Health Services And Information Systems For Communication Technology

Framework for evaluation of health technologies and systems

Describe about the Health Services and Information Systems for Communication Technology.

The provision of the health services is changing with rapid advancement in information and communication technology (Minichiello et al., 2013). A health information system assists in gaining knowledge related to public health status, the determinants of the health problem, their nature, interventions to resolve these issues and the clinical outcomes (Barakat et al., 2013). Significant improvement in health outcomes can be achieved with these advances about a collection of the clinical and demographic information, its transmission and retrieval for allowing seamless continuity of care (Knowles & Mikocka-Walus, 2014).

The report deals with the framework for evaluating the e-health technology system and explains how the technology will improve the health outcomes of the patients. Further the report sates the benefits of introducing the technology or system as identified in the literature. The report deals with the risks associated with introducing the e-health technology in the health care organization as well as the risks for the patients. The report comprehensively presents the potential hazards, the likelihood of the risk occurrence, its impact on the health care organization and the mitigating solutions. A thorough literature review is performed to support the facts in the report. Based on the discussion, results are summarized to draw a conclusion and recommendations are suggested.

The eHealth technology in Australia aims to introduce an effective method to collect and share information such as test results and prescriptions (Suominen et al., 2013). The eHealth technology aims to strengthen communication between medical professional by allowing the electronic communication of the clinical records, information, and referrals (Yardley et al., 2015). The various eHealth tools include electronic prescribing software, electronic health records, decision support programs and health information websites (Bergmo, 2015). The aim of the eHealth technology is to deliver “efficient, effective and sustainable” system. However, it was found form the research paper of (Meier, Fitzgerald & Smith, 2013) that the health care settings where the information communication technologies and the enabling environment are at the early stage, the eHealth systems fail to demonstrate  sustainability. So far very few such projects have been found to sustain themselves in both developed and developing countries (Minichiello et al., 2013). There are various challenges associated with eHealth systems such as legal issues, lack of ICT skills, insufficient financial resources, weak monitoring, and evaluation.

Conceptual framework

There is a need for the effective conceptual framework for the evaluation of this technology to ensure it’s sustainability. According to Tyrrell & Redshaw (2016), within the developed and the developing world, the environmental, economic and social dimensions vary significantly. The developing countries experience shortage of ICT skills, inadequate ICT infrastructure, and the shortage of funds (Mastellos et al., 2015). On the other hand, the developed countries are well equipped with the required infrastructure.  To successfully implement the eHealth technology system, it is necessary to understand the operational environment of the system and it’s interaction with the system of interest.

Conceptual framework

The literature review highlights four factors to evaluate the eHealth technology. The conceptual framework aims to evaluate based on these factors which are – social, technological, environmental and technological factors (Khoja et al., 2013). The economic factors about the sustainability of the eHealth involve sufficient and sustainable funding, cost effectiveness, and return on investment. The aim of the economic factors is to promote affordable health care. The technological factors include technical indicators such as reliability, efficiency, data quality, availability, scalability, accuracy, and adaptability (Suominen et al., 2013). Further the social and the environmental factors are discussed in the chart below.

 

Figure: Context diagram- eHealth system

(Source: Suominen et al., 2013)

Social factors
Social outcome	Ethical	Stakeholders	Behavioral	Culture
·         Improved safety and quality of care ·         Stability and acceptability of eHealth ·         Better clinical outcomes ·         Rapid health care service and its equity ·         Enhanced support, clinical care, and effective decision making ·         Improved clinical care and health management	·         Confidentiality of the information, and  maintenance of the patient’s identity ·         Sensitivity to sociocultural issues ·         Sharing of the health information with different entities of health care in same or different countries, within the same health care facility	·         Users in the routine work get direct benefit ·         Involvement of the stakeholders	·         Satisfaction, trust and willingness in using eHealth ·         Benefit in awareness  and learning eHealth ·         Adoption of the technology among the users ·         Ready to make changes ·         Promotion  of human-computer interaction	Individual cultured of using electronic information

Environmental factors
Legal	Capability and  capacity building	User and Organizational Readiness	Policy	Technical, Management and Political Support
·         Privacy of the health data ·         eHealth and ICT laws ·         Protection of intellectual property ·         Software piracy	·          ICT technology training  and other support for technical team	·         Availability of the hardware and softwares,  electric power and mobile network coverage ·         High speed internet and security of servers	·         eHealth and ICT  procurement policy ·         Change Management  and eGovernment policy	·         ICT services and support ·         Environment of leadership support, coordination and effective partnership ·         Support of eHealth among policy makers

The social, environmental and economic factors are associated with the success of the eHealth. Environmental factors like lack of policy regulations, ICT skills, are the major challenges to the eHealth implementation. Amongst the economic factors funding issues is the eHealth sustainability challenge (Barakat et al., 2013). The conceptual framework can help the policy makers, managers and the developers to make sure there is a sustainable eHealth implementation even in the resource constrained setting (Rippen et al., 2013).

Evaluation of the eHealth technology

Evaluation should be carried out in several iterative stages constituting the lifecycle of the system right from the first step to the last step. Firstly, assessment of the stakeholder is conducted to identify their needs and test the same with the “content experts” to confirm that the needs are fulfilled. This is simultaneously followed by concept and prototype evaluation which is necessary to identify that the eHealth tool is technically robust (Khoja et al., 2013). The new interventions can be developed based on the assessment. Secondly, the effect of the innovative technology on the healthcare outcomes is determined in the target setting. This stage of evaluation involves hard measures such as clinical status, cost, efficiency, and error rates. Soft measures are also evaluated such as attitude of the users and the level of satisfaction. Thirdly, a pragmatic evaluation is performed. It involves the evaluation of the system roll out such as reported errors, variation in the uptake, technical problems, long-term effects on the outcome indicators, and others (Rippen et al., 2013). The evaluator at this stage expects to obtain results that reflect continuous improvement in the quality of the health care.  The figure given illustrates the evaluation of the resources at different steps of development and implementation.

Evaluation of the eHealth technology

 

(Source: Rippen et al., 2013)

The primary health care sector in Australia can substantially benefit from the eHealth technology. The quality of health care services delivered to the patient is believed to be conducive to improve by providing updated information (Kaye et al., 2013).

The “Personally Controlled Electronic Health Records” are under the control of individual patients. These patients can make decisions about which providers can access which information (Minichiello et al., 2013). This system is easily accessible and can be modified as per the need. It is easy to store and share the collected information in this system, unlike the paper-based counterparts.  The “Computerized Provider Order Entry And Electronic Prescribing System” has been found to improve the safety of the patient through the use of “automatic dosage adjustments” thereby reducing the chance of prescribing ineffective medication doses (Ossebaard et al., 2013). Real time alerts and reminders facilitate patients with rapid intervention during a critical period. It leads to improved operational efficiency and decrease in length of hospital stay. Consequently, it ensures decreased a number of “avoidable clinical incidents” (Lam et al., 2013). As studied by Ossebaard et al., (2013), the “Electronic clinical decision support systems,” stores and use electronic prescription data for generating advice that is patient specific. It helps to identify and report the effects of potential drugs interaction. It prompts reminders about the lifestyle modification and screening (Popescu, 2014). This robust decision support features are oriented towards exceptional patient outcomes, patient needs, and patient satisfaction.

Patients in remote and rural communities can have increased access to health care services. In Australia, a number of Indigenous populations are represented in death and disability than the non-Indigenous (Meier et al., 2013). It is expected that the eHealth technology provides this community with increased access to “health knowledge and education.” Introducing this technology assist these group of people to enjoy improved health monitoring and reporting. They will receive health care delivery with enhanced efficiency, higher quality, and safety (van Gemert-Pijnen et al., 2013).

In Australia, the “National E-Health Transition Authority” is developing and an eHealth uptake plan was working together with allied health professionals, numerous stakeholders and general practitioners (van Gemert-Pijnen et al., 2013).  The “RESEARCH ROUNDup” is focusing on the implementation of this technology in primary health care sector. The literature review highlights several benefits of this technology.

The quality of health care services delivered to the patient is believed to be conducive to improve by providing updated information (Meier et al., 2013). There are several benefits of introducing this technology. The Electronic Health Record System creates a database of the health information that can be accessed by all the care providers anytime in the health care setting. This system can contain scanned documents and digital images along with treatment notes and medical histories. This prevents the duplication of services resulting in better care services. These benefits are essential for management of the chronic diseases (Nijeweme-d’Hollosy et al., 2015). The providers in the multi-disciplinary team access the shared information as a result of which they can support “team-based care” across geographical boundaries. This will result in improved continuity of care. Further, this system expands the capacity to “use clinical data” for the purpose of improving quality either within practices or benchmarked against similar practices (van Gemert-Pijnen et al., 2013). Systems such as Electronic Medical Record improve operational effectiveness and cost control which saves precious time locating or collecting the patient’s information (Yardley et al., 2015).

How the technology will improve patient care or health outcomes

eHealth technology tool such as “computerized provider order entry and electronic prescribing system” fosters greater efficiency as it reduces the burden of physical transportation of the orders and the test results between the providers (Ossebaard et al., 2013). This decreases the turnaround time. This eHealth technology facilitates the “direct and efficient communication” between the providers and pharmacies. It does not depend on the courier services, or on the patient that are responsible for the loss or delay of information. This technology is expected to improve the legibility decreasing the chance of errors (Kaye et al., 2013). The ability for the medical professionals to coordinate care and effectively collaborate will increase the evidence base in this area.  This technology introduced in primary health care sector offers the providers with “instant and automated decision support.” This “Electronic Clinical Decision Support Systems” has the potential to improve the performance of the practitioners. It can enhance their decision-making power in the areas such as exercise advice, or diet which are frequently overlooked (Meier et al., 2013). Digital imaging through “Picture Archiving and Communication Systems (PACS)” are more advantageous then the traditional X-ray film. It is helpful to make reports and images that can be simultaneously made available to “multiple physicians in multiple locations.” It provides consistent image quality. It reduces the time spent for “filming and processing studies” and offset film expenses. Along with current images, it gives access to complementary images. It eliminates the space of physical storage needed for film images (Nelson & Staggers, 2014). Overall the eHealth technology provides the care providers with an attractive environment to work. It reduces their burden of performing unnecessary administrative tasks. As a result, care providers can communicate with patients for more time addressing their needs.

Inspite of the plenty of literature available highlighting the benefits of the various eHealth technologies, some researchers have identified the potential risks of this technology. These risks include changes in workflow, privacy and security concerns, loss of productivity with EHR adoption and implementation, and other intended consequences (Nijeweme-d’Hollosy et al., 2015). Financial issues   include high cost of maintaining EHR, decline in revenue due to with decrease and loss of productivity. Several unintended consequences include change in power structure, higher chance of medical errors, negative emotions, and overdependence on the technology. Medical errors are mainly expected to occur due to lack of training. Further physicians may contribute to poorer performance if they overestimate the effectiveness and accuracy of decision support system. It may lead to deterioration of the skills of the healthcare providers (Kaye et al., 2013). Additional risks such as slow server of internet and long waiting hours may delay the treatment process and hinder the quality of care services.

There is a need of more trusted data on efficacy, cost effectiveness and impact of the eHealth tools.  Intense research is required to address the issues related to women accessibility of the mobile phones for health purposes due to gender power relationships, gender inequality, and other socio-cultural norms. Appropriate measures must be developed to address these issues and integrate them into the project designs (Kaye et al., 2013). The security of the patient’s personal data is a major concern and the existing system of the governance is too weak to handle this breach of privacy or “enforce any regulatory framework if the eHealth projects take off.” There is a need for the strong ethical frameworks and policies for sustainability of the eHealth projects. The key dimensions that need careful considerations are the effective IT system integration, awareness related to the high quality evaluation of the new eHealth products, a need for communicating the need paying attention to “usability engineering and other software design methodologies” (Mastellos et al., 2015).

Conclusion

eHealth technology is the promising solution to reduce the burden of the diseases and death. It has emerged to improve the quality and safety of health services. There are several challenges due to which the eHealth projects could not be sustainable such as inadequate funding, lack of ICT skills, and weak infrastructure. Further, it has discussed the framework to evaluate and improve the success of implementing eHealth technology. The report has discussed the four factors mainly used to discuss the sustainability of the eHealth technology. It can be concluded based on the discussion that the designing and implementation of the effective eHealth services require the support of experts from diverse fields. Effective eHealth can be facilitated by interdisciplinary collaboration working with a common goal of achieving transdisciplinary working. There is a need for effective funding strategies that can realize the importance of joint effort from evaluators and developers. The maximization of the eHealth potential demands the involvement of social, legal, management and scientists and all the other stakeholders. The concerning features identified in the area through evaluation implies for the policy makers, managers, developers, program implementers, and others involved in the implementation of the eHealth technology to address the “ large-scale population health needs in resource-constrained settings.” There are several benefits to the patients and the health care providers due to eHealth technology. Therefore, a strategic approach must be taken for successful implementation of the system. 

References

Barakat, A., Woolrych, R. D., Sixsmith, A., Kearns, W. D., & Kort, H. S. (2013). eHealth technology competencies for health professionals working in home care to support older adults to age in place: outcomes of a two-day collaborative workshop. Medicine 2.0, 2(2).

Bergmo, T. S. (2015). How to measure costs and benefits of eHealth interventions: An overview of methods and frameworks. Journal of medical Internet research, 17(11).

Kaye, R., Kokia, E., Shalev, V., Idar, D., & Chinitz, D. (2013). Barriers and success factors in health information technology: A practitioner’s perspective. Journal of Management & Marketing in Healthcare.

Khoja, S., Durrani, H., Scott, R. E., Sajwani, A., & Piryani, U. (2013). Conceptual framework for development of comprehensive e-health evaluation tool. Telemedicine and e-Health, 19(1), 48-53.

Knowles, S. R., & Mikocka-Walus, A. (2014). Utilization and efficacy of internet-based eHealth technology in gastroenterology: a systematic review.Scandinavian journal of gastroenterology, 49(4), 387-408.

Lam, R., Kruger, E., & Tennant, M. (2013). A critical discussion of the benefits of e-health in population-level dental research. Australian journal of primary health, 19(4), 303-307.

Mastellos, N., Andreasson, A., Huckvale, K., Larsen, M., Curcin, V., Car, J., … & Delaney, B. (2015). A cluster randomised controlled trial evaluating the effectiveness of eHealth-supported patient recruitment in primary care research: the TRANSFoRm study protocol. Implementation Science, 10(1), 1.

Meier, C. A., Fitzgerald, M. C., & Smith, J. M. (2013). eHealth: extending, enhancing, and evolving health care. Annual review of biomedical engineering, 15, 359-382.

Minichiello, V., Rahman, S., Dune, T., Scott, J., & Dowsett, G. (2013). E-health: potential benefits and challenges in providing and accessing sexual health services. BMC Public Health, 13(1), 1.

Nelson, R., & Staggers, N. (2014). Health informatics: An interprofessional approach. Elsevier Health Sciences.

Nijeweme-d’Hollosy, W. O., van Velsen, L., Huygens, M., & Hermens, H. (2015). Requirements for and barriers towards interoperable eHealth technology in primary care. IEEE internet computing, 19(4), 10-19.

Ossebaard, H. C., Bruijn, A., Gemert-Pijnen, J. E. W. C., & Geertsma, R. E. (2013). Risks related to the use of eHealth technologies-an exploratory study.

Ossebaard, H., van Gemert-Pijnen, L., de Bruijn, A., & Geertsma, R. (2013). Magnitude of ehealth technology risks largely unknown. Int J Adv Syst Meas, 6, 57-71.

Popescu, G. H. (2014). The economic implications of ehealth and mhealth technologies. American Journal of Medical Research, 1(2), 31-31.

Rippen, H. E., Pan, E. C., Russell, C., Byrne, C. M., & Swift, E. K. (2013). Organizational framework for health information technology. International journal of medical informatics, 82(4), e1-e13.

Suominen, H., Salanterä, S., Velupillai, S., Chapman, W. W., Savova, G., Elhadad, N., … & Leveling, J. (2013, September). Overview of the ShARe/CLEF eHealth evaluation lab 2013. In International Conference of the Cross-Language Evaluation Forum for European Languages (pp. 212-231). Springer Berlin Heidelberg.

Tyrrell, J. S., & Redshaw, C. H. (2016). Physical Activity in Ankylosing Spondylitis: evaluation and analysis of an eHealth tool. Journal of Innovation in Health Informatics, 23(2), 510-522.

van Gemert-Pijnen, J. E. W. C., Peters, O., & Ossebaard, H. C. (Eds.). (2013). Improving eHealth. Den Haag, The Netherlands: Eleven international publishing.

Yardley, L., Morrison, L., Bradbury, K., & Muller, I. (2015). The person-based approach to intervention development: application to digital health-related behavior change interventions. Journal of medical Internet research, 17(1), e30.