Stakeholder behavior in national eHealth implementation programs

Improving the Acceptability and Implementation of Information and Communication Technology-Based Health Care Platforms for Older People With Dementia or Parkinson Disease: Qualitative Study Results of Key Stakeholders

BACKGROUND

The management of neurodegenerative diseases (NDDs) in older populations is usually demanding and involves care provision by various health care services, resulting in a greater burden on health care systems in terms of costs and resources. The convergence of various health services within integrated health care models, which are enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative health care solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and health care professionals, with reported discrepancies in the needs and preferences among these groups.

OBJECTIVE

Complementing a previous publication, which reported on the needs and requirements of end users in the development of the European Union-funded project PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older People), this paper aimed to report on the opinions of other key stakeholders from various fields, including academia, media, market, and decision making, for improving the acceptability and implementation of an integrated ICT-based health care platform supporting the management of NDDs.

METHODS

The study included 30 individual semistructured interviews that took place between June and August 2020 in 5 European countries (Germany, Italy, Portugal, Romania, and Spain). Interviews were mostly conducted online, except in cases where participants requested to be interviewed in person. In these cases, COVID-19 PROCare4Life safety procedures were applied.

RESULTS

This study identified 2 themes and 5 subthemes. User engagement, providing training and education, and the role played by the media were identified as strategic measures to ensure the acceptability of ICT-based health care platforms. Sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process.

CONCLUSIONS

The importance of the user-centered design approach in ensuring the involvement of users in the development of ICT-based platforms has been highlighted. The most common challenges that hinder the acceptability and implementation of ICT-based health care platforms can be addressed by creating synergies among the efforts of users, academic stakeholders, developers, policy makers, and decision makers. To support future projects in developing ICT-based health care platforms, this study outlined the following recommendations that can be integrated when conducting research on users' needs: (1) properly identify the particular challenges faced by future user groups without neglecting their social and clinical contexts; (2) iteratively assess the digital skills of future users and their acceptance of the proposed platform; (3) align the functionalities of the ICT platform with the real needs of future users; and (4) involve key stakeholders to guide the reflection on how to implement the platform in the future.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/22463.

The Stakeholders' Involvement in Healthcare 4.0 Services Provision: The Perspective of Co-Creation

Literature research on cocreation in healthcare indicates the theoretical sophistication of research on collaboration between healthcare professionals and patients. Our research continues in the new area of Health 4.0. Cocreation has become an essential concept in the value creation process; by involving consumers in the creation process, better results are achieved regarding product quality and alignment with customer expectations and needs. In addition, consumer involvement in the creation process improves its efficiency. Cocreation allows for more efficient diagnosis and treatment of patients, as well as better and more effective use of the skills and experience of the health workforce. Our main objective is to determine the scope and depth of the cocreation of health services based on modern technological solutions (Health 4.0). We selected four cases involving Health 4.0 solutions, verified the scale and scope of cocreation using them as examples, and used the cocreation matrix. We used literature, case studies, and interviews in our research. Our analysis shows that patients can emerge as cocreators in the value creation process in Health 4.0. This can happen when they are genuinely involved in the process and when they feel responsible for the results. The article contributes to the existing theory of service cocreation by pointing out the limited scope of patient involvement in the service management process. For cocreation in Health 4.0 to increase the effectiveness of medical services, it is necessary to implement the full scope of cocreation and meaningfully empower the patient and medical workers in the creation process. This article verifies the theoretical analysis presented in our team's previous article.

Co-Creation in Health 4.0 as a New Solution for a New Era

Previous research on co-creation in healthcare indicates that the use of co-creation in the design process of health solutions influences their greater acceptance and adaptation, resulting in greater efficiency of health services and higher usability of implemented health solutions. Analysis of adaptation and acceptance of new technologies reveals the problem of misunderstanding and the need for more trust in modern tools implemented in the healthcare system. The remedy may be the use of co-creation in the process of developing modern medical products and services. This article's main purpose is to explore the co-creation process in Health 4.0, which is understood as the development of healthcare through the application of methods and tools of the Fourth Industrial Revolution. The literature review provided insights for an analytical framework-the co-creation matrix. We analyzed the case of the Italian medical platform Paginemediche.it to reveal the actors' engagement in co-creation. The results demonstrated different levels of engagement in improving the efficiency of implementing medical and technological solutions. Both theoretical and practical analysis proved that the co-creation matrix helps more precisely define the scale and scope of co-creation in Health 4.0.

Are we on the same page? Exploring stakeholders' shared mental models of mobile health in rural Nigeria

Despite the benefits promised by mobile health, the introduction of these solutions is often met with resistance from various stakeholders. This article adopts a shared mental model approach to unearth the current perceptions, concerns, and mentalities of key stakeholders engaged in the provision of healthcare in Nigeria. These include policy makers, academics, healthcare professionals, and health information systems developers. Interviews and focus groups were used to examine stakeholders' views across three mental models: (1) the technology, (2) processes, and (3) the team. Our investigations reveal disparities in stakeholders' existing mental models and their perceptions of the proposed mobile health solution. We argue that fostering a common understanding of mobile health, as well as elucidating an improved understanding of processes and team behaviours, will mitigate the risk of resistance among stakeholders involved in the design and delivery of community healthcare services and culminate in a positive attitude towards new mobile health solutions among these stakeholders. We highlight the need to enhance communication and training from national to rural levels to promote complementary mental models and positively influence team performance.

Sharing Frailty-related information in perioperative care: an analysis from a temporal perspective

BACKGROUND

Especially patients older than 65 years undergoing surgery are prone to develop frailty-related complications that may go far beyond the index hospitalization (e.g., cognitive impairment following postoperative delirium). However, aging-relevant information are currently not fully integrated into hospitals' perioperative processes.

METHODS

We introduce a temporal perspective, which focuses on the social construction of time, to better understand existing barriers to the exchange of frailty-related data, targeting complexity research. Our chosen context is perioperative care provided by a tertiary hospital in Germany that has implemented a special track for patients over 65 years old undergoing elective surgery. The research followed a participatory modelling approach between domain and modelling experts with the goal of creating a feedback loop model of the relevant system relationships and dynamics.

RESULTS

The results of the study show how disparate temporal regimes, understood as frameworks for organizing actions in the light of time constraints, time pressure, and deadlines, across different clinical, ambulant, and geriatric care sectors create disincentives to cooperate in frailty-related data exchanges. Moreover, we find that shifting baselines, meaning continuous increases in cost and time pressure in individual sectors, may unintentionally reinforce - rather than discourage - disparate temporal regimes.

CONCLUSIONS

Together, these results may (1) help to increase awareness of the importance of frailty-related data exchanges, and (2) impel efforts aiming to transform treatment processes to go beyond sectoral boundaries, taking into account the potential benefits for frail patients arising from integrated care processes using information technology.

Health information systems evaluation frameworks: A systematic review

BACKGROUND

Evaluation of health information systems (HISs) is complicated because of the complex nature of the health care domain. Various studies have proposed different frameworks to reduce the complexity in the assessment of these systems. The aim of these frameworks is to provide a set of guidelines for the evaluation of the adequacy of health care information systems.

OBJECTIVE

This paper aims to analyse studies on the evaluation of HISs by applying a content, context and process (CCP) framework to address the 'who', 'what', 'how', 'when', and 'why' of the evaluation processes used. This will allow for a better understanding of the relative strengths and weaknesses of various HISs evaluation frameworks, and will pave the way for developing a more complete framework for HISs.

METHOD

A systematic literature review on HIS evaluation studies was undertaken to identify the currently available HIS evaluation frameworks. Five academic databases were selected to conduct this systematic literature review.

RESULTS

Most of the studies only address some, but not all, of the five main questions, i.e. the who, what, how, when, why, and that there was a lack of consensus in the way these questions were addressed. The critical role of context was also largely neglected in these studies.

CONCLUSIONS

Evaluation of HISs is complex. The health care domain is highly context sensitive and in order to have a complete assessment of HISs, consideration of contextual factors is necessary. Specifically, to have the right set of criteria to measure the 'what', the answer to the 'who' of the evaluation is necessary.