Home care delivery through the mobile telecommunications platform: the Citizen Health System (CHS) perspective

Health delivery practices are shifting towards home care. The reasons are the better possibilities for managing chronic care, controlling health delivery costs, increasing quality of life and quality of health services and the distinct possibility of predicting and thus avoiding serious complications. For the above goals to become routine, new telemedicine and information technology (IT) solutions need to be implemented and integrated in the health delivery scene, and these solutions need to be assessed through evidence-based medicine in order to provide solid proof for their usefulness. Thus, the concept of contact or call centers has emerged as a new and viable reality in the field of IT for health and telemedicine. In this paper we describe a generic contact center that was designed in the context of an EU funded IST for health project with acronym Citizen Health System (CHS). Since the generic contact center is composed by a number of modules, we shall concentrate in the modules dealing with the communication between the patient and the contact center using mobile telecommunications solutions, which can act as link between the internet and the classical computer telephony communication means. We further elaborate on the development tools of such solutions, the interface problems we face, and on the means to convey information from and to the patient in an efficient and medically acceptable way. This application proves the usefulness of wireless technology in providing health care services all around the clock and everywhere the citizen is located, it proves the necessity for restructuring the medical knowledge for education delivery to the patient, and it shows the virtue of interactivity by means of using the limited, yet useful browsing capabilities of the wireless application protocol (WAP) technology.     

Opportunities and challenges of cloud computing to improve health care services

Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate the opportunities and challenges of this computing model. Strategic planning that could be used by a health organization to determine its direction, strategy, and resource allocation when it has decided to migrate from traditional to cloud-based health services is also discussed.     

Expanding multi-disciplinary approaches to healthcare information technologies: what does information systems offer medical informatics?

The effective use of information technology (IT) is a crucial component for the delivery of effective services in health care. Current approaches to medical informatics (MI) research have significantly contributed to the success of IT use in health care but important challenges remain to be addressed. We believe that expanding the multi-disciplinary basis for MI research is important to meeting these research challenges. In this paper, we outline theories and methods used in information systems (IS) research that we believe can inform our understanding of health care IT applications and outcomes. To do so, we discuss some general differences in the focus and methods of MI and IS research to identify broad opportunities. We then review conceptual and methodological approaches in IS that have been applied in health care IT research. These include: technology-use mediation, collaborative work, genre theory, interpretive research, action research, and modeling. Examples of these theories and methods in healthcare IS research are illustrated.     

Collaboration--a new IT-service in the next generation of regional health care networks

During the past 10–15 years, Regional Health Care Networks (RHCN) have been established in many regions throughout the world. RHCN build on well-known techniques, methodologies and appropriate standards. Most of the European Countries today have set up IT strategic plans that focus on the establishment of RHCN. The benefits of having access to all relevant information are tremendous and contribute to cost-effective and coherent health services. By the rapid spread and use of Internet, technology has made it possible to interconnect all kinds of applications. In 2000, the most experienced regions in Europe joined PICNIC, a European project to develop the Next Generation Regional Health Care Networks and to support their new ways of providing health and social care. The previous generation of Regional Health Care Networks supported the interconnection of applications by transfer of messages. Messaging is an effective means of integration for isolated high-specialised systems that only need to exchange data. This service will continue to be one of the most important services in the future health care networks. However, tighter coupling may be desirable in some instances to avoid replicating the same functionality in several applications. In other words, certain services can be common and used by a number of applications instead of building that service inside each application. These common services are called middleware services. In PICNIC (http://www.medcom.dk/picnic), a new middleware Collaboration IT service has been identified and developed. This service allows the end users to perform real-time clinical collaboration, with exchange of text, structured data, voice and images across the limits of a single region. A clinical collaboration is associated with the shared clinical context to provide a record of relevant clinical information and facilitates synchronous as well as asynchronous collaboration. This new IT service builds on the increasing popularity of instance messaging and presence systems that facilitate smooth transition between synchronous and asynchronous interaction. The new Collaboration IT service is expected to have a strong impact on the practice of health care in the next generation of Regional Health Care Networks.     

Considerations on the quality of medical software and information services

Fast developments in information and communication technology have made it possible to develop new services for citizens. One of the most interesting areas is health care. Medical knowledge is usually valid all over the world that makes the market global. Information services and decision support software are becoming important tools for medical professionals but also ordinary citizens are interested in health related information. It has been estimated that by the year 2010 the turnover of health care telematics industry may be close to that of the drug industry today. The nature of this global information industry is very different from any industry in history. Since there are no frontiers, no clear products and no shops in the information market, it is difficult to develop any effective legislation. However, the history of medicine has shown that health care sector cannot be free from regulation without risking citizens' health. The huge commercial potential of the Internet has already been used to promote products and services that have no proven effect on health and that may sometimes be even dangerous. In this paper we discuss the needs and possibilities to assess the quality of medical decision support software and information services. For brevity the terms medical software and medical knowledge are used, but the issues also relate to informatics systems used by any health professional, and to computerised systems used to schedule care or to organise record systems.     

Indicators of organizational readiness for clinical information technology/systems innovation: a Delphi study

The study presented in this article represents the second phase in a multi-phased research program focused on health care organization readiness for clinical information technology/system (IT/S) innovation. The overall purposes of this exploratory study were to: (1) validate the seven IT/S innovation readiness sub-dimensions of a heuristic organizational information technology/systems innovation model (OITIM) developed in phase one of the research program, and (2) identify indicators to assess the validated sub-dimensions. The study was conducted with an expert panel using a two-round modified Delphi technique. In Round #1, panelists supported retention of the OITIMs' seven theoretical IT/S innovation readiness sub-dimensions with an interrater agreement level range of 82-100%. Their sub-dimension importance ratings ranged from 3.27 to 3.72 (1=not important to 4=critically important) with the resources sub-dimension receiving the highest rating of 3.72. Panelists recommended that two sub-dimensions, 'Staffing and Skills' and 'Operations', be renamed to 'End-Users' and 'Management Structures', respectively, and that one sub-dimension, 'Administrative Support' be added. In Round #2, panelists identified a total of 316 indicators to assess the eight sub-dimensions. A two-step thematic analysis process was done with these indicators to reduce duplication and overlap. In Step 1, the investigator created ten preliminary theme categories per sub-dimension. In Step 2, a coding team categorized 279 (88%) of the 316 indicators into preliminary sub-dimension themes to create an organizational IT/S innovation readiness assessment taxonomy. This preliminary taxonomy was used to develop an organizational information technology/systems innovation readiness scale that is currently being pilot tested in phase three of the research program.     

Security of the distributed electronic patient record: a case-based approach to identifying policy issues

The growth of managed care and integrated delivery systems has created a new commodity, health information and the technology that it requires. Surveys by Deloitte and Touche indicate that over half of the hospitals in the US are in the process of implementing electronic patient record (EPR) systems. The National Research Council has established that industry spends as much as $15 billion on information technology (IT), an amount that is expanding by 20% per year. The importance of collecting, electronically storing, and using the information is undisputed. This information is needed by consumers to make informed choices; by physicians to provide appropriate quality clinical care: and by health plans to assess outcomes, control costs and monitor quality. The collection, storage and communication of a large variety of personal patient data, however, present a major dilemma. How can we provide the data required by the new forms of health care delivery and at the same time protect the personal privacy of patients? Recent debates concerning medical privacy legislation, software regulation, and telemedicine suggest that this dilemma will not be easily resolved. The problem is systemic and arises out of the routine use and flow of information throughout the health industry. Health care information is primarily transferred among authorized users. Not only is the information used for patient care and financial reimbursement, secondary users of the information include medical, nursing, and allied health education, research, social services, public health, regulation, litigation, and commercial purposes such as the development of new medical technology and marketing. The main threats to privacy and confidentiality arise from within the institutions that provide patient care as well as institutions that have access to patient data for secondary purposes.     

Using conceptual work products of health care to design health IT

This paper introduces a new, model-based design method for interactive health information technology (IT) systems. This method extends workflow models with models of conceptual work products. When the health care work being modeled is substantially cognitive, tacit, and complex in nature, graphical workflow models can become too complex to be useful to designers. Conceptual models complement and simplify workflows by providing an explicit specification for the information product they must produce. We illustrate how conceptual work products can be modeled using standard software modeling language, which allows them to provide fundamental requirements for what the workflow must accomplish and the information that a new system should provide. Developers can use these specifications to envision how health IT could enable an effective cognitive strategy as a workflow with precise information requirements. We illustrate the new method with a study conducted in an outpatient multiple sclerosis (MS) clinic. This study shows specifically how the different phases of the method can be carried out, how the method allows for iteration across phases, and how the method generated a health IT design for case management of MS that is efficient and easy to use.     

Informatics in the Croatian health care system

Informatization process of the Croatian health care system started relatively early. Computer processing of data of persons not covered by health insurance started in 1968 in Zagreb. Remetinec Health Center served as a model of computer data processing (CDP) in primary health care and Sveti Duh General Hospital in inpatient CDP, whereas hospital administration and health service were first introduced to Zagreb University Hospital Center and Sestre Milosrdnice University Hospital. At Varazdin Medical Center CDP for health care services started in 1970. Several registries of chronic diseases have been established: cancer, psychosis, alcoholism, and hospital registries as well as pilot registries of lung tuberculosis patients and diabetics. Health statistics reports on healthcare services, work accidents and sick-leaves as well as on hospital mortality started to be produced by CDP in 1977. Besides alphanumeric data, the modern information technology (IT) can give digital images and signals. Communication in health care system demands a standardized format of all information, especially for telemedicine. In 2000, Technical Committee for Standardization in Medical Informatics was founded in Croatia, in order to monitor the activities of the International Standardization Organization (ISO) and Comite Européen de Normalisation (CEN), and to implement their international standards in the Croatian standardization procedure. The HL7 Croatia has also been founded to monitor developments in the communication standard HL7. So far, the Republic of Croatia has a number of acts regulating informatization in general and consequently the informatization of the health care system (Act on Personal Data Confidentiality, Act on Digital Signature, Act of Standardization) enacted. The ethical aspect of data security and data protection has been covered by the Code of Ethics for medical informaticians. It has been established by the International Medical Informatics Association (IMIA), and the Croatian Society of Medical Informatics (CSMI) has translated it into Croatian and published it on its website. Based on a survey of medical staff attitudes toward health care system informatization, the Croatian health system appears to be ready for informatization. The only requirement is that the present and future health care providers have appropriate medical informatics education, proper computer equipment at their workplace, and an opportunity to participate in the development and/or improvement of the health information system. One of the EU health strategy priorities is the improvement of health information and knowledge. It means that integrated health information systems are required, i.e. systems able to provide key information on health and health care system to the politicians, health professionals and public in general.     

Information technology infusion model for health sector in a developing country: Nigeria as a case.

To date, information technology (IT) has not been widely adopted in the health sector in the developing countries. Information Technology may bring an improvement on health care delivery systems. It is one of the prime movers of globalization. Information technology infusion is the degree to which a different information technology tools are integrated into organizational activities. This study aimed to know the degree and the extent of incorporation of Information Technology in the Nigerian health sector and derive an IT infusion models for popular IT indicators that are in use in Nigeria (Personal computers, Mobile phones, and the Internet) and subsequently investigates their impacts on the health care delivery system in Nigerian teaching hospitals. In this study, data were collected through the use of questionnaires. Also, oral interviews were conducted and subsequently, the data gathered were analyzed. The results of the analysis revealed that out of the three IT indicators considered, mobile phones are spreading fastest. It also revealed that computers and mobile phones are in use in all the teaching hospitals. Finally in this research, IT infusion models were developed for health sector in Nigeria from the data gathered through the questionnaire and oral interview.     

Proactively Monitoring Departmental Clinical IT Systems with an Open Source Availability System

The goal of all radiology information technology (IT) support organizations is excellent customer service through the availability of critical clinical information services, such as picture archiving communication systems and radiology information systems. Despite these goals, IT support personnel often act like firefighters, reacting to each problem, but unable to prevent or predict other problems. Proactive support is always more desirable than reactive support. Warning signs may exist well before a technical issue becomes system wide or the user is affected. The objective for IT support organizations in health care should be to maximize system uptime by using proactive monitoring systems for failures and to automatically detect failures through systems management tools. We report on the implementation of Nagios, an open source monitoring tool, as an availability management system in a diagnostic imaging department and on customized applications and protocols specific to radiology needs.     

Determinants of physicians' technology acceptance for e-health in ambulatory care

BackgroundGermany is introducing a nation-wide telemedicine infrastructure that enables electronic health services. The project is facing massive resistance from German physicians, which has led to a delay of more than five years. Little is known about the actual burdens and drivers for adoption of e-health innovations by physicians.ObjectiveBased on a quantitative study of German physicians who participated in the national testbed for telemedicine, this article extends existing technology acceptance models (TAM) for electronic health (e-health) in ambulatory care settings and elaborates on determinants of importance to physicians in their decision to use e-health applications.MethodsThis study explores the opinions, attitudes, and knowledge of physicians in ambulatory care to find drivers for technology acceptance in terms of information technology (IT) utilization, process and security orientation, standardization, communication, documentation and general working patterns. We identified variables within the TAM constructs used in e-health research that have the strongest evidence to determine the intention to use e-health applications.ResultsThe partial least squares (PLS) regression model from data of 117 physicians showed that the perceived importance of standardization and the perceived importance of the current IT utilization (p < 0.01) were the most significant drivers for accepting electronic health services (EHS) in their practice. Significant influence (p < 0.05) was shown for the perceived importance of information security and process orientation as well as the documentation intensity and the e-health-related knowledge.ConclusionsThis study extends work gleaned from technology acceptance studies in healthcare by investigating factors which influence perceived usefulness and perceived ease of use of e-health services. Based on these empirical findings, we derive implications for the design and introduction of e-health services including suggestions for introducing the topic to physicians in ambulatory care and incentive structures for using e-health.     

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.     

Antecedents of open source software adoption in health care organizations: A qualitative survey of experts in Canada

PurposeOpen source software (OSS) adoption and use in health care organizations (HCOs) is relatively low in developed countries, but several contextual factors have recently encouraged the consideration of the possible role of OSS in information technology (IT) application portfolios. This article aims at developing a research model for investigating the antecedents of OSS adoption decisions in HCOs.MethodsBased on a conceptual framework derived from a synthesis of the literature on IT adoption in organizations, we conducted 18 semi-structured interviews with IT experts from all levels of the Province of Quebec's health and social services sector in Canada. We also interviewed 10 IT suppliers in the province. A qualitative data analysis of the interviews was performed to identify major antecedents of OSS adoption decisions in HCOs.ResultsEight factors associated with three distinct theoretical perspectives influence OSS adoption. More specifically, they are associated with the classical diffusion of innovations theory, the theory of resources, as well as institutional theory and its spin-off, the organizing vision theory. The factors fall under three categories: the characteristics of OSS as an innovation, the characteristics of the HCO with respect to its ability to absorb OSS, and the characteristics of the external environment with respect to institutional pressures and public discourse surrounding OSS. We shed light on two novel factors that closely interact with each other: (1) interest of the health care community in the public discourse surrounding OSS, and (2) clarity, consistency and richness of this discourse, whether found in magazines or other media.ConclusionsOSS still raises many questions and presents several challenges for HCOs. It is crucial that the different factors that explain an HCO's decision on OSS adoption be considered simultaneously. Doing so allows a better understanding of HCOs’ rationale when deciding to adopt, or not to adopt, OSS.     

The Technology Acceptance Model: Its past and its future in health care

Increasing interest in end users’ reactions to health information technology (IT) has elevated the importance of theories that predict and explain health IT acceptance and use. This paper reviews the application of one such theory, the Technology Acceptance Model (TAM), to health care. We reviewed 16 data sets analyzed in over 20 studies of clinicians using health IT for patient care. Studies differed greatly in samples and settings, health ITs studied, research models, relationships tested, and construct operationalization. Certain TAM relationships were consistently found to be significant, whereas others were inconsistent. Several key relationships were infrequently assessed. Findings show that TAM predicts a substantial portion of the use or acceptance of health IT, but that the theory may benefit from several additions and modifications. Aside from improved study quality, standardization, and theoretically motivated additions to the model, an important future direction for TAM is to adapt the model specifically to the health care context, using beliefs elicitation methods.     

Is there a role for telemedicine in adult allergy services?

Telemedicine refers to the application of telecommunication and information technology (IT) in the delivery of health and clinical care at a distance or remotely and can be broadly considered in two modalities: store‐and‐forward and real‐time interactive services. Preliminary studies have shown promising results in radiology, dermatology, intensive care, diabetes, rheumatology and primary care. However, the evidence is limited and hampered by small sample sizes, paucity of randomized control studies and lack of data relating to cost‐effectiveness, health‐related quality of life and patient and clinician satisfaction. This review appraises the evidence from studies that have employed telemedicine tools in other disciplines and makes suggestions for its potential applications in specific clinical scenarios in adult allergy services. Possible examples include: triaging patients to determine the need for allergy tests; pre‐assessment for specialized treatments such as allergen immunotherapy, follow‐up to assess treatment response and side effects; and education in self‐management plan including training updates for self‐injectable adrenaline and nasal spray use. This approach might improve access for those with limited mobility or living far away from regional centres, as well as bringing convenience and cost savings for the patient and service provider. These potential benefits need to be carefully weighed against evidence of service safety and quality. Keys to success include delineation of appropriate clinical scenarios, patient selection, training, IT support and robust information governance framework. Well‐designed prospective studies are needed to evaluate its role.     

Information technology as tool for change

It looks that networking welfare thinking and implementations of network projects only follow the development of data transfer possibilities. It is a danger that seamless chain of care in health care is just a data transferring generator based on easy connections, only creating needs for new data transferring. This is an 'illusion of core skills' that does not extend to the development of the contents of services. Easy access to the system makes more contacts and need for more also clinical services. New needs for data transfer burden the personnel with unnecessary information and networking functional model does not emancipate them to use their substantial skills. It means more costs and it is also a danger that normal life will be medicated. Public sector cannot finance all these new possibilities and consequences of modern technology. Does all this create a new combination of public and private sector and push them to allocate responsibilities in developing work? If the public and private sectors do not find the balance in controlling this development, also actors outside health care get to influence the choices and health care loses its autonomy. It becomes a business means for companies producing data transfer and network services. From the prioritization point of view this is not a good vision for financing and delivery of health care services either in public or private sector.     

Exploring nurses’ confirmed expectations regarding health IT: A phenomenological study

Health information technology (IT) benefits both patients and providers with respect to health care quality and perceived usefulness. Although existing research provides a preliminary understanding of nurses’ perception of health IT, perceptions do not guide actions. This phenomenological study explored nurses’ perceptions regarding electronic health records and bar code medication administration four months post implementation on a medical–surgical unit in an academic medical center. Ten staff nurses (8 females and 2 males) participated. We categorized the results into five themes from personal-level to organizational-level confirmed expectations: (1) nurses’ interaction with computer, (2) nursing performance regarding task accomplishment, (3) unit-specific teamwork, (4) interdisciplinary teamwork, and (5) quality of care. We discovered that effective health IT must be congruent with nursing expectations. IT professionals, nursing and organizational leaders may use findings to structure an environment supportive of effective health IT in nursing practice.     

Use of a Wiki as a Radiology Departmental Knowledge Management System

Information technology teams in health care are tasked with maintaining a variety of information systems with complex support requirements. In radiology, this includes picture archive and communication systems, radiology information systems, speech recognition systems, and other ancillary systems. Hospital information technology (IT) departments are required to provide 24 × 7 support for these mission-critical systems that directly support patient care in emergency and other critical care departments. The practical know-how to keep these systems operational and diagnose problems promptly is difficult to maintain around the clock. Specific details on infrequent failure modes or advanced troubleshooting strategies may reside with only a few senior staff members. Our goal was to reduce diagnosis and recovery times for issues with our mission-critical systems. We created a knowledge base for building and quickly disseminating technical expertise to our entire support staff. We used an open source, wiki-based, collaborative authoring system internally within our IT department to improve our ability to deliver a high level of service to our customers. In this paper, we describe our evaluation of the wiki and the ways in which we used it to organize our support knowledge. We found the wiki to be an effective tool for knowledge management and for improving our ability to provide mission-critical support for health care IT systems.     

The impact of clinical leadership on health information technology adoption: Systematic review

PurposeTo conduct a systematic review to examine evidence of associations between clinical leadership and successful information technology (IT) adoption in healthcare organisations.MethodsWe searched Medline, Embase, Cinahl, and Business Source Premier for articles published between January 2000 to May 2013 with keywords and subject terms related to: (1) the setting – healthcare provider organisations; (2) the technology – health information technology; (3) the process – adoption; and (4) the intervention – leadership. We identified 3121 unique citations, of which 32 met our criteria and were included in the review. Data extracted from the included studies were assessed in light of two frameworks: Bassellier et al.’s IT competence framework; and Avgar et al.’s health IT adoption framework.ResultsThe results demonstrate important associations between the attributes of clinical leaders and IT adoption. Clinical leaders who have technical informatics skills and prior experience with IT project management are likely to develop a vision that comprises a long-term commitment to the use of IT. Leaders who possess such a vision believe in the value of IT, are motivated to adopt it, and can maintain confidence and stability through the adversities that IT adoptions often entail. This leads to proactive leadership behaviours and partnerships with IT professionals that are associated with successful organisational and clinical outcomes.ConclusionsThis review provides evidence that clinical leaders can positively contribute to successful IT adoption in healthcare organisations. Clinical leaders who aim for improvements in the processes and quality of care should cultivate the necessary IT competencies, establish mutual partnerships with IT professionals, and execute proactive IT behaviours to achieve successful IT adoption.