Required reading, videos, and attached files
Kakkar, A., Naushad, S., & Khatri, S. K. (2017). Telemedicine and EHR integrated approach for an effective E-governance healthcare framework. International Journal of Medical Research and Health Sciences, 6(5), 108-114. Retrieved from:
https://www.ijmrhs.com/medical-research/telemedicine-and-ehr-integrated-approach-for-an-effective-egovernance-healthcare-framework.pdf
The 7 Categories of Healthcare Information Technology
Video: Transforming Healthcare with Technology
Assignment #1:Technology is changing and evolving. Conduct a search of the Internet, library, or print literature to identify several new or emerging technologies for maintaining health records. Prepare a 10-slide PowerPoint to explain the following questions:
- Describe each technology and discuss its potential use in the management of health care information or the development of health care information systems.
- What proportion of the data in the patient’s medical record is captured electronically? What information is recorded manually? Do you think the method of capture affects the quality of the information?
- List three major inpatient clinical information systems and explain how technology enables these systems to deliver improved care.
- Identify two outpatient clinical information systems and explain how these systems differ from inpatient clinical information systems.
Assignment #1 Expectation:
- Your references and citations should be consistent with a particular formatting style, such as APA.
- Provide references from at least three scholarly articles and peer-reviewed journals.
- Your response should be based on reliable and scholarly material, such as peer-reviewed articles, white papers, technical papers
Assignment #2: continue with the selected healthcare organization from Module 1, and respond to the items below:
- How would you explain data analytics to your leadership team? What does it mean?
- What are three opportunities to use Big Data in your organization?
- How can Big Data benefit your patients?
- How is Big Data used to identify healthcare fraud?
Assigment #2 Expectation: same as #1
Ruiz Morilla et al. BMC Medical Informatics and Decision Making (2017) 17:92
DOI 10.1186/s12911-017-0489-2
RESEARCH ARTICLE
Open Access
Implementing technology in healthcare:
insights from physicians
Maria Dolors Ruiz Morilla1,2,5*, Mireia Sans2,3, Albert Casasa2,4 and Nuria Giménez5,6
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.
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
Background
There has been a rise in the demand in healthcare
systems in Western countries due to aging of the population, an increase in the prevalence of chronic diseases,
and limitations in funding, especially after the recent
economic recession [1]. In this context, the introduction
of computers and technology can help to improve the
* Correspondence: acupuntmedica@gmail.com
1
CAP Terrassa Oest. MútuaTerrassa, Terrassa, Barcelona, Spain
2
Health 2.0 section of the Col·legi Oficial de Metges de Barcelona, Barcelona,
Spain
Full list of author information is available at the end of the article
efficiency of the healthcare system and the care provided
to patients/users [2].
For the purpose of this paper we use the terminology
in the following way. E –health is used referring to
health services and information delivered or enhanced
through the Internet and related technologies [3]. We
consider telemedicine (TM) as the use of medical information to improve the health of patients via electronic
communication [4]. E-health allows access to health
resources and healthcare by electronic means [5]. It
provides an opportunity to not only to preserve or
© The Author(s). 2017 Open Access This 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.
Ruiz Morilla et al. BMC Medical Informatics and Decision Making (2017) 17:92
improve the quality of healthcare more cost-effectively
but also allows healthcare services to be reinvented in
order to make them more dynamic and able to adapt to
technological changes. Finally we talk about having a 2.0
attitude in relation to having incorporated the principles
of Web 2.0. It is characterized by greater user interactivity and collaboration, more pervasive network connectivity and enhanced communication channels.
The role of TM in public healthcare is controversial.
Many technological solutions are currently possible [6],
however, it is not the technology of TM that is important
but rather the new approach to provide and organize
healthcare services. Indeed, TM changes physician-patient
relationships allowing more direct patient involvement in
the decision making related to their health [7–9].
However, despite political commitment and significant
investment, the application of technology to healthcare
systems has not always been successful [4, 10]. The factors which can facilitate or hinder the introduction of
TM in healthcare have been described in depth [11],
with legal and regulatory issues, questions involving reimbursement and the impact on the effectiveness and
the quality of care being the most common barriers
reported [6, 12].
The success of TM depends on the end-users, that is
the physicians and patients actually using it, and this
largely depends on how it is implemented [13]. Different
models have been proposed to predict what factors will
determine its success. For example, the Technology
Acceptance Model (TAM) has been applied to determine how physicians come to accept and use TM [14],
and two factors have been identified as important predictors of the use of technology: perceived ease-of-use
and perceived usefulness [15–17].
Thus, physicians must be involved and their needs
taken into account in order to implement this change
[18]. Moreover, it is important to understand the relationship between physicians and technology and how
they evaluate the introduction of new technologies in
their daily clinical practice.
Taking all of the above into account, the main objective of this study was to evaluate the opinions of physicians regarding e-health. Secondary objectives were to
evaluate what variables influence their opinion regarding
e-health, to describe the advantages, inconveniences and
threats these professionals perceive with the use of telemedicine and how they use new technologies.
Methods
A cross-sectional questionnaire-based study was designed. A TM questionnaire which had previously been
designed and validated by our team in collaboration with
other healthcare professionals was used [19]. A new section on the use of technological devices was added to
Page 2 of 9
the questionnaire. In total, the questionnaire included
eight theoretical sections and 46 variables (Additional
file 1: Table S1).
The study population consisted of physicians belonging to the Barcelona Medical Association -Col · legi
Oficial de Metges de Barcelona- (n = 31,972) the official
institution including all the physicians practicing in the
province of Barcelona (Spain). Only physicians who
had agreed to be interviewed by telephone were
chosen (n = 20,189) according to the law on data protection and were randomized. A total of 930 physicians were contacted by phone from May to June
2015, 760 of whom responded to the questionnaire
(response rate 82%). A researcher recorded their response to each question done over the phone. Participation was voluntary, and information on the nature
of the study was provided during the telephone call.
The participants were informed that the information
would only be used for the purpose of investigation
and confidentiality and anonymity were guaranteed.
Details on participation are provided in Fig. 1.
According to Murray et al., we consider professionals who are dedicated to management to be
“implementers” because of their role in the planning
of healthcare services and in the final decision as to
whether or not to incorporate technology into these
services [20].
The professionals studied were classified into three age
groups: under 40 years of age, 40–50 years, and over 50
years old.
Fig. 1 Participation diagram
Ruiz Morilla et al. BMC Medical Informatics and Decision Making (2017) 17:92
Statistical analysis
We evaluated the reliability of the questionnaire using
the Cronbach alpha coefficient. No variable presented
losses greater than 5%. In addition, quantitative variables
were expressed as numbers and percentages, and semiquantitative variables were scored on a scale of 1–10
(from the lowest to the highest) and were expressed
quantitatively with at least one measurement of central
tendency and one of dispersion. The normality was
explored with the Kolmogorov-Smirnov test. The Chisquare test was used to compare qualitative variables
and means were compared with the Student’s t test and
ANOVA. In the multivariate multiple regression model,
the evaluation of the utility of TM by the physicians was
considered as a dependent variable, and predicted variables were those showing statistical significance in the
bivariate analysis adjusted for age. The enter method
was used to perform the analyses. Statistical significance
was accepted with a p value < 0.05, with a bilateral approach. The SPSS 17.0 programwas used (SPSS Inc.,
Chicago, USA).
Data exclusion
Participants who refused to participate in the study were
excluded, as were those who could not be contacted.
Results
Seven hundred sixty physicians responded to our survey,
being a response rate of 82% (Fig. 1).
All of the questions were answered by more than 95%
of participants.
Table 1 shows the characteristics of the study population; 53% were women with a mean age of 46 years
(SD 11).
Opinion of e-health
Participation in telemedicine and the perception of its
usefulness
The mean score of the usefulness of TM was 7.4 (SD
1.8). Thirty percent of the responders reported having
previously participated in a TM project. This participation was significantly more frequent among physicians
in the public compared to the private sector (p < 0.001),
especially among physicians in primary care or third
level hospitals.
Table 2 describes the factors that influence the usefulness of TM. Physicians with previous experience with
TM scored its utility higher and perceived greater possibilities or benefits with its use. No differences were
found in the area of needs and difficulties.
Table 3 shows the data from the multiple regression
model with the usefulness of TM as a dependent variable. The independent variables were those found to be
significant in the bivariate analysis in addition to age.
Page 3 of 9
Table 1 Socio-demographic data of the physicians included in
the study
Variable
Frequency (percentage)
N total
760 (100%)
Age
Under 40
285 (38%)
41–50
163 (21%)
Over 50
312 (41%)
Sex
Male
355 (47%)
Female
405 (53%)
Residence
Barcelona area
444 (58%)
Other
316 (42%)
Specialty
Primary
348 (46%)
Hospital:
Medical
240(32%)
Surgical
104 (14%)
Central support services
68 (9%)
Sector
Public
425 (56%)
Private
142 (19%)
Both
188 (25%)
Place of work
Primary health centre
312 (41%)
Level 3 hospital
169 (22%)
Level 1–2 hospital
112 (15%)
Private practice
112 (15%)
Healthcare centre
25 (3%)
Other
30 (4%)
Position
Medical staff
697 (92%)
Management
61 (8%)
The factors that were found to influence telemedicine
were previous experience with telemedicine, the quality
of clinical practice and patient health.
Differences according to age and devices available
Professionals under the age of 40 years with a smartphone scored the utility of TM higher than those
without and considered TM to be able to improve
the health of patients and therapeutic compliance
(Additional file 2: Table S2).
No differences were observed in the opinion of professionals regarding TM according to whether or not they
had a PC.
Ruiz Morilla et al. BMC Medical Informatics and Decision Making (2017) 17:92
Page 4 of 9
Table 2 Factors that influence the usefulness of TM
Opportunities –benefits
Item
Needs
Average score ± SD
Difficulties
Item
Average
score ± SD
Item
Average
score ± SD
Has experience
with TM
Has not experience
with TM
Frequency of in-person
visits
6.5 ± 2.0
6.2 ± 1.9
Patients’ preference for
in-person visits
6.5 ± 2.1
Safety and confidentiality
of information
5.7 ± 2.3
Administrative work
6.4 ± 2.1
6.3 ± 2.2
Professionals’ preference
for in-person visits
6.4 ± 2.0
Ease-of-use of electronic
devices
6.9 ± 1.9
Therapeutic
compliance*
7.0 ± 1.8
6.5 ± 1.8
Patients’ technological
skills
6.7 ± 1.9
Record of profesionals’
performance
6.8 ± 2.0
Healthcare costs
6.7 ± 1.7
6.5 ± 1.8
Professionals’
technological skills
6.9 ± 1.9
Needfor training
7.1 ± 1.9
Quality of clinical
practice*
6.9 ± 1.9
6.4 ± 1.9
Appropiate electronic
device
7.6 ± 2.0
Technical difficulties in the
use of TM
6.3 ± 2.0
Patient health*
7. 0 ± 1.7
6.4 ± 1.6
Project funding
7.8 ± 2.0
Time needed for
electronic visits
6.4 ± 2.1
Professional workload
6.1 ± 2.1
6.1 ± 2.1
Time needed for each
patient
6.2 ± 2.0
Presence of incentives
for TM
6.2 ± 2.3
Sum of opportunities*
6.6 ± 1.2
6.3 ± 1.3
Sum of needs
6.9 ± 1.2
Sum of difficulties
6.5 ± 1.2
Variables are scored on a scale of 1–10 (from least to greatest)
*p < 0.05 difference between having or not having previous experience in TM project using the T-student test
Physicians over the age of 50 with a tablet gave more
importance to the Internet in the workplace and evaluated the usefulness of TM higher compared to those
without a tablet. These physicians also considered that
TM would improve the quality of clinical practice, patient health, therapeutic compliance, healthcare costs
and administrative work. This group expected more difficulties in the introduction of TM into clinical practice
and were more concerned about the ease-of-use of the
devices, registry of professional performance and the
presence of incentives. They also considered that adequate funding was essential.
Implementers and telemedicine
Physicians working in management scored the following areas higher compared to the remaining participants: benefits of TM in therapeutic compliance (7.2
vs. 6.6, p = 0.02), improvement of healthcare costs (7.1
vs. 6.5, p < 0.01), and administrative work (7.1 vs. 6.2,
p < 0.01), and the need for incentives for professionals
to use TM to ensure its success (6.8 vs. 6.2, p < 0.06).
Private medicine and the perception of telemedicine
Physicians working in private medicine scored the following areas higher than those in public institutions:
benefits of TM in improving patient health (6.8 vs. 6.5,
p