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Background: Sleep disordered breathing (SDB) is an under-recognised independent risk factor and a potential consequence of stroke. We systematically reviewed and meta-analysed the effectiveness of positive airway pressure (PAP) therapy in improving post-stroke outcomes. Methods: We searched CENTRAL, Embase, PubMed, CINAHL, PsycINFO, Scopus, ProQuest, Web of Science and CNKI (China National Knowledge Infrastructure) for randomised controlled trials comparing PAP therapy against a control or placebo group. We evaluated the pooled effects of PAP therapy on recurrent vascular events, neurological deficit, cognition, functional independence, daytime sleepiness and depression using random effects meta-analyses. Results: We identified 24 studies. Our meta-analyses showed that PAP therapy reduced recurrent vascular events (risk ratio 0.47, 95% CI 0.28–0.78), and showed significant beneficial effects on neurological deficit (Hedges’ g= −0.79, 95% CI −1.19– −0.39), cognition (g=0.85, 95% CI 0.04–1.65), functional independence (g=0.45, 95% CI 0.01–0.88) and daytime sleepiness (g= −0.96, 95% CI −1.56– −0.37). However, there was insignificant reduction in depression (g= −0.56, 95% CI −2.15–1.02). No publication bias was detected. Conclusions: Post-stroke patients with SDB benefited from PAP therapy. Prospective trials are needed to determine the ideal initiation period and the minimum effective therapeutic dose.

Purpose: The current literature related to patient safety of interorganizational health information is fragmented. This study aims to identify interorganizational health information exchange-related patient safety incidents occurring in the emergency department, emergency medical services, and home care. The research also aimed to describe the causes and consequences of these incidents. Methods: A total of sixty (n = 60) interorganizational health information exchange-related patient safety incident free text reports were analyzed. The reports were reported in the emergency department, emergency medical services, or home care between January 2016 and December 2019 in one hospital district in Finland. Results: The identified interorganizational health information exchange-related incidents were grouped under two main categories: “Inadequate documentation”; and “Inadequate use of information”. The causes of these incidents were grouped under the two main categories “Factors related to the healthcare professional “ and “Organizational factors”, while the consequences of these incidents fell under the two main categories “Adverse events” and “Additional actions to prevent, avoid, and correct adverse events”. Conclusion: This study shows that the inadequate documentation and use of information is mainly caused by factors related to the healthcare professional and organization, including technical problems. These incidents cause adverse events and additional actions to prevent, avoid, and correct the events. The sociotechnical perspective, including factors related to health care professionals, organization, and technology, should be emphasized in patient safety development of inter-organizational health information exchange and it will be the focus of our future research. Continuous research and development work is needed because the processes and information systems used in health care are constantly evolving.

Digital counselling may improve patients’ health outcomes, when eHealth solutions are accessible and tailored to the patients’ needs, which is especially important for people with chronic and long-term conditions such as knee osteoarthritis. This study aims to identify patients’ eHealth needs to improve the quality of digital counselling in a primary care management of symptomatic knee osteoarthritis. A qualitative study was used to collect patients’ eHealth needs through semi-structured interviews in a single outpatient clinic in Finland between August 2020 and November 2020. The data was analyzed using both deductive and inductive content analysis approaches. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research checklist to improve the transparency of the study. Analysis of the data revealed five main categories to be considered when implementing digital counselling in patients with symptomatic knee osteoarthritis: background factors (functional impairments, health literacy, digital literacy, cost-related access barriers), resources (digital methods and materials), sufficiency (knee osteoarthritis-related knowledge and skills), implementation (simplicity, trust, patient-centeredness), and benefits (self-care capabilities, confidence). According to our findings, both health and digital literacy seems to be important contributors to the adoption of digital counselling in a primary care management of symptomatic knee osteoarthritis. New eHealth solutions should not replace the first visit in the outpatient clinic. Instead, the use of eHealth solutions should be based on the first visit, during which a trusting relationship between patients and healthcare providers is established. In future, the level of health and digital literacy in patients with symptomatic knee osteoarthritis should be taken account.

Mobile health solutions for patient support have been proposed as promising and safe alternatives to usual care in adults undergoing primary total hip and knee arthroplasty. Studies of such applications, however, have produced conflicting results and only moderate- to low-quality evidence. This study aims to evaluate the short-term effects of a digital patient journey solution on patient-reported outcomes and health care utilization in patients undergoing total hip and knee arthroplasty using a pragmatic randomized controlled trial design. Randomly allocated patients in the control arm (n = 35, 64 ± 9 years) received usual care, while patients in the intervention arm (n = 34, 62 ± 11 years) received the digital patient journey solution in addition to usual care. The primary outcome was health-related quality of life as measured by the EuroQol EQ-5D-5L scale. Secondary outcomes included functional recovery, pain, self-efficacy, patient experience, adherence to fast-track protocol, and health care utilization. Participants were followed from a preoperative surgical visit until a postoperative follow-up visit at 6–12 weeks. The health-related quality of life, functional recovery, pain, patient experience, adherence to the fast-track protocol, and health care utilization did not differ between the arms. During the study, however, the self-efficacy to use digital health services (p=0.027) increased in the intervention arm. The use of the digital patient journey solution was not superior to usual care in terms of patient-reported outcomes and health care utilization. However, the solution improved the self-efficacy of patients to use digital health services, which may lead to greater demand for similar digital offerings as patient become more familiar with mobile health solutions.

Personal data has become an important resource in today’s market and in platform business models. In fact, the essence of many platform business models is to create value for an individual by offering a free service and to capture value by collecting and selling collected data. In this study, we analyse the drivers for platform business model innovation in the context of personal data used in the healthcare sector. Platform business models are shaped and designed with respect to the internal and external drivers in the market. However, few studies have increased our understanding of the drivers for platform business model innovation. For that, we conducted an exploratory study for five personal data platform providers that enable individuals to control the use of their personal data in digital services by interviewing the personal data platform providers and using company presentation material. The findings show that by adopting a human-centred approach to personal data, giving control over data to the individual, personal data platform providers change how value is created and captured. This research has managerial implications and contributes to the business model innovation literature by extending the current knowledge about drivers for personal data-based platform business model innovation in the healthcare sector.

Objective: This systematic review aimed to identify, critically appraise, and synthesize the best available literature on registered nurses’ and medical doctors’ experiences of patient safety in health information exchange (HIE) during interorganizational care transitions. Methods: The review was conducted according to the JBI methodology for systematic reviews of qualitative evidence. A total of 5 multidisciplinary databases were searched from January 2010 to September 2020 to identify qualitative or mixed methods studies. The qualitative findings were pooled using JBI SUMARI with the meta-aggregation approach. Results: The final review included 6 original studies. The 53 distinct findings were aggregated into 9 categories, which were further merged into 3 synthesized findings: (1) HIE efficiency and accuracy support patient safety during interorganizational care transitions; (2) inaccuracies in content and structure, along with poor HIE usability, jeopardize patient safety during interorganizational care transitions; and (3) health care professionals’ (HCP) actions in HIE are associated with patient safety during interorganizational care transitions. Conclusions: The results of this review identified several advantages of HIE, namely, improvements in patient safety based on reduced human error. Nevertheless, a lack of usability and functionality can amplify the effects of human error and increase the risk of adverse events. In addition, HCPs’ individual actions in HIE were found to influence patient safety. Hence, the cognitive and sociotechnical perspectives of work related to HIE should be studied. In addition, HCPs’ experiences of each stage of HIE deployment should be clarified to ensure a high standard of patient safety. Registration: PROSPERO CRD42020220631, registered on November 13, 2020.

Purpose: Covid has increased the usage of multisided digital platforms. For companies, this has become a business opportunity. Data usage on platforms requires that platform companies co-create services for common customers. In this case, the target is not to make the same value proposition but rather to use the resources such as data, knowledge, technology, or institutions in a complementary manner. Platforms are characterized as a combination of hardware and software including standards, interfaces, and rules making it possible for different ecosystem players to complement and interact in the ecosystem. Current ecosystems include several platforms that do not work without resource integration. The purpose of this study is to increase understanding what do we mean by resource complementarity in service ecosystems. Design/methodology/approach: This study was done via an in-depth qualitative case study in which a health service ecosystem co-creating technological surgery innovation was used as a unit of analysis. Findings: The authors’ findings suggest that key resource capabilities, to enable complementarity in service ecosystems, are motivation, knowledge, skills, data and complementary designed technology components. Research limitations/implications: The authors’ study increases theoretical understanding of what does one mean by construct of resource complementarity. Practical implications: From a managerial perspective, it is shown that organizations need to develop adaptive capabilities to utilize internal and external competencies and resources and enable co-creative processes within the service ecosystem. Originality/value: Very few empirical studies in the marketing literature have focused on multi-sided digital platforms and their resource complementarity in the data-driven healthcare ecosystem settings.

Digital transformation has disrupted various healthcare domains, yet we are just starting to witness the enrollment of digital solutions enabled by technologies such as artificial intelligence and machine learning. Stroke is one of the leading causes of death and permanent disability globally. Research evidence suggests a need for newer technology-enabled collaborative service models that will not only improve stroke care but are economically viable for stakeholders (i.e., service providers, patients, and payers). A new collaborative service model equally requires the development of new collaborative business models in the stroke care cycle. In a large-scale research ecosystem in Finland, the stroke care pathway is utilized to identify the scope of digitalization in early stroke diagnosis, treatment, rehabilitation, and secondary prevention. This study presents how the stroke care pathway has been used as the basis for new collaborative business models and healthcare service innovation.

This study explores data-based value creation in the context of service delivery networks; specifically, a holistic preventive healthcare service in its development phase. The purpose of this study is to understand data-based value creation in service delivery networks by exploring 1) the nature and character of data-based value, 2) the key determinants of data-based value creation, and 3) the contextual characteristics of the service delivery network in relation to data-based value creation. In this way the study contributes to the fragmented research on value creation and networks. The empirical part of the study is conducted in the form of a qualitative single-case study. The data collection consisted of extensive observation and interviewing by the author as part of a research project. Eleven separate interviews were arranged with nine actors from the service delivery network to gain a descriptive and holistic understanding of the research phenomenon. The primary empirical data collection process was finalized in a final workshop wherein all the interviewed organizations were invited to provide feedback on the initial findings. In this study the potential value for each of the actors in the service delivery network was analyzed, which resulted in an improved understanding of how to conceptualize data-based value, emphasizing the ongoing, iterative, and multi-loci nature of data-based value. Secondly, the resources and activities inherent to data-based value creation were analyzed to discover the key determinants of data-based value creation. Thirdly, contextual analysis provided insights into the actors and roles in the service delivery network, as well as to the essential collective actions. The investigation of these aspects of the research phenomenon enabled the creation of a realistic overview of data-based value creation in service delivery networks. Finally, an empirically grounded model was synthesized to describe data-based value creation in ser, Tiivistelmä Tämä tutkimus käsittelee datapohjaista arvonluontia palveluverkostoissa; erityisesti tarkastelun kontekstina on ennaltaehkäisevän terveydenhuollon palveluverkosto sen kehityksen alkuvaiheessa. Tämän tutkimuksen tarkoituksena on luoda ymmärrystä datapohjaisesta arvonluonnista palveluverkostojen kontekstissa tutkimalla 1) datapohjaisen arvon luonnetta ja määritelmää, 2) datapohjaisen arvonluonnin keskeisimpiä tekijöitä, sekä 3) palveluverkostolle luonteenomaisia piirteitä datapohjaisessa arvonluonnissa. Tällä tavoin tutkimus edistää arvonluonnin ja verkostojen sirpaloitunutta tutkimuskenttää. Tutkimuksen empiirinen osa on suoritettu kvalitatiivisena yksittäistapaustutkimuksena. Aineistonkeruu koostui havainnoinnista, työpajoista, ja haastatteluista osana tutkimusprojektia. Kokonaisuudessaan yksitoista erillistä haastattelua järjestettiin palveluverkoston yhdeksän eri toimijan kanssa, jotta tutkimusilmiöstä saataisiin kuvaava ja kokonaisvaltainen käsitys. Ensisijainen empiirinen tiedonkeruuprosessi saatiin päätökseen lopputyöpajassa, jossa kaikkia haastateltuja organisaatioita pyydettiin antamaan palautetta alustavista tuloksista. Tässä tutkimuksessa analysoitiin datan potentiaalista arvoa palveluverkoston kullekin toimijalle, mikä johti parempaan ymmärrykseen siitä, miten datapohjainen arvo voidaan käsitteellistää, korostaen datapohjaisen arvon jatkuvaa, iteratiivista ja monipaikkaista luonnetta. Myös datapohjaiseen arvonluontiin liittyvät resurssit ja aktiviteetit analysoitiin terveydenhuollon palveluverkostossa, jotta saadaan parempi ymmärrys datapohjaisen arvonluonnin keskeisimmistä määräävistä tekijöistä. Kolmanneksi kontekstuaalinen analyysi antoi syvällisen näkemyksen palveluverkoston toimijoista ja rooleista sekä oleellisista kollektiivisista toimista. Näiden tutkimusilmiön eri näkökohtien selvittäminen mahdollisti realistisen yleiskuvan luomisen datapohjaisesta arvonluonnista palveluverkostoissa. Lopuksi syntetisoitiin empiirisesti perusteltu malli

Aims: To describe a study protocol for a randomized controlled trial which will evaluate the effectiveness of a gamified mobile health intervention for children in whole day surgery care. Design: A study protocol for a two-arm randomized controlled trial. Methods: Participants will be randomly assigned to the intervention group (N = 62), in which patients receive routine care and play a mobile game designed for children or the control group (N = 62), in which patients receive routine care, including a mobile phone application that supports parents during the care path. The primary outcome is children’s pre-operative anxiety, while the secondary outcome measures included fear and postoperative pain, along with parental satisfaction and anxiety. Data collection started in August 2020. Results: The results of the ongoing randomized controlled trial will determine whether the developed gamified mobile health intervention can be recommended for hospital use, and whether it could be used to educate children about their surgical treatment to decrease anxiety.

Introduction: As the number of patients undergoing primary lower-limb joint replacement has risen continuously, hospital-based healthcare resources have become limited. Delivery of any ongoing rehabilitation needs to adapt to this trend. This systematic literature aimed to examine the effects and safety of telerehabilitation in patients with lower-limb joint replacement. Methods: A systematic review of randomized controlled trials was conducted according to procedures by the Joanna Briggs Institute. Studies published prior to February 2020 were identified from Medline Ovid, Scopus, Ebsco Databases and Web of Science. Reference lists of relevant studies were also manually checked to find additional studies. Two researchers conducted study selection separately. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results whereas effect sizes were estimated for different outcomes. Results: Nine studies with 1266 patients were included. Study quality was predominantly affected by the lack of blinding. The patients who completed telerehabilitation showed an improvement in physical functioning that was similar to that of patients completing conventional in-person outpatient physical therapy without an increase in adverse events or resource utilization. The effect of telerehabilitation on physical functioning, however, was assessed as heterogeneous and moderate- to low-quality evidence. Discussion: Telerehabilitation is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. However, more robust studies are needed to build evidence about telerehabilitation.

The purpose of the study was to develop a gamified mobile health intervention in order to evaluate its effectiveness in the pediatric day surgery pathway. The aim was to produce new research information on an intervention suitable for day surgery that benefits children and their parents at different stages of the care pathway. The study consisted of three phases: (I) systematic literature review, (II) interview and questionnaire study, and (III) randomized controlled trial (RCT). In the last phase, a gamified mobile health intervention and a study protocol for a randomized controlled trial were described in the methods section. The phase I systematic literature review included 722 children (n=8 studies). Of them six studies were selected for the meta-analyses assessing children’s (n = 560) anxiety, and three studies assessed parents’ (n = 257) anxiety. The results showed that web-based mobile health interventions were (a) either active (n = 6) or (b) passive (n = 2) distractors or solutions that were effective for reducing children’s anxiety and increasing parental satisfaction. There was insufficient evidence for their effectiveness of reducing children’s pain or reducing parental anxiety. The phase II interview study for health care professionals (n = 15) revealed that a digital gaming solution could be used in children’s day surgery to support information, care, and guidance at different stages of the care pathway in nursing. Similarly, an open-ended questionnaire survey of parents (n = 31) revealed that the challenges of the care pathway were related to guiding the parents, supporting the children and family, and involving a child in his or her own pathway. The parents hoped that preparing for the treatment would be possible with the help of a digital gaming solution and that the communication between the family and nursing staff would be enabled via the solution. The study provides new information on the needs of a gaming mobile health interventions fo, Tiivistelmä Tutkimuksen päätarkoituksena oli kehittää pelillinen mobiilisovellusinterventio sen vaikuttavuuden arvioimiseksi lasten päiväkirurgisella hoitopolulla. Tavoitteena oli tuottaa uutta tutkimustietoa päiväkirurgiaan soveltuvasta interventiosta, josta hyötyvät lapset ja heidän vanhempansa hoitopolun eri vaiheissa. Tutkimus koostui seuraavista kolmesta vaiheesta: I järjestelmällinen kirjallisuuskatsaus, II haastattelu- ja kyselytutkimus ja III satunnaistettu kontrolloitu tutkimus (RCT). Viimeisestä vaiheesta kuvattiin pelillinen mobiilisovellusinterventio ja sen vaikuttavuuden arvioinnin protokolla tutkimuksen menetelmät -osiossa. Vaiheen I järjestelmällisessä kirjallisuuskatsauksessa oli mukana 722 lasta (n = 8 tutkimusta). Näistä tutkimuksista tehtiin kaksi meta-analyysia. Toiseen valittiin kuusi tutkimusta, joissa arvioitiin lapsen (n = 560) ahdistuneisuutta, ja toiseen kolme tutkimusta, joissa arvioitiin vanhemman (n = 257) ahdistuneisuutta. Tulosten mukaan internetpohjaisia interventioita oli kahdenlaisia: joko lasta aktivoivia (n = 6) tai passiivisia (n = 2) sovelluksia. Molemmilla oli vaikuttavuutta lasten ahdistuneisuuden vähenemiseen ja vanhempien tyytyväisyyden lisääntymiseen. Sen sijaan niiden vaikuttavuudesta lasten kivun vähenemiseen tai vanhempien ahdistuneisuuden vähenemiseen ei ollut riittävää näyttöä. Terveydenhuollon asiantuntijoiden (n = 15) haastattelututkimus osoitti, että digitaalinen pelillinen mobiilisovellus voi toimia tiedon, hoidon ja ohjauksen apuvälineenä lasten päiväkirurgisella hoitopolulla. Lasten vanhempien (n = 31) avoin kyselytutkimus taas osoitti, että hoitopolun haasteet liittyivät vanhempien ohjaamiseen, lapsen ja perheen tukemiseen sekä lapsen osallistamiseen omaan hoitopolkuunsa. Vanhemmat toivoivat, että digitaalisen sovelluksen avulla voisi valmistautua toimenpiteeseen ja että sovellus mahdollistaisi yhteydenpidon perheen ja hoitohenkilökunnan välillä. Tutkimus tuotti uutta tietoa siitä, millaista pelillistä mobiiliso

To respond to the notable changes in the field of healthcare, innovation networks bringing together industry and public sector actors are needed. Subsequently, the orchestration of such networks has attracted increasing attention. However, most research on network orchestration takes the point of view of the orchestrator and/or the innovation producers. It lacks explicit discussion on the users, especially lead users, in the network orchestration context. On the other hand, while the user-innovation literature tells how lead users can be involved in innovation processes, it focuses on those managerial actions that are meant to specifically influence lead users and misses the network-wide orchestration-related dynamics. Furthermore, a lead user discussion with a focus on customers viewing market trends does not necessarily fully acknowledge healthcare professionals or end users of public sector services. This study starts to bridge these discussions as it introduces findings from a theoretical examination and an illustrative case study. It provides a context-sensitive approach to innovation network orchestration in a situation where active involvement of lead users is crucial for the functioning of the innovation network. Acknowledging the interaction between the innovation network orchestrator, innovating companies, and lead users adds to existing knowledge on how to orchestrate innovation networks.

Background: As the number of patients with orthopaedic conditions has risen continuously, hospital-based healthcare resources have become limited. Delivery of additional services is needed to adapt to this trend. Purpose: The purpose of this study was to describe the current literature of computer- and telephone-delivered interventions on patient outcomes and resource utilization in patients with orthopaedic conditions. Methods: The systematic review was conducted in January 2019. The standardized checklist for randomized controlled trials was used to assess the quality of the relevant studies. A meta-analysis was not possible due to heterogeneity in the included studies, and a narrative synthesis was conducted to draw informative conclusions relevant to current research, policy, and practice. Results: A total of 1,173 articles were retrieved. Six randomized controlled trials met the inclusion criteria, providing evidence from 434 individuals across four countries. Two studies reported findings of computer-delivered interventions and four reported findings of telephone-delivered interventions. The patients who received both computer- and telephone-delivered interventions showed improvements in patient outcomes that were similar or better to those of patients receiving conventional care. This was without any increase in adverse events or costs. Conclusion: Computer- and telephone-delivered interventions are promising and safe alternatives to conventional care. This review, however, identifies a gap in evidence of high-quality studies exploring the effects of computer- and telephone-delivered interventions on patient outcomes and resource utilization. In future, these interventions should be evaluated from the perspective of intervention content, self-management, and patient empowerment. In addition, they should consider the whole care journey and the development of the newest technological innovations. Additionally, future surgery studies should take into ac

With the rapid spread of the COVID-19 pandemic, the novel Meaningful Integration of Data Analytics and Services (MIDAS) platform quickly demonstrates its value, relevance and transferability to this new global crisis. The MIDAS platform enables the connection of a large number of isolated heterogeneous data sources, and combines rich datasets including open and social data, ingesting and preparing these for the application of analytics, monitoring and research tools. These platforms will assist public health author ities in: (i) better understanding the disease and its impact; (ii) monitoring the different aspects of the evolution of the pandemic across a diverse range of groups; (iii) contributing to improved resilience against the impacts of this global crisis; and (iv) enhancing preparedness for future public health emergencies. The model of governance and ethical review, incorporated and defined within MIDAS, also addresses the complex privacy and ethical issues that the developing pandemic has highlighted, allowing oversight and scrutiny of more and richer data sources by users of the system.

Business model literature has been focused on value co-creation and co-capture logic in understanding business models in the ecosystem. To understand the “Ex Ante” source of ecosystem-based value creation/capture, this paper proposes opportunity complementarity as a key antecedent and construct for the ecosystem-based value creation and capture in data-driven business ecosystems.

Background: The parents of hospitalized children are often dissatisfied with waiting times, fasting, discharge criteria, postoperative pain relief, and postoperative guidance. Parents’ experiences help care providers to provide effective, family-centered care that responds to parents’ needs throughout the day surgery pathway. Objective: The objective of our study was to describe parental experiences of the pediatric day surgery pathway and the needs for a digital gaming solution in order to facilitate the digitalization of these pathways. Methods: This was a descriptive qualitative study. The participants (N=31) were parents whose children were admitted to the hospital for the day surgical treatments or magnetic resonance imaging. The data were collected through an unstructured, open-ended questionnaire; an inductive content analysis was conducted to analyze the qualitative data. Reporting of the study findings adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Parental experiences of the children’s day surgery pathway included 3 main categories: (1) needs for parental guidance, (2) needs for support, and (3) child involved in his or her own pathway (eg, consideration of an individual child and preparation of child for treatment). The needs for a digital gaming solution were identified as 1 main category—the digital gaming solution for children and families to support care. This main category included 3 upper categories: (1) preparing children and families for the day surgery via the solution, (2) gamification in the solution, and (3) connecting people through the solution. Conclusions: Parents need guidance and support for their children’s day surgery care pathways. A digital gaming solution may be a relevant tool to support communication and to provide information on day surgeries. Families are ready for and are open to digital gaming solutions that provide support and guidance and engage children in the da

The World Health Organization recognized that the global population is rapidly ageing and effecting the global demographics. Among other effects of a growing ageing population, additional stress on healthcare services is a serious concern for policy makers. There is parallel positive relation observable between advancements in information and communication technologies (ICT) and advancements in healthcare services. To deal with the issues raised by growing ageing population, global healthcare sector has been using ICT advancements adeptly. One such emerging healthcare model is known as “Connected Health”. Connected health is a multi-stakeholder context, where more private institutes are entering rapidly. This study attempts to explore Connected Health Business Ecosystems through Business Models. While business model conceptualizations are evident in various ICT sectors, the healthcare domain seems to have underutilized the value of business model conceptualizations up until recently. In European context, one of the underlying reasons could be that the healthcare sector is widely perceived as public good. Through a structured literature review, this study offers a framework to look at ecosystemic contexts through the business model lens. The study highlights three key elements of business model relevant to ecosystemic contexts; namely: Opportunity, Value, and Advantage. Similarly, the study identifies three broad characteristics of business ecosystems; they are: Structure, Interaction, and Value re-configuration. The study utilizes three qualitative case studies in the four original publications. The results of the study include: 1) business models relate to the business ecosystems through opportunity exploration and exploitation, value creation and capture, and advantage exploration and exploitation; 2) the process of exploring Business Ecosystems through business models can include Visioning, Mapping, Understanding causal interaction, and Understanding val, Tiivistelmä Maailman terveysjärjestö WHO:n mukaan ikääntyminen vaikuttaa väestörakenteeseen globaalisti. Ikääntyvä väestö tuo lisää paineita poliittiselle päätöksenteolle erityisesti terveydenhuollon palveluihin liittyen. Terveydenhuollossa digitalisaatio ja erilaiset informaatioteknologian ratkaisut ovatkin nousseet entistä tärkeämpään rooliin palveluiden kehittämisessä. Yksi näistä uusista terveydenhuollon toimintamalleista on digitaalinen integroitu terveydenhuolto, josta tässä tutkimuksessa käytetään englanninkielistä termiä Connected Health. Digitaalinen integroitu terveydenhuolto voidaan nähdä monitoimijakontekstina tai liiketoimintaekosysteeminä, johon myös yksityisen sektorin toimijat ovat tulleet mukaan. Tässä tutkimuksessa keskitytäänkin liiketoimintamalleihin digitaalisen integroidun terveydenhuollon ekosysteemeissä. Liiketoimintamallinäkökulmaa on perienteisesi käytetty digitaalisten palveluiden yritystoiminnassa ja ekosysteemeissä, mutta terveydenhuollossa on liiketoimintamallien hyödyntämiseen herätty vasta viime aikoina. Euroopassa tähän on vaikuttanut se, että terveydenhuolto on laajalti nähty julkisena palveluna ennemminkin kuin monitoimijaekosysteeminä. Tällaista monitoimijaekosysteemiä varten tutkimuksen kirjallisuusosiossa rakennetaan liiketoimintamalliajatteluun perustuva analyysikehikko. Tässä kehikossa keskeisinä käsitteinä ovat liiketoimintamahdollisuudet, arvonluonti, ja kilpailuetu. Lisäksi tutkimuksessa kiinnitetään huomiota monitoimijaekosysteemien rakenteeseen, toimijoiden vuorovaikutukseen sekä muutoksiin arvonluonnin prosesseissa. Työn empiirinen osa koostuu kolmesta tapaustutkimuksesta ja sisältää neljä alkuperäisjulkaisuartikkelia. Työn keskeisenä kontribuutiona esitetään prosesseja joissa 1) liiketoimintamahdollisuuksien, arvonluonnin ja kilpailuedun etsintä ja hyödyntäminen yhdistää liiketoimintamallit ekosysteemeiksi ja joissa 2) visiointi, kartoittaminen, vuorovaikutussuhteiden ymmärtäminen sekä arvonluonnin prosessit nähdään kes

Aim: To describe a randomized controlled trial (RCT) protocol that will evaluate the effectiveness of a digital patient journey (DPJ) solution in improving the outcomes of patients undergoing total hip and knee arthroplasty. Background: There is an urgent need for novel technologies to ensure sustainability, improve patient experience, and empower patients in their own care by providing information, support, and control. Design: A pragmatic RCT with two parallel arms. Methods: The participants randomized assigned to the intervention arm (N = 33) will receive access to the DPJ solution. The participants in the control arm (N = 33) will receive conventional care, which is provided face to face by using paper‐based methods. The group allocations will be blinded from the study nurse during the recruitment and baseline measures, as well as from the outcome assessors. Patients with total hip arthroplasty will be followed up for 8–12 weeks, whereas patients with total knee arthroplasty will be followed up for 6–8 weeks. The primary outcome is health‐related quality of life, measured by the EuroQol EQ‐5D‐5L scale. Secondary outcomes include functional recovery, pain, patient experience, and self‐efficacy. The first results are expected to be submitted for publication in 2020. Impact: This study will provide information on the health effects and cost benefits of using the DPJ solution to support a patient’s preparation for surgery and postdischarge surgical care. If the DPJ solution is found to be effective, its implementation into clinical practice could lead to further improvements in patient outcomes. If the DPJ solution is found to be cost effective for the hospital, it could be used to improve hospital resource efficiency.

The healthcare and wellness sector currently attempts to provide more proactive service models with data-driven solutions. This study examines the expectations and values related to personal data i.e. data valences from the perspective of service providers and individual users. The study is based on the analysis of extensive empirical material collected through interviews and a collaborative workshop. The data was collected in one cultural context, Finland. The results suggest that the potential service providers and users have similar expectations regarding self-evidence of data while the main differences concern the expectations of transparency. The results of the study propose some basic requirements for the development of personalised data-driven services in future. The study suggests that basic requirements for the development of future data driven services concern expectations to usable data visualisations, data as a motivator, data accuracy and data transparency. Even though there are varying expectations to personal health data and even some concerns, it can be seen that here different ecosystem actors primarily perceived the wider use of personal health and wellness data as a positive trend. It can be concluded that collaborative personal data-driven service ecosystems are an integral part of development towards proactive service models in healthcare.

According to the WHO Global Digital Health Strategy 2020–2024, we should advocate people-centred health systems, promote global collaboration and strengthen the governance of global digital health practices. All this requires a new open innovation approach, which means that stakeholders from regional administrations, hospitals, companies and intermediate organisations openly work together towards commonly identified global and regional digital health goals. Although both practice and theory have proven that the open innovation approach is beneficial for companies and end-users, there is still a need for increased understanding of what leads to the success of digital health related to regional competitiveness through the implementation of policies based on people-centred open innovation. This study is a longitudinal case study in which open innovation ecosystem partners (including challengers (healthcare organisation representatives), solvers (companies), funders (policy organisations) and supporters (intermediate organisations) were monitored and analysed in three countries. The focus of the paper is to explore a digital health open innovation ecosystem over the years. The results show that the created demand-driven open innovation model can be used to strengthen the governance of digital health, and to improve communication density and knowledge transfer between the ecosystem actors. The new model is a useful way to make funding structures clearer and to improve the people centricity of digital health solutions. The findings help policy-makers to use open innovation as a policy instrument supporting hospital and company managers to increase understanding of the opportunities of demand-driven open innovation.

Aims and objectives: To identify opportunities for gamification in the elective primary fast‐track total hip and knee arthroplasty journey in order to support patients’ health‐related behaviour. Background: Gamification provides an opportunity to increase engagement in a given health behaviour and, eventually, the possibility of reaching improved outcomes through continued or consistent behaviour. Design: A secondary analysis. Methods: Semi‐structured interviews were conducted with 20 healthcare professionals in a single joint‐replacement centre in Finland during autumn 2018. NVivo software was used for deductive and inductive coding. The open codes were also calculated. The consolidated criteria for reporting qualitative research were followed. Results: Gamification opportunities were identified related to six dimensions: accomplishment, challenge, competition, guided, playfulness and social experience. Based on the frequencies of the coded content, most opportunities for gamification can be identified in the context of personalised counselling, monitoring and social support. Conclusions: Several opportunities for gamification were identified and quantified. While various needs and limitations need to be considered when developing digital gamified solutions and more research into the effectiveness of such solutions will be required, the current study opens possible future avenues for exploring the use of gamification in lower limb joint replacement journey and other specialisms. Relevance to clinical practice: This study provides an important insight into healthcare professionals’ views of the current state of the total hip and knee arthroplasty journey and the potential for its development. In addition, it pinpoints the biggest opportunities for gamified services in the context of personalised counselling, monitoring and social support. Despite the focus of this secondary analysis being on the arthroplasty journey, the findings can also be generalised in

Purpose: This paper identifies emerging revenue models for personal data platform operators that facilitate the exchange of resources between an individual and a service provider for their mutual benefit. Context of this study is human-centered personal data management, which refers to individuals being able to control the use and access of their personal data for third-party services. Design: This research is conducted by analysing qualitative questionnaire data from 27 organizations from 12 different countries that are considered as forerunners in creating services in this context. Findings: Our study shows that personal data platform operators can generate revenue by combining transaction-, service-, connection- and membership fees. The study also reveals context-specific propositions for the foundation of revenue model creation. Monetising personal data in the form of advertising like we know it today is explicitly avoided among personal data platform operators. Research limitations/implications: This study calls for further research about how does providing control over personal data to individuals influence on business models of platform operators and other service providers in the market. Practical implications: For practitioners, this research offers new insights on revenue models that are being developed by the forerunners of human-centered personal data management approach in the European market. Originality/value: Revenue models for personal data platform operators when taking a human-centered approach to personal data management. Propositions to consider when creating revenue models in this context.

Aims and objectives: This study examined the lived experience of healthcare professionals providing care for patients with total hip and knee arthroplasty. The aim of this study is to understand healthcare professionals’ proposed eHealth needs in elective primary fast‐track hip and knee arthroplasty journey. Background: There is little evidence in nursing literature to indicate how to develop new eHealth services to support surgical care journeys. Evidence is particularly lacking regarding the development of eHealth solutions. Design: This was a qualitative interview study. Methods: Semi‐structured interviews were conducted with four surgeons, two anaesthesiologists, ten nurses, and four physiotherapists in a single joint replacement centre during autumn 2018. The data were analysed using an inductive content analysis method. NVivo qualitative data analysis software was used. The COREQ checklist for qualitative studies was followed. Results: Our research addressed the gap in evidence by focusing on the four main parts of the patient journey in the selected context. Analysis of the data revealed nine main categories for the proposed eHealth needs: eligibility criteria, referrals, meeting the Health Care Guarantee, patient flow, post‐discharge care, patient counselling, communication, transparency of the journey, and receiving feedback. In addition, the requirements and further development needs for eHealth solutions were generally identified. Conclusions: From the point of view of healthcare professionals, eHealth solutions have huge potential in supporting the elective primary fast‐track hip and knee arthroplasty journey. However, it is important to acknowledge that these needs may be very different depending on the technological and organisational environment in question. Relevance to clinical practice: More effective use of information and communication technologies is needed for organisational optimisation resulting in a streamlined pathway, better acces

Data is becoming a more and more important resource for future innovations. Companies are currently considering how to leverage personal data in preventive healthcare and in other sectors. However, there are many challenges hindering the development of data-driven businesses in extant business networks. The purpose of this paper is to explore the success factors of data-driven service delivery networks in the context of preventive healthcare. The results are examples of the benefits and challenges of data availability and usage, based on a qualitative case study, in which a network of actors is integrating resources to solve the needs of their end customers. The results underline the success factors for service delivery networks, creating a baseline for human-centric, personalized and preventive healthcare solutions. The study enriches the theoretical perspective of data, services and service delivery networks by continuing discussion on how big data resources become cooperative assets not only in a firm but also on the network level. This study has multiple implications for practitioners trying to navigate the turbulent waters of the changing business environment and evolving service delivery network of preventive healthcare. Especially small and medium size of firms could use the identified success factors when planning new data-driven services in their networks. Our analysis brings new perspective between a firm and the actors in its network, particularly in the preventive healthcare sector wherein data needs to be shared between actors via consent of the individuals.

Purpose: Services are evolving from generic to personalized, and the reverse use of customer data has been discussed in both academia and industry for the past few years. The aim of this study is to understand how personal data is working as a resource for business model transformation in emerging service ecosystems. Design/methodology/approach: The primary data was gathered over the time in the recorded and transcripted workshops, in which future personal data-based services were conceptualized by analyzing future scenarios from a business perspective. Findings: The results have implications to theory and practice, indicating that adopting personal data management principles requires transformation of the business model, which, if successfully managed, may provide access to more resources, potential to offer better value, and additional customer channels. Research limitations/implications: Being a single case study imposes restrictions to the generalizability of the results. Expanding the scope of this study to include actors from different sectors would improve the validity of the research. Social implications: The study views the future business landscape with human centered personal data management lenses. The exploration of the effects of an approach that benefits both people and businesses provides a positive societal aspect. Originality/value: While a few studies have examined the linkage between business models and personal data usage, no empirical studies have looked at how a company should change their business model due to new data access. This paper shows one way to think about this issue.

Tiivistelmä Ensihoitopalvelujen tarve kasvaa sosiaali- ja terveydenhuollon palvelurakenteessa tapahtuvien uudistusten sekä väestön ikääntymisen myötä. Uusimmat teknologia- ja analytiikkaratkaisut auttavat palveluiden uudelleen organi-soimisessa ja hoitopolkujen kehittämisessä. Tässä tutkimuksessa tarkastellaan tulevaisuuden yhdistettyjen terveys teknologioiden mahdollisuuksia pohjautuen asiantuntija työpajoihin liittyen ei-kiireellisiin ensihoidon tehtäviin. Tapauksen nykytilanne ja tulevaisuuden hoitopolut kuvattiin ja analysoitiin yhdessä terveysalan asiantuntijoiden, teknologiatoimittajien, tutkijoiden ja potilasnäkökulman edustajien kanssa. Kuvattu potilastapaus keskittyi kotisai-raanhoidon piirissä olevaan ikääntyneeseen henkilöön, joka kärsii toistuvista virtsatieinfektioista. Tutkimuksen tuloksena löydettiin mm., että potilas tapauksiin liittyviä hoitopolkuja voidaan parantaa tukemalla hätätilanteen tunnistamista, lisäämällä terveystietämystä ja kehittämällä ratkaisuja, jotka mahdollistavat ensi- ja lääkehoidon nopeamman aloituksen sekä tehokkaamman yhteistyön potilaan, kotisairaanhoidon, sairaalan ja ensihoidon välillä. Lisäksi havaittiin, että tulevaisuudessa etämittarit mahdollistavat kotimittaustulosten nopeamman hyödyntämisen ja uusien teknologiaratkaisujen myötä tietoa on paremmin saatavilla., Future connected health technology opportunities in non-urgent emergency care actions The need of emergency care services increases due to health and social services reformation and the ageing of the population. Mobile technologies, virtual communication technologies, sensor solutions and data analytics help to organize services and to develop care paths. The described patient case in this study, concentrated on the ageing woman of home care who suffered from repeated urinary tract infections. The present situation of patient case and the future care path was described and analyzed together with the healthcare professionals, technology suppliers, researchers, and patients. Based on the collected material the care paths of patient cases can be improved by increasing health knowledge, by utilizing better the remote meters, home measurement results, connected health solutions and available information, and by enabling the quicker beginning of the required medical treatments. Additionally, it was found that the existing solutions and information can be better utilized by developing the consultation center of the healthcare professionals, the real-time follow-up system of care institutions, the common user interface of different systems that centralized directs the identification and the access of the professionals to the defined systems.

A business ecosystem supports relationships between its stakeholders. Although it has been recognized that ecosystem stakeholders neither solely compete, nor collaborate, but rather co-develop their capabilities, empirically-based research evidence on this interactive co-development in ecosystems remains scarce. The interaction among ecosystem stakeholders is approached from the business model perspective. Accordingly, this article builds on business model literature, and on empirical data gathered within an emerging connected health ecosystem. This article conceptualizes business models as dynamic capabilities that enable ecosystemic and symbiotic interaction through opportunity exploration and exploitation, value creation and capture, and, advantage exploration and exploitation. This article argues that co-developing business models through sensing, seizing and transforming is a key enabler for ecosystem’s success and sustainability.

This study examines orchestration roles in a networked innovation context characterized by significant transformation. In particular, an exploratory case study approach is taken to study the roles of innovation network orchestrators and their actions to facilitate networked activities in different phases of the innovation process. The context of the case study, a healthcare ecosystem that aims to co-create technological innovations to support the pediatric surgery journey, provides valuable insights about orchestration and adds knowledge on specific limitations set by the orchestrator-specific and context-related issues in a professional context. The findings of this study highlight the need for careful coordination that allows shared understanding of the goals of the orchestration process and achievable innovation implementations. It is shown that parallel, evolving, and even changing orchestrator roles are needed in complex networked innovation settings.

Background: Constantly increasing health care costs have led countries and health care providers to the point where health care systems must be reinvented. Consequently, electronic health (eHealth) has recently received a great deal of attention in social sciences in the domain of Internet studies. However, only a fraction of these studies focuses on the acceptability of eHealth, making consumers’ subjective evaluation an understudied field. This study will address this gap by focusing on the acceptance of MyData-based preventive eHealth services from the consumer point of view. We are adopting the term "MyData", which according to a White Paper of the Finnish Ministry of Transport and Communication refers to "1) a new approach, a paradigm shift in personal data management and processing that seeks to transform the current organization centric system to a human centric system, 2) to personal data as a resource that the individual can access and control." Objective: The aim of this study was to investigate what factors influence consumers’ intentions to use a MyData-based preventive eHealth service before use. Methods: We applied a new adoption model combining Venkatesh’s unified theory of acceptance and use of technology 2 (UTAUT2) in a consumer context and three constructs from health behavior theories, namely threat appraisals, self-efficacy, and perceived barriers. To test the research model, we applied structural equation modeling (SEM) with Mplus software, version 7.4. A Web-based survey was administered. We collected 855 responses. Results: We first applied traditional SEM for the research model, which was not statistically significant. We then tested for possible heterogeneity in the data by running a mixture analysis. We found that heterogeneity was not the cause for the poor performance of the research model. Thus, we moved on to model-generating SEM and ended up with a statistically significant empirical model (root mean square error of approximat

Digitalisation is seen as a vehicle for restructuring practices of social and health care in Finland. A conceptual model of connected health has evolved over time focusing on bringing together individuals and health professionals by means of ‘eHealth’, ‘telecare’, ‘telemedicine’ or ‘telehealth’ services and data connected via the Internet of Things. Digital transformation has triggered the emergence of innovative connected health services, as well as novel business models in the health and healthcare sector. Additionally, current literature emphasises growing importance of ecosystems in advancing the connected health business. The main reason for this, the increased understanding of business ecosystems would allow companies to create coherent services that would be easier for patients and health professionals (e.g. doctors and nurses) to use. This paper aims to develop and present a conceptual model for business ecosystem for connected health by mapping service needs for healthcare in the future. For this research, we conducted 16 meetings/workshops related to business models and business ecosystems. We also involved different end-user groups in our research (seven doctor interviews, four workshops with nurses and digital discussions and workshops with 12 parents with sick children). This qualitative case study illustrates the construct of the Nordic Central Hospital test lab — an innovation ecosystem for connected health service providers. Alongside the broad service map, we demonstrate the logic of value flow between different layers of services in the ecosystem. From an originality perspective, this multidisciplinary paper focuses on the pediatric day surgery to check the scope of connected health, which has not been done before.