An International Comparison of Factors Inhibiting Physicians\u27 use of Hospital Information Systems

Finding ways to strengthen health care systems is a matter of great concern all around the world. Health care operations struggle with limited resources and diminishing workforce capabilities, making it imperative for effective and efficient operations. Hospital information systems (HIS) can help achieve this mission, providing reliable, timely, and relevant information about patient characteristics, reimbursement, and status of tests and quality metrics. However, there are still barriers toward the adoption of HIS by health care professionals. This study explores the inhibitors perceived by physicians for adopting HIS. The main motivation for this research is to answer the question: What are the factors inhibiting physicians\u27 use of Hospital Information Systems? This research question is of great interest as physicians are considered to be the key to successful HIS deployment, adoption and use. This study takes a qualitative research approach, employing ninety-eight (98) interviews at nine different hospitals, complemented by more than 40 hours of workplace shadowing. We conducted our research in the United States, Chile and Germany, as the three countries have developed healthcare systems but take different approaches to fostering the use of IT in hospitals and have implemented at different organizational levels. Our findings show that the alignment of user, system and process is important as expected. However, the results point out that leadership and organizational setting play vital roles, although they were often neglected in previous studies

Cross-border purchases of health services : a case study on Austria and Hungary

This paper explores the structure of cross-border health purchasing between Austria and Hungary and determines the size of this phenomenon as well as the barriers to a further increase. Austrian patients may receive health care treatment in Hungary in three different ways. First, patients may receive benefits in the context of the European Community Regulations 1408/71 and 574/72 (Category I patients). Second, outside those regulatory structures, Austrian patients travel to Hungary to receive medical treatment, especially dental treatment, and then seek reimbursement from their Austrian insurance (Category II patients). Third, some patients receive medical treatment in Hungary outside both schemes (Category III patients). There are about 42,500 Category I patients per year; and 58,000 Category II patients world-wide per year. An unknown but supposedly greater number of patients travel to Hungary to receive mainly dental treatment and cosmetic surgery (Category III). Most health actors in both Austria and Hungary do not regard cross-border purchasing of health services as having cost-saving effects. They put forward major legal, institutional, political, and psychological barriers, which inhibit public and private Austrian providers, to facilitate trade in health care and which inhibit individual patients to realize cost savings through capitalizing on lower health care prices in Hungary. Therefore, for the time being, trade in health care and patient mobility between Austria and Hungary is a circumscribed phenomenon in terms of quantities, and it will most probably remain so in the near future.access to health care; adequate resources; aid; beds; cataract surgery; clinics; Community hospitals; Consumer Protection; cost effectiveness; costs of treatment; dental care; dental treatment; dentists; Diagnosis; discrimination; disease; doctor; doctors; domestic law; employment; entitlement; expenditures; families; financial resources; fundamental principles; general practitioner; Health Affairs; health care; health care centers; health care costs; health care coverage; health care facilities; health care institutions; health care insurance; health care law; health care provider; health care providers; health care sector; health care services; health care standards; health care system; health care systems; Health Care Systems in Transition; health expenditure; health facilities; health insurance; health insurance companies; health insurance funds; health insurance system; health insurers; Health Organization; health organizations; health policy; health providers; health sector; health service; Health Services; health system; health systems; Health Systems in Transition; Healthcare; hospital care; hospital financing; Hospital Operator; hospital sector; hospital treatment; hospitals; hygiene; income; insurance; insurance coverage; insurance systems; Integration; judicial proceedings; legal provisions; marketing; Medical Association; medical associations; medical benefits; medical care; medical facilities; medical science; medical services; medical treatment; medicine; Migration; National Health; National Health Insurance; National Health Insurance Fund; national health policy; nurses; patient; patient care; patient treatment; patients; physician; physicians; Policy ReseaRch; Primary Care; private health insurance; private health insurers; private hospitals; private households; private insurance; private insurer; private insurers; private sector; provision of health care; provision of services; public health; public health care; public health insurance; public hospitals; public sector; quality control; quality of health; quality of health care; rehabilitation; reimbursement rates; right to health care; social health insurance; social insurance; Social Policy; social security; social security schemes; social security systems; surgery; therapy; treatments; Use of Health Care Services; visits; workers

Communication in Information Seeking Behaviour

Abstracts Much research has been carried out into information behaviour over many years. In every field, researchers study information seeking and use in yet another context (culture, organization, health, community, domain, and so on) without regard to any understandings of information seeking and use in other contexts.” This research set out to address these criticisms by building on existing models from library and information science and from communication studies to develop a new representation of information behaviour – one that encompasses seeking, use and communication of information. The ISCM model has been used to examine information behaviour in health care in order to investigate its validity and the insights that it can provide. By testing the model’s validity, the research also investigates the practical relevance of the models on which it is based and the elements of information behaviour that they identify. Health care was chosen to test the model because it has been a fertile field for exploration of information behaviour. The information needs and behaviour of physicians: content analysis of individual studies to examine further the applicability and validity of the Information Seeking and Communication Model a number (5) of studies of physicians’ information behaviour have been analysed in more detail using deductive content analysis. The findings indicate that, the specific collaborative information behaviours observed in the study were collaborative information seeking, collaborative information processing, and collaboration in decision making and taking action, and a related activity was information sharing. These findings indicate that the ISCM adequately represents key features of information users’ behaviour and factors affecting it. The five studies together provide evidence that all of this is true with regard to physicians’ information behaviour. They provide examples of the activities of physicians in seeking information and some of the thoughts and feelings they may have as they seek information. They also provide examples of physicians’ processing and assessing information and using it to make decisions, take actions or to increase their knowledge

Communication in Information Seeking Behaviour

Abstracts Much research has been carried out into information behaviour over many years. In every field, researchers study information seeking and use in yet another context (culture, organization, health, community, domain, and so on) without regard to any understandings of information seeking and use in other contexts.” This research set out to address these criticisms by building on existing models from library and information science and from communication studies to develop a new representation of information behaviour – one that encompasses seeking, use and communication of information. The ISCM model has been used to examine information behaviour in health care in order to investigate its validity and the insights that it can provide. By testing the model’s validity, the research also investigates the practical relevance of the models on which it is based and the elements of information behaviour that they identify. Health care was chosen to test the model because it has been a fertile field for exploration of information behaviour. The information needs and behaviour of physicians: content analysis of individual studies to examine further the applicability and validity of the Information Seeking and Communication Model a number (5) of studies of physicians’ information behaviour have been analysed in more detail using deductive content analysis. The findings indicate that, the specific collaborative information behaviours observed in the study were collaborative information seeking, collaborative information processing, and collaboration in decision making and taking action, and a related activity was information sharing. These findings indicate that the ISCM adequately represents key features of information users’ behaviour and factors affecting it. The five studies together provide evidence that all of this is true with regard to physicians’ information behaviour. They provide examples of the activities of physicians in seeking information and some of the thoughts and feelings they may have as they seek information. They also provide examples of physicians’ processing and assessing information and using it to make decisions, take actions or to increase their knowledge

Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated$18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the$40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment

Personalized medicine : the impact on chemistry

An effective strategy for personalized medicine requires a major conceptual change in the development and application of therapeutics. In this article, we argue that further advances in this field should be made with reference to another conceptual shift, that of network pharmacology. We examine the intersection of personalized medicine and network pharmacology to identify strategies for the development of personalized therapies that are fully informed by network pharmacology concepts. This provides a framework for discussion of the impact personalized medicine will have on chemistry in terms of drug discovery, formulation and delivery, the adaptations and changes in ideology required and the contribution chemistry is already making. New ways of conceptualizing chemistry’s relationship with medicine will lead to new approaches to drug discovery and hold promise of delivering safer and more effective therapies

Understanding Patient Journeys with Telehealth: A Poisson-Factor-Marked Hawkes Process

The emerging telehealth platforms connect patients with physicians using telecommunication technologies and are transforming the traditional healthcare delivery process. Meanwhile, patient care journeys spreading across online and offline health service channels call for new research methodologies. Using a dataset from a telehealth platform, we develop a novel Poisson-factor-marked Hawkes process to model such a journey and quantify the mutual-modulating effects of various patient activities. Our estimation results demonstrate the disparate impacts of the patient’s health conditions and physician characteristics on choosing care channels. Taking advantage of the self-generation property of our model, we simulate policy and strategic interventions, which highlights the practical value of the proposed model and offers implications for better patient routing and service design for telehealth platforms

Investigation of the adoption of telemedicine technology in the Kuwaiti health system: Strategy and policy of implementation for overseas referral patients

This thesis was submitted for the degree of Doctor of Philosophy and was awarded by Brunel UniversityThe cost of health care services is rising and the number of patients requesting overseas treatment from the Kuwait Government continues to increase; this is becoming an unsustainable financial burden. A telemedicine system has the potential to support the Kuwaiti health system to provide medical consultations from global medical centres, and thereby reduce the number of Kuwaiti patients being sent abroad for treatment, and so reduce costs. This research investigates the readiness of the key stakeholders in regard to adoption of telemedicine systems in the Kuwaiti healthcare system. This is achieved by assessing the readiness of individuals (physicians and patients), the organisation (policy makers) and the technical infrastructure (IT managers). Moreover, the lack of research on this topic, particularly in the Arabian Gulf Region, was the reason behind carrying out this study. An in-depth study was conducted by using a quantitative and qualitative approach. A questionnaire was used to explore the attitudes of specialised physicians and patients by obtaining their opinions based on specific criteria. Next, semi-structured interviews were conducted: (1) with IT managers to assess the technical infrastructure of the health system; and (2) with policy makers to assess the organisation in regard to its readiness towards telemedicine adoption. The study shows that the overseas referral patients are ready to use telemedicine systems, as a consequence of their need to receive medical consultations from global experts. However, they expressed some concerns, such as privacy and confidentiality of their data. The specialised physicians also showed readiness towards adoption of telemedicine in the Kuwaiti health system, and their responses indicated that they are willing to use such systems. However, the findings of the interviews reveal that the current technical infrastructure for ICT in the Kuwaiti healthcare system is not ready for telemedicine adoption and there are needs to be change in the way management is organized in order to improve and enhance trust among departments. The qualitative approach identified factors that would inhibit and hinder the adoption of telemedicine in Kuwait, as well as the supportive factors in the organisation. Using the results, a strategy was developed to demonstrate how the Kuwaiti health system could be made ready to receive a telemedicine system, together with policies for the use of telemedicine systems by overseas referral patients. A comparison with Jordan and Syria shows that the Kuwaiti healthcare system is more ready to adopt a telemedicine system with respect to the individuals, technical infrastructure and governmental support. Finally, an economic analysis was performed in order to investigate the cost effectiveness of the proposed system

Does a public single payer system deliver integrated care? A national survey study among professional stakeholders in Denmark

Background: Integrated health care delivery is a goal of health care systems; to date there has been limited information on the integration of medical care in practice. Purpose: To examine and compare perceptions of clinical integration and to identify associated strategic, cultural, technical and structural factors. Design and setting: A national survey addressed to: all county administrative managers (n=15); all hospital managers (n=44); and randomized selected samples of hospital department physician managers (n=200) and general practitioners (n=700) in Denmark. Results: Several initiatives have been implemented in Denmark to integrate care. Nevertheless, most physicians agree that only half of all patients experience well coordinated pathways. Clinical integration is a strategic priority at the managerial levels, but this is not visible at the functional levels. Financial incentives are not used to encourage coordination. The information communication technology to facilitate clinical integration is perceived to be inadequate. Conclusion: The scope for improvement is high due to the structural composition of the system. Increased managerial stewardship, alignment of the financial incentives, and expanded use of information communication technology to link sub-organisations will be a way to move the system forward to meet its explicit goal of providing an integrated delivery of services