Use of ICTs in Healthcare Delivery Systems

Literature identifies the growing innovation and use of ICT devices within the healthcare delivery system. However, there is a lack of exploratory qualitative research to investigate into the perspectives and experiences of patients that use ICT devices/tools for home care. Therefore, this research project suggests the qualitative method to investigate into this phenomena.

Keywords: ICT, healthcare, technology, innovation

NO CPT

The use of “information and communication technologies” (ICTs) has benefited both developed and developing countries; especially in terms of the wide use of ICTs within the healthcare system. This is known as “e-health system” and with the rapid growth of e-health systems healthcare professionals (HCPs) are able to diagnose and treat patients, immediately (Qureshi, Kundi, Qureshi, Akhtar, & Hussain, 2015). ICTs acts like an aid, which enables the hospitals, physicians, and nurses to work together either from home or the office visits and facilitates the transfer of patient data within the hospital (Salerno, 2015). Furthermore, the advancements in ICTs has resulted into a better and developed healthcare system, especially, in rural areas. The implementation of telemedicine has improved the health conditions of rural patients. Whereas the number of clinical services that provide awareness and help to rural poor patients is less. However, due to the presence of academic research centers, telemedicine awareness and comprehension exists among the people of rural areas. These research centers also play an important role and provide tele-education, within the rural areas. On the other hand, the high rate of mobile phone usage, facilitates telemedicine, which eventually benefits the clinical practices (Mars, 2013).

According to Qureshi et al (2015), the use of tele-health is rapidly increasing within the developing countries; such as mobile phones, computers, texting, video chat, and hotlines that provide immediate access to physicians. Thus, the use of ICTs has enabled an active and interactive role on behalf of patients and HCPs residing in different locations and working in different institutions and hospitals, respectively (Scholl & Olaniran, 2015). This has resulted into “the potential to save time and effort, reduce transportation costs and minimise drug stock-outs” (Nilseng et al., 2014, p. 1). Moving on, the use of ICTs in healthcare delivery system requires a number of ICT skills and professional attitude because it influences the adoption and develops a positive attitude towards e-health by HCPs (Olok, Yagos, & Ovuga, 2015). However, lack of ICT skills and motivation is considered as a barrier that hinder the effective use of e-health system by HCPs. Additionally, motivational barriers exists due to the association of high risk perceptions with social media (Dalton et al., 2014).

Furthermore, the use of ICTs has resulted to increase the knowledge of HCPs and improves patient care on all the levels of healthcare system (Nilseng et al., 2014). Moreover, with the aid of ICT tools, HCPs can support patients suffering from chronic illnesses and can guide them to achieve healthcare while staying in their homes. This shows that, the roots of ICTs are strongly embedded within the healthcare system. And it benefits the patients through providence of increased accessibility to home care. Eventually, this results in gain of control over their chronic illnesses and promotes patient’s self-care. However, there is a need for qualitative studies to understand the use of ICTs at home from the perspectives of patients and their immediate or close relatives (Lindberg, Nilsson, Zotterman, Söderberg, & Skär, 2013).

Therefore, this research project proposes to investigate qualitatively upon the use of ICTs at home through the perspectives and experiences of patients. Whereas the findings of the study will be able to describe the patient’s accessibility to home care and promotion of self-care. Eventually, these findings will help the HCPs, businesses, ICT engineers, and patients to better understand the role of ICTs to provide support and gain control over chronic diseases, respectively.

Relationship of the Topic to 699 Class

Figure 1: Taken from AEHRC (2015)

The above figure 1 represents the broader picture of the identified problem and the relevance of this project to the 699 class. The figure thoroughly describes the use of ICTs by the patients for home and self-care the HCPs mentor and keeps a track of the patients’ health. Through the use of ICTs and mobile applications. Eventually, this represents the use of ICTs in the form of an android application that enables the patients and the HCPs to keep a track of patient’s overall health that includes physical activities and on-time medications (Nilseng et al., 2014). Furthermore, the figure also represents patient’s data synchronisation, which are also one of the many benefits of ICTs (Salerno, 2015). Therefore, keeping these details in view, it can be seen that this project lies within the scope of 699 class.

Definitions of Commonly Used Terms  

• Information and Communication Technologies- it is an umbrella term and it comprises of all means of electronic communication; such as computers, mobile phones, network, hardware and software, television, satellite systems, and long distance video chatting etc. (Rouse, 2014)
• Healthcare Delivery System- a system that comprises of all the medical help and support available and delivered to the patients
• Healthcare Professionals (HCPs)- represents as list of medical professionals; such as physicians, nurses, medical practitioners, midwives, and clinicians etc.
• Chronic Illnesses- diseases that last for long time or life time, for example, high cholesterol, high blood pressure, type II diabetes etc.
• Telemedicine- patient’s diagnosis or treatment through ICT
• Tele-education- represents the use of ICT to spread education and knowledge

A large variety of ICT tools are used by HCPs and patient for home care because there is an increase accessibility of the ICT tools (Lindberg et al., 2013). According to König et al (2015), the designing of ICT tools in healthcare delivery system requires the input from patients, caregivers, clinicians, ICT engineers, and businessmen. Whereas all these work together in the form of a team. However, among this list, most important are the patient needs that is given a lot of attention and with the screening of patient needs the rest of the team (caregivers, clinicians, ICT engineers, and businessmen) co-design ICT tools through generation of ideas. Moreover, the process involves a prototype development it and the test of its easability and usage on the patients. Furthermore, patients suffering from life threatening diseases use ICT tools to overcome the different challenges, for example, the use of ICT tools has proven to facilitate Alzheimer patients, through early identification. Besides, ICT tools are cost-effective and save time therefore they are popularly used by clinicians (König et al., 2015).

Therefore, this research proposal seeks to answer; what are different perceptions and needs of patients using ICT tools at home? And in order to answer this questions, this research will adopt a qualitative explanatory research design because there is a need for qualitative studies to investigate into this phenomenon (Lindberg et al., 2013). Eventually, the findings of this study will provide better insight of the different perceptions and needs of the patients. Thus, this study comes into the domain of “applied research” as this information will be useful for the caregivers, clinicians, ICT engineers, and businessmen to co-deign better ICT tools for healthcare delivery system.

Conceptual Framework

Given below is the conceptual framework that describes the inputs and deliverables of this study:

The above conceptual framework s self-explanatory and represent the research question that is to be investigated through this research project.

A literature review conducted by Gurses & Xiao (2006), indicates the vast advancements within healthcare delivery system. They reviewed published literature from 1990 to 2005 about ICT tools, necessary information required for the design of ICT tools, effect of ICT tools, and the different measure through, which ICT tools can be evaluated. The researchers started collection of published literature through investigation from the communication within the healthcare delivery system. And then expanded their research to the communication through ICT tools between patients and HCPs. Moving on, the researchers also defines the patient-centric information tools that are used by HCPs to keep a record of the patient history; such as medication lists, nursing flow sheets, and bedside patient monitoring devices etc. Additionally, the analysis of the review involves a successful categorization of the different use of ICT tools and the researchers analysed these tools to further assess and evaluate the effect of tools on the care and satisfaction of patients.

Furthermore, the use of ICT has gone beyond just then just the treatment and diagnosis and this has been identified in another review by Blaschke, Freddolino, & Mullen (2009). The researchers investigated the literature for the role of assistive technologies (AT) and ICTs to improve the physical and mental health and delay the onset of different diseases. Whereas the investigation in this review started through the evidence collection of different technological tools that are used by older adults. Moreover, the review also investigated to learn more about the effectiveness and utility of these ICT tools, within the healthcare delivery system. Additionally, the researcher extended the literature review scope and identified the importance of social work practice within the digital age and discussed the limitations and effectiveness of ICT tools. Furthermore, in another review the extended role and effectiveness of ICT was investigated within the field of nursing education. Now-a-days, more universities train and provide e-education to HCPs through the use of ICT tools. Eventually, this improves the overall role of ICT within the healthcare delivery system. The researchers conducted this literature review through analysis of the published articles between January 2001 and December 2012. These articles mainly focused upon the use of ICT within the healthcare education. The review was concluded with future directions that, the use of ICT tools are important for lifelong learning skills within the nursing students and other HCPs. And the healthcare delivery system should incorporate e-learning through the use of ICT tools (Button, Harrington, & Belan, 2014).

Moving on, in developing countries, ICT sustainability is a concern and requires a lot of attention. This has been identified in a literature review and the researchers attempted to develop a conceptual framework for a sustainable telemedicine information systems within Middle East countries. The literature review was conducted through identification of the need of telemedicine technologies within the developing countries; such as Saudi Arabia, Jordan, Kuwait and Syria. The review further identifies the different issues and barriers that does not support telemedicine information systems; such as lack of funding, IT trainings, doctors and patients resistance, less knowledge and education, and poor technological infrastructure. The reviews concluded with the importance and the need of telemedicine information systems to promote healthcare delivery systems. The review was able to identify the common barriers that hinder the growth of ICT in developing countries. Additionally, the researchers also commented that, education and awareness are essential to promote the use of ICT in healthcare delivery systems (Jaber, Ghani, & Herman, 2014).

On the other hand, there a lot of risks, challenges, and potential harm associated with the use of telemedicine (telecare or telehealth) at home. This has been identified in literature review that was conducted from 6 different electronic databases. The literature review began with the initial focus on the patient safety issues that is associated with the potential risk of telemedicine home care. Moreover, the literature investigated into the different harm that telemedicine can cause to patients at home and was unable to identify any specific trainings that are provided to patient to identify patient safety issues. With the help of the systematic literature review, the researchers were able to identify the associated risk factors in the use of telemedicine at home and how these risk factors are highlighted within the patient’s telecare training. The paper concludes that, ICT tools should identify the different patient safety risks and reframe the different challenges that patients can suffer due to the implementation of ICT tools within the healthcare delivery system (Guise, Anderson, & Wiig, 2014).

According to Dalton et al (2014), HCPs also suffer from different challenges during the implementation of different ICT tools. For instance, in case of midwives the different barriers that exists are; “material access, skills access, usage access and motivational access” (p. 168). Similarly, in another systematic review, the researcher investigated the different factors that affect the adoption of e-health applications by HCPs. The review covered published articles from 4 databases published from the period of 2000 to 2014. The researchers began their investigation from the different perceptions of HCPs regarding the barriers and facilitators that occur during the use of ICT tools. The literature showed that, out of 4223 papers only 33 met identified the different barriers at individual, organizational, and contextual levels. Whereas the different factors that affect the use of ICT tools by HCPs are given as; “perceived usefulness and ease of use, design and technical concerns, cost, time, privacy and security issues, familiarity with the technology, risk-benefit assessment, and interaction with others (colleagues, patients, and management)” (Gagnon, Ngangue, Payne-Gagnon, & Desmartis, 2015, p. 1).

Focus of the Current Research

Based on the above literature review, it can be analysed that less information and published peer-reviewed and scholarly articles available on this problem statement, due to the exploratory nature of the identified gap. Therefore, it is essential to expand the lens and focus of the search of the published articles throughout the different time periods to attain support from the literature. Moreover, it is important to search for different words that are used interchangeably for ICT tools; such as digital technologies, digital interventions, innovative technologies, and any name of device that helps patients with home care.

Given below is literature review that has been attained through the increase of the scope of research to the use of ICT on different levels; such as different age groups and illnesses.

A meta-analysis conducted by McLean et al (2016), on the use of digital technologies (ICT) by the asthma patients. The scope of the search was limited to patients aged 16 years or older. The use of different digital interventions and care with the use of comparator was observed. Whereas the outcomes indicated that the use of self-management digital technologies is cost-effective and improves asthma patient’s well-being and quality of life. Khosravi & Ghapanchi (2016) also contributed and added that, the use of innovative technologies is cost-effective. However, less research is available to support the use and acceptance of innovative technologies in daily life by seniors. Therefore, in this review, the researchers collected information from different databases and investigated into the studies that looked into the assistive and innovative technologies in geriatric care (old age care). Moreover, the paper also enlists the different assistive technologies; such as “general ICT, robotics, telemedicine, sensor technology, medication management applications, and video games” (p. 17). Besides, the paper depicted that, a positive relationship exists between the use of assistive technologies and improved quality life in geriatric care.

Moving on, ICT project not always attain success within the field of healthcare delivery systems. Therefore, it is important that businesses should implement a patient-centric modelling approach to better understand the challenges and changes within the healthcare delivery system. Keeping these issues in view, a review was conducted to check the implementation of ‘circle of caring model (CCM) in three different case studies. And it revealed that with the help of CCM and application of patient-centric approach, ICT engineers and businesses are able to identify the gaps and improve the implementation of ICT. Furthermore, it is also suggested that, intervention of different approaches are also necessary along with the updated technology (Price, 2016). Eventually, this explains the necessity of the different components mentioned above in the conceptual framework.

Furthermore, due to the increased life expectancy in western countries, there is an increased pressure on the community services, that is, caregivers. This has increased in the demand of technological advancements and innovations for home care older people in the form of ‘personal emergency response system’ (PERS). The perceptions about the use of PERS was further investigated in a literature review and the review explored the different experiences of older people across different studies. The results showed that, the caring practices evolved across studies as the technology emerged and the older people played active roles. Besides, the literature also identified that telemedicine requires different abilities, resources, and attitudes for enhanced technological innovations. On the other hand, ICT also requires actors, networks, and contexts (Stokke, 2016). Regardless, of all the updated and innovative technologies, there is still a need for the society to get aware and educated about the self-care patients can achieve from ICT devices. A review conducted upon the received e-health education indicated positive changes towards the attitudes of patients and resulted in decreased barriers, towards the use of ICT devices (Nwolise, Carey, & Shawe, 2016). Another review conducted by Calvillo, Román, & Roa (2013), identified that the use of technology within healthcare delivery system has increased “patient empowerment” (PE). However, it is necessary that “health literacy of patients, remote access to health services, and self-care mechanisms” (p. 643) should be given more value because without these it is difficult to accomplish PE. Regardless of the updated technology, there is still a need to change the attitudes of patients, professionals, policy makers etc. (Calvillo, Román, & Roa, 2013).

Therefore, it can be argued that the identified problem or research question is not investigated throughout the different time periods. It is depicted from the literature that, patient’s perceptions and experiences are assumed to be good due to the innovative technologies. However, no evidence exists in the literature. On the other hand, patient self-care management has been given a lot of importance for the effective implementation and use of ICT devices. Whereas patient self-care is also an integral part to accomplish patient empowerment. Other than this, stakeholders; such as businesses, HCPs, and ICT engineers needs to know the different perceptions and experiences of patient with the home self-care ICT devices. Thus, this need will be investigated through the future proposed exploratory research.

A research paradigm or philosophy is a guideline that helps a researcher throughout the investigation because it is a framework that consists of assumptions and knowledge of nature. The two of paradigms that are mostly used by researchers are interpretivism and positivism (Collis & Hussey, 2009). Therefore, in this research the primary focus is on interpretivism.

Interpretivism- In the philosophy of interpretivism, a researcher plays an important role and acts like an investigator and a social actor. The researcher investigates a real situation and interprets it with the help of analysis of people’s thoughts and existing literature. Interpretivism involves investigation on behalf of researcher and is usually related to qualitative research (Saunders, Lewis, & Thornhill, 2009). Moreover, this philosophy utilizes small sample sizes and results in the development of theories, texts, models, and useable information (data). Whereas the research findings are used to shape theories (Collis & Hussey, 2009). According to Easterby-Smith, Thorpe, & Lowe (2002), reality is non-subjective, therefore, after collection of data, different meanings can be interpreted. Furthermore, data collection is easier through the help of interpretivism approach and no additional focus is on writing style. Additionally, the findings of this approach is safe from researchers and participants/respondents biasness (Lee & Lings 2008). Therefore, keeping these facts in view, it is better to implement this paradigm to investigate fully into the research question.

Research Approach

Research refers to the systematic investigation and collection of information, which is further interpreted through different methods (Saunders et al., 2009). Whereas research approach explains the different means through, which information is collected and further analysed. Moreover, research approach is based on different philosophical and theoretical assumptions (Collis & Hussey 2013). According to Saunders et al (2009), inductive (qualitative) and deductive (quantitative) approaches are the two broad research approaches that are adopted by a researcher. However, a researcher can either pick of these two or can implement both together in the form of mix methodology. Besides, the requirements of the research decides the kind of approach that has to be adopted.

Inductive approach– Inductive approach is defined as, “a theory building process, starting with observations of specific instances, and seeking to establish generalisations about the phenomenon under investigation” (Hyde, 2000, p. 83). Furthermore, a research can investigate an identified gap and get to a conclusion with the help of inductive approach. And this further helps the researcher to collect the responses of respondents and generate theories (Collins & Hussey 2009). Besides, the sequence of investigation in inductive approach follows a pattern of information from general observation to development of information patterns and these patterns are further refined into tentative information, which are later derived into theories. Because inductive reasoning is open-ended and exploratory (Trochim 2005). Therefore, based on this information, this research project will follow an inductive approach and will be qualitative in nature. Whereas no hypothesis will be tested, instead, the results and conclusion of the study will result into a new hypothesis (theory generation), which is a characteristic of qualitative study.

Data Collection Method

This research project will follow semi-structured interview to investigate into the research question. With the help of semi-structured interviews patients perceptions, behaviours, and understandings of the ICT tools can be easily investigated. According to Matthews & Ross (2010) the qualities of semi-structured interview will allow the researcher to follow a set of common questions and ask new questions during the interview. Moreover, the quality of semi-structured interview will also enable the patients to answer the questions upon their individual comprehension. Additionally, with semi-structured interviews the researcher can also observe and investigate into the attitudes, expressions, and body language of the patients.

Furthermore, this study will conduct one-to-one interviews because Zikmund (2013) stated that, it will make the interviewee (patients) feel comfortable and they will be able to answer questions with honesty. Additionally, “under the interpretive paradigm, interviews are concerned with exploring ‘ data on understandings, opinions, what people remember doing, attitudes, feelings and the like, that people have in common’ and will be unstructured” (Collins & Hussey 2009, p. 144). Therefore, this research study lies under the umbrella of descriptive exploratory research and it will follow an interpretivist approach to analyse the semi-structured interviews.

Target Population

This research study will select patients of any age group that use ICT tools provided by HCPs at the hospitals for home care and this will be done with the help of non-probability purposive technique because this sampling technique is suggested with the conduction of semi-structured interviews by Matthews & Ross (2010). Furthermore, based upon the convenience of the researcher, the research will also follow non-probability convenience sampling and data will be collected from patients of Bryn Mawr Hospital and Chester County Hospital, Pennsylvania. Additionally, the patients using the ICT tools at home will be selected purposively either at the hospitals or at their home. According to Matthews & Ross, the number of interview participants is dependent upon the “saturation of data”, that is, a researcher needs to conduct interviews until the data repeats. Therefore, the sample size of this research project will follow the rule of “data saturation”.

Designing of Interview Questions- In this study, the interview questions were designed with the help of identified gaps from the literature review and from the developed conceptual framework. The procedure involved, identification of themes from literature review, which were further divided into dimensions and then into sub-dimensions (Collins & Hussey 2009). Lastly, from these sub-dimensions, interview questions are developed. Whereas the researcher also developed new questions during interview process because of the quality of semi-structure interviews (Collins & Hussey 2009).

Data Analysis Method

In qualitative research, the research plays an important role and acts like a primary tool for data analysis of raw social data. Moreover, the researcher stays involved in the whole process of data interpretation. Whereas with the help of memos and personal comprehension the researcher interprets the data and develop new themes. This process is known as “Thematic Analysis” (Matthews & Ross, 2010).

Thematic Analysis- It is defined as, “a process of working with raw data to identify and interpret key ideas or themes, as a process of segmentation, categorization, and relinking of aspects of data prior to final interpretation” (Matthews & Ross 2010, p. 373). In this process, the researcher plays the primary role and looks for repetitive information, words, or meanings across different interviews. Eventually, this results in the interpretation and identification of social data and themes, which is further used to develop a thematic analysis map. Moreover, the identified themes are either represented in the tabular or in the graphical form (Matthews and Ross 2010). Therefore, this study will use the process of thematic analysis to interpret the social data.

Validity

According to Creswell (2013), there are two different method to increase the validity; such as the use of rich data and interviewee validation. With the use of these methods, researcher’s biasness and reactivity can be reduced. Moreover, systematic literature review investigation will increase the validity of the raw social data. And with the use of respondent validation, researcher’s biasness can be reduced. Eventually, with the implementation of these two will increase the validity and quality of this research paper.

Given below is the propose work plan to implement the research project

This research proposal identifies the need for exploratory qualitative study to investigate into the perspective and experiences of patients upon the use of ICT devices for home care. Whereas this objective will be achieved through semi-structured interviews with the patients selected through researcher’s non-probability purposive sampling and convenience sampling methods. Moreover, the findings of this study will provide support to HCPs, businesses, ICT engineers, and patients.

References

AEHRC. (2015). Smarter safer homes platform. Retrieved January 14, 2017, from The Australian E-Health Research Center, https://aehrc.com/research/projects/smarter-safer-homes-platform/

Blaschke, C. M., Freddolino, P. P., & Mullen, E. E. (2009). Ageing and technology: A review of the research literature. The British Journal of Social Work, 39(4), 641-656. doi:10.1093/bjsw/bcp025

Button, D., Harrington, A., & Belan, I. (2014). E-learning & information communication technology (ICT) in nursing education: A review of the literature. Nurse Education Today, 34(10), 1311-1323. doi:10.1016/j.nedt.2013.05.002

Calvillo, J., Román, I., & Roa, L. M. (2013). How technology is empowering patients? A literature review. Health Expectations, 18(5), 643-652. doi:10.1111/hex.12089

Collis, J. and Hussey, R. (2013). Business research: A practical guide for undergraduate and postgraduate students. Palgrave Macmillan.

Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.

Dalton, J. A., Rodger, D. L., Wilmore, M., Skuse, A. J., Humphreys, S., Flabouris, M., & Clifton, V. L. (2014). “Who’s a