Development of a communication platform for patients with head and neck cancer for effective information delivery and improvement of doctor–patient relationship: application of treatment journey-based service blueprint

The use of information and communication technology (ICT) helps reduce medical costs, improve health outcomes, and increase patient satisfaction [1‐3]. Information technology (IT) provides value-based healthcare and a seamless patient experience (PE) [4]. Health IT can be used effectively to address problems that may arise during the data collection process and integration with electronic health records (EHRs) or separate IT systems [5]. ICT is changing healthcare methods, targets, and content, such as the type of provision process, patient–provider interactions, and information management [6, 7].

Technology has transformed healthcare systems from hospital-to patient-centric, and the rapid growth of ICT has improved access to healthcare services [8]. In particular, ICT has had a positive impact on patients’ access to healthcare services and authorization, improving quality of life, empowering individuals to adhere to healthier lifestyles, and supporting social participation [9]. Therefore, ICT innovation plays a crucial role in increasing patient satisfaction with accessibility to healthcare services. Information systems and analytics research can also significantly contribute to the development of new and innovative health strategies and solutions [7, 10].

As of 2021, ICT development to treat cancer patients includes over 350,000 mobile health applications (apps) [11], and this field is growing every year [12]. However, despite the rapid growth rate of ICT, most data used for cancer treatment are not systematically organized in electronic systems [4].

Patient medical data are typically difficult to integrate, standardize, and use, as they often remain siloed in healthcare systems. Developing an integrated and innovative digital platform is crucial for enabling efficient healthcare services because lack of data-sharing restricts clinicians’ ability to establish integrated treatment paths, track patient behavior, and support self-management plans [9].

Regarding the digital healthcare platform, Hermes et al. [13], through a systematic review, classified the newly emerging roles of the health industry into six categories: Information platform, Platform for remote & on-demand healthcare, Data collection technology, Market intermediaries, Data management and analysis for healthcare providers, and Investors and consultants. Among these, it was found that most of the digital healthcare platforms, which have recently been on the rise, are focused on remote and on-demand healthcare. The purpose of the communication platform we targeted is effective information delivery and building a positive doctor-patient relationship, which is based on the active interaction between the stakeholders. Thus, the communication platform proposed in our study plays the role of an information platform.

According to the research results of Hermes et al. [13], the market share of information platforms is very low compared to other fields. Considering that seamless interaction between doctor and patient based on information delivery and emotional support is very important to improve the quality of care of HNC patients, the development of an information platform is of great significance. In addition, the digital platform has many functions such as information sharing, remote consulting and self-care app, and patient data management and analysis that must be considered integrated rather than presented independently for successful implementation in an actual healthcare setting.

Meanwhile, Parker et al. [14] and Jacobides et al. [15] mentioned that an advantage of a digital platform is the enhanced ability to promote interaction between communities comprising various stakeholders, including service users and service providers. However, due to the complexity of health information, access by third parties, including patients, is very limited, and this limitation prevents seamless interaction and communication between stakeholders due to knowledge barriers. In addition, due to a mechanism that fails to consider the perspectives of the medical staff who must actually operate the system, the platform developed with great cost and effort is often being ignored by the medical staff. Due to limited patient access to the system or non-application of the user-friendly interface, the platform has the problem of not functioning properly in actual hospital settings. Therefore, the development of an information platform that allows close interaction and seamless information delivery between patients and medical staff is necessary for the balanced development of the emerging digital healthcare industry.

The recent studies on digital platforms to improve communication and interaction between patients and doctors include a mobile app to support patient self-management [16], a real-time decision tool and communication tool development [17], and implementation of a web-based telemonitoring strategy [18]. Thies et al. [16] identified barriers that arise related to the use of mHealth apps to improve clinical outcomes. As points of improvement, they identified that medical staff did not have enough time to check the app, patients did not know how to use it properly, and the app was not integrated with the existing EHR system. Patel et al. [17] developed real-time decision support tool integrated with EHR, communication tool between patients and medical staff, automated audit tool for feedback, and web portal to provide performance trends as interventions for quality improvement for risk management. Through the case study, they identified that, to increase the effectiveness of this intervention, it should be accompanied by activation of all team members and strengthening of IT infrastructure. Dijkstra et al. [18] explored the implementation strategy of web-based telemonitoring for teenagers. They conducted an evaluation based on seven domains to explore the applicability of the telemonitoring strategy they developed to hospital sites. As a result, face-to-face consultation between patients and doctors, simple data collection and management were identified as positive factors. Summarizing the above research results, it can be seen that various formats of digital platforms such as apps, communication tools, and telemonitoring systems are being developed to increase patients' satisfaction and quality of medical services. For their practical implementation, it is critical that simple data collection and management, active user participation, integration and interoperability with existing medical systems, and maintaining face-to-face contact service as important parameters.

In addition to the forementioned cases, the digital platform presented ways to improve communication between patients and medical staff in various forms: face-to-face coaching [19], home-based training program [20], web-based software for communication [21], telemonitoring [22], E-consult [23], Web-based lesson [24], and self-monitoring program [25]. However, most studies focused on telemedicine and often did not consider interoperability with existing EHR systems. In addition, the scope of operation of the platform was mostly limited on the premise of online interaction, making it challengeable to meet the practical needs of patients who prefer face-to-face contact.

Enhancing communication between medical staff and patients is crucial for establishing optimal pain treatment and supporting high-quality pain self-management [26].

Head and neck cancer (HNC) requires a long treatment period and is associated with functional deficits in vocalization, speech, swallowing, and breathing. Older adult patients sometimes have a poor understanding of the disease and treatment process and may be unable to communicate verbally because of tracheostomy or other treatments. Medical staff have limited communication with patients owing to excessive workloads [27]. Effective patient communication is at the core of patient-centered treatment because understanding the treatment and interaction affects the bond between patients and doctors, increases the patient’s willingness to receive treatment, and leads to favorable treatment results [28]. Various stakeholders are involved in the treatment process for HNC, and vast amounts of complex information related to treatment are delivered to patients during the treatment journey. Effective information-oriented communication improves patient experience (PE) with HNC and health outcomes. Regarding the diagnosis system for Nasopharyngeal disease, as a type of HNC, Mohammed et al. [29] reviewed the existing diagnosis system and found that there was a need to explain the critical evidence of the existing systems, expand the required information in NPC diagnosis, and develop an interoperable diagnosis system. Kouroubali et al. [9] emphasized the necessity of seamless information sharing among all stakeholders in developing an integrated healthcare delivery platform for older patients. Considering that most patients with HNC are older adults, the development of an integrated healthcare platform is crucial. Such a platform should reflect the perspectives of both service users and providers, allowing efficient information sharing among stakeholders and comprehensive management of the data related to emotions or behavior. Communication should be enhanced by presenting a platform in which both perspectives contribute to seamless integration. Service blueprints (SBs) are often used as an effective methodology to support stakeholder collaboration. They map service processes and interactions between stakeholders from the user’s perspective [30‐35] by visualizing a service system. This is beneficial for educating service users, evaluating service systems from various perspectives, and establishing specific response strategies for new service concepts or systems [36, 37]. The format helps service providers understand tasks and responsibilities and make effective decisions [35, 38, 39].

In the field of healthcare, there is a growing trend toward utilizing SBs to understand the service delivery process [40]. Healthcare is a complex domain with a large amount of medical information delivered to patients and requires seamless communication between patients and medical staff. This necessitates structural visualization of the quality and quantity of information provided to patients and the interaction between medical staff and patients. Visualizing the service delivery process can enhance stakeholder understanding and contribute to increased implementation effectiveness in the field.

This study aims to 1) develop an innovative user-centered communication platform that focuses on effective information delivery and improvement of the doctor–patient relationship aligned with the patients’ treatment journey with HNC, and 2) present a tangible mechanism through an SB on how the proposed platform can be applied to the current service system to improve HNC treatment.

The proposed platform utilizes SB to visually explain the service delivery process considering its implementation in the field and interoperability with current systems. Patient-centered communication platforms can increase patients’ willingness to receive treatment, improve treatment adherence, and induce positive treatment results by efficiently allocating doctors’ time and resources.

According to Bitner et al. [41], the use of SBs is a customer-centric approach to service innovation and improvement. They effectively visualize service processes, points of customer contact, and physical evidence related to services from the customer’s perspective to reveal potential points of improvement. As the global need for service innovation increases, developing and applying innovative tools and techniques to enhance customer experience in healthcare has become crucial. In a complex healthcare environment, improving PE requires not only the enhancement of the entire medical service process but also the refinement of individual stages.

Improving service processes requires a comprehensive understanding of all functional and psychological elements patients experience throughout their service journey. Key components included in building an SB are customer actions, on-stage (visible) contact employee actions, back-stage (invisible) contact employee actions, support processes, and physical evidence.

This study built an SB based on these five components to visually represent the service processes and systems of the proposed communication platform. The existing HNC treatment service processes and systems requiring service improvement before the introduction of the proposed platform were identified through the “As-is” SB, highlighting the service FPs. The improved service process including the proposed platform and operability with current systems were visualized using the “To-be” SB.

The study was conducted in three phases: 1) requirement elicitation, 2) HNC communication platform development, and 3) visualization of the improved HNC treatment process/system using the proposed platform (Fig. 1).

For the requirement elicitation phase (phase 1), the needs of patients and medical staff were identified, and the current HNC treatment process and EHR system were reviewed. Based on the identified needs and review, an As-is SB was created.

In Phase 2, the core needs for service improvement were derived from the service FPs. Then, a co-creation workshop was conducted with an interdisciplinary team to develop solutions corresponding to the core needs, and two focus group meetings were conducted with the HNC medical staff to evaluate the feasibility of the solutions. Finally, the four proposed solutions were integrated into an HNC communication platform.

In Phase 3, to specify and practice the mechanism such that the proposed platform could interoperate with the current hospital service system, the system architecture was created based on an adjusted model Donabedian framework of Structure-Process-Outcome (SPO) [42]. By integrating the proposed architecture and the As-is SB, the To-be SB presented how the current hospital service system could interoperate with the proposed platform and how the service FPs of the current service delivery process could be improved through the developed solutions.

In the Discussion section, we address which challenges should be solved for the suggested service system to operate seamlessly in an actual HNC treatment setting.