can be perceived as discriminatory and it is seen as a human right to always be monitored personally by a caregiver face to face.
Difficulty in accountability: In case of the bot making a wrong decision that results in negative effects for a patient, finding the responsible party can be a complex task. Errors in development, procurement, or customizing the bot to the affected patient can all lead to the bot not behaving in a sought-after manner. Here, traceability is vital for reducing the impact of any of the errors mentioned above.
Environmental impact: Since the project is based around self-monitoring and self-care, it benefits the environment by reducing the amount of travel to and from clinics and hospitals. Health care professionals will also not have to visit patients in their home which further reduces the environmental footprint of healthcare in general. By adopting such a system, our customers would also be perceived as more environmentally friendly and may influence other regions to go greener in the future.
Attractive to highlight eco-friendly thinking: As society becomes more conscious about its environmental impact, a service that is accessible anywhere and does not mandate the patient or health care professionals can help to make the region promote their green thinking, which is good for their image.
A SWOT analysis is used in order to examine whether the project can claim benefits from the market opportunities offered as well as whether the project has what it takes to cope with the external threats that exist [2]. To find this out, the project’s strengths, weaknesses, opportunities, and threats were identified.
| Strength | Weakness | Opportunities | Threats |
|---|---|---|---|
| Easy to use | Requires maintenance | Increased demand for healthcare services carried out remotely | Accountability is complex |
| Economic and environmentally solution | Not well established in healthcare | Growing demographic for this solution | Reluctant patients and healthcare employees |
| Increased patient participation | More complex than existing solution | Can take advantage of increased environmental awareness within the society | New data integrity and patient’s rights laws |
| Higher quality of care due to lessened administrative load for caregivers | Can take advantage of technical development and digitalization of the society | ||
| Easier for relatives to get an overview of loved one’s situations |
One of the greatest strengths with the chatbot is that it is easy to use for the patients that are not used to the home monitoring system as the bot provides guides for each measurement performed. Instead of having to navigate around on a web application, the patient only needs to stay in the chat whereby the chatbot helps the patient depending on what kind of help is required. The help is also instantly received, which is also a strength. This reduces help required from the caregivers personally which makes this solution more economic.
Another strength is that this solution increases the patient participation as the chatbot puts focus on the user experience in order for the patients to continue their measurements. Feeling participated in their own condition makes it easier to maintain a proper treatment method. Also, as the results are regularly collected by the patients, the quality of care may increase due to lessened administrative load for caregivers.
This solution also differentiates from other solutions of home monitoring systems which shows that Region Östergötland is progressive and explores new technical solutions. This is good for competitiveness between regions and makes it more attractive to move to Östergötland.
For the chatbot to adequately simulate a meeting with a healthcare professional, with follow-ups and detection of deviating values, it needs to be continuously tuned to each patient. While our solution aims to result in more time to focus on the patients that really need help for the health care professionals, it will mandate more administration than the current solution.
A weakness is that there is little experience of similar solutions among healthcare professionals. This means that the home monitoring system has a long way to go before it becomes an established healthcare solution.
Another weakness with the system is that the patients get less face-to-face contact with their caregivers. This puts high technical requirements towards the system to maintain good patient experience. Having the functions working properly will be fundamental since the system is dealing with healthcare.
One opportunity for the system is that the general demand for remote services has increased significantly over the past years, with no sign of stagnating. There is a good chance that the demand for healthcare services carried out remotely will keep on rising in the future. Also, the current covid-19 pandemic has further boosted the need for remote services, especially in the healthcare sector. This may contribute to an increased demand for these kinds of services in the future as well.
People in Sweden are generally more concerned about the environment now than they have ever been before. This can be an opportunity for the system since a remote healthcare solution means less emissions from transportation to/from the hospital.
Yet another opportunity is the possible advantage to be taken from the technological development of today. As technological solutions are getting more and more common in all aspects of every-day life, the general attitude towards technological development may be considered more positive than ever. Also, technological development gives us a better chance to develop a system that satisfies the needs of both patients and healthcare professionals.
Along with technical development the digitalization of the society increases. As digitalization affects people’s norms, values and traditions, the attitude towards this project will get better which will increase the chance of having patients that accept and will use this solution as home monitoring in the future.
A legal issue that’s discussed fervently in an AI context is the complexity in finding the accountable party in case the AI behaves in an undesirable manner: for example, if a self-driving car hits a pedestrian, who is responsible? The same dilemma can arise when our solution is implemented, which is a threat to the system.
Many patients are elderly and may therefore not be very comfortable with new technology. The new system results in a new way to work for healthcare professionals where face-to-face communication is the exception rather than the norm. If they aren’t convinced of the benefits, they have little incentive to change their way of work and our solution might never gain popularity within the region. Therefore, a threat to the new system is that patients and health care employees may be satisfied with the current self-monitoring solution and therefore resistant to change.
The system handles personal data and must comply with various data protection and integrity laws. Another threat is therefore if new legislation restricts the ways one can handle this type of data and forces us to change the way data is collected and used. This can result in functionality disappearing from the chat bot.
The marketing mix model, also known as the 4Ps of marketing, is used as a tool to help define the marketing strategy. By mixing the 4P – product, price, place and promotion, an optimal strategy is generated to the specific target market adjusted by their need and demand. [3]
The solution within this project is to develop and integrate a chatbot as an additional feature to the existing web application for home monitoring. Using this chatbot the patient shall efficiently be able to perform all their measurements, follow guides, ask questions, book consultations, check symptoms and receive notifications. It shall be an alternative solution rather than replacing functions that already exist. Instead of having to navigate around on a web application, the patient only needs to stay in the chat whereby the chatbot helps the patient.
Using a chatbot framework, it shall be possible for the patient to interact with the bot using different inputs (click, write) and devices in order to perform all the services offered. The patient should have a feeling of talking to the caregivers and therefore get a feeling of human interaction, that copes with the lack of face-to-face contact home monitoring system otherwise provides. What is especially important for the solution to work properly is that it is easy for everyone to use and should be a solution that improves the patients’ overall experience.
What is essential for the chatbot to be a successful solution is that the patients must feel trust and familiarity towards the system. If the trust for the system is high and the patient uses it effectively it can also address another problem with home monitoring which is how the caregivers can handle many patients simultaneously. The healthcare system can save lots of resources by having a system that makes the amount of required human interactions less. From the caregiver's perspective this means that this is also a solution that decreases their total workload - which implies that they can release time for more important issues whom the chatbot cannot help with.
The chatbot is a service that is completely free to use for the patients in need of home monitoring. As the healthcare is completely funded by tax money the cost for this project will also be covered by tax money. Therefore, deciding a specific price for the patients is not relevant and will not be included in this marketing strategy.
At this stage, the bot needs to be customized to the user by someone who has insight in what they need. A few customization options are which metrics are to be measured, how often and when the user should measure, and how to use the measuring equipment. Because of this, new users should primarily hear about the service through their health care team.
If the bot gets AI/ML capabilities, it may be able to handle new users without needing to be tailored to each patient. In that case, it might be suitable to offer the service to everyone who can benefit from it. However, we do not believe that it should be marketed heavily, and a user should be aware of the limitations of the service before using it.
The chatbot should not be promoted to patients as it’s only offered to someone when a health care professional deems it to be a fitting solution for the patient. However, when it’s implemented in Region Östergötland, it can be promoted to regions searching for a self-monitoring service.
Our solution will make self-measuring easier for the patient while getting them more involved in how their condition progresses over time. It will also offer the patients answers to questions that they may have and a hassle-free way to schedule meetings with their health care team. It will also free up time for the people working in health care, so they get more time with patients who really need it.
However, the benefits of the service must be communicated properly to both patients and health care professionals, so that they are willing to accept a small disruption in the workflow they’re used to, in order to get rewards down the line.
The service has environmental benefits and stands to get more capabilities as technologies such as artificial intelligence and machine learning matures. For the user, the value of being able to manage their condition without having to be visited by a health care worker is highlighted by the pandemic.
We believe that the best method for rolling out the system is by prioritizing quality over quantity; to enjoy the advantages of our solution, the chat bot should be tailored to each patient which will require the health care professionals to spend more time administrating the self-measuring systems than with the current solution. Future technology can enable the system to become capable of tailoring itself to new patients. Until then, it should not be marketed to the general public.
After a successful implementation in Östergötland, we believe that it will improve the image of the region, highlighting the drive to try out new methods for improving healthcare. We also believe that other regions will be interested in procuring the solution when its gains are realized in Region Östergötland.
[1]: SCB, Folkmängd efter år och ålder, http://www.statistikdatabasen.scb.se/sq/95644 (2020-11-08)
[2]: Expertvalet, Hur ska SWOT-analysen användas?, https://www.expertvalet.se/blogg/2014/08/vad-aer-en-swot-analys (2020-11-09)
[3]: MindTools, The Marketing Mix and the 4Ps of Marketing, https://www.mindtools.com/pages/article/newSTR_94.htm (2020-11-09)