A Business Model for Digital Healthcare Environments: An Organic

Approach and a Use Case for Handling Cognitive Impairment

Andrea Pistorio

, Paolo Locatelli

, Federica Cirilli

, Luca Gastaldi

and Simona Solvi

Department of Management Engineering, Politecnico di Milano, Milan, Italy

Fondazione Politecnico di Milano, Milan, Italy

Keywords: Healthcare Services, Business Models, Service Models, Digital Solutions, Cognitive Impairment.

Abstract: Ageing has significant impacts on the organization of healthcare systems and on social inclusion—especially

for elderly people affected by Cognitive Impairment (CI). These people are significantly exposed to

undeniable risks that can affect their health and wellbeing (falling, malnutrition, hygiene issues, etc.) –

especially when living alone. This paper defines a Business Model (BM) allowing independent living for

elderly people affected by CI. This BM include: (i) an up-to-date, modular, flexible and scalable

organizational model describing the activities to be accomplished by regulators and service suppliers; and (ii)

a digital platform based on innovative and easy-to-replicate information and communication technologies.

The organic approach to the development of the BM is then focused in an Italian use case as a part of “DECI”,

a “Horizon 2020” project with four pilot projects in Israel, Italy, Spain and Sweden.

1 INTRODUCTION

The prevalence of Cognitive Impairment (CI) in

elderly patients is one of the key issues in Western

Countries since it involves loss of memory, cognitive

slow down, aphasia, apraxia, sensorial and movement

deficit, personality and mood disorders (Alexander et

al. 2015; Rizzi et al. 2014). The elderly people with

cognitive limits - especially those living in solitude -

are significantly exposed to undeniable risks for their

own safety: falling, malnutrition or unhealthy nutri-

tion, hygiene issues due to lack of mobility, isolation

and depression (Alzheimer’s Association 2016).

The needs of these patients range from daily aid

to dedicated medical assistance (Alzheimer’s

Association 2016; Miranda-Castillo et al. 2013).

Though digital technologies can be one key lever to

answer these needs, most of current solutions are

immature for mass implementation.

In this context, the goal of this paper is to define a

Business Model (BM) for supplying assistive services

to elderly people affected by CI. This BM will

include: (i) an up-to-date, modular, flexible and

scalable organisational model describing the roles

and the activities to be accomplished by policy

makers and service suppliers; and (ii) a digital

platform based on innovative and easy-to-replicate

Information and Communication Technologies (ICT)

streamlining and simplifying the flow of information

and the communication among the various key

stakeholders.

2 METHODS

This paper is based on DECI – Digital Environments

for Cognitive Inclusion – a project funded by the

European Commission under the Horizon 2020

program (grant agreement No 643588) that is aimed

at improving a healthy lifestyle for elderly people

affected by CI, passing through a system monitoring

vital signs, treating and managing diseases (Locatelli

et al. 2015).

DECI Consortium is led by Fondazione

Politecnico di Milano (Italy) and involves partners

from five different countries (Italy, Sweden, Spain,

Israel and The Netherlands). The consortium merges

academic and research competences, care and social-

care providers, healthcare authorities, ICT industry

and their broad network of stakeholders. Four pilots,

involving 100 to 250 patients each, will allow

assessing the feasibility, the effectiveness and the

potential economic benefits of the proposed measures

340

Pistorio A., Locatelli P., Cirilli F., Gastaldi L. and Solvi S.

A Business Model for Digital Healthcare Environments: An Organic Approach and a Use Case for Handling Cognitive Impairment.

DOI: 10.5220/0006168803400347

In Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2017), pages 340-347

ISBN: 978-989-758-213-4

within specific local healthcare systems and real-life

environments in Israel, Italy, Spain and Sweden.

The overall research process followed to develop

the BM as well as the related processes encompassed

three subsequent phases that are depicted in Figure 1

and described in the following paragraphs.

Figure 1: Research process.

2.1 First Phase

A literature review has been conducted to identify the

most relevant articles dealing with the state of the art,

good practices and trends related to the digital

solutions for assisting elderly people with CI. The

analysis of these articles allowed producing a general

BM to focus the main variables that increase the

likelihood of providing effective digital services.

Web of Science™ and Google Scholar™ have

been used to research the articles. The literature has

been analysed according to two complementary

frameworks.

Initially, we relied on the STOF framework

(Bouwman et al. 2008), which provides an overall

picture of a BM from four interrelated perspectives—

service, technology, organization and finance.

Next, we progressively deepened each insight

through the Business Model Canvas (BMC) frame-

work (Osterwalder and Pigneur, 2010), which

allowed focusing on key design elements.

2.2 Second Phase

The second phase of the research was based on two

steps that allowed to obtain, starting from the general

BM developed through the first phase, the BM

Canvases

and, then, the Service Models (SMs) depicted in

Figure 1. BM

Canvases

represent the Country-specific

subsets of the elements included within the general

BM. SMs contain configurations mainly focused on

value propositions in all the considered Countries–

with an emphasis on common aspects to be exploited.

The first step is made through two tools: (i) the

Business Model Environment (BME) (Osterwalder &

Pigneur 2010); (ii) a Coherence Matrix (CM). On the

one hand, these tools have been used to reduce the

multitude of elements proposed in the general BM.

On the other hands, they allow prioritizing the

required activities for the implementation of the pilot

projects—distinguishing among relevant and

irrelevant elements.

The BME organizes and describes the key

contextual variables useful to synthetically

characterize each Country involved in the research,

according to the four macro-areas: (i) key trends; (ii)

macro-economic forces; (iii) industry forces; (iv)

market forces.

The CM has been developed by the research

group and is characterized by the following five

dimensions: (i) country; (ii) customer segment; (iii)

functionalities; (iv) actions to address the needs of the

patient and of the overall system; (v) relevance of the

specific need. The CM describes the underlying

interrelations among these dimensions and allows

discerning between: (a) coherent and incoherent pairs

functionality-action to address the need (i.e. need of

the patient or of the overall system); (b) relevant and

not relevant pairs functionality-action to address the

need; (c) Country-specific and common among

Country pairs functionality-action.

The second step allows switching from BM

Canvases

to SMs. It reduces the complexity of the vast number

of elements of the BM

Canvases

focusing on the key

building blocks of value proposition and customer

segments. The path between BM

Canvases

and SMs

requires to select the common value propositions

among all considered Countries (general SM), and to

consider also the peculiar aspects of the contexts

(Country-specific SMs). All the functionalities,

related to the pairs functionality-action have been

clustered according to two levels: the main target of

the solutions (i.e. patient, care provider, care pathway

plan) and technological functionalities.

2.3 Third Phase

SMs are implemented within the third phase of the

research project following a Business Process

Reengineering (Hammer, 1990; Champy, 2002)

General

Canvases

Environment

Coherence

Matrix

General

Service

Model

Specific

Service

Models

Application

Service

Models

Business

Pro cess

Reengineering

A Business Model for Digital Healthcare Environments: An Organic Approach and a Use Case for Handling Cognitive Impairment

341

approach that includes the following phases: (1)

design of the care process model, which firstly

defines the macro-phases of a general care process for

CI patients. (2) analysis of the AS-IS process models

in each pilot site; (3) design of the TO-BE process

models in each pilot site, underlining the difference

between AS-IS and TO-BE process models. Conside-

ring also digital solutions (Locatelli et al. 2014).

3 RESULTS

This paragraph describes the results of the research.

Firstly, the outcomes of the literature analysis and the

evidences related to the STOF framework are

grouped into the 9 building blocks of the BMC

framework. Secondly, the results related to the

application of the BME and CM are presented.

3.1 General Business Model

The general BM is characterized by the following 9

building blocks. For each of them we report the main

results of the analysis of the literature accomplished.

1. Customer segments are convenient set of clients

with common needs, behaviours or attributes. Follo-

wing Petersen (2004), the main customer segments to

be considered in CI are the following: (i) patients with

dementia; (ii) patients with amnestic Mild CI (a-

MCI); (iii) patients with non-amnestic Mild CI (na-

MCI).

2. Value proposition is the reason why a customer

chooses one product and/or service. In CI domain, a

tool adopted to assess the various needs is the

Camberwell Assessment of Need for the Elderly

model (CANE) (Reynolds et al. 2000). The

application of the model highlights that patients with

dementia have more care needs than MCI patients.

Furthermore, there are several solutions for the

various actors involved into the care process.

3. Channels are the interfaces used to interact with

the customers in order to deliver a value proposition.

Literature shows that the main channels by which

care services are delivered to elderly people with CI

are the following: (i) caregiver; (ii) general physician;

(iii) healthcare specialist; (iv) healthcare structure.

4. Customer relationships regards how relating

with customer segments. Patients suffering from CI

tend to communicate with their caregivers or social

workers. These two support patients in adopting and

using any digital solution for providing enhanced

services. From the viewpoint of the actors involved in

the care process, many companies maintain online

most of their relationships with caregivers.

5. Revenue streams deal with the cash generated

from every customer segment. Following Stroetmann

et al. (2003), the main revenues for a digital solution

in CI domain are the following: (i) service paid by

insurance funds; (ii) service paid by governments;

(iii) service paid by the patient or by his

relatives/caregivers through out-of-pocket expenses.

Three groups of people or organizations pay for the

digital solution: (a) Business to Consumer (B2C): the

service is sold directly to the patient or his caregiver.

(b) Business to Public (B2P): the service is sold to

public entities i.e. local authorities, NHSs and

housing associations; (c) Business to Business (B2B):

the service is sold to private companies and, in some

countries, most of them are private medical insurance

companies. Furthermore, there could be the following

types of transactions between the provider of digital

solutions and the healthcare organization: (1)

healthcare organization purchases the entire system

(one-time capital investment); (2) healthcare

organization pays a license fee for each patient

connected to the system.

6. Key resources are the essential assets necessary

to create and offer the value proposition. From the

perspective of the patient suffering from CI, human

resources that will be crucial in the establishment of

the BM are health professional and caregivers (or the

social worker if the patient has not relatives that

support her) (Robert et al. 2013). The human resource

that is vital in the establishment of the BM is the

specialist of digital services through which assisting

people with CI (Kapadia et al. 2015). From the

standpoint of physical assets required to provide the

service, technologies play a key role both for the

patient and for the overall system (Kerssens et al.

2015; Robert et al. 2013; Bharucha et al. 2009). Other

key resources are patents, licenses and copyrights.

7. Key activities are actions that have to be

performed in order to create and offer a value

proposition. From the patient standpoint, the key

activities are related to her involvement: (i)

engagement of the patient; (ii) maintenance of the

relationship with the patient. From the stand point of

the actors involved in the care process, key activities

are related to the creation and sustainment of the

relationships among these key actors: (a) create the

connection between healthcare specialist and

caregiver/social worker; (b) maintenance of the

relationship between healthcare specialist and

caregivers/social workers. Following Ógáin and

Mountain (2015), these activities can be supported

through the contributions of governmental actors in

terms of: (c) national/regional awareness campaigns;

(d) financial incentives to healthcare organizations;

(e) financial incentives to healthcare specialist for the

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diagnosis of MCI and dementia; (f) financial

incentives to healthcare specialists and healthcare

organizations for the adoption of digital solutions to

treat MCI and dementia. Following Robert et al.

(2013), the key activities in the BM related to the

technology adopted are the following: (1) production

of the equipment and sensors; (2) selection of the

most appropriate technology/sensor; (3) installation

of technologies in patients’ home; (4) calibration of

the sensors.

8. Key partnerships refers to the network of

suppliers useful to improve the BM. Literature on CI

suggests that some key partnership for the BM could

be: (a) government; (b) research center/university; (c)

local regional community (Kapadia et al. 2015); (d)

private organizations (König et al. 2015); (e)

networks between the providers of digital solutions

and healthcare organizations.

9. Cost structure deals with relevant costs

characterizing a feasible BM. Literature suggests that

the main costs for a digital solution in the CI domain

are the following (Kapadia et al. 2015): (i) training

costs; (ii) personnel costs; (iii) installation and

maintenance costs; (iv) purchasing and

manufacturing costs; (v) customer service costs.

3.2 Business Model Canvases

The next steps of the research allowed to move from

the general BM to BM

Canvases

through the BME and

CM. BME allows to describe the context in which

BM will be implemented, considering the following

4 macro areas:

1. Key trends: (a) national socio-healthcare

system overview; (b) general government

expenditure on health; (c) private expenditure on

health; (d) “Out-of-pocket” expenditure; (e) per-

capita total expenditure on health (WHO 2015);

2. Macro-economic forces: (a) payment

mechanisms; (b) policies regarding the sources of

revenue and financial flow;

3. Industry forces: (a) balance between public and

private healthcare; (b) centralization vs.

decentralization (c) main actors of the NHS; (d)

number of health and social care integration hospitals

per 100.000 population (e) number of psychiatric

beds per million population (WHO 2015);

4. Market forces: (a) percentage of population

aged > 60 years compared to the overall population;

(b) life expectancy at age 60 (WHO 2015); (c)

estimated prevalence of dementia per 1.000

population (OECD 2015; Prince et al. 2013); (d)

percentage of population living in urban areas (WHO

2015); (e) population ICT readiness; (f) tendency to

informal care (Lupianez et al. 2013).

In addition to BME, the implementation of the

CM returns different combinations of coherent,

relevant and Country-specific technological

functionalities and actions to address patients’ needs.

The tool allows highlighting the value propositions to

focus the attention on while designing BM

Canvases

. The

synthesis of the findings related to BME and CM

allows defining the BM

Canvases

. The latter, though

grounded on already established frameworks (e.g.

Business Model Canvas, BME, etc.), take advantage

of the flexibility of the tools adopted to build them,

thus making them adaptable to the various possible

contexts (i.e. specificities of the various countries) or

other patients’ clusters different from those adopted

in this research.

3.3 Service Models

In order to design a general SM able to encase a value

proposition common to all the four countries involved

in DECI, the needs marked by clinicians as extremely

relevant

have been highlighted and clustered as follow:

. Diagnosis and assessment: (i) overall medical

condition; (ii) behavior and mood; (iii) assess the risk

of malnutrition; (iv) Activities of Daily Living

(ADL); (v) risk for falls.

. Patient psychological needs: (i) cognitive

stimulation; (ii) online cognitive training.

. Clinical team needs: (i) coordination of care;

(ii) clinical team information sharing; (iii) improve

diagnosis method; (iv) advising on deciding course of

action; (v) better access to and relevance of non-

pharmacological therapies; (vi) standardized care

pathway.

. Follow-up: (i) monitoring overall condition;

(ii) measurement of adherence and compliance of

patients to treatment; (iii) assess timely changes

evolving needs for social care support.

Starting from these clusters, it is possible to

cluster also the technological functionalities that

allow meeting these needs, and which are common to

all Countries. Regarding the patient layer, the

following 5 clusters

have been identified

(technological functionality in brackets):

TFP

. Patient’s status (monitoring): (i) automatic

remote-based measurement of patient’s blood

pressure; (ii) automatic remote-based measurement

of patient’s O

saturation; (iii) automatic provision

and submitting of questionnaires (of various nature,

including patient’s health status and to support

change detection) to care-involved subjects; (iv)

gathering on non-structured information on patient’s

health status from informal caregivers or social

caretakers; (v) evaluation and monitoring of cognitive

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skills and monitoring of decay curves and other

trends.

TFP

. Patient’s status (alert): automatic provision

of feedbacks and alerts on patients’ progresses or

deterioration.

TFP

. Patient’s status (communication-cognitive

stimulation): (i) cognitive games/exercises to

stimulate patients to preserve cognitive/ executive

functions; (ii) tele-consultation (tele-presence)

functionalities allowing patients and professionals to

communicate to each other visually.

TFP

. Patient’s Activities (alert): (i) automatic

provision of remote real-time feedback on patients’

activities, including non-pre-scheduled activities; (ii)

automatic provision of remote real-time patient-

tailored motivational messages based on patients’

activities, including non-pre-scheduled activities; (iii)

automatic provision of remote feedback on patients’

activities, building on long-time data analysis on

patients’ status.

TFP

. Patient’s Activities (monitoring): activity

monitoring through accelerometer for elderly

monitoring (also outdoor, with batch data download

once reconnected to base station): stand / sit / walk /

steps + intensity of activity; GPS-based patient

monitoring and structured health-based data

gathering for outdoor step counting or activity

monitoring (including detection of falls); registering

of pre-scheduled activities performed by the patient

(who is monitored real-time by sensors when

performing the activity).

TFP

. Patient’s status (storage and sharing

information): (i) activity monitoring through

accelerometer for elderly monitoring (also outdoor,

with batch data download once reconnected to base

station): stand / sit / walk / steps + intensity of

activity; (ii) GPS-based patient monitoring and

structured health-based data gathering for outdoor

step counting or activity monitoring (including

detection of falls); (iii) Registering of pre-scheduled

activities performed by the patient (patient is

monitored real-time by sensors when performing the

activity).

Regarding the actors involved in the care process,

the following 4 clusters

have been identified:

TFS

. Care providers (communication): informal

communication (messaging) among various actors

(e.g.: family members and doctors);

TFS

. Care providers (teamwork): enablement of

multidisciplinary teamwork across care providers,

doctors and informal caregivers (or some of these);

TFS

. Care pathway/treatment plan (monitoring):

coherence check between clinical

guidelines/protocols and data gathered as part of care

activities;

TFS

. Care pathway/treatment plan (sharing

information): sharing of a treatment plan among

caregivers, doctors and family members (or some of

these).

Combining the clusters of common relevant needs

with the clusters of common relevant functionalities,

it is possible to point out the match between the two

as number of notable crossings, in order to highlight

packages of SM common to all four countries.

3.4 Italian Service Model

An example of the intersection between the two

clusters and of the specificities of a Country is

provided regarding the Italian context. Starting from

the value proposition common to all the 4 countries,

the general SM is enriched with further specificities

related to the Italian Customer Segments.

Given Italian specific needs, further specific

elements of the Italian SM are available: (i)

immobility detection for elderly monitoring at home

(indoor) for patient physical needs; (ii) fall detection

for elderly monitoring at home (indoor) for patient

physical needs; (iii) trend analyses performed on data

gathered from various patients’ monitoring activities

for diagnosis and assessment & for caregivers needs;

(iv) registering of pre-scheduled activities performed

by the patient (patient is formally required to provide

a yes/no answer) for patient environmental needs &

for patient physical needs; (v) automatic reminder to

patients for the performing of a scheduled activity for

patient environmental needs & for patient physical

needs; (vi) availability of personalized and adaptable

remote-based training programs automatically

tailored on individual patient’s characteristics for

patient physical needs; (vii) drug management for

patient physical needs.

The functionalities clusters are enriched, for the

Italian case, as follow:

Patient's status (monitoring): (i) Immobility

detection for elderly monitoring at home (indoor); (ii)

Fall detection for elderly monitoring at home

(indoor);

Patient's activities (monitoring): (i) Trend

analyses performed on data gathered from various

patients’ monitoring activities; (ii) Registering of pre-

scheduled activities performed by the patient (patient

is formally required to provide a yes/no answer);

Patient’s Activities (alert): (i) Provision of

automatic reminder to patients for the performing of

a scheduled activity; (ii) Availability of personalized

and adaptable remote-based training programs

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automatically tailored on individual patient’s

characteristics;

Care pathway/Treatment plan (monitoring): drug

management.

These packages complete the general SM, shaping

the Italian specific one.

The other building blocks are grouped as follows:

upstream building blocks (Key partners, Key

activities and Key resources), downstream building

blocks (Customer Relationships, Customer Segments

and Channels), and cost and revenues (Cost Structure

and Revenue Streams). The main impacts are:

Upstream building blocks: (i) Italian clinicians

consider the diagnosis and assessment crucial (GPs

should be involved for an early detection); (ii) given

clinical team needs, it is important to provide the

technological functionalities to the local health

authorities to the municipalities and to the case

service providers; (iii) the monitoring of the patient’s

status and activities meet all the 7 clusters of needs;

(iv) to provide automatic reminders to patients for the

performing of a scheduled activity is important to

personalize the service; (v) from the point of view of

the actors involved in the care process, is crucial to

enable multidisciplinary teamwork across local

health authorities, municipalities, case service

providers, informal caregivers and voluntary

associations.

Downstream building blocks: (1) from clinical

standpoint, patient physical needs, caregiver needs

and the ones regarding the patient environment are

considered relevant; (2) the caregiver has a central

role and must be engaged and informed about the

evolution of symptoms and disease; (3) personal

assistance based on human interaction should be

preferred to meet the patient psychological needs.

Cost and revenues: (a) Revenue Streams should

be a B2P and B2C mix: (a.i) B2P: some

functionalities, for example the ones for the storage

and sharing to external EMR or other care

management tools, should be funded from general

taxation; (a.ii) B2C: some services should be sold

directly to the patient or his caregiver, for example

the ones for monitoring the patient’s status or for the

cognitive stimulation; (b) Considering the central

role of the caregivers, their training costs must be

considered also to meet their needs.

3.5 Application of the Service Models

This paragraph is focused on the application of the

SMs in the Italian pilot site, through three steps: (1)

the design of a general Care Process Model for

patients affected by CI; (2) the analysis of the AS-IS

Process Models in each pilot site, and finally (3) the

design of the TO-BE Process Models in each pilot

site, starting from the Service Model resulted from

literature analysis.

3.5.1 Design of the Care Process Model

The analysis highlighted four common phases to

every care process for people with CI (Figure 2).

Figure 2: Care Process Model for patients affected by CI.

A. Noticing Symptoms and First Detection: this

phase includes the access point of the patient with CI

in the care process and it considers the first

identification of the patient with suspected CI.

B. Assessment and Diagnosis: clinical activities

aimed at the assessment and diagnosis of the CI in the

patient identified in the previous phase. The phase

includes: a first basic assessment of CI that can be

owned by the GP, the socio-health care provider or

external specialized physicians; and then, a

comprehensive assessment that is usually owned the

socio-health care provider, although some of the

requested exams are provided by external physicians.

C. Treatment and Care Service Definition:

analysis of the patient needs, both clinical (emerged

from the clinical assessment delivered in the previous

phase) and social needs (usually analysed with the

patient and the family with a social assistant). When

needs are defined, the care service is designed.

D. Service Delivery and Maintenance: delivery of

the care service designed and continuous monitoring

of the patient’s status.

3.5.2 Analysis of the as-IS Process Models

We will describe in detail the Italian process model,

in Palazzolo Institute of Fondazione Don Carlo

Gnocchi Onlus in Milano, following the four macro-

phases.

A. Noticing Symptoms and First Detection: the

process starts though a first meeting between patients

and physicians, like a check-up visit, or after an acute

episode in a long term care facility. The visit can be

owned by the GPs or specialized physicians (both

within Palazzolo Institute as well as external). Once

patients with certain kind of characteristics have been

identified during a physician’s visit, their path

continues in the care process.

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B. Assessment and Diagnosis: in case there are

symptoms of CI, a basic assessment can be

performed. Note that usually the GP points out the

patient to specialists (at Palazzolo Institute or

externally). This initial assessment consists of a basic

examination of the patient with suspected CI, aimed

at understanding more regarding patients’ health

conditions and social situation. In case the basic

assessment strengthens the initial suspicion of CI, a

comprehensive assessment follows. At Palazzolo

Institute, for a comprehensive assessment, patients

can be referred to a specialized geriatrics unit, which

starts the assessment protocol aimed at reaching the

diagnosis.

C. Treatment and Care Service Definition: in

Italy, it is common that patients’ relatives or

caregivers take the responsibility for organizing the

care pathway of the patient. The care pathway can be

managed through the activation of home-based and

facility-based services, whose activation is discussed

together with the family.

D. Service Delivery and Maintenance: Palazzolo

Institute delivers an integrated socio-healthcare

service to patients affected by CI. During the service

delivery the patient is continuously monitored by the

professionals of the Institute.

3.5.3 Design of the to-BE Process Models

As regards the TO-BE process models, we will

describe in detail the differences between the Italian

AS-IS and the TO-BE process model. The

fundamental differences from AS-IS and the TO-BE

process models are linked to some new technologies,

which ensure the sharing of information among the

various actors enabling independent living.

A. Noticing Symptoms and First Detection: during

the visit, physicians visualise the patient’s medical

records on the DECI platform connected with the

databases of local hospitals and GP.

B. Assessment and Diagnosis: data collected by

the specialized geriatrics unit are entered in a tablet

and immediately shared (through a cloud service)

with the other stakeholders of the care network.

C. Treatment and Care Service Definition: A first

needs analysis can be performed by the

patient/caregiver filling in on-line questionnaire on

the DECI platform. Then a visit could confirm the

results of the questionnaire.

D. Service Delivery and Maintenance: A

wearable sensor could be used to detect abnormalities

in the level of activity and send alert messages to

family members or assistance operator. The GP and

specialists can share the information collected

through the DECI platform and plan together a

revision of the medication and treatment plan, and

schedule visits. The program can alternate sessions in

physical presence of the physiotherapist with tele

rehabilitation sessions. Some cognitive stimulation

and rehabilitation exercises could be done also at

home through the online platform. The platform can

also be used by the case manager to communicate

with the patient or the caregiver.

4 CONCLUSIONS

The approach adopted to design the BM is relevant

because: (i) it adopts already established frameworks

(e.g. Business Model Canvas); (ii) it highlights

common traits and differences among the Countries

within the DECI project; (iii) it allows distinguishing

firstly between coherent and not coherent elements,

then between high-priority and low-priority ones; (iv)

it provides information about the impact of the

various digital solutions; (v) it is applicable in other

contexts (i.e. Countries) therefore it can overcome the

boundaries of the DECI project thanks to its

scalability; (vi) it supports decision-making processes

also after the pilot phases because, once the first most

relevant needs are addressed, it will be possible to

proceed with the actions to address the needs with a

lower relevance.

Furthermore, the approach was validated and

refined also through a Scientific Advisory Board with

the involvement of external stakeholders. Finally, the

approach is aimed to support the definition and

implementation of a comprehensive and multifaceted

BM in a complex and continuously evolving context.

The next steps of the DECI project are: (1) the

implementation of the Pilot site (Italy, Sweden, Israel

and Spain) adopting the proposed SMs and (2) the

evaluation of key performance indicators considering

different perspectives (e.g.: economics, social, etc.) in

order to highlight the potential benefits of the

designed approach.

ACKNOWLEDGEMENTS

The authors would like to thanks the whole

Consortium of the DECI project: Fondazione

Politecnico di Milano, Consoft Sistemi SpA,

Fondazione Don Carlo Gnocchi Onlus (Italy), Centre

for Healthcare Improvement – Chalmers University

of Technology, Västra Götalandsregionen (Sweden),

Hospital Universitario de Getafe - Servicio de

HEALTHINF 2017 - 10th International Conference on Health Informatics

346

Geriatría (Spain), Maccabi Healthcare Services

(Israel), Roessingh Research and Development (The

Netherlands).

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