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Technology Adoption In Healthcare: It’s More Than The Technical Features

Despite the constant development of healthcare technologies, many challenges still persist, usually ones that go beyond the technology itself to involve other contextual factors.

A study “Understanding Clinicians’ Adoption of Mobile Health Tools: A Qualitative Review of the Most Used Frameworks” published in JMIR mHealth and uHealth proposes an aggregated technology acceptance framework that complements the gaps in existing ones and informs on the elements to look for in order to better foster mHealth adoption. Summary: • Although there is a push toward encouraging technology adoption in healthcare, many challenges persist. • Researchers have been using a multitude of frameworks to help them get a better understanding of user acceptance and adoption in healthcare. • This study looked into the frameworks used to analyze mHealth adoption in 50 peer-reviewed articles published over the last ten years to identify potential gaps and complement them. Existing models often offered oversimplified methods that overlook the fact that healthcare technologies are usually more complex than tools that address a single specific user need. The findings suggest an extended framework that takes into account the complexity of the healthcare ecosystem, its highly regulated nature, and interdependencies

User resistance Understanding user adoption of technology is a complex process. Research has shown that a new tool’s acceptance is not only influenced by its technical features and reliability but also encompasses other contextual factors such as social and organizational elements that affect the users’ unique views and their decisions. This explains why, despite the constant development of healthcare technologies, many challenges still persist. Research has shown that there are situations where users, mainly clinicians, resist mHealth tools. This is particularly relevant, bearing in mind studies, both in developed and developing countries, that showed that clinicians’ adoption is the most influential factor for a successful implementation of new health technologies.

Taking the complexity of healthcare organizations into account Given the slow adoption of new healthcare technologies, researchers have been using a multitude of frameworks to help them get a better understanding of user acceptance and adoption of these new tools. The study looked into the frameworks used to analyze mHealth adoption in 50 peer-reviewed articles published over the last ten years to identify potential gaps and complement them. The researchers found that many commonly used frameworks offer an over

» Healthcare technologies are generally more complex than tools that address one specific user need. «

simplified view of factors that need to be looked at in much more detail. This could be due to the fact that the majority of these frameworks were not developed within a healthcare context, and thus overlook its organizational and regulatory complexity. It’s important to remember that healthcare technologies are generally more complex than tools that address one specific user need. They typically serve patients with comorbidities that are mostly

r e k l a m a treated by multidisciplinary teams of clinicians, potentially working across more than one organization. This particular nature of the healthcare sector calls for some expansions to the existing technology adoption frameworks since healthcare technology cannot be successfully implemented in isolation from the broader context in which it is being used.

Looking beyond technology The study concludes that in order to account for all relevant adoption factors fully, it is crucial to expand our focus beyond the technology itself to address clinicians’ differing concerns. These include stringent healthcare policies and regulations, data privacy and security issues, existing workload and shortage of resources, the tool’s fit into clinical practice and workflow, training and education, and leadership support. “Our aggregated framework suggests a shift toward a more holistic view of technology acceptance in healthcare, one that does not only look into a tool’s technical features, but also takes into account the specificity of the healthcare ecosystem, and the interdependence between the technical, social and organizational factors,” says digital strategist Christine Jacob, the first author of the study, health tech researcher at Anglia Ruskin University, Cambridge, and external lecturer at the university of applied sciences Northwestern Switzerland. 

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Understanding The Transformation

In discussions on the digital transformation of healthcare, the emphasis is usually put on digitization. The context of transformation is neglected. In reality, it is not about the implementation of IT systems in hospitals or e-health solutions such as e-prescription, but a profound reformation of the current model of healthcare, also in areas that seemingly have little to do with digitization.

Health in a schematic framework If everything worked well in healthcare, there would be no need for major changes. But it does not. Health systems around the world are in deep crisis. Expenditures are rising due to an aging population and an increasing burden of chronic non-infectious diseases such as diabetes, cardiovascular diseases and mental illnesses. The requirements and expectations of patients are also growing, as are inequalities in access to health services. There is a shortage of doctors and nurses in almost every corner of the world. These are not just data and statistics, but facts leading to human suffering and deaths that could be prevented if an efficient and effective health system was built. Such a wide set of problems requires radical action. Small modifications, larger financial outlays, more effective medicines and more modern medical technologies are no longer enough. We need to transform the organization of health care, the way doctors work, the role of the patient as well as planning and implementing health policy. A chance for a new opening in healthcare has appeared quite recently, along with computerization, development of artificial intelligence systems, robotics and the Internet. We are talking about the fourth technological revolution that has changed the way we live, communicate and participate in society. And the most significant acceleration came with the advent of smartphones – miniature computers at hand. For medicine, this discovery may not be as unequivocally reflected in treatment effects as the invention of antibiotics, but it gives us tools of unimaginable potential.

It is not technology, but possibilities The whole health care journey through

digitization started with a simple concept: replacing paper records with their digital form. The aim was to facilitate the work of doctors, streamline internal administrative processes in health care facilities, and make it easier to account for the costs of medical services. The first IT systems for hospitals were created based on the functionality focused on these priorities. Along with this, we could see rapid development of IT companies focused on the development of software for health care. It was not until the popularization of access to the Internet, personal computers and then smartphones that the digitalization of health care began to leave the four walls of hospitals. Completely new possibilities such as telemedicine and remote medical consultations have emerged. They gave rise to the assumption of modern healthcare in the era of digitization. The terminology has also evolved – today we are talking about ‘digital health’, and less often about ‘ehealth’. The difference is that the first concept focuses on patient-centered health care processes, while the second focuses on IT solutions. In the meantime, new technologies have emerged, including robotics, artificial intelligence, big data – practical solutions driving a paradigm shift in health care.

Care is replacing treatment This new health care is moving away from the classic role of the patient, hospital and doctor. We are talking about a transformation process that will not take several years, but several decades. One thing is certain: we are only at the beginning of a long road, and before the first benefits for patients can be seen, we will have to do the grassroots work to create a uniform ecosystem of health data. The target station of this transformation is to move away from medicine based on treatment of a sick patient – which is reactive medicine – towards prevention and holistic, personalized care of every citizen – health risk management. The patient is no longer a disease entity, a unit of account in the reimbursement scheme, but an entity co-responsible for health. A system of services is being built around the patients to involve them in the health care process, so that health and wellbeing are the result of cooperation between the patient and the doctor, and not the task of the doctor acting in a paternalistic role. To provide the services quietly in the background of

» The new health care should move away from the classic role of the patient, hospital and doctor. «

everyday life, without absorbing our attention. Many models have been developed on the basis of these assumptions, such as coordinated care or care focused on the patient’s needs. All of them are linked by a single denominator of digitization: informational coupling of health care processes and smooth flow of patient data through the entire health care ecosystem. This, in turn, is only possible when the data is in digital form and is therefore not trapped in data silos, i.e. paper files locked in the place where they were created. Data is knowledge that is missing today. Doctors make decisions based on residual facts, having no control over what happens to the patient when he or she leaves the doctor’s office. Similarly, the patient makes decisions based on guesses and intuition. The doctor is called when the first symptoms of the disease occur, sometimes developing for years. It is often too late for classical medicine to help. Ministries of health, when planning specific actions in the field of population health or investments, are guided by historical data that tend to change quickly. In such an inefficient model, money leaks through growing holes. As a result, the system requires ever-increasing budgets, which do not translate into quality of services. Even rapid progress in the field of new medicines and treatment technologies has not allowed dealing with lifestyle diseases.

It will not be an easy mission Several fundamental technological and strategic problems need to be overcome in order to achieve idealistic digital health. The digitalization of healthcare developed rapidly in the initial period of the IT revolution, but it was progress without rules, data exchange standards or strategies. Many systems collecting data in different formats were created in this way, which makes it impossible to exchange it. On the other hand, new technologies are constantly emerging, such as mobile health apps, which remain outside the sphere of regulation. This chaos is slowly getting organized, but it will be a long time before we can talk about interoperability of systems and exchange of medical data. And this is a prerequisite for moving to a higher level of digital health – connected health systems. This shows that politics is not keeping up with the wave of technology triggered by the fourth technological revolution, it cannot actively stimulate and formulate the development of, for example, artificial intelligence, but it rushes to frame what the technology industry will bring to the market. This does not facilitate the sustainable development of technology, but may lead to the emergence of new problems undermining the benefits of digitization, from ethical controversies to the widening digital divisions in society.

Leaders, technology and a different point of view It is also important to remember that transformation, although driven by the development of technology, means a change in the way we think about health. This change has to be implemented at the patient level, and its stimulation will be triggered by a pro-innovative health policy. When we talk about shifting the focus from treatment to prevention, it is necessary to take into account the whole health care infrastructure or funding directed towards hospitality and drug reimbursement. This is almost like the transition from a fossil fuel economy to clean energy from renewable sources. Every transformation entails a change in social structures, a shift in employment, and requires large investments, education, vision and leadership. However, the role of politics is not only to regulate the statusquo, but to actively formulate a new reality. New applications – systems based on artificial intelligence or robots – are not just additional tools, but solutions influencing social processes. It should be remembered that we are talking about health, where the focus is placed on different values than those governing other branches of the economy. One of them is health as a fundamental right of the patient. For the next decades to pass under the sign of approaching such a goal, the digital transformation of health care must be under the sign of wise digitization as a factor stimulating the transformation. 