Physicians&amp;rsquo; experience adopting the electronic transfer of care communication tool: barriers and opportunities

Grood, Chloe de; Eso, Katherine; Santana, Maria

doi:10.2147/jmdh.s72953

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…Other aspects that affect both front-line and end-user uptake include the time it takes to adopt new technology, interruption of traditional practices, lack of organization, uneasiness of use, problems integrating more technology into an already complicated technological environment, dissatisfaction with the physical constraints of the digital technology, and ineffectiveness of the technology [35]. As most health workplaces in LMICs are understaffed and already overburdened, achieving uptake of additional tasks can be difficult [36].…”

Section: User Considerationsmentioning

confidence: 99%

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Integrating mHealth at point of care in low- and middle-income settings: the system perspective

Wallis

Blessing

Dalwai

et al. 2017

Global Health Action

118

121

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While the field represents a wide spectrum of products and services, many aspects of mHealth have great promise within resource-poor settings: there is an extensive range of cheap, widely available tools which can be used at the point of care delivery. However, there are a number of conditions which need to be met if such solutions are to be adequately integrated into existing health systems; we consider these from regulatory, technological and user perspectives. We explore the need for an appropriate legislative and regulatory framework, to avoid ‘work around’ solutions, which threaten patient confidentiality (such as the extensive use of instant messaging services to deliver sensitive clinical information and seek diagnostic and management advice). In addition, we will look at other confidentiality issues such as the need for applications to remove identifiable information (such as photos) from users’ devices. Integration is dependent upon multiple technological factors, and we illustrate these using examples such as products made available specifically for adoption in low- and middle-income countries. Issues such as usability of the application, signal loss, data volume utilization, need to enter passwords, and the availability of automated or in-app context-relevant clinical advice will be discussed. From a user perspective, there are three groups to consider: experts, front-line clinicians, and patients. Each will accept, to different degrees, the use of technology in care – often with cultural or regional variation – and this is central to integration and uptake. For clinicians, ease of integration into daily work flow is critical, as are familiarity and acceptability of other technology in the workplace. Front-line staff tend to work in areas with more challenges around cell phone signal coverage and data availability than ‘back-end’ experts, and the effect of this is discussed.

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Section: User Considerationsmentioning

confidence: 99%

“…Older people tend to have a more difficult time adapting, driven by anxiety around new technology as well as decreased computer experience [35,42]. Both anxiety around, and lack of experience with, technology are negatively correlated with end-user uptake [42].…”

Section: User Considerationsmentioning

confidence: 99%

Integrating mHealth at point of care in low- and middle-income settings: the system perspective

Wallis

Blessing

Dalwai

et al. 2017

Global Health Action

118

121

View full text Add to dashboard Cite

show abstract

“…For instance, recent studies developed and implemented an e-health communication tool to transfer patient summary of stay in hospital from acute to community-based physicians, assessing the experiences of both group of physicians. 9 , 10 This study revealed that although the e-health communication tool was well received, the adoption of the new technology was very slow. 10 …”

Section: Introductionmentioning

confidence: 95%

“… 9 , 10 This study revealed that although the e-health communication tool was well received, the adoption of the new technology was very slow. 10 …”

Section: Introductionmentioning

confidence: 95%

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

Grood

Raissi

Kwon

et al. 2016

JMDH

Self Cite

114

111

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ObjectiveThe goal of this scoping review was to summarize the current literature identifying barriers and opportunities that facilitate adoption of e-health technology by physicians.DesignScoping review.SettingMEDLINE, EMBASE, and PsycINFO databases as provided by Ovid were searched from their inception to July 2015. Studies captured by the search strategy were screened by two reviewers and included if the focus was on barriers and facilitators of e-health technology adoption by physicians.ResultsFull-text screening yielded 74 studies to be included in the scoping review. Within those studies, eleven themes were identified, including cost and liability issues, unwillingness to use e-health technology, and training and support.ConclusionCost and liability issues, unwillingness to use e-health technology, and training and support were the most frequently mentioned barriers and facilitators to the adoption of e-health technology. Government-level payment incentives and privacy laws to protect health information may be the key to overcome cost and liability issues. The adoption of e-health technology may be facilitated by tailoring to the individual physician’s knowledge of the e-health technology and the use of follow-up sessions for physicians and on-site experts to support their use of the e-health technology. To ensure the effective uptake of e-health technologies, physician perspectives need to be considered in creating an environment that enables the adoption of e-health strategies.

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“…15 In addition, in a cohort study of acute and community care physicians completed alongside this RCT, acute care physicians preferred eDCT over traditional dictation and discharge methods. 16 Acknowledging this user preference may further increase provider satisfaction. Thus, when a framework such as the quadruple aim is adopted, eDCT may be viewed as an important step towards healthcare system improvement in 3 of the 4 domains (cost, patient satisfaction and provide satisfaction).…”

Section: Discussionmentioning

confidence: 99%

Prospective economic evaluation of an electronic discharge communication tool: analysis of a randomised controlled trial

et al. 2017

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ObjectiveTo complete an economic evaluation within a randomised controlled trial (RCT) comparing the use of an electronic discharge communication tool (eDCT) compared with usual care.SettingPatients being discharged from a single tertiary care centre’s internal medicine Medical Teaching Units.ParticipantsBetween January 2012 and December 2013, 1399 patients were randomised to a discharge mechanism. Forty-five patients were excluded from the economic evaluation as they did not have data for the index hospitalisation cost; 1354 patients contributed to the economic evaluation.InterventioneDCT generated at discharge containing structured content on reason for admission, details of the hospital stay, treatments received and follow-up care required. The control group was discharged via traditional dictation methods.Primary and secondary outcome measuresThe primary economic outcome was the cost per quality-adjusted life year (QALY) gained. Secondary outcomes included the cost per death avoided and the cost per readmission avoided.ResultsThe average transcription cost was $C22.28 per patient, whereas the estimated cost of the eDCT was $C13.33 per patient. The cost per QALY gained was $C239 933 in the eDCT arm compared with usual care due to the very small gains in effectiveness and approximately $C800difference in resource utilisation costs. The bootstrap analyses resulted in eDCT being more effective and more costly in 29.2% of samples, less costly and more effective in 29.2% of samples, less effective and more costly in 23.9% of samples and finally, less costly and less effective in 17.7% of samples.ConclusionsThe eDCT reduced per patient costs of the generation of discharge summaries. The bootstrap estimates demonstrate considerable uncertainty supporting the finding of neutrality reported in the clinical component of the RCT. The immediate transcription cost savings and previously documented provider and patient satisfaction may increase the impetus for organisations to invest in such systems, provided they have a foundation of eHealth infrastructure and readiness.Trial registration number NCT01402609.

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Physicians’ experience adopting the electronic transfer of care communication tool: barriers and opportunities

Cited by 9 publications

References 13 publications

Integrating mHealth at point of care in low- and middle-income settings: the system perspective

Integrating mHealth at point of care in low- and middle-income settings: the system perspective

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

Prospective economic evaluation of an electronic discharge communication tool: analysis of a randomised controlled trial

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