Incentives and barriers that influence clinical computerization in Hong Kong: a population-based physician survey

Assessment of electronic surveillance and knowledge, attitudes, and practice (KAP) survey toward imported malaria surveillance system acceptance in France

Objective

An electronic surveillance system was released to monitor morbidity and mortality incidence of imported malaria cases, investigate autochthonous cases, and assess chemosensitivity of Plasmodium isolates among travelers to and from endemic areas. The aim of this study is to evaluate the use of an electronic surveillance system for imported malaria in France.

Materials and Methods

Three main indicators were used to assess the online malaria web-based surveillance system: (1) the quality of the surveillance system; (2) the capacity of the online system to early warning in case of particular events of public health; (3) the knowledge, attitude, and practice of online electronic system by practitioners of malaria network in France.

Results

Overall, the median time onset a case is reported to the system decrease by 99%, ranging from 227 days (144–309) to 2 days (1–6) in 2006 and 2020, respectively.

Conclusion

The online malaria surveillance system in France has demonstrated its effectiveness and can therefore be extended to carry out numerous investigations linked to research on malaria.

We describe the surveillance activities of the imported malaria surveillance in travelers from and to endemic areas in France caused by the bite of infected mosquitoes. Furthermore, we evaluate how the participants to the network navigate, appreciate, and report their diagnosed cases to the French National Reference Center for malaria. The main findings are the stability of the network from 1996 through 2020; the reduction of the time between the diagnosis and the declaration of the case in the database. This study provides the effectiveness and ability of this surveillance system to carry out numerous investigations linked to research on malaria and the willingness of their members to participate in the surveillance of imported malaria.

Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature

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.

Stages of Adoption Concern and Technology Acceptance in a Critical Care Nursing Unit

OBJECTIVE

The aim of this study is to examine the stages of concern (self, task, and impact) and usability (trust, perceived usefulness, and ease of use) shifts experienced by nurses adopting new technology.

BACKGROUND

Patient care processes in critical care units can be disrupted with the incorporation of information technology. New users of technology typically transition through stages of concern and experience shifts in acceptance during assimilation.

METHODS

Critical care nurses (N = 41) were surveyed twice: (1) pre, immediately after training, and (2) post, 3 months after implementation of technology.

RESULTS

From presurvey to postsurvey, self-concerns decreased 14%, whereas impact concerns increased 22%. Furthermore, there was a 30% increase in trust and a 17% increase in perceived usefulness, even with a 27% decrease in ease of use.

CONCLUSION

Adoption of new technology requires critical care nurses to adapt current practices, which may improve trust and perceived usefulness yet decrease perceptions of ease of use.

Information and communication technologies in primary healthcare facilities in Egypt

BACKGROUND

The health sector has always relied on technologies. According to World Health Organization, they form the backbone of the services to prevent, diagnose, and treat illness and disease. It is increasingly viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system. Aim of the study This was to assess the current situation of information and communication technologies (ICTs) in primary healthcare in the terms of describing and classifying the existing work, identify gaps and exploring the personal experiences and the challenges of ICTs application in the primary healthcare. Subjects and methods A mixed research method in the form of sequential explanatory design was applied. In the quantitative phase a cross-sectional study was conducted among 172 family physicians using a predesigned questionnaire. Followed by qualitative data collection among 35 participants through focused group discussions.

RESULTS

Nearly half of the physicians have ICTs in their work and they were trained on it. None of them developed a community-based research using ICTs technology. Training on ICTs showed a statistically significant difference regarding the availability and the type of ICTs present in the workplace (P<0.05). Focused group discussion revealed that the majority of the participants believe that there is poor commitment of policymaker toward ICTs utilization in the primary care. Nearly 97% thinks that there is insufficient budget allocated for ICTs utilization in the workplace. Almost 88% of the participants demanded more incentives for ICTs users than non-user at the workplace.

CONCLUSIONS

ICTs resources are underutilized by health information professionals. Lack of funds, risk of instability of the electric supply and lack of incentives for ICTs users were the most common barriers to ICTs implementation thus a steady steps toward budget allocation and continuous training is needed.

Understanding attitudes toward information and communication technology in home-care: Information and communication technology as a market good within Norwegian welfare services

The aim of this study was to better understand nurses' and other staff members' attitudes toward the usefulness of information and communication technology in home-care settings. Research has found that beliefs about the expected benefits of information and communication technology impact the use of technology. Furthermore, inexperience with using information and communication technology may cause negative attitudes. This article is based on a questionnaire to 155 nurses and other staff members in home-care in Sogn og Fjordane county in Norway. The results revealed minimal use of information and communication technology at work; however, participants had positive attitudes regarding the potential benefits of information and communication technology use in home-care. Individuals' extensive use of and familiarity with different solutions in private lives could be an important context for explaining employees' attitudes. Given that information and communication technology is both a welfare service and a market good, this may explain individuals' positive attitudes toward information and communication technology despite their lack of experience with it at work. Experiences with information and communication technology as a market good and the way new technologies can affect work routines will affect the implementation of information and communication technology in home-care.

Adoption of e-health technology by physicians: a scoping review

OBJECTIVE

The goal of this scoping review was to summarize the current literature identifying barriers and opportunities that facilitate adoption of e-health technology by physicians.

DESIGN

Scoping review.

SETTING

MEDLINE, EMBASE, and PsycINFO databases as provided by Ovid were searched from their inception to July 2015. Studies captured by the search strategy were screened by two reviewers and included if the focus was on barriers and facilitators of e-health technology adoption by physicians.

RESULTS

Full-text screening yielded 74 studies to be included in the scoping review. Within those studies, eleven themes were identified, including cost and liability issues, unwillingness to use e-health technology, and training and support.

CONCLUSION

Cost and liability issues, unwillingness to use e-health technology, and training and support were the most frequently mentioned barriers and facilitators to the adoption of e-health technology. Government-level payment incentives and privacy laws to protect health information may be the key to overcome cost and liability issues. The adoption of e-health technology may be facilitated by tailoring to the individual physician's knowledge of the e-health technology and the use of follow-up sessions for physicians and on-site experts to support their use of the e-health technology. To ensure the effective uptake of e-health technologies, physician perspectives need to be considered in creating an environment that enables the adoption of e-health strategies.

Benefits of ICT Adoption and Use in Regional General Medical Practices: A Pilot Study

This paper presents a pilot study of benefits derived from information and communications technology (ICT) adoption and use in medical practices in regional Australia. The study involved 122 regional medical practitioners. The results show that like the more general small business sector, the perception of certain benefits is associated with the size of the practice (in terms of employee levels) and/or the gender of the respondent practitioner. The data also showed that the level of skill of certain software used within the practice was significantly associated with the level of perceived benefit derived from ICT adoption and use.

Preferences of Knowledge Users for Two Formats of Summarizing Results from Systematic Reviews: Infographics and Critical Appraisals

OBJECTIVES

To examine and compare preferences of knowledge users for two different formats of summarizing results from systematic reviews: infographics and critical appraisals.

DESIGN

Cross-sectional.

SETTING

Annual members' meeting of a Network of Centres of Excellence in Knowledge Mobilization called TREKK (Translating Emergency Knowledge for Kids). TREKK is a national network of researchers, clinicians, health consumers, and relevant organizations with the goal of mobilizing knowledge to improve emergency care for children.

PARTICIPANTS

Members of the TREKK Network attending the annual meeting in October 2013.

OUTCOME MEASURES

Overall preference for infographic vs. critical appraisal format. Members' rating of each format on a 10-point Likert scale for clarity, comprehensibility, and aesthetic appeal. Members' impressions of the appropriateness of the two formats for their professional role and for other audiences.

RESULTS

Among 64 attendees, 58 members provided feedback (91%). Overall, their preferred format was divided with 24/47 (51%) preferring the infographic to the critical appraisal. Preference varied by professional role, with 15/22 (68%) of physicians preferring the critical appraisal and 8/12 (67%) of nurses preferring the infographic. The critical appraisal was rated higher for clarity (mean 7.8 vs. 7.0; p = 0.03), while the infographic was rated higher for aesthetic appeal (mean 7.2 vs. 5.0; p<0.001). There was no difference between formats for comprehensibility (mean 7.6 critical appraisal vs. 7.1 infographic; p = 0.09). Respondents indicated the infographic would be most useful for patients and their caregivers, while the critical appraisal would be most useful for their professional roles.

CONCLUSIONS

Infographics are considered more aesthetically appealing for summarizing evidence; however, critical appraisal formats are considered clearer and more comprehensible. Our findings show differences in terms of audience-specific preferences for presentation of research results. This study supports other research indicating that tools for knowledge dissemination and translation need to be targeted to specific end users' preferences and needs.

EHR adoption across China's tertiary hospitals: a cross-sectional observational study

HEADING

EHR adoption across China's tertiary hospitals: a cross-sectional observation study

OBJECTIVES

To assess electronic health record (EHR) adoption in Chinese tertiary hospitals using a nation-wide standard EHR grading model.

METHODS

The Model of EHR Grading (MEG) was used to assess the level of EHR adoption across 848 tertiary hospitals. MEG defines 37 EHR functions (e.g., order entry) which are grouped by 9 roles (e.g., inpatient physicians) and grades each function and the overall EHR adoption into eight levels (0-7). We assessed the MEG level of the involved hospitals and calculated the average score of the 37 EHR functions. A multivariate analysis was performed to explore the influencing factors (including hospital characteristics and information technology (IT) investment) of total score and scores of 9 roles.

RESULTS

Of the 848 hospitals, 260 (30.7%) were Level Zero, 102 (12.0%) were Level One, 269 (31.7%) were Level Two, 188 (22.2%) were Level Three, 23 (2.7%) were Level Four, 5 (0.6%) was Level Five, 1 (0.1%) were Level Six, and none achieved Level Seven. The scores of hospitals in eastern and western China were higher than those of hospitals in central areas. Bed size, outpatient admission, total income in 2011, percent of IT investment per income in 2011, IT investment in last 3 years, number of IT staff, and duration of EHR use were significant factors for total score.

CONCLUSIONS

We examined levels of EHR adoption in 848 Chinese hospitals and found that most of them have only basic systems, around level 2 and 0. Very few have a higher score and level for clinical information using and sharing.

An R package for analyzing and modeling ranking data

Background

In medical informatics, psychology, market research and many other fields, researchers often need to analyze and model ranking data. However, there is no statistical software that provides tools for the comprehensive analysis of ranking data. Here, we present pmr, an R package for analyzing and modeling ranking data with a bundle of tools. The pmr package enables descriptive statistics (mean rank, pairwise frequencies, and marginal matrix), Analytic Hierarchy Process models (with Saaty’s and Koczkodaj’s inconsistencies), probability models (Luce model, distance-based model, and rank-ordered logit model), and the visualization of ranking data with multidimensional preference analysis.

Results

Examples of the use of package pmr are given using a real ranking dataset from medical informatics, in which 566 Hong Kong physicians ranked the top five incentives (1: competitive pressures; 2: increased savings; 3: government regulation; 4: improved efficiency; 5: improved quality care; 6: patient demand; 7: financial incentives) to the computerization of clinical practice. The mean rank showed that item 4 is the most preferred item and item 3 is the least preferred item, and significance difference was found between physicians’ preferences with respect to their monthly income. A multidimensional preference analysis identified two dimensions that explain 42% of the total variance. The first can be interpreted as the overall preference of the seven items (labeled as “internal/external”), and the second dimension can be interpreted as their overall variance of (labeled as “push/pull factors”). Various statistical models were fitted, and the best were found to be weighted distance-based models with Spearman’s footrule distance.

Conclusions

In this paper, we presented the R package pmr, the first package for analyzing and modeling ranking data. The package provides insight to users through descriptive statistics of ranking data. Users can also visualize ranking data by applying a thought multidimensional preference analysis. Various probability models for ranking data are also included, allowing users to choose that which is most suitable to their specific situations.

Perceived impact of electronic medical records in physician office practices: a review of survey-based research

BACKGROUND

Physician office practices are increasingly adopting electronic medical records (EMRs). Therefore, the impact of such systems needs to be evaluated to ensure they are helping practices to realize expected benefits. In addition to experimental and observational studies examining objective impacts, the user's subjective view needs to be understood, since ultimate acceptance and use of the system depends on them. Surveys are commonly used to elicit these views.

OBJECTIVE

To determine which areas of EMR implementation in office practices have been addressed in survey-based research studies, to compare the perceived impacts between users and nonusers for the most-addressed areas, and to contribute to the knowledge regarding survey-based research for assessing the impact of health information systems (HIS).

METHODS

We searched databases and systematic review citations for papers published between 2000 and 2012 (May) that evaluated the perceived impact of using an EMR system in an office-based practice, were based on original data, had providers as the primary end user, and reported outcome measures related to the system's positive or negative impact. We identified all the reported metrics related to EMR use and mapped them to the Clinical Adoption Framework to analyze the gap. We then subjected the impact-specific areas with the most reported results to a meta-analysis, which examined overall positive and negative perceived impacts for users and nonusers.

RESULTS

We selected 19 papers for the review. We found that most impact-specific areas corresponded to the micro level of the framework and that appropriateness or effectiveness and efficiency were well addressed through surveys. However, other areas such as access, which includes patient and caregiver participation and their ability to access services, had very few metrics. We selected 7 impact-specific areas for meta-analysis: security and privacy; quality of patient care or clinical outcomes; patient-physician relationship and communication; communication with other providers; accessibility of records and information; business or practice efficiency; and costs or savings. All the results for accessibility of records and information and for communication with providers indicated a positive view. The area with the most mixed results was security and privacy.

CONCLUSIONS

Users sometimes were likelier than nonusers to have a positive view of the selected areas. However, when looking at the two groups separately, we often found more positive views for most of the examined areas regardless of use status. Despite limitations of a small number of papers and their heterogeneity, the results of this review are promising in terms of finding positive perceptions of EMR adoption for users and nonusers. In addition, we identified issues related to survey-based research for HIS evaluation, particularly regarding constructs for evaluation and quality of study design and reporting.

Use of health information technology among racial and ethnic underserved communities

This article examines the potential role of health IT in addressing healthcare disparities among racial and ethnic minority populations. An overview of health IT utilization among healthcare providers notes certain characteristics that may disproportionately affect minority populations. Current and emerging health IT use among racial and ethnic minority populations is examined, highlighting areas in which technology use in these populations differs from that of nonminority populations and emphasizing the importance of new social media applications in healthcare education and delivery. Following a discussion of adoption and utilization barriers for providers as well as for patients and caregivers, specific opportunities to address healthcare disparities through health IT use are identified at the provider, patient/caregiver, and healthcare system levels. The article identifies several technical, practical, and human challenges to health IT adoption and stresses the need for the healthcare system to embrace the full spectrum of emerging health IT opportunities to address healthcare disparities.

A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review

Background

The health care sector is an area of social and economic interest in several countries; therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is evidence suggesting that these systems have not been adopted as it was expected, and although there are some proposals to support their adoption, the proposed support is not by means of information and communication technology which can provide automatic tools of support. The aim of this study is to identify the critical adoption factors for electronic health records by physicians and to use them as a guide to support their adoption process automatically.

Methods

This paper presents, based on the PRISMA statement, a systematic literature review in electronic databases with adoption studies of electronic health records published in English. Software applications that manage and process the data in the electronic health record have been considered, i.e.: computerized physician prescription, electronic medical records, and electronic capture of clinical data. Our review was conducted with the purpose of obtaining a taxonomy of the physicians main barriers for adopting electronic health records, that can be addressed by means of information and communication technology; in particular with the information technology roles of the knowledge management processes. Which take us to the question that we want to address in this work: "What are the critical adoption factors of electronic health records that can be supported by information and communication technology?". Reports from eight databases covering electronic health records adoption studies in the medical domain, in particular those focused on physicians, were analyzed.

Results

The review identifies two main issues: 1) a knowledge-based classification of critical factors for adopting electronic health records by physicians; and 2) the definition of a base for the design of a conceptual framework for supporting the design of knowledge-based systems, to assist the adoption process of electronic health records in an automatic fashion. From our review, six critical adoption factors have been identified: user attitude towards information systems, workflow impact, interoperability, technical support, communication among users, and expert support. The main limitation of the taxonomy is the different impact of the adoption factors of electronic health records reported by some studies depending on the type of practice, setting, or attention level; however, these features are a determinant aspect with regard to the adoption rate for the latter rather than the presence of a specific critical adoption factor.

Conclusions

The critical adoption factors established here provide a sound theoretical basis for research to understand, support, and facilitate the adoption of electronic health records to physicians in benefit of patients.

User testing and stakeholder feedback contributed to the development of understandable and useful Summary of Findings tables for Cochrane reviews

OBJECTIVE

To develop a Summary of Findings (SoF) table for use in Cochrane reviews that is understandable and useful for health professionals, acceptable to Cochrane Collaboration stakeholders, and feasible to implement.

STUDY DESIGN AND SETTING

We gathered stakeholder feedback on the format and content of an SoF table from an advisory group of more than 50 participants and their constituencies through e-mail consultations. We conducted user tests using a think-aloud protocol method, collecting feedback from 21 health professionals and researchers in Norway and the UK. We analyzed the feedback, defined problem areas, and generated new solutions in brainstorming workshops.

RESULTS

Stakeholders were concerned about precision in the data representation and about production feasibility. User testing revealed unexpected comprehension problems, mainly confusion about what the different numbers referred to (class reference). Resolving the tension between achieving table precision and table simplicity became the main focus of the working group.

CONCLUSION

User testing led to a table more useful and understandable for clinical audiences. We arrived at an SoF table that was acceptable to the stakeholders and in principle feasible to implement technically. Some challenges remain, including presenting continuous outcomes and technical/editorial implementation.

'To take care of the patients': Qualitative analysis of Veterans Health Administration personnel experiences with a clinical informatics system

Background

The Veterans Health Administration (VA) has invested significant resources in designing and implementing a comprehensive electronic health record (EHR) that supports clinical priorities. EHRs in general have been difficult to implement, with unclear cost-effectiveness. We describe VA clinical personnel interactions with and evaluations of the EHR.

Methods

As part of an evaluation of a quality improvement initiative, we interviewed 72 VA clinicians and managers using a semi-structured interview format. We conducted a qualitative analysis of interview transcripts, examining themes relating to participants' interactions with and evaluations of the VA EHR.

Results

Participants described their perceptions of the positive and negative effects of the EHR on their clinical workflow. Although they appreciated the speed and ease of documentation that the EHR afforded, they were concerned about the time cost of using the technology and the technology's potential for detracting from interpersonal interactions.

Conclusions

VA personnel value EHRs' contributions to supporting communication, education, and documentation. However, participants are concerned about EHRs' potential interference with other important aspects of healthcare, such as time for clinical care and interpersonal communication with patients and colleagues. We propose that initial implementation of an EHR is one step in an iterative process of ongoing quality improvement.

Barriers to use of information and computer technology by Australia's nurses: a national survey

AIMS AND OBJECTIVES

To support policy planning for health, the barriers to the use of health information and computer technology (ICT) by nurses in Australia were determined.

BACKGROUND

Australia, in line with many countries, aims to achieve a better quality of care and health outcomes through effective and innovative use of health information. Nurses form the largest component of the health workforce. Successful adoption of ICT by nurses will be a requirement for success. No national study has been undertaken to determine the barriers to adoption.

DESIGN

A self-administered postal survey was conducted.

METHOD

A questionnaire was distributed to 10,000 members of the Australian Nursing Federation. Twenty possible barriers to the use of health ICT uptake were offered and responses were given on a five point Likert scale.

RESULTS

Work demands, access to computers and lack of support were the principal barriers faced by nurses to their adoption of the technology in the workplace. Factors that were considered to present few barriers included age and lack of interest. While age was not considered by the respondents to be a barrier, their age was positively correlated with several barriers, including knowledge and confidence in the use of computers.

CONCLUSIONS

Results indicate that to use the information and computer technologies being brought into health care fully, barriers that prevent the principal users from embracing those technologies must be addressed. Factors such as the age of the nurse and their level of job must be considered when developing strategies to overcome barriers.

RELEVANCE TO CLINICAL PRACTICE

The findings of the present study provide essential information not only for national government and state health departments but also for local administrators and managers to enable clinical nurses to meet present and future job requirements.

Electronic health records approaches and challenges: a comparison between Malaysia and four East Asian countries

An integrated Lifetime Health Record (LHR) is fundamental for achieving seamless and continuous access to patient medical information and for the continuum of care. However, the aim has not yet been fully realised. The efforts are actively progressing around the globe. Every stage of the development of the LHR initiatives had presented peculiar challenges. The best lessons in life are those of someone else's experiences. This paper presents an overview of the development approaches undertaken by four East Asian countries in implementing a national Electronic Health Record (EHR) in the public health system. The major challenges elicited from the review including integration efforts, process reengineering, funding, people, and law and regulation will be presented, compared, discussed and used as lessons learned for the further development of the Malaysian integrated LHR.

Factors influencing diffusion of electronic medical records: a case study in three healthcare institutions in Japan

This study examines the effect of three factors: information technology (IT) skills of healthcare workers, present status of computerisation in their organisations, and workers' attitudes on the diffusion of electronic medical records (EMRs) in the healthcare environment. Data were obtained from a self-questionnaire distributed to 390 healthcare workers. The study finds that respondents need an expanded EMR capability to include decision support systems and reminder systems, and that diffusion of EMR is heavily influenced by attitudes of healthcare workers. However, targeted training of healthcare workers is needed to foster positive attitudes about EMR, and build confidence in the benefits of these systems.

The impact of electronic health records on time efficiency of physicians and nurses: a systematic review

A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.

Physicians' perceptions towards the impact of and willingness to pay for clinical computerization in Hong Kong

BACKGROUND AND OBJECTIVES

We evaluated factors associated with physicians' perceptions towards the effects of computers on health care and on current levels of computerization in their practice. We also performed a contingent valuation to quantify physicians' perceived benefits from computerization in a hypothetical ambulatory, solo clinic.

METHODS

We surveyed 949 representative physicians in Hong Kong by post. Factor analysis was performed to summarize similar items into categories. Multivariable log-linear regression models were employed to assess the relationships between different factor scores and the number of functions computerized. We elicited their willingness-to-pay (WTP) for three defined computer systems using contingent valuation techniques. WTP values were estimated using econometric modeling by both, parametric and geometric methods. Sociodemographic, attitudinal, and practice-related predictors of WTP were estimated through regression analyses.

RESULTS

Factor analysis revealed a three-factor solution which explained 53% of total variance. The overall mean score (mean = 3.51 +/- 0.45) showed a generally positive attitude towards the effects of computers on health care. Respondents with a higher level of computer knowledge had significantly higher mean overall (P = 0.002) and factor scores for all three factors (P < 0.01). Higher factor scores on the effects of computers on patient care and clinicians (P = 0.006) and on the health system (P = 0.032) were associated with a higher number of functions computerized. The parametric median WTP values for computerizing administrative, clinical, and both sets of functions were HK dollars 21205 (US dollars 2719), HK dollars 34231 (US dollars 4389), and HK dollars 45720 (US dollars 5862), respectively, which were lower than the estimates obtained from demand curves using the geometric method [HK dollars 43286 (US dollars 5549), HK dollars 59570 (US dollars 7637), and HK dollars 84623 (US dollars 10849), respectively]. Doctors with higher incomes were willing to pay more to computerize the clinic, with strong dose-response gradients demonstrated. Those who worked in corporate settings were also more likely to accept higher WTP values.

CONCLUSIONS

Our findings confirm that better knowledge about computers is contributory to a more positive attitude towards the effects of computers on health care, which is in turn significantly associated with higher levels of actual computerization in clinical practice. WTP values represent the likelihood, in monetary terms, of translating doctors' perceived benefits from computerization into investment action.

Do doctors act on their self-reported intention to computerize? A follow-up population-based survey in Hong Kong

BACKGROUND AND OBJECTIVES

We performed a follow-up survey to document changes in the level of computerization among physicians in Hong Kong between 2000 and 2001, specifically examining whether their self-reported intention to computerize various clinical or administrative tasks actually translated into computerization of these tasks 1 year later. Determining such a relationship will indicate the reliability, and thus the utility of questions regarding self-reported intention to computerize clinical practice.

METHODS

A self-completed follow-up postal questionnaire was sent to all 949 physicians who responded to the original questionnaire. Pairwise repeated dichotomous responses from 2000 and 2001 on the computerization of specific functions were compared using McNemar test. Wilcoxon sign-ranked test was employed to compare the total number of tasks computerized in the 2 years. Multivariate logistic regression modeling was carried out to determine predictors for the translation of intention to computerize into actual computerization.

RESULTS

The response rate was 77.0%. There was a significant increase in the number of tasks computerized for both "corporate" and "individual" practices between 2000 and 2001. The proportion of physicians who intended to computerize and actually computerized ranged from 7.7 to 51.0% for different tasks. For five clinical tasks, more than 50% respondents in corporate practices translated the intention to implementation, compared to fewer than 20% in individual practices. Predictors found to be associated with the translation of intention to computerize into actual computerization included higher number of tasks intended to computerize, higher number of tasks already computerized, and more positive physicians' attitudes on the impact of computerization to clinical practice.

CONCLUSIONS

We conclude that physicians' self-reported intention to computerize the clinical practice 12 months previously was moderately associated with actual implementation, with varying degrees of concordance for different clinical and administrative tasks. The identified predictors for the translation of intention to actual computerization may be useful in targeting specific strategies to promote computerization of clinical practice.

Prepayment was superior to postpayment cash incentives in a randomized postal survey among physicians

OBJECTIVE

Improving response rates, particularly among physicians, is important to minimize nonresponder bias and increase the effective sample size in epidemiologic research. We conducted a randomized trial to examine the impact of prepayment vs. postpayment incentives on response rates.

STUDY DESIGN AND SETTING

Self-completion postal questionnaires were mailed to 949 physicians who were respondents to an earlier survey and representative of the general physician population in Hong Kong. These physicians were randomly allocated to receive a HK dollar 20 cash prepayment incentive that accompanied the survey (n=474) or a postpayment reward of the same amount on receipt of the completed questionnaire (n=475).

RESULTS

The final prepayment response rate was 82.9%, compared with 72.5% in the postpayment arm (P < .001). Of the eight alternative incentive and follow-up strategies evaluated, three lie on the efficiency frontier (i.e., not dominated), including postpayment with three mailings at HK dollar 42.7, prepayment with three mailings at HK dollar 66.5 and prepayment with three mailings and telephone follow-up at HK dollar 112.1 per responder recruited (US dollar 1=HK dollar 7.8).

CONCLUSION

The findings demonstrate that prepayment cash incentives are superior to postpayment of the equivalent amount in improving response rates among a representative sample of Hong Kong physicians. Further research should concentrate on confirming the generalizability of these findings in other health care occupation groups and settings.