To assess their readiness for further eHealth use, we analysed Australia’s allied health practitioners along three dimensions: their infrastructural readiness (their operating environment, as well as their IT hardware, software and connections); their aptitudinal readiness (depth of skills and capability to use eHealth solutions); and their attitudinal readiness (willingness to use current and future eHealth solutions). We found consistently strong aptitudinal readiness for basic, self-contained computer applications, but infrastructure readiness varied within and among sectors, and these were amplified by differences in attitudinal readiness. Attitudinal readiness requires the closest analysis due to the high degree of variation observed.
Infrastructural readinessAllied health practitioners in general have the basic IT equipment and connectivity for eHealth adoption. However, the landscape of available eHealth solutions is highly fragmented, reflecting the diversity of allied health practice, with few mainstream applications designed specifically for allied health sectors, and little connectivity between applications. Addressing system connectivity, interoperability and security barriers will help drive increased use among early adopters.
Most allied health practitioners have access to computers in their main practice setting (88% in major cities, 94% for inner and outer regional areas, decreasing to 69% in remote areas), and 58% of practitioners have access to a computer less than 3 years old. Most practitioners have internet access in the main practice setting (83% in major cities, 90% for both inner and outer regional, decreasing to 58% in remote areas), almost all of those being broadband (82%).
The relative fragmentation of the eHealth solutions space targeted towards allied health means that few disciplines are able to benefit from mature applications designed specifically for their use. In particular, the different care processes required for counselling-based, physical and specialist technical therapies require a very different practitioner interface. Over 75 commercial eHealth software solutions were observed in use across allied health, of which the top 3 comprise 22% of the market, while the top 10 comprise 42% – no system has emerged into common usage across allied health. (There are several professions, notably ATSIH workers and dental allied health, where common systems are emerging, but these are the exception rather than the rule.) In addition, there are a large number of practices that have developed their own record-keeping systems, typically a series of templates in standard office software. In itself, this fragmentation would not be an issue – the broad spectrum of care processes found within allied health suggest a large number of solutions may indeed be required. However, the applications used rarely share operating platforms or interoperability standards, and rarely have the functionality, reliability and support required of integrated eHealth applications.
Allied health practitioners that have already invested in eHealth solutions also face infrastructural barriers to expanding their use. For example, any additional system should be compatible with currently used ones, and need to securely connect with external systems. The systems should also accommodate the practitioner’s work process, rather than the other way around. Chiropractors, for example, find that user interfaces are not aligned to the flow of their practice processes.
Aptitudinal readinessAllied health practitioners typically have the necessary aptitudinal readiness for eHealth, having sufficient capabilities from their combined professional and personal IT use. However several interviewees suggested the familiarisation period for the specialist applications they use has been shortened considerably through intensive introductory training.
Current eHealth usage levels suggest that most allied health practitioners are relatively technology literate. Although usage decreases with age (from 75% of practitioners aged 24-45 who use at least one eHealth application, down to 56% of practitioners aged over 55), there is high personal internet usage across the entire allied health community (97% of practitioners use the internet at home) suggesting strong basic eHealth capability and skill.
Specialised software applications will generally require a period of familiarisation and are likely to include some system training. However, the majority of practitioners do not believe that the difficulty selecting and implementing a system, or the potential for productivity drop during transition, are significant barriers to adoption. Further, practitioners who have made the transition describe the inconvenience as minor in comparison to the benefits gained.
Attitudinal readinessAllied health practitioners have varied attitudes towards eHealth, ranging from strongly convinced of its need, to expressively negative. Underlying these attitudes are their perceptions of the benefits of eHealth applications, and the barriers and risks they confront as they consider adopting those applications. These attitudes are strong determinants of adoption rates in each profession. But as with the allied health sector as a whole, each profession is heterogeneous: in each there are practitioners who are quite resistant to eHealth applications, and those that verge on being eHealth evangelists. Identifying who will be resistors and who will be catalysts for change will be critical, as will discovering what will motivate those who are eHealth’s strongest advocates to help influence others.
To better explore and understand these attitudes and underlying perceptions, we deepened our analysis to identify six clusters of allied health practitioners with quite distinct attitudes to eHealth possibilities. We now turn to that cluster analysis as the clearest way of identifying insights to practitioner attitudes that are actionable, and upon which a meaningful strategy to support eHealth engagement and adoption can be built.