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Archer N, Lokker C, Ghasemaghaei M, DiLiberto D. eHealth Implementation Issues in Low-Resource Countries: Model, Survey, and Analysis of User Experience. J Med Internet Res 2021; 23:e23715. [PMID: 34142967 PMCID: PMC8277330 DOI: 10.2196/23715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/01/2020] [Accepted: 05/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The implementation of eHealth in low-resource countries (LRCs) is challenged by limited resources and infrastructure, lack of focus on eHealth agendas, ethical and legal considerations, lack of common system interoperability standards, unreliable power, and shortage of trained workers. OBJECTIVE The aim of this study is to describe and study the current situation of eHealth implementation in a small number of LRCs from the perspectives of their professional eHealth users. METHODS We developed a structural equation model that reflects the opinions of professional eHealth users who work on LRC health care front lines. We recruited country coordinators from 4 LRCs to help recruit survey participants: India, Egypt, Nigeria, and Kenya. Through a web-based survey that focused on barriers to eHealth implementation, we surveyed 114 participants. We analyzed the information using a structural equation model to determine the relationships among the constructs in the model, including the dependent variable, eHealth utilization. RESULTS Although all the model constructs were important to participants, some constructs, such as user characteristics, perceived privacy, and perceived security, did not play a significant role in eHealth utilization. However, the constructs related to technology infrastructure tended to reduce the impact of concerns and uncertainties (path coefficient=-0.32; P=.001), which had a negative impact on eHealth utilization (path coefficient=-0.24; P=.01). Constructs that were positively related to eHealth utilization were implementation effectiveness (path coefficient=0.45; P<.001), the countries where participants worked (path coefficient=0.29; P=.004), and whether they worked for privately or publicly funded institutions (path coefficient=0.18; P<.001). As exploratory research, the model had a moderately good fit for eHealth utilization (adjusted R2=0.42). CONCLUSIONS eHealth success factors can be categorized into 5 groups; our study focused on frontline eHealth workers' opinions concerning 2 of these groups: technology and its support infrastructure and user acceptance. We found significant disparities among the responses from different participant groups. Privately funded organizations tended to be further ahead with eHealth utilization than those that were publicly funded. Moreover, participant comments identified the need for more use of telemedicine in remote and rural regions in these countries. An understanding of these differences can help regions or countries that are lagging in the implementation and use of eHealth technologies. Our approach could also be applied to detailed studies of the other 3 categories of success factors: short- and long-term funding, organizational factors, and political or legislative aspects.
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Affiliation(s)
- Norman Archer
- Information Systems, DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - Cynthia Lokker
- Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Maryam Ghasemaghaei
- Information Systems, DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - Deborah DiLiberto
- Global Health, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Baashar Y, Alhussian H, Patel A, Alkawsi G, Alzahrani AI, Alfarraj O, Hayder G. Customer relationship management systems (CRMS) in the healthcare environment: A systematic literature review. COMPUTER STANDARDS & INTERFACES 2020; 71:103442. [PMID: 34170994 PMCID: PMC7194637 DOI: 10.1016/j.csi.2020.103442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 05/15/2023]
Abstract
Customer relationship management (CRM) is an innovative technology that seeks to improve customer satisfaction, loyalty, and profitability by acquiring, developing, and maintaining effective customer relationships and interactions with stakeholders. Numerous researches on CRM have made significant progress in several areas such as telecommunications, banking, and manufacturing, but research specific to the healthcare environment is very limited. This systematic review aims to categorise, summarise, synthesise, and appraise the research on CRM in the healthcare environment, considering the absence of coherent and comprehensive scholarship of disparate data on CRM. Various databases were used to conduct a comprehensive search of studies that examine CRM in the healthcare environment (including hospitals, clinics, medical centres, and nursing homes). Analysis and evaluation of 19 carefully selected studies revealed three main research categories: (i) social CRM 'eCRM'; (ii) implementing CRMS; and (iii) adopting CRMS; with positive outcomes for CRM both in terms of patients relationship/communication with hospital, satisfaction, medical treatment/outcomes and empowerment and hospitals medical operation, productivity, cost, performance, efficiency and service quality. This is the first systematic review to comprehensively synthesise and summarise empirical evidence from disparate CRM research data (quantitative, qualitative, and mixed) in the healthcare environment. Our results revealed that substantial gaps exist in the knowledge of using CRM in the healthcare environment. Future research should focus on exploring: (i) other potential factors, such as patient characteristics, culture (of both the patient and hospital), knowledge management, trust, security, and privacy for implementing and adopting CRMS and (ii) other CRM categories, such as mobile CRM (mCRM) and data mining CRM.
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Affiliation(s)
- Yahia Baashar
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
- Corresponding author.
| | - Hitham Alhussian
- Center for Research in Data Science (CERDAS), Institute of Autonomous Systems, Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Malaysia
| | - Ahmed Patel
- Computer Networks and Security Laboratory, State University of Ceara, Fortaleza 60020-181, Brazil
| | - Gamal Alkawsi
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
| | | | - Osama Alfarraj
- Computer Science Department, King Saud University, Riyadh 11451, Saudi Arabia
| | - Gasim Hayder
- College of Graduate Studies, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
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Granja C, Janssen W, Johansen MA. Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature. J Med Internet Res 2018; 20:e10235. [PMID: 29716883 PMCID: PMC5954232 DOI: 10.2196/10235] [Citation(s) in RCA: 276] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/09/2018] [Indexed: 01/18/2023] Open
Abstract
Background eHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality. Objective Our objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure. Methods We searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles. Results Among the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1). Conclusions The reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved.
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Affiliation(s)
- Conceição Granja
- Future Journal, Norwegian Centre for E-health Research, Tromsø, Norway
| | - Wouter Janssen
- Telemedicine and E-health Research Group, University of Tromsø-The Artic University of Norway, Tromsø, Norway
| | - Monika Alise Johansen
- Future Journal, Norwegian Centre for E-health Research, Tromsø, Norway.,Telemedicine and E-health Research Group, University of Tromsø-The Artic University of Norway, Tromsø, Norway
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Mettler T, Vimarlund V. All that Glitters is not Gold: Six Steps Before Selecting and Prioritizing e-Health Services. J Med Syst 2017; 41:154. [PMID: 28852918 DOI: 10.1007/s10916-017-0801-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/21/2017] [Indexed: 11/30/2022]
Abstract
Since the market for e-health applications is constantly growing, it is getting an ever more complex endeavor to select and prioritize the right service offering given a particular situation. In examining the extant literature, it was revealed that little emphasis is actually placed on how to analyze contextual or environmental factors prior to the selection and prioritization of e-health services. With this paper, we therefore propose a formative framework consisting of six fundamental yet very pragmatic steps that may support decision makers in identifying the most important contextual pre-requisites that e-health services need to fulfill in order to be considered as effective for their environment to be implemented.
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Affiliation(s)
- Tobias Mettler
- Swiss Graduate School of Public Administration, University of Lausanne, Rue de la mouline 28, 1022, Chavannes-près-Renens, Switzerland.
| | - Vivian Vimarlund
- Department of Computer and Information Science, Linköping University, Ingång 29C Campus Valla, 58183, Linköping, Sweden
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Rejeb O, Pilet C, Hamana S, Xie X, Durand T, Aloui S, Doly A, Biron P, Perrier L, Augusto V. Performance and cost evaluation of health information systems using micro-costing and discrete-event simulation. Health Care Manag Sci 2017; 21:204-223. [PMID: 28516345 DOI: 10.1007/s10729-017-9402-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 05/01/2017] [Indexed: 11/25/2022]
Abstract
Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach. The methodology is applied to the consultation for cancer treatment process. Simulation scenarios are established to conclude about the impact of HIS on patient pathway. We demonstrated that although high level HIS lengthen the consultation, occupation rate of oncologists are lower and quality of service is higher (through the number of available information accessed during the consultation to formulate the diagnostic). The provided method allows also to determine the most cost-effective ICT elements to improve the care process quality while minimizing costs. The methodology is flexible enough to be applied to other health-care systems.
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Affiliation(s)
- Olfa Rejeb
- UMR CNRS 6158 LIMOS, MINES Saint-Étienne, 158 cours Fauriel, 42023, Saint-Étienne, cedex 2, France
| | - Claire Pilet
- UMR CNRS 6158 LIMOS, MINES Saint-Étienne, 158 cours Fauriel, 42023, Saint-Étienne, cedex 2, France
| | - Sabri Hamana
- UMR CNRS 6158 LIMOS, MINES Saint-Étienne, 158 cours Fauriel, 42023, Saint-Étienne, cedex 2, France
| | - Xiaolan Xie
- UMR CNRS 6158 LIMOS, MINES Saint-Étienne, 158 cours Fauriel, 42023, Saint-Étienne, cedex 2, France
- Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai, China
| | - Thierry Durand
- Direction du système d'information, Centre Léon Berard, 28 Promenade Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Saber Aloui
- Centre Hospitalier de Sens, 1 Avenue Pierre de Coubertin, 89100, Sens, France
| | - Anne Doly
- Centre Jean Perrin, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Pierre Biron
- Département de médecine, Centre Léon Berard, 28 Promenade Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Lionel Perrier
- Direction de la recherche clinique et de l'innovation, Universit'e de Lyon, Centre Léon Bérard, GATE L-SE UMR 5824, 28 Promenade Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Vincent Augusto
- UMR CNRS 6158 LIMOS, MINES Saint-Étienne, 158 cours Fauriel, 42023, Saint-Étienne, cedex 2, France.
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Wu JH, Kao HY, Sambamurthy V. The integration effort and E-health compatibility effect and the mediating role of E-health synergy on hospital performance. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2016. [DOI: 10.1016/j.ijinfomgt.2016.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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