eHealth Adoption Research Articles

Designing an Electronic Patient Management System for Multiple Sclerosis: Building a Next Generation Multiple Sclerosis Documentation System.

BackgroundTechnologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients and their physicians as well as among health care professionals. Today, every part of the treatment process from diagnosis, treatment selection, and application to patient education and long-term care may be enhanced by a quality-assured implementation of health information technology (HIT) that also takes data security standards and concerns into account. In order to increase the level of effectively realized benefits of eHealth services, a user-driven needs assessment should ensure the inclusion of health care professional perspectives into the process of technology development as we did in the development process of the Multiple Sclerosis Documentation System 3D. After analyzing the use of information technology by patients suffering from multiple sclerosis, we focused on the needs of neurological health care professionals and their handling of health information technology.ObjectiveTherefore, we researched the status quo of eHealth adoption in neurological practices and clinics as well as health care professional opinions about potential benefits and requirements of eHealth services in the field of multiple sclerosis.MethodsWe conducted a paper-and-pencil–based mail survey in 2013 by sending our questionnaire to 600 randomly chosen neurological practices in Germany. The questionnaire consisted of 24 items covering characteristics of participating neurological practices (4 items), the current use of network technology and the Internet in such neurological practices (5 items), physicians’ attitudes toward the general and MS-related usefulness of eHealth systems (8 items) and toward the clinical documentation via electronic health records (4 items), and physicians’ knowledge about the Multiple Sclerosis Documentation System (3 items).ResultsFrom 600 mailed surveys, 74 completed surveys were returned. As much as 9 of the 10 practices were already connected to the Internet (67/74), but only 49% preferred a permanent access. The most common type of HIT infrastructure was a complete practice network with several access points. Considering data sharing with research registers, 43% opted for an online interface, whereas 58% decided on an offline method of data transmission. eHealth services were perceived as generally useful for physicians and nurses in neurological practices with highest capabilities for improvements in clinical documentation, data acquisition, diagnosis of specific MS symptoms, physician-patient communication, and patient education. Practices specialized in MS in comparison with other neurological practices presented an increased interest in online documentation. Among the participating centers, 91% welcomed the opportunity of a specific clinical documentation for MS and 87% showed great interest in an extended and more interconnected electronic documentation of MS patients. Clinical parameters (59/74) were most important in documentation, followed by symptomatic parameters like measures of fatigue or depression (53/74) and quality of life (47/74).ConclusionsPhysicians and nurses may significantly benefit from an electronically assisted documentation and patient management. Many aspects of patient documentation and education will be enhanced by eHealth services if the most informative measures are integrated in an easy-to-use and easily connectable approach. MS-specific eHealth services were highly appreciated, but the current level of adoption is still behind the level of interest in an extended and more interconnected electronic documentation of MS patients.

Factors Influencing Physicians' Acceptance of e-Health in Developing Country

E-Health is one of the solutions to provide better access for patients and physician to healthcare facilities. In developing countries, e-Health is particularly important due to a shortage of physician and medical workers. Although most physicians in developing countries like Bangladesh acknowledge the benefits of e-Health, low adoption is not uncommon. The objective of this study is to identify the critical factors affecting e-Health adoption among physicians in Bangladesh. A cross-sectional survey questionnaire method was used for this study. The structural equation modeling (SEM) with the partial least square (PLS) approach was used to analyze the data. The study found that Performance Expectancy, Effort Expectancy, Social Influence and Personal Innovativeness had a significant impact on the behavioral intention to use e-Health, while Facilitating Conditions had no significant effect. The findings of this study will facilitate the degree of more acceptance of new technology by the physicians for their own betterment.

National health models and the adoption of eHealth and ePrescribing in primary care – new evidence from Europe

ObjectiveRecent research from the European Commission (EC) suggests that the development and adoption of eHealth in primary care is significantly influenced by the context of the national health model in...

Guided Internet-Based Parent Training for Challenging Behavior in Children With Fetal Alcohol Spectrum Disorder (Strongest Families FASD): Study Protocol for a Randomized Controlled Trial

BackgroundFetal alcohol spectrum disorder (FASD) is a term used to encompass the full range of neurobehavioral and cognitive dysfunction that may occur as a consequence of prenatal alcohol exposure. There is relatively little research on intervention strategies that specifically target the behavioral problems of children with FASD. Availability and access to services are barriers to timely and effective care for families. The Strongest Families FASD intervention was recently adapted from the Strongest Families “Parenting the Active Child” program to include FASD-specific content delivered via an Internet-based application in conjunction with 11 telephone coaching sessions.ObjectiveOur objectives are to (1) evaluate the effectiveness of Strongest Families FASD in reducing externalizing problems (primary outcome), internalizing problems, and parent distress (secondary outcomes) in children aged between 4 and 12 years diagnosed with FASD when compared to a control group with access to a static resource Web page; (2) evaluate the effectiveness of Strongest Families FASD in improving social competence (secondary outcome) in school-aged children aged between 6 and 12 diagnosed with FASD when compared with an online psychoeducation control; and (3) explore parental satisfaction with the Strongest Families FASD online parenting program.MethodsParents and caregivers (N=200) of children diagnosed with FASD who have significant behavioral challenges, ages 4-12, are being recruited into a 2-arm randomized trial. The trial is designed to evaluate the effectiveness of the Web-based Strongest Families FASD parenting intervention on child behavior and caregiver distress, compared to a control group receiving access to a static resource Web page (ie, a list of FASD-specific websites, readings, videos, and organizations).ResultsThe primary outcome will be externalizing problems measured by the Child Behavior Checklist (CBCL). Secondary outcomes include (1) internalizing problems and (2) social competence, both measured by the CBCL; and (3) parental distress measured by the Depression Anxiety Stress Scale-21. The Client Satisfaction Questionnaire-8 (CSQ-8) and the Satisfaction Survey are completed by the intervention group at the end of session 11. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials (CONSORT) Statement.ConclusionsIt is hypothesized that the Strongest Families FASD intervention group will improve child behavior and parental distress. Caregiver satisfaction is anticipated to be positive. Advancing evidence on the effectiveness and acceptance of distance services can inform policy and adoption of eHealth programs.ClinicalTrialClinicalTrials.gov NCT02210455; https://clinicaltrials.gov/ct2/show/NCT02210455 (Archived by WebCite at http://www.webcitation.org/6bbW5BSsT)

Cultural Influence on Adoption and Use of e-Health: Evidence in Bangladesh.

E-health is an important initiative among the public and private hospitals in Bangladesh in the last few years. The factors influencing e-health adoption have been a well-investigated research area in both developed and developing countries. However, there have been only a few studies exploring the role of cultural factors in the adoption and use of e-health, particularly in developing countries. In this study, we investigated the influence of culture on the adoption of e-health in Bangladesh. This study developed a more adequate research framework by integrating Hofstede's cultural dimension model and the Technology Acceptance Model (TAM). A structured questionnaire was used to collect data from respondents in different private and public hospitals in Bangladesh. The partial least squares method, a statistical analysis technique based on the Structural Equation Model, was used to analyze the collected data. The study found that cultural dimensions such as Power Distance, Masculinity, and Restraint had significant impacts on Intention to Use e-Health, whereas Uncertainty Avoidance, Collectivism, and Pragmatism had no significant impact on Intention to Use e-Health in Bangladesh. The results also revealed that Perceived Usefulness was a significant indicator of e-health adoption decisions, whereas Perceived Ease of Use was an insignificant predictor of e-health adoption. The findings of this study may assist governments, organizations, and policy makers to understand the key factors affecting e-health adoption and to develop strategies and policies to enhance e-health services in Bangladesh.

Cloud Computing Framework for E-Health in Ghana: Adoption Issues and Strategies: Case Study of Ghana Health Service

professionals do not always have all the information they require and at the time when it is most needed to make rapid patient-care decisions. Also healthcare services are still being provided using manual tools and technologies. The adoption of current technologies such as Cloud Computing provides an avenue to overcome these challenges. This paper therefore measures the ICT awareness of stakeholders in healthcare while also providing an evidence of the possibility of cloud implementation by Ghana Health Services (GHS) in relation to the ICT awareness of stakeholders. It also provides a framework for a cloud based E-Health adoption by the GHS.

Security and privacy in cloud-assisted wireless wearable communications: Challenges, solutions, and future directions

Cloud-assisted wireless wearable communications have been increasingly pervasive with the profound development of sensor, wireless communication, and cloud computing technologies, in addition to the wide adoption of e-health, location-based service, and mobile smart communities. In this article we mainly focus on the goals and tactics of privacy-preserving data aggregation in cloud-assisted wireless wearable communications. With respect to the unique security and privacy requirements and the efficiency consideration for resource-constrained wearable devices, we identify the inappropriateness of secure multiparty computation and fully homomorphic encryption and give new generalized solutions to tackle the challenging issue of efficient privacy-preserving data aggregation and outsourced computation in wireless wearable communications. Last but not least, a series of interesting open problems are suggested along with potential solutions to cast light on the research in this emerging area.

What Are Complex eHealth Innovations and How Do You Measure Them? Position Paper.

eHealth and innovation are often regarded as synonyms - not least because eHealth technologies and applications are new to their users. This position paper challenges this view and aims at exploring the nature of eHealth innovation against the background of common definitions of innovation and facts from the biomedical and health informatics literature. A good understanding of what constitutes innovative eHealth developments allows the degree of innovation to be measured and interpreted. To this end, relevant biomedical and health informatics literature was searched mainly in Medline and ACM digital library. This paper presents seven facts about implementing and applying new eHealth developments hereby drawing on the experience published in the literature. The facts are: 1. eHealth innovation is relative. 2. Advanced clinical practice is the yardstick. 3. Only used and usable eHealth technology can give birth to eHealth innovatio. 4. One new single eHealth function does not make a complex eHealth innovation. 5. eHealth innovation is more evolution than revolution. 6. eHealth innovation is often triggered behind the scenes; and 7. There is no eHealth innovation without sociocultural change. The main conclusion of the seven facts is that eHealth innovations have many ingredients: newness, availability, advanced clinical practice with proven outcomes, use and usability, the supporting environment, other context factors and the stakeholder perspectives. Measuring eHealth innovation is thus a complex matter. To this end we propose the development of a composite score that expresses comprehensively the nature of eHealth innovation and that breaks down its complexity into the three dimensions: i) eHealth adoption, ii) partnership with advanced clinical practice, and iii) use and usability of eHealth. In order to better understand the momentum and mechanisms behind eHealth innovation the fourth dimension, iv) eHealth supporting services and means, needs to be studied. Conceptualising appropriate measurement instruments also requires eHealth innovation to be distinguished from eHealth sophistication, performance and quality, although innovation is intertwined with these concepts. The demanding effort for defining eHealth innovation and measuring it properly seem worthwhile and promise advances in creating better systems. This paper thus intends to stimulate the necessary discussion.

Formative second opinion: qualifying health professionals for the unified health system through the Brazilian Telehealth Program.

The World Health Organization's World Health Assembly WHA58.28/2005 Resolution recommends the adoption of e-health by health systems of State Members. The Brazilian Telehealth Program integrates the national policy of education for health that combines many strategies with complementary foci, including technical-level workers, undergraduate students of the 14 health professions, residency, postgraduate courses, support, and continuing health education at work. The Brazilian Unified Health System has approximately 1.5 million workers. The objectives of this work areas are as follows: to define a new concept, the so-called "formative second opinion" (FSO); to describe the methodology for its construction; and to show its structure as well as the number of FSOs already available, classified according to the field of knowledge. The Brazilian Telehealth Program was created in 2007 and has already offered around 41,000 teleconsultations. Based on their relevance and pertinence, 710 questions asked through teleconsulting by health professionals were selected. The questions were handled so that each question should not contain any specific information about patients, preserving professional confidentiality. For each question, a bibliographic review was performed and used to build a structured and standardized answer, based on the best available scientific and clinical evidence. This question-and-answer combination, originated thru teleconsulting, created by the Brazilian Telehealth Program, was termed the FSO and has been made available, with open access for all health professionals, at the Web site of the Program. Among the total number of 710 FSOs, diagnosis and treatment support corresponded to 238 questions (33.5%), followed by primary healthcare (90 questions) and then by subjects concerning oral health (68 questions) and nursery (39 questions). The structure and design of the FSO are also shown. The FSO helps professionals and health workers to use the already produced best evidence and scientific knowledge to solve their daily practice questions, improving, qualifying, and increasing the resolution of primary healthcare by the Unified Health System in Brazil. Oral health is frequently asked about by professionals, matching the high prevalence of oral disease in primary healthcare.

Governance structures impact on eHealth

BackgroundNational eHealth implementation efforts need to move beyond the scope of making technology the primary focus and instead consider the broader spectrum of influences that can either hinder or facilitate eHealth adoption such as governance structures and policies. In this study, Denmark serves as an ideal candidate for further examination due to the country׳s rich history of intertwining events that have played an important role in the dynamic relationship between governance and eHealth success and failures. MethodsA case study approach was used to gather a combination of primary and secondary data sources. All data collection was carried out through desk-research. Data collection relied on performing an extensive search of literature for relevant studies using combinations of keywords that reflected eHealth and governance-related topics. Inclusion and exclusion criteria׳s were applied to identify relevant papers. ResultsThis study reveals that despite Denmark׳s high deployment of eHealth technologies, the Danish healthcare system faces significant interoperability challenges which stem from the country׳s decentralized and centralized approach to eHealth implementation. ConclusionStructural reforms, policies and the processes driving the rapid dissemination of eHealth have a combined influence on the overall progress of eHealth adoption. Successful national eHealth implementation requires that countries act sensitive to the dynamics of governance, and specifically strive for the right balance between centralization and decentralization to nurture synergy and transparency between all stakeholders involved in the dissemination of eHealth systems.

Issues on E-health Adoption in Nigeria

E-health is the application of information technology for health care management. It includes all applications of information communication technologies to promote healthcare services support, delivery and education for improving efficiency in health care delivery to the citizens. Many factors contribute to the poor state of the medical sector of Nigeria, and in fact many developing countries, two of the most important being record keeping and accessibility. Nigeria still operates a paper based healthcare delivery system; meeting demands of citizens have been increasingly difficult due to her huge population, understaffed hospitals, apathy towards embracing ICTs and other issues. On the other hand, ICT applications have been used successfully in developed countries to address most of these problems. This paper presents an in-depth analysis of the healthcare system in Nigeria while highlighting confronting issues with a view to proposing a viable solution.

Trends in U.S. Consumers’ Use of E-Health Services: Fine-Grained Results from a Longitudinal, Demographic Survey

Although growth in U.S. consumers’ overall use of e-health is strong, it is being driven by only a portion of the e-health services that are offered through online health portals. Fine-grained, longitudinal analysis of three representative e-health services shows that, while online communication with medical personnel has grown consistently between 2003 and 2012, the purchase of health supplies online plateaued by 2007, and participation in online support groups has been flat since 2003. Socio-economic factors of income and education level continue to have an impact on consumers’ use of e-health; however, differences based on age, sex, and race/ethnicity are trending lower during this period. The findings caution against the common practice of studying e-health adoption principally at the level of online health portals, which can mask substantial variation in adoption trends among the underlying e-health services, and suggest that it is important to update trend studies on a regular basis to maintain currency.

EHealth in Denmark: A Case Study

Denmark is widely regarded as a leading country in terms of eHealth integration and healthcare delivery services. The push for eHealth adoption over that past 20 years in the Danish health sector has led to the deployment of multiple eHealth technologies. However, in reality the Danish healthcare suffers from eHealth system fragmentation which has led to eHealth's inability to reach full potential in delivering quality healthcare service. This paper will presents a case study of the current state of eHealth in the Danish healthcare system and discuss the current challenges the country is facing today.

The promise of the services sector sustainability:A United Arab Emirates (UAE) perspective

Emirates value their health care system above any other social program. The system of health care in the United Arab Emirates (UAE) faces significant financial and population pressures, relating to comprehensiveness, universality, accessibility and portability, healthcare quality, healthcare cost, and communication technologies (ICTs). All of these challenges are significant catalysts in the development of technologies that aim to significantly mitigate or eliminate these selfsame challenges. The privatization of many governmental hospitals by foreign specialized institutions in the UAE may play an increasingly significant role in these initiatives, as the management of health information becomes a more crucial factor in the successful delivery of health care services in the new millennium. The new corporate body ‘John Hopkins Health System’ is developing a pan-UAE electronic health solution. The Ministry of Health (MOH) and privatization initiatives will play an increasingly significant role in these initiatives, as the management of health information becomes a more crucial factor in the successful delivery of health care services in the present time. The MOH will play an increasingly significant role in these initiatives, as the management of health information becomes more crucial. UAE is actively developing and implementing technological solutions to deliver health information and health care services across the country. The major objectives of this paper was to analyze the changing social contexts and factors influencing the transformation from a real community to a virtual community by the adoption of e-health, and to propose actions needed to create an enabling environment for e-health services growth and utilization in the UAE. Key words: e-Health, healthcare, communication technologies (ICT), John Hopkins System, United Arab Emirates (UAE).

Health Care Provider Adoption of eHealth: Systematic Literature Review

BackgroundeHealth is an application of information and communication technologies across the whole range of functions that affect health. The benefits of eHealth (eg, improvement of health care operational efficiency and quality of patient care) have previously been documented in the literature. Health care providers (eg, medical doctors) are the key driving force in pushing eHealth initiatives. Without their acceptance and actual use, those eHealth benefits would be unlikely to be reaped.ObjectiveTo identify and synthesize influential factors to health care providers’ acceptance of various eHealth systems.MethodsThis systematic literature review was conducted in four steps. The first two steps facilitated the location and identification of relevant articles. The third step extracted key information from those articles including the studies’ characteristics and results. In the last step, identified factors were analyzed and grouped in accordance with the Unified Theory of Acceptance and Use of Technology (UTAUT).ResultsThis study included 93 papers that have studied health care providers’ acceptance of eHealth. From these papers, 40 factors were identified and grouped into 7 clusters: (1) health care provider characteristics, (2) medical practice characteristics, (3) voluntariness of use, (4) performance expectancy, (5) effort expectancy, (6) social influence, and (7) facilitating or inhibiting conditions.ConclusionsThe grouping results demonstrated that the UTAUT model is useful for organizing the literature but has its limitations. Due to the complex contextual dynamics of health care settings, our work suggested that there would be potential to extend theories on information technology adoption, which is of great benefit to readers interested in learning more on the topic. Practically, these findings may help health care decision makers proactively introduce interventions to encourage acceptance of eHealth and may also assist health policy makers refine relevant policies to promote the eHealth innovation.

Nurses in Australian acute care settings: experiences with and outcomes of e-health. An integrative review.

The World Health Organization (WHO) defines e-health as the use of information and communication technology for health [1]. The use of e-health, including electronic medical records (EMR), is a growing trend. This integrative review of the literature examines nurses experiences of e-health in Australian acute care settings. A search of the literature identified 21 papers for inclusion in this review. Two discernable themes in the literature are apparent. Research to date largely focuses on nurses experiences of e-health, including its usefulness in their work. Findings indicate that nurses attitudes to e-health and computer usage are positive, however there are indications that nurses currently using e-health in practice are often dissatisfied with the implementation of new e-health systems in their workplace and that there are a number of barriers to its successful implementation. Secondly, a discernable gap in the literature regarding the impact of e-health, and in particular EMRs, on nursing outcomes is identified with research to date limited to findings related to nursing documentation and multi-disciplinary discharge planning. Future research that considers nurse experiences in implementing e-health and applies focused strategies across a range of health settings, both in Australia and around the world, can influence successful adoption and implementation of e-health.

Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review

BackgroundAn ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities?MethodsWe conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption.ResultsOf the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption.ConclusionsRural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”).

Perspectives on the enablers of e-heath adoption: an international interview study of leading practitioners

Studies examining the application of information technology to the delivery of health-care services often highlight the anticipated benefits. In consequence, the benefits of health-care information technology adoption, often referred to as 'e-health', are widely reported yet there is limited empirical evidence as to how such benefits can be realized. Design and implementation guidelines have been considered from a socio-technical perspective and there is support for the successful application of these principles. There are also some global surveys on the topic, but these often report only statistical data and lack richness of content. This study draws on existing literature to examine whether the principles of health-care information technology adoption are currently applied in practice. The paper presents a timely international analysis of the drivers, critical enablers and successful deployment strategies for e-health from the perspective of leading practitioners. The study considers the adoption of e-health in 15 countries. A qualitative research design was used and semistructured interviews were conducted with 38 thought leaders with expertise in health-care information systems and technology. The study presents a comparative analysis of the lessons learned from implementing, integrating and embedding e-health in practice, and presents a four-phase approach from the perspective of practitioners for the accelerated deployment of e-health systems: (i) develop a strategic approach, (ii) engage the workforce, (iii) capitalize on information technology and (iv) partner with the patient/citizen.

A Manifesto for E-Health Success

Healthcare is the biggest service industry on the globe. Sadly, it has yet to realize the full potential of e-health, which is in stark contrast to other e-business initiatives such as e-government and e-education, e-finance, or e-commerce. However, as all OECD countries grapple with key challenges which are impacting the delivery of cost effective quality healthcare, all are agreed that e-health may hold the key. This makes it more important than ever for successful adoption of e-health. It is the contention of this paper that to be e-health prepared is necessary but not sufficient for successful e-health solutions to be realized. The paper asserts that it is only by embracing a rich theoretical lens of analysis that the full potential of e-health can be harnessed and thus it proffers ANT (Actor-network Theory) as such a lens.

Factors affecting implementation of hospital management information systems in Pakistan

Information technology is not being optimally incorporated in developing countries for improving healthcare practices and the implementation problems have been so portrayed that it has further reduced investors’ confidence in hospital management information systems (HMIS). The purpose of this study was to ascertain the actual impact of various factors on HMIS in Pakistan for which an exploratory study was conducted base on qualitative and quantitative survey in which staff from eight hospitals was approached. Data from randomly selected 145 respondents was analysed and it was found that organizational culture is the main issue in transition from conventional to IT based hospital management system. Other significant factors like organizational functionality, finances, skills, infrastructure, lack of standardization and lack of government sponsorship also affect. Doctor’s commitment in implementation of HMIS plays a pivotal role, therefore, they have to be motivated and taken on board. HMIS awareness in Pakistan was significant and a positive trend exists in the private sector to adopt it while public hospitals have been slow to follow. An assertive drive at government level can steer the process, thereby, paving a solid foundation for adoption of e-health in near future. Key words: Healthcare, e-health, hospital management information systems (HMIS).