Holistic System Design for Distributed National eHealth Services

publishedVersio

A Multi-Level Assessment of Healthcare Facilities Readiness, Willingness, and Ability to Adopt and Sustain Telehealth Services

Telehealth technologies are becoming more pervasive throughout the healthcare system as a way to provide services to patients that would otherwise have difficulty with access. Currently, little is known about the current state of telehealth use within clinics and hospital in the US. Most studies evaluating telehealth programs are feasibility or small patient outcome studies from one location. Utilizing a hybrid framework combining the levels of complex socio-technical systems with the theory of ready, willing and able. The theory of ready, willing, and able is founded on the basis that these three preconditions need to be met for a change in behavior to occur, such as adoption of telehealth technologies. Study 1 utilizes multiple national healthcare data sets to analyze the higher levels of organizational factors that are associated with US hospitals who are ready and willing to implement telehealth technologies but lack the ability. Providing insight to the factors that can facilitate the ability to adopt such innovations. Study 2 is a mixed methods study that evaluates clinic data from the state of Nebraska. The quantitative survey data was used to develop interview questions and determine the sample population. The qualitative interviews yielded several themes on barriers to implementing and sustaining telehealth services in Nebraska. These include lack of providers to network with and technology malfunction issues. Many clinics want to increase their telehealth programs but are lacking the ability to do so. Study 3 is a combination of two meta-analyses that evaluate the effect of telehealth programs on the QOL for cancer patients in treatment and cancer survivors who are no longer in active treatment. The effect of the telehealth interventions on survivors QOL is significantly increased compared to survivors in usual care. More needs to be done to standardize telehealth evaluation and connection processes. Positive patient outcomes and clinical benefits can strengthen the legitimacy of telehealth technologies as part of normal healthcare practice. Yet without accurate data, the benefits cannot be fully assessed. Innovation is outpacing policy and procedures, this needs to be amended to fully maximize the benefits of telehealth technologies in the healthcare system

Frameworks for implementation, uptake and use of digital health interventions in ethnic minority populations: a scoping review using cardiometabolic disease as a case study

Background: Digital health interventions have become increasingly common across health care, both before and during the COVID-19 pandemic. Health inequalities, particularly with respect to ethnicity, may not be considered in frameworks that address the implementation of digital health interventions. We considered frameworks to include any models, theories, or taxonomies that describe or predict implementation, uptake, and use of digital health interventions. Objective: We aimed to assess how health inequalities are addressed in frameworks relevant to the implementation, uptake, and use of digital health interventions; health and ethnic inequalities; and interventions for cardiometabolic disease. Methods: SCOPUS, PubMed, EMBASE, Google Scholar, and gray literature were searched to identify papers on frameworks relevant to the implementation, uptake, and use of digital health interventions; ethnically or culturally diverse populations and health inequalities; and interventions for cardiometabolic disease. We assessed the extent to which frameworks address health inequalities, specifically ethnic inequalities; explored how they were addressed; and developed recommendations for good practice. Results: Of 58 relevant papers, 22 (38%) included frameworks that referred to health inequalities. Inequalities were conceptualized as society-level, system-level, intervention-level, and individual. Only 5 frameworks considered all levels. Three frameworks considered how digital health interventions might interact with or exacerbate existing health inequalities, and 3 considered the process of health technology implementation, uptake, and use and suggested opportunities to improve equity in digital health. When ethnicity was considered, it was often within the broader concepts of social determinants of health. Only 3 frameworks explicitly addressed ethnicity: one focused on culturally tailoring digital health interventions, and 2 were applied to management of cardiometabolic disease. Conclusions: Existing frameworks evaluate implementation, uptake, and use of digital health interventions, but to consider factors related to ethnicity, it is necessary to look across frameworks. We have developed a visual guide of the key constructs across the 4 potential levels of action for digital health inequalities, which can be used to support future research and inform digital health policies

Consumer Survey into Factors Influencing Mobile Health Monitoring Service perceptions in the UK

Mobile health monitoring services have the potential to provide individual health profiles and monitor patients’ health conditions. While there is a variety of systems and devices to help patient’s health management, there is little understanding regarding the factors that influence mobile health monitoring service perceptions. Thus, this UK study will examine the factors that influence users across different age groups towards well-being and Mobile Health monitoring services. This study applied a conceptual framework based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model to examine the factors that may influence the attitude towards mobile health services among consumers

Smart and Pervasive Healthcare

Smart and pervasive healthcare aims at facilitating better healthcare access, provision, and delivery by overcoming spatial and temporal barriers. It represents a shift toward understanding what patients and clinicians really need when placed within a specific context, where traditional face-to-face encounters may not be possible or sufficient. As such, technological innovation is a necessary facilitating conduit. This book is a collection of chapters written by prominent researchers and academics worldwide that provide insights into the design and adoption of new platforms in smart and pervasive healthcare. With the COVID-19 pandemic necessitating changes to the traditional model of healthcare access and its delivery around the world, this book is a timely contribution

THE AMERICAN CORRECTIONAL HEALTHCARE SYSTEM IS AILING: TECHNOLOGY INNOVATION AS A PRESCRIPTION FOR PENAL SYSTEM HEALTHCARE DELIVERY

The U.S. corrections industry has a history of poor inmate healthcare delivery, with penal-system reform advocates and other stakeholders highlighting these failures. Inmates receiving poor medical and psychiatric care behind jail walls experience greater difficulty becoming self-sufficient, and this situation contributes to the nation’s recidivism problem. Caring for inmates is often a neglected proposition and because of this, the U.S. courts impose legal requirements that inmates receive healthcare. Access to quality healthcare specialists for inmates led the penal system to investigate and implement use of telehealth during the 1990s. This thesis investigates how the evolving field of telehealth and emerging technologies may contribute to improved inmate healthcare in the future. A myriad of factors discussed in the thesis pose as challenges to implementing innovations that could improve penal system healthcare. For all the challenges confronting corrections administrators and criminal reform advocates, the corrections system is at a crossroads, as there is potential to modernize jail facilities and use technology to improve the safety and healthcare of inmates, corrections officers and those who render care. Investing in technology infrastructure that supports emerging technologies could also facilitate simpler integration of future innovations that address suicide, mental illness and other medical health maladies that would otherwise go unaddressed.Civilian, Dallas Fire-Rescue DepartmentApproved for public release. Distribution is unlimited

Identifying benefits and barriers for IS adoption: A sociotechnical framework applied to health care

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University, 13/11/2007.The aim of this research is to propose a sociotechnical framework to identify stakeholders involved in information systems and the benefit and barriers to the adoption of such systems. The proposed framework (BEBAF) would help to acknowledge the potential problematic areas for the implementation and adoption of information systems for each actor or social group and to be able to offer solutions based on the potential benefits for each of them. Precursors of BEBAF are social construction of technology (SCOT) and stakeholder identification process. Two case studies in the healthcare contexts, one in the UK and one in Spain, have been conducted in this dissertation using a qualitative approach to provide a rich picture of the influences on e-Health, and the users and organisational response to those influences. Both case studies aimed to support chronically ill patients at home or in nursing homes. BEBAF was then applied to both case studies. Among the most important implications are that those systems hold the promise for improving the quality of life of patients with chronic conditions, providing a better control over the disease. However, their impact on the organisational structures, the lack of funding and the difficulties of alignment of all the actors involved are relevant constraints to their adoption into the mainstream healthcare services. The main contributions of this thesis are: first, the definition and evaluation of a socio-technical framework to investigate IS adoption. Apart from the two closure mechanisms proposed by SCOT, BEBAF proposes a new closure mechanism by reinterpretation of benefits. In turn, the application of the framework has led to identify an extensive list of barriers and benefits for the adoption of e-Health systems with some suggested solutions. Another outcome is a comprehensive list of stakeholders involved in the adoption of such systems

An analysis of the effects of certified electronic health records on organizations and patients.

The growing technological advancement of electronic health records can become an issue with quality and electronic patient information exchange if hospitals do not adhere to federal guidelines. It is recommended that hospitals utilize certified electronic health records (EHRs) to receive financial incentives. This certification is supposedly also associated with the quality of the EHR itself. The certification process is criticized for allowing EHR vendors to meet a set of limited functions known in advance. EHRs can affect healthcare quality and electronic health information exchange. This dissertation explored what is known about the effects of certified EHRs on length of stay (LOS) and patient generated health data (PGHD), the relationship between hospital utilization of certified EHRs and LOS, and the relationship between hospital utilization of certified EHRs with hospital capability of allowing the function of PGHD. The first analysis was a scoping review guided by the PRISMA protocol to explore what is known of the effects of certified EHRs on LOS and PGHD. The second analysis used datasets from the American Hospital Association Survey and Information Technology Supplement and Kentucky Cabinet for Health and Family Services, Office of Health Policy from 2015 to 2019 to understand the relationship between hospital utilization of certified EHRs and LOS through a fixed effects regression model. The final paper analysis used datasets from the American Hospital Association Survey and Information Technology Supplement from 2016 to 2020 to understand the relationship between hospital utilization of certified EHRs and the function of enabling PGHD through a binary logistic regression. There is support amongst researchers on EHRs improving quality, such as, LOS and the function of PGHD improving technology efficiency and others supporting EHRs with more customization and open architecture. There is less known about whether an EHR, certified or non-certified, are different from one another with providing advantages for hospitals. Hospitals with certified EHRs have a longer LOS compared to hospitals with non-certified EHRs. Most hospitals experienced barriers with receiving, sending, or other electronic information exchange. Most hospitals with certified EHRs were more likely to not enable the function for PGHD compared to hospitals with non-certified EHRs. EHRs can be problematic while hospitals are providing hospital care. Although most hospitals possess certified EHRs, most do not enable the function of PGHD. Secondary sources from the survey were completed by the Chief Technology Officer or Chief Information Officer. Further research could be continued with understanding different groups’ health effects with health information technology. Hospitals may be satisfied with their EHRs but not as abreast on how functional the EHR is and how the EHR can benefit patients

The role of health kiosks: a scoping review

Background: Health kiosks are publicly accessible computing devices that provide access to services including health information provision, clinical measurement collection, patient self-check-in, telemonitoring and teleconsultation. While the increase in internet access and ownership of smart personal devices could make kiosks redundant, recent reports have predicted that the market will continue to grow. Objectives: We sought to clarify the current and future roles of health kiosks by investigating: (a) the setting, role, and clinical domains in which kiosks are used; (b) whether usability evaluations of health kiosks are being reported and if so, what methods are being utilized; and (c) what the barriers and facilitators are for the deployment of kiosks. Methods: We conducted a scoping review by a bibliographic search of the Google Scholar, PubMed and Web of Science databases for studies and other publications between January 2009 and June 2020. Eligible papers describe the implementation, either as primary studies, systematic reviews, or news and feature articles. Additional reports were obtained by manual searching and through querying key informants. For each article we abstracted settings, purposes, health domains, whether the kiosk was opportunistic or integrated with a clinical pathway, and inclusion of usability testing. We then summarized the data in frequency tables. Results: A total of 141 articles were included, 134 primary studies and seven reviews. 47% of the primary studies described kiosks in secondary care settings, other settings included community (23.9%), primary care (17.9%), and pharmacies (6.0%). The most common roles of health kiosks were providing health information (35.1%), taking clinical measurements (20.9%), screening (12.7%), telehealth (8.2%), and patient registration (6.0%). The five most frequent health domains were multiple conditions (24.6%), Human Immunodeficiency Virus (HIV) (7.5%), hypertension (7.5%), pediatric injuries (5.2%), health and wellbeing (4.5%) and drug monitoring (4.5%). Kiosks were integrated in the clinical pathway in 70.1%, opportunistic kiosks accounted for 23.9% and 6.0% were being used in both. Usability evaluations of the kiosk were reported in 20.1% of the papers. Barriers (use of expensive proprietary software) and enablers (handling on-demand consultations) to deploying health kiosks were identified. Conclusions: Health kiosks still play a vital role in the healthcare system, including collecting clinical measurements and providing access to online health services and information to those with little or no digital literacy skills, and others without personal internet access. We identified research gaps, such as training needs for teleconsultations, and scant reporting on usability evaluation methods