The challenges of using information communication technologies in the healthcare systems in Ethiopia from provider's perspectives

The adoption of eHealth is very slow despite evidences showing its benefits. This research examines the individual, clinical, technical and organizational challenges for eHealth adoption from healthcare provider‟s perspectives. A cross-sectional study design with a quantitative paradigm was used. The study was conducted on 312 doctors and nurses randomly selected from ten hospitals in Addis Ababa, Ethiopia. Most respondents viewed eHealth positively with no significant differences in terms of profession or gender. Computer skill, workload, patient interaction, management support, cost and infrastructure were the main concerns. Privacy and security were not the main concerns. Knowledge of eHealth applications and utilization was low, even for evidence-based medicine and online databases. Specialists and males were better aware of eHealth applications. The study showed that eHealth acceptance was good. Increasing eHealth literacy was recommended as a cost effective means for improving access to updated information to improve the quality of healthcare.Health StudiesM.A. (Public Health (Medical Informatics)

Factors affecting the acceptance and meaningful use of picture archive and communication systems by referring clinicians in private practice

A Picture Archive and Communication System (PACS) is a health information technology that facilitates the electronic storage, transmission, presentation and processing of digital medical-imaging datasets. The benefits of PACS have been well-documented. It provides a means to replace traditional film-based workflows and their inherent limitations. Referring clinicians’ acceptance is a critical factor in the overall success of a PACS implementation; and given the financial implications of project failure, research into physician acceptance and meaningful use is crucial. Very few PACS acceptance studies have focused on the referring clinicians, and even less in the context of the private sector. Therefore, the problem that this research aims to address is: There is a lack of understanding on which factors influence PACS acceptance and the meaningful use thereof by referring clinicians in private practice. This explorative study follows an embedded mixed methodology approach in order to meet the research objectives, favouring a qualitative method of inquiry with the support of a quantitative strand. Electronic questionnaires were distributed to private practice referring clinicians to probe the aspects related to PACS acceptance and its meaningful use. The conceptual framework, as devised by Paré and Trudel (2007), was used as a theoretical lens to categorize and discuss the research results in terms of Project, Technological, Organizational and Behavioural factors that affect PACS acceptance and its meaningful use. The findings showed good acceptance rates, which is in line with other research conducted in this field, including research done in the public sector. Technical and Organizational factors were the most prevalent. An extension of the above-mentioned theoretical framework was proposed to assist in maintaining positive results after the project Implementation phase has been completed. This research expands the Information Technology PACS body of knowledge – by identifying both the technical and the non-technical factors that are crucial in private practice referring doctor acceptance and meaningful use. By addressing these factors, institutions can improve the likelihood of PACS project success in private practice settings. Maximising referring doctor acceptance and meaningful use could also give private practices a competitive advantage over their competitors

ADOPTION OF ELECTRONIC HEALTH RECORDS SYSTEM: DIFFERENTIATING MAIN ASSOCIATIONS

Health organizations are implementing health information technologies such as electronic health records (EHR), information systems (IS), and health information exchange (HIE) networks to improve decision-making. However, over the years, the healthcare environment has demonstrated numerous unsuccessful implementations of such technologies. One of the reasons is that physicians tend not to make use of these technologies in the healthcare environment. The various explanations put forward typically refer to patient, physician, and/or work environment-related factors. \ \ This study evaluated the factors associated with the EHR use among physicians in the complex environment of emergency departments. \ \ We used log-files retrieved from an integrative and interoperable EHR that serves Israeli hospitals. We found that EHR was primarily consulted for patients presenting with internal diagnoses, patients of older age, and it was used more by internists than by surgical specialists. Furthermore, EHR usage was larger for admitted patients than for those discharged. \ \ The findings show factors associated with EHR use and suggest that it is mostly related to case-specific features and to physician specialty. The findings strongly suggest that when planning assimilation projects for EHR systems and HIE networks, attention should be paid to those factors associated with system usage. Specifically, in order to increase the efficiency of the system, and enhance its use in the ED environment, physicians´ preferences and practice-related needs need to be taken into account. Furthermore, well-thought IT design and implementation are necessary to generate an increase in meaningful use of HIT, which can serve both physicians´ and patients´ needs

Future developments and trends in use of picture archiving and communication systems

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University London.Objectives: This study identifies modern information technologies that can improve the clinical practice of Picture Archiving and Communication Systems (PACS) and determines the approaches that are needed to improve the functionality of current PACS to provide better next generation PACS and to improve the future of radiology practices and workflow with future PACS generations. Method: A parallel mixed method approach was adopted including qualitative method (semi-structured interviews), quantitative method (questionnaire survey) and observation of online discussion groups on PACS. Five databases were searched to find salient literature, including Science Direct, Springer Link, Scopus, CINAHL Plus and Google Scholar. Six radiologists were interviewed and questionnaires were collected from 120 radiologists. Four online discussion groups related to PACS were monitored via LinkedIn. The data were analysed thematically using the thematic analysis method. Finally, a focus group was held with a separate group of radiologists to validate the findings. Results: Eight themes emerged from the thematic analysis of the data: (1) limitations of traditional PACS; (2) user needs and requirements that can increase PACS functionality; (3) Web based solutions of PACS; (4) PACS on mobile phones; (5) Vendor Neutral Archive (VNA); (6) full integration of voice recognition in PACS; (7) backup solutions for the system and (8) continuous training for PACS users. Discussion: With the development of healthcare information and communication technology (ICT) and with the increased demands of the radiologists to expand PACS usability, traditional PACS must be updated to follow the changes. Modern technologies can provide better solutions to enhance the functionality of current PACS. The next generation of PACS can fulfil the future requirements of users. This study considers the issues between the needs and requirements of the users of a PACS system in the future and the developing solutions in ICT and the PACS industry. Moreover, highly developed PACS systems with advanced features will have a direct impact in changing and improving radiology workflow. Accordingly, a model has been developed that proposes new features for the next generation PACS system, which may be applied to the next generation radiology practice. The model was validated with the focus group and, by using a separate group of radiologists in another country, was determined to be generalisable. Conclusion: It is widely recognised that traditional PACS must be updated to adopt recent advances in ICT. This research has identified themes that, when incorporated, will enhance the functionality of PACS and radiology workflow and provide better quality clinical practice. The findings from this empirical research can be used: as recommendations to vendors; for technology development; and by medical institutes to consider aspects when undertaking implementation of PACS and training future radiologists. Keywords: 'Picture archiving and communication system’, PACS, Future trends, next generation, Organisational efficiency, Productivity, Clinical practice, Ubiquitous.Ministry of Health, Government of Kuwai

The unified theory of acceptance and use of technology (UTAUT): a literature review

YesPurpose – The purpose of this paper is to perform a systematic review of articles that have used the unified theory of acceptance and use of technology (UTAUT). Design/methodology/approach – The results produced in this research are based on the literature analysis of 174 existing articles on the UTAUT model. This has been performed by collecting data including demographic details, methodological details, limitations, and significance of relationships between the constructs from the available articles based on the UTAUT. Findings – The findings indicated that general purpose systems and specialized business systems were examined in the majority of the articles using the UTAUT. The analysis also indicated that crosssectional approach, survey methods, and structural equation modelling analysis techniques were the most explored research methodologies whereas SPSS was found to be the largely used analysis tools. Moreover, the weight analysis of independent variables indicates that variables such as performance expectancy and behavioural intention qualified for the best predictor category. Moreover, the analysis also suggested that single subject or biased sample as the most explored limitation across all studies. Research limitations/implications – The search activities were centered on occurrences of keywords to avoid tracing a large number of publications where these keywords might have been used as casual words in the main text. However, we acknowledge that there may be a number of studies, which lack keywords in the title, but still focus upon UTAUT in some form. Originality/value – This is the first research of its type which has extensively examined the literature on the UTAUT and provided the researchers with the accumulative knowledge about the model

A model on factors affecting nurses adoption of health information technology

Healthcare organisations are using Health Information Technology (HIT) to improve efficiency, reduce cost and reduce medical errors. This study focused on the factors that influence the acceptance of HIT among nurses in Saudi hospitals. This research used a 6 stage mixed-methods research approach. Literature was used to search for established models and frameworks of technology acceptance, and the many factors that could play a role. In the field study, the nature of practical HIT issues at the Prince Sultan Military Medical City (PSMMC) and the Heraa Hospital were studied, and combined with literature to create a HIT Implementation Issues Framework. The framework consolidates elements from the Technological, Organisational, Environmental and Human dimensions. The researcher participated in further PSMMC projects in the design and implementation of the new Cardio Pulmonary Resuscitation System and the Nurses and Pharmacists’ Communication System. From the implementation experience, pertinent factors were added to the Technology Acceptance Model and the “Nurses Acceptance Model” was proposed. The proposed model has eleven independent parameters, two dependent parameters, as well as seven moderators of key relationships. A questionnaire with 71 entries was distributed to over 2800 nurses in 52 wards in PSMMC. SPSS was used for data screening and descriptive statistics. The SmartPLS software was used for analysis and testing of the proposed hypotheses. The findings refined the “Nurses Acceptance Model” and highlight the significance of User Involvement and Training. The “Nurses Acceptance Model” enhances the scientific understanding of variables that affect technology acceptance among nurses in Saudi hospitals. The HIT Implementation Issues Framework helps hospital decision makers to plan HIT projects to improve the likelihood of successful adoption

A mixed methods study of factors influencing health managers acceptance of eHealth services in the Kingdom of Saudi Arabia.

The Kingdom of Saudi Arabia (KSA) is a country with one of the largest land masses and most difficult geographical terrain in the Middle East. The accessibility of advanced health services, especially for people in rural areas, has been considered one of the main health challenges. Health services across the country are accessible through three categories of providers. The Ministry of Health (MOH), which is the dominant health provider, is responsible for 60% of all health services and facilities. The private health sector and other government-run health authorities are the providers for the remaining 40%. Many initiatives to embrace technology in healthcare were launched by the MOH to advance the level of acceptance. One of the initiatives was the ambitious National eHealth Strategy, which was launched in 2011 to govern eHealth projects across the country, and to set consistent standards, policies, and procedures for the practice activities. This study was sponsored by the MOH as part of a bigger plan to involve stakeholders in the digital transformation. The overall aim of this doctoral research was to explore the factors that influence health managers' acceptance of eHealth services in KSA. The 1st phase was a systematic review (SR): based on a PRISMA-P guided protocol published with CRD Prospero, five databases were searched for studies published between 1993 and 2017. One reviewer performed the search; two reviewers screened the titles and abstracts. Exclusions were recorded with reasons. Tools appropriate to study design were applied independently by two reviewers to assess the quality of included studies. After duplicates were removed, 110 papers were screened and 15 studies met the inclusion criteria. From these 15 papers, 39 factors were identified as influencing varying levels of eHealth adoption and acceptance in KSA. Lack of studies on the views of health managers and limited studies from only a few geographical settings were also identified as knowledge gaps. The 2nd phase was a survey: an online questionnaire in both Arabic and English language was designed around the Unified Theory of Acceptance and Use of Technology (UTAUT) model determinants. Professionals with a health managerial role from multiple disciplines - such as health professions, administration, and health IT - were invited to take part in the study. Ethical approval had been gained. Participation links were distributed across a range of social media platforms. SPSS v25 was used for data analysis. Findings from the 2nd phase survey showed the significance (p < 0.05) of Performance Expectancy and Social Influence moderated by age to the Behavioural Intention of health managers as well as the Performance Expectancy and Facilitating Conditions to the actual Use Behaviour. Some ambiguous results need further investigations. The 3rd phase consisted of a mixture of face-to-face and telephone in-depth interviews with 21 health managers from Aseer province, KSA. Four umbrella domains were derived from the UTAUT model. The pre-defined themes from phases 1 and 2 were explored and mapped against the domains. Ethical approval had been gained. Microsoft Excel and NVivo were used for the data analysis. Through the interviews, ambiguity in the previous phase was clarified and the most influential factors based on the views of health managers in Aseer province, KSA, were identified. Three domains out of four showed significance: Performance Expectancy, Social Influence, and Facilitating Conditions. This mixed methods research design presented across three phases was adopted with the findings from each phase informing the next. Overall, the research confirmed the influence of the same factors on health managers' acceptance of eHealth services in KSA and generated original findings. First, by providing evidence that this area has not been previously studied through registering a protocol and publishing a systematic review. Second, by using social media platforms to support a novel recruitment approach for the study. Third, by employing UTAUT as a theoretical framework in both quantitative and qualitative phases. Finally, exploring eHealth practice in Aseer province, a part of KSA that has not previously been explored in the published literature. These original findings draw a clearer picture of the potential challenges faced by health managers in KSA in accepting and using eHealth services. The findings may also work as a foundational basis from which to better prepare other stakeholder groups for accepting eHealth services. By doing so, staff can more effectively utilise health technology interventions as key concepts in making successful and positive transformational and sustainable change to the delivery of healthcare

Effects of EMR on Community Health Center Communication

Electronic medical record (EMR) systems impact healthcare communication in a significant number of ways. The physical presence of the EMR in the examination room can negatively impacts patient-provider communication. This research examined the impact of EMR on patient-provider communication within the microcosm of the community health center. The data for this research was collected via a quantitative survey using a random sample of 513 (10%) of the 5,101 patients of the Northwest Community Health Center (August 2021 to August 2022). These participants were at least 18 years of age and had seen their medical provider in the previous 12 months. Many themes arose from the research participants who were uncomfortable with the EMR or the use of technology in the exam room. Understanding the benefits or even the general functionality of the EMR allows the patient to feel more comfortable with its use and to become more tolerant of the presence and use of technology during the physician encounter. Furthermore, as the possession and use of current technologies diminishes amongst the study’s participants, so does their preference for their provider to use an EMR. To comprehend the impact EMR knowledge has on the patients’ perception of its utilization, a crosstabulation between staff and non-staff patients underlined the fundamental difference. When asked what type of chart they would prefer their medical provider to use, a quarter of non-staff patients preferred electronic medical records, whereas two-thirds of the staff, who are also patients of the community health center, preferred the same. These findings indicate a need to educate patients about the benefits of the EMR and the advantage of accessing the EMR in the exam room. Furthermore, enhancing the providers’ communication skills will help them comprehend the prevalent communication barriers created by accessing the EMR in the exam room. The quality of the interaction between the patient and provider is critical to the patient’s health outcomes. Improved communication leads to better emotional and physiological health, compliance with treatment recommendations, pain management, and symptom resolution