Health Care Provider Adoption of eHealth: Systematic Literature Review

Health information systems with technology acceptance model approach: A systematic review

In the rapidly evolving landscape of information technologies, individuals and organizations must adapt to the digital age. Given the diversity in users' knowledge and experience with technology, their acceptance levels also vary. Over the past 30 years, various theoretical models have been introduced to provide a framework for understanding user acceptance of technology. Among these, the Technology Acceptance Model (TAM) stands out as a key theoretical framework, offering insights into why new technologies are either accepted or rejected. Analyzing user acceptance of technology has thus become a critical area of study. Healthcare organizations aim to assess the perceived efficacy and user-friendliness of a given technology. This will help health organisations design and implement HIS that meet users' needs and preferences. In this context, how does the TAM clarify the acceptance and use of Health Information Systems (HIS)? To address this inquiry, a comprehensive literature review will be carried out. The systematic review involved 29 studies issued between 2018 and 2023 and searched the databases Pubmed, Scopus, Wos and Ulakbim TR Index. The PRISMA flowchart was used to identify the included studies. According to the results, some variables stand out in the acceptance and utilisation of HIS. Among the users of HIS, it can be said that the results relating to nurses stand out. In particular, there are studies which emphasise that 'gender' is a crucial factor in explaining the models. Another crucial finding of the current systematic review is the need to train users in the acceptance and use of HIS.

Analyzing health service employees' intention to use e-health systems in southwest Ethiopia: using UTAUT-2 model

BACKGROUND

E-health systems have the potential to improve healthcare delivery and access to medical services in resource-constrained settings. Despite its impact, the system exhibits a low level of consumer acceptance and intention to use it. This research paper aims to analyze the intention of health service employees to use e-health systems in southwest Ethiopia using the UTAUT-2 model.

METHOD

Institutional-based cross-sectional studies were conducted at four referral hospitals (two private and two public) to examine the acceptance of e-health among consumers. Employees who had previous experience with diagnostic information systems and the health logistic information system were given structured questionnaires based on the UTAUT-2 model. The data were analyzed using the PLS-SEM method to identify the key factors that influence the intention to use e-health systems. The data were analyzed using SPSS version 20 and SmartPLS 3 software.

RESULT

Out of the 400 surveyed employees, 225 (56.25%) valid questionnaires were collected. The findings indicate that three factors-effort expectancy (β = 0.276, t = 3.015, p = 0.001), habit (β = 0.309, t = 3.754, p = 0), and performance expectancy (β = 0.179, t = 1.905, p = 0.028)-had a significant positive impact on employees' intention to use e-health systems. On the other hand, factors such as social influence, facilitating conditions, hedonic motivation, and price values did not appear as significant predictors of intention to use e-health. The study model was able to predict 63% of employees' intentions to use e-health systems.

CONCLUSION

Effort expectancy, habit, and performance expectancy were significant predictors of employees' intention to use e-health systems among health service employees in southwest Ethiopia. The study supports the ideas that ease of use, experience with information systems, and the role of the systems in improving job performance contribute to employees' intention to use e-health. Policymakers and healthcare organizations in the region can use these findings to develop strategies for successful implementation and adoption of e-health systems, ultimately improving healthcare services and outcomes for the population.

Perception of middle-aged and older adults towards mHealth apps: A comparative factor analysis between Australia and Germany

OBJECTIVE

Although evidence of the global effectiveness and usability of mobile health (mHealth) apps as non-drug interventions is growing, older adults often demonstrate low adoption rates of these apps. This study aims to identify the perspectives of older adults on introducing and adopting mHealth apps in Australia and Germany.

MATERIALS AND METHODS

We conducted two online cross-sectional surveys to examine factors from contextual, technological and personal perspectives that influence older adults in mHealth app adoption. Using descriptive statistics, chi-square tests and exploratory factor analysis, we identified the differences and similarities between respondents' perspectives across two countries.

RESULTS

A total of 290 respondents (149, Australia; 141, Germany) completed the survey. Older adults' ability to use a mHealth app, the user-friendliness of the app, their positive self-efficacy regarding their health and resource availability for using mHealth apps were related to intended adoption. Differences between Germany and Australia were found in issues concerned with data sharing and empowerment by the doctor, while similarities were related to trust in the doctor and their treatment approaches.

DISCUSSION AND CONCLUSION

This study highlights participants' perspectives and attitudes towards mHealth app use, unmet needs and barriers, and the facilitating influences in the two countries. These insights can be used to inform the development and implementation of mHealth apps and to construct tailored strategies to increase the adoption rates of mHealth apps among older adults and to maximise their potential benefits.

Measuring the adoption of internet and communication technologies among practitioners in routine disability services: a stepped inclusive approach

PURPOSE

Existing measurements of the use of information and communication technologies (ICTs) among practitioners in disability services often treat ICT adoption as a monolithic concept, overlooking its multifaceted nature within the disability field. This study introduces a stepped, inclusive approach to capturing this complexity, elucidating disparities in the utilization of various ICT dimensions, the present vs. anticipated use, and variations among different clinical-demographic groups.

MATERIALS AND METHODS

A cross-sectional survey was conducted in Hong Kong, gathering valid data from 324 practitioners spanning diverse disciplines and disability services.

RESULTS

Data analysis produced a three-factor model categorizing ICT tools into (1) information and communication tools, (2) screening and monitoring tools, and (3) treatment and rehabilitation tools. The first category was identified as the predominant ICT utilized currently, with significant projected growth in the latter two categories' usage. Variances in current ICT adoption were influenced by practitioners' roles, clientele, positions, affiliating agencies, and educational attainments.

CONCLUSIONS

This research provides a deeper understanding of the key dimensions of ICT adoption within disability services. It underscores the importance of devising specific and customized strategies for the effective integration of ICTs, ensuring a more tailored approach to meeting the unique demands of the disability field.

Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: a review of reviews

OBJECTIVES

Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs.

DESIGN

Systematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

DATA SOURCES

Embase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline.

ELIGIBILITY CRITERIA

Quantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal.

DATA EXTRACTION AND SYNTHESIS

Regarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators.

RESULTS

Thirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients' aptitude with the technology (n=9/33), and technical issues (n=12/33).

CONCLUSIONS

The implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.

Digital Health Support: Current Status and Future Development for Enhancing Dialysis Patient Care and Empowering Patients

Chronic kidney disease poses a growing global health concern, as an increasing number of patients progress to end-stage kidney disease requiring kidney replacement therapy, presenting various challenges including shortage of care givers and cost-related issues. In this narrative essay, we explore innovative strategies based on in-depth literature analysis that may help healthcare systems face these challenges, with a focus on digital health technologies (DHTs), to enhance removal and ensure better control of broader spectrum of uremic toxins, to optimize resources, improve care and outcomes, and empower patients. Therefore, alternative strategies, such as self-care dialysis, home-based dialysis with the support of teledialysis, need to be developed. Managing ESKD requires an improvement in patient management, emphasizing patient education, caregiver knowledge, and robust digital support systems. The solution involves leveraging DHTs to automate HD, implement automated algorithm-driven controlled HD, remotely monitor patients, provide health education, and enable caregivers with data-driven decision-making. These technologies, including artificial intelligence, aim to enhance care quality, reduce practice variations, and improve treatment outcomes whilst supporting personalized kidney replacement therapy. This narrative essay offers an update on currently available digital health technologies used in the management of HD patients and envisions future technologies that, through digital solutions, potentially empower patients and will more effectively support their HD treatments.

Investigating perceptions and attitude toward telenursing among undergraduate nursing students for the future of nursing education: a cross-sectional study

BACKGROUND

Telenursing is poised to emerge as a novel healthcare delivery system in the digital age. Hence, understanding nursing students' perspectives and readiness is pivotal for its effective implementation. This study investigated nursing students' perceptions regarding, and attitudes toward, telenursing and the factors that influenced their attitudes based on the technology acceptance model.

METHODS

This study used a cross-sectional descriptive approach. The participants consisted of 188 nursing students (first to fourth year) enrolled in the College of Nursing in Korea. Differences in attitudes toward telenursing were analyzed using independent t-test and one-way analysis of variance. Pearson's correlation coefficient was used to examine the correlations between the main variables. Factors that influenced attitudes toward telenursing were analyzed using multiple regression.

RESULTS

Of the participants, 65.4% lacked substantial awareness of telenursing and 19.1% had prior telenursing experience. Although prospects on telenursing indicated that 90.4% had an optimistic view, face-to-face nursing was heavily preferred for both satisfactory and favored healthcare delivery. Many cited the Internet as their source of knowledge, and only 18.6% had received telenursing education. Attitude toward telenursing was significantly more positive among those with experience of telenursing, telenursing observation in clinical practice, and telenursing education exposure. The regression model was statistically significant (F = 67.445, p < .000). Factors, such as perceived usefulness, social influence, innovativeness, and self-efficacy, influenced attitudes toward telenursing.

CONCLUSIONS

Nursing students exhibited a lack of substantial awareness of telenursing; however, they simultaneously displayed a positive outlook. This lack of comprehensive understanding could stem from the absence of formal education in telenursing. Understanding and utilizing the potential of telenursing could be significantly aided by nursing students' education and knowledge. Thus, it is necessary to include telenursing education in the nursing curriculum. The skills and knowledge required for telenursing clinical practice can be developed through telenursing education. Such preparedness will affect nurses' attitudes and intentions and the quality of telenursing offered to patients in the future.

A qualitative interview study of patients' attitudes towards and intention to use digital interventions for depressive disorders on prescription

Background

Depressive disorders are an emerging public health topic. Due to their increasing prevalence, patients with depressive disorders suffer from the lack of therapeutic treatment. Digital health interventions may offer an opportunity to bridge waiting times, supplement, or even substitute in-person treatment. Among others, the Unified Theory of Acceptance and Use of Technology (UTAUT) explains that actual technology use is affected by users' behavioural intention. However, patients' perspectives on digital interventions are rarely discussed within the specific context of primary care provided by general practitioners (GP) and need further exploration.

Method

A qualitative study design with semi-structured interviews was used to explore DTx-acceptance of patients with mild or moderate depression (n = 17). The audio-recorded interviews were transcribed verbatim, coded, and thematically analysed by qualitative content analysis.

Results

Patients' performance expectancies reveal that DTx are not perceived as a substitute for face-to-face treatment. Effort expectancies include potential advantages and efforts concerning technical, motivational, and skill-based aspects. Moreover, we identified health status and experience with depressive disorders as other determinants and potential barriers to patients' DTx acceptance: Difficult stages of depression or long-time experience are perceived hurdles for DTx use. GPs' recommendations were just partly relevant for patients and varied according to patients' consultancy preferences. But still, GPs have a crucial role for access due to prescription. GPs' influence on patients' DTx acceptance varies between three situations: (1) pre-use for consultation, (2) pre-use for access and (3) during DTx-use. Further, GPs' guidance could be especially relevant for patients during DTx-use in routine care.

Discussion

The UTAUT-based exploration suggests that acceptance determinants should be considered independently and embedded in personal and situational aspects. DTx require a healthcare professional to prescribe or diagnose the disease, unlike other digital offerings. We identified prescription- and depression-related determinants, exceeding existing theoretical constructs. GPs' guidance can compensate for some barriers to DTx use e.g., by increasing commitment and motivational support to strengthen patients' acceptance.

Conclusion

We argue for a multidimensional integration of acceptance determinants for further development of health technology acceptance research. Future research should specify how DTx can be integrated into routine care to strengthen user acceptance.

The additional value of e-Health for patients with a temporomandibular disorder: a mixed methods study on the perspectives of orofacial physical therapists and patients

PURPOSE

To assess the experience and perceived added value of an e-Health application during the physical therapy treatment of patients with temporomandibular disorders (TMD).

MATERIALS AND METHODS

A mixed-methods study including semi-structured interviews was performed with orofacial physical therapists (OPTs) and with TMD patients regarding their experience using an e-Health application, Physitrack. The modified telemedicine satisfaction and usefulness questionnaire and pain intensity score before and after treatment were collected from the patients.

RESULTS

Ten OPTs, of which nine actively used Physitrack, described that the e-Health application can help to provide personalised care to patients with TMD, due to the satisfying content, user-friendliness, accessibility, efficiency, and ability to motivate patients. Ten patients, of which nine ended up using Physitrack, felt that shared decision-making was very important. These patients were positive towards the application as it was clear, convenient, and efficient, it helped with reassurance and adherence to the exercises and overall increased self-efficacy. This was mostly built on their experience with exercise videos, as this feature was most used. None of the OPTs or patients used all features of Physitrack. The overall satisfaction of Physitrack based on the telemedicine satisfaction and usefulness questionnaire (TSUQ) was 20.5 ± 4.0 and all patients (100%) showed a clinically relevant reduction of TMD pain (more than 2 points and minimally 30% difference).

CONCLUSION

OPTs and patients with TMD shared the idea that exercise videos are of added value on top of usual physical therapy care for TMD complaints, which could be delivered through e-Health.Implications for RehabilitationPhysical therapists and patients with temporomandibular disorders do not use all features of the e-Health application Physitrack in a clinical setting.Exercise videos were the most often used feature and seen as most valuable by physical therapists and patients.Based on a small number of participants, e-Health applications such as Physitrack may be perceived as a valuable addition to the usual care, though this would need verification by a study designed to evaluate the therapeutic effect (e.g., a randomised clinical trial).

What would it take to improve the uptake and utilisation of mHealth applications among older Australians? A qualitative study

Objective Health-related apps on mobile devices (mHealth apps) have become an effective self-management tool and treatment support for patients. There is limited research, however, on how older people (50 and over) perceive the opportunity of using mHealth apps. Our aim was to investigate the perceptions of older people in Australia regarding the opportunity of using prescribed or doctor-recommended mHealth apps and provide insights which can enhance their uptake of mHealth. Methods This was a qualitative study using semi-structured interviews involving 21 participants aged 51-82 years. Qualitative thematic analysis was used to categorise the factors that influence the adoption of mHealth apps by older adults. Results We show that beyond the prominent influencing factors from technology adoption research (such as performance and effort expectancy, social influence and facilitating conditions), health-specific factors such as a trusting doctor-patient relationship and strong health self-efficacy positively influence the intended adoption of mHealth apps among older adults. In addition, the IT security and accurate interpretation of participants' input in an mHealth app can present barriers to mHealth app adoption. Conclusion Our analyses provide additional insights complementing existing technology adoption research. Their successful adoption and utilisation require further empirical evidence on its effectiveness along with attention to the voices of those who are meant to use them. To address potential barriers, improve the quality and security of mHealth apps, and thus achieve greater patient safety, the involvement of consumers, regulators and health professionals is necessary.

Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study

BACKGROUND

The enactment of the "Act to Improve Healthcare Provision through Digitalisation and Innovation " (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany's medical landscape.

OBJECTIVE

This study aims to investigate physicians' responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps.

METHODS

Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021.

RESULTS

The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians' self-perceived digital competence and their evaluation of patients' digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps.

CONCLUSIONS

Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians' and patients' sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice.

Barriers and facilitators to utilizing digital health technologies by healthcare professionals

Digital technologies change the healthcare environment, with several studies suggesting barriers and facilitators to using digital interventions by healthcare professionals (HPs). We consolidated the evidence from existing systematic reviews mentioning barriers and facilitators for the use of digital health technologies by HP. Electronic searches were performed in five databases (Cochrane Database of Systematic Reviews, Embase®, Epistemonikos, MEDLINE®, and Scopus) from inception to March 2023. We included reviews that reported barriers or facilitators factors to use technology solutions among HP. We performed data abstraction, methodological assessment, and certainty of the evidence appraisal by at least two authors. Overall, we included 108 reviews involving physicians, pharmacists, and nurses were included. High-quality evidence suggested that infrastructure and technical barriers (Relative Frequency Occurrence [RFO] 6.4% [95% CI 2.9-14.1]), psychological and personal issues (RFO 5.3% [95% CI 2.2-12.7]), and concerns of increasing working hours or workload (RFO 3.9% [95% CI 1.5-10.1]) were common concerns reported by HPs. Likewise, high-quality evidence supports that training/educational programs, multisector incentives, and the perception of technology effectiveness facilitate the adoption of digital technologies by HPs (RFO 3.8% [95% CI 1.8-7.9]). Our findings showed that infrastructure and technical issues, psychological barriers, and workload-related concerns are relevant barriers to comprehensively and holistically adopting digital health technologies by HPs. Conversely, deploying training, evaluating HP's perception of usefulness and willingness to use, and multi-stakeholders incentives are vital enablers to enhance the HP adoption of digital interventions.

Patient satisfaction with stoma care and their expectations on mobile apps for supportive care

AIM

Self-efficacy in stoma care is essential, as it reduces morbidity and psychosocial problems. Mobile applications (apps) may optimise patients' self-efficacy. This article investigates patients' satisfaction with stoma care, their attitudes towards a supporting app aiming to promote self-efficacy and evaluate which functionalities are desired.

METHOD

A survey was sent to members of the two stoma-related patient associations in the Netherlands. Associations between patient characteristics, satisfaction concerning received stoma care, and willingness to use an app were evaluated.

RESULTS

The survey was completed by 1868 patients. Overall satisfaction was scored as 6.6, with shortfalls reported in the preoperative information provision, stoma site selection, and postoperative care. Patients of older age, who were unaware of getting a stoma, had an ileostomy, a low quality of life or psychosocial problems, were less satisfied. An app was expected to be of added value by 59.4% of the patients having a stoma for less than three years, compared to the significantly lower 43.8% expectation rate of the remaining study population (p < 0.001). Moreover, patients with a high frequency of physical or psychosocial problems expressed higher levels of interest.

CONCLUSION

Patients were only moderately satisfied with their received stoma care. A supportive app is most likely beneficial for patients who had a stoma for less than three years, were in an acute situation, and/or have stoma-related problems. Most patients prefer information via internet or on paper, although apps may offer additional benefits. It is important to acknowledge digital literacy and to council patients appropriately about the benefits and help them to use apps.

Military Doctors' and Nurses' Perceptions of Telemedicine and the Factors Affecting Use Intention

Purpose: This study investigated military doctors' and nurses' perceptions of telemedicine and the factors influencing their intention to use it based on the unified theory of acceptance and use of technology. Method: This study adopted a questionnaire-based, cross-sectional descriptive approach. It used a web questionnaire for data collection over a 5-week period, starting in June 2021. Results: A total of 72.6% of participants indicated that telemedicine is required in the military. The intention to use telemedicine was significantly higher among women, younger individuals (<30 years), and military nurses. In addition, factors such as voluntariness of use, performance expectancy, social influence, and facilitating conditions positively affected the intention to use telemedicine. Conclusions: To improve military doctors' and nurses' use and understanding of telemedicine, consensus must be reached regarding its use in military contexts. Discussions that incorporate opposing views should be encouraged as well. Moreover, the voluntariness of use significantly affected respondents' intention to use telemedicine. There is an urgent need, therefore, for in-depth analyses of the various factors associated with voluntariness of use of telemedicine; the resulting insights could be used to encourage military doctors and nurses to adopt telemedicine. Finally, along with promoting the use of smartphones for medical consultation among military personnel, military nurses' role should be extended to include health consultation using smartphones. This could promote the active use of telemedicine in military nursing, which could contribute to health promotion among military personnel.

Development and pilot study of "Smart Cancer Care": a platform for managing side effects of chemotherapy

BACKGROUND

As outpatient chemotherapy treatment increases, cancer patients receiving chemotherapy spend more time at home. In addition, since the types of chemotherapy are gradually expanding, it will be essential to prepare patient self-management strategies for various chemotherapy-related side effects. This study aimed to develop a platform (called Smart Cancer Care) to implement a chemotherapy side effect management program and to evaluate its feasibility.

METHODS

Smart Cancer Care comprises an application for patients and a dashboard for medical staff. Thirty-two symptoms to be managed using Smart Cancer Care were summarized through a literature review and Delphi. Management guidelines were developed based on the severity of each symptom (3 stages), and installed in Smart Cancer Care according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 guidelines. To evaluate the feasibility of the developed application and medical dashboard, cancer patients and cancer treatment medical staff used Smart Cancer Care for 2 to 3 weeks and subsequently reported the experience of using them.

RESULTS

The patient application provided a list of symptoms according to the cancer type and anticancer drug enabling presence and severity of each symptom to be evaluated. Patients received management guidelines for symptoms based on the symptom evaluation results. On the medical staff dashboard, administrators and authorized medical personnel could access and assess information regarding side effects and symptom severity submitted by the patient. The feasibility and usefulness of Smart Cancer Care were confirmed through a pilot test targeting 30 patients and 24 chemotherapy-related medical staff. For patients, the evaluation score for the "The program will be helpful when seeing medical staff" item was the highest. For medical staff, the score for the "By checking the patient's symptoms using the program, it helps to take appropriate measures for the patient" item was the highest. Although minor corrections were raised, most patients and medical staff expected that Smart Cancer Care would help their treatment.

CONCLUSIONS

The configuration of the application and dashboard of Smart Cancer Care detailed in this study could be used for the development of a widely accepted platform to implement a chemotherapy side effect management program.

eHealth in Geriatric Rehabilitation: An International Survey of the Experiences and Needs of Healthcare Professionals

While eHealth can help improve outcomes for older patients receiving geriatric rehabilitation, the implementation and integration of eHealth is often complex and time-consuming. To use eHealth effectively in geriatric rehabilitation, it is essential to understand the experiences and needs of healthcare professionals. In this international multicentre cross-sectional study, we used a web-based survey to explore the use, benefits, feasibility and usability of eHealth in geriatric rehabilitation settings, together with the needs of working healthcare professionals. Descriptive statistics were used to summarize quantitative findings. The survey was completed by 513 healthcare professionals from 16 countries. Over half had experience with eHealth, although very few (52 of 263 = 20%) integrated eHealth into daily practice. Important barriers to the use or implementation of eHealth included insufficient resources, lack of an organization-wide implementation strategy and lack of knowledge. Professionals felt that eHealth is more complex for patients than for themselves, and also expressed a need for reliable information concerning available eHealth interventions and their applications. While eHealth has clear benefits, important barriers hinder successful implementation and integration into healthcare. Tailored implementation strategies and reliable information on effective eHealth applications are needed to overcome these barriers.

Survey on digital dependency, writing by hand, and group learning as learning styles among Japanese medical students: Assessing correlations between various accomplishments

BACKGROUND

Although digital learning devices have become increasingly more common in medical education settings, it remains unclear how they influence medical student learning styles and various outcome measures. This study aimed to assess student learning styles, specifically as they relate to digital dependency, writing habits, and group learning practices among current medical students.

MATERIALS AND METHODS

This questionnaire study was approved by the Research Ethics Committee of Osaka Medical and Pharmaceutical University. We conducted a questionnaire survey of 109 medical students who were 5th year students during the 2021 school year. Medical students were asked about their level of digital dependency, writing by hand, and group learning practices. We also analyzed the correlation between student learning styles and their respective outcomes on several summative evaluations.

RESULTS

Of the 109 students targeted, we received responses from 62 (response rate, 56.8%). Among the respondents, digital dependency was 83.4 ± 18.6%, while hand writing ratio 39.8 ± 29.9% and group learning ratio 33.5 ± 30.5%. We also assessed correlations between these learning styles and scores on the CBT, OSCE, CC, and CC Integrative Test. Only writing by hand showed a small positive correlation with CC Integrative Test scores.

CONCLUSION

Our questionnaire survey assessed the rates of digital dependency, writing by hand, and group learning practices, and analyzed the correlations between these learning styles and respective outcomes. Current medical students exhibited high digital dependency which was not correlated with performance outcomes.

Digital Health Training, Attitudes and Intentions to Use It among Romanian Medical Students: A Study Performed during COVID-19 Pandemic

INTRODUCTION

This study focuses on medical students from the University of Medicine and Pharmacy in Cluj-Napoca, Romania, and has three objectives. First, it evaluates the opinions of medical students regarding their previous training as well as their needs for future training in the field of digital health. Second, it assesses their attitudes regarding digital health and their intention to use digital tools as physicians. Lastly, the interrelationship between these issues as well as the socio-demographic factors which influence them are investigated.

MATERIALS AND METHODS

A cross-sectional survey was performed during June-August 2021 among fifth and sixth year students of the Faculty of Medicine from the Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. Anonymous online questionnaires were used which were filled in by 306 students.

RESULTS

Less than half of the participating students declared that they benefited from training or different practical examples during medical education regarding the use of digital tools in different medical areas, while the majority said that they would like to receive more training in the field of digital health. A total of 58.2% said that they totally agree with the introduction of a formal training in the medical curricula regarding digital health. Many students declared positive attitudes toward the use of digital tools in different domains within the medical field and intention to use digital tools as physicians; several differences were noted, including gender, year of study, type of domain, and previous training with regard to the use of digital tools in those domains. Moreover, the need for future training and the desire for the introduction of a formal training program into the medical curricula with regard to this field were stronger among those with more positive attitudes and higher intentions to use digital tools in their medical activity.

CONCLUSIONS

To the best of our knowledge, this is the first study from Romania which investigated the training, attitudes, and intentions regarding the use of digital health among Romanian medical students, and offers valuable information to guide the education of medical students.

Computer Skills and Electronic Health Records (EHRs) in a State Tertiary Hospital in Southwest Nigeria

Adopting change is something that is often resisted, as is often the case in the adoption of electronic health records (EHRs) in healthcare organizations. Embracing this will require computer knowledge to handle the system for the management of patients and their care. This study aims to determine the computer skills required for the uptake of electronic health records (EHR) by healthcare workers in an annex of the state teaching hospital, Okela Health Centre (OHC) Ado-Ekiti. The study uses a cross-sectional research design with a structured questionnaire distributed to 30 healthcare workers across seven disciplines working in the hospital. Descriptive statistics of frequency tables and percentages were used to ascertain the relationship between computer skill usage and the adoption of EHR. The majority of respondents were only efficient in Microsoft Word (MW), email, and WhatsApp, with efficiency rates of 63.4%, 76.6%, and 73.3%, respectively. The majority were not efficient in Microsoft Excel (ME) and Microsoft Access (MA), at 56.7% and 70%, respectively. Computer appreciation is an important basis for the adoption of EHR in hospitals.

Associations between adoption of eHealth management module and optimal control of HbA1c in diabetes patients

In January 2021, the eHealth App was launched in Hong Kong by the Hong Kong government to support the Electronic Health Record Sharing System (eHRSS). A Health Management Module in the eHealth App introduced new functions to record blood pressure, blood sugar, and heart rate, and downloading and sharing records. This study aims to compare the level of glycaemic control between users of the eHealth App and non-users. Type 2 diabetes patients who have joined the eHRSS with existing haemoglobin A1c (HbA1c) level records are recruited. Correlations between predictors and optimal HbA1c control (<7%) are examined using logistic regression analyses. A total of 109,823 participants are included, with 76,356 non-users of eHealth App, 31,723 users of eHealth App, and 1744 users of the eHealth Management Module together with the App. We collect HbA1c values from Jan 2021 to May 2022, and they are 6 months after the use of the App on average. Users of the eHealth Management Module are found to have more optimal HbA1c levels across all subgroups, with the strongest effect observed in younger females (aOR = 1.66, 95% CI = 1.27-2.17). eHealth App usage is also positively associated with optimal HbA1c levels, particularly amongst younger females (aOR = 1.17, 95% CI = 1.08-1.26). Overall, users of eHealth App and eHealth Management Module demonstrate more optimal HbA1c levels when compared with non-users, particularly among younger adults and females. These findings support its potential adoption in diabetes patients. Future studies should examine the impact of eHealth interventions on other clinical targets and diabetes complications.

Organizational and health professional readiness for the implementation of electronic medical record system: an implication for the current EMR implementation in northwest Ethiopia

OBJECTIVE

The WHO developed a manual outlining the preliminary organizational and health professionals' readiness to implement electronic medical records (EMR). On the other hand, the readiness assessment in Ethiopia only includes the evaluation of health professionals, leaving out organisational readiness components. As a result, this research aimed to determine health professionals' and organizational readiness to implement EMR at a specialized teaching hospital.

METHODS

An institutional-based cross-sectional study design was conducted among 423 health professionals and 54 managers. Self-administered and pretested questionnaires were used to collect data. Binary logistic regression analysis was used to identify factors associated with health professionals' readiness for EMR implementation. An OR with a 95% CI and p<0.05 was used to determine the strength of the association and the statistical significance, respectively.

RESULTS

In this study, 53.7% management capacity, 33.3% finance and budget capacity, 42.6% operational capacity, 37.0% technology capability and 53.7% organisational alignment among the five dimensions evaluated to assess an organisation's readiness to implement an EMR system. Of 411 health professionals in this study, 173 (42.1%) with (95 CI 37.3% to 46.8%) were ready to implement an EMR system at the hospital. Sex (AOR 2.69, 95% CI 1.73 to 4.18), basic computer training (AOR 1.59, 95% CI 1.02 to 2.46), knowledge of EMR (AOR 1.88, 95% CI 1.19 to 2.97) and attitudes towards EMR (AOR 1.65, 95% CI 1.05 to 2.59) were significantly associated with health professionals' readiness towards EMR system implementation.

CONCLUSIONS

Findings showed that most dimensions of organizational readiness for EMR implementation were below 50%. This study also revealed a lower level of EMR implementation readiness among health professionals compared with previous research studies' results. To improve organisational readiness to implement an electronic medical record system, a focus on management capability, financial and budget capability, operational capability, technical capability and organisational alignment was crucial. Likewise, having basic computer training, giving special attention to female health professionals and improving health professionals' knowledge of and attitudes towards EMR could help improve the readiness level of health professionals for implementing an EMR system.

Perceptions of Dutch general practitioners towards eHealth for patients with type-2 diabetes: a qualitative study

BACKGROUND

eHealth provides a viable option to facilitate type-2 diabetes mellitus self-management and adherence. To this end, a web-based computer-tailored eHealth programme, My Diabetes Profile (MDP), was developed and implemented in Dutch diabetes care. To fully utilize the potential of eHealth, the reach of effective programmes like MDP should be maximized. Therefore, it is vital to explore perceptions of general practitioners (GPs) regarding eHealth and factors that influence GPs' decision to adopt eHealth programmes.

OBJECTIVE

To shed light on Dutch GPs' perceptions towards eHealth in general and specifically, the adoption of MDP.

METHODS

Interviews were conducted among a heterogeneous sample of 16 Dutch GPs. The interview guide, based on the Diffusion of Innovations Theory, addressed perceptions about eHealth in general, characteristics of MDP, organizational characteristics, and external influences on adoption. Audio-recordings were transcribed and analysed using deductive coding in NVivo.

RESULTS

Nearly all GPs used some form of eHealth and listed many benefits and few drawbacks about eHealth. Sometimes, GPs were unaware of what eHealth encompassed; programmes resembling MDP were not mentioned. COVID-19 immensely increased eHealth uptake, especially for remote communication. Regarding MDP, the organizational and external influences on adoption were limited, while characteristics of the innovation were deemed more important. GPs expressed benefits of MDP (e.g. uncomplex, user-friendly, tailored) other than attributed to eHealth in general and fewer drawbacks.

CONCLUSION

While GPs' opinions about eHealth and MDP were positive, the concept of MDP was relatively unfamiliar. Future research should focus on targeting GPs' awareness of eHealth possibilities.

An evaluation of the risk factors associated with implementing projects of health information technology by fuzzy combined ANP-DEMATEL

BACKGROUND

Application of a Clinical Information System (CIS) like Electronic Patient Record (EPR), PACS system and CPOE has turned into one of the most important criteria of priorities of health care systems. The aims of the clinical information system include improving the physicians' efficiency level, integrating the caring process, and expanding the fuzzy quality of the services offered to patients. Achievement of these benefits in reality is not an easy task, and there are lots of plans in this field which are doomed to failure. About 50% of the implementation plans of clinical information systems in health care organizations have failed, and this trend is significantly affecting industrial countries. Proper implementation of hospital information systems lies in identifying and assessing the relationships among the most important risk factors of fuzzy. The present study aimed to provide an applicable model for identifying, ranking and evaluating the risk factors associated with projects of clinical information technology in hospitals of Shiraz University of Medical Sciences.

METHOD

This is an applied study which evaluates the risk factors associated with implementation of clinical information technology projects in hospitals of Shiraz Medical Sciences University. The participants consisted of professionals and senior experts of clinical information technology. Fuzzy logic was used in this study. We also applied ANP-DEMATEL combined model with fuzzy procedure to provide the analytic model of the study.

RESULTS

According to the study findings, lack of top-executive supports, and unstable organizational environment were the two most important risk factors, while the main organizational factors and technology were also highly important. In addition, the factors associated with technology had the highest influence on the other studied risk factors.

CONCLUSION

Hospital authorities can benefit from this proposed model to reduce the risk of implementing the projects of clinical information technology and improve the success coefficient of the risk of such projects.

A Review of the State of the Art of Data Quality in Healthcare

Effective implementation of strategic data-driven health analysis initiatives is heavily dependent on the quality of the electronic medical records that serve as the foundation from which to improve clinical decisions and, in turn, the quality of care. Although there is a large body of research on the quality of healthcare data, a systematical understanding of the methods used to address the issues of data quality is missing. This study analyzes research articles in health information systems/healthcare informatics on data quality to derive a set of dimensions for understanding data quality. Issues related to each dimension are identified and methods used to address them summarized. The issues and methods can inform healthcare professionals of how to improve data practices.

Strengthening the evidence base for mHealth in clinical practice: Conducting research with standalone or interoperable systems - a viewpoint

Objective

The aim of this viewpoint is to inform mobile health (mHealth) evidence development in using standalone or interoperable systems in hospital practice.

Methods

There is a gap between mHealth research and its widespread uptake in clinical practice. Evidence generation is not keeping up with the introduction and implementation of technologies. This is partly a consequence of the technology characteristics and the way research is conducted in a clinical setting. Research and development of mHealth technology can be conducted standalone in a laboratory like setting, standalone in a clinical setting or interoperable with already existing technology in hospital practice.

Results

Standalone systems operate relatively independent from an organizations' existing infrastructure. Using laboratory settings does not reflect the complexity of real-life, but in clinical practice this may be suitable for research assessing usability, feasibility or even clinical and process outcomes at a small scale. Realizing research and development on interoperable mHealth technology solutions, especially with operational EMR systems, is a challenging, time- and resource intensive process and requires large(r) investments, as it is often complicated by a myriad of interfering factors. Interoperable systems are however a more sustainable option in the long run, and generated evidence reflects the real hospital care setting and this option may therefore facilitate dissemination. Choosing either a standalone or interoperable setting affects the research design, the implementation pace and ultimately widespread adoption of the mHealth technology.

Conclusion

We recommend to include these technology characteristics in implementation frameworks and think of evaluation research designs in an early phase.

Development and evaluation of a mobile application trauma registry for use in low- and middle-income countries

Introduction

Trauma registries are a means for improving trauma care in low- and middle-income countries, though a number of challenges for the sustainability of these trauma registries exist. Mobile health applications represent a promising technology for low- and middle-income country trauma registries. The development, implementation and evaluation of a mobile application trauma registry for use at the Mbarara Regional Referral Hospital, Uganda is demonstrated.

Methods

A paper-based trauma registry was implemented at the Mbarara Regional Referral Hospital. Based on feedback from local stakeholders, this was developed into an open-source mobile application version of the trauma registry. The mobile application was evaluated by 17 healthcare workers using a modified Unified Theory of Acceptance and Use of Technology questionnaire and qualitative analysis.

Results

Unified Theory of Acceptance and Use of Technology scores showed the majority of participants responding positively to the major constructs of Performance Expectancy, Effort Expectancy, Social Influence and Facilitating Conditions, with mean Likert scores (out of 7) of 6.41 (±1.43), 6.25 (±1.41), 5.44 (±1.43) and 5.32 (±1.99), respectively. There was also a young average user age (29.1 years). Qualitative analysis identified response themes of ease of use, efficiency and potential for future research and clinical use; users also suggested expansion of the type of platforms the application was available on.

Conclusion

Though a number of challenges exist for sustaining trauma registries in low- and middle-income countries, substantial involvement of local stakeholders and responsiveness to feedback should be used to facilitate the use of these technologies in developing countries. This study demonstrates a potential methodology for developing and evaluating trauma registry technologies for use in low- and middle-income countries.

Utility, barriers and facilitators to the use of connected health to support families impacted by paediatric cancer: a qualitative analysis

AIM

As healthcare systems are increasingly burdened, the efficiencies and cost savings offered by connected health (CH, i.e. two-way communicative healthcare technologies such as eHealth or mHealth) present an attractive solution for supporting families impacted by cancer. More research is required, however, to examine attitudes towards CH to better facilitate its use in practice. This study seeks to examine the utility, barriers and facilitators of CH use for families affected by paediatric cancer living in Ireland.

METHODS

Healthcare professionals (n = 5) and parents of children with cancer (n = 7) completed semi-structured interviews on their experiences of and attitudes to CH via Microsoft Teams. A reflexive thematic approach to analysis was employed.

RESULTS

CH was perceived to provide support for a number of current needs with themes of 'shifting responsibilities', 'individualisation of care' and 'knowledge as power'. Through facilitating communication, information sharing and monitoring of child health, CH was perceived to support decreased parental burden and increased parental control, with positive child outcomes thought likely. Perceived barriers and facilitators to the use of CH included the 'importance of trust', 'pace of change' and 'access'.

CONCLUSION

While results suggest an acceptance of CH across key stakeholders, barriers and facilitators should be considered to support effective implementation. While further analysis of the efficacy of CH to support families impacted by paediatric cancer is needed, these findings highlight key areas where CH may be effectively employed.

Acceptance of E-mental health interventions and its determinants among psychotherapists-in-training during the first phase of COVID-19

BACKGROUND

Although E-mental health (EMH) interventions have been shown to be effective in the treatment of mental health problems and empirical knowledge regarding EMH acceptance for different occupations in health care is established, little is known regarding EMH and psychotherapists-in-training. This seems particularly relevant as psychotherapists-in-training will shape the future health care system since they are as being the next generation of psychotherapists. With social distancing measures in place, COVID-19 has led to an increased demand for EMH, which is broadening the way psychological treatments are delivered.

OBJECTIVE

The present study aims to assess the acceptance of EMH and its determinants among psychotherapists-in-training of different EMH modalities and to retrospectively compare current acceptance with pre-COVID-19 times.

METHODS

Altogether, 29 training institutions in Switzerland and 232 training institutions in Germany were contacted, resulting in a sample of N = 216 psychotherapists-in-training (88.4 % female) who filled out the self-administered web-based questionnaire in summer 2020. The acceptance of EMH was assessed considering several different modalities (e.g., videoconference, guided self-help programs) as well as further possible predictors of EMH acceptance based on the Unified Theory of Acceptance and Use of Technology. Acceptance scores were categorized as low, moderate or high based on prior research and predicted using multiple regression.

RESULTS

Acceptance of EMH was moderate (M = 3.40, SD = 1.11) and increased significantly (t(215) = 12.03, p < .01; d = 0.88) compared to pre-COVID-19 (M = 2.67, SD = 1.11); however, acceptance varied significantly between modalities (F(2.6, 561.7) = 62.93, p < .01, partial η² = 0.23), with videoconferencing being the most accepted and unguided programs the least. Stepwise regression including three of 14 variables (R² = 0.55, F (14, 201) = 17.68, p < .001) identified performance expectancy, social influence and concerns about the therapeutic alliance as significant determinants of EMH acceptance.

DISCUSSION

Acceptance by psychotherapists-in-training was moderate and in line with prior research and comparable with other clinicians' acceptance scores. Performance expectancy, social influence and concerns about the therapeutic alliance were predictive of EMH acceptance, indicating their significance in the implementation of EMH in health care.

CONCLUSION

These findings underline the importance of the aforementioned determinants of EMH acceptance and the need for further studies investigating EMH acceptance in order to derive adequate educational programs and to facilitate dissemination among psychotherapists-in-training.

Health Care Professionals' Experiences of Web-Based Symptom Checkers for Triage: Cross-sectional Survey Study

Background

Web-based symptom checkers are promising tools that provide help to patients seeking guidance on health problems. Many health organizations have started using them to enhance triage. Patients use the symptom checker to report their symptoms online and submit the report to the health care center through the system. Health care professionals (registered nurse, practical nurse, general physician, physiotherapist, etc) receive patient inquiries with urgency rating, decide on actions to be taken, and communicate these to the patients. The success of the adoption, however, depends on whether the tools can efficiently support health care professionals’ workflow and achieve their support.

Objective

This study explores the factors influencing health care professionals’ support for a web-based symptom checker for triage.

Methods

Data were collected through a web-based survey of 639 health care professionals using either of the two most used web-based symptom checkers in the Finnish public primary care. Linear regression models were fitted to study the associations between the study variables and health care professionals’ support for the symptom checkers. In addition, the health care professionals’ comments collected via survey were qualitatively analyzed to elicit additional insights about the benefits and challenges of the clinical use of symptom checkers.

Results

Results show that the perceived beneficial influence of the symptom checkers on health care professionals’ work and the perceived usability of the tools were positively associated with professionals’ support. The perceived benefits to patients and organizational support for use were positively associated, and threat to professionals’ autonomy was negatively associated with health care professionals’ support. These associations were, however, not independent of other factors included in the models. The influences on professionals’ work were both positive and negative; the tools streamlined work by providing preliminary information on patients and reduced the number of phone calls, but they also created extra work as the professionals needed to call patients and ask clarifying questions. Managing time between the use of symptom checkers and other tasks was also challenging. Meanwhile, according to health care professionals’ experience, the symptom checkers benefited patients as they received help quickly with a lower threshold for care.

Conclusions

The efficient use of symptom checkers for triage requires usable solutions that support health care professionals’ work. High-quality information about the patients’ conditions and an efficient way of communicating with patients are needed. Using a new eHealth tool also requires that health organizations and teams reorganize their workflows and work distributions to support clinical processes.

A Bibliometric Analysis of Digital Health & Mobile Health Related Global Research Publications

The dataset was generated from Scopus database for the study due to its compatibility with bibliometrix R package. The dataset shows that there is a gradual increase in publication of research articles on digital health and mobile health till 2016 before a sudden rise in number of publications from 2017 onwards. This paper contributes by providing a consolidation of fragmented literature in the research domain giving us information on significant sources, authors and documents. The analysis of conceptual structure reveals that the topics of study have evolved from mobile health to digital health, e-health, technology acceptance model, privacy, implementation and self-management.

Nurses' experiences with continuous vital sign monitoring on the general surgical ward: a qualitative study based on the Behaviour Change Wheel

Background

To support early recognition of clinical deterioration on a general ward continuous vital signs monitoring (CMVS) systems using wearable devices are increasingly being investigated. Although nurses play a crucial role in successful implementation, reported nurse adoption and acceptance scores vary significantly. In-depth insight into the perspectives of nurses regarding CMVS is lacking. To this end, we applied a theoretical approach for behaviour change derived from the Behaviour Change Wheel (BCW).

Aim

To provide insight in the capability, opportunity and motivation of nurses working with CMVS, in order to inform future implementation efforts.

Methods

A qualitative study was conducted, including twelve nurses of a surgical ward in a tertiary teaching hospital with previous experience of working with CMVS. Semi-structured interviews were audiotaped, transcribed verbatim, and analysed using thematic analysis. The results were mapped onto the Capability, Opportunity, Motivation – Behaviour (COM-B) model of the BCW.

Results

Five key themes emerged. The theme ‘Learning and coaching on the job’ linked to Capability. Nurses favoured learning about CVSM by dealing with it in daily practice. Receiving bedside guidance and coaching was perceived as important. The theme ‘interpretation of vital sign trends’ also linked to Capability. Nurses mentioned the novelty of monitoring vital sign trends of patients on wards. The theme ‘Management of alarms’ linked to Opportunity. Nurses perceived the (false) alarms generated by the system as excessive resulting in feelings of irritation and uncertainty. The theme ‘Integration and compatibility with clinical workflow’ linked to Opportunity. CVSM was experienced as helpful and easy to use, although integration in mobile devices and the EMR was highly favoured and the management of clinical workflows would need improvement. The theme ‘Added value for nursing care’ linked to Motivation. All nurses recognized the potential added value of CVSM for postoperative care.

Conclusion

Our findings suggest all parts of the COM-B model should be considered when implementing CVSM on general wards. When the themes in Capability and Opportunity are not properly addressed by selecting interventions and policy categories, this may negatively influence the Motivation and may compromise successful implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00837-x.

Remote continuous monitoring with wireless wearable sensors in clinical practice, nurses perspectives on factors affecting implementation: a qualitative study

Background

Continuous monitoring using wireless wearable sensors is a promising solution for use in clinical practice and in the home setting. It is important to involve nurses to ensure successful implementation. This paper aims to provide an overview of 1) factors affecting implementation of continuous monitoring using wireless wearable sensors by evaluating nurses’ experiences with its use on the nursing ward, and 2) nurses’ expectations for use in the home setting.

Methods

Semi-structured interviews were conducted with 16 nurses from three teaching hospitals in the Netherlands, covering constructs from the Consolidated Framework for Implementation Research (CFIR). A deductive approach of directed content analysis was applied. One additional factor was added using the Unified Theory for Acceptance of Technology (UTAUT). The quotes and domains were rated on valence (positive, neutral, negative) and strength (strong: − 2, + 2, neutral 0, and weak: − 1, + 1).

Results

Data was collected on 27 CFIR constructs and 1 UTAUT construct. In the experience of at least 8 nurses, five constructs had a strong positive influence on implementation on the nursing ward, including relative advantage (e.g., early detection of deterioration), patient needs and resources (e.g. feeling safe), networks and communications (e.g. execute tasks together), personal attributes (e.g. experience with intervention), and implementation leaders (e.g., project leader). Five constructs had a strong negative influence: evidence strength and quality (e.g. lack of evidence from practical experience), complexity (e.g. number of process steps), design quality and packaging (e.g., bad sensor quality), compatibility (e.g, change in work) and facilitating conditions (e.g, Wi-Fi connection). Nurses expected continuous monitoring in the home setting to be hindered by compatibility with work processes and to be facilitated by staff’s access to information. Technical facilitating conditions (e.g. interoperability) were suggested to be beneficial for further development.

Conclusions

This paper provides an overview, of factors influencing implementation of continuous monitoring including relative importance, based on nurses’ experiences with use on nursing wards, and their perspectives for use in the home setting. Implementation of continuous monitoring is affected by a wide range of factors. This overview may be used as a guideline for future implementations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00832-2.

Healthcare providers' readiness for electronic health record adoption: a cross-sectional study during pre-implementation phase

BACKGROUND

The adoption of an electronic health record (EHR) in the healthcare system has the potential to make healthcare service delivery effective and efficient by providing accurate, up-to-date, and complete information. Despite its great importance, the adoptions of EHR in low-income country settings, like Ethiopia, were lagging and increasingly failed. Assessing the readiness of stakeholders before the actual adoption of EHR is considered the prominent solution to tackle the problem. However, little is known about healthcare providers' EHR readiness in this study setting. Accordingly, this research was conducted aiming at examining healthcare providers' readiness for EHR adoption and associated factors in southwestern Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted from September 1 to October 30, 2021. A total of 423 healthcare providers working in public hospitals were selected using a simple random sampling technique. Multivariable logistic regression was fitted to identify determinant factors of overall healthcare providers' readiness after the other covariates were controlled.

RESULT

In this study, the overall good readiness level of EHR adoption was 52.8% (n = 204) [95% CI of 47.9% to 56.6%]. Age, computer literacy, computer access at health facilities, attitude towards EHRs, awareness about EHRs, perceived benefit, and perceived technology self-efficacy were significantly associated with the overall health care providers' readiness for the adoption of EHR using a cut point of P-value less than 0.05.

CONCLUSION

Around half of the respondents had a good level of overall healthcare providers' readiness for the adoption of EHR which was considered inadequate. This finding implied that a huge effort is required to improve readiness before the actual implementation of EHRs. The finding implied that younger-aged groups were more ready for such technology which in turn implied; the older one needs more concern. Enhancing computer literacy, confidence building to raise self-efficacy of such technology, addressing the issue of computer availability at health facilities, building a positive attitude, awareness campaign of EHR, and recognizing the usefulness of such systems were the necessary measures to improve EHR readiness in this setting. Additionally, further studies are recommended to encompass all types of EHR readiness such as organizational readiness, technology readiness, societal readiness, and so on. Additionally, exploring the healthcare provider opinion with qualitative study and extending the proposed study to other implementation settings are recommended to be addressed by future works.

Predicting Health Care Providers' Acceptance of a Personal Health Record Secure Messaging Feature

BACKGROUND

Personal health records (PHRs) can facilitate patient-centered communication through the secure messaging feature. As health care organizations in the Kingdom of Saudi Arabia implement PHRs and begin to implement the secure messaging feature, studies are needed to evaluate health care providers' acceptance.

OBJECTIVE

The aim of this study was to identify predictors of health care providers' behavioral intention to support the addition of a secure messaging feature in PHRs using an adapted model of the Unified Theory of Acceptance and Use of Technology as the theoretical framework.

METHODS

Using a cross-sectional survey design, data on acceptance of secure messaging features in PHRs were collected from health care providers working at the Ministry of National Guard Health Affairs between April and May 2021. The proposed model was tested using partial least squares structural equation modeling in SmartPLS.

RESULTS

There were 224 participants: female (66.5%), 40 to 49 years of age (39.9%), nurses (45.1%), and those working more than 10 years in the organization (68.8%). Behavioral intention to support the addition of a secure messaging feature was significantly influenced by performance expectancy (β = 0.21, p = 0.01) and attitude (β = 0.50, p < 0.01), while other predicting factors, such as effort expectancy, social influence, and facilitating condition, did not significantly affect the intention. Furthermore, age, years of experience, and professional role did not moderate the relationships.

CONCLUSION

Health care professionals will support introducing a secure messaging feature in the PHRs if they serve the intended purpose. Considering attitude also plays a significant role in acceptance, it is necessary to arrange for training and support, so that caregivers, health care providers, and the patients become familiar with the benefits and expected outcomes of using the feature.

Toward digital transformation in healthcare: a framework for remote monitoring adoption

Purpose

Digital transformation (DT) is a priority for the healthcare sector. In many countries, it is still considered in the early stages with an underestimation of its benefits and potentiality. Especially in Italy, little is known about the impact of digitalization – particularly of the Internet of Things (IoT) – on the healthcare sector, for example, in terms of clinician's jobs and patient's experience. Drawing from such premises, the paper aims to focus on an overlooked healthcare area related to the chronic heart diseases field and its relationship with DT. The authors aim at exploring and framing the main variables of remote Monitoring (RM) adoption as a specific archetype of healthcare digitalization, both on patients and medical staff level, by shedding some lights on its overall implementation.

Design/methodology/approach

The authors empirically inquiry the RM adoption within the context of the Cardiology Department of the Casilino General Hospital of Rome. To answer our research question, the authors reconstruct the salient information by using induction-type reasoning, direct observation and interviewees with 12 key informants, as well as secondary sources analysis related to the hospital (internal documentation, presentations and technical reports).

Findings

According to a socio-technical framework, the authors build a model composed of five main variables related to medical staff and patients. The authors classify such variables into an input-process-output (I-P-O) model. RM adoption driver represents the input; cultural digital divide, structure flexibility and reaction to change serve the process and finally, RM outcome stands for the output. All these factors, interacting together, contribute to understanding the RM adoption process for chronic disease management.

Research limitations/implications

The authors' research presents two main limitations. The first one is related to using a qualitative method, which is less reliable in terms of replication and the interpretive role of researchers. The second limitation, connected to the first one, is related to the study's scale level, which focuses on a mono-centric consistent level of analysis.

Practical implications

The paper offers a clear understanding of the RM attributes and a comprehensive view for improving the overall quality management of chronic diseases by suggesting that clinicians carefully evaluate both hard and soft variables when undertaking RM adoption decisions.

Social implications

RM technologies could impact on society both in ordinary situations, by preventing patient mobility issues and transport costs, and in extraordinary times (such as a pandemic), where telemedicine contributes to supporting hospitals in swapping in-person visits with remote controls, in order to minimize the risk of coronavirus disease (COVID-19) contagion or the spread of the virus.

Originality/value

The study enriches the knowledge and understanding of RM adoption within the healthcare sector. From a theoretical perspective, the authors contribute to the healthcare DT adoption debate by focusing on the main variables contributing to the DT process by considering both medical staff and patient's role. From a managerial perspective, the authors highlight the main issues for RM of chronic disease management to enable the transition toward its adoption. Such issues range from the need for awareness of the medical staff about RM advantages to the need for adapting the organizational structure and the training and education process of the patients.

Perceptions of Patients and Physicians on Teleconsultation at Home for Diabetes Mellitus: Survey Study

Background

Diabetes mellitus (DM) is one of the most challenging diseases in the 21st century and is the sixth leading cause of death. Telemedicine has increasingly been implemented in the care of patients with DM. Although teleconsultations at home have shown to be more effective for inducing HbA_1c reduction than other telemedicine options, before the 2019 coronavirus disease crisis, their use had been lagging behind. Studies on physicians’ or patients’ perceptions about telemedicine have been performed independently of each other, and very few have focused on teleconsultations. In a time of great pressure for health systems and when an important portion of health care has to be assured at a distance, obtaining insights about teleconsultations at home from the stakeholders directly involved in the health care interaction is particularly important.

Objective

The perceptions of patients and physicians about their intentions to use home synchronous teleconsultations for DM care are examined to identify drivers and barriers inherent to programs that involve home teleconsultations.

Methods

Two identical questionnaires integrating the technology acceptance model and the unified theory of acceptance and use of technology and assessing the confidence in information and communication technology use of patients and physicians were developed. Responses by patients (n=75) and physicians (n=68) were analyzed using canonical correlation analysis.

Results

Associations between predictor constructs (performance, effort, social influence, facilitating conditions, and attitude) and intention to use yielded significant functions, with a canonical R² of 0.95 (for physicians) and 0.98 (patients). The main identified barriers to patient intention to use were the expected effort to explain the medical problem, and privacy and confidentiality issues. The major drivers were the facilitation of contact with the physician, which is beneficial to patient disease management and treatment, time savings, and reciprocity concerning physicians’ willingness to perform teleconsultations. Responses from physicians revealed an association between intention to use and the expected performance of home teleconsultations. The major barrier to intention to use expressed in physicians’ answers was doubts concerning the quality of patient examination. The major drivers were time savings, productivity increases, improvements in patient’s health and patient management, National Health System costs reduction, and reciprocity relative to patients’ willingness to engage in teleconsultations.

Conclusions

To promote the use of home teleconsultations for DM, decision makers should improve patients’ health literacy so the physician–patient communication is more effective; explore information and communication technology developments to reduce current limitations of non–face-to-face examinations; ensure patient privacy and data confidentiality; and demonstrate the capabilities of home teleconsultations to physicians.

Stakeholders' Perceptions of the Implementation of a Patient-Centric Digital Health Application for Primary Healthcare in India

OBJECTIVES

Health systems are shifting from traditional methods of healthcare delivery to delivery using digital applications. This change was introduced at a primary care centre in Chandigarh, India that served a marginalised population. After establishing the digital health system, we explored stakeholders' perceptions regarding its implementation.

METHODS

Ethnographic methods were used to explore stakeholders' perceptions regarding the implementation of the Integrated Health Information System for Primary Health Care (IHIS4PHC), which was developed as a patient-centric digital health application. Data were collected using focus group discussions and in-depth interviews. Participatory observations were made of day-to-day activities including outpatient visits, outreach field visits, and methods of health practice. The collected information was analysed using thematic coding.

RESULTS

Healthcare workers highlighted that working with the digital health system was initially arduous, but they later realised its usefulness, as the digital system made it easier to search records and generate reports, rapidly providing evidence to make decisions. Auxiliary nurse midwives reported that recording information on computers saved time when generating reports; however, systematic and mandatory data entry made recording tedious. Staff were apprehensive about the use of computer-based data for monitoring their work performance. Patients appreciated that their previous records were now available on the computer for easy retrieval.

CONCLUSIONS

The usefulness of the digital health application was appreciated by various primary healthcare stakeholders. Barriers persisted due to perceived needs for flexibility in delivering healthcare services, and apprehensions continued because of increased transparency, accountability, and dependence on computers and digital technicians.

The Acceptance and Use of the e-Health Instrument 'The Personal Health Check' in Four Dutch Municipalities: Lessons Learned

This pilot study assessed the acceptance and use of the e-Health instrument “the Personal Health Check” (PHC) among clients and professionals in primary care settings. By filling in the online PHC instrument, participants were provided insights into their health and lifestyle. When results revealed an increased health risk, participants were advised to undertake additional lab tests measuring blood pressure and haemaglobin levels. Based on the online questionnaire and optional lab tests, participants then received a report that included individually-tailored feedback from the e-Health application about personal health risks and suggestions for health interventions. The PHC was implemented in 2016 in four Dutch municipalities that determined which neighbourhood(s) the PHC targeted and how participants were invited. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework to address our research questions. Methods used to assess acceptance were: PHC instrument data, data from additional questionnaires completed by PHC participants, focus groups with PHC participants and professionals in primary care, and telephone interviews with non-responders to the invitation to participate in the online PHC. Of the 21,735 invited, 12% participated. Our results showed that participants and professionals in this pilot were predominantly positive about the PHC. Participants reported that they made an effort to apply the PHC lifestyle advice they received. Almost all had the knowledge and resources needed to use the PHC online instrument. Invitations from general practitioners almost doubled participation relative to invitations from the sponsoring municipalities. The overall low response rate, however, suggests that the PHC is unsuitable as a foundation on which to develop local public health policy.

Health Care Providers' Acceptance of a Personal Health Record: Cross-sectional Study

BACKGROUND

Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs' acceptance of PHRs in the Kingdom of Saudi Arabia.

OBJECTIVE

The aim of this study was to identify predictors of HCPs' acceptance of PHRs using behavioral intention to recommend as a proxy for adoption.

METHODS

This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling.

RESULTS

Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy (β=.17, P=.03) and attitude (β=.61, P<.01). No moderating effects were present.

CONCLUSIONS

This study identified performance expectancy and attitude as predictors of HCPs' behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors.

Barriers to the Adoption of Electronic Medical Record System in Ethiopia: A Systematic Review

Background

Electronic medical records (EMRs) can improve the quality of health care and patient safety. Various countries have gone through the local application of EMRs to various health care organizations in national implementation and integration of EMRs. Ethiopia lags far in the back in this regard, as solely some hospitals have implemented EMR.

Objective

This study aimed to identify barriers to the adoption of EMRs in Ethiopia through a systematic review of the literature.

Methods

PubMed, Semantic Scholar, and Google Scholar have been searched for applicable articles. The search method focuses on peer-reviewed, empirical research conducted in Ethiopia. The ultimate set that met the inclusion standards was 9 studies. The authors extracted, analyzed, and summarized empirical results associated with EMR barriers in these studies.

Results

This systematic review identified the following 17 barriers to EMR adoption: absence of EMR training, limited access to computers, insufficient computer literacy, deficiency of EMR knowledge, inadequate technical help, absence of EMR manual, negative attitude to EMR, limited internet access, lack of management support, electric power interruption, absence of perceived system quality, absence of perceived information quality, lack of willingness, the complexity of the system, performance expectancy, effort expectancy, and lack of IT qualification.

Conclusion

The most common barriers for EMR adoption are absence of EMR training, limited access to a computer, poor computer literacy, poor EMR knowledge, lack of technical support, and absence of an EMR manual. As this study summarizes the available evidence regarding barriers to adopting EMR in Ethiopia, future research will rest on this evidence and specialize in building a proper framework for EMR implementation in Ethiopia.

Mapping eHealth Education: Review of eHealth Content in Health and Medical Degrees at a Metropolitan Tertiary Institute in Australia

BACKGROUND

With the increasing use of digital technology in society, there is a greater need for health professionals to engage in eHealth-enabled clinical practice. For this, higher education institutions need to suitably prepare graduates of health professional degrees with the capabilities required to practice in eHealth contexts.

OBJECTIVE

This study aims to understand how eHealth is taught at a major Australian university and the challenges and suggestions for integrating eHealth into allied health, nursing, and medical university curricula.

METHODS

Cross-disciplinary subject unit outlines (N=77) were reviewed for eHealth-related content, and interviews and focus groups were conducted with the corresponding subject unit coordinators (n=26). Content analysis was used to identify themes around challenges and opportunities for embedding eHealth in teaching.

RESULTS

There was no evidence of a standardized approach to eHealth teaching across any of the health degrees at the university. Where eHealth content existed, it tended to focus on clinical applications rather than systems and policies, data analysis and knowledge creation, or system and technology implementation. Despite identifying numerous challenges to embedding eHealth in their subjects, unit coordinators expressed enthusiasm for eHealth teaching and were keen to adjust content and learning activities.

CONCLUSIONS

Explicit strategies are required to address how eHealth capabilities can be embedded across clinical health degrees. Unit coordinators require support, including access to relevant information, teaching resources, and curriculum mapping, which clearly articulates eHealth capabilities for students across their degrees. Degree-wide conversations and collaboration are required between professional bodes, clinical practice, and universities to overcome the practical and perceived challenges of integrating eHealth in health curricula.

Implementation for Sustained Impact in Teleophthalmology (I-SITE): applying the NIATx Model for tailored implementation of diabetic retinopathy screening in primary care

Background

Teleophthalmology provides evidence-based, telehealth diabetic retinopathy screening that is underused even when readily available in primary care clinics. There is an urgent need to increase teleophthalmology use in the US primary care clinics. In this study, we describe the development of a tailored teleophthalmology implementation program and report outcomes related to primary care provider (PCP) adoption.

Methods

We applied the 5 principles and 10 steps of the NIATx healthcare process improvement model to develop and test I-SITE (Implementation for Sustained Impact in Teleophthalmology) in a rural, the US multi-payer health system. This implementation program allows patients and clinical stakeholders to systematically tailor teleophthalmology implementation to their local context. We aligned I-SITE components and implementation strategies to an updated ERIC (Expert Recommendations for Implementing Change) framework. We compared teleophthalmology adoption between PCPs who did or did not participate in various components of I-SITE. We surveyed PCPs and clinical staff to identify the strategies they believed to have the highest impact on teleophthalmology use.

Results

To test I-SITE, we initiated a year-long series of 14 meetings with clinical stakeholders (n=22) and met quarterly with patient stakeholders (n=9) in 2017. Clinical and patient stakeholder groups had 90.9% and 88.9% participant retention at 1 year, respectively. The increase in teleophthalmology use was greater among PCPs participating in the I-SITE implementation team than among other PCPs (p < 0.006). The proportion of all PCPs who used the implementation strategy of electing diabetic eye screening for their annual performance-based financial incentive increased from 0% (n=0) at baseline to 56% (n=14) following I-SITE implementation (p = 0.004). PCPs and clinical staff reported the following implementation strategies as having the highest impact on teleophthalmology use: reminders to ask patients about diabetic eye screening during clinic visits, improving electronic health record (EHR) documentation, and patient outreach.

Conclusions

We applied the NIATx Model to develop and test a teleophthalmology implementation program for tailored integration into primary care clinics. The NIATx Model provides a systematic approach to engaging key stakeholders for tailoring implementation of evidence-based telehealth interventions into their local context.

Physicians' Use of the Computerized Physician Order Entry System for Medication Prescribing: Systematic Review

BACKGROUND

Computerized physician order entry (CPOE) systems in health care settings have many benefits for prescribing medication, such as improved quality of patient care and patient safety. However, to achieve their full potential, the factors influencing the usage of CPOE systems by physicians must be identified and understood.

OBJECTIVE

The aim of this study is to identify the factors influencing the usage of CPOE systems by physicians for medication prescribing in their clinical practice.

METHODS

We conducted a systematic search of the literature on this topic using four databases: PubMed, CINAHL, Ovid MEDLINE, and Embase. Searches were performed from September 2019 to December 2019. The retrieved papers were screened by examining the titles and abstracts of relevant studies; two reviewers screened the full text of potentially relevant papers for inclusion in the review. Qualitative, quantitative, and mixed methods studies with the aim of conducting assessments or investigations of factors influencing the use of CPOE for medication prescribing among physicians were included. The identified factors were grouped based on constructs from two models: the unified theory of acceptance and use of technology model and the Delone and McLean Information System Success Model. We used the Mixed Method Appraisal Tool to assess the quality of the included studies and narrative synthesis to report the results.

RESULTS

A total of 11 articles were included in the review, and 37 factors related to the usage of CPOE systems were identified as the factors influencing how physicians used CPOE for medication prescribing. These factors represented three main themes: individual, technological, and organizational.

CONCLUSIONS

This study identified the common factors that influenced the usage of CPOE systems by physicians for medication prescribing regardless of the type of setting or the duration of the use of a system by participants. Our findings can be used to inform implementation and support the usage of the CPOE system by physicians.

Willingness to Use Digital Health Tools in Patient Care Among Health Care Professionals and Students at a University Hospital in Saudi Arabia: Quantitative Cross-sectional Survey

BACKGROUND

The adoption rate of digital health in the health care sector is low in many countries. A facilitating factor for successful implementation and adoption of digital health is acceptance by current and future health care professionals.

OBJECTIVE

This study was conducted to identify factors associated with willingness to use digital health tools in patient care among health care professionals and students.

METHODS

This was a quantitative cross-sectional survey study conducted among health care professionals and students at a university hospital in Riyadh, Saudi Arabia. A nonprobability convenience sampling procedure was used to recruit participants. Data were collected using a self-completed e-questionnaire that was distributed by email. Chi-square tests, t tests, and logistic regression were used to analyze the data.

RESULTS

We found that 181 out of 218 health care professionals (83.0%; 75.6% [59/78] physicians; 87.1% [122/140] nurses) and 115 out of 154 students (74.7%; 80.0% [76/95] medical students and 66.1% [39/59] nursing students) were willing to use digital tools in patient care. Willingness to use digital tools was significantly associated with attitude (Adjusted Odds Ratios [AOR] 1.96; 95% CI 1.14-3.36) and self-efficacy (AOR 1.64; 95% CI 1.17-2.30) among health care professionals, and with current year of study (AOR 2.08; 95% CI 1.18-3.68) and self-efficacy (AOR 1.77; 95% CI 1.17-2.69) among students. No significant difference in willingness to use digital tools was found between physicians and nurses (P=.113), and between medical and nursing students (P=.079).

CONCLUSIONS

The findings of this study should encourage policy makers and hospital managers to implement relevant eHealth interventions within routine health care systems in Saudi Arabia. For successful implementation, digital health education programs should be implemented simultaneously, so that current and future health care professionals are able to develop required positive attitudes as well as practical skills and competencies.

Out of Control - Privacy Calculus and the Effect of Perceived Control and Moral Considerations on the Usage of IoT Healthcare Devices

People are increasingly applying Internet of Things (IoT) devices that help them improve their fitness and provide information about their state of health. Although the acceptance of healthcare devices is increasing throughout the general population, IoT gadgets are reliant on sensitive user data in order to provide full functioning and customized operation. More than in other areas of IoT, healthcare applications pose a challenge to individual privacy. In this study, we examine whether actual and perceived control of collected data affects the willingness to use an IoT healthcare device. We further measure actual behavior as a result of a risk-benefit trade-off within the framework of privacy calculus theory. Our experiment with N = 209 participants demonstrates that while actual control does not affect the willingness to use IoT in healthcare, people have a higher intention to use an IoT healthcare device when they perceive to be in control of their data. Furthermore, we found that, prior to their decision, individuals weigh perceived risks and anticipated benefits of information disclosure, which demonstrates the potential to apply the privacy calculus in the context of IoT healthcare technology. Finally, users' moral considerations of IoT in healthcare are discussed.

Factors Influencing Healthcare Professionals' Perception towards EHR/EMR Systems in Gulf Cooperation Council Countries: A Systematic Review

Electronic health and medical records are widely adopted in many healthcare settings worldwide to improve the quality of care. Users’ perception is a significant factor influencing the successful implementation and use of e-health technologies. This systematic review aimed to identify factors influencing the perceptions of healthcare professionals towards the adoption and use of electronic health and medical record systems to improve the quality of healthcare services in the countries of the Gulf Cooperation Council. We identified primary studies evaluating healthcare professionals’ perception towards electronic health records and/or electronic medical records in the Gulf region. Seven electronic databases, including Medline, CINAHL, Informit Health Collection, Science Direct, ProQuest, PubMed, and Scopus were used to search for the relevant articles published between January 2007 and December 2016. Thirteen articles met the inclusion criteria and were included in this systematic review. Both individual and system-related factors were found to positively or negatively influence healthcare providers’ perceptions towards the systems. Understanding the impact of healthcare professionals’ perception of health information technology is important for policymakers involved in the implementation programs to ensure their success. Future studies should evaluate other individual characteristics such as age, gender, and profession of the healthcare providers on their perceptions towards e-health technologies.

Understanding Medical Students' Attitudes Toward Learning eHealth: Questionnaire Study

BACKGROUND

Several publications on research into eHealth demonstrate promising results. Prior researchers indicated that the current generation of doctors is not trained to take advantage of eHealth in clinical practice. Therefore, training and education for everyone using eHealth are key factors to its successful implementation. We set out to review whether medical students feel prepared to take advantage of eHealth innovations in medicine.

OBJECTIVE

Our objective was to evaluate whether medical students desire a dedicated eHealth curriculum during their medical studies.

METHODS

A questionnaire assessing current education, the need for education about eHealth topics, and the didactical forms for teaching these topics was developed. Questionnaire items were scored on a scale from 1 (fully disagree with a topic) to 10 (fully agree with a topic). This questionnaire was distributed among 1468 medical students of Maastricht University in the Netherlands. R version 3.5.0 (The R Foundation) was used for all statistical procedures.

RESULTS

A total of 303 students out of 1468, representing a response rate of 20.64%, replied to our questionnaire. The aggregate statement "I feel prepared to take advantage of the technological developments within the medical field" was scored at a mean value of 4.8 out of 10. Mean scores regarding the need for education about eHealth topics ranged from 6.4 to 7.3. Medical students did not favor creating their own health apps or mobile apps; the mean score was 4.9 for this topic. The most popular didactical option, with a mean score 7.2, was to remotely follow a real-life patient under the supervision of a doctor.

CONCLUSIONS

To the best of our knowledge, this is the largest evaluation of students' opinions on eHealth training in a medical undergraduate curriculum. We found that medical students have positives attitudes toward incorporating eHealth into the medical curriculum.