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Encyclopedia of E-Health and Telemedicine Maria Manuela Cruz-Cunha Polytechnic Institute of Cávado and Ave, Portugal Isabel Maria Miranda Câmara Municipal de Guimarães, Portugal Ricardo Martinho Polytechnic Institute of Leiria, Portugal Rui Rijo Polytechnic Institute of Leiria, Portugal
Volume I Categories:
Category: Developments and Solutions
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GuiMarket:
An E-Marketplace of Health and Social Care Services Maria Manuela Cruz-Cunha Polytechnic Institute of Cávado and Ave, Portugal Ricardo Simoes Polytechnic Institute of Cávado and Ave, Portugal Isabel Miranda Câmara Municipal de Guimarães, Portugal João Varajão University of Minho, Portugal Luís Ferreira Polytechnic Institute of Cávado and Ave, Portugal Ricardo Martinho Polytechnic Institute of Leiria, Portugal Rui Rijo Polytechnic Institute of Leiria, Portugal
INTRODUCTION Literature suggest that Assistive Technologies and Information and Communication Technologies (ICT) may improve quality of life, extend length of community residence, improve physical and mental health status, delay the onset of serious health problems and reduce family and caregiver burden (see for example Blaschke, Freddolino & Mullen, 2009; Cunha & Putnik, 2008; Cruz-Cunha, Varajão, Miranda et al., 2012; Cruz-Cunha, Miranda, Lopes et al., 2013; Doukas et al., 2011; Muncert et al., 2012; Ilahi, Ghannouchi & Martinho, 2014). There is a wide range of assistive technologies that can contribute to this purpose, such as web portals, electronic marketplaces (e-marketplaces) and search engines. The authors proposed an electronic marketplace (e-marketplace) as an integrative environment, to help the match between offer and demand of health and social care services, integration and management, performance monitoring and evaluation, and the enforcement of commitments of both parties involved in the transactions. However, the full exploitation of an electronic service of this nature depends on the broader access to ICT and the ability to use them (Cunha, Putnik & Gunasekaran, 2003; Cunha, Putnik, Gunasekaran & Ávila, 2005). Simultaneously the authors undertook a study aiming the definition and implementation of an e-marketplace for healthcare and social care and well-being services in Guimarães1: a municipality of the North of Portugal (Cruz-Cunha et al., 2013; Cruz-Cunha, Simões, Varajão & Miranda, 2014). The project, called GuiMarket, was developed envisaging people with special needs (elderly or with tempo-
DOI: 10.4018/978-1-4666-9978-6.ch018 Copyright © 2016, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.
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rary or permanent disabilities), their caregivers, their family and institutions. Additionally, most of the services to be provided by this e-Marketplace can be used by all inhabitants in general. The effectiveness and efficiency in the delivery of social and health care services and the well-being of the users of these services is based on a correct coordination between the offer (the service providers: individual professionals and organizations) and demand (individuals and organizations) to address their specific needs and expectations. The services include the so-called physical care, such as domestic work, home care, personal care services and wellness, physiotherapy, nursing services, transport, catering, among others. The Social Development Plan for the Municipality of Guimarães, conceived by the Department of Social Intervention for the period 2008-2011 (Miranda, 2008), considered several pilot actions in order to put ICT at the service of the population, in particular of both elderly and temporarily/permanently disabled people, and their caregivers or potential caregivers. The GuiMarket appeared as a pilot project to an answer to this plan. This article summarises the project, the main results of the above-mentioned study and the main achievements so-far. Thus it makes three main contributions to the state-of-the-art in the field: 1. The results of the study confirm the interest and the perceived potential of such a service from an end-user perspective; 2. The findings support the advantage of expanding this pilot project to a full scale implementation; and 3. The performed analysis improves our understanding of the relations between the characteristics of the inquired population and their perceived interest in such a platform. After the background section, the article presents the GuiMarket users, a short specification of the service, functionalities and services to be offered, some implementation aspects and a prototype. The article ends with some conclusions and remarks for future development. This encyclopedia article was based on earlier publications of the authors (cited in the text) produced along the project development.
BACKGROUND There are many different aspects that contribute to the increased expenditure in health. A main cause is based on the combined effect of the altered demographics (the projected, and actually observed, increase in the percentage of older people relative to the entire population), and the tendency for health expenditures per capita to increase with age (Martins & Maisonneuve, 2006). Some of the main challenges that Europe healthcare systems are facing includes the rising demand for health and social care services, due to an ageing population, with previsions for 2051 pointing to 40% of the Union’s population older than 65 years old (Braun et al., 2003), and the increasing expectations of citizens who want the best care available, and at the same time to experience a reduction in inequalities in access (European Commission, 2004). Local health care and social care units in Portugal have geographically dispersed facilities, covering both urban and rural areas, according to geographic-population criteria. Among these units we can find health centers, hospitals, private and non-profit institutions, non-governmental organizations, community/communitarian institutions and individual professionals active in the health care and social care intervention. Similarly, a wide range of services related to wellbeing, which can be included in the category of social care services, is provided by independent enterprises, organizations and individuals.
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Frequently, individuals have difficulty knowing the available services in their region or their specific location, and even less available is the opportunity to select among different service providers which might offer considerably different service conditions. This happens mainly because a network of health care, social care and professional services providers, working articulately with an underlying effective management and intermediation service, is missing. Such a network is proposed by the authors as an emarketplace for health care and social care services. A platform for this purpose can be a powerful tool and result in effective and efficient service to citizens in general, but in particular to people with special needs, elder people and their caregivers. The proposed e-marketplace is an integrating environment to receive user needs transmitted over an online platform and the allocation of service providers to answer these needs. Additionally, it foresees other features including integration and management, performance monitoring and evaluation and commitment control, at each phase of the service lifecycle.
USERS AND THEIR REQUIREMENTS This section introduces the users of the services to be provided by GuiMarket (both offer and demand sides) and the platform manager.
Offer and Demand The GuiMarket platform is an environment to coordinate and manage the match between the offer of healthcare and social care services and both individual users and institutions, that at a particular moment need the services of a professional (Cruz-Cunha et al., 2010). GuiMarket facilitates the matching between 1. The offer or services providers (professionals and specialized institutions that provide social and healthcare services) and 2. The demand side (consisting of both individuals and entities that use the e-marketplace to search resources to satisfy their needs), in a context of geographical proximity. The entities and their roles are presented in Table 1. The objective of GuiMarket consists of offering new solutions in the area of health care and social care, provision of home services, making available privileged communication means between: • • •
The individual and the entities with social concerns, or entities that provide social and healthcare services or independent service providers; Institutions that provide social /healthcare services and independent service providers; Different institutions providing social / healthcare services, to complementarily solve a given situation.
Figure 1 presents the users’ interactions with the providers of health and social care services, which can take place by traditional communication means, or using the proposed platform, or even using a mediation service – a call centre – when users do not have Internet competencies or available technology (Rijo, Varajão, Gonçalves, 2012).
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Table 1. Offer and demand in an e-marketplace of health and social care services Individuals
The service is designed having in mind firstly individuals with special needs, elder or disabled, but it is accessible to all population of the Municipality. Currently a significant number of these targeted users cannot access these technologies, but that task can be performed by their caregivers, relatives, neighbours or friends; alternatively, they can use a call centre service where an operator mediates the search and selection tasks.
Organizations
In a perspective of complementarities to the services they offer, or as demanders of services provided by the other classes of providers represented in the e-marketplace.
Individuals and enterprises
Individuals and enterprises certified to provide social care, health care or home specific services, such as gerontology services, transportation, plumbing, catering, cleaning, transportation, home assistance, or therapists.
Organizations
Certified entities of the social network of services and care providers, the health care network.
Demand
Offer
The GuiMarket Manager Considering the type of services offered and the need to ensure a high standard of quality and reliability of the services, the GuiMarket portal manager is a vital component of the system. He is responsible for creating new service categories (either requested by users or by providers), validating that the new providers are legally allowed to offer the service, benchmarking the quality of providers based on user feedback (including discriminating useful feedback), and ensuring the system is functional (quickly acting whenever there are problems). Aside from these logistic tasks, the portal manager has two critical roles in the growth and sustainability of the business: 1. Communicate with users along time in order to identify new possible areas of activity and also implement modifications to improve the usability of the portal; and 2. Use the necessary traditional communication mechanisms to allow people access to the market without the use of the portal (management of a supporting call centre). Figure 1. Interaction between participants in the GuiMarket Cruz-Cunha et al., 2010.
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The latter allows all types of interaction with the market, including the personal and direct contact such as in any traditional business.
OVERALL SPECIFICATION This section introduces GuiMarket, firstly with a description of the main activities offered, and followed by a brief specification of its overall structure using an IDEF0 diagram2. The main activities of search and selection of resource providers using GuiMarket are the following: •
•
•
Request: Request involves the specification of the required service. This can be done navigating through the market of resource providers (or more narrowed sets of providers called focused markets), or for complex situations, using a chat facility with the “broker” of the market, when the service specification is not immediate and requires “knowledge” about the required service. Search and Selection: Search, negotiation and selection consist of several steps: the identification of potential resource providers, separation of eligible providers, negotiation among these to identify the candidate providers (according to availability, price, conditions to provide the service), and finally the selection of the most suitable. Negotiation is a facility that is possible for certain classes of professional services (request for quotations is the most usual). When it is not needed negotiation, selection is made from the services directory or catalogue. For complex situations, the final selection can be controlled by the broker or in interaction with him. Contractualization: An automated contractualization by which the user and the provider agree on the conditions to be respected in the service to be provided.
The overall functioning of GuiMarket is represented by an IDEF0 diagram in Figure 2. It consists of the creation and management of the market of resources (GuiMarket database) (Process A.1.), as the environment to support search, negotiation, selection and contractualization of resource providers (Process A.2.) that, after the conclusion of the service, are evaluated (Process A.3.).
FUNCTIONALITIES AND SERVICES TO BE OFFERED A wide set of services could be offered, and Figure 3 gives some examples. The set of services to be offered in the prototype platform were identified by the survey undertaken and reported in this section. GuiMarket envisages the alignment between the user needs and the suppliers of health and social care services. The study presented in this section consists of the capture of the user needs and expectations, which will allow the definition of the business model and organizational structure of the e-marketplace that will respond to the user.
Study on Perceived Interest and Expectations: Methodology The implementation of this service requires the understanding of the needs, expectancies and importance granted by the inhabitants towards the GuiMarket platform. With this purpose, the authors have undertaken a study (Cruz-Cunha et al., 2013) which results allow to understand the viability of the solution and the requirements to the deployment of the pilot experi-
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Figure 2. IDEF0 representation of the global process for the GuiMarket creation and maintenance, the resource providers search and selection and the final evaluation of the service provided
ment, as well as to drive the selection of domains of activities or typology of services to be offered by the platform. The methodology consisted of gathering information from a stratified random sample of residents on the perceived interest of GuiMarket, its expected use and the services deemed most relevant, together with the demographics of the sample considering age, education, internet access, possession of a computer and internet usage. The information collection was performed at different times of day and different places of each parish, to encompass a high diversity of people and also to fulfil the defined stratification by age. It was used a semi-structured interview based on a questionnaire with open questions and closed questions. The sample is layered beginning at the age of 18. Of the 333 interviews, 18 could not be considered. Some demographic data of respondents is summarized in Table 2. It should be noted that it was a prerequisite for being respondent, to be currently or have already been a caregiver, or cohabit with people with special needs.
Study on Perceived Interest and Expectations: Some Results Table 3 represents the importance that participants acknowledge to the existence of an e-Marketplace for social care and assistance services. For 49.2% of the citizens, the service is stated as very important. Table 4 presents the expected frequency of use of the services provided by GuiMarket. More than a half of the inquired expect to use them several times, and only a few intent to use them frequently (daily or several times per week), that may look contradictory to the importance granted to this platform.
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Figure 3. Functionalities to be implemented through the platform
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However, the authors were able to confirm a strong relation among the recognized importance of the GuiMarket and the intention of use (Cruz-Cunha et al., 2013). Services such as healthcare and social care services, home monitoring/ accompanying services 24 hours per day, and personal hygiene services provided at home are the ones recognized by the inquired citizens as very important to be provided by GuiMarket, and this indicates that the potential users will be mostly people with special needs or their family or caregivers (Cruz-Cunha, Miranda, Simões & Varajão, 2015). Figure 4 shows the average rate granted by the citizens to the most relevant services to be offered, in a scale starting at 1 – irrelevant to 5 – very important.
GUIMARKET IMPLEMENTATION The technical requirements to support GuiMarket development can be grouped under three heads. An information infrastructure and support mechanisms, bounded by a project management guide to regulate the implementation and operation of the service (Cruz-Cunha et al., 2010): •
An Information Infrastructure: The information infrastructure must provide information exchange, security, access, monitoring, recovery and emergency handling and contingency operations. Technology elements include functional engines (file servers, network servers, distributed database engines, search engines and security mechanisms), distributed information resources built upon these engines (such as catalogues, distributed databases) and services to access these
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Table 2. Respondent demographics Characteristics Age groups
Level of education
Owning a computer and Internet access at home
Frequency of Internet utilization
•
N
%
< 30 years old
51
16.2
30 - 39
74
23.5
40 - 49
59
18.7
50 - 59
68
21.6
60 - 69
44
14.0
70 or more
19
6.0
Total
315
100.0
Illiterate
11
3.5
Incomplete primary education
157
49.8
Complete primary education
59
18.7
Secondary education
49
15.6
Higher education
39
12.4
Total
315
100.0
Have a personal computer at home
243
77.1
Has Internet access
223
70.8
Does not have Internet access but has someone to help to solve a problem if there is the need of Internet access
31
9.8
Never
131
41.6
Rarely
16
5.1
Sometimes
49
15.6
Often
41
13.0
Everyday
78
24.8
Total
315
100.0
resources (building on the existing techniques including HTML, File Transfer Protocol, messaging and collaboration techniques). Appropriate Support Mechanisms and Tools for the Supra Infrastructure: An information infrastructure de per si is not enough; participants require mechanisms and tools to operate within the infrastructure, namely performance evaluation, electronic negotiation systems, authentication and other supporting tools. Participants (clients and providers) need supporting tools to quantify service levels, evaluate the performance and assess targets, among others.
Table 3. Importance granted to GuiMarket Frequency
%
Not important / Little importance / Indifferent
14
4.4
Important
146
46.3
Very important
155
49.2
Total
315
100.0
Cruz-Cunha et al., 2013.
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Table 4. Expected frequency of utilization of the e-Marketplace Frequency
%
Never
15
4.8
Rarely
101
32.1
Sometimes
177
56.1
Frequently (daily or a few times per week)
22
7.0
Total
315
100.0
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•
Project Management and Regulation: Management and regulation of the market are critical aspects. In defining this component, we considered the following: ◦◦ Various User Profiles: Taking into account several characteristics such as computer skills and level of education; the purpose is to look out for the interests of those with more difficulties in using this type of services, ensuring an overall level of quality and satisfaction; and ◦◦ Various Service Provider Profiles: According to their specific characteristics; in all cases, providers must be legally enabled to provide a certain service before they are added to the portal, and are required to deliver legal supporting documentation for that. Table 5 systematizes these requirements and lists the required technologies and tools.
A PROTOTYPE Figure 5 represents the homepage of GuiMarket (the webpage is in Portuguese language).
Figure 4. Importance granted to the most relevant services to be provided by the platform
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Table 5. Technologies for the implementation of the technical requirements of GuiMarket Technical Requirements Information Infrastructure • Servers • Distributed database systems • E-Marketplaces development platforms • Electronic catalogues • Communication technologies • Messaging and collaboration techniques
Support Mechanisms and Tools • Benchmarking and metrics • Electronic negotiation mechanisms • Electronic contracting • Algorithms or protocols • Market regulation • Intelligent decision making systems • Computer aided tools
Project Management/ GuiMarket Regulation • Market organisation • Management procedures • Business models • Performance evaluation • Contract management • GuiMarket management (maintenance, control, coordination, enforcement, etc.)
CONCLUSION AND FUTURE RESEARCH DIRECTIONS The results of the referred study were of major relevance to understand what are the expectations of the people of the Guimarães Municipality regarding this new service, in order to shape it accordingly, i.e. to identify the suitable service providers. As a consequence, it is expected to assure more flexibility and quality of life to individuals that for any reason should stay at home, as they can find in the platform many of the services required to support their daily life activities. It is certain that at this moment many potential users will be excluded by the digital divide problem – a global concern nowadays. New progresses are being made at this level, and new actions and efforts (such as active ageing and e-inclusion) are being taken at a world-wide level policies that will gradually allow going beyond these limitations. The next step consists on the implementation of the prototype for demonstration and validation in a pilot study with a selected set of citizens in order to perform an adoption study and usability testing. After the adjustments that the adoption study will indicate, the platform will be further developed aiming at the real utilization. The results of the study enabled us to understand the feasibility of the proposed solution and also identifying the types of services to offer. These are two fundamental aspects considering the development of a platform prototype for validating the use of this innovative solution in the field of social assistance in the form of an e-marketplace of social services and health and welfare services.
ACKNOWLEDGMENT Financial support provided by the Municipality of Guimarães, under a collaboration project with the University of Minho.
REFERENCES Blaschke, C. M., Freddolino, P. P., & Mullen, E. E. (2009). Ageing and Technology: A Review of the Research Literature. British Journal of Social Work, 39(4), 641–656. doi:10.1093/bjsw/bcp025 Braun, A., Constantelou, A., Karounou, V., Ligtoet, A., & Burgelman, J.-C. (2003). Prospecting eHealth in the context of a European Ageing Society: Quantifying and qualifying needs (Final Report). Brussels: IPTS/ESTO.
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Figure 5. Prototype GuiMarket webpage (in Portuguese)
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Cruz-Cunha, M. M., Miranda, I., Simoes, R., & Varajão, J. (2015). Aggregating Community Resources of Care and Assistance Services for the Elderly Population. In Proceedings of the 28th Bled eConference. Bled, Slovenia: University of Maribor; available online at https://domino.fov.uni-mb.si/proceedings Cruz-Cunha, M. M., Miranda, I. M., Lopes, N., & Simoes, R. (2013). An e-Marketplace of Healthcare and Social Care Services. The Learning Organization, 20(6), 408–418. Cruz-Cunha, M. M., Simoes, R., Varajão, J., & Miranda, I. (2014). Information Technology Supporting Healthcare and Social Care Services: An e-Marketplace Case Study. Information Technology Research, 7(1), 41–58. doi:10.4018/jitr.2014010104 Cruz-Cunha, M. M., Tavares, A. J., Simoes, R. J., & Miranda, I. M. (2010). GuiMarket: an e-Marketplace of Healthcare and Social Care Services for Individuals with Special Needs. In M. M. Cruz-Cunha, A. J. Tavares, & R. J. Simões (Eds.), Handbook of Research on Developments in e-Health and Telemedicine: Technological and Social Perspectives (pp. 904–916). Hershey, PA: Medical Information Science Reference. Cruz-Cunha, M. M., Varajão, J., Miranda, I. M., Lopes, N., & Simoes, R. (2012). An e-Marketplace of Healthcare and Social Care Services: The Perceived Interest. Procedia Technology, 5(0), 959–966. doi:10.1016/j.protcy.2012.09.106 Cunha, M. M., & Putnik, G. D. (2008). Market of Resources for Healthcare Teleservices Management. In G. D. Putnik & M. M. Cunha (Eds.), Encyclopedia of Networked and Virtual Organizations. Hershey, PA: IGI-Global. doi:10.4018/978-1-59904-885-7.ch120
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Cunha, M. M., Putnik, G. D., & Gunasekaran, A. (2003). Market of Resources as an Environment for Agile/Virtual Enterprise Dynamic Integration and for Business Alignment. In A. Gunasekaran & O. Khalil (Eds.), Knowledge and Information Technology Management in the 21st Century Organisations: Human and Social Perspectives (pp. 169–190). London: Idea Group Publishing. doi:10.4018/978-159140-032-5.ch011 Cunha, M. M., Putnik, G. D., Gunasekaran, A., & Ávila, P. (2005). Market of Resources as a Virtual Enterprise Integration Enabler. In G. D. Putnik & M. M. Cunha (Eds.), Virtual Enterprise Integration: Technological and Organizational Perspectives (pp. 145–165). London: Idea Group Publishing. doi:10.4018/978-1-59140-405-7.ch007 Doukas, C., Metsis, V., Becker, E., Le, Z., Makedon, F., & Maglogiannis, I. (2011). Digital cities of the future: Extending @home assistive technologies for the elderly and the disabled. Telematics and Informatics, 28(3), 176–190. doi:10.1016/j.tele.2010.08.001 European Commission. (2004). e-Health - Making Healthcare better for European Citizens: An Action Plan for a European e-Health Area (No. COM(2004) 356). Brussels: Commission of the European Communities. Ilahi, L., Ghannouchi, S. A., & Martinho, R. (2014). Healthcare Information Systems Promotion: From an Improved Management of Telemedicine Processes to Home Healthcare Processes. In Proceedings of the Second International Conference on Technological Ecosystems for Enhancing Multiculturality (pp. 333-338). Retrieved from http://doi.acm.org/10.1145/2669711.2669920 Magnusson, L., Hanson, E., & Borg, M. (2004). A literature review study of Information and Communication Technology as a support for frail older people living at home and their family carers. Technology and Disability, 16(4), 223–235. Martins, J. O. & Maisonneuve, C. (2006). The Drivers of Public Expenditure on Health and Long-term Care: an integrated approach: OECD Economic Studies, N.º 42, 2006/2. Miranda, I. (2008). Plano de Desenvolvimento Social para o Município de Guimarães 2008-2011. Guimarães, Portugal: Câmara Municipal de Guimarães. Muncert, E. S., Bickford, S. A., Guzic, B. L., Demuth, B. R., Bapat, A. R., & Roberts, J. B. (2012). Enhancing the Quality of Life and Preserving Independence for Target Needs Populations Through Integration of Assistive Technology Devices. Telemedicine Journal and e-Health, 17(6), 478–483. doi:10.1089/tmj.2010.0206 PMID:21631385 Rijo, R., Varajão, J., & Gonçalves, R. (2012). Contact center: Information systems design. Journal of Intelligent Manufacturing, 23(3), 497–515. doi:10.1007/s10845-010-0389-0
KEY TERMS AND DEFINITIONS Electronic Marketplace (E-Marketplace): An Internet-based platform where several buyers and several sellers meet to do business. It is a third party mediating offer and demand, offering value-added services and promoting trust and support to negotiation and transactions.
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GuiMarket: A pilot project of an e-marketplace for healthcare and social care services currently being developed in the Municipality of Guimarães, Portugal. GuiMarket is an e-marketplace of healthcare and social care resource providers to facilitate the matching between users looking for service providers and individuals/institutions offering their resources. GuiMarket Manager: The e-Marketplace portal (GuiMarket) has a manager, who is responsible for the major maintenance and coordination tasks. ICT: Information and communication technologies. This is a term that covers all advanced technologies in manipulating and communicating information. IDEF0: Integration Definition for Function Modeling. A function modeling methodology which offers a functional modeling language for the analysis, development, reengineering, and integration of information systems; business processes; or software engineering analysis. Individuals with Special Needs: Individuals with disabilities, temporary or permanent, that require special attention (healthcare and social care).
ENDNOTES
1
2
Guimarães is a northern Portuguese municipality with a population of circa 160,000 inhabitants, 54,000 of which in its urban area, and occupies an area of roughly 241 km2. IDEF stands for ICAM DEFinition methodology (ICAM – Integrated Computer-Aided Manufacturing). IDEF diagrams illustrate the structural relations between two processes and the entities present in the system. The processes (represented as boxes) transform the inputs into outputs (respectively the left and the right arrows of a process), using the mechanisms for the transformation (the bottom arrows of a process) and constrained by control information or conditions under which the transformation occurs (the top arrows).
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