Cura

2012
Tallinn University of Technology

2
The paper has been written independently and all
sources of information have been referenced
student’s code: 111650
student’s e-mail: janno.nou@eesti.ee
student’s e-mail: urho@printon.ee
student’s e-mail: birgitaavik@live.com
student’s e-mail: kim.kisenja@gmail.com
student’s e-mail: taneltammjarv@gmail.com

3
PITCH ........................................................................................... 4
INTRODUCTION ............................................................................. 4
Market and Industry .................................................................... 5
1.1 Industry and market description ........................................... 5
1.2 Key competitor’s strategy ................................................... 7
1.3 Hocoma Business Model ....................................................... 9
HIGH GROWTH IDEA ...................................................................... 12
2.1 Cura Business Model ............................................................. 12
2.2 Product description .............................................................. 17
2.2.1 Technical working .............................................................. 18
2.3 Execution Strategy ............................................................... 20
2.3.1 Future ideas ....................................................................... 23
CONCLUSION ................................................................................ 23
SOURCES CITED ........................................................................... 24
APPENDIXES ................................................................................ 26
Janno Nõu
Mechanics
Birgit Aavik
Business
Kim Kišenja
Business
Tanel Tammjärv
Business
Urho Orasmäe
IT

4
PITCH
The main idea of Cura is to give reassurance to
the patient that one is being looked after,
knowledge what to do when the patient is
exercising, motivation to exercise and all that in
home enviroment - we achieve it with the sensors
that will be placed on the body.
Our solution consists three different parts:
Sensors: fixed to the right place of the body with
patches during the first visit to the doctor.
Therapy bracelet: gives information to the patient.
Application (in tablet or smart phone):
communicates with sensors and bracelet,
processes the information, shows the right
movements and sends processed data via Internet
from where doctor can see the patient’s
exercising results online.
The communication between these devices is
done by Bluetooth v4. Every device has its specific
role. Sensors gather information, bracelet warns
patient if the exercise is done incorrectly and
shows the number of exercises left. The applica-
tion analyzes the data that gives feedback to the
patient and provides doctor with updated
information via Internet.
Cura binds together existing technology and
provides a whole new concept of values. Cura’s
customer segment will be health-care institutions
and the end-users will be patients who need to do
rehabilitative exercises. The clients who use Cura
will experience the ability to take more patients,
make the rehabilitation process more efficient, get
data and feedback more easily and quicker from
the patients.
Cura’s technological platform remains open for
further developments. For example, the idea is to
release additional solution for athletes with 3D
mapping, technique analyzing feature and other.
Cura’s technological platform remains open for
further developments. The strategic goal is to
develop different products for different clients
segments. For example professional sports, where
coaches and doctors can better measure indica-
tors of a sportsman like speed and power. It allows
coaches to improve the technique and get better
performance of sportsmen.
INTRODUCTION
One of the most dynamic industries in our
society is health-care technology. Health-care is
fast growing, impacting our very well being, while
technology is the engine fueling both societal and
economic change. Pediatric physician at Boston
Medical Center who has been involved with
several health care startups has said “The more
the technology is integrated into the workflow
that a doctor is used to, the more likely it’s going
to be accepted:“
This work has been done by team of five students
from Tallinn University of Technology for
„strategic management” course and in addition to
participate in a business model contest „Mektory”.
There are two objectives. Firstly, to give an over-
view of the health-care field and to take a look
inside to our main competitors’ business model
and strategy. Secondly, to introduce our business
idea through building up a business model and
strategy.
This work is divided into two sections. The first
part describes market and industry and the sec-
ond part focuses on authors high growth idea.
Business Models are described through Alexander
Osterwalder’s and Yves Pigneur’s „The 9 Building
Blocks” and Cura’s strategy is built up with
assistance of InnoTools.

5
The first part is divided into three chapters where
in the first chapter authors give a brief overview
of the health-care industry, in last two chapters
there are used different theories to describe one
of the competitor’s strategy and to analyze
competitor’s business model.
The aim of the second part is to introduce Cura’s
business model, and execution strategy. Theories
are used to give academical proof to author’s
statements on business model and company’s
strategy. This part also contains descriptions and
pictures of the author’s innovative idea.
For better understanding, authors have used
academical articles and presentations. In addition,
there were interviews with experts like The North
Estonian Medical Centre’s chief doctor Sergei
Nazarenko, the board member of SportMed
Foundation Mihkel Mardna, and others like the CEO
of the GSM Valve Hans Alter. The authors also in-
terviewed patients from different age groups with
various injuries.
“The more the technology is
integrated into the workflow
that a doctor is used to, the
more likely it’s going to be
accepted“
MARKET AND INDUSTRY
1.1. Industry and market description
Americans spend approximately $7,600 a year
per person on health-care and avarage wait time
to see a doctor is 20 days. The entire system is
starting to change thanks to health-care
technology companies. “We are about to see a
fundamental transformation in the way care is
delivered and the way patients are engaged with
that care,” said Frank Moss, head of the New
Media Medicine Group at the M.I.T. Media Lab.
Entrepreneurs are evolving model of health-care
which is more focused on outcome than just a
service (Zimmerman 2012).
Health-care startup numbers are increasing and
they are trying to provide better coordination of
care. The main thing is to offer value by
technology. According to article „A Framework to
Manage the Early Value Proposition of
Emerging Health-Care Technologies” it has to be
proven that the new product is better than the
existing one in terms of value (Shirley 2011). Value
is the main starting point for thinking on
innovation and it leads to more integrated
solutions.
The two most dynamic industries in the world are
health-care and technology. It is necessary to
provide people with the right information at the
right time. People may think that something as
simple as smart phone is just a device but in
health care, it is a gateway product. They allow
you to find the information what, when or where
ever you need it (Reiss 2012). It makes life easier
and more enjoyable to coordinate everything from
one product.
Even those companies which are not technological
companies, like health-care, have included social
networking or mobile technology into their busi-
ness models (Debaise 2011). Everything is moving

6
towards integration and therefore products are
easy to use and may implement different
functions.
Health-care industry using IT is inevitable. The
unique combination of health-care and IT may be
realized in a different manner in the health care
industry than in other industries because it could
be employed to improve the productivity benefits
of IT. It is difficult to improve patient care, reduce
the cost of care or ensure patient privacy but IT
helps better to seek those goals (Timur 2012).
In health care technology, complicated web of
payment and reimbursement have removed the
„build it and they will come“ strategy, because it
is no longer effective. Innovation has shifted from
a push model to pull model. Startups need more
than just a good idea to secure capital growth.
It has to be known who your customer is. The
customer mix varies for each company (Kurtzman
2012). Customer segment depends on what
product or service company is providing.
Regulations in this industry are often complicated
for participators. Health care sector is the second
most regulated sector after the nuclear power
industry. For example, in 2010, Samer Hamadeh,
who founded Zeel, which offers booking with
alternative medicine practitioners, like chiroprac-
tors and acupuncturists, had to comply with
HIPAA (Health Insurance Portability and Account-
ability Act) privacy rules. It means he had to make
booking appointments secure by providing only
first names and last initials. There was also one
other problem. He wanted to add small fee for
doctors who were referring the service for
patients, but it can be considered as fee-splitting.
The founder and CEO of Private Health
Management, which offers treatment plans
tailored to patient needs, considers it a weird
dynamic because technology is changing
rapidly but everything else is stuck thirty years
ago (Moukheiber 2012).
On the other hand, governments value health-care
companies and support entrepreneurs in this
sector. For example, health-care is a golden sector
for the UK. Governments may want that health-
care sector would be more transparent and more
convenient to orient but rewriting legislation may
take some time.
However, it can be more difficult to smaller
companies. Joanne Rohde, founder of health-care
startup pointed out that government policies
make it hard for smaller companies to cope at the
market. Laws are written from the perspective of
a big company (Brussel 2012). That may be the
reason why bigger companies can benefit from the
smaller ones. Smaller companies help bigger ones
to cope.
Venture capitalists believe there are two promis-
ing areas. Companies that serve consumers di-
rectly and those that help hospitals provide better
quality and cheaper services.
Bigger companies want that smaller ones to do
great, hoping to benefit from their ideas.
Bigger companies often buy ambitious startups
and when the founder leaves, one starts some-
thing new. In health-care case, there may be
hospitals, pharmaceutical companies or other
health-care conglomerates. It can be explained
using capability lifecycle from resource based
view theory as health care is one of the most
dynamic industry in the world. This theory deals
with resources and capabilities over time. There is
founding, development and maturity stage. (Helfat
2003) Therefore, mostly in the founding stage,
resources and capabilities are influenced by other
companies or investors.
According to the Wall Street Journal, second
annual ranking of 50 companies in which venture
capitalists have invested, shows for the second
straight year health-care companies are on the
top of the list (Debaise 2011). Although, the third
ranking is the first time when health care company
did not top the ranking (Zoran 2012).
Health-care angel investor, Joanne Chang pointed
out that grammatical or logic mistakes are
investment deal breakers. Also startups which

7
is 3,53 in a scale of 1-5 (5 being very high
confident). It is said that 6-18 month outlook for
raising funds is pessimistic, but long-term outlook
for health care companies is promising (Baum
2012). Although this long-term time may not be
acceptable to investors or other partners
because of the liquidity despite the opportuni-
ties by changing the structure in the health care
industry. Lisa Suennen, who is managing member
in health care investment firm have said that the
firms that survive this special period (4-5 years)
have advantageous situation. (Baum 2012)
Now, general adoption of health is slow, but soon,
much of this will truly matter. Also ROI will be
more apparent (Kurtzman 2012). Health care is
going to be all about information in the future.
CEO of WebMD said that it’s about being able to
use information to change lives. It’s becoming
more of a dialog between a health care provider
and a patient. (Reiss 2012)
There are many health care start-ups but this field
is difficult to manage, both investments and
regulations. It is a popular industry but only the
best ones will survive. Also, it takes some time for
people to value the outcome of those companies
and their possibilities which can provide better
health care system.
“We are about to see a
fundamental transformation in
the way care is delivered and
the way patients are engaged
with that care”
1.2. Key Competitor’s strategy
Company introduction
In this field every company deals with some
particular customer segment. Nevertheless there
is a company that is operating in relatively same
area and it offers neurological rehabilitation
machinery. The name of the company is Hocoma.
It has a Headquarter in Switzerland and two
subsidiaries in Singapore and in the USA. The
company has 120 employees and the require-
ments for them are very high. The CEO of
Hocoma AG is Gery Colombo and Hocoma
generated a turnover of more than 26 million CHF
(21,5 million euros) in 2010.
Company’s strategy description
Hocoma operates internationally. The company
sold products to 31 countries in 2008 (Colombo
2008). With so small personnel it is hard to work
in so many countries so the firm has to choose
network strategy. On the one hand, working
through networks reduces the costs but on the
other hand it might be risky. Researches show
that firms usually fail half the alliances they form
(Kale et al 2007). There might be some parallels
with network management and formation. Existing
comparisons show that companies have to take
into account the need and strategies of other
actors and no company is capable acting in line
with its strategic intentions (Munksgaard et al
2012). The joint product development networks
can be seen as borderless, adaptive, self –
organizing systems that no single firm can direct
or control (Ibid). Even if the network is established
it is still difficult to extract one’s strategic goals
from it. In Hocoma’s case it is the only opportu-
nity because usually SME’s does not have enough
financial resources and manpower (Pullen et al
2012).
have been trying to unsuccessfully raise money
for years or there have not been any substantive
operations (Chang 2012).
In the field of health care, before it improves, it
is getting even more difficult. The Silicon Valley
Capitalist Confidence Index measured for the Q3

8
The company has brought out two university hos-
pitals as their partners- and these two can be also
seen as the lead users, because they are using
the technology and at the same time they help to
develop the products. Universities are Hocoma’s
partners in product development too. Hocoma re-
lies strongly on four universities by developing the
company’s products with them. Every university is
internationally recognized and the combination of
Zurich University, University of Twente and
University of California Irvine makes good innova-
tive platform (Product Development). In the com-
parison with theory the universities that Hocoma
is working with are adding value to the company.
In some theoretical articles the universities were
seen as passive wait-and-see actors. However in
this case it does not seem so.
Technology labs are also one of the key
developers in Hocoma’s case. As it was mentioned
before the researches show that it is hard to build
up partnerships and network even though Hocoma
has managed to do it effectively in product
development. The products are quite expensive
for individual users. For example robotic walker
Lokomat costs $250 000 but some of the new
developments are aiming towards individual pa-
tient, too (Langreth 2005).
Also, the company has chosen not to distribute
themselves but to use partners. The company
has qualified sales partners in 35 countries (Sales
Partners) into account the smallness of Hocoma it
is crucial for the company to have inter-
mediaries to distribute their products. Even if Ho-
coma’s approach to sales is cheaper it might have
some disadvantages in theory. The use of interme-
diaries can lead to resistance toward adoption of
new products and therefore inter-
mediaries can negatively affect the commercial
success (Aarikka-Stenroos et al 2012).
Hocoma has solved this problem by building up
sales system that even if the product is bought
from intermediaries the company sends its tech-
nicians to install the product and to educate the
clients (Colombo 2008). By this mean Hocoma
stays in touch with clients and intermediaries have
only the representative role.
In theory, the R&D network there could be
distributors, buyers, consultants, suppliers,
research institutes, universities, government agen-
cies, industry associations and even
competitors (Aarikka-Stenroos et al 2012). Good
product development needs fairness trust,
reliability trust and network position strength
(Pullen et al 2012). In Hocoma’s case partners can
be divided mainly in two categories: sales-partners
and R&D partners.
Three main types of development partners can be
distinguished:
• Rehabilitation centers and hospitals - Hocoma
stays in touch with its clients who use its
products. Users are mainly divided into lead
users, mavens, expert opinion leaders and hub
persons (Aarikka-Stenroos, Sandberg 2012).
The users can contribute by demonstrating
the use of products and may act as references
(Ibid). Lead-users can also be connected with
other innovative users in network and they
can shape the product to be more after their
needs (Harrisson, Waluzewski 2007)
• Universities - Public organizations and
educational institutions may support diffusion
by articulating optimistic visions of the use of
the innovation. Due to a lack of power they
often take a wait-and-see stance. (Aarikka-
Stenroos et al 2012)
• Technology Labs
Hocoma stays in touch with its clients by
offering them full support. It means that the
company achieves two goals by this action. They
get feedback from users and at the same time
by offering full support the company gets good
reference. In Hocomas case it is hard to distin-
guish whether the company has lead-users or not
because Hocoma works close with every client.

9
In conclusion Hocoma has a very clear strategy
and it has proven its use. The company has a
niche product and they are developing products
even further. Also, the company stays in touch
with its clients and solves the client’s problem
with their products. It is hard for other companies
to enter this niche because Hocoma has a very
strong position in it. Although Hocoma is
operating internationally it has managed to stay
small and innovative. The product development
and sales are done with partners. It is cheaper to
work with partners because the company gets
more information and resources than it could get
on its own. Hocoma has managed to build inter-
national sales and product development networks
and it makes the company more competitive in
international markets.
1.3. Hocoma Business Model
In this chapter Cura’s competitor Hocoma’s busi-
ness is analyzed through Alexander Osterwalder
and Yves Pigneur 9 blocks. The authors chose
Hocoma because they are the leaders in robotic
rehabilitation therapy for neurological movement
disorders. They develop innovative therapy
solutions working closely with leading clinics and
research centers focusing on rehabilitation.
Table 1. Hocoma’s Business Model
Source: Made by authors

10
To be successful in health care field it is vital to
focus on a certain customer segment. Hocoma’s
success in their business is lying mostly on their
clear segment, which are end-users, who have to
visit physiotherapist to get medical aid. They are
focused on people who have neurological disorder,
whether it is stroke, multiple sclerosis, spinal cord
injury or other difficult disorders. It is their goal
to improve therapy for these kinds of patients
(Patients). Another customer segment is health
care institutions that buy their products and then
offer supporting services and also rent these
products to their patients. Clients are also working
closely with co-operation partners to ensure the
safety of their products (Philosophy).
Health care is high profit area and clients are
willing to pay good money for quality products
and services to ensure their patients well-being.
Hocoma product’s value offer is combined with
many different aspects through which customer
receive full satisfaction from the product and
services provided. Hocoma handles all the activi-
ties to make sure that the product is delivered and
integrated successfully without making customers
any problems. The purchased product delivery is
arranged by Hocoma and it comes with special
training instructor who trains the client’s staff to
use the product. The people that got the training
certificate are able to use the product and to train
other staff members when necessary. Secondly,
the products are very convenient to use. All of
them are fully automated. Hocoma products have
also self-directed functions- it means that patient
can do the exercises on their own so the role of
doctor or a nurse is just to supervise the training
(Hocoma Homepage).
Hocoma is using direct marketing; they get direct
contact with potential customers like hospitals.
This is the most efficient way to market their
products because Hocoma’s products are very
specific and they have to make clients realize that
these products are needed for more effective
rehabilitation service. Another way Hocoma is
reaching its clients through different kind of
fairs they get involved. They have received many
awards and it makes their products more desirable
and trustable for potential customers (Awards.)
Given statement is endorsed by the theory which
indicates that organizational achievements, R&D
and business relations, and reputational knowl-
edge helps company to build up new relationships
with potential customers and partners (Aarikka-
Stenroos et al). If the client is purchasing ones
product they receive well developed costumer
support as well. The product must be strictly
used according to the recommendations therefore
Hocoma offers counseling services to partners
and to patients who can get direct contact with
them or with their sales partners nearby.
They aim for long-term relationships and close co-
operation is to avoid any errors through explaining
how some specific equipment works and how it
should be used. They also use L-Mobile applica-
tion which helps customers to get immediate help
to their problems and because of that they have
sales partners in 35 countries, time-zone is not an
issue (Sales partners).
If one of its sales partner is not available in cer-
tain country, then customer has the opportunity
to contact directly with Hocoma’s headquarter
(Sales Partners). For example if customer have
some problems with one of the Hocoma’s product
in Estonia, they firstly should get contact with
the partner in Finland. If they cannot get contact
or do not find solution to the problem then they
should get contact with Hocoma’s headquarter.
Because of the products specifications the after
sale service is probably needed time to time. It is
unknown whether the after sale service is included
in selling price or not. If assuming that the after
sale service is not included in the selling price,
then the company gets revenues from sells and
after sale service. Despite the fact that after sale
service is needed the company probably receives
most revenues from selling its products.
Based on the fact that Hocoma’s aim is to develop
and produce innovative products for rehabilitation
we can assume that company’s revenue strongly
rely on their employees because innovation in their

11
products can only be achieved by their over 120
employees that that are working at the Zurich’s
headquarter and manufacturing facility, and in
subsidiaries in the United States and in Singapore.
Relying on the company’s vacancies they are only
looking for employees who are highly educated,
experienced and motivated. The fact that Hocoma
has succeeded shows that their employees are
doing well on company’s daily activities which are
consulting and working with R&D and with sales
partners for example the Biorobotics Laboratory
at U.C. Irvine which has skills and knowledge to de-
velop robotic and mechatronic devices,
developing and manufacturing process, logistics
and after sales support. All these activities can-
not be done without reliable partners in different
areas.
The theory suggests that when the quality of a
service is harder to evaluate, this service is more
likely to be supplied by partnerships (Levin 2002).
For example because of their focus on developing
and manufacturing products they probably out-
source logistics service because it is not economi-
cally reasonable to own trucks for just
delivering their products and because of the
measures delivering products can be complicated
therefore logistics knowledge from experts is
viable. Secondly, only with their 18 partners in
R&D it is possible to develop and produce innova-
tive products because of the partner’s contribu-
tion in projects on different fields like robotics,
specialized and leading clinics, hospitals and
research centers like Sensory-Motor Systems Lab
(SMS Lab). These partners provide Hocoma with
the best knowledge and skills.
Hocoma’s products are on sale all over the world,
they have partners who sell rehabilitation equip-
ment and provide rehabilitation services accord-
ing to patient’s needs. Looking the selection of
those 35 countries, they have gained the effect
that every continent is widely covered with their
distributors.
Unfortunately the company is very conservative
and it is hard to find any documentation on the
company’s costs. Nevertheless few most impor-
tant factors can be mentioned:
• R&D- Company produces high tech products
and has 18 partners in product development.
Therefore it can be assumed that this factor
might be one of the most significant costs.
• Logistics- Company claims that it has very
complicated and expensive logistics. (Colombo
2008)
• Personnel- Nevertheless the company has only
120 employees, they are all high professionals
and need to be well paid.
Hocoma’s business model shows that they have
well-planned every aspect and covering company’s
the four main areas of a business: customers,
offer, infrastructure, and financial viability. They
have clearly focused customers segment and
many awards helps to claim new customers and
partners, and are a proof that their products are
valuable. Their sales partners in 35 countries pro-
vides company the opportunity to sell products all
over the world and L-mobile service helps
customers to get immediate help to their prob-
lems even if they dont have partner in ones
country. For such innovative company like Hocoma
their major are R&D, logistics and personnel but
for financial viability and the fact that they have
been successful selling products along with these
sales partner covers the cost and with normal
margin.

12
HIGH GROWTH IDEA
2.1 Cura Business Model
In this section we describe Cura’s business
model through Alexander Osterwalder’s and Yves
Pigneur’s „The 9 Building Blocks” parallelly using
different theories. This Business Model helps to
get organizations work. It describes how an
organization creates, delivers and captures value.
These 9 blocks are described in the following
paragraphs.
Table 2. Cura’s Business Model

13
Value proposition
Cura defines its clients to be organizations that
are dealing with rehabilitation. The company offers
its clients convenience and additional value by
allowing the patients to do rehabilitation exercises
at home. Patient’s activity can be viewed online
and the most of the rehabilitation process can
be done on distance that makes the process less
annoying for patients. They can spare on their
transportation cost and time.
Cura’s gadgets give precise information about the
patient’s workout progress and provide the data
and patients review about their situation via In-
ternet to the doctor. The patients need feedback
when doing exercises because they fear to do
something wrong (Appendixes Patient 1- Patient
8). The doctor and therapist can view how the
patient is doing any time they want because the
data is available online. Easy feedback and data
transfer allows doctors and therapists to analyze
the effectiveness of the trainings. At the moment
the feedback data is poor because of the many
patients and lack of time to give it (Saulus 2012).
Additional value for clients is created through the
flexibility of the system - the system allows to
program different exercises for different patient
who need supervised rehabilitative training (Naza-
renko 2012). Therefore gadgets can increase the
amount of patients the rehabilitation centre can
receive because it cuts down the time spent on
patients by the doctor. According to interviewed
patients given exercises are not difficult and it is
possible to do them at home (Appendixies Patient
1 to Patient 8). Furthermore the rehabilitation
process can be more effective when using Cura’s
developments (Mardna 2012). The patients’
opinion is that they would definitely complete all
the exercises if they knew that doctor can view
their progress via internet (Ibid).
Quoting S. Nazarenko: “The rehabilitation process
needs a lot of vis–a–vis contact but with this
product it is possible to reduce the number of
necessary visits”. The average statistical dura-
Customer segment
Curas’ customer segment is clearly defined for
health care institutions but the end users are
people who are required to visit physiotherapist.
According to Marge Saulus from AS Medicum there
are more younger and middle-aged patients than
older ones.
However, in the long-term, the customer segment
and the whole platform, has to be let open,
because according to our evaluation and inter-
views with different professionals, authors believe
that with this concept it is easy to link different
solution possibilities that can be applied.
According to the theory, segmentation is grouping
customers with similar needs and buying behavior
into segments thereby facilitating each segment
being targeted by a distinct product and
marketing offerings to be developed to suit the
requirements of different customer segments.
Segmenting customers helps a company to
improve customer’s satisfaction, customer loyalty
and customer retention (Epetimehin 2011).
In the future, Cura can offer its value to different
segments through improving today’s short-
comings and requirements of different segmenta-
tion. As it was mentioned before, Curas platform
remains open and in addition to rehabilitation solu-
tion there can be many different segmentation of
this product, for example sports. Future plans are
discussed in the chapter “Curas’ strategy”.
“The rehabilitation process
needs a lot of vis–a–vis
contact but with this product it
is possible to reduce the
number of necessary visits”

14
tion of the cure process is about 15 days. Based
on this information one Cura makes available 72
additional appointmens to new potential patients
(see Appendix 1).
The cost of the one set of gadgets can be around
200-300€ which makes it relatively cheap for a
product in health care business.
Company also provides its client full after sales
support. The client does not have to worry about
the technical issues with the gadgets or repla-
cing used patches with the new ones. Everything
related with the technical issues are solved by
company’s helpdesk and support team.
Channels
At least at the beginning, Cura reaches its clients
mostly through direct marketing. In addition to,
both, end-users and health care institutions can
get information from different journals where the
product is exposed and acquaint with product’s
effectiveness, innovativeness and convenience at
different fairs.
Another way of marketing is word-of-mouth which
means that patients who use Cura are impressed
and recommends it to their friends who are in
need of rehabilitation. Mihkel Mardna’s and Aivo
Normak’s commentaries might be good reference
for further sales of the product.
More value to the product gives customer sup-
port. Sales and technical agents provide
customers with full support 24/7. Along with the
product comes lessons and manual how to use
Cura. After purchasing product all maintenance
activities are provided by Cura’s support team.
Customer relationships
Authors want customers to cooperate with them
and take their opinion into account to provide
better product and service.
Cura is a product, which comes together with
services. Cura uses many ways to gain and keep
good customer relationships. For a client it is very
important that there is always somebody to help
them when problems occur.
As in one research paper is said that customer
satisfaction is considered a prerequisite of cus-
tomer retention and loyalty, and can help to boost
profitability, market share and return on invest-
ment, we believe it too (Sureshchandar et al
2002) Therefore, for customer satisfaction, Cura
has 24/7 telephone helpdesk in every market they
are active. Another solution that boosts patient’s
satisfaction is getting fast feedback from the doc-
tor via mobile application that allows to exchange
data between doctor and patients in a short time.
It also gives doctor the opportunity to constantly
evaluate and give feedback to patient progress.
For patients there are also reviews in online forum
from other people who may have same injuries, so
they can share their information and experience
with each other.
For health care institutions, customer relationship
is maintained by supporting also everything that
they are in need related to this device. For exam-
ple if patches need to be replaced or if technical
problem occur. Cura keeps constant contact with
customers to make sure that everybody are com-
fortable using this product.

15
Revenue
Cura gets its revenues from renting its product
kit. The company provides a technical service to
its clients by fixing bracelets, tablets (or smart
phone) and replacing patches. Patches provided
by Cura, are in personal use which are changed
monthly or according to the needs. Also, a minor
per cent of the revenues comes from the online
forum where different banners are displayed. The
banners are located in the tablet (smart phone)
under the topic “Advertisements for you”. By this
mean people watch advertisement if they want.
The best tablet performance duration is about 1,5
years and after that tablets should be replaced
with new ones. Depending on their amortization
they will be sold or donated.
Key resources
According to the resource-based view theory a
firm resources are strengths that firms can use
to conceive of and implement their strategies. For
purposes of this subject, these firm resources can
be conveniently classified into three categories
which are pointed out in the following paragraphs:
(Barney)
• Physical capital resource - Cura is developed
and produced in Estonia, its headquarter and
manufacturing facilities are in Tallinn which is
ashore of the Baltic sea that provides the
opportunity to export goods out of the Euro-
pean Union. Also well built distribution network
in Finland, Sweden, Norway, Denmark and in
the United States because exporting and sell-
ing its solution in those markets is making the
most of the income. For quality, Cura uses the
newest high technological equipment to make
sure the product is at its best quality and
meet for example International Organization
for Standardization (ISO) standards.
• Human capital resource – this is Cura’s main
resource because success in developing and
manufacturing new products depends on high-
ly qualified and experienced employees. Cura
has undergraduates from Tallinn Universtity of
Technology in logistics, information technol-
ogy, finance, engineering, governance and
employees who are currently studying mas-
ter’s degree in economics. Employees receive
constantly trainings and they are provided
with opportunities to take part in different
medical fairs to generate new ideas for further
development.
• Organizational capital resource – Cura, as an
organization, is well structured. Each depart-
ment has their responsibilities and work tasks
but departments are linked with each other
through manufacturing process and controlled
by production manager. In addition to man-
agement structure in company, Cura provides
employees with different sporting activities,
collective trips and for employees well-being
company offers free beverage and snacks.
Some of the tablet which are not sold are
donated to the orphanages and to children’s
hospitals.
Cura’s resources meet its requirements to
successfully implement Cura as a product. All
three: physical, human and organizational
resources are well-planned and can cover initial
need of the company. Furthermore author’s are
doing a research about patent possibilities for this
solution. Hans Alter, who is the CEO of GSM Valve
(see Appendix 4) said that if there is no way for
patent possibilities, then it is more difficult, be-
cause you got less time and you have no protec-
tion from bigger companies. After the discussion
he added that, if you want to sell the idea to big
companies instead, then it does not matter.

16
Key activities
Every company which is active in their business
has to perform certain activities that they are
performing, like developing, producing and man-
aging service. Cura devices needs different kind
of activities which are outlined in the following
paragraphs:
• Managing information flow – information flow
and integration between patches, bracelet,
mobile application and server is vital for user
satisfaction. This requires mobile applications
working on Windows Phone, iOS, Android plat-
forms, and electronic information center where
all the information is gathered and is possible
to see for both parties online.
• To get customers full satisfaction, Cura offers
24 hour a day client support and in any prob-
lems Cura’s service department are ready to
help.
• Because Cura’s targeted market is mostly
outside of Estonia it is important to manage
and develop distribution centers and logistics
department.
• Another activity for Cura is product develop-
ment and manufacturing. Product develop-
ment and manufacturing includes product
researching, designing, manufacturing.
To sum up, Cura’s key activities are product and
customer oriented. Each activity is well organized
and works toward certain purposes.
Key partners, Partnership
Key partnerships describe specific company part-
ners that make the business model work. Mostly,
companies create alliances to reduce risk and
acquire resources, which are designed to optimize
the allocation of resources and activities.
According to the needs Cura have developed sup-
pliers network and partners to offer high quality
rehabilitation solution. For manufacturing process
Cura has direct links with premier manufacturer
and innovator of hook and loop fasteners Velcro,
in order to provide them with different straps
which are used in bracelets. Another partner Texas
Instruments provides Cura with Bluetooth low
energy chip that is used in bracelet to gather and
send information to the information center. Vibra-
tion alarm systems are provided by leading vibra-
tion motors supplier Precision Micro drives and dif-
ferent colors on LED light are displayed with E-Ink
electronic paper. For research and development
Cura has partnered with many medical institution
and rehabilitation centers like Fertilitas, East-
Tallinn Central Hospital, Tartu University Hospital
and Foundation of Sport Medicine. Cooperating
with different institutions gives Cura an opportuni-
ty to get help from experts whose knowledge and
experiences needed to improve Cura and develop
new solutions. In further development focusing on
athletes technical issues main partners are physi-
cal therapists and sports institutions.
For example Aivo Normak, who is the former
Athletic Association head coach and now working
at Sport Medicine Foundation as a development
officer said if this platform also allows to analyze
sporting techniques, then they would like to offer
their partnership.

17
Cost
There are plenty of costs and expenses which
have a big impact on company’s welfare. Cura’s
main costs are divided in the following paragraphs:
1) Research and development - expenses consist
costs for research and development of new and
existing products and services
2) Sales and Marketing - expenses in customer
service, sales, and sales support functions, as well
as promotional expenditures for example participa-
tion at fairs.
3) General and Administrative expenses consist
primarily costs related for personnel and facilities,
and include costs related to our facilities including
production equipment, human resources, informa-
tion technology.
These are the main costs may vary in time by they
are presented in every phase of the company’s
development. There may also be some consider-
able initial costs.
2.2 Product description
Product
Our solution is to imitate some aspects of the
therapist to give patient reassurance that he is
being looked after, knowledge what to do when
he is exercising, motivation to do the exercises
consistently and all of that in home environment.
We achieve it with sensors that are placed on the
body.
All information about technical issues can be seen
in Appendixes 17-20
There are three devices that are needed: bracelet,
tablet and plasters with sensor
Sensors can’t do anything reasonable by them-
selves - they need some interpretation. Our solu-
tion consists of three different parts. Firstly, as
mentioned there are sensors, secondly there is
a device that is with you all the time (even when
you are sleeping) to monitor your physical activ-
ity and warn you when needed. Thirdly there is a
device that will assist you when you are working
out (tablet or smartphone) - it has more specific
capabilities to help you along the way.
It has been researched by Design & Engineering
student Janno Nõu which would be better, wheth-
er a patches or straps/pants. Authors decided to
go with the plaster concept, mainly so because of
the benefits when wearing it and the fact that it is
less demanding for the patient
Sensors are placed and held on the body with a
kind of plaster. This is done by a doctor to ensure
correct placement of the sensors. The doctor will
set up the devices and teach patient to use them.
Plasters are thereafter changed every few weeks
during visits to the doctor. Sensors and bracelet
are replaced with new ones that have charged
battery. Data stored in the bracelet is transferred
over Bluetooth to tablet/smartphone that pro-
cesses it and then sends the processed data over
mobile network to the doctor. Doctor receives
information about patients’ activity between the
visits, wrong movements made by patients and
monitored limb’s movement amplitude and can
give suggestions and new workouts directly face
to face or, when needed, send information directly
to the tablet/smartphone.
Usability
• Patches
Patient is wearing patches all the time; these are
applied and changed during medical visit that hap-
pens roughly once every month. The patches are
invisible under clothes, they withstand showering
but bathing and swimming is not allowed during
recovery period (this will exclude water therapy as
recovery method). Patches are made from fabric

18
that lets skin breathe and makes the patch more
durable. When a patch has been applied on skin
for a month it could be stuck quite toughly so
solvent can be applied to remove it.
• Bracelet & Tablet
Usability milestones of bracelet:
*uniformly understandable display data
*easily manipulative grasp of the bracelet, so it
is easy to put it on and take it off *antibacterial
material
*good contrast of display colors
*is applicable with one hand
Benefits of bracelet:
*black-white and two warning colors
*uses 3 different possibilities of alarm: visual,
sound and vibration - they all work simultaneously
and complement each other to give clear under-
standing of the situation
*it has also low battery indicator (emergency only,
normally battery is replaced in hospital)
*easy to put on and take off because of mate-
rial of the strap and system of the clasp what is
broaded on the end so that it is impossible to pull
it out of the buckle
The bracelet uses Velcro to open and close easily.
The end of the strap is bigger than the buckle so
the bracelet never completely opens, and is there-
fore easy to slip on the wrist.
Usability of tablet:
Current solution for home rehabilitation exercises
is to give a paper with exercise descriptions to
patient that he must understand (Appendix 14.).
Cura solution takes another path and uses
portable aplication that can be run on
different devices to show videos of the exercises
to be made and give real-time feedback about
your current workout. You can see your results
and compare it to previeous workouts. Aplication
also points out when you make wrong movement
and helps you to correct it as seen on interface
screenshots in Appendix16. If application is run on
a tablet that is used only for rehabilitation pur-
poses it can be run in “one app mode” to make
interaction easier.
2.2.1. Technical working
The figure on the next page describes the interac-
tions between the patches, bracelet and tablet
electronic components.
The patches capture the body movements with
the motion sensors (1) and send it to the brace-
let via bluetooth (2). The collected data is then
processed by the bracelet microcontroller (3) to
calculate the joint angles. These angles are saved
in the bracelet memory (4). The bracelet display
changes according to the quantity of movement
registered (5). If a problem is detected by the
microcontroller, the alarms will work (6).
When the user is working out, the LCD screen
displays a video of the exercise, which is stored in
the tablet memory (7-8). The data processed by
the bracelet are used by the tablet microcontroller
to command the speaker (3-7-9-10).
BraceletPatches
Tablet
Sound
alarm
Interface
Movement
Wired
Wireless
Visual
alarm
Vibration
alarm
1
2
3
4
5
6
6
6
7
8
7
9
10

19
bracelets - opening closing the velcro strip,
patch & suitable tablet (Lenovo IdeaTab A2107)

20
Third very important factor is developing speed.
These companies that can develop the beta ver-
sion relatively fast have a competitive advantage.
As it was mentioned before medicine and medical
equipment is strongly regulated by international
and domestic laws. High regulatory rate in medi-
cine makes this factor also very important.
Last but not least in medical equipment industry
it is very important to find and pay attention to
the lead-users. Lead users are clients who by the
product and at the same time they give very valu-
able feedback. Having cooperative and enthusias-
tic lead-users network can also be a competitive
advantage.
For better performance Cura has to focus the fol-
lowing capabilities:
• Product development. In medical equipment
business it is crucial to have safe and efficient
products (Nazarenko 2012)
• Helpdesk performance. The clients must have
full support to be able to focus on their core
activity. Therefore the helpdesk performance
and ability to solve quickly all emerging issues
is very important.
• Logistics. Third very important capability.
Logistic solutions should be able to deliver the
products to client. In addition, the helpdesk
logistics (product fixing ability and spare parts
delivery) has same importance as product
delivery.
• Lead-users network. Lead-users have impor-
tant knowledge in medicine. Effective lead-
users network can give input for new product
adjustments and develop.
• Regulatory requirements. Medical equipment
developer should meet all the requirements.
For example:
2007/47/EC
93/42/EC
ISO 13485, ISO 14971
2.3 Execution Strategy
In this chapter the authors describe Cura’s
strategy. First the focus would be on mapping
capabilities of the Cura’s team and plans for
further development. After determining the most
critical capabilities it is important to formulate
new mission and vision of the company. Lastly, the
aim of this chapter is to determine the plans of
action for company, sales, product development
and network development.
These capabilities that are difficult to replace are
the base for business growth. Having a unique and
difficult-to-imitate capabilities mean that some ac-
tivities are done considerably better than compet-
itors do. Organizational capability is a combination
of business processes and resources which are
executed to deliver a particular business outcome
(Kolk sine anno). Even though, the dynamic ca-
pabilities consist of routines. (Helfat et al 2003).
Cura is an emerging organization and it has initially
few capabilities that qualify as competitive advan-
tage (see Cura’s SWOT in Appendix 21). However,
some capabilities can be emphasized:
• Team motivation and engagement- team work
is very important. Small team makes the deci-
sion process faster and allows more flexibility.
The team knowledge is very different and
there are people with different knowledge:
information technology, finance etc.
In medical equipment business there are some
important factors that influence the industry. It
seems that one of the most important factor is
quality. The ability to improve patient’s health
condition is the main goals for every medical
organization. Therefore every product has to have
superior quality. The ability to deliver safe and su-
perior medical equipment needs much cooperation
and partnerships.
Therefore another important factor is product
development network, which can increase the abil-
ity to innovate.

21
The most relevant capability for the company is
product development. It is very important to be
fast improvers of existing technologies and to
create new. To have good product development
capability there should be good partners network,
ability to finance and good IT and mechatronics
team. Also, there should be continuous routines
like network meetings, beta versions development,
testing and commercialization.
Cura’s vision:
“To change the understanding
about opportunities in
rehabilitation through
innovative products and to be
the leaders in new concepts
internationally.”
Cura’s mission:
“To offer more convenient,
efficient and independent
rehabilitation solution.”
Company’s main objectives
Company’s objectives can be divided into two
categories. First category is product and market
objectives and second one is company and
expanding objectives.
In 5 years the company should have different
variations of products, which are meant for
different client segments. The core platform
remains the same but the capabilities of the sys-
tem vary throughout the products.
In 5 years there should be three main products:
• Cura rehabilitation
• Cura pro sports
• Cura sports
Cura’s main goal is to take lead role in markets
it enters. In 5 years Cura should have 50% of
the market in rehabilitation, 70% in professional
sports and 40% of nonprofessional sports.
As for company and expanding the initial
objectives are:
• Establish company – All the regulations must
be fulfilled and there should be enough finance
to produce first working version.
• Establish product development network- It is
very important to find lead-users.
• Fix market position in Estonia- Cura should
have control of the market by that time.
• Expand to Scandinavia and USA- Expansion
plans are ambitious but if there would be a
well working version with good reference from
Estonia then the expansion should be easier.
• Widen product capabilities to sports- It is im-
portant to develop products for new potential
clients and markets.

22
Company’s objectives are set as developing steps.
After getting all initial activities settled, it is im-
portant to fixate company’s market position. Fixat-
ing market position would be the milestone for
other objectives like expanding to other markets
and widening product capabilities. If the company
would have market lead innovator position then
the expansions plans can be taken into account.
But, if the company meet problem, then it is wise
to focus on these problems and to reappraise all
strategy.
Strategic activities
The strategic activities (see Appendix 15) are
planned for 3-5 years. The time is set relatively
flexible because it is hard to foresee all issues. In
authors opinion there should be time buffer. There
are four phases which you can see in Appendix
15. Every phase would be briefly discussed in this
sector.
• Preparatory phase- The tactic of the prepara-
tory phase is to focus on inner capabilities.
Because of lacing finance the activities should
be done by the team and for free.
- Team work- It is vital to develop the crea
tivity, communication and cooperation
between team members. Some important
capabilities like physics and mechatronics
should be added to team. Therefore the
team should look for at least two new
members.
- Company structure planning/licenses-
The initial structure needs to be set. Also
member should find potential operating
place and prepare the documentation for
necessary licenses.
- Development of first beta-version-
The milestone of this phase is ready Cura
beta-version.
• Market positioning phase- When the working
beta-version is ready the tactic of the fol-
lowing phase should concentrate on product
developing and sales in Estonia. The most
important activities are the following.
- Seach for additional finance
- Marketing plan and sales-
It is important to find partners who can
be lead-users. It helps to sale the product
and develop it for user’s needs.
- Product development network-
As product development is the most im
portant capability in this industry; every
thing should be done to achieve the best
level on product development.
• Preparation for expansion phase- Initial plan is
to expand company business to Scandinavia.
In this phase the company starts preparing
for building sales-partners network. Working
through sales-partners is a good way to enter
the market with low costs. It is important to
find a partner in logistics.
• Foreign market expansion phase- Sales net-
work is done and it is working actively. The
company have found partner in logistics and
have well organized delivery of products and
spare parts in Scandinavia.
To sum up, there are many aspects to pay atten-
tion to. Every activity is very important and tactic
decisions are very important.

23
2.3.1 Future ideas
As it was mentioned before, Cura plans to set a
core platform open. In the future the platform
should carry out different products. For exam-
ple Cura pro sports is a product for professional
sportsmen and their coaches. This application
would allow exercise perfect techniques.
According to M. Mardna in professional sports it
is getting harder to achieve better results with
dietary supplement and there is a big potential
in improving techniques with electronical devices
like Cura (Mardna 2012). For example Cura can be
helpful in javelin throw or high jump. Cura sports
pro should be able to measure the speed, accel-
eration and power of a sportsman. Sport Medicine
Foundation offered it partnership to develop such
kind of application.
CONCLUSION
Health care sector is the second most regulated
sector after the nuclear power industry, despite
of that startup numbers are increasing. The most
value is offered by healt care technology to meet
people’s need to the right information at the right
time.
This work has been divided to two parts. In the
first part authors made brief overview of the
healt care market and industry. Authors pointed
out that healt care is very regulated area but still
receives support from the government. Start up
companies might meet some barriers entering the
market but if a company can handle them it often
means success. Therefore authors described one
of their main competitor Hocoma’s business model
and strategy.
Hocoma has very clear strategy and it has proven
its use. The company has a niche product and
their international sales and product development
network makes the company more competitive in
international markets. Hocoma’s business model
shows that they have well-planned every aspect
and covering company’s the four main areas of
a business: customers, offer, infrastructure, and
financial viability.
In second part Cura’s business model focuses
mostly on customer segment and the value of
the product. Cura’s segment is clearly defined for
health care institutions but the end users are peo-
ple who are required to visit physiotherapist and
the main idea of Cura is to offer its clients conven-
ience and additional value by allowing the patients
to do rehabilitation exercises at home. For health
care institutions it gives an opportunity to serve
more patients in the same amount of time and
for end-user it helps to cut down costs and time
spent on rehabilitation.
Revenue for Cura is generated by renting the de-
vices to the health care institutions and the costs
for Cura are mostly R&D, producing and managing
customer support.
Cura’s first strategic aim is to get decent market
share in Estonia and find partners in R&D. The next
step is to widen our market to Scandinavia and to
the United Sates. For further development Cura
plans to widen their customer segment to sports-
men. The idea is to release additional technique
analyzing solution for top athletes. Also to re-
lease additional application solutions for amateur
sportsmen. The overall goal is to achieve 50%
market share in rehabilitation services, 70% mar-
ket share in top athlete’s technique solutions and
40% market share in amateur sportsmen applica-
tion market.
According to the product innovativeness and good
feedback from interviews made with health care
experts and patients the product gives additional
value to the health care area. Furthermore, au-
thors plan to program first prototype and develop
sales model for Estonian market. According to
work that is done by now and the interest and
motivation of the team, the work is moving from
paper towards reality.

24
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Health care institutions:
Alter, H. (2012). Health care industry. J. Nõu’s, B.
Aavik’s, T. Tammjärv’s, K. Kišenja’s, U. Orasmäe’s
interview. Notation. Tallinn, 14. December. GSM
Valve.
Nazarenko, S. (2012). Health care industry. B.
interview. Audio recording. Tallinn, 10. December.
The North Estonian Medical Centre.
Tammeka, M. (2012). Health care industry. B.
interview. Audio recording. Tallinn, 10. December.
The North Estonian Medical Centre.
Saulus, M. (2012). Health care industry. B. Aavik’s,
T. Tammjärv’s, K. Kišenja’s. Audio recording.
Tallinn, 6. December. Medicum.
Mardna, M. (2012). Health care industry. B.
Aavik’s, T. Tammjärv’s, K. Kišenja’s, interview.
Notation. Tallinn, 4. December.
The Foundation of Sport Medicine.
A, Normak. (2012). Health care industry. B.
Aavik’s, T. Tammjärv’s, K. Kišenja’s, interview.
Notation. Tallinn, 4. December.
The Foundation of Sport Medicine.

26
Patients:
Patient 1. 23 years old, male. (2012). Patient’s
rehabilitation service experience. B. Aavik’s, T.
Tammjärv’s, K. Kišenja’s interview. E-mail. Tallinn,
1. December.
Patient 2. 24 years old, female. (2012). Patient’s
2. December.
3. December.
Patient 4., 26 years old, male. (2012). Patient’s
3. December.
7. December.
7. December.
Tammjärv’s, K. Kišenja’s interview. Notation.
Tallinn, 12. December.
Tammjärv’s, K. Kišenja’s interview. Notation.
Tallinn, 13. December.
APPENDIXES
Appendix 1.
Interview in SportMed Foundation with
Mihkel Mardna and Aivo Normak
Mardna:
Ma hakkasin mõtlema kuidas tippspordis saab ära
kasutada seda, tehnilistel aladel. Tegevusraadius
peaks olema sellisel juhul suurem. Tegevusraadius
peaks olema 30-40meetrit. Peaks olema algusest
peale. Peate mõtlema laiemalt. Et saaks rakendusi
sellele asjale peale veel lisaks lasta. Sõudmine,
jooksmine. See on laboriväline. Meid huvitab labo-
riväline liikumisanalüüs ehk siis kinesiomaatika. Et
me saaks staadionil, spordiareenil seda kasutada.
Kui ta on selline, et see raadius oleks suurem, siis
oleks, võiks see ka võimalik olla
Normak:
Näiteks kõrgushüpe. Kas seda on võimalik nii
panna, et see muutub 3D mudeliks? Me oleks ise
huvitatud 3D rakenduse kaasaaitamisele.
Mardna:
Täna on 1 doktorant,kes tegeleb kinesionmaatika
ja 3D anaalüüsiga, kus ta filmib ülesse 2-3 kaam-
eraga ja märgib punktid ja kaaderhaaval kannab
punktid programmi ja tal võtab analüüsiks aega
3-4h.
Toidulisanditega ei ole võimailik edasi minna. Selles
mõttes, et treeningu täitustamiseks on enam-
vähem kõik juba ilmselt ära kasutatud; toidulisan-
did jne. Kui siuke 3D asi valmis teha, siis on nagu
KÕIK olemas.
Bluetooth võtab 60m raadiuses infi. Näiteks me
võtame jooksuanalüüsi, mille puhul sõidame au-
toga kõrval.
Kas need andurid on ka kiirendustundlikud. Kas
nad suudavad välja tuua ka parameetrid? See on
tehniline teostus.

27
Kas teil on kaasatud füsioterapeut?
Teoreeriliselt on see võimalik. Iga inimese ana-
toomia on erinev ja igal inimesel on algne pain-
duvus ja lihastoonus individuaalsed. Kui töötada
välja 1 konkreetne harjutusemudel. Siis ma kujutan
ette et keerukas saab olema see koht et kleepsud
lähevad väga õigesse kohta. See arst või füsio
kleebib need ja siis see kuvab pildi arvutisse ja
siis füsioterapeut korrigeerib vajadusel andureid
ja paneb paika konkreetselt selle patsiendi jaoks
konkreetselt tehtud selle sooritatud harjutuse
ja paneb arvutis need parameetrid. Mis nurga all
ja kui kõrgel. See annab signaali siis patsiendile,
arvuti on võimeline tagasisidet andma patsiend-
ile. Kui selles piirides ei tee harjutust, siis annab
märku. Kas siis ekraanil või midagi undab. Patsient
on vaja ära kalibreerida.
Eesmärk on pigem see, et kulutatatud ajaga. Et
näiteks 3 nädala pärast tagasi, et selle aja peale
on harjutustest rohkem kasu. Ta peab seda harju-
tuse õigesti tegema. Nii kui nii kutsub füsiotera-
peut 3 nädala pärast tagasi.
Normak:
Mulle tundub 2 varianti
Esiteks. Andurid ja mehhaanika, mis mõõdavad.
Üks on see, et õpetatakse selgeks õige liigutus ja
nii on hea. See on mudel, mille lähedale peab pat-
sient kodus püüdma
Teine variant. Üldised parameetrid. Kui palju kõi-
kuda kõrvale. Teine on see pool.
Mardna:
Meil see nädal füsioterapeutiliste harjutuskavade
filmimine, mis on prementatiivsed meetmed, et en-
netada vigastusi spordis. Neid on kuskil 25 video
ringis, mis on mõeldud nagu.. noh..erinevad kavad.
Siuke areng, aga see on teine suund. Pigem info
materjal ja erinev spordimaterjal. Aga see haakub
hästi.
Kui bluetooth. Kas märku annab kell ja arvuti regab
ära selle et on mindud järgmise harjutuse juurde.
Liigutuste kava on sisse progretud, mis koosneb
3st komponendist.
M. Mardna answers to questions:
1. Missugune on üldine paberimajandus seotud
ühe patsiendiga (mida ja kuidas peab dokumen-
teerima)?
Protseduurid on funktsionaalsed testid. Koor-
mustestid, aga mis puudutab füsioterapeutilist
tegevust, on erinevad harjutuste kavad.Paberima-
jandust väga palju ei ole. Kirjutame kaartidesse,
teeme füsioterapeutilise hindamise, mis seisus
patsient on. Oridneeridu harjutuste kava. Tavaiselt
on olemas selline füsiotools, kus on palju eirne-
vaid pilte. Väga palju kasutatakse seda. Kordade
arvud muudetakse ära. Väga palju erinevaid ke-
hapiirkondi, erinevatel otstarbetel.Aega dokumen-
tatsiooni peale ca 5 minutit. Ja kui inimene ära
läks, siis kokkuvõte või kui ta tuleb uuesti aatgasi,
kirjutatakse amplituudid, kui palju lihastoonus on
paranenud, vajalik funktsioon. Seda saab hin-
nata näiteks heitjatel kui palju millise jõuga saab
visata. Meid huvitab ka see.. teie selle vidinaga
saab vaadataka võimsust. Võtate kätte 4kg palli ja
massi ja kiirusega on võimalus arvestada võimsust.
Teil võimalik ehitada see peale. Mis on väärtuslik
info. See on see, mida on vaja. Tippspordis on vaja
selliseid asju. Ma näen siin edasirakendusi ja aren-
guvõimalusi, mida on tippspordis vaja. Sinnamaani
välja, et meil on spordimed klaster ja teatud toot-
earenduseks on võimalus meil isegi mingil määral
rahastada.
2. Kui palju 1 visiit patsiendile maksma läheb?
Umbes 32eurot ja 1h. See ei ole 5 min.
Joonsitatakse välja, kontrollitakse.
Reeglina 1h. Võib-olla tuleb sportlane, kellel oleks
vaja kinesioteip uuesti kinni panna. See OK 15 min
võib-olla. On erinevad. Aga kui on jutuks harjutuse
kava koostamine, hindamine jne. See võtab aega
rohkem kui 1h. Hind muidugi sama.
3. Mitu korda keskmiselt patsient kordusvisiidile
taastusravi perioodi jooksul? Kui palju keksmiselt
ühe patsendiga aega läheb?
Keskmisel kordusvisiidil.. keskmiselt.. ma arvan.
Tuleb ütleme 2,5 korda. 2-3 korda tuleb. Mingi aja
pärast kutsub tagasi, et hinnata töö tulemuslik-
kust. Vahel on võib-olla vaja midagi korrigeerida,

28
kuskil tesie arsti juures.. käib seal ära ja siis tagasi.
Kordusvisiidid on umbes poole odavamad.
4. Mis te arvate, kas elektrooniline jälgimise lahen-
dus võib leevendada töökoormust ja suurendada
patsientide arvu?
Ilmselt parandaks töökvaliteeti.
5. Mitu arsti ühe patsiendiga tegeleb?
Oleneb. Me teeme funktsionaalseid teste. Need on
erinevad. Üks lihtsalt koormustest. Hapniku. Väga
keerulised võivad need olla. Tippsportlased või
vastupidamisala sportlased. Mina ja doktor Hel-
dur, vaatame spordivigastusi. Siis füsioterapeudid.
Õed vereanalüüside jaoks. Laborisse saadetakse.
Tegeletakse seal .. võib-olla tal veel mingi eriala
arsti visiiti vaja. Näiteks neuroloogi, siis läheb veel
kuskile suurde haigla. Ma arvan, et tippsportlase
puhul on 4-5 isikut, kes temaga lähemalt tegel-
evad.
6. Kui arstil oleks võimalus lisaks kliinikule ka kodus
töötada, mis te arvate sellest võimalusest?
Patsientidega suhtlemine oleks võimalik Interneti
teel.
Mulle kohe tundus, et hea asi. Ma ei soovita teil
ka kitsalt mõelda. Parandada harjutuse soori-
tuskvaliteeti; mitte ainult seda vaadata. Vaid
ka need, mida me rääkisime. Et saaks mõõta ka
võimsust, kiirust, kiirendust. Need on lisatavad
sellised funktsioonid. Mida võimalik valemisse
sisse kirjutada. Aretada sinna edasi. Mis puudutab
neid harjutusi, millised on? Sellest võib tulla väga
kõva asi. Ja muidugi ei saa teha kõike korraga.
Algselt kavandada nii, et tekiks andmetekogu, mis
süteemis annaks võimaluse erinevaid funktsioone
peale panna et sinna saab veel lisada ideid. Prindin
teile nüüd harjutuste kava välja. A4 formaadis; seal
on pildid ja tekst juures. Te võite neid kasutada.
Appendix 2.
Interview in Põhja-Eesti Regionaalhaigla
(PERH) with Sergei Nazarenko (the board
member and the chief doctor) and Maret
Tammeka (rehabilitation manager)
Kim: „Palun kirjeldada protsessi, alates patsiendi
saabumisest kuni patsiendi ära minekuni.“
Tammeka: „Teid huvitab ilmselt ambulatoorne
osa?“
Kim: Jah
Kim: Veelkord seletab toodet ja Nazarenko küsib
täpsustavaid küsimusi. A’la:
Nazarenko:“ Mul on niisugune küsimus, et need
kiibid paigaldatakse patsiendi nahale ja, et kiibid
annavad informatsiooni iseenda asukoha kohta?“
Meie: Jah
Nazarenko: „Need on inimesele kasutamiseks
lubatud plaastrid, et ei ole mingeid toksilisi aindeid
selles liimis, allergilisi, naha lamatisi - mida iganes.
Kas need plaastrid on teil olemas juba või te otsite
veel lahendusi?“
Birgit: „Me otsime hetkel otsime lahendust. Meie
toote ja disaini tudeng teeb selle kohta magis-
tritöö, milliseid plaastreid tuleks kasutada ja et kas
plaastrite kasutamine on kõige õigem lahendus.“
Kim: „Jah, ta otsib seda lahendust. Ehk on veel
küsimusi?“
Nazarenko: „Tähendab, enne kui edasi minna, mida
minu arvates erakordselt tähtis on arvestada
inimesele ohutuse aspekte. Plaastri puhul kindlasti
ma eeldan, et siin ei teki probleeme. Aga see tee-
ma tuleb ära käsitleda. Kiirgus mis lähtub, et ega
see patsienti ei kahjusta. Pacemakeriga koos, kas
patsiendil või kui pacemaker on tema lähedastel
või sugulastel - ohutusse aspekt. Ma soovitaksin
teil läbi mõelda see aspekt et kui tegemist saab
olema meditsiinilise seadmega siis on olemas med-
itsiiniliste seadmete direktiiv. Millist sorti seadmete
liigi ohuklassi alla see võiks tulevikus kuuluda.
Püüda see ära lokaliseerida ja vaadata, et vastak-
sid sellisele seadme klassile kehtestatud ohuklas-
sile - see oleks üldine soovitus, sest meditsiiniliste
seadmete puhul on kaks olulist asja mida tuleb
alati tõendada kui me võtame seadme kasutusele:

29
ohutus ja toimivus.“
Kim: „Meie aparaat suudaks parandada haiglate
tööd, suudaks taastusvõimlemise protsessi tõhus-
tada. Patsiendi käimise aeg lüheneb ja selle võrra
oleks võimalik haiglatel rohkem kliente võtta.“
Tammeka: „Ma arvan, et teatud protsendil juhtud-
est oleks see väga suureks abiks, oleneb inime-
sest. On selliseid, kelle juures peab olema ja se-
letama korduvalt, et ta üldse aru saaks. See, et on
olemas video ja et keegi teda distantsilt parandab,
ei ole alati toimiv – see on individuaalne.“
Nazarenko: „Me saame positiivsest küljest tõsta
seda, et kui me oleme suutnud identifitseerida
sellised patsiendid, kes saavad nii-öelda iseseisva-
malt hakkama siis me teeme nende jaoks taastus-
ravi mugavamaks. Nad saavad seda teha kodustes
tingimustes ilma kohale sõitmata. Mis Eesti puhul
on ääretult oluline on see, et Eesti on suhteliselt
hõreda asustusega mistõttu taastusravi vajavad
inimesed võivad elada kaugel, ollla oma taastus-
ravi perioodil linnast väljas, suvilas või juba heas
taastus järgus liikudes maailmas ringi ja saata
meile infot selle kohta kuidas tal läheb. Teiseks
see annab ka vabadust. Inimene ei pea tulema kell
11:45 vaid võib seda teha natuke hiljem, või natuke
varem aga info jõuab meile kohale.
Tanel: „Mitu patsitenti taasturavi arst päeva jook-
sul keskmiselt vastu võtab?“
Nazarenko: „Taastusravi arst, kes tegeleb ra-
vivõimlemisega? Kas küsimuse mõte on kui mitme
inimese võrra on võimalik vähendada koorumust
taastusraviga tegelejalt?“
Tanel: „Kas see või et arst saab võtta selle võrra
rohkem patsiente aga koormus jääb samaks.“
Tammeka: „Teid huvitab siis ikka füsioterapeut,
mitte arst.“
Meie: Nõustume.
Tammeka: „Füsioterapeut praegu, tööpäevaga 8
tundi, suudab vastu võtta antud koormuse juures
14-15 inimest, sest üks protseduur kestab 30
minutit. Tegelikult kuskil 13-16 on see vahemik.“
Kim: „Kas see hõlmab patsiendi kordusvisiiti?“
Nazarenko: „Võibolla peaksime paari sõnaga se-
letama kuidas see asi on meil korraldatud?“
Tammeka: „Me juba natukene rääkisime sellest.
Alguses vaatab arst, teeb raviplaani, et mida see
patsient üldse vajab ja kui ta vajab füsioterapeudi
nõustamist siis me planeerime talle füsioterapeudi
ajad. Üldiselt 2-3 korda nädalas aga kuna meie
lepingumaht võimaldab tal käia meie juures mak-
simaalselt 4 korda siis me propageerime 2 korda
nädalas käimist. Kui patsient tuleb kaugelt, tal on
raske siia tulla, siis kord nädalas. Kõigepealt vaada-
takse patsient üle, tehakse esmane harjutuste
kava mis talle võiks sobida, ta tegeleb sellega
kodus. Järgmiseks, kui patsient järgmine kord
tuleb siis vaadatakse üle, mida patsient on vahe-
peal teinud, kas on võimalik midagi veel täiendada,
lisada harjutusi. Nii et üldjuhul, kui patsient tuleb
siis ta saab 2 protseduuri järjest.“
Kim: „Kui oluline on patsienti näha nii-öelda näost-
näkku?“
Tammeka: „Üldiselt on oluline kuna meil teist või-
malust ei ole olnud. Aga kui mina või füsioterapeut
saab selle info kuidagi teisel moel kätte siis ma
arvan, et ta teebki selle järgi otsuse. Et kas piisab
sellest, et ta annab infot edasi mitte ise patsienti
katsudes/kombates või ta vajab selleks patsiendi
kohalolekut.“
Nazarenko: „Ma saan aru, et te otsite meilt seda
argumentatsiooni kuidas seda projekti arendada ja
näidata selle elujõulisust jne?“
Meie: Nõustume.
Nazarenko: „Me liigume siiski individualiseeritud
meditsiini poole, seda me vähemalt deklareerime
ja püüame seda teha vähemalt nii palju kui võima-
lik. See tähendab seda, et me püüame patsiendile
anda võimalikult individuaalset nõu ja just sell-
eks on see vis-a-vis kontakt füsiterapeudiga või
taastusravi arstiga tingimata vajalik. Aga kui see
inimene saab neid harjutusi ise kodus teha siis sel-
lel hetkel ei ole seda vis-a-vis kontkati vaja ja selle
võrra saame me koormust vähendada ning arsti
või taastusravi juurdepääsu parendada.“
Kim: „Me ei taodelnudki seda et patsient ei käi ül-
dse, vaid seda, et see vaheperiood mil ta teeb neid
harjutusi võiks nii-öelda laheneda online vestluse
näol, et mul läheb hästi, teen ära, ei valuta jne.
Hiljem ikkagi fikseerida ära.“
Nazarenko: „Jah, aga ta peab ikkagi käima kuna
seda on raske kauge maa peale hinnata. Kui mingi
liigese liikuvuse ulatust tahame suurendada - seda
peab ikkagi nägema, et kuidas tal on. Või mõõta
mingisuguseid väga spetsiifilisi parameetreid, et ta
peaks ikkagi tulema siia.“
Tanel: „Kui patsient tuleb siis missugust doku-
mentsiooni peab arst täitma ja kui palju see aega
nõuab?“
Tammeka: „Mina isiklikult täidan Estri kirjeldusena
ja kui on väljavõtet vaja perearstile saata siis ma

30
saan selle välja printida, ma ei ütleks et see väga
keeruline on.“
Nazarenko: „Ma ei arva, et see dokumenteerimist
vähendab, tõesti selles osas, et inimene nii tihti ei
käi siis need juhud kukuvad ära. Aga see, milline
on lähteseis ja milline on vahepealne dünaamika,
mis on mingi perioodi lõpptulemus, see jääb ikka
endisesse väärtusesse dokumenteerimise mahus.
Küll ütleksin, et selline automatiseeritud doku-
menteerimine mis toimub selle lahenduse puhul,
on nii-öelda lisaväärtus. Ma oleks väga üllatunud,
kui kukuks natukene teisiti välja kui on toimunud
tegelikult kõigi niisuguste uute rakenduste näitkes
telemeditsiini rakenduste puhul. Nad ei ole andnud
kunagi säästu, nad ei ole kunagi vähendanud min-
gisugust töö, materjalide ja muu kulu, kuid need
mis on ellu jäänud, on andnud mingi lisaväärtuse
see on täiesti minul tekkinud maailmavaateline
point. Vot nende lisaväärtuse peale tasub rõhuda.
Ei maksa öelda, et see säästu ei anna, see peab
niikuinii selge olema aga mingid lisaväärtused(on
olulised).“
Tanel: „Kui patsient tuleb oma probleemiga siia, kui
pikk keskmiselt taastusravi protsess on?“
Tammeka: „Sõltub juhusest/patsiendi haigusloost.
Mõnel on nii kerge häda, et saab tõesti nädala
või paariga hakkama aga on ka neid, kes käivad
siin poole aasta vältel. See ei tähenda seda, et
me teda iga nädal 2 korda siia kutsume, vaid ta
tegeleb vahepeal iseseisvalt kodus. Siis kutsume
kontrolli. Kui ta teeb poole tunniseid protseduure
siis saab kuni 15 patsienti teenindada ja kui tun-
niseid siis 7 patsienti. Statsionaarses ravis saab
pool tundi ja ambulatoorses 2x pool tundi.“
Nazarenko: „Ja no kui kaua see ravi võib kesta
vaadake, ma tahaksin seda rõhutada, et see võib
olla tõesti madal kaar aga võtame ajakirjandusest
Leokid, nad teevad aastaid oma harjutusi. Võibolla
pigem, kui me saaks midagi niisugust öelda, et kui
patsient peab praegu käima füsioterapeudi juures
mingisugune x arv kordi siis mitu korda vähem ta
peaks käima, kui ta rakendast seda süsteemi? Äkki
me saame siit kaudu tulla?“
Tammeka: „Ja kordades vähem peaks Ta käima.“
Nazarenkio: „Oletame, et ta peab harjutusi tegema
iga päev aga siin ta käib kord nädalas. Siis me ta-
haksime teda näha ainult kord kahe nädala tagant
või kord kuus aga harjutusi teeb iga päev.“
Tammeka: „No päris iga ei tee aga..“
Nazarenko: „...aga me tahame, et ta teeks iga
päev. Kui ta teeks neid harjutusi siin haiglas siis
ta käiks 5 korda nädalas siin haiglas tegemas. Mis
teeks 20 korda kuus aga me näeme teda ainult
1 kord siin. Need suhtarvud saab ilmselt... on
mõistlik anda mingisuguses vahemikus, see oleneb
patsiendi haigusest. Just nimelt sellest funktsion-
aalsest seisundist millest me lähtume ja kuhu me
tahame jõuda.“
Tanel: „Kuidas teil järjekorraga on?“
Tammeka: „Järjekordadega on meil hästi.“
Tanel: „Mis see tähendab, järjekordi pole?“
Tammeka: „Meil on selline lubatud järjekord, paar-
kolm nädalat.“
Nazarenko: „Teate see järjekord on meditsiinis
nagu kumm, et sa võid tekitada olukorra, kus ei ole
järjekordi ja samas olukorra kus on pikad järjekor-
rad.
Tammeka: „Meil on siin võibolla natukene erinev
süsteem teistest. Ma ei ole küll küsinud aga meil
on järjekord sellistele plaanilistele tegevustele, kui
on erakorraline näiteks traumaga seoses siis me
ei ole neid lükanud järjekorda. Me võtame nemad
väljaspool järjekorda. Meil on lepingu järgi kavas
võtta 30 uut, plaanilist haiget nädalas aga tege-
likult võtame 90 ja rohkem, kuna meie haigla on
aktiivhaigla siis meile satuvad enamasti traumade-
ga patsiendid. Meil on plaaniline ja erakorraline
tegevus. Kui meil seda poleks, siis ei tea kui pikaks
need järjekorrad võivad minna.“
Nazarenko: „Ma tekitan teil küsimusi ja probleeme
juurde...“
Meie: Meile see meeldib
Nazarenko: „...et järjekord mistahes tervishoiu asu-
tuses on asi, mis on ääretult elastne nähtus selles
mõttes, tervishoid ja taastusravi sealhulgas, et kui
meil oleks võimsust ja riigil ressurssi siis see võiks
olla mitmetes kordsetes mahtudes tegelikult. Kui
me piirame seda ja ütleme, et meil ei ole võimsust
ja võtame tõesti ainult kategooriad siis me need
võtamegi ja meil järjekord ongi lühem. Ma panek-
sin siia meditsiini, ma paneksin siia samuti ka kõik
need spordisaalid jne, sest tegelikult oleks vaja
harjutusi kõikidele nendele haigusrühmadele mis
meil siin käib. Igasugused luu- ja liigesehaigused,
südame veresoonkonnahaigused, närvihaigused,
seda on tohutult palju, seda on isegi raske mõõta
kui palju seda kokku on. Isegi vähi kohta öeldakse,
et on andmeid, mida regulaarsemalt liigud seda
väiksem tõenäosus on haigestuda.“
Kim: „Kui me kujutame ette sellise hüpoteetilise

31
situatsiooni, et meie selline lahendus peakski
näiteks 10% aastas patsientide voogu suuren-
dama, kas lisateenused: massaažid, magnetravid
saaksid selle 10% protsendilise patsientide tõu-
suga hakkama?“
Tammeka: „Praegusel hetkel küll, massaazi kui
sellist haigekassa praktiliselt enam ei tasusta.
On ainult keskmise või raske pareesi puhul, mis
tähendab aga seda, et inimesed ei ole praktiliselt
võimeliselt ambulatoorselt kohale tulema. Massaz
kui selline peaks jääma füsioterapeudi alasse. Nad
on sellise koolituse/väljaõppe saanud. Mis puudu-
tab aparaatset osa siis see dendents on vähen-
emise suunas.“
Tanel: „Kui patsient siia tuleb, missugused kulud
kaasnevad?“
Tammeka: „Visiiditasu ikka.“
Nazarenko: „Visiiditasu on ühekordne, see on
ravijuhu peale, kas ta käib 1 või 40 korda - see on
üks visiiditasu. Mõtlen kuidas teie projekti toetada,
on niisugune asi nagu ravisoostumus. Ma tooks
uuringuid mis on tehtud ravimitega ja ravimitega
on igasuguseid trikke tehtud, eesmärgiga vaada-
ta kuidas inimesed võtavad nendele kirjutatud
ravimeid ja tegelikult on olukord kaugel ideaalsest.
Arsti tudengitele, oli mingi preemia kehtestatud ja
neil oli ülesanne võtta kolm korda päevas tic-tac’i.
Mingist purgist vajutada, mis registreeris selle, kui
tic-tac sealt välja kukkus. Ja vist kolmandik püsis
selle reziimi sees, et ravisoostumise- compliance
aspektist on see kohutavalt suur lisaväärtus mis
tuleb niisugustele süsteemidel, sest inimene ikka
mõtleb, et ma lähen käin täna poes pikemalt ja
see on ka harjutuse eest. Või teine häda, mõned
satuvad sellisesse seisu, et harjutavad üle. See on
ka probleem, et sellist ravissoostumist, see oleks
väga tugev argument, kui te paneksite selle oma
projekti kirjeldusse sisse, viidates et isegi ravimite
puhul tehtud uuringud, mis ei olnud seotud aja
kuluga, muude kulutustega justkui motiveeritud
seltskonnas, näitavad et need asjad tegelikult
ei toimi. Aga siin me räägime sellest, et see on
pikaajaline, aeganõudev, mingil määral oma elusät-
timist nõudev tegevus, see nagu põhjendaks
seda.“
Kim: „Küsiks vahepeal ühe täpsustava küsimuse,
kuidas teil ajaga praegu on?“
Nazarenko: „Mina saan natukene üle 12 olla, äkki
12:15-ks valmis. Me küll räägime teile vahele...“
Meie: Meile see meeldib.
Nazarenko: „.. aga need on olulised asjad. Teie
küsimused on küll väga head aga siin on asjad mida
meie näeme omalt poolt.“
Tanel: „Seda me tulimegi otsima! Mis on kompleks-
vigastus? Kas kompleksvigastus on selline, kui
sul on põlv viga saanud ja samas ka hüppeliiges
vigastatud?“
Tammeka: „Siin on ilmselt mõeldud erinevaid süs-
teeme. Ei ole seal ainult lihaskond ja liiges, vaid on
ka veresoonkond või siis mingi kompleks mingit-
est muudest haigustest aga kompleksvigastus on
erinevate organsüsteemide vigastus ma arvan.“
Nazarenko: „Ja ma kaldun ka nii arvama, et näiteks
trauma kompleksvigastusega me eedlame, et
kuskil on näiteks neurokirurgiline probleem ja
kuskil on mingi jala probleem ja on mingi vasku-
laarne veresoonte probleem, mingi põrnarebend
või muud sellist.“
Tanel: „Kuidas taastusravi arst, füsioterapeut ravi
läbi viib kui patsiendil on kompleksvigastus?“
Tammeka: „Siis tulebki meeskonnatöö. Kõigepealt
võetakse kokku ja arutatakse läbi arstiga eesot-
sas, mis on need esmased tegevused ja mida see
patsiendi seisund võimaldab, millele tähelpanu
pöörata. Kontsentreerutakse olulisemale, ei ole
mõtet hakata sõrmedega tegelema kui on teada,
et üleval pool(õla piirkonnale osutades) on suure-
mat sorti kahjustus(ed). Antud piirkonnaga tuleb
enne tegeleda ja siis hakata sellele piirkonnale
tähelepanu pöörama(sõrmed) kui on juba teada, et
sealt võiks midagi hakata tulema.“
Tanel: „Kas kuidagi samal ajal saab seda ravi/prot-
seduuri läbi viia?“
Tammeka: „See sõltub sellest haigusest/traumast,
seda on väga raske ette öelda ja sageli sealt või-
vad tulla ka ravivead, et me ei hinda alguses või ei
oota ära kõiki uuringute tulemusi. Oluline on täpne
diagnoos ja siis saame alles hakata oma järjekordi
ja raviplaane tegema.“
Tanel: „Valede liigutuste tegemine ja üle tegemine
võib tegelikult ravi tulemust negatiivsemaks
muuta?“
Tammeka: „Jah.“
Kim: „Kas kompleksem vigastus nõuab ka komplek-
semaid harjutusi või selles ei ole olulisust?“
Tammeka: „Sellisel juhul tuleb kombineerida te-
gevusteraapiat ja füsioteraapiat. Füsioteraapia
tegutseb üldise lihsakonna, lihaskorseti parandam-
ise eesmärgil ja valib oma harjutused, tegevustera-
peut siis peenema motoorika osas. Üks(arst) oma

32
poole tunni või tunni jooksul, mis kummalgi on, ei
suuda seda kõike haarata. Eerinevad spetsialistid
tegelevad.“
Kim: „Me kartsime seda, et kui meie lahendus su-
udab ainult teatud liigutused kaardistada, võibolla
mingi eriti keerulise liigutuse puhul võib see prob-
leemiks olla, Me ei oska hästi hinnata kas see võib
takistada harjutuste tegemist?“
Tammeka: „Kui info jookseb temani siis ta peaks
seda ikkagi nägema.“ Toob näite: „Väga palju
aastaid tagasi, üks Raplas elav naine kellel oli
kõõluse kahjustus, kuna tal oli raske käia siis
esmaselt terapeut tegeles temaga. Traumatoloo-
gia poolt oli saadetud. Mõne aja pärast tuli uuesti
ennast näitama, kui ta riidest lahti võttis siis ma
jahmusin/ehmusin. Inimene oli väga tublilt tööta-
nud, ainult et tegi kõike valesti. Trapetsi kohal oli
selline „pall“. Patsient ise ei osanud hinnata, mida
valesti tegi. Töö oli vales suunas ja õlg oli aboslu-
utselt kinni. Oluline distantsi puhul on, et info
tuleks ja vajadusel füsioterapeut saaks öelda „ei
ei” et tehakse valesti või siis seletada, mis tuleb
teha(kuidas).“
Nazarenko: „Mida selle projekti juures võiks
veel rõhutada. Esiteks selle koht aktiivravis ja
haiglapõhise taastusravi juures, ütleme traumad.
Teine asi mis võiks olla, et enne proteese võiks
inimesed hakata lihased harjutama ja peale lõikust
näiteks liigesproteesimine(puusaliiges) jne. Inimene
on proteesimise järjekorras ja me tahame et ta
sellelel ajal hakkaks juba oma lihaseid tugevdama
selle eesmärgiga, et kui see protees tal on, et kõik
funktsioneeriks nii-öelda ennetav taastusravi.“
Kim: „Selle peale me ei olekski tulnud.“
Nazarenko: „Selle võite sinna kirja panna, kui
räägite milleks seda vaja on.“
Tammeka: „Tegelikult ka aktiivhaiglast, trauma-
haiged lähevad praegu väga kiiresti koju. Neile
antakse esmased juhendid kaasa. Patsiendid last-
akse juba nädalaga haiglast välja kuna seisund on
nii palju paranenud, et nad on võimelised enamaks,
et ta ei peaks tulema siia ja et me saame teda siis
kontrollida ja juhendada edasi.
Nazarenko: „Mis ka minu arvates on väga oluline
valdkond(meditsiin) kuna meil elanikkond vananeb
– aktiivne vananemine. Siis kindlasti on teil seal
sees juba niisugune kaitseväele, -jõududele suuna-
tud aspekt, ütleme, et meil on ka siin inimesi kes
on kuskil missioonidel kannatada saanud.“
Kim ja Birgit: „seda meil ei olnud – me oleme
spordi peale mõelnud.“
Nazarenko: „Sport on väga hea mõte! Aga see
ka(kaitseväe/-jõud), kus õnneks neid hädalisi ei
ole Eestis palju aga iseenesest selle aspekti välja
toomine võib kuskil anda lisaväärtust.“
Tanel: Mehhatroonika vallast: „Kas tulevikus on
kiibid painduvad...“
Birgit: „Mõtleme seda, et kas kiibi pealt saaks mas-
sazi teha, kas tohib, kas peaks vastu?“
Nazarenko: „Muidugi oleks parem kui oleks selline
kiip millega saab ka saunas käia ja ujuda, mida on
võimalik nö. masseerida – parem on. Kui ei ole siis
esialgu oleks see ka samm edasi.“
Kim: „Tehnoloogia läheb edasi.“
Nazarenko: „Ma ennustan, et mingi päev tulevad
naha alla kiibid mis on lahustuvad.“
Tammeka: „Kaovad ära siis kui terveks saad...“
Nazarenko: „Jah, nüüd juba on niisuguseid bio-
materjalist asju, mis paigutatakse inimese sisse ja
proteesid. Imenduvad või asendatakse kehaomaste
kudedega. Pole võimatu.“
Tanel: „Kas lihaspinget on kuidagi võimalik mõõta?
Kas seda mõõdetakse ja kas see on tähtis?“
Nazarenko: „On ikka. Lihaspinge jaoks mingisugust
Eesti aparaati kasutati.“(pealtnägija näide, kaaluta
olekus)
Kim: „Mõtlesime seda ka, et kas kui need kiibid
peaksid võimaldama harjutuse täpsust mõõta, kas
nad suudavad mõõta ka venituse täpsust? Venitus
osa on ka väga tähtis taastusravis.“
Tammeka: „Oleks hea aga ma ei kujuta ette kui-
das.“
Nazarenko: „Kui ta lähtub kiipide positsioneerimis-
est siis võibolla midagi on võimalik mõõta aga eks
sellest peabki lähtuma.“
Tammeka: „Kui panna kõõlusele, ülemineku kohale
siis see venivus seal praktiliselt puudub, see ei
anna meile midagi. Kui panna mahukale osale siis
seal võib kasu olla, oleneb kuhu need kiibid panna.“
Nazarenko: „Jah, oleneb kui täpselt me suudame
neid kiipe paigutada.“
Kim: „Esimese visiidi jooksul pannakse täpselt
paika. Võibolla peab paika sättima ja kohandama.
Kui me käisime erataasturavis asutuses, nende
viisidtasu on 32 euri. Siin on viisiditasu 3,2 eurot,
kas see ongi kogu kulu ja ülejäänud kompenseerib
haigekassa?“
Nazarenko: „Ei see ei kata tegelikult midagi see
3,2. See on keeruline küsimus, haigekassa hinnad
ei ole täpselt kulupõhised. Haigekassa arvutab

33
oma hinnad keskmise peale kokku ja see ei pruugi
kajastada tegelikku kulu konkreetses asutuses.
Toon illustreeriva näite, nii tegelikult ei ole aga
kirgastes värvides öeldes, kui ühes haiglas ravi-
takse patsiendi luumurdu, et luumurdu opereer-
itakse, pannakse mingite plaatide, kruvidega kinni
ja teises kohas kaalupommidega üle voodi ääre siis
haigekassa arvestab osakaalusid arvestades nende
kahe tegelikus elus asja keskmise. Üldiselt mis
puudutab taastusravi siis taastusravi hindadega
haigekassa eriti palju tegelenud ei ole, need on
ammustest aegadest ja selles avalikus süsteemis
ei pruugi kaugeltki kajastada oma tegelikke ku-
lusid.“
Kim: „See on siis mingi eelarveline keskmine prog-
noos?“
Nazarenko: „Nad ütlevad, et neil on tegevuspõhine
mudel, ABC mudel – activity based calculation. See
on konkreetse teenuse arvutamise mudel, kus on
palju tinglikkust. Alates sellest, et näiteks tööaja
kulu juures ei pruugi arvestada seda, kui palju
tegelikult kulub vaid võetakse mingisugused kest-
vused ja palgakulud. Võetakse miinimum palgad ja
korrutatakse koefitsentidega läbi ja see ei tähenda
seda, et tegelikult inimesed ka nii palju palka ka
saavad. Kui võtame kogu tervishoiuteenuste pi-
irhinnad mis üldse on Eestis kehtestatud valitsuse
poolt siis on hindasid, kus on natukene rohkem kui
kulub ja on hindasid kus on vähem kui kulub seda
raha. Ja seal, kus on rohkem kui kulub seal võib
olla tegemist mingisuguse optimeerimisega, mis ei
ole tingimata vajalik. See on suhteliselt keeruline
küsimus.
Kui te tahate raha juurde minna siis, rahaline di-
mensioon on alati väga oluline. Te saate öelda, et
mingisugused haigusrühmad põhjustavad ühiskon-
nale mingisuguse kahju ja teie oma tegevusega,
võimaldate seda kahju ennetada või välistada
– oluline. Veelkord, et katsuge mõelda sellele
lisaväärtusele, et te ei ütle, et te olemasolevaid
kulusid vähendate vaid pakute midagi juurde, mille
juurde pakkumine on suhteliselt soodne. Sellise
loogikaga. Ma olen ise radioloog ja ma võin öelda,
et digipiltide arhiveerimine mis on tohutult mahu-
kad, kuni 90 aastate II pooleni erinevates riikides,
erinevates ülikooli haiglates tuldi välja kontsep-
tidega kuidas alustada digiarhiveerimist. Alati
öeldi seda, et see vähendab kulusid ja tegelikult
kõik need juhatajad jne said kiirelt kinga, sest see
kunagi ei toiminud.“
Tanel: „Kas me sellest rääkisime, kui patsient tuleb
siis kas ta peab ka teenuste eest maksma?“
Nazarenko: „Osaliselt peab maksma ise.“
Tammeka: „Hinnakiri on olemas.“
Nazarenko: „Ma püüan väita seda, et vajadus on
tunduvalt suurem kui see, mis haigekassa tasustab
siis see nii-öelda inimese jaoks on kulu. Siin peab
mõtlema kui palju maksab teie poolt välja mõel-
dava toote kasutamine. Ega see ju tasuta ei tule“.
Kim: „Minu viimane küsimus, kui mõistlik ja õige on
haigla perspektiivis näha või vaadata seda rahalist
tasuvust?“
Nazarenko: „Kindlasti on mõistlik aga see on
omaette keeruline protsess.“
Kim: „Me püüdsime viisiditasude ja keskmise pat-
siendi - keskmine teenuste peale kulutatud raha, ja
vaadata, kas see patsientide juurdevool tasub ära
selle süsteemi kasutamisele võtu.“
Nazarenko: „Siin on võimalik minna seda teed, et
kõige rohkem hoiab kulusid kokku, kui meil oleks
võimalik haige võimalikult ruttu koju lasta. Et see
nii-öelda keskmise ravijuhu kestmise lühenemine.
Haigekassa kodulehel peaks olema ka kättesaadav
see, kui palju maksavad haiglas statsionaarsed
ravijuhud närvihaiguste ja nende luu-liigeste hai-
guste puhul. Siin ei ole võimalik öelda, seda peavad
hiljem tehtud uuringud selgitama, kui palju tänu
sellele tehnoloogiale saame seda lühendada. Saate
võtta hüpoteetilise arvu, et kui seda on võimalik
lühendada paar protsenti või 5 protsenti, et mis
siis see kokkuhoid oleks.“
Tanel: „ ...Teenuste hinnakiri on leitav?“
Nazarenko: „Haigekassa hinnakiri?“
Tanel: „Taastusravi.“
Nazarenko: „Me teeme praktiliselt haigekassa hin-
nakirja järgi.“
Tammeka: „Aga on neid asju, mida haigekassa ei
maksa.“
Nazarenko: „Haigekassa kodulehelt leiate hinna-
kirja.“
Tanel: „Aga just see pool, kui patsient peab ise
maksma teenuse eest?“
Nazarenko: „Võite lähtude sellest, et ta maksab/
võib maksta sama hinnakirja alusel(haigekassa).
See on miinimum millest võiks lähtuda.“
Tanel: „Viimane küsimus. Kui patsient on siin taas-
tusravis siis ta on statsionaarses haiglas. Kui ta
saadetakse koju, kas te annate ise kaasa mingeid
seadmeid, vahendeid?“
Birgit: „Kummilinte?“

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