eHealth technologies and solutions offer significant benefits, from better collaboration between practitioners and continuity of care, through to better quality of care and efficiencies. Realising these benefits, however, requires a high degree of connectivity and coordination between numerous players embedded in a complex ecosystem. Although medical specialists form just a small part of the vast health landscape, they serve as critical hubs for information transfer. Their engagement is therefore necessary for advancing the use of eHealth to achieve system-wide outcomes. However, little research has been done to date on understanding medical specialists’ positions with respect to eHealth.
This report sets out our research on the use of and attitudes towards ‘eHealth’ (the combined use of electronic communication and technology in healthcare) among the full range of licensed medical specialists in eight different segments–anaesthesia, diagnostics (radiology and pathology), internal medicine, emergency medicine, obstetrics and gynaecology (including neonatology), ophthalmology and dermatology, psychiatry and surgery.
Our research has been framed around three ’anchor’ questions:
- Are Australian medical specialists ready to adopt and use eHealth technologies and solutions, today and in a way consistent with policy direction in the future?
- What are the barriers impacting eHealth readiness and adoption and how can we minimise them?
- What are the eHealth enablers and how can we apply them to drive adoption and effective usage?
We conducted 20 initial qualitative interviews to design a quantitative survey, ran that survey with 600 medical specialists, and interviewed a further 20 specialists in-depth. The quantitative survey was targeted at a random sample of ~10,000 practitioners, designed to incorporate geographic and demographic stratifications, and secured a response rate of ~6%. The sample sizes achieved imply an ~11% error of estimation at the 95% confidence level for sector-level analyses. All questions within the survey were mandatory. While the sample was designed to capture key demographic lenses, for analysis purposes the responses have been weighted such that responses, and the high-level results drawn from them, are representative of the medical specialist population as a whole. This research is intended to provide a starting point for understanding medical specialists’ eHealth readiness and findings should be interpreted as directional in nature.
Australia’s medical specialists have a strong foundation for eHealth adoption and use, but are far from realising its full potential. Specialists generally take a practice-oriented view, rather than a macro-level perspective to eHealth benefits. For this reason, current use is typically self-contained within a practice or hospital rather than integrated across networks. Specialists are generally ready to adopt eHealth technologies that improve their practice’s operational efficiency, but only to the extent that delivery of care within their practice is not disrupted. Specialists have the skills and tools needed to support self-contained eHealth use, but most lack the connectivity, IT support and conviction required to engage in a way that drives more widespread improvements in patient-focused clinical outcomes. For example, many specialists have adopted computerised record keeping systems within their practice, but are unable to share these records in a computerised format with their patients or with other practitioners.
Attitudes vary not only according to the personality and IT-engagement of the individual specialist, but also according to their operating environment, the nature of their work and the business model of their practice. If those in an emergency ward, for example, are expected to update patient records on the IT infrastructure provided, then they will do so. Private practice surgeons who work more independently, and for whom any IT failure or distraction is costly, are often less enthusiastic. However, even these practitioners may still be willing to adopt certain solutions due to influence from practice managers and support staff, who are often the primary users of practice billing, scheduling and record keeping systems. While comparing specialties helps explain some of the differences between observed eHealth adoption levels, there is still a high degree of heterogeneity with respect to adoption within most specialties.
To help understand these variations, we analysed the eHealth readiness of Australia’s medical specialists 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 infrastructural and aptitudinal readiness for basic, self-contained computer applications, but differences emerged when more connected applications were considered, and these were amplified by differences in attitudinal readiness.
Knowing that each specialty segment contained a proportion of eHealth early adopters and enthusiasts, we sought to more clearly understand the underlying drivers for the observed attitudinal differences. This understanding could, in turn, help inform approaches for increasing adoption and use within each specialty. Through this attitudes-based analysis, we identified five separate groups of specialists, distinct ‘clusters’ in their potential eHealth engagement, which occur across the practice groupings of specialists. Each cluster exhibited differences in perceived benefits, perceived barriers and the likely enablers that will drive their use and adoption of eHealth practices and solutions.
This report works through the above analysis. It opens by confirming the medical specialties that we researched and detailing their current and expected future uses of eHealth solutions. The report then sets out the infrastructural, aptitudinal and attitudinal readiness of medical specialists to use eHealth solutions now and in the future. We then introduce our analysis of the five attitudinal ‘clusters’ that exist in each medical specialty and the eHealth benefits and barriers they perceive. Finally, we demonstrate how these cluster insights might be used in developing a strategy for eHealth adoption: the interventions most likely to be effective, and a considered approach to timing and applying those interventions.