The eHealth Readiness of Australia's Allied Health Sector - Final Report

Cluster analysis of attitudes and drivers

Page last updated: 30 May 2011

Identifying clusters in a stakeholder group is a multi-layered approach to stakeholder segmentation. To identify a stakeholder group, we would ask “what do they do?” Demographics will answer who they are. To identify needs, we ask “how do you operate?” – their revealed behaviour implies what their support requirements and preferences are. Only by analysing those needs directly can we ascertain why people behave the way they do, and what may be stopping them fulfilling those needs. A needs-based lens looks into the future: into what “could be” rather than what “is”.

Applying this needs-based approach, we uncovered six eHealth attitudinal clusters that cut across all allied health professions. Across clusters, practitioners differ in the benefits they see in eHealth applications, the barriers they perceive, and the enabling action needed for them. The biggest influence in defining the boundaries between clusters has proved to be the potential benefits of eHealth perceived by allied health practitioners. We describe the clusters below, in order of their likelihood to adopt, and influence others to adopt, eHealth solutions.

Cluster 1: Proactive pioneers (16% of all respondents)

These practitioners are strong believers in the benefits of eHealth – for collaboration between practitioners (64% of cluster strongly agree), for practice efficiency (62%), and for continuity and quality of patient care. They are the only cluster whose members strongly believe that patient relationships would benefit from eHealth adoption (34%). They are typically early adopters, and perceive few barriers to adoption. Operating almost exclusively in the private sector, they are comfortable with their ability to assess, select and implement solutions, and have significant influence over the practice’s eHealth decisions. Though pro-eHealth they are pragmatic in those decisions, only adopting solutions that do not diminish either practice efficiency or patient outcomes.

In common with other clusters, they use computers heavily for patient scheduling and billing, and for professional reference and education. However, they are more likely to use eHealth solutions for referrals, patient communication and clinical notes. This cluster is well-represented in most sectors, being prominent among dentists and radiographers and found less among dietitians, occupational therapists, speech pathologists and psychologists. They are responsive to any support for eHealth, in particular peer recognition, and will likely act as role models for eHealth adoption and provide risk and benefit data for later users.
Leading current usesPerceived benefitsBarriersAdoption drivers
  • Billing and patient rebates 83%
  • Patient booking and scheduling 73%
  • Referencing online tools 70%
  • Completing continuing education and training 69%
  • Entering patient notes after consultation 63%
  • Ability to collaborate with other practitioners 64%
  • Increases in practice efficiency 62%
  • Continuity of patient care 54%
  • Maintain compatibility with existing systems 25%
  • Prefer established technology 19%
  • Visibility of practitioner performance data 17%
  • Financial incentives 69%
  • Advice of professional body 57%
  • Professional respect and recognition 52%

Cluster 2: Embedded converts (20% of all respondents)

Embedded converts typically work in an environment, such as public hospitals, where computer use is expected and applications are provided for use. They tend to be young and employed in the public sector, with dietitians, radiographers and aboriginal health workers prominent, and chiropractors, dentists, optometrists and psychologists underrepresented.

Where embedded converts have been introduced to eHealth solutions, they have appreciated the experience and the additional capabilities eHealth has brought them. As a result, they have become the strongest believers in the potential of eHealth solutions, seeing benefits in practitioner collaboration and continuity of care. While enthusiastic about the benefits, embedded converts are less likely to control purchasing and adoption decisions within their practices, and so adoption strategies cannot rely on their direct influence.

Being the largest cluster, enlisting their support will provide the critical mass for eHealth adoption in the public sector. They are visible to and can influence a broader base of peers and other healthcare professionals outside the public system. They also appreciate the risks and concerns that they may themselves have once had, so may be a credible influence for more resistant groups: they won’t be perceived as eHealth-enthusiasts who too-readily dismiss the risks.
Leading current usesPerceived benefitsBarriers
    Adoption drivers
  • Patient booking and scheduling 72%
  • Referencing online tools 66%
  • Completing continuing education and training 58%
  • Completing event summaries 47%
  • Entering patient notes after consultation 46%
  • Ability to collaborate with other practitioners 52%
  • Continuity of patient care 51%
  • Increases in practice efficiency 44%
  • Cost of implementing new systems 28%
  • Maintain compatibility with existing systems 23%
  • Advice of professional body 67%
  • Financial incentives 58%

The next three clusters perceive the benefits of eHealth solutions and believe that they will be expected to adopt them, but are hesitant to adopt for different reasons.

Cluster 3: Risk-conscious (17% of all respondents)

Risk-conscious practitioners are aware of the potential benefits of eHealth solutions, but see risks across the board and so remain unenthusiastic. In particular, they are about six times more likely than eHealth-positive clusters (1 and 2) to be concerned about the security and privacy of patient information, and twice as likely to be concerned about the visibility of performance data.

Though relatively young (only 16% are over 55 years of age) and city-based, they perhaps-surprisingly have the lowest average personal internet usage. This relative unfamiliarity with IT systems means they will also need reassurance on the capability and maturity of systems before they adopt them.

They consider the advice of their professional body a reliable guide, suggesting case studies of practitioner adoption and certification from professional bodies of potential system security are a potential adoption lever. This cluster is broadly represented across all allied health practitioner groups, with the exception of dietitians and speech pathologists.
Leading current usesPerceived benefitsBarriers
    Adoption drivers
  • Billing and patient rebates 7%
  • Patient booking and scheduling 68%
  • Referencing online tools 55%
  • Completing continuing education and training 54%
  • Entering patient notes after consultation 43%
  • Viewing/recording patient information during consultation 43%
  • Ability to collaborate with other practitioners 22%
  • Continuity of patient care 14%
  • Increases in practice efficiency 14%
  • Patient privacy 53%
  • System downtime 34%
  • Advice of professional body 47%
  • Financial incentives 40%

Cluster 4: Cost-conscious (15% of all respondents)

These practitioners are interested in eHealth and see a broad spectrum of benefits, in particular practitioner collaboration, practice efficiency and continuity of care. However, their primary concern is the cost of implementing and maintaining new systems and, as with the risk-conscious and doubter clusters, harbour concerns about the visibility of performance data.

Cost-conscious practitioners are receptive to financial incentives, and to evidence of efficiency benefits or to demand from patients. Otherwise, they will remain unconvinced, seeing a limited role for new technology in their practice until the technology becomes better established and the system and implementation costs come down.

The socio-demographic attributes of this cluster are close to the norms for allied health practitioners. Cost-conscious practitioners are represented across all sectors, with psychologists the most prominent profession, and audiologists and Aboriginal and Torres Strait Islander health workers underrepresented.
Leading current usesPerceived benefitsBarriers
    Adoption drivers
  • Billing and patient rebates 60%
  • Completing continuing education and training 53%
  • Patient booking and scheduling 52%
  • Referencing online tools 47%
  • Entering patient notes after consultation 33%
  • Ability to collaborate with other practitioners 36%
  • Continuity of patient care 28%
  • Increases in practice efficiency 30%
  • Cost of implementing new systems 58%
  • Prefer established technology 33%
  • Can’t find a solution to meet needs 27%
  • Advice of professional body 30%
  • Financial incentives 45%

Cluster 5: Doubters (13% of all respondents)

These practitioners have similar concerns to those in the risk- and cost-conscious clusters, but their negative perceptions are stronger. They are uncomfortable with adopting unfamiliar technology in the face of their limited understanding of the broad system choices available. Believing practitioner collaboration to be the only clear benefit from eHealth, they don’t value the latest technology solutions, and harbour a host of concerns about system compatibility and downtime, the availability of IT support, and cost.

While financial incentives and professional body endorsement may give some reassurance, doubters will typically wait for technologies to be almost ubiquitous before they adopt them, and may need direct peer reassurance in their place of work. Besides their attitudes to eHealth solutions, they are difficult to identify in their health networks: their age, gender, experience, location and source of income are close to the norms for allied health practitioners, and no profession is overly represented.
Leading current usesPerceived benefitsBarriers
    Adoption drivers
  • Patient booking and scheduling 55%
  • Referencing online tools 53%
  • Completing continuing education and training 53%
  • Billing and patient rebates 50%
  • Entering patient notes after consultation 33%
  • Ability to collaborate with other practitioners 22%
  • Continuity of patient care 14%
  • Increases in practice efficiency 14%
  • Patient privacy 53%
  • System downtime 34%
  • Advice of professional body 47%
  • Financial incentives 40%

The final cluster have a negative impression of eHealth, disagreeing with the potential benefits and emphasising the barriers.

Cluster 6: Firm non-adopters (17% of all respondents)

Practitioners in our final cluster are significantly more sceptical of the benefits of eHealth, and avoid eHealth use unless the benefits are undeniable and the inconvenience to their ways of work minimal. Despite acknowledging that their peers expect them to use technology in the workplace, firm non-adopters remain unconvinced. They believe that patient relationships would suffer from eHealth use, and that it would diminish patient safety and engagement as well as the delivery, access to and quality of care. They are the most likely of all practitioners to strongly agree with any barrier proposed, in particular cost, privacy, and the visibility of performance data.

Firm non-adopters are more likely to be older, female, more experienced practitioners from the counselling-based therapies of psychology and social work, and will likely delay adoption until any new technology is extremely well established in their profession (if indeed that happens before their retirement). Financial incentives or mandatory participation schemes may be required in the end.
Leading current usesPerceived benefitsBarriersAdoption drivers
  • Referencing online tools 54%
  • Completing continuing education and training 53 %
  • Billing and patient rebates 46%
  • Patient booking and scheduling 41%
  • Communicating with patients before or after consultation 22 %
  • N/A
  • Cost of implementing new systems 78%
  • Patient privacy 62%
  • Prefer established technology 56%
  • Financial incentives 36%
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