Strategic Management Aspects of
- Personalised and human touch in the delivery of care every time.
- No opportunity/limited opportunity to offer expert advice to the customers at all times.
- High costs due to repetition of tests due to unavailability of the results of the
- Diminished efficiency due to limited and essentially archaic communication facilities
available; also especially, in emergency, many cases are not effectively dealt with for
lack of vital informations (e.g., the patients past history, therapeutic history,
- Obsolete facilities, at least perceived to be so by the customers.
- Losses, both in terms of profit-margins and number of patient visiting the organisation,
arising due to failures and consequent inefficiencies as a result of improper
communication between the various service-and-care providers.
- Lower prices of the product line on offer as no additional costs would accrue as a
result of capital expenditures and maintenance expenditures on account of implementation
and maintenance of telemedicine facilities.
- Organisations having telemedical facilities would be in a competitively advantageous
- The consumers may opt for those organisations offering IT solutions as an additional to
their product mix and thereby leading to lowering of the market share. Patients could opt
for the more "technologically advanced and innovative" organisation.
- The customer needs may not be fully satisfied. [Top]
An Organisation With
- Core competency in better product mix and overall increased efficiency.
- Improved and efficient communication between the various wings of the organisation and
its users thereby decreasing the time lag in getting the relevant information at the right
place at the right time.
- Well-thought-of by consumers as they get the best care that there is available anywhere
on this planet, at least potentially.
- Some insulation from strong competitive pressures. Other organisations may only be able
to offer the same technology.
- An acknowledged market leader in innovativeness with a strong vision for the future.
- Improved efficiency.
- Ahead on experience curve over the "would-haves" and other doubters.
- Undoubted technological skills of a superior nature.
Sub-par profitability as a result of lack of proper skilled personnel to handle the
technology, bad marketing/advertisement strategy leading to under-utilisation of the
facilities on offer leading to a low return of investment.
- Potential loss of security, particularly of sensitive information - at least perceived
as such by the consumers .
- Some loss of personalised care if treated by an expert who continuously resides afar and
hardly, if at all, visits the patient in person. The loss of the "human-touch".
- Ability to serve additional customer groups or expand into new markets or market
segments. The development of integrated health care delivery systems would be greatly
facilitated by telemedicine as the various branches of the entity would be able to keep in
close contact at all hours through minimal disruption of their services and activities.
- Ability to expand product mix to meet broader range of customer requirements.
- Acquiring special skills which may be transferred to others at a price.
- Keeping at pace with the emerging technologies.
- Ability to get and remain "connected" with the rest of the world literally at
the touch of a button.
- Increased vulnerability to recession and business cycles as considerable capital and
manpower expenditures are involved, at least initially, leaving the organisation open to
an exposed and weakened free cash flows for the first few years. Since the technology is
in the area of IT, which is developing at an extremely fast pace on its own, telemedicine
would follow a similar pattern until such time it has been able to encompass most of the
opportunities that the IT of the day allows. Therefore, unless the organisation is willing
to stop innovating, which in itself is contrary to the very idea that led it to embrace
telemedicine, the organisation would be looking at least at a period of 10 to 15 years of
technological development and therefore expenditures directly as a result of adopting this
The KSFs that Telemedicine would
bring to the Health Care Industry
- Scientific research expertise. The technology would make available epidemiological
studies, statistical analysis, availability of online medical library, access to a
regional/global depository or data warehouse of medical and health related information
literally at the touch of a button.
- Reduced day-to-day costs. The quality of service would increase as travel time and costs
are cut down, repeat tests minimised, expert opinion more readily available even at long
distances, physicians can be freed to perform the really complex tasks while the
junior doctors/nursing/paramedical staff can successfully carry out the routine diagnosis
and treatment. The consumers would love the innovativeness of this technology and it would
also lead to cost-effectiveness even in only the medium run.
- Continuous accessibility. Access to adequate supply of skilled personnel be increased
tremendously. The medical professional would literally be "always available"
with the help of this technology.
- Increased speed of delivery. The speed of delivery of adequate health care would
- Reduced travelling costs. The consumers would be able to avail of better service from
the relative comfort of their home surroundings as they will be able to cut down on having
to travel to see the doctor more often than not.
- Creation of market niche. This one addition to the service mix would lead to the
organisation offering this technology to be viewed as being a "caring" one in
the eyes of its consumers and would go a long way in creating a strong brand image and
loyalty in their minds, something that the competitors would find very hard to
break/switch even with great efforts and expenses.
- Consultant on call 24-hours a day, 7-days a week, 54 weeks a year. Since the consultant,
who possesses an acknowledged superior skill, need not be hired on a permanent basis by
the organisation and would visit "virtually" if and when required with the help
of this technology, the organisation saves both ways. On the one hand it has less
expenditures by eliminating the necessity to keep consultants on its rolls on a permanent
basis whose expertise is only infrequently called upon, while on the other hand by having
an increased sales since more consumers would visit this organisation in order to avail of
the services of this "virtual" consultant.
- Improved CME through reduced costs. Less expenditures on account of continuous medical
education of its personnel which telemedicine can provide online thereby leading to less
travel and costs thereof as well as less loss of facilities since the personnel would not
have to be away from their workplace to get re-training or fresh training. The savings may
be put to better use somewhere else. The organisation would consequently become more
- Data Warehousing. It would lead to the organisation having superior information systems
as all the details of health and consumer related information may be analysed quickly,
thereby allowing the organisation to foresee future requirements and plan accordingly
(ability to "see ahead"), something that its competitors without telemedicine
would not be able to do. This would also lead to increased profitability. Data warehousing
is an increasing trend in leading industry to pool all data emanating from within and
without and evaluating them in various ways. This helps in identifying strategic points
and formulating strategies in a proactive manner.
- Goodwill. The possession of telemedical facilities by a particular organisation would
doubtlessly lead to the creation of a favourable image and build a huge reputation with
- Increased Profitability. In the medium-to-long run, the overall costs would become low,
thereby increasing profitability as well as DFCFs as more and more consumers begin to
avail the facilities provided with the help of this technology.
- Improved Intra-Organisational Communication. An integrated information systems within
the organisation, the inevitable consequence of having telemedicine in an organisation,
would lead to a more cohesive and efficient functioning and administration of the
organisation as a whole, the payoff of which is always positive in several ways - higher
productivity, lower overall costs, low "losses" due to faulty communication
within the organisation, etc. [Top]
Effects of Telemedicine on Health Care
- The driving forces that the arrival of telemedicine technology is causing the health
care industrys competitive structure and business strategy to change are:
- The buyer demands are changing. They are people who are able to afford to spend higher
to avail of the better and newer technological advances that are taking place in the field
of health care. They do not like to travel (who does when physically or mentally
distressed, unless forced or when bitten by the travel bug?) and would like to
have expert opinion available to them no matter where that expert happens to reside in.
- Telemedicine technology would broaden the industrys consumer base by making those
that reside in remote and rural areas in a position to avail of its facilities more
effectively. An organisation successfully implementing the introduction of this technology
will allow its market position to strengthen, usually at the expense of organisations who
prefer to stick with their old service mix or are slow to follow with their offer of this
- The availability of telemedicine will definitely alter the industrys landscape
dramatically. Organisations offering it would be quickly able to capture a sizeable market
segment and create entry barriers successfully due to higher capital expenditure
requirements, switching costs of buyers and lagging in the learning/experience curve which
the organisations that would like to follow will inevitably encounter.
- The organisation(s) which choose to introduce this technology would be able to have a
very powerful marketing tool in their hands to spark a burst of buyer interest, widen
industry demand, and increase service mix differentiation.
- The industry without telemedicine is currently under a tremendous pressure to become
cost-effective in order to maintain profit margins and therefore acceptable return on
investments, adequate DFCFs for use towards future capital expenditures that the
advancement of technology would inevitably demand, and yet be able to attract and
increasingly wider market segment. Telemedicine is expected to bring in sufficient
revenues to help in this regard.
- The customer is no more satisfied by being made to accept whatever the good old doctor
says. He demands more information, better/second opinion and value for money so that he
may continue to lead an acceptable level of quality of life. He knows that there is a
technology out there that could help him to achieve all this. Consequently, the
organisation that is in a position to offer him this facility would create a strong brand
loyalty almost instantaneously.
- Telecom deregulation and the Internet has opened up tremendous possibilities for a
technology like telemedicine to be made available anywhere from anywhere. It would be
wrong to be left behind for that would mean giving up a strategic advantage. [Top]
The desire for healthier, back-to-nature, and increased awareness about health amongst
the common man along with a growing concern for ones continued well-being has
already led to the industry to open up and begin offering such services that satisfy the
customer needs. Telemedicine would further this process dramatically, to say the least.
While a single standard comprehensive international coding system would seem to be the
ideal solution, this may not be practical. For instance, codes are used to identify
objects such as hospitals, staff, patients, machines and products, as well as medical
concepts such as diseases, treatments and tests. Many coding systems already exist and
have already been adopted for specific purposes. These arrangements cannot easily be
One important rule for any registered coding scheme is that when upgrades are produced,
additional codes may be added as new versions are developed, but none of the meanings of
any existing codes should change. If codes need to be reallocated, then a new registration
identifier must be applied for and issued. This rule applies to all types of codes and
identifiers, including those used for people, places, objects, manufactured articles,
computer databases and medical terms.
Registered coding schemes will be used in messages in the following way. Whenever a
computer sends a message to another system, for example from a hospital to a GP, it will
need to specify what coding schemes it is using. If the receiving system recognises the
identifiers, this message will be accepted, otherwise it will be refused. This
registration scheme allows any coding scheme to be used, but market forces will determine
which are most successful. Software developers will minimise the number of coding schemes
they support. [Top]
Marketing is a social and managerial process by which individuals and groups obtain
what they need and want through creating, offering, and exchanging products of value with
others. A human need is a state deprivation of some basic satisfaction. Wants are desires
for specific satisfiers of needs. Demands are wants for specific products that are backed
by an ability and willingness to buy them.
Wants become demands when supported by purchasing power. Consequently, organisations
must evaluate not only how many people want their product but, more importantly, how many
would actually be willing and able to buy it.
A marketing manager identifies the various needs and wants of his target customer and
then designs products or services to satisfy these requirements at value-for-money prices.
"The aim of marketing is to know and understand the customer so well that the
product or service fits him and sells itself. Ideally, marketing should result in a
customer who is ready to buy. All that should be needed then is to make the product or
Given the above, let us now discuss the Health Care Industry as a whole and
Telemedicine in particular. [Top]
Needs & Wants of the
- A stakeholder is any individual or group that has an interest in how an organisation
operates. They are the very person/groups that are responsible for ensuring the continuity
of the organisation and ultimately that make or break it. The stakeholders for a hospital
are ut infra:
- The management team - information about everything that is going on within the
organisation at the micro-level and the industry as a whole at the macro-level.
- The consultants and other doctors/the general practitioners - access to all pertinent
information about his patient as well as about the latest developments, research, findings
and evaluations in the field of medical sciences in general and his own field of interest
in particular. Such facilities should be available at all hours no matter what day and
time it is. Moreover, all informations, particularly those ones that deal with patient
informations must be held as if they were in the deepest gold-vaults of Fort Knox, USA and
only available to those who have the prior clearance.
- The nursing staff - access to all the instructions and orders about a particular patient
as well as maintaining up-to-date information about them as soon as they become relevant. [Top]
How may these demands be met
Perhaps the ideal solution would be is to have a centralised repository for all
information from which relevant datas may be mined and processed as and when necessary.
However, in reality, the development of such a system is challenging enough in itself and
implementation of the same would most certainly take nothing short of a yeomans
The realistic option is to develop several concomitantly congruent systems that could
seamlessly intertwine with one another as and when every layer is added so that at the end
the ideal solution is achieved at the minimum of effort and costs with the maximum of
efficiency and speed.
In order to achieve the above objective either a single programming language coupled
with a single RDBMS package is taken as the basic platform or a modular approach using
multiple languages and packages may be adopted while ensuring that a common standard is
adopted so that they may seamlessly exchange data amongst them. There are a of course
number of upsides and downsides to either of these methods and the final choice depends on
the particular solution provider.
While the former mode allows faster development of products consequent to the freedom
of not requiring to continuously debug the individual modules and thereby necessitate
several trial runs before releasing the product to the customer, it restricts the
developer to using certain preset rules and regulations that have been built-in by the
developers of the language and package. The exact opposite is the case with the adoption
of the latter mode since the use of multiple programming languages allows the flexibility
for the development of a number of modules that are not preset and hence are not rigid,
but they take a number of trial runs and debugging resulting in a longer product
Software manufacturers are most worried about the shelf-life of their products, so
getting ones product first into the market is what is upper most in the
marketing/finance department and the managements mind. The normal software of today
has a realistic shelf-life ranging 3 to 24 months. If it is a game it normally tends to
have the lower end of the range, and if it is an operating system, it tends to have the
upper end of the range. It is not such that it will not sell, but if there is no next
improvement on the line then that product will be pushed off the shelf with another
competing product that does the very same things better with probably several added
frills. Telemedicine related software, provided it is a good one, is expected to have a
long shelf-life (even upto 5 years). The most important reason for this is that once
medical professionals learn a technique, they find it irritating to change. Old habits die
hard, and all that, you see. Once a software has been around for a while and is being used
by a large body of users, a newer software which does indeed do things much better but
requires considerable re-training and unlearning of previous methods is put on market,
there is a very good possibility that it will be rejected. [Top]
A few important points must however be borne in mind.
- Data security is the overwhelming concern for most of the users, so the product must
have superior security features built in.
- Since the same data, in part or in whole, is expected to be shared by a large number of
users mostly concomitantly, it is imperative that the product must be compatible with
transmission over networks.
- GUI approach is essential for improved ergonomics.
- The database(s) is going to be huge, thus the package has simply got to be efficient
enough to effectively handle it all for the concerned datas would be multifarious - texts,
pictures, sounds, videos, some of which could be in real time.
- The package must be Internet compatible, i.e., the datas should be exchangeable over it,
probably HTML-based web pages with Java Applet/ActiveX controls embedded within them.
- Ability to access datas through telephones/faxes/mobiles/data transmission systems,
should be present. [Top]
The support staff for
- The admission and appointments department - keeping track of all the
details of admission and appointments, including dishonoured appointments.
- The catering department - keeping track of details of all the special
dietary needs of a patient as soon as they are decided and ensuring that the right diet is
administered to the right patient at the right time.
- The accounts department - accurate maintenance of all transactions related
to cash, assets, liabilities, inventory control and costing.
- The pharmacy department - keeping track of every movement of scheduled and
over-the-counter drugs and consumable items, of all medication that is prohibited or
contraindicated or dangerous for a particular patient so that no medication is
administered erroneously, and getting the right item at the right place at the right time.
- The inventory controlling department - establishing an effective JIT in a
health are organisation, a practical nightmare verging on impossibility since one can
hardly predict with any reasonable degree of certainty when a particular item would be
required at a particular point of time unless it is an item of frequent use like a
disposable syringe or piece of gauze.
- The ancillary departments - communicating and liaising with other
departments to ensure a comfortable working environment.
- The marketing department - retrieving, analysing and assessing the facts
and figures emanating from within as well as without the organisation so that effective
marketing strategies may be developed and implemented thereby establishing a competitive
advantage over the others.
- The medical records department - all information held in a systematic
manner and retrievable at the shortest possible time, or as soon as it is demanded by
persons having the authority to do so.
- The patients - the ability to consult a doctor of his own choice at his
own time at a place of his choosing and all informations passed on must be guarded and
held in an absolute veil of utter secrecy. The doctor must however be the best there is
available at that particular point of time and must in the possession of all pertinent
information at his fingertips.
- The attendants/relatives of the patients - continued and as
up-to-the-moment as possible information regarding the treatment and state of health of
their unwell near and dear one.
- The third-party payers and the various donors - the need to know why and
how their hard earned money is being utilised (i.e. spent).
- The responsible local health authority/the responsible regulatory
authority/the government - all the various informations that emanate from within the
organisation. Not only medical records but also financial records.
- The suppliers - how their products are being utilised so that they may be
able to gather/track all the necessary background, and foreground, datas. This would allow
them to improve on their services allowing for better purchaser-supplier relationship.
- The community - the public at large are increasingly being informed about
a number of medical issues by the medical fraternity, particularly about the various the
preventive measures, that affect them still albeit on a "need to know" basis.
However, the public are increasingly demanding to know more about such matters that are
affect their daily existence - both quality and quantity. This is but a result of the
natural, radically germane to humanness and most understandable interest in ones own
life and everything that is directly concerned with it. [Top]