Healthcare systems are currently facing intense challenges due to the growing demand for health care, the decreasing of medical demography and the increasing budgetary constraints. Telehealth appears as a major innovation to overcome these challenges through the use of new information and communication technologies. It is defined as a form of cooperation in medical practice by relating at distance, between them or with a patient, one or more healthcare professionals. Telehealth integration within the existing healthcare system is considered in this research as the incorporation of an innovative technological system within an organizational complex system. Thus, our problematic is to provide an effective help to the success of this integration. This underlies three major questions: How to design new processes for the integration of a new technology into an existing organization? How to design the suitable models to share the economic value in order to succeed in this integration? How to define the strategies to be mobilized to deploy this integration? To develop new processes based on the value creation desired by each stakeholder of the telehealth system, we propose the OCSM (Organizational Complex System Modeling) method. We apply it to model and analyze two processes: a process of teleexpertises in dermatology and a process of specialized teleconsultations with an identification of the patient path across different types of healthcare establishments. To develop new business models, we recommend the FFM (Financial Flow Modeling) method. We designed a specific tool to support it, which calculates the balances margins of each stakeholder. We apply this method to model the economic flows between the telehealth system stakeholders. Thus, hypotheses of shared value can be tested. This work identifies a particular example of sustainable economic model for future deployments. To model the behavior of a system in its environment we use the SDM (System Dynamics Modeling) method. We propose a System Dynamics model of our case study of the Picardie region. Different deployment scenarios of processes are simulated and analyzed. Our model can be used again for other French regions. Thus, this work makes recommendations at the national level for the deployment of telehealth systems. We followed an action-research process to solve practical telehealth problems and to address scientific contributions. Three telehealth projects in the regions Ile-de-France, Picardie and Centre fuelled and validated our models thus demonstrating their genericity in the medical community. More generally, this work recommends the simultaneous use of OCSM, FFM and SDM methods to effectively integrate an innovative system in a complex organizational system
How to successfully integrate innovative technological systems within organizational complex systems? : Application on telehealth in France