There is a strong infrastructural and aptitudinal foundation for eHealth use by specialists. For more advanced, collaborative applications, IT connectivity and practitioner skill levels may be barriers, particularly where specialist software is non-intuitive compared to modern personal and business applications. Attitudinal readiness is highly variable across specialties, and depends significantly on the expectations in place in the specialist’s working environment.
Consistent with observed eHealth use for self-contained applications, most medical specialists have the necessary basic infrastructural readiness. However, system reliability, connectivity and interoperability concerns are major barriers to the use of connected, information-sharing eHealth applications, especially among early adopters.
Most medical specialists have access to computers in their main practice setting (86 percent in major cities and over 90 percent in inner regional and outer regional locations, with access falling to 79 percent when these practitioners travel to remote areas). A majority (62 percent) have access to a computer less than 3 years old. Internet access is also widespread in the main practice setting in major cities (86 percent), but less commonly available in remote areas (70 percent). Of those with access, 84 percent have broadband connectivity.
Beyond basic computer and internet access, which is largely in place, specialists need access to reliable, easy-to-use systems that enable information sharing across practices. Improving reliability and usability will help reduce a major barrier to adoption among 34 percent of respondents, the concern about system malfunction or downtime. System malfunctions can cause enormous disruptions to practitioners’ care delivery process as an inability to access information can paralyse the practice’s workflow. Specialists also commented that eHealth systems can be difficult to learn and use properly, which is even more problematic if users frequently rotate or change practices.
Again, most medical specialists have the skills and interests needed for self-contained eHealth applications (internet navigation, form completion, etc.). Current usage suggests that specialists are as technology literate as doctors as a whole, with widespread computer use. Usage rates decline with age but not steeply, with 76 percent of specialists aged 55–64 using computers in their workplace, and 93 percent of medical specialists aged 65+ spending some personal time online each week. While specialists typically have sufficient levels of competence for basic computer use (e.g. accessing information online and sending emails), those who transitioned to computerised systems acknowledged that they suffered a loss in productivity in part due to the learning process in the first few months of the transition. Some practitioners were unwilling to undergo this learning process for fear that their patients would lose confidence in their skills if they were perceived to be struggling with computer use. One approach taken internationally was to address this challenge by building additional capacity during the transitional period.
Beyond training and support for system installation, specialists also need IT support for troubleshooting when things go wrong – they expect systems to work, and are not always willing or able to spend time resolving IT problems. For this reason, IT support is critical for most specialists, especially when installing and learning to use systems. Specialists in larger practices and hospitals usually have access to dedicated IT personnel, but specialists in smaller practices often struggle to find competent, affordable support when they need it, or don’t appreciate the need to set up access to such support before it is suddenly required. For example, one interviewed paediatrician stopped paying for an IT maintenance and support service, only to see her IT system disabled by a virus after her antivirus software expired.
The lack of IT support for these specialists restricts their readiness to systems that they perceive as proven to be reliable (e.g. some practitioners will only use AppleŽ products) or solutions where malfunctions or downtime could be tolerated on a temporary basis.
Medical specialists have varied attitudes towards eHealth, with some being strongly convinced of the benefits, and others remaining pessimistic. Underlying these attitudes are their perceptions of the benefits of eHealth applications, and the barriers that confront them in adopting those applications. These attitudes are strong determinants of adoption rates in each specialty segment. But the segments are not homogeneous: in each there will be specialists who are resistant to eHealth applications, and those that verge on being eHealth evangelists. Identifying the resistors and the catalysts for change will be critical, as will determining the best approach for mobilising eHealth’s strongest advocates to help influence their peers.
To better explore and understand these attitudes and underlying perceptions, our analysis has identified 5 distinct ‘clusters’ of medical specialists. We now turn to that cluster analysis as the clearest way of identifying insights to medical specialist attitudes that are actionable, and upon which can be built a meaningful strategy to support eHealth engagement and adoption.