Will be given the case: investigate the firms problem(s) as they relate to Information Systems and prepare a written paper for th

DOI: 10.4018/JCIT.2020100103

Journal of Cases on Information Technology Volume 22 • Issue 4 • October-December 2020

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Building a Critical Mass of Users for Digital Healthcare Promotion Programs: A Teaching Case Rennie Naidoo, University of Pretoria, South Africa

https://orcid.org/0000-0001-8392-1136

ABSTRACT

Despiterecenttechnologicaladvancements,theslowadoptionpatternofdigitalhealthcarepromotion programscontinuestobeamajorproblemplaguingmanyhealthcareorganizationstoday.Thehistorical teachingcasestudyisindispensableinimprovingourunderstandingofthecomplexandmultifaceted natureofcontemporarydigitalhealthcarepromotionprograms.Thishistoricalteachingcasepresents informationaboute-health,thee-commerceunitofalargemultinationalhealthcareinsurancecompany. Theteachingcaseshowshowdespitee-health’sabilitytopersuadealargeregisteredbaseofusersto trialitshealthcarepromotionprograms,over90%oftheseregistrantsdiscontinueduseafterashort trialperiodofusingthetechnology.Thishistoricalteachingcasefocusesonthesocialchallenges involved in persuading users to adopt and continue using e-health’s major healthcare promotion innovation:anonlinenutritioncenter.Despiteextensivepromotionsandtheuseofincentives,less than10%oftheuserbaseadoptedandcontinuedtousethishealthcarepromotioninnovation.Thecase reportsonthediscontinuanceamongdigitalhealthcarepromotionusersdespitetheintensiveefforts toretainthem.Studentsandpractitionerswillgaininsightintothekeysocialchallengesinvolved inachievingacriticalmassofusersfordigitalhealthcarepromotioninnovations.Theteachingcase requiresimportantdecisionstobemadebystudentsandpractitionersaboutpresentdigitalhealthcare promotion programs by drawing on inferences from past digital healthcare promotion programs. Finally,thishistoricalteachingcasestudymakesaconvincingcaseforthevalueofhistoricalinsights ininformingpresentdaychallengesfacingcontemporarydigitalhealthcarepromotionprograms.

KeywoRDS Adoption, Electronic Health, Healthcare Informatics, Healthcare Promotion, Preventative Healthcare

INTRoDUCTIoN To DIGITAL HeALTHCARe PRoMoTIoN PRoGRAMS

Astheglobalpopulationrisesandlifeexpectancyratesaroundtheworldcontinuetoincreasedueto advancesinscienceandtechnologyandimprovementstosocio-environmentalconditions,healthcare budgetsarefacingenormouspressure.Onthe21stofNovember1986,theOttawaCharterinitiated theadvocacyofhealthpromotiontoimprovehealthcareglobally(WHO,1986).Healthpromotionis

Thisarticle,originallypublishedunderIGIGlobal’scopyrightonSeptember23,2020willproceedwithpublicationasanOpenAccess articlestartingonJanuary18,2021inthegoldOpenAccessjournal,JournalofCasesonInformationTechnology(convertedtogoldOpen

AccessJanuary1,2021),andwillbedistributedunderthetermsoftheCreativeCommonsAttributionLicense(http://creativecommons.org/ licenses/by/4.0/)whichpermitsunrestricteduse,distribution,andproductioninanymedium,providedtheauthoroftheoriginalworkand

originalpublicationsourceareproperlycredited.

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basedonthepremisethathealthcarecannotbethesoleresponsibilityofthehealthsectorandtherefore seekstoprovidepatientswithbettercontrolovertheirhealththroughinformation,healtheducation, andlifeenhancingskills(Eriksson&Lindström,2008).Thebenefitofempoweringpatientsisnot limitedtothecostreductionofhealthcare,butisalsoariskmitigationfactorfordiseaseaswellas ahealth-enhancingstrategy.

Overtheyears,ICTbegantobeintegratedintohealthsystemsandservicesworldwide.During the 1990s, e-commerce emerged and enabled new ways to conduct transactions via the Internet. eHealth was also enabled by the Internet. The term eHealth refers to the use of information and communication technologies to improve health and the health care system (Oh, Rizo, Enkin & Jadad,2005).TheInternetreferstothegloballyconnectednetworkofcomputers.Althoughtheterm InternetisusedinterchangeablywithWorldWideWebor‘theWeb’,theWorldWideWebrefers tomultimedia-baseddocumentsthatcanbeaccessedonline,overtheInternet(Lupton,2014).This becameknownastheWeb1.0eraortheso-calledbrochurewebera.TheWeb1.0erabeganrapidly in1990sbecauseoftheavailabilityofbrowserswithuser-friendlygraphicalinterfaces.TheWorld Wide Web had become a valuable channel for accessing and seeking health information. Rapid improvementincommunication,hardwareandsoftwaretechnologiesalsoledtonewandbetterhealth serviceofferingsviatheInternet.Bytheearly2000s,therewasanoticeableshiftintheuseofthe webandthedevelopmentofweb-basedapplications.ThiswastermedWeb2.0andinvolvesusers creating,organizing,sharing,critiquingandupdatingcontent.Web2.0connectspeopleandcontent inuniqueways.Web2.0facilitatesan‘architectureofparticipation’–adesignthatencouragesuser interaction,empowermentandcommunitycontributions.PopularWeb2.0applicationsincludeFlickr, Wikipedia,Facebook,MySpace,TwitterandYouTube.Bythemid-2000s,Healthcare2.0emerged totakeadvantageofthenetworkofWeb2.0applicationsandservicesdeliveredthroughtheWeb platform. Health 2.0 uses social networking sites, blogs, email list services, online communities, podcasts,search,tagging,videos,andwikistopersonalizehealthcareandtocollaborateandpromote healtheducation(Lupton,2014).

Recent advances in processor, memory, and disk storage capacity have made digital devices relativelyinexpensiveandaccesstoonlineplatformshavebecomemoreubiquitous.Consequently, increasinglysmallerdigitaldevicesfromthepersonalcomputertothetablettosmartphonestowearable computersarebeingbeenusedinhealthcare(Lupton,2015).m-Healthormobilehealthisdefined astheuseofmobiledevices,suchasmobilephones,patientmonitoringdevices,personaldigital assistants(PDAs),andotherwirelessdevicestosupporthealthpractices(Bert,Giacometti,Gualano& Siliquini,2014).Forexample,trackingdevicescanbeusedtomonitorapatient’scalorieconsumption, exerciseandmetabolicrate.Thesedevicesarebeingintegratedwithsocialmediatoprovidesupport andmotivation.ExpertspredictthattheWebwillevolveintoWeb3.0orthe‘SemanticWeb’(Giustini, 2007).TheSemanticWebaimstoimproveuponthemeaningfulnessofinformationontheWebthereby improvingcooperationbetweendigitaldevices,healthcarepractitionersandpatients.

Apartfromthecreationofdigitalcontentbyhealthcareuserswhentheyuploadinformationto theInternet,sensorsembeddedinhealthcaredigitaldevicesandphysicalhealthcareenvironmentsare alsogeneratingmassivedatasets(NevesStachyra,Rodrigues2008;Panesar,2019).Thesemassive datasetsarereferredtoas‘bigdata’.Cloudcomputingtechnologiesarebeingusedtofacilitatethe production,storageandsharingofthesebigdatasetstoprovidedigitalhealthcaresolutions(Darwish, Hassanien,Elhoseny,Sangaiah&Muhammad,2019).Artificialintelligenceandmachinelearning are being used to uncover hidden connections and patterns in these massive data sets to provide evidence-baseddigitalhealthcaresolutions(Panesar,2019).Today’shealthcareICTecosystemis much more complex and involves network providers, network operators, digital device suppliers, platform,contentandapplicationsproviders,healthcarecompanies,healthagencies,governments andpatients(Fransman,2007).Theterm‘digital’isnowbeingemployedtodescribepaper-based elementsthathavebeentransformedintodigitalformats,andthedevices,communicationnetworks andsoftwareapplicationsthatusetheseformats.

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ICTshaveplayedacrucialroleinprovidingadigitalplatformforpublishinganddisseminating healthalertsandinformationtothegeneralpublic,scientistsandhealthcareprofessionals.eHealth innovations like electronic health records, computer assisted prescription systems, and clinical databases have already directly benefited many patients and holds great promise for the future. Digitalplatformsareplayingandwillcontinuetoplayacrucialroleinhealthpromotion.eHealth innovationsareexpectedtoempowerandprovidecost-effectiveapproachesforpatientcareandtohelp governmentagenciesandhealthcareorganizationstocopewiththechallengesofincreasinghealthcare costs.However,theevidenceshowsthatthelevelsofuseruptakeformanyoftheseinnovationsare currentlyverylowandthatthediffusionofmanyoftheseeHealthinnovationsisbeingimpededby anumberofsignificantbarriers(Oderanti&Li,2018;Gugglberger,2018;Parasuraman&Colby, 2007).Despitethetechnologicaladvancementsandthepotentialofdigitalhealthpromotiontotackle theglobalhealthcrisis,someresearchersarguethatthattherecontinuestobeacrisisindigitalhealth promotiondelivery(vanGemert-Pijnen,Nijland,vanLimburg,Ossebaard,Kelders,Eysenbach& Seydel,2011;KeshavarzMohammad,2019).Thekeychallengesarenottechnologicalbutsocial.

Healthcare promotion innovations have earned a reputation for diffusing relatively slowly comparedtootherhealthcareinnovations(Rogers,2002;Rogers,2010;Greenhalgh,Robert,Bate, Macfarlane & Kyriakidou, 2008). It may be simplistic to assume that strong monetary, and other formsofincentivesforprevention,willresolvethecomplexproblemofconsumerhealth(Reichheld &Schefter,2000;Jost,2007).Despitethemixedviewsabouttheefficacyofhealthcarepromotion programsintheliterature(Adam&DeBont,2003;Bandura,2004;Lister,West,Cannon,Sax& Brodegard,2014),informationandcommunicationtechnologiesaredeemedtobeimportantenablers in healthcare services (Larkin, 2001; Schraefel & Churchill, 2014; Sulaiman & Wickramasinghe, 2014;Orji&Moffatt,2018).However,healthcarepromotionprogramsarequitecomplex(Solberg, Kottke,Conn,Brekke,Calomeni&Conboy,1997),yettheycontinuetobehandledpoorlyandfail todeliveronanticipatedbenefits(Ward,2013;Ginter,Duncan,&Swayne,2018;Greenhalgh,2018). Tomanagethiscomplexity,somescholarshavesuggestedthattheseinterventionsneedtoaddress thesocialchallenges(McLeroy,Bibeau,Steckler,&Glanz,1988;Green,Richard,&Potvin,1996; Iyengar&Nair,2000;Schlosser,2002;PorterandTeisberg,2006).

Thiscaseisaboutthedifficultiesinvolvedindigitalhealthcarepromotionprogramsattaininga criticalmassofusers.Asstudentsexplorethecasetheywillberequiredtoaddressthemanysocial challenges raised by digital healthcare promotion programs. This case highlights the challenges experiencedbye-Health,thee-commercechannelforHealthInsuranceCompany(HIC),anditsOnline NutritionCenter.AfterabandoningtheOnlineNutritionCenter,some15yearsago,HICisrevisiting whetherornottopursueadigitalstrategyforthepromotionofnutritionamongitscustomers,given thelatestadvancesintechnology.Beforeproceeding,theExecutivehasconcludedthatareviewof thepastOnlineNutritionCenterinitiativeisneeded.Theybelievethatsuchanassessmentofthe pastcouldprovidevaluableinsightsandlessonslearnedtoinformtheirdecisionaboutthefuture.

SeTTING THe STAGe

Introducing the e-Health Case Study Terry Rossi burst into his office, walked directly to his desk and slumped into his chair. He had just arrived from another tough Exco meeting. The committee was concerned that the “wellness innovations”deliveredontheWebhadsofarappealedtoonlyaminorityofcustomersandnotthe highnumbersthathadbeenpromisedbye-Health.Atbest,thehealthcarepromotionprogram,the onlinenutritioncenter,wasservingasacomplementarychannelforasmallcaptiveaudience.Terry wonderedhowhewasgoingtoimprovetheperformanceoftheonlinenutritioncenter.Terryknew that if he were to convince the Exco that this healthcare promotion program was a success, this programwouldhavetoattainacriticalmassofusers.Hewasconsideringthestepshecouldtaketo ensurethate-Healthbuiltacriticalmassofusers.

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CASe DeSCRIPTIoN

e-Health’s Nutrition Centre E-HealthistheindividualbrandnameofthewebsiteforHealthcareInsuranceCompany(HIC)(Figure 1).HICiscomposedoftwootherbusinessunits:WellnessScienceCompany(WSC),acompanythat providedwellnessandloyaltyprogramsforcustomers,andBritishHealthcareInsuranceCompany (BHC)whichfocusesonoffering“consumer-engagedhealthcareproducts”forUK’sprivatemedical insurancemarket.TheaimofWSCistoprovidememberswithtoolsto“preventdiseaseandimprove theirwell-being”.WSCwaslaunchedin1997inresponsetothegrowingtrendtowardsahealthier, moreactivelifestyle,basedonthepremisethathealthierlifestylescouldtranslateintolong-termsavings onhealthcarecosts.WSCprovidesmemberswithaccesstoselectedhealthandfitnessfacilities,and createsstrongincentivesfortheircustomerstousethem.Membersarepersuadedtoearnincentive pointstoimprovetheirwellnessstatus.Thegreaterthestatus,themoreaccesstobenefits,suchas discountedtravelandleisureprices.WSCalsoprovidesallsortsofincentivestousee-Healthand e-Health’sNutritionCenter(Figure2).Bytheendof2005,HICwascoveringmorethan1.8million lives(Figure6)whileWSCwascoveringmorethan1.2millionlives(Figure7).Atthesametime, e-Health’sregistereduserbaseexceeded430,000(Figure8).

TheNutritionCentrewasconceivedin2002.Theobjectivewastoprovideanonlinemechanism thatpromotedhealthyeatinghabitsamongWSC’smembers.Thedesignprocesswasmanagedby awellnessnutritionpanel,composedofdieticians,cliniciansandnutritionacademics.Therewasa hugeemphasisondesigningthetoolwithastrongscientificbasis.

…