Ebook: User Acceptance of Health Telematics Applications

The European Workshop on Acceptance of Telematics Applications and Services by Healthcare Professionals, called “Looking for the Convincing Cases”, took place 12-13 December, 1997 in Thessaloniki, Greece. It was supported by the European People’s Party of the European Parliament, together with the scientific assistance of the Health Telematics sector of the TELEMATICS APPLICATIONS Programme of the European Commission.

This book contains examples of “Convincing Cases” that were selected from all over Europe and presented by experienced users and healthcare decision-makers. These examples are based on successful cases of implementation of health telematics applications and services such as electronic healthcare records and hospital information systems, specialised departmental systems, emergency telemedicine, and regional healthcare networks. Examples of experiences relating to medical informatics education are also included since the education is a crucial factor in the area of user acceptance. Cases of successful promotion of good quality applications and other issues related to users and technology are included in the last section.

The need for the workshop came from the 10 years of experience in the research and development in the area of the European Commission in the area of health telematics and the recognition and support of the European Parliament for the user-friendliness and user acceptance of the new technologies and applications by all citizens in the upcoming Information Society. Promotion and dissemination of “Convincing Cases” are seen as important mechanism towards user acceptance and wider implementation of results of European RTD projects such as those supported by the TELEMATICS APPLICATIONS Programme.

The readers will find qualitative and quantitative descriptions of many useful experiences of implementation and use of health telematics systems and services. The text of many of the papers is very rich in quantitative analysis and statistics providing good source of reference data.

Finally, the editors would like to thank again the participation and support of the European Parliament, the European Commission, and all the participants and contributors to this workshop. It is the wish of the editors that this workshop, together with this book, constitute another small step towards user-friendly healthcare systems and services for the benefit of all the citizens.

Antonios Trakatellis

Stavroula Maglavera

Ilias Iakovidis

The research and development TELEMATICS APPLICATIONS Programme (TAP) is one of the 19 specific R&D programmes which are supported under the European Union’s RTD Fourth Framework Programme (1994-1998). Its budget of some 900 million ECU, represents approximately 7% of the total budget of the RTD Fourth Framework Programme. The activities of TAP cover several application areas of general interest such as Health Care, Integration of Disabled and Elderly, Transport, Environment and Education and Training. For more information see www2.echo.lu/telematics or http://europa.eu.int.

This paper is presenting the rational that lead to the organisation of the European workshop on Acceptance of Telematics Applications by Healthcare Professionals “Looking for the convincing cases”, that took place in Thesaloniki 12-13 December, 1997. A brief overview is presented of the health telematics sector, the current situation of the usage of some applications, and major challenges towards wide implementation of health telematics applications. It focuses on user acceptance as one of the critical challenges towards wider implementation. It concludes that the support and promotion “Convincing cases” are important components contributing to user acceptance.

DIOGENE 2 is a full-scale distributed / open hospital information system that by June 1995 had already achieved its migration from a former mainframe system. Thanks to that architecture there is an obvious need for a common «glue» devoted to tightening up scattered applications into a middleware-based network of interoperability. After this the design of open / distributed Electronic Patient Records (EPRs) became feasible. A brief historical sketch of DIOGENE is presented from its initial to its present phase. A working prototype of these distributed EPRs is discussed showing current achievements during its first stage of production in the clinics of the University Hospitals of Geneva. On-going expansion to other public hospitals, as well as to general practioners (GPs) in the Geneva area, are partly described.

The present study aimed to analyse physicians' attitudes towards IMASIS, and their potential influence on IMASIS medical record project. IMAS (Institut Municipal d'Assistència Sanitària) is the health care organisation of the City Council of Barcelona. IMAS hospital information system (IMASIS), which first applications were designed and implemented in 1984, is currently facing a new phase, focused on clinical information management. Our approach included a personal interview with representatives of every hospital unit, and a self-administered questionnaire distributed to every clinician. Both provided a worthy insight into the cultural patterns to be considered in the HIS implementation process. Moreover, the results helped to define the subsequent steps of IMASIS evolution. Our experience is proposed as a tool to assess clinical informations systems from a user point of view.

Information is essential for the taking care of the patients and is also a guarantee for the quality of cares. In this objective, the University Hospital of Lille has developed for 10 years a politic based on information and communication divided in 3 phases:

1. The University Hospital has developed a HIS based on the communication between hospitals and medical centers for a better sharing of data concerning the patient.

2. The second phase consisted in the integration of external platforms to the HIS with a middleware.

3. The actual phase consists in the opening of the HIS to the external environment of the hospital and especially to the GPs through a Regional Medical Information System.

Application of an integrated Hospital Information System in Areteion University Hospital was launched 3 years ago. As it was the very first time that a fully fledged Hospital Information System was applied in complex university hospital environment, numerous problems and issues were brought up during this first period. The most critical issues are described in this paper, giving simply the essence of the problem and the general strategic line which was followed. Issues of hospital’s strategic goals, behavioural aspects of the users, technical problems of the software application, as well as issues of maturity of key players and tools per se and in their interaction, were faced by the management team of Hospital Information System.

The AEDMI project, carried out in the Bellvitge University Hospital, near Barcelona, is proposed as an example of clinical decision system prototype development. Several difficulties have been encountered to develop this project. One of them was to find the adequate understanding for the project and proper funding for personnel resources. The support by FIS grants and from the hospital structures was essential to the survival of the project; however the resources always have been below the real needs for development. The difficulties with clinical coding systems, the excessive expectancies upon prototypes, and the lack of culture in information methods were other relevant hinders. The complexity of clinical realm, the uncertainty of medical decisions, and the current trends to substitute the clinical information by data obtained from electronic devices, or analytical monitoring of patients, are additional problems for clinical information managing.

The simultaneous events of Health Care reorganisation, Information Technology progress and increased demands on Health Care outcome evaluation have created a new concept of a more sophisticated way how to use an electronic health care patient record. The importance of health care process analysis and case processing is illustrated and an operating patient record system in Umeå, Sweden, is demonstrated.

This paper describes the conditions for, and actually use of telematics in a regional Health Network in a Danish county. This paper gives an introductory view over the organisation of the Danish health care system, and the general practitioners place in it. The advantages experienced and the actual use of telematics in general practice today is described. Finally, the expectations for the near future is mentioned.

Emergency Medicine is considered the neglected speciality of contemporary medicine, although it is widely acknowledged that improvement in the outcome of the acutely and critically ill depends on its timely and effective management during the critical first hour [1], the so called «golden hour». The crucial question therefore is whether Telematics can affect this outcome and in particular how they can assist the existing models of Prehospital Emergency Medical Services (EMS) to meet this goal. The Hector Pilot of Crete tries to give a convincing answer to this question, taking into account the concept and some of the requirements of Emergency Medicine.

MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) are considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

The application, integration and development of methods and technology facilitating the seamless interchange of clinical, demographic and administrative information presented the medical and clinical community with unforeseen problems. Surprisingly, the wealth of existing solutions did not find the expected application and acceptance in hospital/General Practice environments. Even more surprising was the fact of the failure of many computer-based solutions to deliver the expected benefits. This paper outlines the Telematics project established in the Northern United Kingdom and its success in maintaining a working balance between technological needs and the clinical requirements. The result is a robust service linking five major Trusts and 12 General Practices in terms of clinical and administrative data, e-mail and other facilities.

OTE SA, the Hellenic Telecommunications Organization, is the major public network operator of Greece and aims to actually promote all services made available through this technology and more peculiarly that of telemedicine. Through its modernization plan in progress, OTE aims at providing wide/range, high/quality competitive services on the basis of customer oriented policies. Its activities cover, besides basic telephony (5,9 million lines), data communications, leased lines, maritime communications and value-added services. The public health service has a lot to profit from efficient use of telecommunications. The greatest challenge the health service is faced with, is the growing gap between the expectations of the population, and the resources that society can set-aside for health purposes. Increasing the level of efficiency and co-operation is therefore the best probable response to the challenge. Telecommunications may contribute to a more effective utilization of resources, tying together those that could be in benefit of the health sectors in the process of implementing a large number of telemedical services.

The Hospital District of Varsinais-Suomi consists of five hospitals for non-psychiatric diseases to deliver specialised health care for the population of 440000 inhabitants in South-western Finland. We have applied an open regional information system to aid clinical resource management in such a complex expert organisation. The main areas of application have been assessment of inpatient care usage in different communities and in different diagnosis-related-groups (DRG), measurement of length of hospital stay in different DRGs and comparison of DRG unit weight costs of different hospitals. The open structure of the data base and its distribution to all parties of health care professionals has resulted in mutual decisions on structural changes and increased cost containment activities.

Medical Informatics is a multidisciplinary field, dealing mainly with informatics and technology applications in health care. Medical Informatics is composed from a number of sub-areas such as computer based patient record (CPR), processing of multimedia information (signals, images), coding and transmission through high speed networks of medical information (telematics), medical decision support systems, data security and integrity, integration of technologies in hospital and regional environments, and development of educational tools. The people who receive such an education are capable of development, integration and maintenance of complex hospital and health information systems both at departmental and regional levels. A very important issue however is the acceptance of information technology (IT) solutions engineered by medical informaticians from the medical personnel. In mis paper we shall deal with the set-up of a medical informatics and medical technology educational environment, as well as the areas from medical informatics that the average user needs to be familiar with in order for the successful deployment of IT solutions in health care.

Since the new Handbook of Medical Informatics was published in 1997, a p-version of a web site (“MI WEB”) has been opened that supports the teaching of the Handbook. MI Web refers to the text of the full Handbook, using an extensive Glossary that is shared by both the paper Handbook and the web site. New material for teaching will continuously be added to the MI Web, realizing that the field of health informatics is progressing exponentially, that the teaching of medical informatics is of great importance for students in medicine and health care, and that these students will be the health professionals of the future. Training in medical informatics is also of value for practicing clinicians who are overwhelmed by the avalanche of systems that are available on the market.