Information and Communication Technology and The Future of Healthcare: Multi-scenario Delphi Survey

The Problem

As a healthcare administrator exploring the future trends of information technology in the healthcare setting has to be a daily practice. With an ever-changing patient population addressing future needs today can better prepare a facility when population changes or environmental issues arise. Two major factors that come into play are a steady increase in the elderly population and a shortage of physicians and nurses, especially in rural areas. Telehealth would be able to bridge the gap between patient and healthcare provider while still creating a traditional face-to-face relationship and still remaining cost-effective. Passive health monitoring devices and sensors would be able to offer an inexpensive way to manage a patient's health while also using minimal resources. The implementation of healthcare IT and telehealth has improved healthcare by making sure health information is confidential, available when and where it is needed, contributing to safer, higher quality, more coordinated, and more efficient, and less costly care for everyone. The purpose of this study is to survey the perceptions of medical experts regarding telehealth and its application as healthcare stakeholders have a large influence over the decision-making process. It is hypothesized that the hesitation for a facility's adoption of telehealth is the initial financial investment. Key terms that are defined include Telehealth (Telecommunication Healthcare), ICT (Information and communication technology), and data security and confidentiality.

Review of Literature

Jungwirth & Haluza cited a number of scholarly sources that were relevant and relativity recent in publication. The review was a little broad in reference as the majority of the data that was collected was through Austrian medical experts with reference to the geopolitical climate while also referencing certain United States-based healthcare practices. Also, many references seem to be from other countries where their political or healthcare practice factors may differ from Austria's including Canada and Taiwan. The authors cited come from a number of agencies and backgrounds in the healthcare industry which in turn gives references and data from a number of viewpoints within the system. There doesn't seem to be any indication or evidence of biased data. There is a declaration by the author stating there are no potential conflicts of interest regarding research, authorship, and publication. Also with the statement that the author receives no financial support or research, authorship, or publication, indicates little evidence of bias processing.

The study was done in a cross-sectional study manner, in which data is compiled from a population at a specific point in time. It also was conducted under a quasi-experimental design where the experiment looks a bit like an experimental design but is missing a key ingredient of random assignment. The study was original and was done through a Delphi survey sectioned into two parts. A Delphi survey is a questionnaire that gives future scenarios in order to forecast possibilities for new processes and relies of expert responses. The survey was broken into two parts with one assessing sociology-demographics and the second evaluating 10 scenarios. These scenarios are in ascending order using the corresponding fixed questionnaire items for benefits, obstacles, degree of innovation, desirability, and implementation date. There was a pilot test and after that SoSci survey was used in the software application of the Delphi survey. A sample of Austrian experts was eligible and invites were sent via email. Written informed consent was taken before participating in the survey. Sampling was done in two rounds, the first being the online questionnaire via email. Round two was a PHP (Program Home Page) program code and a Microsoft Excel template where summarized responses and ratings were presented to adapt previous ratings.

Data Analysis

The data in this study were analyzed using the stepwise method. This allowed for an analysis of a multiple scenario survey on a micro, meso, and macro level analysis where the macro data was used in this study. The data collected was quantitative and the findings supported the fact that most the major connecting interest was the financial investment in telehealth. Strengths of this study included the fact that it was a large population that participated (n= 73) and the participants were high ranking within the Austria healthcare sector. Although this article states that having 73 participants is a lot, there are other studies based out of the United States that include a number more participants from the healthcare sector in their studies. Limitations of this study include the fact that this data was gathered in 2010 and since then not only have societal changes occurred but so have technological changes this could impact the expert's current perspectives. The surveys were intended to be strongly linked to the currently existing concerns of policymakers addressing the key question of where to place resources in telehealth implementation processes.

Conclusion

The results of the study show that there is a hesitation to implement telehealth and that there is a concern when it comes to financial investment and patient accountability. Another major obstacle that presented itself was the protection of data and the distrust that was felt when it came to this issue. It discussed that in order to obtain a nationwide adoption there would have to be innovation in protecting that data. In order to successfully integrate telehealth within the system, there needs to be both the organization and patient on board. The Delphi survey shows that cooperation, networking, communication, and practice sharing must be utilized in order for there to be an ease of transition when starting this program. There also needs to be standards addressed as to not enable ageism as the inequalities can prevent the elderly or disabled from receiving the care they need. Telehealth access and digital education must be promoted to successfully reach the clients in rural areas this program has in mind to help.

This article really gave me an insight on the need for telehealth and the lack of resources there are in many parts of not only the world but in our own backyard. They talk in this study about the aging population and that even getting the program out there is not enough but we also have to educate the people that would be using these services. I can see this being a huge obstacle to overcome as getting education out there in a form that is easily understood could be difficult. Methods to reach those targeted populations may need to be better understood in order to get that information across. Although the numbers are higher then they have ever been for internet use by the elderly, still, only 67 percent of adults over 65 have regular access to the internet so trying to promote telehealth over the internet may not reach everyone in your target audience. The Advanced Communications Law and Policy Institute reports that 53 percent of seniors use the internet to find information about health care and medical issues. This is something I personally have to keep in mind as I plan to have to take care of my parents later in life. Many places such as the Hospital of the University of Pennsylvania have applications on smartphones that allow you to create an appointment and check current appointments, check lab and test results, research physician specialties, and even have virtual sessions with a PA where if you have something minor they can write you a prescription then and there. This ease of information fits in the palm of your hand but if a patient or my own parents are not educated on how to use it its useless. I can also understand the hesitation by institutions as it takes a lot of resources to get these platforms up and running and keep them going once they are up. That is why for institutions that have already taken that leap and begun the process we need to use it before we lose it.

References

1. (HHS) U.S. Department of Health and Human Services. (2019, January 18). Health IT: Advancing America’s Health Care.
2. Retrieved from https://www.healthit.gov/sites/default/files/pdf/health-information-technology-fact-sheet.pdf.
3. Jungwirth, D., & Haluza, D. (2019). Information and communication technology and the future of healthcare: Results of a multi-
4. scenario Delphi survey.Health Informatics Journal,25(1), 161–173. doi: 10.1177/1460458217704256
5. Schaub, H. (2016, July 29). Why Senior Citizens Use the Internet. Retrieved from
6. https://www.brookings.edu/blog/techtank/2014/04/11/why-senior-citizens-use-the-internet/.