No description available.

In 2011, the Saudi Arabian Ministry of Health (MOH) launched the Saudi Telemedicine Network (STN) as the first national project for telemedicine in the KSA, which is planned to be completed by 2020. The benefits associated with the STN will only be realised through its successful implementation within the Healthcare Facilities (HCFs) across the Kingdom of Saudi Arabia (KSA). There is a high failure rate of implementation projects of telemedicine within other countries (approximately 75% globally, and 90% in developing countries). Furthermore, there is high failure rate of implementation projects of complex Health Information Technology (HIT) systems within HCFs of the KSA (roughly 80%). These dramatic statistics demonstrate the great need for a suitable framework to assist the STN implementation and increase the likelihood of its successful implementation. Prior studies have asserted that there could not be a one-size-fits-all framework that could be applicable and used by all countries for assisting the implementation of telemedicine. To the best of our knowledge, there is not any existing framework that has been specifically developed for assisting the STN implementation. Thus, this research is aimed at developing a novel, agile, holistic framework, referred to as “JoinSTNassistant Framework”, aimed to assist HCFs across the KSA regarding their organisational decision to join the STN. It must be ensured that this JoinSTNassistant Framework is theoretically rigorous, as well as relevant specifically to the context and the needs of the KSA, its HCFs, and the STN roadmap. Therefore, the JoinSTNassistant Framework has been developed through three-sequential phases. The First Phase of development defines and applies the theoretical and philosophical foundations of the JoinSTNassistant Framework. In this First Phase, 56-selected studies from an extensive literature review were analysed. The Second and Third phases of development reflect the practical and pragmatic requirements of the JoinSTNassistant Framework. These two phases must be considered as two stages of validation of the findings of the First Phase, involving as many potential users as possible in the development of the Framework, so as to ensure that it reflects their expectations and meets their needs. The Second Phase of development involved interviews with 81 strategic-level decision makers of HCFs within the KSA. The Third Phase implemented an even higher level of validation, involving as many as 905 potential users, forming a representative sample size of the decision makers of all HCFs across the KSA. In addition, a web-based application (i.e., Portal) for the JoinSTNassistant Framework, referred to as “JoinSTNassistant Portal” was developed for modifying and adjusting the JoinSTNassistant Framework in order to be applicable for each one of HCFs across the KSA, for assisting and guiding them in reaching a decision to join the STN. This research is part of the STN project and is collaborating with the National eHealth Strategy and Change Management Office in the MOH of KSA, and with the STN agency, who is the sponsor and the owner of the STN project.

Telecare – the use of technology to facilitate access to health and social care services – has risen in prominence over the last decade in the context of population ageing, a rise in long-term conditions and economic uncertainties. UK policy advocates adoption of telecare at scale, citing the promotion of independence and empowerment as benefits, but local implementation has been variable and the experiences of service users show a nuanced picture. This thesis investigates telecare policy, and its interpretation and implementation. It draws on an argumentative discourse analysis and material-semiotic approach to understand the experiences of telecare at a case study site. Narrative interviews and observations were undertaken, involving service provider and technology industry stakeholders and service users. Findings reveal four ‘story-lines’ of telecare policy but discrepancies between this discourse and local experiences. People are shown to engage with telecare to different extents, with the prevailing technology ‘script’ influencing non- or mis-use of devices. New work roles created by telecare sometimes appear ‘invisible’ or devalued. Furthermore, there is a lack of meaningful involvement of service users in decision-making. This study adds a theoretically-informed voice to the academic field and makes recommendations for future telecare policy, practice and research.

This study aims to understand the use of a computer during GP consultations and to enable the development of EPR systems which are easier to review, enter data into, use to take action, and is more sensitive to the clinical context. This thesis reports the development of a multi-channel video and data capture toolkit, the ALFA (Activity Log File Aggregation) because existing observation techniques have limitations. None of the existing tools are designed to assess human-computer interaction in the context of the clinical consultation, where the social interaction is the prime focus. The ALFA tool-kit has been used to observe and study 163 live primary care consultations supported by computer systems with four different designs. A detailed analysis of consultation interactions was then performed focusing on doctor-patient communication and the integration of the computer into the consultation workflow. The data collection elements of the ALFA supported recording of consultation activities by providing rating techniques attuned with the characteristics of those interactions. The Log File Aggregation (LFA) component of the ALFA toolkit aggregated those multitudes of data files into a single navigable output that can be studied both quantitatively and qualitatively. A set of Unified Modelling Language (UML) sequence diagrams were then created as they could be used by software engineers to develop better systems. This research proposes a framework with three elements to analyse the computerised clinical consultation; (1) the overview of the context within which the consultation was carried out, (2) time taken to perform key consultation tasks and (3) the process used. Traditional analysis with its emphasis on the technology often misses crucial features of the complex work environments in which the technology is implemented. Direct observation could inform software designers in developing systems that are more readily integrated into clinical workflow. Direct observation of the consultation, using the ALFA toolkit is acceptable to patients; captures the context of the consultation the precise timing and duration of key tasks; and produces an output a software engineer can understand. ALFA offers a range of possibilities for research in the consulting room. The computer should be considered as an active element of the consultation; room layout and consultation models should let the computer in, while software engineers take in the capacity to sustain patient centred social interactions as a core facet of their design agenda.

In Sri Lanka, urban hospitals offer specialized healthcare services, while rural hospitals have limited services and normally offer only basic hospital facilities. Therefore people in rural areas have to travel relatively long distances to urban hospitals which offer specialized healthcare. This is expensive, while the poor transportation systems in rural areas make travel to urban hospitals time-consuming often involve an overnight stay. The aim of this research is to improve access to healthcare by adopting telemedicine in rural areas where the patient and the clinician in the rural hospital can contact the consultant in the urban hospital using audio, video and data communication methods for specialized healthcare services. The methods used were questionnaires and interviews in the exploratory study, which had small number of participants (83) covering three regions, followed by the main survey which had large number of participants (225) and ten regions. A model for adoption of a telemedicine system in Sri Lanka was developed from the analysis of the literature and the exploratory study. The exploratory study was conducted in three districts of Sri Lanka involving clinicians, hospital staff and the general public from both rural and urban areas, and Health Ministry officials, medical directors and consultants. The major study was conducted in ten districts and on two islands of Sri Lanka to identify the factors in the model which influenced the adoption of telemedicine. The findings of the main survey clearly indicate how important the telemedicine solution is to the rural population. The results also show that hospital staff and the general public were very much in favour of adopting telemedicine. The results also indicate that both clinicians and hospital staff believe that staff involvement, and introducing new policies and standards, will influence the adoption of telemedicine. Clinicians believe that Internet connectivity and the equipment used will not have an effect on introducing telemedicine. This model will be beneficial when implementing a telemedicine system into rural areas of Sri Lanka, which will provide patients with access to specialized healthcare services.

The promise of telemedicine is great as observed in developed countries. However, its adoption in developing countries has been very slow. The Kenyan government approved telemedicine (use of ICT to overcome geographical barriers and increase access to health care services) as a strategic approach of improving healthcare delivery especially in the marginalised areas of the country. However, the adoption of telemedicine is further hindered in developing countries by the fact that the cost of implementing telemedicine technology is deemed high and the resources needed are scarce especially in the public sector. Extant literature on healthcare technological innovation indicates that organisation collaboration can expedite the adoption of telemedicine especially in developing countries. Since it is highlighted that empirical evidence on how organisation collaboration can facilitate telemedicine deployment in developing countries is still lacking, this research aims to develop a model to examine the potential of various organisation factors in facilitating telemedicine deployment in developing countries. This study employed a conceptual research framework to examine organisation factors that may influence organisation collaboration in facilitating telemedicine deployment in developing countries. A questionnaire survey was conducted in 50 private and public hospitals located in Eastern Kenya. 177 valid questionnaires were received and analysed using SPSS software (version 20). The findings of this research revealed that Kenyan hospitals collaborate with other organisations mainly to lessen budget restrained suffered during technological innovation process. Further, it was revealed that organisation affiliation might enhance their ability to adopt telemedicine. Organisation affiliation was observed to significantly influence organisation resources, organisation’s innovation acceptance, organisation’s innovative capacities, organisation agility and collaborative innovation aspects. In addition, all the organisational model factors were supported and explained 46.5% of the variance in collaborative innovation internal outcomes and 53.2% of the variance in collaborative innovation external outcomes. However, personnel innovation acceptance made no significant effect on collaborative innovation outcomes.

Rural and geographically isolated, the majority of Nepalese communities have very low incomes, poor transportation, and scarce health care resources; these people provide the context for this study. The consequences of these deprivations include high maternal and infant mortality rates, high prevalence of infectious disease and poverty. There are therefore exceptional challenges and disparities in meeting health care needs. However the recent advent of modern information communication technology (ICT) or Telemedicine has unleashed a new wave of opportunities for supporting the delivery of health care services. Despite suggestions that telemedicine will offer hope in developing countries there is only limited published evidence to support this claim. Telemedicine is and must remain a process of the delivery of care rather than a technology. The system must connect patients and healthcare professionals in a chain of care, rather than follow the wide array of existing or new and advanced technology. The successful introduction of telemedicine with tangible outputs requires an in-depth understanding of the existing health care system of the country and its challenges; strongly expressed ‘genuine need’ for the service by all the stakeholders as interested partners (patients, practitioners, health care service providers and the public); the actual status of ICT infrastructure in the country and costs. This study used a Participatory Action Research (PAR) approach to explore the feasibility, acceptability and impact of a telemedicine system in partnership with Dhulikhel Hospital: Kathmandu University Hospital and with three of its 12 rural, remote outreach centres, and the populations they serve. Participatory, repeated data collection methods included surveys, interviewing, listening and being with staff and communities over a two year period. The researcher and researched engaged in a complex inter-locking journey from which the Unlocking, Unblocking and Validation concepts emerged. The findings of this study emphasise the pivotal role that the rural health care workers play. Telemedicine not only has a place in improving access to healthcare through enhanced communication but it also empowers health care workers. These people need continued support to develop their competencies and boost their confidence within the changing health care environment. In conclusion telemedicine is primarily about people rather than technology. Effective and holistic telemedicine development is built upon a combined, interactive model involving access, communication and empowerment.