Factors influencing health information technology adoption in Thailand's community health centers: Applying the UTAUT model

Background

One of the most important factors for the success of health information technology (IT) implementation is users’ acceptance and use of that technology. Thailand has implemented the national universal healthcare program and has been restructuring the country's health IT system to support it. However, there is no national data available regarding the acceptance and use of health IT in many healthcare facilities, including community health centers (CHCs). This study employed a modified Unified Theory of Acceptance and Use of Technology (UTAUT) structural model, to understand factors that influence health IT adoption in community health centers in Thailand and to validate this extant IT adoption model in a developing country health care context.

Methods

An observational research design was employed to study CHCs’ IT adoption and use. A random sample of 1607 regionally stratified CHC's from a total of 9806 CHCs was selected. Data collection was conducted using a cross-sectional survey by means of self-administered questionnaire with an 82% response rate. The research model was applied using the partial least squares (PLS) path modeling.

Results

The data showed that people who worked in CHCs exhibited a high degree of IT acceptance and use. The research model analyses suggest that IT acceptance is influenced by performance expectancy, effort expectancy, social influence and voluntariness. Health IT use is predicted by previous IT experiences, intention to use the system, and facilitating conditions.

Conclusions

Health IT is pervasive and well adopted by CHCs in Thailand. The study results have implications for both health IT developmental efforts in Thailand and health informatics research. This study validated the UTAUT model in the field context of a developing country's healthcare system and demonstrated that the PLS path modeling works well in a field study and in exploratory research with a complex model.     

The role of ethics in information technology decisions: a case-based approach to biomedical informatics education

The purpose of this paper is to propose a case-based approach to instruction regarding ethical issues raised by the use of information technology (IT) in healthcare. These issues are rarely addressed in graduate degree and continuing professional education programs in health informatics. There are important reasons why ethical issues need to be addressed in informatics training. Ethical issues raised by the introduction of information technology affect practice and are ubiquitous. These issues are frequently among the most challenging to young practitioners who are ill prepared to deal with them in practice. First, the paper provides an overview of methods of moral reasoning that can be used to identify and analyze ethical problems in health informatics. Second, we provide a framework for defining cases that involve ethical issues and outline major issues raised by the use of information technology. Specific cases are used as examples of new dilemmas that are posed by the introduction of information technology in healthcare. These cases are used to illustrate how ethics can be integrated with the other elements of informatics training. The cases discussed here reflect day-to-day situations that arise in health settings that require decisions. Third, an approach that can be used to teach ethics in health informatics programs is outlined and illustrated.     

Computer-based execution of clinical guidelines: a review

Purpose

Clinical guidelines are useful tools to standardize and improve health care. The automation of the guideline execution process is a basic step towards its widespread use in medical centres. This paper presents an analysis and a comparison of eight systems that allow the enactment of clinical guidelines in a (semi) automatic fashion.

Methods

This paper presents a review of the literature (2000-2007) collected from medical databases as well as international conferences in the medical informatics area.

Results

Eight systems containing a guideline execution engine were selected. The language used to represent the guidelines as well as the architecture of these systems were compared. Different aspects have been assessed for each system, such as the integration with external elements or the coordination mechanisms used in the execution of clinical guidelines. Security and terminology issues complement the above study.

Conclusions

Although these systems could be beneficial for clinicians and patients, it is an ongoing research area, and they are not yet fully implemented and integrated into existing careflow management systems and hence used in daily practice in health care institutions.     

Patients' attitudes towards sharing their health information

OBJECTIVES: The current policies of the governments of Australia and New Zealand encourage the use of electronic information systems to exchange patient information between various stakeholders. This research investigated (1) the attitudes of patients toward sharing their medical information and (2) whether patients considered themselves to be well-informed about the uses that are made of their information. METHODS: A questionnaire survey of adult primary-care patients was conducted in five clinics within a medium sized New Zealand city. Outcome measures were the proportions of respondents willing to share different categories of their information with different classes of recipients. Patients' evaluations of their knowledge about the uses made of their information were also collected. RESULTS: Over 200 responses were collected from five clinics. Respondents' attitudes toward sharing their information were found to be influenced by three factors. (1) Identity of recipient: whilst respondents were generally willing to have their information shared between health professionals, they were increasingly unwilling for it to be distributed to other stakeholders, such as administrators, researchers or other government departments. (2) Level of anonymity: respondents were more prepared to share anonymous information. (3) Type of information: respondents were increasingly unwilling to share their information as it takes on a more personal nature. Respondents were also found to be very poorly informed about the use of their information, 90% of respondents indicated that they had either incomplete or no knowledge of how their information was shared and 79% had no knowledge of the uses of their National Health Index (NHI) number. The findings also indicate that respondents would prefer to be consulted about the distribution of their information. CONCLUSIONS: These findings indicate that many respondents were unwilling to have their personal information distributed other than for purposes of clinical care and a sizeable proportion of the respondents would like to be consulted before their information is released. The high level of interest and concern that this research revealed among respondents, suggests that more attention should be directed towards ensuring that patients are fully informed about current information sharing practices. The findings also imply that the design and development of future systems should also incorporate sophisticated and flexible access control policies that can be adapted to meet the preferences of individual patients.     

Optimization of infobutton design and Implementation: A systematic review

ObjectiveInfobuttons are clinical decision tools embedded in the electronic health record that attempt to link clinical data with context sensitive knowledge resources. We systematically reviewed technical approaches that contribute to improved infobutton design, implementation and functionality.MethodsWe searched databases including MEDLINE, EMBASE, and the Cochrane Library database from inception to March 1, 2016 for studies describing the use of infobuttons. We selected full review comparative studies, usability studies, and qualitative studies examining infobutton design and implementation. We abstracted usability measures such as user satisfaction, impact, and efficiency, as well as prediction accuracy of infobutton content retrieval algorithms and infobutton adoption/interoperability.ResultsWe found 82 original research studies on infobuttons. Twelve studies met criteria for detailed abstraction. These studies investigated infobutton interoperability (1 study); tools to help tailor infobutton functionality (1 study); interventions to improve user experience (7 studies); and interventions to improve content retrieval by improving prediction of relevant knowledge resources and information needs (3 studies). In-depth interviews with implementers showed the Health Level Seven (HL7) Infobutton standard to be simple and easy to implement. A usability study demonstrated the feasibility of a tool to help medical librarians tailor infobutton functionality. User experience studies showed that access to resources with which users are familiar increased user satisfaction ratings; and that links to specific subsections of drug monographs increased information seeking efficiency. However, none of the user experience improvements led to increased usage uptake. Recommender systems based on machine learning algorithms outperformed hand-crafted rules in the prediction of relevant resources and clinicians’ information needs in a laboratory setting, but no studies were found using these techniques in clinical settings. Improved content indexing in one study led to improved content retrieval across three health care organizations.ConclusionBest practice technical approaches to ensure optimal infobutton functionality, design and implementation remain understudied. The HL7 Infobutton standard has supported wide adoption of infobutton functionality among clinical information systems and knowledge resources. Limited evidence supports infobutton enhancements such as links to specific subtopics, configuration of optimal resources for specific tasks and users, and improved indexing and content coverage. Further research is needed to investigate user experience improvements to increase infobutton use and effectiveness.     

The impact of inaccurate Internet health information in a secondary school learning environment

Background

Patients in the United States commonly use the Internet to acquire health information. While a significant amount of health-related information is available on the Internet, the accuracy of this information is highly variable.

Objectives

The objective of the study was to determine how effectively students can assess the accuracy of Internet-based material when gathering information on a controversial medical topic using simple keyword searches.

Methods

A group of 34 students from the science magnet high school in Houston, Texas searched for the terms “vaccine safety” and “vaccine danger” using Google and then answered questions regarding the accuracy of the health information on the returned sites. The students were also asked to describe the lessons they learned in the exercise and to answer questions regarding the strength of evidence for seven statements regarding vaccinations. Because of the surprising revelation that the majority of students left the exercise with inaccurate information concerning the safety and efficacy of vaccines, these same students participated in a follow-up study in which a fact-based vaccine video was shown, after which the assessment of student knowledge was repeated.

Results

Of the 34 participants, 20 (59%) thought that the Internet sites were accurate on the whole, even though over half of the links (22 out of 40, 55%) that the students viewed were, in fact, inaccurate on the whole. A high percentage of the students left the first exercise with significant misconceptions about vaccines; 18 of the 34 participants (53%) reported inaccurate statements about vaccines in the lessons they learned. Of the 41 verifiable facts about vaccines that were reported by participants in their lessons-learned statement, 24 of those facts (59%) were incorrect. Following presentation of the film, the majority of students left the exercise with correct information about vaccines, based on their lessons-learned statement. In this case, 29 of the 31 participants (94%) reported accurate information about vaccines. Of the 49 verifiable facts about vaccines that were reported by participants, only 2 (4%) were incorrect. Students had higher correct scores in the “strength of evidence” exercise following exposure to the video as well.

Conclusions

Allowing students to use the Internet to gain information about medical topics should be approached with care since students may take away predominantly incorrect information. It is important to follow up conflicting information with a solid, unambiguous message that communicates those lessons that the instructor deems most important. This final message should be fact based but may need to contain an anecdotal component to counter the strong emotional message that is often delivered by inaccurate Internet sites.     

Visions and strategies to improve evaluation of health information systems. Reflections and lessons based on the HIS-EVAL workshop in Innsbruck

BACKGROUND: Health care is entering the Information Society. It is evident that the use of modern information and communication technology offers tremendous opportunities to improve health care. However, there are also hazards associated with information technology in health care. Evaluation is a means to assess the quality, value, effects and impacts of information technology and applications in the health care environment, to improve health information applications and to enable the emergence of an evidence-based health informatics profession and practice. OBJECTIVE: In order to identify and address the frequent problems of getting evaluation understood and recognised, to promote transdisciplinary exchange within evaluation research, and to promote European cooperation, the Exploratory Workshop on "New Approaches to the Systematic Evaluation of Health Information Systems" (HIS-EVAL) was organized by the University for Health Sciences, Medical Informatics and Technology (UMIT), Innsbruck, Austria, in April 2003 with sponsorship from the European Science Foundation (ESF). Methods: The overall program was structured in three main parts: (a). discussion of problems and barriers to evaluation; (b). defining our visions and strategies with regard to evaluation of health information systems; and (c). organizing short-term and long-term activities to reach those visions and strategies. RESULTS: The workshop participants agreed on the Declaration of Innsbruck (see ), comprising four observations and 12 recommendations with regard to evaluation of health information systems. Future activities comprise European networking as well as the development of guidelines and standards for evaluation studies. CONCLUSION: The HIS-EVAL workshop was intended to be the starting point for setting up a network of European scientists working on evaluation of health information systems, to obtain synergy effects by combining the research traditions from different evaluation fields, leading to a new dimension and collaboration on further research on information systems' evaluation.     

An international course on strategic information management for medical informatics students: aim, content, structure, and experiences

We report on a course for medical informatics students on hospital information systems, especially on its strategic information management. Starting as course at the Medical Informatics Program of the University of Heidelberg/University of Applied Sciences Heilbronn, it is now organized as international course in the framework of the International Partnership for Health Informatics Education (http:// www.iphie.org) jointly for medical information science students from the University of Amsterdam, medical informatics students, as well as health information management students from the Universities of Heidelberg/Heilbronn. In 2002, medical informatics students from the Master of Science program of the newly founded University for Health Informatics and Technology Tyrol (UMIT) at Innsbruck, Austria, joined. We report about the aim of this course, its audience, and the educational programs involved, about its content and structure, as well as about our experiences gained so far.     

The impact of information technology on histopathology

Pathology is one of the most computer intensive areas of medicine and as a result diagnostic pathologists in histopathology have often been at the cutting edge of computer literacy. The majority of laboratories use laboratory information systems to issue and store pathology reports. Many of these systems provide the diagnostician with the ability to retrieve reports and cases using coding systems such as SNOMED, but more advanced computer facilities that might assist the pathologist in the diagnosis or interpretation of a case are often lacking. In recent years advances in computer technology have begun to have a much wider impact on the practice of medicine and newer technologies are beginning to find their way into the reporting room. In this review, I cover some of the recent and emerging advances in IT that have the potential to revolutionize the practice of diagnostic histopathology in the next 5 years. The major area of telepathology has been a subject of several recent reviews and will not be covered here.     

The impact and utility of encounter patient decision aids: Systematic review,meta-analysis and narrative synthesis

Objective

To determine the effect of encounter patient decision aids (PDAs) as evaluated in randomized controlled trials (RCTs) and conduct a narrative synthesis of non-randomized studies assessing feasibility, utility and their integration into clinical workflows.

Health information overload among health consumers: A scoping review

ObjectiveTo examine and identify the scope of research addressing health information overload in consumers.MethodsIn accordance with a published protocol, six electronic databases (PubMed, CINAHL, ERIC, PsycINFO, Embase, and Scopus), reference lists of included articles, and grey literature (Google Advanced Search and WorldCat) were searched. Articles in English were included, without any limit on the date of publication.ResultsOf the 69 records included for final analysis, 22 studies specifically examined health information overload, whereas the remainder peripherally discussed the concept alongside other concepts. The 22 studies focused on one or more of the following: 1) ways to measure health information overload (multi-item/single-item scales); 2) predictors of health information overload - these included low education level, health literacy, and socioeconomic status; and 3) interventions to address information overload, such as videotaped consultations or written materials. Cancer information overload was a popular topic amongst studies that focused on information overload.ConclusionBased on the identified studies, there is a clear need for future studies that investigate health information overload in consumers with chronic medical conditions other than cancer.Practice ImplicationsThis review is the initial step in facilitating future efforts to create health information that do not overload consumers.     

The influence of online health information on health decisions: A systematic review

ObjectivesThis systematic review assessed the influence of online health information (OHI) search behaviour on health and medical decisions.MethodsEligible studies were identified by searching electronic databases PubMed, Scopus, and CINAHL in February 2020 for studies reporting OHI search behaviour and its influence on health decisions. Information was extracted pertaining to either consumers’ (self-reported) perceptions of the influence of OHI on decision-making or the association between online search behaviour and health decision-making.ResultsA total of 3995 articles were screened, with 48 included in the final analysis. The reviewed studies indicated that OHI assisted in making subsequent health related decisions such as asking questions during a consultation, increased professional visits, improved adherence to the advice of a physician, being more compliant with taking medication, and improved self-care.ConclusionConsumers largely used OHI to support information provided by their physicians. The strength of the patient-provider relationship was considered important in moderating the potential negative outcomes of OHI.Practice implicationsHealth care systems have a unique opportunity to direct OHI search behaviours towards empowering consumers to engage as an informed, active and joint decision-maker in their own health care.     

Cognitive systems at the point of care: The CREDO program

CREDO is a framework for understanding human expertise and for designing and deploying systems that support cognitive tasks like situation and risk assessment, decision-making, therapy planning and workflow management. The framework has evolved through an extensive program of research on human decision-making and clinical practice. It draws on concepts from cognitive science, and has contributed new results to cognitive theory and understanding of human expertise and knowledge-based AI. These results are exploited in a suite of technologies for designing, implementing and deploying clinical services, early versions of which were reported by Das et al. (1997) [9] and Fox and Das (2000) [26]. A practical outcome of the CREDO program is a technology stack, a key element of which is an agent specification language (PROforma: Sutton and Fox (2003) [55]) which has proved to be a versatile tool for designing point of care applications in many clinical specialties and settings. Since software became available for implementing and deploying PROforma applications many kinds of services have been successfully built and trialed, some of which are in large-scale routine use. This retrospective describes the foundations of the CREDO model, summarizes the main theoretical, technical and clinical contributions, and discusses benefits of the cognitive approach.     

Balancing volume and duration of information consumption by physicians: The case of health information exchange in critical care

BackgroundThe realization of the potential benefits of health information exchange systems (HIEs) for emergency departments (EDs) depends on the way these systems are actually used. The attributes of volume of information and duration of information processing are important for the study of HIE use patterns in the ED, as cognitive load and time constraints may result in a trade-off between these attributes. Experts and non-experts often use different problem-solving strategies, which may be consequential for their system use patterns. Little previous research focuses on the trade-off between volume and duration of system use or on the factors that affect it, including user expertise.ObjectivesThis study aims at exploring the trade-off of volume and duration of use, examining whether this relationship differs between experts and non-experts, and identifying factors that are associated with use patterns characterized by volume and duration.MethodsThe research objectives are pursued in the context of critically-ill patients, treated at a busy ED in the period 2010–2012. The primary source of internal and external data is an HIE linked to 14 hospitals, over 1300 clinics, and other clinical facilities. We define four use profiles based on the attributes of duration and volume: quick and basic, quick and deep, slow and basic, and slow and deep. The volume and duration of use are computed using HIE log files as the number of screens and the time per screen, respectively. Each session is then classified into a specific profile based on distances from predefined profile centroids. Experts are physicians that are board-certified in emergency medicine. We test the distribution of use profiles and their associations with multiple variables that describe the patient, physician, situation, information available in the HIE system, and use dynamics within the encounter.ResultsThe quick and basic profile is the most prevalent. While available admission summaries are associated with quick and basic use, lab and imaging results are associated with slower or deeper use. Physicians who are the first to use the system or are sole users during an encounter are less inclined to quick and deep use. These effects are intensified for experts.DiscussionA trade-off between volume and duration is identified. While system use is overall similar for experts and non-experts, the circumstances in which a certain profile is more likely to be observed vary across these two groups. Information availability and multiple-physician dynamics within the encounter emerge as important for the prediction of use profiles. The findings of this study provide implications for the design, implementation, and research of HIE use.     

Organizational issues in the implementation and adoption of health information technology innovations: An interpretative review

PurposeImplementations of health information technologies are notoriously difficult, which is due to a range of inter-related technical, social and organizational factors that need to be considered. In the light of an apparent lack of empirically based integrated accounts surrounding these issues, this interpretative review aims to provide an overview and extract potentially generalizable findings across settings.MethodsWe conducted a systematic search and critique of the empirical literature published between 1997 and 2010. In doing so, we searched a range of medical databases to identify review papers that related to the implementation and adoption of eHealth applications in organizational settings. We qualitatively synthesized this literature extracting data relating to technologies, contexts, stakeholders, and their inter-relationships.ResultsFrom a total body of 121 systematic reviews, we identified 13 systematic reviews encompassing organizational issues surrounding health information technology implementations. By and large, the evidence indicates that there are a range of technical, social and organizational considerations that need to be deliberated when attempting to ensure that technological innovations are useful for both individuals and organizational processes. However, these dimensions are inter-related, requiring a careful balancing act of strategic implementation decisions in order to ensure that unintended consequences resulting from technology introduction do not pose a threat to patients.ConclusionsOrganizational issues surrounding technology implementations in healthcare settings are crucially important, but have as yet not received adequate research attention. This may in part be due to the subjective nature of factors, but also due to a lack of coordinated efforts toward more theoretically-informed work. Our findings may be used as the basis for the development of best practice guidelines in this area.     

An Integrated Model for Patient Care and Clinical Trials (IMPACT) to support clinical research visit scheduling workflow for future learning health systems

We describe a clinical research visit scheduling system that can potentially coordinate clinical research visits with patient care visits and increase efficiency at clinical sites where clinical and research activities occur simultaneously. Participatory Design methods were applied to support requirements engineering and to create this software called Integrated Model for Patient Care and Clinical Trials (IMPACT). Using a multi-user constraint satisfaction and resource optimization algorithm, IMPACT automatically synthesizes temporal availability of various research resources and recommends the optimal dates and times for pending research visits. We conducted scenario-based evaluations with 10 clinical research coordinators (CRCs) from diverse clinical research settings to assess the usefulness, feasibility, and user acceptance of IMPACT. We obtained qualitative feedback using semi-structured interviews with the CRCs. Most CRCs acknowledged the usefulness of IMPACT features. Support for collaboration within research teams and interoperability with electronic health records and clinical trial management systems were highly requested features. Overall, IMPACT received satisfactory user acceptance and proves to be potentially useful for a variety of clinical research settings. Our future work includes comparing the effectiveness of IMPACT with that of existing scheduling solutions on the market and conducting field tests to formally assess user adoption.