As we have seen, each cluster has its own distinct perceptions of eHealth benefits, risks and barriers to adoption, and these distinctions are more actionable in a change strategy than any differences between specialties: see section 6 above. Any strategy for eHealth adoption will therefore need to include interventions targeted at clusters in each specialty, reinforcing the benefits they perceive, while addressing the barriers and risks. Before identifying what those actions should be, we should confirm what each cluster will be influenced by, and how each cluster might be leveraged to influence others. The following section provides an overview, summarised in Exhibit 22, of the most effective likely approach to influence each cluster towards adoption.
Cluster 1: eHealth entrepreneursAs keen early adopters and eHealth advocates, the eHealth entrepreneurs have the ability to act as strong change enablers. It is critical that engagement strategies targeted at these specialists work with and not against their existing investment in eHealth solutions and infrastructure, and that they are encouraged to adopt solutions compatible with the standards being put in place (as there is a risk that as early adopters, they start using solutions that are not compliant with standards). This cluster’s experience and enthusiasm position it especially well as an influencing driver to persuade more hesitant practitioners. Since the cluster is well-represented in most specialty groups, they have the ability to collectively reach a large number of other medical specialists.
Engagement strategies should therefore aim to harness the energy of eHealth entrepreneurs and garner not only their endorsement, but also their leadership and ownership of the eHealth technologies and their application in the context of their practice. They can serve as valuable contributors to designing and shaping solutions and defining relevant value propositions for their peers. Additionally, they can lead or support demonstrations of usability and benefits, and liaise with their relevant professional bodies for further engagement.
Cluster 2: Network adoptersThe network adopters are similarly predisposed towards eHealth, but are primarily confined to a small number of specialty segments (emergency, anaesthesia, and diagnostics) and typically reside within public hospitals. As such, they are often constrained and heavily influenced by the hospital environments in which they operate. Because their hospitals often have the scale and scope to justify eHealth expenditure, the use of eHealth tools (e.g. ePathology, electronic medical records) is often mandated and as a result, many network adopters are avid eHealth users. However, other network adopters voiced concerns that the pace of investment decisions in their hospitals is very slow, which prevents them from increasing their take up of eHealth.
Network adopters can play an important role as change advocates within their networks of care because they interact with a wide range of other specialists and other healthcare professionals, as well as with patients. As eHealth supporters, they are able to disseminate information and influence perspectives more broadly within their operating environments. For example, radiology specialists frequently share imaging with surgeons and could use this connection to help surgeons understand benefits of electronic imaging over traditional films.
One critical factor for increased adoption is connecting the network adopters so that they can share information in a structured format outside of their hospitals. Public hospital systems typically restrict access to information to hospital practitioners and these records are not typically interoperable with systems external to the hospital.
Cluster 3: Capable but unconvincedThis cluster is willing to adopt eHealth, but only if convinced that the benefits are there, and that it will not compromise the efficiency of their practice. The case for adoption must be carefully prepared for them, and include propositions for improvements in either their practice or clinical outcomes. The case must include clear evidence that the proposed eHealth solution has been implemented successfully by other practitioners whom they respect. Evidence that the eHealth solution being proposed to them is an integral part of a broader and positive healthcare reform will be important to them. However, that argument will not be decisive unless they are sure they can adopt the solution without losing practice efficiency. They are less concerned about other risks perceived by the apprehensive follower cluster.
The ‘capable but unconvinced’ cluster is fairly evenly distributed across specialty segments, so a specialty-focused approach will be less appropriate. Those operating in hospital environments may be reached through their more enthusiastic network adopter peers. Beyond general communication with private practitioners, the adoption strategy will need to target specialists who are known networkers and influencers. As the specialists may make less direct use of the eHealth solution than their administrative staff, they may also be influenced by initiatives that help their staff adopt the solutions.
The news that these unconvinced specialists are starting to adopt eHealth solutions will be particularly persuasive for apprehensive followers. They may well expect eHealth pioneers in private practice to take up new systems, as well as those in the public sector who have had the decision made for them by the Department or hospital administrations. That slightly more sceptical practitioners have been convinced will mean the eHealth initiative has crossed a threshold to the mainstream.
Cluster 4: Apprehensive followersThis will be a challenging cluster because it is less likely to perceive eHealth benefits, faces several major barriers, and is relatively difficult to influence. Therefore, adoption strategies targeted towards these practitioners will need to take a multi-faceted approach; simply addressing one or two major barriers will not be sufficient to drive adoption.
As their name suggests, there are two arguments for not targeting apprehensive followers too early in the strategy. First, given this group’s lack of IT support, it will be better to present them with proven systems and surround them with a network of competent users. Second, members are much more likely to be persuaded if they feel that a large number of healthcare professionals in the system has already adopted, particularly previously unconvinced specialists. Frequently updated, transparent information on adoption level and momentum within their relevant communities of care will provide some of the pressure and encouragement needed for them to change.
This does not mean, however, that they should be uniformly deferred until later, as a number of this group can be mobilised in early phases if adoption levels and rates are sufficiently high within their specific healthcare network/community, e.g. anaesthetists. In earlier stages, they could be invited to participate in discussions that shape eHealth solutions and delivery models and provide feedback on ways that the solutions could best address their needs and concerns.
Cluster 5: UninterestedGiven their uniformly negative attitudes towards eHealth, this will be the most challenging cluster to change. It should not be ignored, however, as some of its members can be in positions that influence their peers or public opinion.
The cluster is comprised largely of specialists with little perceived use for eHealth in their care delivery process (e.g. surgeons and psychiatrists). They are primarily private-sector based practitioners, often in small, isolated practices with minimal incentive to change. While not interested in eHealth for its own sake, they may be persuaded by the need for them to adopt eHealth solutions as part of an overall strategy to improve overall health outcomes. However, there will be a point at which the best approach will be to require, rather than request, them to adopt.
An active communication plan addressing their perceptions with evidence should be pursued, even if active adoption is not expected early. Additionally, for those who may be open to change, it will be much easier to persuade them once they see their peers using the systems effectively, and once systems have been developed that address their specific needs.
Other avenues of change support for this cluster are the practice managers and support staff. While these personnel may have limited influence on practitioners’ perceptions and behaviours, they frequently determine computer use within the practice because the specialists have such limited involvement in IT.