Joris van de Klundert

Managing brands and customer engagement in online brand communities

Purpose – Given the dramatic technology‐led changes that continue to take place in the marketplace, researchers and practitioners alike are keen to understand the emergence and implications of online brand communities (OBCs). The purpose of this paper is to explore OBCs from both consumer and company perspectives.Design/methodology/approach – The study provides a synthesis of the extant OBC literature to further our understanding of OBCs, and also puts forth future priorities for OBC research.Findings – A conceptual framework is provided that extends our understanding of OBCs and consumer engagement. Four key OBC dimensions (brand orientation, internet‐use, funding and governance) are identified and three antecedents (brand‐related, social and functional) are proposed of consumer‐OBC engagement.Originality/value – This study is the first to explore key dimensions of OBCs, and the differing but related perspectives of the consumers and organizations involved.

Measuring clinical pathway adherence

As clinical pathway adoption continues worldwide, it is necessary to establish adherence measurement methods in order to understand the difficulties and results of implementation. Adherence measurement literature mostly provides binary measurements of adherence to guidelines regarding individual medical activities over patient groups. The resulting measurements are of limited value in view of the pathways actually followed by individual patients. We develop and test dynamic programming formulations for adherence measurement in clinical pathways--based on partially ordered data in medical records and pathway definitions. With these new methods at hand, we analyze clinical pathway adherence at the Cardiovascular Center of Maastricht University Medical Center.

Characteristics of Patient Portals Developed in the Context of Health Information Exchanges: Early Policy Effects of Incentives in the Meaningful Use Program in the United States

Background In 2014, the Centers for Medicare & Medicaid Services in the United States launched the second stage of its Electronic Health Record (EHR) Incentive Program, providing financial incentives to providers to meaningfully use their electronic health records to engage patients online. Patient portals are electronic means to engage patients by enabling secure access to personal medical records, communication with providers, various self-management tools, and administrative functionalities. Outcomes of patient portals have mainly been reported in large integrated health systems. This may now change as the EHR Incentive Program enables and supports the use of patient portals in other types of health systems. In this paper, we focus on Health Information Exchanges (HIE): entities that facilitate data exchange within networks of independent providers. Objective In response to the EHR Incentive Program, some Health Information Exchanges in the United States are developing patient portals and offering them to their network of providers. Such patient portals hold high value for patients, especially in fragmented health system contexts, due to the portals’ ability to integrate health information from an array of providers and give patients one access point to this information. Our aim was to report on the early effects of the EHR incentives on patient portal development by HIEs. Specifically, we describe the characteristics of these portals, identify factors affecting adoption by providers during the 2013-2014 time frame, and consider what may be the primary drivers of providers’ adoption of patient portals in the future. Methods We identified four HIEs that were developing patient portals as of spring 2014. We collected relevant documents and conducted interviews with six HIE leaders as well as two providers that were implementing the portals in their practices. We performed content analysis on these data to extract information pertinent to our study objectives. Results Our findings suggest that there are two primary types of patient portals available to providers in HIEs: (1) portals linked to EHRs of individual providers or health systems and (2) HIE-sponsored portals that link information from multiple providers’ EHRs. The decision of providers in the HIEs to adopt either one of these portals appears to be a trade-off between functionality, connectivity, and cost. Our findings also suggest that while the EHR Incentive Program is influencing these decisions, it may not be enough to drive adoption. Rather, patient demand for access to patient portals will be necessary to achieve widespread portal adoption and realization of potential benefits. Conclusions Optimizing patient value should be the main principle underlying policies intending to increase online patient engagement in the third stage of the EHR Incentive Program. We propose a number of features for the EHR Incentive Program that will enhance patient value and thereby support the growth and sustainability of patient portals provided by Health Information Exchanges.

What do we know about developing patient portals? a systematic literature review

OBJECTIVE Numerous articles have reported on the development of patient portals, including development problems and solutions. We review these articles to inform future patient portal development efforts and to provide a summary of the evidence base that can guide future research. MATERIALS AND METHODS We performed a systematic review of relevant literature to answer 5 questions: (1) What categories of problems related to patient portal development have been defined? (2) What causal factors have been identified by problem analysis and diagnosis? (3) What solutions have been proposed to ameliorate these causal factors? (4) Which proposed solutions have been implemented and in which organizational contexts? (5) Have implemented solutions been evaluated and what learning has been generated? Through searches on PubMed, ScienceDirect and LISTA, we included 109 articles. RESULTS We identified 5 main problem categories: achieving patient engagement, provider engagement, appropriate data governance, security and interoperability, and a sustainable business model. Further, we identified key factors contributing to these problems as well as solutions proposed to ameliorate them. While about half (45) of the 109 articles proposed solutions, fewer than half of these solutions (18) were implemented, and even fewer (5) were evaluated to generate learning about their effects. DISCUSSION Few studies systematically report on the patient portal development processes. As a result, the review does not provide an evidence base for portal development. CONCLUSION Our findings support a set of recommendations for advancement of the evidence base: future research should build on existing evidence, draw on principles from design sciences conveyed in the problem-solving cycle, and seek to produce evidence within various different organizational contexts.

ASAP: The After-Salesman Problem

We consider the operational scheduling or dispatching problem of assigning servicemen to service requests that arrive in real time. The objective is to optimize responsiveness, i.e., to minimize waiting in excess of a promised response time. We study how responsiveness is influenced by modeling decisions and solution methods that arise when solving the dynamic problem by repeatedly solving real-time problems. Most results are derived using a set-partitioning based solution approach, which is shown to perform best among considered alternatives. Our research is based on a large-scale real-life application regarding roadside service assistance.

Allocation and matching in kidney exchange programs

Living donor kidney transplantation is the preferred treatment for patients suffering from end‐stage renal disease. To alleviate the shortage of kidney donors, many advances have been made to improve the utilization of living donors deemed incompatible with their intended recipient. The most prominent of these advances is kidney paired donation (KPD), which matches incompatible patient–donor pairs to facilitate a kidney exchange. This review discusses the various approaches to matching and allocation in KPD. In particular, it focuses on the underlying principles of matching and allocation approaches, the combination of KPD with other strategies such as ABO incompatible transplantation, the organization of KPD, and important future challenges. As the transplant community strives to balance quantity and equity of transplants to achieve the best possible outcomes, determining the right long‐term allocation strategy becomes increasingly important. In this light, challenges include making full use of the various modalities that are now available through integrated and optimized matching software, encouragement of transplant centers to fully participate, improving transplant rates by focusing on the expected long‐run number of transplants, and selecting uniform allocation criteria to facilitate international pools.

Developing patient portals in a fragmented healthcare system.

BACKGROUND Use of patient portals may contribute to improved patient health and experiences and better organizational performance. In the Netherlands, patient portals have gained considerable attention in recent years, as evidenced by various policy initiatives and practical efforts directed at developing portals. Due to the fragmented setup of the Dutch healthcare system patient portals that give patients access to information and services from across their providers are developed in inter-organizational collaboration. OBJECTIVE The objective of this paper is to identify and describe the types of collaborations, or networks, that have been established to develop patient portals in the Netherlands. Understanding the characteristics of these networks as well as the development of their respective portals enables us to assess the enabling and constraining effects of different network types on patient portal initiatives. METHODS We used qualitative methods including interview and documents analysis. In a first step, we interviewed eighteen experts and reviewed relevant national policy and strategy documents. Based on this orientation, we selected three networks we deemed to be representative of inter-organizational efforts to develop Dutch patient portals in 2012. In a second step, we interviewed twelve representatives of these patient portal networks and collected documents related to the portals. We applied content analytic techniques to analyze data from the three cases. RESULTS The three studied networks differed in their number and diversity of actors, the degree to which these actors were mutually dependent, the degree to which network governance was decentralized, and the dynamics of the network structures. We observed that the portals developed in networks displaying the highest degree of these characteristics experienced most difficulties associated with developing patient portals - such as achieving interoperability, successful implementation, regulatory complaisance, and financial sustainability. Yet, at the same time, the portals developed in these networks may hold the highest functionality to patients, since they can consolidate information and services from a broad array of health service providers. CONCLUSIONS The early empirical evidence provided here indicates that effective development of patient portals begs a tradeoff between envisioned functionality and ease of development.

Kidney exchange with long chains: An efficient pricing algorithm for clearing barter exchanges with branch-and-price

Barter exchange markets are markets in which agents seek to directly trade their goods with each other. Exchanges occur in cycles or in chains in which each agent gives a good to the next agent. Kidney exchange is an important type of barter exchange market that allows incompatible patient–donor pairs to exchange kidneys so the involved patients can receive a transplant. The clearing problem is to find an allocation of donors to patients that is optimal with respect to multiple criteria. To achieve the best possible score on all criteria, long cycles and chains are often needed, particularly when there are many hard-to-match patients. In this paper we show why this may pose difficulties for existing approaches to the optimization of kidney exchanges. We then present a generic iterative branch-and-price algorithm that can deal effectively with multiple criteria, and we show how the pricing problem may be solved in polynomial time for a general class of criteria. Our algorithm is effective even for large, realistic patient–donor pools. Our approach and its effects are demonstrated by using simulations with kidney exchange data from the Netherlands and the United States.

Productivity and quality of Dutch hospitals during system reform

This study addresses the productivity of Dutch hospitals since the start of the health systems reform in 2005. We consider DEA based measures, which include efficiency and quality for the complete set of Dutch hospitals and present cross-sectional and longitudinal analysis. In particular, we consider how hospital efficiency has developed. As the reform created an environment of regulated competition, we pay special attention to relative efficiency. Our results suggest that the differences in efficiency among hospitals have become larger. In the years 2009–2010, the number of hospitals identified as (close to) efficient by DEA analysis decreased.

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: A qualitative study of Kaiser Permanente

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world’s largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal’s development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal’s ability to ease access to services improves some patients’ satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the ‘stickiness’ of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal’s development - and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs.