A specialist’s eHealth infrastructure includes the IT hardware, software and connections in their operating 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), although access does decrease slightly when these practitioners travel to remote areas (79 percent) (Exhibit 7). Similarly, internet access is widespread in the main practice setting in major cities (86 percent), but less commonly available in remote areas (70 percent). The reduced availability of computer and internet access in remote regions is only relevant for the 30 percent of specialists travelling to these areas on an occasional basis, as less than 1 percent of specialists are based in a remote area.
The majority of specialists have broadband connectivity (84 percent of respondents with internet access) and access to a computer less than 3 years old (62 percent of respondents with computers). Although the ~30 percent of specialists with older computers might have difficulties with certain software programs, they are usually able to use basic web-based eHealth applications.
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 the concern about system malfunction or downtime, a major barrier to adoption among 34 percent of specialists (Exhibit 8). System malfunctions can cause enormous disruptions to practitioners’ care delivery process as an inability to access information can paralyse the practice’s workflow. A further complaint uncovered in interviews is that the eHealth systems can be difficult to learn and use properly, which is even more problematic if users frequently rotate or change practices. eHealth software applications used are based on older programming platforms and operating systems, and so are not as intuitive or flexible to change as specialists experience with modern personal and business software. For example, one specialist mentioned that a new receptionist accidentally pushed the wrong button on the practice’s electronic medical record system and it accidentally deleted several months of appointment bookings.
Consistent adherence to interoperability standards will also improve information sharing, as 32 percent of specialists strongly agreed that maintaining internal compatibility is a barrier to eHealth adoption and 23 percent strongly agreed that connecting with external systems is a barrier. Furthermore, some specialists and hospitals are postponing adoption decisions in anticipation of a universal, enforced standard or other similar directive. Connectivity between private specialist rooms and public hospitals is particularly difficult to establish because hospital systems are currently designed and used for internal connectivity only.
The current landscape for electronic medical records is highly fragmented, explaining some of the concerns about software compatibility and hardware connectivity (Exhibit 9). For example, the top 10 vendors account for ~65 percent of all survey respondents, with the single largest vendor (Genie Solutions) accounting for ~23 percent of respondents. Discussions with users listed the following drivers for choosing one electronic medical record system over another:
- Peer endorsement. Specialists frequently ask peers who have already adopted for advice to determine the most user-friendly and most suitable options. Peer recommendations are an especially strong driver among private practitioners
- Knowledgeable and enthusiastic salespeople who provide strong demonstrations. Specialists adopting a system for the first time conclude that if a salesperson isn’t able to understand and use a system, then they probably won’t have much success with it either
- Solutions that work out-of-the box. Specialists appreciate being able to use a system immediately, but also want access to more advanced functions if and when they are ready to explore them
- Relevance. Solutions need to be tailored to meet specialists’ needs – specialists do not want to spend additional time working through endless drop-down menus and capturing irrelevant information (e.g. geriatricians do not need to ask their patients if they are pregnant)
- Flexibility across specialties. Some private-sector specialists practice in consulting suites alongside specialists from other disciplines (frequently a spouse or colleagues sharing space in the same unit). Since EMR systems can be an expensive investment, specialists often seek a common platform that enables them to distribute costs among multiple co-locating practitioners.