Aalto University School of Science Master’s Programme in Industrial Engineering and Management Tuomo Tanila Value Formulation of Digital Health Technologies – A Multiple Case Study on the Implementation of an Intelligent Patient Flow Management System Master’s Thesis Espoo, July 29, 2019 Supervisor: Paul Lillrank, Professor Advisor: Henni Tenhunen, M.Sc. (Econ) Tiivistelmä Tekijä Tuomo Tanila Työn nimi Digitaalisten terveysteknologioiden arvon muodostuminen – monitapaustutkimus älykkään potilasvirtajärjestelmän toteutuksesta Koulutusohjelma Tuotantotalous Pää-/sivuaine Strateginen johtaminen ja kasvuyrittäjyys Koodi SCI3050 Työn valvoja Paul Lillrank Työn ohjaaja(t) Henni Tenhunen Päivämäärä 29.7.2019 Sivumäärä 102+3 Kieli Englanti Tiivistelmä Ikääntyvien väkimäärän kasvu haastaa terveydenhuoltojärjestelmiä maailmanlaajuisesti kasvattaen kysyntää uusille terveysteknologisille ratkaisuille. Tästä johtuen uusien digitaalisten terveysteknologisten investoinnit ovat jatkuvassa kasvussa. Näiden ratkaisujen arvoa on kuitenkin haastavaa mitata. Vaikka monia arviointityökaluja on kehitetty kyseisille teknologioille, puutteita ilmenee erityisesti arvonluonnin mekanismien selittämisessä. Tässä työssä tutkittiin uudenlaista lähestymistä digitaalisten terveysteknologioiden arvon määrittämiseksi ja jäsentämiseksi. Hyödyntäen CIMO-logiikkaa (konteksti, interventio, mekanismi, ja vaikutus) monitapaustutkimuksessa työ pyrkii soveltamaan arvon muodostumisen PROVE-IT-mallia hoidon hakeutumiseen ja hoidontarpeen arviointiin suunnatulle digitaaliselle terveysteknologialle. Tutkimusongelma kiteytyy kolmeen tavoitteeseen. Ensimmäisenä tavoitteena on löytää mekanismit, jotka selittävät tarkastellun terveysteknologian toimivuutta. Toisena tavoitteena on tarkastella miten havaittuja mekanismeja ja niiden suhdetta vaikutuksiin voisi mitata. Kolmantena päätavoitteena on mallin kehittäminen käytännönläheisemmäksi ja yleistettävämmäksi. Diplomityössä havaittiin CIMO-logiikan olevan toimiva tapa jäsentää arvon muodostumista ja sen mekanismeja. Kontekstien erovaisuudesta huolimatta mekanismien havaittiin olevan hyvin samankaltaiset eri tapaustutkimusten välillä, mikä kyseenalaistaa mallin yleistävän luonteen. Tämän vuoksi, työ antaa pohjan jatkotoimenpiteille mallin selkeyttämiseksi sekä suuntaviivoja sen operationalisoinniksi. Tämä tutkimus täydentää arviointityökalujen kirjallisuutta tarjoamalla uuden näkökulman arvon muodostumiseen mekanismeja korostaen. Lisäksi työ tarjoaa näkemystä arvon muodostamisen osoittamisesta yritysten myynnin tukemiseksi. Avainsanat digitaalinen terveysteknologia, vaikuttavuusperustainen terveydenhuolto, CIMO, markkinalaajeneminen i Abstract Abstract Author Tuomo Tanila Title of thesis Value Formulation of Digital Health Technologies – A Multiple Case Study on the Implementation of an Intelligent Patient Flow Management System Degree programme Industrial Engineering and Management Major/minor Strategy and Venturing Code SCI3050 Thesis supervisor Paul Lillrank Thesis advisor(s) Henni Tenhunen Date 29.7.2019 Number of pages 102+3 Language English Abstract Aging populations set challenges to healthcare systems on a global scale, thus increasing demand for new technological solutions. As a result, investments in new digital health technologies are constantly increasing. Yet the value of these solutions is difficult to measure. Although many evaluation models for digital health interventions exist, there seems to be a lack of proper explanation of the mechanisms behind the value formulation. This thesis explores a novel approach to evaluate and structure value formulation for digital health interventions. Utilizing a CIMO-logic (context, intervention, mechanisms, and outcomes) in a multiple case study, this study set out to apply a recently developed value formulation model, PROVE-IT, for a digital health intervention for seeking of treatment and triage purposes. The research problem was divided into three objectives. The first aim was to discover the mechanisms explaining the functionality of the examined intervention. Second, the thesis explored how the relationship between the mechanisms and outcomes can be measured. Third, the ultimate goal was to develop the existing model to be more practical and generalizable for all digital health interventions. The CIMO-logic was perceived to be a suitable tool for evaluating digital health interventions and their dynamics. Despite differences in contexts, the mechanisms for each case were found to be very similar, thus questioning the generalizable characteristic of the model. As a result, this research suggests further actions to clarify each section in the PROVE-IT model besides presenting means to apply practical metrics to operationalize the model. This thesis contributes to the existing evaluation literature by providing a new approach for value formulation by emphasizing the mechanism perspective. Furthermore, this study provides insight into the practical use of value formulation model to be utilized in sales narratives of health technology companies. Keywords digital health intervention, value-based healthcare, CIMO, market expansion ii Preface Being born to a medical doctor seems to typically lead in a similar career path. Nevertheless, I had always developed my interest in all the things other than healthcare, which has been my father’s specialty. Simultaneously, I never saw myself as a researcher. My mother’s musical background still affect my current hobbies, whereas the heavily engineer-oriented background in our family led me to pursue studies in industrial engineering and management. However, the interest in healthcare never truly kicked in – until this point. Despite my long-term avoidance towards the topic, I somehow ended up in this situation of researching digital health technologies, which I even find incredibly fascinating. Thus, a cliché of never saying never remains true. Aalto University has been a truly inspirational and educational environment to grow as an individual. I have had a chance to befriend numerous tremendous people who have also greatly influenced me. I have experienced many unique moments that still make me delighted, inspired, and thankful. During my studies, I have had an opportunity to truly challenge myself to learn my limits and capabilities. One of these challenges has been this thesis, which is simultaneously a perfect endpoint to my studies. Yet, learning never ends. I want to send my gratitude to my supervisor Paul Lillrank of his first-class support with my thesis. During my time at the university, I have had a pleasure to work with such an inspirational character as you. I want to also heartily thank my advisor Henni Tenhunen to have this marvelous opportunity to study digital health technologies besides learning the ability to create a great confusion with just a single e-mail. Your self-sacrificing attitude pushed me forward when I was stuck. Furthermore, I want to send my regards to Petteri Hirvonen and the rest of the Klinik team for this fantastic opportunity to use you as my case company. I want to also thank the entire team at the Institute of HEMA for all the support and great experiences with all of you. Finally, I want to send my deepest thanks for all the support I have received from my family and my closest friends. Without you Mari and Heikki I would not be in this position. I could never wish better parents than you. I want to thank my big brother Tatu of being a relentless role model for your little brother. I also want to thank my little sister Tuulia of your everlasting encouragement when I have felt like hitting the wall. Espoo, July 29, 2019 Tuomo Tanila iii Table of Contents Tiivistelmä .................................................................................................................................. i Abstract ..................................................................................................................................... ii Preface ..................................................................................................................................... iii Table of Contents ................................................................................................................... iv List of Figures .......................................................................................................................... vi List of Tables .......................................................................................................................... vii Abbreviations ........................................................................................................................ viii 1 Introduction ............................................................................................................................ 1 1.1 Motivation and Background ......................................................................................... 1 1.2 Objectives and Research Questions ........................................................................ 2 1.3 Scope ............................................................................................................................... 5 1.4 Structure of the Thesis ................................................................................................ 5 2 Theoretical Background ......................................................................................................7 2.1 Operations Management in Healthcare ....................................................................7