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Barriers and Enablers in the Adoption of Widespread Digital Solutions in Healthcare

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Digital Health".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 28098

Special Issue Editor

Prof. Dr. George Crooks

E-Mail Website
Guest Editor
Digital Health & Care Innovation Centre, Inovo Building, 121 George Street, Glasgow G1 1RD, UK
Interests: innovation in health and care; digital tools and services for healthcare; telehealth; telecare; technology-enabled care
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The digital health sector is characterised as emerging from the conjunction of health and care services, mobile health and ICT, and it is one of the fastest growing economic sectors globally. One of the most significant barriers to the adoption of digital tools and services in support of the delivery of healthcare is that of TRUST.

This raises the question: how do we gain the trust of citizens as well as health and care providers and policy makers in the use of digital technologies? This is particularly so in the application of machine learning and AI in pursuit of the delivery of safe and effective healthcare delivery.

This Special Issue is seeking to focus on the barriers and enablers to the adoption of digital healthcare services and explore the importance of trust.

By inviting contributions from academics from around the world, we are seeking to ensure that we develop a better understanding of the issues that create barriers to the adoption of digital technologies, not only from the healthcare professionals’ and patients’ perspective but also that of policy makers and commissioners of services. It is important that we do not disable the contribution that digital technologies can make in the global recovery from COVID-19. We are thus inviting academics to share their current work on the enablers and barriers to adoption and in particular are seeking contributions that focus on trust. Papers on the lessons learned in relation to the use of digital tools and services in the management of the COVID-19 pandemic and on COVID-19 recovery are encouraged. This can also include research into explainable and trustworthy AI, but all trust aspects of digital service adoption and scaling across all aspects of health and care delivery will be welcomed. By exploring how trust can be gained and communicated as well as lost, we can better understand how it is built into the innovation process from the early stages of product and service development.

Prof. Dr. George Crooks
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • trust
  • healthcare
  • digital
  • AI
  • machine learning
  • enablers
  • barriers

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Published Papers (6 papers)

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22 pages, 1128 KiB  
Article
Organizational e-Health Readiness: How to Prepare the Primary Healthcare Providers’ Services for Digital Transformation
by Agnieszka Kruszyńska-Fischbach, Sylwia Sysko-Romańczuk, Tomasz M. Napiórkowski, Anna Napiórkowska and Dariusz Kozakiewicz
Int. J. Environ. Res. Public Health 2022, 19(7), 3973; https://doi.org/10.3390/ijerph19073973 - 27 Mar 2022
Cited by 15 | Viewed by 6547
Abstract
The COVID-19 pandemic has had two main consequences for the organization of treatment in primary healthcare: restricted patients’ access to medical facilities and limited social mobility. In turn, these consequences pose a great challenge for patients and healthcare providers, i.e., the limited personal [...] Read more.
The COVID-19 pandemic has had two main consequences for the organization of treatment in primary healthcare: restricted patients’ access to medical facilities and limited social mobility. In turn, these consequences pose a great challenge for patients and healthcare providers, i.e., the limited personal contact with medical professionals. This can be eased by new digital technology. While providing solutions to many problems, this technology poses several organizational challenges for healthcare system participants. As the current global situation and the outbreak of the humanitarian crisis in Europe show, these and other likely emergencies amplify the need to learn the lessons and prepare organizations for exceptional rapid changes. Therefore, a question arises of whether organizations are ready to use modern e-health solutions in the context of a rapidly and radically changing situation, and how this readiness can be verified. The aim of this article is to clarify the organizational e-heath readiness concept of Polish primary healthcare units. This study employs the triangulation of analytical methods, as it uses: (i) a literature review of e-health readiness assessment, (ii) primary data obtained with a survey (random sampling of 371 managers of PHC facilities across Poland) and (iii) the Partial Least Squares Structural Equation Modeling (PLS-SEM) method, employed to estimate the structural model. The evaluation of the model revealed that its concept was adequate for more mature entities that focus on the patient- and employee-oriented purpose of digitization, and on assuring excellent experience derived from a consistent care process. In the context of patients’ restricted access to medical facilities and limited social mobility, a simpler version of the research model assesses the readiness more adequately. Finally, the study increases the knowledge base of assets (resources and capabilities), which will help healthcare systems better understand the challenges surrounding the adoption and scaling of e-health technologies. Full article
(This article belongs to the Special Issue Barriers and Enablers in the Adoption of Widespread Digital Solutions in Healthcare)
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19 pages, 342 KiB  
Article
Scaling Digital Health Innovation: Developing a New ‘Service Readiness Level’ Framework of Evidence
by Janette Hughes, Marilyn Lennon, Robert J. Rogerson and George Crooks
Int. J. Environ. Res. Public Health 2021, 18(23), 12575; https://doi.org/10.3390/ijerph182312575 - 29 Nov 2021
Cited by 5 | Viewed by 4142
Abstract
Digital innovation has scaled exponentially in many sectors including tourism, banking, and retail. It is well cited that the health sector is slower to embrace digital health innovations (DHI) beyond the pilot stage and consequently, many successful DHI pilot projects have failed to [...] Read more.
Digital innovation has scaled exponentially in many sectors including tourism, banking, and retail. It is well cited that the health sector is slower to embrace digital health innovations (DHI) beyond the pilot stage and consequently, many successful DHI pilot projects have failed to scale up. Such failure arises in part from a knowledge gap around what type and level of evidence are needed to convince implementers and decision makers to fund, endorse, or adopt new innovations into care delivery systems and sustainable practice. Much is known about the range of DHI evaluation methods used; however, less is published on the evidence that decision makers need to move innovations to scale. This paper draws on interviews (N = 18) with decision makers/project leads engaged in DHI in Scotland to identify what evidence matters when making DHI adoption/scale decisions. The results are used to present a heuristic service readiness level (SRL) framework that captures the changing nature of the evidence base required over a project lifecycle for progression to scale. We utilise this framework to discuss ‘what evidence’ is required and ‘how data accumulate’ over time to assist project teams to build a ‘DHI case for scale’. Full article
(This article belongs to the Special Issue Barriers and Enablers in the Adoption of Widespread Digital Solutions in Healthcare)
12 pages, 1405 KiB  
Article
Is It Possible to Have Home E-Monitoring of Pulmonary Function in Our Patients with Duchenne Muscular Dystrophy in the COVID-19 Pandemic?—A One Center Pilot Study
by Eliza Wasilewska, Agnieszka Sobierajska-Rek, Sylwia Małgorzewicz, Mateusz Soliński, Dominika Szalewska and Ewa Jassem
Int. J. Environ. Res. Public Health 2021, 18(17), 8967; https://doi.org/10.3390/ijerph18178967 - 26 Aug 2021
Cited by 9 | Viewed by 3015
Abstract
Background: Duchenne muscular dystrophy (DMD) is the most common, progressive, irreversible muscular dystrophy. Pulmonary function is crucial for duration of life in this disease. Currently, the European Respiratory Society is focused on digital health, seeking innovations that will be realistic for digital respiratory [...] Read more.
Background: Duchenne muscular dystrophy (DMD) is the most common, progressive, irreversible muscular dystrophy. Pulmonary function is crucial for duration of life in this disease. Currently, the European Respiratory Society is focused on digital health, seeking innovations that will be realistic for digital respiratory medicine to support professionals and patients during the COVID-19 pandemic. Aims: The aim of this study was to investigate whether it is possible to monitor pulmonary function at home using an individual electronic spirometry system in boys with Duchenne muscular dystrophy. Materials and methods: In this observational, prospective study, conducted from March 2021 to June 2021, twenty boys with DMD (aged 8–16) were enrolled. The patients were recruited from the Rare Disease Centre, University Clinical Centre, of Gdańsk, Poland. Medical history and anthropometric data were collected, and spirometry (Jaeger, Germany) was performed in all patients at the start of the study. Each patient received an electronic individual spirometer (AioCare) and was asked to perform spirometry on their own every day, morning and evening, at home for a period of 4 weeks. The number of measurements, correctness of performing measurements, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) were evaluated. Results: Finally, 14 out of 20 boys enrolled in the study with a mean age of 12.5 years (7 non-ambulatory) applied and received a home spirometer (AioCare). A total of 283 measurements were performed by all patients at home for 4 weeks. Half of the patients were able to perform measurements correctly. There were no significant differences between mean values of FVC, FE1, PEF between home and hospital spirometry (p > 0.05) expect PEF pv% (p < 0.00046). Patients with higher FEV1 (p = 0.0387) and lower BMI (p = 0.0494) were more likely to take home spirometer measurements. The mean general satisfaction rating of home-spirometry was 4.33/5 (SD 0.78), the mean intelligibility rating was 4.83/5 (SD 0.58). Reasons for irregular measurements were: forgetting (43%), lack of motivation (29%), difficulty (14%), lack of time (14%). Conclusion: Home electronic monitoring of pulmonary function in patients with DMD is possible to implement in daily routines at home. This protocol should be introduced as early as possible in patients 7–8 years old with good, preserved lung function. Patients accept this form of medical care but require more education about the benefits of e-monitoring. There is a need to implement a system to remind patients of the use of electronic medical devices at home, e.g., via SMS (short message service). Full article
(This article belongs to the Special Issue Barriers and Enablers in the Adoption of Widespread Digital Solutions in Healthcare)
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18 pages, 1342 KiB  
Systematic Review
Artificial Intelligence Implementation in Healthcare: A Theory-Based Scoping Review of Barriers and Facilitators
by Taridzo Chomutare, Miguel Tejedor, Therese Olsen Svenning, Luis Marco-Ruiz, Maryam Tayefi, Karianne Lind, Fred Godtliebsen, Anne Moen, Leila Ismail, Alexandra Makhlysheva and Phuong Dinh Ngo
Int. J. Environ. Res. Public Health 2022, 19(23), 16359; https://doi.org/10.3390/ijerph192316359 - 6 Dec 2022
Cited by 35 | Viewed by 7153
Abstract
There is a large proliferation of complex data-driven artificial intelligence (AI) applications in many aspects of our daily lives, but their implementation in healthcare is still limited. This scoping review takes a theoretical approach to examine the barriers and facilitators based on empirical [...] Read more.
There is a large proliferation of complex data-driven artificial intelligence (AI) applications in many aspects of our daily lives, but their implementation in healthcare is still limited. This scoping review takes a theoretical approach to examine the barriers and facilitators based on empirical data from existing implementations. We searched the major databases of relevant scientific publications for articles related to AI in clinical settings, published between 2015 and 2021. Based on the theoretical constructs of the Consolidated Framework for Implementation Research (CFIR), we used a deductive, followed by an inductive, approach to extract facilitators and barriers. After screening 2784 studies, 19 studies were included in this review. Most of the cited facilitators were related to engagement with and management of the implementation process, while the most cited barriers dealt with the intervention’s generalizability and interoperability with existing systems, as well as the inner settings’ data quality and availability. We noted per-study imbalances related to the reporting of the theoretic domains. Our findings suggest a greater need for implementation science expertise in AI implementation projects, to improve both the implementation process and the quality of scientific reporting. Full article
(This article belongs to the Special Issue Barriers and Enablers in the Adoption of Widespread Digital Solutions in Healthcare)
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9 pages, 1000 KiB  
Commentary
Foundation Level Barriers to the Widespread Adoption of Digital Solutions by Care Homes: Insights from Three Scottish Studies
by Lucy Johnston, Heidi Koikkalainen, Lynda Anderson, Paul Lapok, Alistair Lawson and Susan D. Shenkin
Int. J. Environ. Res. Public Health 2022, 19(12), 7407; https://doi.org/10.3390/ijerph19127407 - 16 Jun 2022
Cited by 7 | Viewed by 2219
Abstract
The care home sector has great potential to benefit from technological innovations and to be at the forefront of developing novel digital solutions to improve the experiences of care home residents, their families, and the staff caring for them. The COVID-19 pandemic exposed [...] Read more.
The care home sector has great potential to benefit from technological innovations and to be at the forefront of developing novel digital solutions to improve the experiences of care home residents, their families, and the staff caring for them. The COVID-19 pandemic exposed variability in digital capabilities and longstanding data challenges within the care home sector. Paradoxically, however, it also increased the use of digital tools and services to support residents and staff. There are, however, a number of barriers to sustained and widespread adoption of digital solutions by care homes. Here, the focus is on foundation-level barriers and the groundwork required to overcome them. Using data from three Scottish-based studies, foundation-level barriers to the adoption of digital tools and services faced by care homes are discussed. These main barriers are the need for robust basic internet connectivity; capabilities for digital data collection; access to data to inform and drive digital solutions; the need for trust in the use of resident data by commercial companies; and the danger that poorly coordinated strategies undermine efforts to build a care home data platform and the digital solutions it can support. Sustained and widespread adoption of digital solutions by care homes will require these foundation-level barriers to be addressed. Strong and stable data and digital foundations supported by sector-specific scaffolding are major prerequisites to the widespread adoption of digital solutions by care homes. Full article
(This article belongs to the Special Issue Barriers and Enablers in the Adoption of Widespread Digital Solutions in Healthcare)
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16 pages, 729 KiB  
Systematic Review
Does Connected Health Technology Improve Health-Related Outcomes in Rural Cardiac Populations? Systematic Review Narrative Synthesis
by Matthew James Fraser, Trish Gorely, Chris O’Malley, David J. Muggeridge, Oonagh M. Giggins and Daniel R. Crabtree
Int. J. Environ. Res. Public Health 2022, 19(4), 2302; https://doi.org/10.3390/ijerph19042302 - 17 Feb 2022
Cited by 7 | Viewed by 3036
Abstract
Individuals living in rural areas are more likely to experience cardiovascular diseases (CVD) and have increased barriers to regular physical activity in comparison to those in urban areas. This systematic review aimed to understand the types and effects of home-based connected health technologies, [...] Read more.
Individuals living in rural areas are more likely to experience cardiovascular diseases (CVD) and have increased barriers to regular physical activity in comparison to those in urban areas. This systematic review aimed to understand the types and effects of home-based connected health technologies, used by individuals living in rural areas with CVD. The inclusion criteria included technology deployed at the participant’s home and could be an mHealth (smart device, fitness tracker or app) or telehealth intervention. Nine electronic databases were searched across the date range January 1990–June 2021. A total of 207 full texts were screened, of which five studies were included, consisting of 603 participants. Of the five studies, four used a telehealth intervention and one used a form of wearable technology. All interventions which used a form of telehealth found a reduction in overall healthcare utilisation, and one study found improvements in CVD risk factors. Acceptability of the technologies was mixed, in some studies barriers and challenges were cited. Based on the findings, there is great potential for implementing connected health technologies, but due to the low number of studies which met the inclusion criteria, further research is required within rural areas for those living with cardiovascular disease. Full article
(This article belongs to the Special Issue Barriers and Enablers in the Adoption of Widespread Digital Solutions in Healthcare)
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