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

7. eHealth readiness of Australia’s allied health sector

Page last updated: 30 May 2011

eHealth readiness in the allied health sector varies by profession, practice and individual. Allied health professionals assess the eHealth benefits to their particular processes and practice, the risks that adopting any solutions might entail, and any barriers preventing them adopting if they were so inclined. These are practice-level rather than health system-level assessments, yet a health system-level adoption strategy that ignores practice-level dynamics is unlikely to be effective.

Accordingly, we framed our assessment of eHealth readiness with three research questions:

  1. Are Australian allied health practitioners ready to adopt and use eHealth technologies and solutions, today and in a way consistent with policy direction in the future?
  2. What are the barriers impacting eHealth readiness and adoption and how can we minimise them?
  3. What are the eHealth enablers and how can we apply them to drive adoption and effective usage?

To answer these questions, we conducted 20 initial qualitative interviews to design a quantitative survey, ran that survey with 1,125 allied health practitioners, and interviewed a further 21 practitioners in-depth on the themes that emerged from the survey. Additional detail on our research methodology is provided in Appendix 2.

At a high level, we found that although attitudes vary across sectors, most allied health practitioners see the potential benefits of eHealth to their practice and health outcomes, and can and will use well-designed solutions if the perceived benefits clearly outweigh the costs and barriers. Self-contained administrative, research and note viewing applications are being widely used. As yet, though, when considering more networked, care-focussed solutions, most practitioners see the costs and barriers outweighing the benefits. Many barriers stem from the fragmented landscape of eHealth solutions as they serve the diverse needs of the allied health community.

Are Australian allied health practitioners ready?

We analysed the eHealth readiness of Australia’s allied health practitioners along three dimensions: their infrastructural readiness (their IT hardware and connections, as well as the software and solutions available to them); their aptitudinal readiness (depth of skills and capability to use eHealth solutions); and their attitudinal readiness (willingness to use current and future eHealth solutions).

Infrastructural readiness

Allied health practitioners generally 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 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, approximately 94% for inner and outer regional areas, decreasing to 69% in remote areas): see Exhibit 17. Overall, 58% of practitioners have access to a computer less than 3 years old. Most practitioners have good internet access in the main practice setting (83% in major cities, approximately 90% for both inner and outer regional areas, decreasing to 58% in remote areas), almost all of those being broadband (82%).

EXHIBIT 17 – Computer and internet access, by geographies


EXHIBIT 17 – Computer and internet access, by geographiesD

Infrastructure limitations

Even practitioners who are enthusiastic for eHealth solutions, and who are armed with excellent computers and broadband connections, find it difficult to identify and adopt the solutions they need. Systems do not suit their practice, are unreliable, or do not connect with existing systems or to the systems of other practitioners with whom they want to share information.

To understand the evolution of infrastructural readiness as the adoption of eHealth increases, we profiled the “early adopters” (i.e., those that were rated as having the highest overall eHealth readiness) and their views on eHealth barriers. We found that even the practitioners that are the most eHealth-ready perceive significant barriers around compatibility: see Exhibit 18. Problems were identified with both internal compatibility (with their own systems and devices) and external compatibility (those of other providers in the health ecosystem).

A quarter of these early adopters believe that they are not adopting eHealth solutions because the solution has not been adequately proven. Qualitative interviews suggest that this group understand the determinants of their decision to adopt, and are capable of deciding quickly. However, they are also pragmatic, and adopt only where they perceive both a need and a valid workable solution. Successful systems cannot intervene with either practice efficiency or patient outcomes.

EXHIBIT 18 – eHealth barriers perceived by early adopters


EXHIBIT 18 – eHealth barriers perceived by early adoptersD

Market fragmentation

Many of the infrastructural limitations perceived by early adopters stem from the highly fragmented nature of the eHealth solutions vendor market. In the market for computerised record systems (both administrative and clinical records), no application or group of applications has emerged as the preferred solution: Exhibit 19. There are over 75 commercial systems in use, and the 10 most used account for just 42% of the market. In itself, this fragmentation would not be an issue. However, the applications used rarely share operating platforms or standards, and may not have the functionality, reliability or support expected of modern IT applications.

EXHIBIT 19 – Computerised record systems used, all professions


EXHIBIT 19 – Computerised record systems used, all professionsD

Aptitudinal readiness

Allied health practitioners typically have the necessary aptitudinal readiness for eHealth, having sufficient capabilities from their combined professional and personal IT use. some specialised software applications will require a period of familiarisation and/or system 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 years who use at least one eHealth application, down to 56% of practitioners aged over 55 years, individual personal internet use remains high regardless of age (nearly all practitioners (97%) regularly use the internet in their personal lives). This suggests a strong underlying capability for basic eHealth solution use.

Specialised software applications will generally require a period of familiarisation, likely to include some system training. However, the majority of practitioners do not see major barriers in selecting and implementing a system, or risks in productivity dropping during a transition. Further, practitioners who have made the transition describe the inconvenience as minor compared with the benefits gained.

A common complaint though is that available eHealth software applications used are based on outdated programming platforms and operating systems. Though they may not be expected to be as intuitive as the personal and business software that practitioners use, their user interface may need improving. Vendors of preferred eHealth applications among allied health practitioners tend to include education and training of rural students and junior workers.

It is very hard for allied health practitioners to obtain funding for these initiatives, which are either supported by the professional peak bodies, or through private practices investing their own funds in patient support, monitoring and motivational tools. Psychologists can give patients access to online cognitive behavioural therapy tools such as the iCBT program developed by the Clinical Research Unit for Anxiety and Depression at Vincent’s Public Hospital. Other examples are the ‘Pro-conditioning’ and ‘Silicon Coach’ rehabilitation tools used by exercise physiologists and physiotherapists.

Attitudinal readiness

Allied health practitioners vary from those who are strongly convinced of the need for eHealth, to those who remain expressively negative. Underlying these attitudes are their perceptions of the benefits of any particular eHealth application, relative to the barriers and risks of adoption. There is some consistency in these attitudes within each allied health profession, which in turn helps determine adoption rates in each profession. However, a profession-level view cannot be the basis for an eHealth adoption strategy. As with the allied health sector as a whole, each profession is very heterogeneous: in each there are practitioners who are quite resistant to eHealth applications, and those that verge on being eHealth evangelists. A further analysis of practitioners is needed to identify these variations within professions. Identifying who will be resistors and who will be catalysts for change will be critical, as will understanding what will motivate those who are eHealth’s strongest adopters to help influence others.

Perception of benefits

Allied health practitioners believe it is expected for them to use computers, and that most of their peers use computers in their practice on a daily basis. They expect that improving collaboration, continuity of care, and practice efficiency will be the primary benefits of eHealth, far more than the potential benefits to patient engagement, satisfaction and relationships: Exhibit 20.

EXHIBIT 20 – Primary perceived benefits of eHealth, all professions


EXHIBIT 20 – Primary perceived benefits of eHealth, all professionsD

When analysing the perceived benefits by profession, it is striking how consistently the same three benefits – collaboration, continuity of care, and practice efficiency – are expected across all professions: Exhibit 21. All but two of the professions expect that eHealth will enable them to collaborate more with other care providers; all but one profession sees continuity of care as the second or third most expected benefit; while all but three professions see practice efficiency as the most likely benefit.

Although it is useful to know what benefits are most expected in a particular profession, that knowledge is not strongly actionable. Different practitioners in the same profession use computers and eHealth applications in different ways, seek different benefits, and are concerned about different risks. Interventions to drive eHealth adoption cannot target the ‘average’ dietitian or dentist.

Some other segmentation of each profession is needed to better understand the variations in eHealth motivation, and build adoption strategies that reflect those attitudes. Consider how the same list of potential benefits is perceived by the segments introduced in Exhibit 22 and 23.

EXHIBIT 21 – Ranking of perceived benefits, by profession


EXHIBIT 21 – Ranking of perceived benefits, by professionD

EXHIBIT 22 – Perceived benefits of eHealth


EXHIBIT 22 – Perceived benefits of eHealthD


EXHIBIT 23 - Perceived benefits of eHealth


EXHIBIT 23 - Perceived benefits of eHealthD

Looking at the first two rows, we see that a large proportion of both ‘proactive pioneers’ and ‘embedded activists’ (more on them shortly) strongly agree that eHealth will provide all of the suggested practice and health benefits. Along the bottom row, we see that many “firm non-adopters” strongly disagree that eHealth will bring any of these improvements. The three segments that make up the middle rows seem far more neutral, though the analysis confirms that collaboration, continuity of care and practice efficiency remained the favoured perceived benefits of eHealth. Using these analyses, an adoption strategy can build on perceived benefits in different ways with different practitioners within the same profession.

Cluster analysis of allied health attitudes

Exhibit 24 shows six clusters of allied health practitioners with quite distinct attitudes to eHealth possibilities. Using these clusters to analyse practitioner attitudes is the most effective path to identifying insights into practitioner attitudes that are actionable, and to developing a meaningful strategy to support eHealth engagement and adoption.

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. Their revealed behaviour may imply what their needs and preferences are. But 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. Only this needs-based lens looks into the future: into what “could be” rather than what “is”. (See Appendix 2 for more on this research methodology.)

Analysis of the research data revealed that the six distinct eHealth attitudinal “clusters” within the allied health population have a relatively even distribution, with each having between 13% and 20% of total practitioner numbers: see Exhibit 24.

EXHIBIT 24 – Attitudinal cluster segmentation of allied health sector


EXHIBIT 24 – Attitudinal cluster segmentation of allied health sectorD

While the biggest influence in defining the boundaries between clusters has proved to be the potential benefits of eHealth perceived by allied health practitioners (as seen in Exhibit 25), these are far from the only differences. Between clusters, practitioners are also quite distinct in their attitudes to computers, in the barriers they perceive, and in the enabling action needed for them. The two clusters most supportive of eHealth differ mainly in their work setting, though there is some crossover. Most proactive pioneers are in smaller private practice and make their own decisions on eHealth use, while most embedded converts have had eHealth decided for them in a larger public-sector setting and feel expected to use it, but have seen the eHealth benefits outweigh any earlier concerns. The three clusters that we found to be neutral on benefits are better defined by their perceptions of associated risk – safety and confidentiality, cost and reliability. These clusters may be persuaded to adopt eHealth, while practitioners in the final cluster of firm non-adopters are unlikely to be.

EXHIBIT 25 – Key attitudes, benefits and concerns, by cluster


EXHIBIT 25 – Key attitudes, benefits and concerns, by clusterD


We describe the clusters below, in order of their likelihood to adopt, and influence others to adopt, eHealth solutions. A further analysis of the most effective approach to clusters in any eHealth adoption strategy is set out below.

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

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, proactive pioneers are using 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 in 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.

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

Embedded converts typically work in a public-sector environment, hospitals or other care facilities, where computer use is expected and applications are provided for use. They tend to be younger, 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 initiatives to influence their eHealth adoption need also to convert their positive attitudes into pressure for organisational adoption.

Being the largest cluster, enlisting their support will provide the critical mass for eHealth adoption in the public sector. However, 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.

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 practitioners)

Risk-conscious practitioners are aware of the potential benefits of eHealth solutions, but remain unenthusiastic as they see risks across the board. In particular, they are about six times more likely than eHealth-positive clusters 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 the 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. Risk-conscious practitioners are found widely in across all allied health practitioner professions, with the exception of dietitians and speech pathologists.

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

Cost-conscious 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, they 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 systems and implementations costs come down.

The socio-demographic attributes of this cluster are close to the norms for allied health practitioners. The cost-conscious cluster is well represented across all sectors, with psychologists the most prominent profession and audiologists and Aboriginal and Torres Strait Islander health workers underrepresented.

Cluster 5: Doubters (13% of all practitioners)

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.

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

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

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 ‘conversational 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 to employ support staff in their practice may in the end be required, as might mandatory use secured through registration or reimbursement conditions.

A cluster analysis of professions

The clusters allow a stronger analysis of attitudes to eHealth within and between professions. The distribution of clusters within professions is uneven compared to the allied health sector overall, reflecting the clinical needs of each profession: Exhibit 26. Importantly, though, each of the six clusters is represented in all but one of the 15 professions (there are no embedded converts among the largely private-sector chiropractors). This confirms that a range of interventions will be needed within the eHealth adoption strategy for each profession.

EXHIBIT 26 – Cluster distribution, by profession


EXHIBIT 26 – Cluster distribution, by professionD

In each profession there is as well a strong representation of the positive clusters (proactive pioneers and embedded converts), ranging from 14% for chiropractors up to 77% for ATSIH workers. Accordingly, eHealth adoption strategies will have a solid base of support within each profession. These supporting clusters are explored further in Exhibit 27 and 28, which confirms that the differing attitudes to eHealth between professions is more to do with the nature and structure of work in those professions, rather than any demographic or philosophical differences between them.

EXHIBIT 27 – Rationale of pro-eHealth clusters, by profession


EXHIBIT 27 – Rationale of pro-eHealth clusters, by professionD

EXHIBIT 28 - Rationale of pro-eHealth clusters, by profession


EXHIBIT 28 - Rationale of pro-eHealth clusters, by professionD

Barriers to eHealth readiness and adoption

Compared to their perceptions of benefits, the perceptions of barriers to eHealth adoption vary greatly across allied health, whether looked at through a cluster lens (Exhibit 29 and 30) or a profession lens (Exhibit 31). The most identified barriers to wider eHealth use among allied health practitioners are:
  • Affordability: the most-identified barrier for embedded converts, cost-conscious and non-adopter clusters, and the highest-ranked perceived barrier for eight of the 15 professions
  • Compatibility with existing IT systems: both internal and external (the biggest barrier for the doubter cluster, with concern over internal compatibility consistently felt across all professions

There are also significant concerns about:
  • Privacy: among risk-conscious and non-adopting practitioners, particularly in audiology and psychology
  • Visibility of practitioner performance: felt particularly by ATSI health workers, osteopaths, chiropractors and physiotherapists
  • System malfunction and downtime (particularly among risk-conscious and non-adopting dentists, chiropractors, osteopaths and optometrists

Basic infrastructure is generally not a barrier to eHealth adoption, as most allied health practitioners in major cities and regional areas have computer and internet access in their practice. For those practitioners in rural or remote areas, this may be a limitation. Significantly, a greater proportion of allied health practitioners than other health professionals (particularly medical specialists) work regularly in remote areas, so this may have a larger impact for the allied health sector.

Strategies to minimise these barriers are discussed below.

EXHIBIT 29 – Perceived barriers to eHealth adoption


EXHIBIT 29 – Perceived barriers to eHealth adoptionD

EXHIBIT 30 – Perceived barriers to eHealth adoption


EXHIBIT 30 – Perceived barriers to eHealth adoptionD

EXHIBIT 31 – Ranking of eHealth barriers, by profession


EXHIBIT 31 – Ranking of eHealth barriers, by professionD

Drivers of eHealth adoption and usage

Most allied health practitioners will use eHealth to secure certain benefits, so long as the concerns they have raised are largely met. Additional measures may be taken to persuade practitioners that the benefits outweigh their concerns. Financial incentives gain strong agreement as an effective driver of adoption across clusters, as do advice from professional bodies: Exhibit 32. To varying degrees, practitioners are responsive to the expectations of their peers, and to the demands of patients and support staff.

The financial incentives contemplated by practitioners go beyond simple ‘cash handouts’ – in fact, it was suggested that these would be ineffective in the absence of tailored eHealth solutions for the allied health markets. The incentives suggested included IT support, training, and potentially tax relief for eHealth-enabling investments.

The breadth of and support for these drivers shown in the research suggest there is strong potential to increase eHealth adoption within the allied health practitioner sector. These drivers, and how they relate to other interventions as part of a comprehensive eHealth strategy, are discussed further below.

EXHIBIT 32 – Drivers of eHealth adoption, by cluster


EXHIBIT 32 – Drivers of eHealth adoption, by clusterD

Summary

The eHealth readiness of the allied health sector was explored through 40 qualitative interviews and a quantitative survey of 1,125 allied health practitioners. The high-level findings are that, though attitudes vary across sectors, most allied health practitioners see the potential benefits of eHealth to their practice and health outcomes, and can and will use well-designed solutions if the perceived benefits clearly outweigh the costs and barriers.

Computer hardware, connectivity and practitioner aptitude are not major barriers to readiness. Self-contained administrative, research and note-viewing applications are being used, and the sector is ready and very interested in more networked, care-focused solutions. However, due to the fragmented market for eHealth solutions in the allied health community, the adoption risks and barriers are currently too high. Available systems do not suit their practice, are unreliable, or do not connect with existing systems or to the systems of other practitioners with whom they want to share information. There are over 75 commercial systems in use, and few have been tailored to specific allied health needs.

Differences in practitioner readiness emerge when considering their attitudes to eHealth benefits and barriers. To analyse these differences, we considered six “clusters” of allied health practitioners with quite distinct attitudes to eHealth possibilities. Two of these six clusters, representing 36% of all practitioners, are strong eHealth supporters and are present in both public and private practice. Another three clusters may be persuaded about eHealth benefits but are defined by their perceptions of risk – safety and confidentiality, cost and reliability. The final 20% of practitioners are firm non-adopters, seeing risks across the board and few if any benefits.

These six clusters are represented across all 15 allied health professions, confirming a range of interventions will be needed within the eHealth adoption strategy for each profession. In each profession as well the eHealth positive clusters are also strongly represented, so that eHealth adoption strategies will have a solid base of support within each profession.

All but the firm non-adopters are fairly consistent in believing that eHealth would improve collaboration, continuity of care, and practice efficiency, rather than suggested benefits to patient engagement, satisfaction and relationships. Access to and quality of care are also acknowledged benefits, though not strongly. The strongest perceived barriers are system affordability and compatibility. Privacy, visibility of practitioner performance, and system reliability also cause considerable concern.

Adoption of eHealth will be influenced by financial incentives and the support and advice of professional bodies. Practitioners will also be responsive to the expectations of their peers, and to the demands of patients and support staff. These and many more intervention levers will need to be integrated in effective adoption strategies to convert latent eHealth readiness into widespread use.
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