Information and communication technologies in health care

service delivery

An exploratory study

Acknowledging that technology as used in healthcare service delivery is a

social-technical system

A case study exploring elements within the use and possible future

use of Internet and mobile technologies

for health service delivery

Service sector under scrutiny -midwifery service delivery

Midwifery health service sector was chosen: Why?

• Users of midwifery service are well women who receive relatively standardised care for a clearly defined period of time.

• Data collection does not interfere with service delivery as semi-structured interview data is collected after the healthcare service encounter.

• Women ~15 – 45 are likely to be active users of new technologies compared with other groups of people receiving healthcare.

Why (continued)

• Midwives practice in clinics and birthing centres/hospitals and women’s homes, therefore it is a mobile service setting and mobility presents a challenge.

• Different generational populations have different perceptions and expectations. Current service users are predominantly ‘generation Y’ (~18 – 32) but ‘generation Z’ (0 – 18) are now reaching childbearing age and are the first generation to be termed ‘digital natives’. Marketers of products and services are heeding these generational differences.

Time frame under scrutiny (~40 weeks, women care at ~6 weeks post

conception )

Players

Guiding questions

• What are the current assets and actions (use) of technology of both groups?– Current every-day assets and actions and also– Within the defined setting

• What are the initial perceptions, attitudes and feelings of consumers (women) and health care professionals (midwives) regarding the value of using the Internet and mobile technology?

• What are the barriers (perceived or otherwise) and facilitators to acceptance of these technologies?

(continued)

• Are there time saving efficiencies?• Are there perceived risks?• Are there perceived benefits?• Can current information and communication

technologies enhance the service delivery process?

• If so, how?

Methodology

Case study using semi structured interviews and grounded theory

techniques

Case study

• Using one (of twenty one) District Health Boards (DHB) in New Zealand.

• One clearly defined geographical region (Hawke’s Bay).

• Using only independent midwives gives a tightly defined group.

• Using a population which includes a high percentage of Maori women, Pacific Island women, and rural women groups.

Data collection:Semi-structured interviews

• Midwives: who practice independently within the Hawke’s Bay region.

• Women: after they have been discharged from midwifery care.

Data collection

Mobile and Internet technologies

Explosion in growth

• There has been an explosion in the growth of information and communication technologies and particularly mobile technologies.

• There are around 45 million Internet users compared with <4 billion mobile phone subscribers (2008)*

• Cost is an inhibiter for mobile but many more now rely on mobile only and there is a clear shift in this direction..

*http://www.itu.int/newsroom/press_releases/2008/29.html

The rise and rise of mobile phone subscribers *

http://www.itu.int/newsroom/press_releases/2008/29.html

Percentage increase in broadband subscription rates 2004 – 2006 (NZ) *

* ttp://www.med.govt.nz/templates/MultipageDocumentPage____32729.aspx

Broadband

• New Zealand broadband subscription rates are 20th out of 24 OECD countries but the rate growth in uptake of broadband is second out of 14 countries.* *http://www.med.govt.nz/templates/MultipageDocumentPage____32729.aspx

Mobile phone subscribers per 100 inhabitants (2005)

http://www.med.govt.nz/templates/MultipageDocumentPage____32729.aspx

New Zealand has more mobile phone subscriptions than people (6th out of 24 OECD countries.*)

*http://www.med.govt.nz/templates/MultipageDocumentPage____32729.aspx

Mobile phones

• Mobile phones can be seen as disruptive technologies because they are changing the ‘traditional’ way of communicating and transferring information.

Mobile phones (continued)

• In New Zealand, there is greater use of mobile phones using 2G technology which enables voice and SMS.

• 3G networks enable high speed broadband but cost is an inhibiter.

New Zealand isstepping towards ubiquitous computing

anytime

anywhere

always available

and there is a trend towards …

Internet-centred communication

and a shift towards….

By the end of 2008, there were over three times more mobile cellular subscriptions than fixed telephone lines globally. Two thirds of those are now in the developing world compared with less than half in 2002. International Telecommunication Union Reporthttp://www.itu.int/newsroom/press_releases/2009/07.html

Mobile communication

and convergence of technologies

Health consumers are seeking and are expecting appropriate (to the person) information to

make better informed decisions.But they would do better with

guidance.

Participatory health care results in care that is

customised to the needs of each particular person. This may lead to greater

ownership of decision outcomes.

Information and communicationtechnologies are now able to

provide more and diverse ways for health care providers and patients to communicate and

transfer information.

Midwife Woman

Information from midwiveshas been found to be

important in trust development

within midwifery service delivery.

Bova, C., Fennie, K. P., Watrous, E., Dieckhaus, K. & Williams, A. B. (2006) The health care relationship(HCR) trust scale: Development and psychometric evaluation. Research in nursing & health, 29, 5, 477-488.

Communication enables the midwife – women’s relationship

Recent new and converging technologies have

provided many diverse ways of communicating.

Consumer expectations

Web 2.0 aware consumers will demand to have access to, and to control their data.

Eysenbach: Consumer health informaticshttp://www.slideshare.net/eysen/eysenbach-consumer-health-informatics

Eysenbach: Consumer health informaticshttp://www.slideshare.net/eysen/eysenbach-consumer-health-informatics

Another definition of Consumer Health Informatics

Opportunities and conditions for information and communication Technologies to increase consumer satisfaction

Acceptance of new technologiesis affected by many conditions.

Venkatesh and Rogers are major contributors to understanding this topic.

Venkatesh, V., Morris, M.G., Davis, F.D., and Davis, G.B. “User Acceptance of Information Technology: Toward a Unified View,” MIS Quarterly, 27, 2003, 425-478

Conditions affecting user acceptance of technologyVenkatesh

Diffusion of innovations (Rogers 1995)

Rogers, E. Diffusion of Innovations. 4th edition 1995

Rogers Diffusion of Innovation Curve (1995)

Some people take longer to accept inevitable change

Dallas Knight April 2010