Editorial

Editorial International Journal of Biomedical Engineering and Technology, 2009, vol. 2, n° 1, pp. 1-3 Special Issue on Telemedicine & E-HealthInternational audienc

Bringing Telemedicine Initiatives into Regular Care: Theoretical Underpinning for User-Centred Design Processes

Telemedicine is said to change the way care is delivered. Nevertheless, it still faces barriers to overcome the pilot stage and reach a majority of patients in regular care. Missing consideration of user-centred design processes is one major reason for this development as individuals are a key component for the technology’s success. Therefore, we aim to provide recommendations for a user-centred design process, which is, in turn, crucial to successfully implementing telemedicine innovations. To reach this aim, we identified individual-related barriers for telemedicine with an umbrella review. Furthermore, we related the barriers to the Unified Theory of Acceptance and Use of Technology (UTAUT2) proposed by Venkatesh and colleagues. A theoretical explanation helps to generate a broader understanding of what prevents individual acceptance of telemedicine innovations. The provided recommendations are supposed to support researchers and practitioners planning future telemedicine solutions

Telerehabilitation Technologies: Accessibility and Usability

In the fields of telehealth and telemedicine, phone and/or video technologies are key to the successful provision of services such as remote monitoring and visits. How do these technologies affect service accessibility, effectiveness, quality, and usefulness when applied to rehabilitation services in the field of telerehabilitation? To answer this question, we provide a overview of the complex network of available technologies and discuss how they link to rehabilitation applications, services, and practices as well as to the telerehabilitation end-user.This white paper will first present the numerous professional considerations that shape the use of technology in rehabilitation service and set it somewhat apart from telemedicine. It will then provide an overview of concepts essential to usability analysis; present a summary of various telerehabilitation technologies and their strengths and limitations, and consider how the technologies interface with end users’ clinical needs for service accessibility, effectiveness, quality, and usefulness. The paper will highlight a conceptual framework (including task analyses and usability issues) that underlies a functional match between telerehabilitation technologies, clinical applications, and end-usercapabilities for telerehabilitation purposes. Finally, we will discuss pragmatic issues related to user integration of telerehabilitation technology versus traditional face-to-face approaches.Key Words: Remote, Technology, Usability, Accessibility, Decision Factors, Decision Support

Telerehabilitation Technologies: Accessibility and Usability

In the fields of telehealth and telemedicine, phone and/or video technologies are key to the successful provision of services such as remote monitoring and visits. How do these technologies affect service accessibility, effectiveness, quality, and usefulness when applied to rehabilitation services in the field of telerehabilitation? To answer this question, we provide a overview of the complex network of available technologies and discuss how they link to rehabilitation applications, services, and practices as well as to the telerehabilitation end-user. This white paper will first present the numerous professional considerations that shape the use of technology in telerehabilitation service and set it somewhat apart from telemedicine. It will then provide an overview of concepts essential to usability analysis; present a summary of various telerehabilitation technologies and their strengths and limitations, and consider how the technologies interface with end users’ clinical needs for service accessibility, effectiveness, quality, and usefulness. The paper will highlight a conceptual framework (including task analyses and usability issues) that underlies a functional match between telerehabilitation technologies, clinical applications, and end-user capabilities for telerehabilitation purposes. Finally, we will discuss pragmatic issues related to user integration of telerehabilitation technology versus traditional face-to-face approaches. Key Words: Remote, Technology, Usability, Accessibility, Decision Factors, Decision Suppor

Introducing Wireless Grids Technology to the Field of Telemedicine

While telemedicine and technology-enabled education are not new concepts and have significant bodies of research, in depth application to management and treatment of veteran Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) is relatively new. The conflicts in the Southwest Asia over the last two decades have significantly increased the need for healthcare and support services for these returning warriors. Creative thinking and innovative technologies are needed to meet the growing and changing demand of these patients in the face of many competing demands within the U.S. healthcare sector. This doctoral research study investigated the potential for a platform-agnostic (ad hoc) networking technology to serve as a trusted social networking and training platform for healthcare providers who are striving to provide quality healthcare that meets the needs of veterans suffering from PTSD and TBI. This research study analyzed the effectiveness of a digitally networked environment to deliver desired training and certification outcomes in a military healthcare environment. The level of acceptance of an ad hoc network technology (GridstreamRx) by healthcare professionals using it as an enabler of collaboration during the training process was evaluated. The results also assessed the readiness of healthcare professionals to use this Information Communications Technology (ICT), or analogous new applications and services, to help them perform their healthcare responsibilities. This thesis study, accomplished with the support of the U.S. Army and National Science Foundation, took place at two large military medical centers over a twelve-month period of time. Data was gathered from 568 healthcare professionals using quantitative survey instruments. Ninety-six respondents provided additional quantitative and qualitative inputs at various times during a proscribed training regimen. DeLone and McLean\u27s 2003 Information System Success Model, modified by findings of more recent research, provided the theoretical lens for analyzing the data from 32 of the training participants in determining the perceived net benefit of the GridstreamRx technology. The data gathered for the study showed, at the 95% level of confidence, that a majority of the professionals of these two medical centers would perceive a positive net benefit from using GridstreamRx in a healthcare training environment. The conclusion from this analysis was that not only are the healthcare providers in this study ready to use ICT and social networking in this professional setting, but also that GridstreamRx is an acceptable platform for performing these functions. The study participants provided input with respect to their priorities regarding information sharing techniques, functionality, and suggestions for improving the platform. The outcomes confirmed that GridstreamRx can be a successful introduction of ad hoc networking to telemedicine. This thesis concluded with recommendations for scholars and practitioners to pursue in the future; and should be followed up with further research and actions in order to build toward a Fully Integrated Virtual Healthcare Environment (FivHe)

Be patient:A longitudinal study on adoption and diffusion of information technology innovation in Dutch healthcare

Three factors played an important role in the IT innovation alignment for the VBVS: economy, policy and technology. IT management played a crucial role in the alignment process of these factors. However, IT management still has an internal focus when it comes to IT innovations. At best, healthcare professionals are treated as customers, instead of the patients. When IT management realizes that the actual adoption and diffusion of IT innovations in healthcare is an expression of the intangible benefit it brings the patients... ... IT management can consider stimulating the adoption and diffusion of IT innovations by aligning the decision making process around the patients’ needs, and literally ‘be patient.’

How can health care organizations create value? : business model explorations

Background: The Triple Aim posits that health care should strive to improve patient experience, improve population health, and maintain or lower costs. However, most organizations are not organized to achieve the Triple Aim. Attempts to improve the ability of health care organizations to deliver increased value through the introduction of management concepts, most recently Value-based Health Care (VBHC), have led to the emergence of a pattern of pseudoinnovation, where concepts are frequently replaced with similar content, but in new “packaging”. This suggests that organizations and their ability to adapt to their environment and integrate new management concepts could potentially be explored by looking at how the concepts themselves are understood and at how organizations deliver care. In management terms, the latter can be described as the business model (i.e., how an organization creates, delivers, and captures value). Aim: The overall aim of this thesis is to understand how management concepts about value are understood and to explore how health care organizations in a publicly financed health care system are organized so that they create, deliver, and capture value. Methodology: In Study I, citation registry data and literature were sequentially analyzed qualitatively and quantitatively to assess diffusion and understanding of VBHC as a nascent management concept in the literature. Study II, a systematic review, employed an explanatory synthesis approach to understand how business model frameworks have been applied in health care. Studies III and IV apply the Business Model Canvas (BMC) framework in a deductive content analysis of interviews with top managers (Study III) and with multiple data sources (Study IV) to conceptualize a hospital business model and to compare perinatal clinics’ business models in a publicly financed, Swedish health care setting. Findings: VBHC and business model frameworks are commonly and increasingly used to improve value in health care. VBHC is superficially understood in the literature (Study I). Business model frameworks are primarily applied in e-health. They include a broad range of elements and have been used to identify essential elements, assess finances, and classify, analyze, develop, and evaluate organizations (Study II). Managers conceptualized the hospital business model differently, primarily related to customer segments. A tension between espoused and de facto value propositions was identified (Study III). Four distinct perinatal business models were identified within the same regional health system (New Thinkers, a Local Service Provider, Continuous Capacity Keepers, and a Hybrid) (Study IV). Conclusions: The superficial understanding of VBHC and the ambiguity and lack of empirical data in business model applications risk diluting the potential benefits of both these management approaches. The multiple, co-existing business models within the same organization or health care system raise questions about how organizations are aligned and how we should view the role of different stakeholders in creating, delivering, and capturing value

Service-Oriented Framework for Developing Interoperable e-Health Systems in a Low-Income Country

e-Health solutions in low-income countries are fragmented, address institution-specific needs, and do little to address the strategic need for inter-institutional exchange of health data. Although various e-health interoperability frameworks exist, contextual factors often hinder their effective adoption in low-income countries. This underlines the need to investigate such factors and to use findings to adapt existing e-health interoperability models. Following a design science approach, this research involved conducting an exploratory survey among 90 medical and Information Technology personnel from 67 health facilities in Uganda. Findings were used to derive requirements for e-health interoperability, and to orchestrate elements of a service oriented framework for developing interoperable e-health systems in a low-income country (SOFIEH). A service-oriented approach yields reusable, flexible, robust, and interoperable services that support communication through well-defined interfaces. SOFIEH was evaluated using structured walkthroughs, and findings indicate that it scored well regarding applicability, usability, and understandability