How to orchestrate the VCO Platform ecosystem? - Fares Georges Kahlil, visiting doctoral researcher

MASSE project¹  was born alongside a growing trend in health care digitization and integration of care. MASSE’s Virtual Care Operator (VCO) concept answers to the fragmentation of care and patient journey disruptions for long-term and complex patient care (chronic and multi-morbid patients). With care being fragmented across multiple providers, patient journey disruptions occurring with little remedial action, and patient outcomes not systematically evaluated, there seems to be a white space for digital solution providers to innovate.

Problem area: siloed efforts, one-sided partial solutions; increasing complexity, but not resolving fragmentation

A look at global investment trends in digital health care shows a burgeoning number of digital start-ups, investments by big tech, and a trend towards consolidation. Amazon, Google, Microsoft, Apple, and Oracle all ramp up investments in health care as they fight for an $11T market ².

Developed countries also show advancing digitalization and a promising first step for integration with central repositories for health care data. A step further is exemplified by Finland with the ongoing health and social integration and systemic reform. To encourage digitalization, many countries like the US ³, the UK ⁴, and Finland ⁵ have instated technical standards for IT solutions with detailed specifications for interoperability and other forms of compliance. Still, this is relatively nascent, and the marketplace is still grappling with how to respond and co-develop as systems evolve.

As new solutions and interfaces are created, is this creating more complexity and potential fragmentation?

Integration and complexity reduction are underlying principles behind MASSE’s VCO concept, but it remains to be seen how this can come to life in an ecosystem consisting of many different players and offerings. While the global marketplace sees more collaboration in the form of one-product solution offerings and value-chain integrations, ecosystem-level innovations are more ambitious in scope, involve more actors, and are reportedly tougher to manage ⁶. In this sense, MASSE project seems more ambitious than previous similar projects.

The VCO is conceptualized as a platform that can be adapted to any number of care providers as it builds on top of an interoperable data infrastructure ⁷ with a modular architecture based on an open API model. Through the VCO platform, any number of providers can assemble their services (complementary parts) into different solutions that can be offered to care providers or directly to patients. The vision is a systematic yet personalized approach that supports a comprehensive and ongoing care experience. Head of project Professor Lillrank describes this care function as resembling a guardian angel who intervenes when appropriate to make sure patient care stays on course.

The VCO vision manifest at different ecosystem levels

For integration at the patient level, understanding a patient's resources, motivations, and unique settings is necessary. This can be facilitated with continuous monitoring, utilizing patient-generated health data (PGHD), and personal network exploitation.

Next, examples of integration at the service level include the management of medications, combining treatments into a "unified care plan," and knowing which services are best for the patient.

This calls for dependable cross-registry data and enabling information access between providers. It also incorporates brand-new ways for coordinating services and patient populations (MASSE’s ‘Service card’ concept – “all available services visible in one place”).

Data must also be organized into formats that professionals and patients can use. Processes must be coordinated and complementary solutions must be effective across companies. This requires a shared resources to provide visibility throughout (MASSE’s Patient card concept – “all patient information in one place”  ⁸).

Additionally, this calls for some degree of standardization and harmonization at the system level such as with more favourable incentives and regulation for data sharing and reimbursements.

"We know that the envisioned VCO is technically doable. But for the vision to take form, incentives, strategic priorities, and operational logics need to be aligned."

The VCO ecosystem requires orchestration

Coordination is needed between the different ecosystem levels. Therein two orientations can be distinguished. A top-down approach sees the need for leadership, structuring, and orchestration for a VCO platform ecosystem to emerge. At the same time, a bottom-up perspective including participatory design and entrepreneurial innovativeness is necessary to identify and solve actual patient and professional needs. While differing opinions exist with respect to the ideal orchestrator (neutral or public actor; large private keystone), or the ownership and governance of the platform (several smaller organizations vs a keystone), there is a penchant towards a public-private partnership.

Moreover, the platform’s architecture reveals some tension between top-down and bottom-up drivers. Boundary permeability ⁹, or openness vs closeness of the platform, may vary. On one hand, a closed approach would involve tighter control and a small set of contributors offering their digital health applications / modules on the platform. On the other hand, a more open approach would enable more competition (and innovation), allowing any potential contributor to make offerings (similar to mobile application ecosystems).

A de-centralized spirit could find fit with innovative start-ups, whereas a controlled approach might be more appropriate at the onset for accountability, governance, and particularly to ‘own the front end and customer experience’.

"The potential for an open platform can bee seen as a genuine revolution in the field of health care."

For some, openness also included decentralizing the data infrastructure layer in favour of several independent "interoperable nodes" ¹⁰. Others, however, questioned whether this was practical for health care, in part because of the difficulties associated with public procurement and the integrations required to improve user experience. In actuality, one major hurdle is the end users' (patients and professionals') disdain of the abundance of apps and interfaces (app fatigue).

An innovative provider of a platform as a service (PaaS) recommends an open cloud platform architecture with application building tools and functionalities. On the platform, partners can build their standalone applications or modules and connect their health devices on the same platform. This may help solve part of the issue with digital fragmentation.

Because applications would be built using the same tools, on the same platform, it would be simpler to connect various applications and modules together into working solutions. A software-as-a-service (SaaS) ‘VCO offering’ could then be made available to clients in the health care industry.

Integration would still be a challenge, particularly at the level of EHR integrations, but this "open health platform approach” creates synergies that make it possible to deliver a more complete solution at a cheaper cost.

However, and for several reasons, public health may prefer to build and own their platform instead of procuring it as a service. Although a topic for more research, this illustrates some tension between market-driven and public-driven innovation.

"Bridging together public- and market-driven innovation is important."

To conclude, the environment will dictate what shape and pathway an innovation like the VCO may take. A shared intent and understanding are important as an ecosystem emerges around a common problem. Facilitating the conversation and creating an inclusive space for ideas to develop are equally vital. A spirit of collaboration or co-opetition is favorable, and it is probably best to avoid one-sided approaches that result in vendor lock-ins.

We look forward to continuing this evolutionary journey together!

References

1. https://www.aalto.fi/en/news/virtual-care-management-system-for-solving-fragmentation-of-chronic-diseases-treatment

2. The Big Tech in Healthcare Report: How Amazon, Google, Microsoft, Apple, & Oracle are fighting for the $11T market. (n.d.). Retrieved December 19, 2022, from https://www.cbinsights.com/research/report/famga-big-tech-healthcare/

3. https://www.healthit.gov/isa/

4. https://www.england.nhs.uk/digitaltechnology/connecteddigitalsystems/interoperability/

5. https://www.cleverhealth.fi/en/news

6. Internationally significant innovation and growth ecosystems in Finland - https://teknologiateollisuus.fi/sites/default/files/2020-01/Internationally%20significant%20innovation%20and%20growth%20ecosystems%20in%20Finland.pdf

7. https://www.cgi.com/fi/fi/ratkaisu-lehti/3-2017/una-ratkaisee-soten-onnistumisen

8. Lillrank, P., Khalil, F. G., Bengts, A., Chen, A., Kontunen, P., Kaleva, S., & Torkki, P. (2022). Personalized care with mass production efficiency: integrating care with a virtual care operator. Journal of Integrated Care, ahead-of-print(ahead-of-print). https://doi.org/10.1108/JICA-01-2022-0006/FULL/PDF

9. Hurmelinna-Laukkanen, P., Möller, K., & Nätti, S. (2022). Orchestrating innovation networks: Alignment and orchestration profile approach. Journal of Business Research, 140, 170–188. https://doi.org/10.1016/J.JBUSRES.2021.11.084

10. Langford, J., Jogi Poikola, A., Janssen, W., Lähteenoja, V., & Rikken, M. (2022). Understanding MyData Operators. MyData Global. https://mydata.org/organisation-members