Emerging Frontiers in Healthcare: Strategy & Technology

2 Credits BU.350.720.xx Class Day/Time & Start/End date Semester Class Location Instructor Full Name Contact Information Phone Number: (###)###-#### E-mail Address: Office Hours Day/s Times Required Text and Learning Materials Required Text: Collections of readings and cases compiled by instructor. List of Readings: The following collection of chapters from textbooks, articles, and Cases will be used as instructional material in the course. Book Chapters: 1. Chapter 1: The Innovator's Prescription: A Disruptive Solution for Health Care by Clayton M. Christensen, Jerome H. Grossman M.D., Jason Hwang M.D. 2. Chapter 2: The Innovator's Prescription: A Disruptive Solution for Health Care by Clayton M. Christensen, Jerome H. Grossman M.D., Jason Hwang M.D. 3. Chapter 3: The Innovator's Prescription: A Disruptive Solution for Health Care by Clayton M. Christensen, Jerome H. Grossman M.D., Jason Hwang M.D. Articles: 1. Unbundling The Corporation - John Hagel III and Mark Singer, McKinsey Quarterly, June 2000. 2. Another Hurdle to Health Care Reform: Too Few General Practice Doctors, July 22, 2009 in Knowledge@Wharton.

3. One Way to Lower Health Costs: Pay People to Be Healthy, June 24, 2009 in
Knowledge@Wharton.

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4. Case: Narayana Hrudayalaya Heart Hospital: Cardiac Care for the Poor: (A), Harvard Business School, June 22, 2005, Prod. #: 505078-PDF-ENG 5. Case: Narayana Hrudayalaya Heart Hospital: Cardiac Care for the Poor: (B), Harvard Business School, August 5, 2011, Prod. #: 712402-PDF-ENG 6. Case: Aravind Eye Hospital, Madurai, India: In Service for Sight, Harvard Business Review, May 15, 2009, Prod. #: 593098-PDF-ENGOne Way to Lower Health Costs: Pay People to Be Healthy, June 24, 2009 in Knowledge@Wharton. 7. Aron, R., Dutta, S., Janakiraman, R., Pathak, P.A., The Impact of Automation of Systems on Medical Errors: Evidence from Field Research, Information Systems Research, Vol. 22, No. 3, September 2011, pp. 429446. 8. Unprepared for changes in health care: McKinsey Global Survey Results, McKinsey Quarterly, July 2009. Case: Electronic Medical Records System Implementation at Stanford Hospital and Clinics, Harvard Business Review, Dec 14, 2010, OIT-103-PDF-ENG. 9. Lean Health Care: Lower Costs, Better Outcomes, November 11, 2009 in Knowledge@Wharton. 10. Information Technology: Not a Cure for the High Cost of Health Care, June 10, 2009 in Knowledge@Wharton. 11. A Prescription for Healthier Medical Care Decisions: Begin by Defining 'Risk', September 05, 2007 in Knowledge@Wharton. Bangkok's Bumrungrad Hospital: Expanding the Footprint of Offshore Health Care, September 02, 2009 in Knowledge@Wharton. 12. Innovative Health Service Models for the Worlds Poor, Harvard Business Review, Harvard Business Review, September 01, 2011, ROT147-PDF-ENG. 13. What does it take to make integrated care work? McKinsey Quarterly, January 2010. Blackboard Site A Blackboard course site is set up for this course. Each student is expected to check the site throughout the semester as Blackboard will be the primary venue for outside classroom communications between the instructors and the students. Students can access the course site at https://blackboard.jhu.edu. Support for Blackboard is available at 1-866-669-6138. Course Evaluation As a research and learning community, the Carey Business School is committed to continuous improvement. The faculty strongly encourages students to provide complete and honest feedback for this course. Please take this activity seriously because we depend on your feedback to help us improve so you and your colleagues

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will benefit. Information on how to complete the evaluation will be provided towards the end of the course. Disability Services Johns Hopkins University and the Carey Business School are committed to making all academic programs, support services, and facilities accessible. To determine eligibility for accommodations, please contact the Carey Disability Services Office at time of admission and allow at least four weeks prior to the beginning of the first class meeting. Students should contact Rachel Hall in the Disability Services office by phone at 410-234-9243, by fax at 443-529-1552, or email: carey.disability@jhu.edu. Important Academic Policies and Services Honor Code Statement of Diversity and Inclusion Tutoring Carey Writing Center Inclement Weather Policy Students are strongly encouraged to consult the Johns Hopkins Carey Business School Student Handbook and Academic Catalog and the School website http://carey.jhu.edu/syllabus_policies for detailed information regarding the above items. Course Description Advances in Information and Communication Technologies when coupled with advances in diagnostic and other medical technologies, have resulted in the emergence new business models as well as new strategies for the delivery of health care to populations that are characterized by wide heterogeneity of wealth, education and access to medical services. Health care providers ranging from the large multi-specialty, tertiary care delivering hospitals to small physicians practices need to be aware of the rapidly changing terrain of health care delivery and how the changing economics of care delivery can produce disruptive business practices by entities in the health care ecosystem. Many industries have been transformed by the advances in Information and Communication Technologies (ICT). It is now possible to transmit rich information across the boundaries of the corporation and across geographical boundaries thus enabling enterprise-wide systems of various entities to connect to each other. This deep linking of information systems has in turn greatly amplified the ability of companies to deliver products and services across a variety of channels to consumers. Further, these advances have also enabled corporations to forge new business models and create highly specialized value chains and supply chains. The ability to source highly information-intensive services from a variety of suppliers in real-time have enabled firms to specialize and develop deeper core competencies. The availability of cheap and ubiquitous bandwidth has also enabled corporations to improve their internal efficiencies and drive productivity gains. Just as other industries were impacted by the advances in Information and Communication Technologies, the Health Care industry too stands at the threshold of a transformation. Information and Communication technologies will impact the delivery and consumption of health care in a variety of ways. Technology will allow

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health care providers to explore business models that are different from the prevailing ones: they may be able to specialize in one or more kinds of service and source others from a network of providers. They will be able to offer information to groups of patients that allow them monitor their health better these information portals have the potential to greatly increase the efficacy of health care delivery by engaging patients in both prevention and intervention functions. The course will also address best practices in the use of technology to deliver health care. We will explore how technologies can be combined with operational innovations to improve both the workings of multi-specialty hospitals aspects of productivity, cost management and safety and better meet the needs of patients. Towards this end we will investigate best practices in the production and delivery of health care from entities known for their excellence in the US and abroad. The course will look at a rapidly growing phenomenon: the globalization health care delivery. We investigate the factors that drive this trend and explore the implications for the delivery and consumption of health care in the US as well as the policy implications of this phenomenon.

Student Learning Objectives for This Course All Carey graduates are expected to demonstrate competence on four Learning Goals, operationalized in eight Learning Objectives. These learning goals and objectives are supported by the courses Carey offers. For a complete list of Carey learning goals and objectives, please refer to the website http://carey.jhu.edu/LearningAtCarey/LGO/index.html. The learning objectives for this course are: 1. Analyze how the four forces that shape outcomes in networked markets will impact on specific businesses and industries. They will also demonstrate how versioning and bundling can be used effectively to deliver superior value proposition in information products. 2. Analyze the sources of value creation and distribution with a special emphasis on the production, delivery and consumption of information-intensive health care services. 3. Formulate frameworks that apply the core concepts of strategy to analyze the workings of the health care systems and multi-specialty hospitals. 4. Analyze the core business models of service industry firms. 5. Students will also analyze the roles of the different members of the healthcare ecosystem. 6. Demonstrate how health care delivery systems can drive efficiency gains from the introduction of the technology and/or operational innovations. 7. Analyze how technological and operational innovations can improve the production and delivery of complex health care solutions. 8. Formulate frameworks that will help determine the optimal Information Architecture of health care delivery systems. Design an Information Architecture that enables specific health care production and delivery objectives to be met. 9. Demonstrate how information and communication technologies can be used for efficient collaboration between members of health care ecosystems. 10. Analyze and predict the impact of global delivery of health care systems on domestic policies including the pricing of health care services. Attendance Policy [The university attendance policy states that instructors will clearly communicate

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attendance expectations and grading policy in the course syllabus.] Attendance and class participation are part of each students course grade. Students are expected to attend all scheduled class sessions. Each class will include opportunities for teams to work together. Failure to attend class will result in an inability to achieve the objectives of the course. Excessive absence will result in loss of points for team participation. Regular attendance and active participation are required for students to successfully complete the course. Evaluation and Grading: The students grade will be based on a combination of evaluation exercises consisting of two assignments, a final project and the students class participation. The breakdown of weights of each of the above is shown below. 1. 2. 3. 4. Practicums 45% of final grade In Class Assessment 15% of final grade Final Project 30% of final grade Class Participation 10% of final grade

Important notes about grading policy: The grade for good performance in a course will be a B+/B. The grade of A- will only be awarded for excellent performance. The grade of A will be reserved for those who demonstrate extraordinarily excellent performance. *The grades of D+, D, and D- are not awarded at the graduate level. Grade appeals will ONLY be considered in the case of a documented clerical error. Practicums: There are three practicums that will be delivered by student groups in class. Each practicum will count for 15% of final grade. In Class Assessment: Students will be called to answer questions at the end of practicums, case discussions and class sessions. Individual students will be asked questions in class and they will be graded by the instructor on the quality of their answers. The assessment could take the form of viva voce and/or a short, written test. Final Project: Students will work in groups and identify specific areas in the delivery of health care that can be improved, reformulated, redesigned or analyzed using the frameworks and concepts learned in this course. They will also demonstrate how their proposed solution is an improvement on the existing situation and analyze the limitations of their recommendations. The format of submission is flexible. Students may submit a written project report, deliver a multi-media presentation that combines a written deliverable with other media formats. Class Participation: Students will be evaluated on the quality of their case preparation, the insights and understanding of material that they demonstrate, the rigor and originality of their analysis and the extent to which they generate informed and relevant responses to questions in class. Students will also be evaluated on the quality of their participation in class discussions where they will be evaluated on rigor, extent of preparation,

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relevance of ideas, originality and insightful understanding of the core concepts of the course. NOTICE ON ACADEMIC INTEGRITY The use of unauthorized material, communication with fellow students during an examination, attempting to benefit from the work of another student, and similar behavior that defeats the intent of an examination or other class work is unacceptable to the University. It is often difficult to distinguish between a culpable act and inadvertent behavior resulting from the nervous tensions accompanying examinations. Where a clear violation has occurred, however, the instructor may disqualify the student's work as unacceptable and assign a failing grade on the paper. COURSE OUTLINE: Session 1: Technological Innovation, Disruption and Business Models The session deals with technological innovation and the nature of the disruption that it creates in how firms deliver services and products to consumers. Students will learn about the nature of technology-enabled innovations, how they impact on firms and their operating models with a special emphasis on hospitals and providers of health care. Students will learn about the key drivers of efficiency economies of scale, economies of scope and specialization and speed and how these have an impact on the space of strategies that firms may adopt, with special emphasis on health care providers. Students will then apply these concepts to analyze the functional dynamics of health care ecosystems. Readings: 4. Chapters 1-2: The Innovator's Prescription: A Disruptive Solution for Health Care by Clayton M. Christensen, Jerome H. Grossman M.D., Jason Hwang M.D. 5. Unbundling The Corporation - John Hagel III and Mark Singer, McKinsey Quarterly, June 2000. Session 2: Information & Communication Technologies And Their Impact on The Service Industry Part I: This session will deal with the sources of value creation and distribution with a special emphasis on the production, delivery and consumption of informationintensive services (including health care services). Students will also be exposed to the ideas of the atomic functions of corporations the core functions of the firm and the key to their economic feasibility. They will learn about the contradictions and constraints involved in the joint optimization of these functions. They will then apply these concepts to the workings of multispecialty hospitals and analyze techniques for managing operational complexity.

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Part II: Practicum: The Multi-Specialty Hospital: Understanding the cost quality frontier. Student groups will deliver a practicum on how the multi-specialty hospital is impacted by the emergence of new technologies and delivery models. Each presenting group will be evaluated by peers and the instructor using a structured evaluation instrument. Readings: 1. Unbundling The Corporation - John Hagel III and Mark Singer, McKinsey Quarterly, June 2000 [Continued from Session I]. Session 3: The Health Care Value Chain: Business Models & Operational Implications I: Frameworks And Toolkits For Analysis This session will explore the core business models of service industry firms. Students will then apply these models to the healthcare industry. Students will also analyze the roles of the different members of the healthcare ecosystem. They will formulate scenarios under which information transparency can help better align the incentives of the members of the health care ecosystem. Readings: 1. Chapter 3: The Innovator's Prescription: A Disruptive Solution for Health Care by Clayton M. Christensen, Jerome H. Grossman M.D., Jason Hwang M.D.

2. Another Hurdle to Health Care Reform: Too Few General Practice Doctors, July
3. 22, 2009 in Knowledge@Wharton. One Way to Lower Health Costs: Pay People to Be Healthy, June 24, 2009 in Knowledge@Wharton.

Session 4: The Health Care Value Chain: Delivering High Quality Frugal Care: Two Case Spotlights Student groups will discuss/spotlight ideas on the use of technology and innovations in health care. Students will apply the concepts learned to analyze a case that deals with the delivery of frugal, high quality care. Readings: 1. Case: Narayana Hrudayalaya Heart Hospital: Cardiac Care for the Poor: (A), Harvard Business School, June 22, 2005. [Prod. #: 505078-PDF-ENG] 2. Case: Narayana Hrudayalaya Heart Hospital: Cardiac Care for the Poor: (B), Harvard Business School, August 5, 2011. [Prod. #: 712402-PDF-ENG] 3. Case: Aravind Eye Hospital, Madurai, India: In Service for Sight, Harvard Business Review, May 15, 2009. [Prod. #: 593098-PDF-ENG] The case analysis will deal with the Narayana Hrudayalaya cases A & B. Students will read the Aravind Eye Hospital case as a reference case to bring out the similarities and differences between the two approaches to delivery of high quality care. They will then analyze the principal lessons for the formulation of strategy in the delivery of high quality care.

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Session 5 The Information Architecture of Efficient Health Care Delivery Part I: Practicum 2: Production of Health Care Services: Policy, Technology and Drivers of excellence. Student groups will deliver practicums on best practices in the delivery of health care with special emphasis on the drivers of excellence in care delivery. Each presenting group will be evaluated by peers and the instructor using a structured evaluation instrument. Part II: The Architecture of effective care delivery Students will learn about the different elements of the Information Architecture of health care delivery systems. They will investigate the key issues in the design of health care delivery systems and explore the emerging trends in the use of clinical information systems. Readings: 1. Aron, R., Dutta, S., Janakiraman, R., Pathak, P.A., The Impact of Automation of Systems on Medical Errors: Evidence from Field Research, Information Systems Research, Vol. 22, No. 3, September 2011, pp. 429446. 2. Aron, R., Gao, G., Pathak, P.A., Information Automation in Chronic Care Processes: Implications for Efficiency and Quality, Working Paper (to be supplied by the instructor). 3. Unprepared for changes in health care: McKinsey Global Survey Results, McKinsey Quarterly, July 2009. [POST CLASS OPTIONAL READING] Session 6: Impact of IT & Operational Innovations on The Delivery Of Health Care. Students will learn about the different ways in which innovations in operations and information systems can impact on the health care ecosystem. They will analyze some of the complexities associated with implementing strategic technologies in hospitals. The case Electronic Medical Records System Implementation at Stanford Hospital and Clinics will be analyzed and used to illustrate the ideas central to this session. Students will formulate frameworks for analyzing the role played by Information and Communication technologies in shaping the delivery of high quality care. Readings: 1. 2. 3. 4. Case: Electronic Medical Records System Implementation at Stanford Hospital and Clinics, Harvard Business Review, Dec 14, 2010. [Prod # OIT103-PDF-ENG] Lean Health Care: Lower Costs, Better Outcomes, November 11, 2009 in Knowledge@Wharton. Information Technology: Not a Cure for the High Cost of Health Care, June 10, 2009 in Knowledge@Wharton. A Prescription for Healthier Medical Care Decisions: Begin by Defining 'Risk', September 05, 2007 in Knowledge@Wharton.

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Session 7: The Global Delivery of Health Care Students will learn about the emerging trends in the global delivery of health care. They will explore how Information and Communication technologies have enabled the globalization of health care wherein hospitals located in the developing economies are able to deliver health care services to patients in the developed economies. Students will also look at how these hospitals have used innovative methods spanning the use of ICT and formulating innovative strategies to attract customers from world over and deliver high quality health care at comparatively lower costs. Students will analyze the strategic implications of these trends for large hospitals and health delivery systems in the US and in other developed economies. Readings: 1. Bangkok's Bumrungrad Hospital: Expanding the Footprint of Offshore Health Care, September 02, 2009 in Knowledge@Wharton. 2. Innovative Health Service Models for the Worlds Poor, Harvard Business Review, Harvard Business Review, September 01, 2011. [ROT147-PDF-ENG] Session 8: The Delivery Of health Care: Emerging Frontiers Part I: Student groups will deliver practicums on how an emerging technology and/or business trends will drive changes in the delivery of health care. They will identify a key technology and/or business trend Telemedicine, use of mobile platforms in the delivery of health, use of data mining, patient self-care portals, use of social networks, global delivery of care, disaggregation of care delivery models, etc. and discuss how this will impact on the delivery of care. They will illustrate their ideas in the context of a particular entity in the health care ecosystem a hospital, a physicians practice, pharmaceutical firm (drug maker) and comment on how this entitys space of strategies will be impacted by the trend. Part II: Synthesis Workshop: Pulling It All Together Students will review the key concepts, strategic frameworks and principles learned in the course and tie these together to create frameworks for making integrated care delivery systems work well. Each presenting group will be evaluated by peers and the instructor using a structured evaluation instrument. Readings: 1. What does it take to make integrated care work? McKinsey Quarterly, January 2010. Copyright Statement Unless explicitly allowed by the instructor, course materials, class discussions, and examinations are created for and expected to be used by class participants only.

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The recording and rebroadcasting of such material, by any means, is forbidden. Violations are subject to sanctions under the Honor Code.