Implementing technology in healthcare: insights from physicians

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Abstract

Background

Technology has significantly changed the way health organizations operate. However, the role it plays in healthcare systems remains unclear. This aim of this study was to evaluate the opinion of physicians regarding e-health and determine what factors influence their opinion and describe the advantages, inconveniences and threats they may perceive by its use.

Methods

A cross-sectional questionnaire-based study. A questionnaire which had been previously designed and validated by the authors was used to interview physicians from the Barcelona Medical Association. 930 physicians were contacted by phone to participate in the study.

Results

Seven hundred sixty physicians responded to the questionnaire (response rate: 82%). The usefulness of telemedicine scored 7.4 (SD 1.8) on a scale from 1–10 (from the lowest to the highest) and the importance of the Internet in the workplace was 8.2 points (SD 1.8). Therapeutic compliance (7.0 -SD 1.8-) and patient health (7.0 -SD 1.7-) showed the best scores, and there were differences between professionals who had and had not previously participated in a telemedicine project ( p < 0.05). The multivariate regression model explained the 41% of the variance for 7 factors: participation in telemedicine project ( p < 0.001), quality of clinical practice ( p < 0.001), patient health ( p < 0.001), professional workload ( p = 0.005), ease-of-use of electronic device ( p = 0.007), presence of incentives for telemedicine ( p = 0.011) and patient preference for in-person visits ( p = 0.05).

Conclusions

Physicians believe in the usefulness of e-health. Professionals with previous experience with it are more open to its implementation and consider that the benefits of technology outweigh its possible difficulties and shortcomings. Physicians demanded projects with appropriate funding and technology, as well as specific training to improve their technological abilities. The relationship of users with technology differs according to their personal or professional life. Although a 2.0 philosophy has been incorporated into many aspects of our lives, healthcare systems still have a long way to go in order to adapt to this new understanding of the relationship between patients and their health.

Electronic supplementary material

The online version of this article (doi:10.1186/s12911-017-0489-2) contains supplementary material, which is available to authorized users.

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Most cited references 22

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Adoption of telemedicine: from pilot stage to routine delivery

Paolo Zanaboni, Richard Wootton (2012)

Background Today there is much debate about why telemedicine has stalled. Teleradiology is the only widespread telemedicine application. Other telemedicine applications appear to be promising candidates for widespread use, but they remain in the early adoption stage. The objective of this debate paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. Discussion We have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. For each topic, we have formulated hypotheses. First, the advantages for users are the crucial determinant of the speed of adoption of technology in healthcare. Second, the adoption of telemedicine is similar to that of other health technologies and follows an S-shaped logistic growth curve. Third, evidence of cost-effectiveness is a necessary but not sufficient condition for the widespread adoption of telemedicine. Fourth, personal incentives for the health professionals involved in service provision are needed before the widespread adoption of telemedicine will occur. Summary The widespread adoption of telemedicine is a major -- and still underdeveloped -- challenge that needs to be strengthened through new research directions. We have formulated four hypotheses, which are all susceptible to experimental verification. In particular, we believe that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications in future. Research is also required to identify suitable financial and professional incentives for potential telemedicine users and understand their importance for widespread adoption.

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Why is it difficult to implement e-health initiatives? A qualitative study

Elizabeth Murray, Joanne Burns, Carl May … (2011)

Background The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers -- the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives. Methods We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT). Results Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization. Conclusions Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning.

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Systematic review of studies of the cost-effectiveness of telemedicine and telecare. Changes in the economic evidence over twenty years.

Hema Mistry (2011)

A systematic review of studies of the cost-effectiveness of telemedicine and telecare was undertaken from 1990 until September 2010. Twelve databases were searched, using economic evaluation terms combined with telemedicine terms. The search identified 80 studies which were classed as full economic evaluations; the majority (38) were cost-consequence analyses. There were 15 cost-effectiveness analyses (CEA) and seven cost-utility analyses (CUA). In the period January 2004 to September 2010 there were 47 studies. Eleven were CEA and seven were CUA. Economic tools are being increasingly used for telemedicine and telecare studies, although better reporting of the methodologies and findings of the economic evaluations is required. Nonetheless, the results of the review were consistent with previous findings, i.e. there is no further conclusive evidence that telemedicine and telecare interventions are cost-effective compared to conventional health care. Copyright © 2012 by the Royal Society of Medicine Press Ltd

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Author and article information

Contributors

Maria Dolors Ruiz Morilla: acupuntmedica@gmail.com

Mireia Sans: mireiasanscorrales@gmail.com

Albert Casasa: acasasa@eapsardenya.cat

Nuria Giménez: nuria.gimenez@uab.cat

Journal

Journal ID (nlm-ta): BMC Med Inform Decis Mak

Journal ID (iso-abbrev): BMC Med Inform Decis Mak

Title: BMC Medical Informatics and Decision Making

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6947

Publication date (Electronic): 27 June 2017

Publication date PMC-release: 27 June 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 92

Affiliations

[1 ]CAP Terrassa Oest. MútuaTerrassa, Terrassa, Barcelona, Spain

[2 ]Health 2.0 section of the Col·legi Oficial de Metges de Barcelona, Barcelona, Spain

[3 ]CAP Comte Borrell. CAPSBE. Hospital Cínic, Barcelona, Spain

[4 ]EAP Sardenya. Biomedical Research Institut Sant Pau, Barcelona, Spain

[5 ]ISNI 0000 0004 1937 0247, GRID grid.5841.8, , Mútua Terrassa Research Foundation, Universitat de Barcelona, ; Barcelona, Spain

[6 ]GRID grid.7080.f, , Toxicology Laboratory, Universitat Autònoma de Barcelona, ; Barcelona, Spain

Article

Publisher ID: 489

DOI: 10.1186/s12911-017-0489-2

PMC ID: 5488364

PubMed ID: 28655299

SO-VID: 0be2a5c2-6c77-4d59-b8ca-1598416a6d63

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 20 January 2017

Date accepted : 13 June 2017

Funding

Funded by: Col·legi Oficial de Metges de Barcelona

Custom metadata

ScienceOpen disciplines: Bioinformatics & Computational biology

Keywords: attitude to health,health knowledge,attitudes,telemedicine,delivery of healthcare,diffusion of innovation,physician-patient relations,attitude to computers,surveys and questionnaires,organizational innovation

Data availability:

ScienceOpen disciplines: Bioinformatics & Computational biology

Keywords: attitude to health, health knowledge, attitudes, telemedicine, delivery of healthcare, diffusion of innovation, physician-patient relations, attitude to computers, surveys and questionnaires, organizational innovation

Implementing technology in healthcare: insights from physicians

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Most cited references 22

Adoption of telemedicine: from pilot stage to routine delivery

Why is it difficult to implement e-health initiatives? A qualitative study

Systematic review of studies of the cost-effectiveness of telemedicine and telecare. Changes in the economic evidence over twenty years.

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