Mobile technology and healthcare: the adoption issues and systemic problems

What can healthcare systems learn from looking at tensions in innovation processes? A systematic literature review

Background

Until now, scholarship on innovation processes in healthcare systems lack an in-depth appreciation of tensions. Tensions often revolve around barriers and result from individual assessments and prioritizations that guide actions to eventually overcome these barriers. In order to develop a more differentiated understanding of tensions’ role in healthcare innovation processes, this paper aims to shed light on the multifaceted ways in which tensions emerge, are being dealt with, and how they hinder or, at times, facilitate innovation processes.

Methods

A systematic review of published and grey literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. The review involved searching three databases for original research articles and manually searching citations. Twenty-nine original full texts were identified, evaluated, and coded. These include papers on innovation in healthcare systems that investigated innovation-related organizational tensions. The findings were synthesized into different types of tensions in healthcare system innovation and the descriptions of the conflicting elements. We also analyzed the investigated innovations by type, process stages, and across different countries and healthcare systems.

Results

A total of forty-two tensions were identified and grouped into nine categories. Organizing tensions were predominant, followed by learning/belonging, performing, and performing/organizing tensions. Tensions most frequently occurred in the implementation phase and in the form of a dilemma. Included studies were conducted mainly in government-funded healthcare systems.

Conclusion

Our data suggest that innovation processes in healthcare systems are impaired by conflicts between contradictory elements, working cultures, and convictions and the organizational and regulatory context. Since the majority of the tensions we collected in our study can be addressed, future policy-making and research should take advantage of this fact and develop strategies that significantly influence the successful management of tensions and thus improve the implementation of innovations.

Value of normative belief in intention to use workplace health promotion apps

BACKGROUND

Mobile applications (apps) have started to be used for workplace health promotion (WHP). However, the factors that lead to the usage of apps in the workplace from the end-user perspective remain unclear.

METHODS

To investigate the research gap, the study evaluates a model for the adoption of WHP apps by combining the theory of planned behavior, the health belief model, and the technology acceptance model. A self-administered questionnaire with validated scales among 354 participants was used to evaluate the proposed model for WHP.

RESULTS

Although the study indicated a limited overall model fit, interesting aspects were derived. In particular, the study demonstrated that normative belief (especially), perceived usefulness, and attitudinal belief play important roles in the intention to use WHP apps.

CONCLUSION

The study is among the first to validate the theoretical models of mHealth adoption for WHP. Moreover, it shows that not only normative belief but also adjustment to several target groups is a necessary factor to be considered in the development and implementation of an app for WHP.

Lessons on mobile apps for COVID-19 from China

The COVID-19 pandemic has impacted the global society and human life profoundly. Many countries have launched COVID-19 mobile apps with a wide range in how these apps work. While it is hoped that these apps can assist in the fight against COVID-19, many are worried about user privacy. China implemented “health code” systems, which assigned neighborhoods and citizens a specific health code, meant to indicate their risk of having been exposed to COVID-19. The most widely used health code systems were hosted on the popular apps WeChat and Alipay, each with billions of users. Some experts argued that China's use of mobile applications was essential to its successful combat against COVID-19.

Included in this study are a summary of mobile technology usage in China, a review of previous studies of mobile technology in healthcare, and a brief survey of some existing mobile applications for COVID-19 that were implemented. Also included are outcomes of interviews with healthcare and public safety experts and a public survey to understand how mobile applications were used in China's response to COVID-19. The interviews revealed four important themes: personal privacy, community involvement, government involvement, and situational specificity. It was found that a key concern was maintaining a balance between collecting and utilizing personal information, as well as protecting this information. In addition, close collaboration between local communities and the national government was essential. Mobile applications assisted in communication and coordination but did not replace the work of people such as delivery drivers and contact tracers. Our results also showed that there was room for improvement, especially accessibility for the elderly or those unfamiliar with technology.

Similar results were obtained from our survey. It was interesting to find that the apps were mostly used for “accessing information on COVID-19.” In addition, respondents overwhelmingly identified “information” as the most valuable feature of COVID-19 apps. Both interview and survey results revealed the importance of providing information as a primary function of COVID-19 apps.

Based on our findings we distilled four main lessons: mobile applications should assist in existing COVID-19 responses, inform users, protect users’ personal information, and adapt to users’ environments.

We recommend that public health officials and app developers take these lessons into consideration when developing COVID-19 related mobile applications. In addition, we encourage researchers to utilize this report as a jumping off point for further research.

Evaluating the E-Health Cloud Computing Systems Adoption in Taiwan's Healthcare Industry

Although the electronic health (e-health) cloud computing system is a promising innovation, its adoption in the healthcare industry has been slow. This study investigated the adoption of e-health cloud computing systems in the healthcare industry and considered security functions, management, cloud service delivery, and cloud software for e-health cloud computing systems. Although numerous studies have determined factors affecting e-health cloud computing systems, few comprehensive reviews of factors and their relations have been conducted. Therefore, this study investigated the relations between the factors affecting e-health cloud computing systems by using a multiple criteria decision-making technique, in which decision-making trial and evaluation laboratory (DEMATEL), DANP (DEMATEL-based Analytic Network Process), and modified VIKOR (VlseKriterijumska Optimizacija I Kompromisno Resenje) approaches were combined. The intended level of adoption of an e-health cloud computing system could be determined by using the proposed approach. The results of a case study performed on the Taiwanese healthcare industry indicated that the cloud management function must be primarily enhanced and that cost effectiveness is the most significant factor in the adoption of e-health cloud computing. This result is valuable for allocating resources to decrease performance gaps in the Taiwanese healthcare industry.

Evaluation of Four Artificial Intelligence-Assisted Self-Diagnosis Apps on Three Diagnoses: Two-Year Follow-Up Study

Background

Consumer-oriented mobile self-diagnosis apps have been developed using undisclosed algorithms, presumably based on machine learning and other artificial intelligence (AI) technologies. The US Food and Drug Administration now discerns apps with learning AI algorithms from those with stable ones and treats the former as medical devices. To the author’s knowledge, no self-diagnosis app testing has been performed in the field of ophthalmology so far.

Objective

The objective of this study was to test apps that were previously mentioned in the scientific literature on a set of diagnoses in a deliberate time interval, comparing the results and looking for differences that hint at “nonlocked” learning algorithms.

Methods

Four apps from the literature were chosen (Ada, Babylon, Buoy, and Your.MD). A set of three ophthalmology diagnoses (glaucoma, retinal tear, dry eye syndrome) representing three levels of urgency was used to simultaneously test the apps’ diagnostic efficiency and treatment recommendations in this specialty. Two years was the chosen time interval between the tests (2018 and 2020). Scores were awarded by one evaluating physician using a defined scheme.

Results

Two apps (Ada and Your.MD) received significantly higher scores than the other two. All apps either worsened in their results between 2018 and 2020 or remained unchanged at a low level. The variation in the results over time indicates “nonlocked” learning algorithms using AI technologies. None of the apps provided correct diagnoses and treatment recommendations for all three diagnoses in 2020. Two apps (Babylon and Your.MD) asked significantly fewer questions than the other two (P<.001).

Conclusions

“Nonlocked” algorithms are used by self-diagnosis apps. The diagnostic efficiency of the tested apps seems to worsen over time, with some apps being more capable than others. Systematic studies on a wider scale are necessary for health care providers and patients to correctly assess the safety and efficacy of such apps and for correct classification by health care regulating authorities.

Implementation of smart phones to facilitate in-hospital telephone communication: Challenges, successes and lessons from a neonatal intensive care unit

Implementation Lessons 1. Mobile telephony use in the hospital setting is complex and sub-optimal implementation of mobile communication technology can create inefficiencies in clinical workflow 2. Objective measurement of mobile technology's impact on clinical communication workflow is necessary to identify and remediate associated inefficiencies in real-time 3. Functionality between mobile applications and devices should be evaluated when implementing technology, particularly when an application is non-native to a device 4. Continual collaboration between front-line clinicians and technical teams allows for early identification of adverse impacts from, and optimization of, mobile communication technology implementation.

Development process of a mobile electronic medical record for nurses: a single case study

Background

With the growing shortage of nurses, labor-saving technology has become more important. In health care practice, however, the fit with innovations is not easy. The aim of this study is to analyze the development of a mobile input device for electronic medical records (MEMR), a potentially labor-saving application supported by nurses, that failed to meet the needs of nurses after development.

Method

In a case study, we used an axiomatic design framework as an evaluation tool to visualize the mismatches between customer needs and the design parameters of the MEMR, and trace these mismatches back to (preliminary) decisions in the development process. We applied a mixed-method research design that consisted of analyzing of 118 external and internal files and working documents, 29 interviews and shorter inquiries, a user test, and an observation of use. By factoring and grouping the findings, we analyzed the relevant categories of mismatches.

Results

The involvement of nurses during the development was extensive, but not all feedback was, or could not be, used effectively to improve the MEMR. The mismatches with the most impact were found to be: (1) suboptimal supportive technology, (2) limited functionality of the app and input device, and (3) disruption of nurses’ workflow. Most mismatches were known by the IT department when the MEMR was offered to the units as a product. Development of the MEMR came to a halt because of limited use.

Conclusion

Choices for design parameters, made during the development of labor-saving technology for nurses, may conflict with the customer needs of nurses. Even though the causes of mismatches were mentioned by the IT department, the nurse managers acquired the MEMR based on the idea behind the app. The effects of the chosen design parameters should not only be compared to the customer needs, but also be assessed with nurses and nurse managers for the expected effect on the workflow.

Electronic supplementary material

The online version of this article (10.1186/s12911-018-0726-3) contains supplementary material, which is available to authorized users.

A study on students' acceptance of mobile phone use to seek health information in South Africa

BACKGROUND

In South Africa, inequitable access to healthcare information has made many young people with limited resources more vulnerable to health risks. Mobile phones present a unique opportunity to address this problem due to the high penetration of mobile phones in South Africa and the popularity of these devices among young adults.

OBJECTIVE

This research sought to examine the adoption of mobile phones to access health information among students at a traditional university in the Eastern Cape, South Africa.

METHOD

A cross-sectional survey approach was used to collect information from a convenience sample of 202 university students (58 males; 104 females), the majority (71.3%) of whom were aged between 18 and 27 years and of Black African ethnicity (75.2%). The unified theory of acceptance and use of technology (UTAUT) framework formed the theoretical foundation for the questionnaire. A research model was developed to test the hypotheses that behavioural intention to use a mobile phone to access health information would be influenced by: perceived usefulness (PU), perceived effort, social influence (SI), attitude towards technology (AT) and mobile phone experience.

RESULTS

Factor analyses indicated that the research model explained 36% of the variance in behavioural intention to use mobile devices to search for health-related queries, with PU being the largest predictor, followed by mobile experience, SI, and AT. Perceived effort did not make a statistically significant contribution.

CONCLUSION

Using mobile phones to disseminate health information to students is a useful, convenient, and cost-effective health-promotion strategy. This research has contributed to the body of knowledge concerning the applicability of the UTAUT framework to study the adoption of technology and provided useful information to guide future research and implementation of mHealth initiatives.

Complexity and the science of implementation in health IT--knowledge gaps and future visions

OBJECTIVES

The intent of this paper is in the examination of health IT implementation processes - the barriers to and facilitators of successful implementation, identification of a beginning set of implementation best practices, the identification of gaps in the health IT implementation body of knowledge, and recommendations for future study and application.

METHODS

A literature review resulted in the identification of six health IT related implementation best practices which were subsequently debated and clarified by participants attending the NI2012 Research Post Conference held in Montreal in the summer of 2012. Using the framework for implementation research (CFIR) to guide their application, the six best practices were applied to two distinct health IT implementation studies to assess their applicability.

RESULTS

Assessing the implementation processes from two markedly diverse settings illustrated both the challenges and potentials of using standardized implementation processes. In support of what was discovered in the review of the literature, "one size fits all" in health IT implementation is a fallacy, particularly when global diversity is added into the mix. At the same time, several frameworks show promise for use as "scaffolding" to begin to assess best practices, their distinct dimensions, and their applicability for use.

CONCLUSIONS

Health IT innovations, regardless of the implementation setting, requires a close assessment of many dimensions. While there is no "one size fits all", there are commonalities and best practices that can be blended, adapted, and utilized to improve the process of implementation. This paper examines health IT implementation processes and identifies a beginning set of implementation best practices, which could begin to address gaps in the health IT implementation body of knowledge.

The implementation of electronic health records: a case study of bush computing the Ngaanyatjarra lands

OBJECTIVE

The adoption of Information and Communication Technologies (ICT) in the health sector has often lagged behind adoption in other sectors as there are a number of systemic inhibitors that make the adoption of ICT far more complex. This paper aims to explore and investigate the drivers, facilitators and barriers to electronic health records adoption in the health sector and provide some guidance on how to improve the prospect of successful adoption.

METHODS

A case study of the successful development of electronic health records in remote Western Australia is used to identify and highlight the drivers, facilitators and barriers to electronic records adoption. A content analysis was undertaken on the in-depth interviews with participants in the region to identify the key issues and challenges and how they were overcome.

RESULTS

The geographically isolated nature of the region had a number of benefits since it meant the electronic health records project was a manageable size and cost, the focus could be on developing a workable system rather than a 'perfect solution', decisions could be made autonomously without considering integration issues with other regions, the transient nature of the patients was a key driver, the patient centred approach elevated the importance of overcoming problems, and the system champions were determined to make the system a workable success.

CONCLUSIONS

Complex systemic problems often derail ICT projects. The case study of an isolated region provides a number of lessons and insights to improve electronic records adoption projects. The limited resources and limited choices faced by the region lead to the development of a number of key approaches that revolved around aiming for a workable system rather than a high-end flawless solution. This ethos pervaded the electronic health records project and was underpinned by a patient centred approach and a strong desire to improve the service given to patients.

Design and implementation of a wearable healthcare monitoring system

A wearable healthcare monitoring unit that integrates various technologies was developed to provide patients with the option of leading a healthy and independent life without risks or confinement to medical facilities. The unit consists of various sensors integrated to a microcontroller and attached to the patient's body, reading vital signs and transmitting these readings via a Bluetooth link to the patient's mobile phone. Short-Messaging-Service (SMS) is incorporated in the design to alert a physician in emergency cases. Additionally, an application program running on the mobile phone uses the internet to update (at regular intervals) the patient records in a hospital database with the most recent readings. To reduce development costs, the components used were both off-the-shelf and affordable.