Health Care Professionals' Experiences of Patient-Professional Communication Over Patient Portals : Systematic Review of Qualitative Studies

Background: The popularity of web-based patient-professional communication over patient portals is constantly increasing. Good patient-professional communication is a prerequisite for high-quality care and patient centeredness. Understanding health care professionals' experiences of web-based patient-professional communication is important as they play a key role in engaging patients to use portals. More information is needed on how patient-professional communication could be supported by patient portals in health care. Objective: This systematic review of qualitative studies aims to identify how health care professionals experience web-based patient-professional communication over the patient portals. Methods: Abstract and full-text reviews were conducted by 2 reviewers independently. A total of 4 databases were used for the study: CINAHL (EBSCO), ProQuest (ABI/INFORM), Scopus, and PubMed. The inclusion criteria for the reviewed studies were as follows: the examination of health care professionals' experiences, reciprocal communication between patients and health care professionals, peer-reviewed scientific articles, and studies published between 2010 and 2019. The Joanna Briggs Institute's quality assessment criteria were used in the review process. A total of 13 included studies were analyzed using a thematic synthesis, which was conducted by 3 reviewers. Results: A total of 6 analytical themes concerning health care professionals' experiences of web-based patient-professional communication were identified. The themes were related to health care professionals' work, change in communication over patient portals, patients' use of patient portals, the suitability of patient portals for communication, the convenience of patient portals for communication, and change in roles. Conclusions: Health care professionals' experiences contain both positive and negative insights into web-based patient-professional communication over patient portals. Most commonly, the positive experiences seem to be related to the patients and patient outcomes, such as having better patient engagement. Health care professionals also have negative experiences, for example, web-based patient-professional communication sometimes has deficiencies and has a negative impact on their workload. These negative experiences may be explained by the poor functionality of the patient portals and insufficient training and resources. To reduce health care professionals' negative experiences of web-based patient-professional communication, their experiences should be taken into account by policy makers, health care organizations, and information technology enterprises when developing patient portals. In addition, more training regarding web-based patient-professional communication and patient portals should be provided to health care professionals.Peer reviewe

Social, Organizational, and Technological Factors Impacting Clinicians’ Adoption of Mobile Health Tools: A Systematic Literature Review

Background: There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success. Objective: The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives. Methods: A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process. Results: The technological factors impacting clinicians’ adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions: The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits

Reporting health data in waiting rooms with mobile technology: Patient expectation and confirmation

Objectives: Hospitals and medical staff use digital devices such as mobile phones and tablets to treat patients. Prior research has examined patient-reported outcomes, and the use of medical devices to do diagnosis and prognosis of patients, but not whether patients like using, and intend to use in future, mobile devices to self-report medical data. We address this research gap by developing a theoretical model based on the expectancy confirmation model (ECM) and testing it in an empirical study of patients using mobile technology to self-report data. Design: This study adopts a non-interventional cross-sectional research design. Randomly-selected patients provided data via survey and physical measurements. The target population comprises adults visiting a healthcare laboratory to get their blood drawn. Materials and methods: We surveyed 190 randomly-selected patients waiting for treatment in the clinic. They were surveyed at two points in time - before and after their blood was drawn - on their demographic characteristics, research variables concerning their use of mobile devices to provide medical information, and perceived clinical data (blood pressure, height and weight). The research model was tested using structural equation modeling. Results: The study found strong support for the research model, with seven of eight hypotheses being supported. Both self-disclosure effort and feedback expectation positively affect both perceived feedback quality and confirmation. Contrary to expectations, perceived feedback quality was not found to affect confirmation. Perceived feedback quality, along with confirmation, was found to positively affect satisfaction, which was found to affect intention to disclose medical data through mobile technology. Conclusions: The study\u27s findings support the proposed path from feedback expectation and self-disclosure effort to confirmation to satisfaction to disclosure intention. Although perceived feedback does not affect confirmation, it affects satisfaction. Overall, we believe the results provide novel insights to both scientific research community and practitioners about using mobile technologies for self-reporting medical data

Studies on Inequalities in Information Society. Proceedings of the Conference, Well-Being in the Information Society

Siirretty Doriast

Rethink Digital Health Innovation: Understanding Socio-Technical Interoperability as Guiding Concept

Diese Dissertation sucht nach einem theoretischem Grundgerüst, um komplexe, digitale Gesundheitsinnovationen so zu entwickeln, dass sie bessere Erfolgsaussichten haben, auch in der alltäglichen Versorgungspraxis anzukommen. Denn obwohl es weder am Bedarf von noch an Ideen für digitale Gesundheitsinnovationen mangelt, bleibt die Flut an erfolgreich in der Praxis etablierten Lösungen leider aus. Dieser unzureichende Diffusionserfolg einer entwickelten Lösung - gern auch als Pilotitis pathologisiert - offenbart sich insbesondere dann, wenn die geplante Innovation mit größeren Ambitionen und Komplexität verbunden ist. Dem geübten Kritiker werden sofort ketzerische Gegenfragen in den Sinn kommen. Beispielsweise was denn unter komplexen, digitalen Gesundheitsinnovationen verstanden werden soll und ob es überhaupt möglich ist, eine universale Lösungsformel zu finden, die eine erfolgreiche Diffusion digitaler Gesundheitsinnovationen garantieren kann. Beide Fragen sind nicht nur berechtigt, sondern münden letztlich auch in zwei Forschungsstränge, welchen ich mich in dieser Dissertation explizit widme. In einem ersten Block erarbeite ich eine Abgrenzung jener digitalen Gesundheitsinnovationen, welche derzeit in Literatur und Praxis besondere Aufmerksamkeit aufgrund ihres hohen Potentials zur Versorgungsverbesserung und ihrer resultierenden Komplexität gewidmet ist. Genauer gesagt untersuche ich dominante Zielstellungen und welche Herausforderung mit ihnen einhergehen. Innerhalb der Arbeiten in diesem Forschungsstrang kristallisieren sich vier Zielstellungen heraus: 1. die Unterstützung kontinuierlicher, gemeinschaftlicher Versorgungsprozesse über diverse Leistungserbringer (auch als inter-organisationale Versorgungspfade bekannt); 2. die aktive Einbeziehung der Patient:innen in ihre Versorgungsprozesse (auch als Patient Empowerment oder Patient Engagement bekannt); 3. die Stärkung der sektoren-übergreifenden Zusammenarbeit zwischen Wissenschaft und Versorgungpraxis bis hin zu lernenden Gesundheitssystemen und 4. die Etablierung daten-zentrierter Wertschöpfung für das Gesundheitswesen aufgrund steigender bzgl. Verfügbarkeit valider Daten, neuen Verarbeitungsmethoden (Stichwort Künstliche Intelligenz) sowie den zahlreichen Nutzungsmöglichkeiten. Im Fokus dieser Dissertation stehen daher weniger die autarken, klar abgrenzbaren Innovationen (bspw. eine Symptomtagebuch-App zur Beschwerdedokumentation). Vielmehr adressiert diese Doktorarbeit jene Innovationsvorhaben, welche eine oder mehrere der o.g. Zielstellung verfolgen, ein weiteres technologisches Puzzleteil in komplexe Informationssystemlandschaften hinzufügen und somit im Zusammenspiel mit diversen weiteren IT-Systemen zur Verbesserung der Gesundheitsversorgung und/ oder ihrer Organisation beitragen. In der Auseinandersetzung mit diesen Zielstellungen und verbundenen Herausforderungen der Systementwicklung rückte das Problem fragmentierter IT-Systemlandschaften des Gesundheitswesens in den Mittelpunkt. Darunter wird der unerfreuliche Zustand verstanden, dass unterschiedliche Informations- und Anwendungssysteme nicht wie gewünscht miteinander interagieren können. So kommt es zu Unterbrechungen von Informationsflüssen und Versorgungsprozessen, welche anderweitig durch fehleranfällige Zusatzaufwände (bspw. Doppeldokumentation) aufgefangen werden müssen. Um diesen Einschränkungen der Effektivität und Effizienz zu begegnen, müssen eben jene IT-System-Silos abgebaut werden. Alle o.g. Zielstellungen ordnen sich dieser defragmentierenden Wirkung unter, in dem sie 1. verschiedene Leistungserbringer, 2. Versorgungsteams und Patient:innen, 3. Wissenschaft und Versorgung oder 4. diverse Datenquellen und moderne Auswertungstechnologien zusammenführen wollen. Doch nun kommt es zu einem komplexen Ringschluss. Einerseits suchen die in dieser Arbeit thematisierten digitalen Gesundheitsinnovationen Wege zur Defragmentierung der Informationssystemlandschaften. Andererseits ist ihre eingeschränkte Erfolgsquote u.a. in eben jener bestehenden Fragmentierung begründet, die sie aufzulösen suchen. Mit diesem Erkenntnisgewinn eröffnet sich der zweite Forschungsstrang dieser Arbeit, der sich mit der Eigenschaft der 'Interoperabilität' intensiv auseinandersetzt. Er untersucht, wie diese Eigenschaft eine zentrale Rolle für Innovationsvorhaben in der Digital Health Domäne einnehmen soll. Denn Interoperabilität beschreibt, vereinfacht ausgedrückt, die Fähigkeit von zwei oder mehreren Systemen miteinander gemeinsame Aufgaben zu erfüllen. Sie repräsentiert somit das Kernanliegen der identifizierten Zielstellungen und ist Dreh- und Angelpunkt, wenn eine entwickelte Lösung in eine konkrete Zielumgebung integriert werden soll. Von einem technisch-dominierten Blickwinkel aus betrachtet, geht es hierbei um die Gewährleistung von validen, performanten und sicheren Kommunikationsszenarien, sodass die o.g. Informationsflussbrüche zwischen technischen Teilsystemen abgebaut werden. Ein rein technisches Interoperabilitätsverständnis genügt jedoch nicht, um die Vielfalt an Diffusionsbarrieren von digitalen Gesundheitsinnovationen zu umfassen. Denn beispielsweise das Fehlen adäquater Vergütungsoptionen innerhalb der gesetzlichen Rahmenbedingungen oder eine mangelhafte Passfähigkeit für den bestimmten Versorgungsprozess sind keine rein technischen Probleme. Vielmehr kommt hier eine Grundhaltung der Wirtschaftsinformatik zum Tragen, die Informationssysteme - auch die des Gesundheitswesens - als sozio-technische Systeme begreift und dabei Technologie stets im Zusammenhang mit Menschen, die sie nutzen, von ihr beeinflusst werden oder sie organisieren, betrachtet. Soll eine digitale Gesundheitsinnovation, die einen Mehrwert gemäß der o.g. Zielstellungen verspricht, in eine existierende Informationssystemlandschaft der Gesundheitsversorgung integriert werden, so muss sie aus technischen sowie nicht-technischen Gesichtspunkten 'interoperabel' sein. Zwar ist die Notwendigkeit von Interoperabilität in der Wissenschaft, Politik und Praxis bekannt und auch positive Bewegungen der Domäne hin zu mehr Interoperabilität sind zu verspüren. Jedoch dominiert dabei einerseits ein technisches Verständnis und andererseits bleibt das Potential dieser Eigenschaft als Leitmotiv für das Innovationsmanagement bislang weitestgehend ungenutzt. An genau dieser Stelle knüpft nun der Hauptbeitrag dieser Doktorarbeit an, in dem sie eine sozio-technische Konzeptualisierung und Kontextualisierung von Interoperabilität für künftige digitale Gesundheitsinnovationen vorschlägt. Literatur- und expertenbasiert wird ein Rahmenwerk erarbeitet - das Digital Health Innovation Interoperability Framework - das insbesondere Innovatoren und Innovationsfördernde dabei unterstützen soll, die Diffusionswahrscheinlichkeit in die Praxis zu erhöhen. Nun sind mit diesem Framework viele Erkenntnisse und Botschaften verbunden, die ich für diesen Prolog wie folgt zusammenfassen möchte: 1. Um die Entwicklung digitaler Gesundheitsinnovationen bestmöglich auf eine erfolgreiche Integration in eine bestimmte Zielumgebung auszurichten, sind die Realisierung eines neuartigen Wertversprechens sowie die Gewährleistung sozio-technischer Interoperabilität die zwei zusammenhängenden Hauptaufgaben eines Innovationsprozesses. 2. Die Gewährleistung von Interoperabilität ist eine aktiv zu verantwortende Managementaufgabe und wird durch projektspezifische Bedingungen sowie von externen und internen Dynamiken beeinflusst. 3. Sozio-technische Interoperabilität im Kontext digitaler Gesundheitsinnovationen kann über sieben, interdependente Ebenen definiert werden: Politische und regulatorische Bedingungen; Vertragsbedingungen; Versorgungs- und Geschäftsprozesse; Nutzung; Information; Anwendungen; IT-Infrastruktur. 4. Um Interoperabilität auf jeder dieser Ebenen zu gewährleisten, sind Strategien differenziert zu definieren, welche auf einem Kontinuum zwischen Kompatibilitätsanforderungen aufseiten der Innovation und der Motivation von Anpassungen aufseiten der Zielumgebung verortet werden können. 5. Das Streben nach mehr Interoperabilität fördert sowohl den nachhaltigen Erfolg der einzelnen digitalen Gesundheitsinnovation als auch die Defragmentierung existierender Informationssystemlandschaften und trägt somit zur Verbesserung des Gesundheitswesens bei. Zugegeben: die letzte dieser fünf Botschaften trägt eher die Färbung einer Überzeugung, als dass sie ein Ergebnis wissenschaftlicher Beweisführung ist. Dennoch empfinde ich diese, wenn auch persönliche Erkenntnis als Maxim der Domäne, der ich mich zugehörig fühle - der IT-Systementwicklung des Gesundheitswesens

2017 Working Papers

The Next Decade: Amplifying the Women, Peace and Security Agendahttps://digital-commons.usnwc.edu/wps/1000/thumbnail.jp

A Framework for Evaluating Technology-Mediated Collaborative Workflow

The adoption of new technology into collaborative workflows has permeated every aspect of our personal and professional lives with the promise of performing work processes more efficiently and with greater capability. The continued rise of ubiquitous computing and heightened need for collaborative features suggest that a view of enabling technologies in a workflow should include the physical computing infrastructure, the collaborative interaction between humans and computers, and the informatics (i.e., collection and representation of data within the workflow). The development and integration of technology for collaborative workflows introduces many variables that are of great concern to companies, organization, and individuals. These variables include the costs of development, the switching cost associated with migrating from the current workflow to the technology-enhanced workflow, and details of how the technology-mediated workflow functions compare to the current workflow functions. There is, however, no consistent, generalizable approach to evaluate and compare an existing workflow with the enhanced technology-mediated workflow in a manner that identifies improvements and barriers in replicable qualitative and quantitative measures. In order to develop such a consistent, generalizable approach, this research investigates what necessary set of cross-disciplinary metrics and methodology is required to effectively evaluate technology-mediated collaborative workflow through an analysis of related works from four disciplines (Social Sciences, Organization and Behavioral Management, Industrial Engineering, and Human-Computer Interaction). The research introduces the Collaborative Space – Analysis Framework (CS-AF), a cross-disciplinary model and methodology designed to evaluate and compare collaborative workflows. The research includes testing the CS-AF model using two diverse empirical studies designed to evaluate a current-state workflow, compared to a technology-mediated workflow on five key collaborative areas (Context, Technology, Process, Attitude and Behavior, and Outcomes). The research incorporates the CS-AF model and methodology to test the effectiveness of the approach for capturing and analyzing essential quantitative and qualitative parameters of the collaborative workflows. The second empirical study tested hypertensive patients currently involved in clinical maintenance with regular outpatient monitoring. The test included 50 hypertension patients, selected based on matched-pairs for age and gender to test the workflow model in a 3-week trial. All participants were tested on an existing workflow (current-state), then the population was randomly split within pairs. The matched-pairs were assigned to one of two alternative workflows: 25 patients were introduced to a manual hypertension self-exam workflow (control group), and their matched-pair counterparts were introduced to technology-mediated hypertension self-exam workflow. All participants were tested on the existing workflow (current-state), followed by the introduction of an alternate workflow, and then tested a second time (pre-/ post-) with the same CS-AF procedure. The study incorporated the research findings from these two tests and a comparison between the workflows introduced using the CS-AF metrics. Findings from the two diverse empirical studies using the CS-AF (Graphic Communications sales order process, and Health Information Technology hypertension exam workflow) indicate that technology-mediated workflows do improve collaborative performance; however, adoption is not as pronounced as hypothesized. The research findings indicate that the lack of acceptance is due to non-technology factors, such as attitude and behavior, which play a significant role in adoption and need similar attention as technology innovation to drive true adoption and ultimately better collaborative performance. The research findings also indicate that the effectiveness of the CS-AF may have potential as a generalizable approach for evaluating technology-mediated collaborative workflow in a variety of unique domains

Systemic problems related to multiple stakeholders in technology adoption and use in organizations : a systems thinking perspective

Understanding and creating the conditions under which information systems will be embraced by human organizations (thinking systems) remain high-priority research issues. Despite numerous benefits associated with information technology (IT), implementing an information system (IS) in organizational environment is challenging. The literature reports numerous IS project failures. During IS implementation, several factors impede technology’s widespread adoption and use in organizations. These organizational problems often result from such barriers or ‘systemic problems’. The proposed work is based on the argument that addressing ‘systemic problems’ can reduce barriers to organizational progress. Most of the IS/IT adoption theories (e.g. TAM, UTAUT, TAM2 and TAM3) highlight factors related to system users, completely ignoring the other stakeholders who are affected by the adoption process. The purpose of this study is to apply an holistic or systems thinking approach to identify systemic problems in information technology adoption and use within an organizational context by considering the complete stakeholder set as a ‘system of stakeholders’. It involves the study of a web portal implementation project in an Australian university referred to as Aus-Uni. Data was collected through face-to-face interviews of different stakeholders across Aus-Uni and were fundamentally classified into the two categories of ‘involved’ and ‘affected’. Their relevant comments and experiences have been analysed using the lens of a systems thinking-based framework of Critical Systems Heuristics (CSH). The interpretive approach, based on structured-case study method, and the technique of practising CSH have been used as a data gathering framework for this case study. The study’s findings contribute towards identifying information needs and systemic problem scenarios, related to multiple stakeholders in the context of the web portal project. However, its insights may allow broader applications. The roles which these stakeholders play have been classified under the categories prescribed by the CSH methodology of boundary critique. This generated ‘system of stakeholders’ was further analysed to explore problem scenarios as subsystems to this ‘system of stakeholders’. Each problem scenario identifies who was involved and affected by it. It is believed that identifying problems holistically will lead to smoother IS adoption, and reduce IS project failures. This research also proposes two theoretical models based on Critical Systems Heuristics (CSH); one for IS adoption, which demonstrates how CSH can be coupled with the existing IS implementation methodologies to create a holistic perspective of IS implementation issues. This model uses Systems Development Life Cycle (SDLC) as an example, and proposes that the stakeholder roles need to be identified using boundary critique throughout the project life cycle. The second model is for managing conflicts in the context of organizational change, and is applicable for implementing innovative practices inside organizations, and identifying conflicting scenarios which surface during that process

E-Governance: Strategy for Mitigating Non-Inclusion of Citizens in Policy Making in Nigeria

The Nigerian federation that currently has 36 states structure adopted the Weberian Public Administrative system before now as an ideal way of running government, which was characterized with the traditional way of doing things without recourse to the deployment of Information Communication Technology (ICT). Today e-governance is seen as a paradigm shift from the previous way of governance. Research has shown that, the adoption and implementation of e-governance is more likely to bring about effective service delivery, mitigate corruption and ultimately enhance citizens’ participation in governmental affairs. However, it has been argued that infrastructure such as regular electricity power and access to the Internet, in addition to a society with high rate of literacy level are required to effectively implement and realize the potentials of e-governance for improved delivery of services. Due to the difficulties currently experienced, developing nations need to adequately prepare for the implementation of e-governance on the platform of Information Communication Technology (ICT). Hence, this study seeks to examine whether the adoption and implementation of e-governance in the context of Nigeria would mitigate the hitherto non-inclusion of citizens in the formulation and implementation of government policies aimed at enhanced development. To achieve the objective of the study, data were sourced and analyzed majorly by examining government websites of 20 states in the Nigerian federation to ascertain if there are venues for citizens to interact with government in the area of policy making and feedback on government actions, as a way of promoting participatory governance. The study revealed that the adoption and implementation of e-governance in the country is yet to fully take place. This is due to lack of infrastructure, low level of literacy rate and government inability to provide the necessary infrastructure for e-governance to materialize. The paper therefore, recommends among others the need for the Federal Government to involve a sound and clear policy on how to go about the adoption and implementation of egovernance through deliberate effort at increasing budgetary allocation towards infrastructural development and mass education of citizens

The Impact of e-Democracy in Political Stability of Nigeria

The history of the Nigerian electoral process has been hitherto characterized by violence stemming from disputes in election outcomes. For instance, violence erupted across some states in Northern Nigeria when results indicated that a candidate who was popular in that part of the country was losing the election leading to avoidable loss of lives. Beside, this dispute in election outcome lingers for a long time in litigation at the electoral tribunals which distracts effective governance. However, the increasing penetrating use of ICTs in Nigeria is evident in the electoral processes with consequent shift in the behavior of actors in the democratic processes, thus changing the ways Nigerians react to election outcomes. This paper examines the trend in the use ICT in the Nigerian political system and its impact on the stability of the polity. It assesses the role of ICT in recent electoral processes and compares its impact on the outcome of the process in lieu of previous experiences in the Nigeria. Furthermore, the paper also examines the challenges and risks of implementing e-Democracy in Nigeria and its relationship to the economy in the light of the socio-economic situation of the country. The paper adopted qualitative approach in data gathering and analysis. From the findings, the paper observed that e-democracy is largely dependent on the level of ICT adoption, which is still at its lowest ebb in the country. It recognizes the challenges in the provision of ICT infrastructure and argues that appropriate low-cost infrastructure applicable to the Nigerian condition can be made available to implement e-democracy and thus arouse the interest of the populace in governance, increase the number of voters, and enhance transparency, probity and accountability, and participation in governance as well as help stabilize the nascent democrac