This thesis is dealing with problems of eHealth specified on particular conditions on the territory of the Czech Republic in context of national economy. Positive and negative aspects of implementation of eHealth solution into health services is evaluated in theoretic part of thesis as well as dominative problems which faces development of eHealth in the Czech Republic. Fundamental plans of support eHealth in the European Union and Czech Republic are described as well. Practical part of thesis is concerned with particular projects of eHealth in the Czech republic. Evaluation of project IZIP is performed due to questionnaire inquiry among the doctors. The example of contribution of implementation eHealth solution into health services is shown on Oblastní nemocnice Mladá Boleslav, a.s.

This diploma thesis is dedicated to the analysis of eHealth strategies of the German speaking countries and to the proposal of a conception for the Czech Republic. The first part is dedicated to theory. At the beginning, it provides a brief review of the literature which has already been written about this topic. Further, it deals with the topic and definition of eHealth in general, its history, applications, benefits, and the way how eHealth is approached by the European Union. The second chapter provides analysis of eHealth and its technologies in Austria, Germany and Switzerland. At the end of the chapter, the comparison of the current states of eHealth in these countries is conducted. The third chapter deals with the current state of eHealth in the Czech Republic. The last chapter is dedicated to the proposal of the conception for the Czech Republic.

[EN] EHealth plays an essential role in supporting healthcare in today's digital society; it is perceived as crucial for high quality and cost-effective healthcare. However, getting the expected benefits from eHealth has been difficult to demonstrate. There has been a raising interest in adopting eHealth Governance frameworks to obtain re-assurance that investments return the expected results in health care. How IT Governance is implemented within healthcare, the actual impact on strategic alignment and its influence to the information society progress, remains poorly understood. For this purpose we have explored the application of these frameworks within the National Health Service in Scotland and their impact on the following three aspects: eHealth Governance maturity, strategic alignment with healthcare and local progress of digital societies. This research is a longitudinal study (2008-2013), involving an exploratory and explanatory multi-case analysis of three representative organisations across Scotland. A combination of empiric methods has been used: semi-structured interviews with implementers, surveys (Strategic Alignment Model), cross-sectoral/national benchmarking based on a literature review and a qualitative analysis of established eHealth progress indicators. Ninety-two participants have been involved across three case studies. The outcomes of this study have been published over a period of 5 years representing a composite thesis based on relevant publications. Results sustain that EHealth Governance is in its infancy across sectors and countries. 80% of the organisations worldwide are in a transition point between a "committed" and an "established" process. Our results support that the more mature eHealth Governance is, the better the strategic alignment between eHealth and health care organisations (HCOs), hence the better progress of eHealth and the Digital Society. The Strategic alignment is slowly maturing across organisations (15% since 2008), indicating a faster development than the overall Digital Society (Scotland) progress indicators. The National eHealth Strategy shows signs of steady progress and very positive eHealth uptake in society with an overall growth of 12% since 2008, despite the deep economical recession within the period of this research. The conclusions of this study as a longitudinal analysis are limited and more research over the forthcoming years is required. For this purpose, a simplified and adapted method to monitor these trends in future HCOs research has also been provided. / [ES] La eSalud juega un papel esencial en el desarrollo de la asistencia médica en sociedades digitales; se percibe como un elemento crucial en la provisión de servicios médico-sanitarios alta calidad y costo-efectivos. A pesar de ello, hasta ahora ha sido difícil demostrar la materialización de los beneficios esperados de la eSalud, pero hay un interés creciente en la adopción de marcos de referencia basados en buenas prácticas, y estándares profesionales internacionales para la gestión y dirección de la eSalud, con el propósito de asegurar que las inversiones revierten los resultados esperados en el cuidado y servicios de la salud. Hasta ahora se sabe muy poco sobre el fenómeno de cómo la eSalud es integrada en el cuidado y servicios de la salud, y del impacto que esta tiene en la alineación estratégica de la eSalud. Igualmente, sabemos muy poco de la influencia real que estas prácticas tienen en el progreso de sociedades digitales. Este estudio se centra en explorar la aplicación de buenas practicas y estándares internacionales como marco de referencia en el gobierno de la eSalud en el servicio de salud Escocés; también contrastamos y comparamos el fenómeno con otros países y sectores. Esta investigación es un estudio longitudinal (2008-2013) que incorpora un análisis exploratorio y explicativo de casos. Se obtuvieron un total de noventa y dos participantes a lo largo de los tres casos estudiados, con representación de los principales grupos de interés (médicos y no médicos). Los resultados se han divulgado a lo largo del periodo de investigación en un compendio de publicaciones relevantes que conforman la tesis. Los principales hallazgos muestran que el gobierno de la eSalud está en su infancia en los sectores y países analizados: el 80% de las organizaciones a nivel mundial presentan este proceso en un punto de transición entre "comprometido" y "establecido" (Modelo SAM). Los resultados corroboran que cuanto más maduro es el gobierno de la eSalud, mayor alineación estratégica entre la eSalud y la organización, y mayor progreso de la variable eSalud en los indicadores de la sociedad de la información. La alineación estratégica esta madurando lentamente (15% desde 2008), sin embargo este crecimiento es mas rápido que el progreso observado en los indicadores de la sociedad digital (Escocia). La estrategia nacional Escocesa muestra signos de progreso sostenido y de integración (por uso o adopción) de las iniciativas de eSalud en la sociedad (crecimiento del 12% desde 2008), a pesar de la profunda depresión económica durante el periodo de investigación. Las conclusiones de esta investigación, como estudio longitudinal, son limitadas y requieren la captura de más datos y observaciones durante los próximos anos. Con el fin de facilitar este proceso, se ha propuesto un método simplificado y adaptado al sector salud, que permite capturar observaciones, comparar y monitorizar estas tendencias en futuras investigaciones en el sector salud. / [CAT] La eSalut juga un paper essencial en el suport a l'assistència sanitària a la societat digital de hui en dia; es percep com crucial per a l'alta qualitat i efectivitat del servicis de salut. No obstant això, ha estat difícil de demostrar la obtenció dels beneficis esperats de la eSalut. Hi ha hagut un interès en augmentar l'adopció de marcs de governança de la eSalut per obtenir re-assegurament que les inversions retornen els resultats esperats en els servicis sanitaris. Com s'implementa la governança de les TIC dins de l'assistència sanitària, l'impacte real en l'alineació estratègica i la seua influència en el progrés de la societat de la informació, continua sent poc conegut. Aquest estudi explora l'aplicació d'aquests estàndards i marcs de referència dins dels Serveis Nacionals de Salut d'Escòcia i el seu impacte en els tres aspectes següents: la maduresa de la governança de la eSalut", l'alineació estratègica amb l'assistència sanitària i, finalment, el progrés local de les societats digitals. Aquesta investigació és un estudi longitudinal (2008-2013), que implica una anàlisi multi cas exploratori i explicatiu de tres organitzacions representatives del servici nacional de salut de Escòcia. S'ha utilitzat una combinació de mètodes empírics: entrevistes semi estructurades, enquestes (Model SAM) comparatives de mercat intersectorial i internacional basat en una revisió bibliogràfica i, finalment, una anàlisi qualitativa dels indicadors de progrés eSalut. Noranta dos participants han informat a través de tres estudis de casos. Els resultats s'han divulgat al llarg del període d'investigació en un compendi de publicacions rellevants que conformen la tesi. Els resultats assenyalen que la governança de la eSalut està en la seua infància en tots els sectors i països. 80% de les organitzacions de tot el món es troben en un punt de transició entre un procés "compromès" i "establint". Els nostres resultats apunten que quan més madur es la governança de la eSalut, millor serà l'alineació estratègica entre la eSalut i les organitzacions d'atenció sanitària (HCOs), per tant el millor progrés de la sanitat electrònica a la Societat Digital. L'alineació estratègica està madurant lentament en les organitzacions (15% des de 2008); aquest desenvolupament és més ràpid que el progrés de la societat digital (Escòcia). L'estratègia Nacional de eSalut mostra signes de progrés constant i l'absorció de la eSalut en la societat es prou positiva, amb un creixement global del 12% des de l'any 2008, tot i la profunda recessió econòmica durant el període de temps d'aquesta investigació. Les conclusions d'aquest estudi com una anàlisi longitudinal són limitades i es requereix més investigació en els propers anys. / Beratarbide Sobrado, ME. (2016). Longitudinal analysis of eHealth Governance within healthcare organizations as a critical factor in the adaptation to the Information Society in Scotland [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/63456 / TESIS

Background: Covid-19 is disrupting the healthcare industry. Policies and regulatory changes in general necessitate adaptation from the healthcare industry, particularly those affecting the payment system, clients, and the environment. On the other hand, as policymakers around the world look to digital transformation to make healthcare systems more resilient, affordable, and accessible, a rare and remarkable opportunity for the information systems research community to leverage its in-depth knowledge to both advance theory and influence practice and policy has emerged.    Problem discussion: The changes brought by Covid necessitate resilience in the healthcare industry, which most countries are not yet prepared for, as it will necessitate a large number of workers and effective policies for the recovery process in the post of Covid 19. Crucially, many people lack the resources to scale up health interventions as well as the financial resources to implement support measures and improve resilience. This research will answer the following considerable question, how can countries now build more resilient healthcare systems capable of withstanding pandemics? What role can technology play in these efforts?    Purpose: The thesis will aim to discover how the healthcare industry in developing countries will be resilient as they digitize their operations in the post of Covid disruption situations. The finding in this research will be identified by the combination of the HIT framework following four major sectors of health information technology: financial, functional, user, and environmental, and the resilience capabilities such as anticipating, monitoring, responding, and learning. The result of the finding will be involved in chapter 4.    Method: In this paper, a qualitative method was used to answer the research question. Inductive and deductive techniques were used to expand the research by moving from individual data to broader generalizations and ideas. The detail of all the methodology steps will be explained in chapter 3.  First, we began with specific observations and measurements by interviewing organizations and individuals related to the healthcare industry in one highlighted developing country for the primary data and used reliable websites such as Google Scholar, Microsoft Academic, Academic databases, etc for the secondary data. Due to the limitation of the interview responses, we chose Vietnam as our sample. Then we started noticing the HIT strategies, then we went a step further with interpretation to explain these preliminary discoveries that we wanted to investigate, and finally ended up developing some general digital conclusions or theories. Conclusion: Putting these innovations in place now helps the healthcare sector build a stronger resilience health ability, allowing it to be better prepared for future peaks and valleys. In conclusion, some innovative technology solutions from HIT strategies have been proposed, such as the top-down governance system which has been used to support the leaders to reach all levels of government. Aside from that, the effectiveness of the information system's preparation and the role of the surveillance system are critical in the early stages of resilience.  All of the detail from the HIT recommendation strategies will be explained in chapter 5.

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Cancer patients have significant healthcare needs and are likely to encounter complex health information along the course of their treatment, making it important for that information to be accessible and understandable. Online health resources strive to improve existing gaps in access to health services and information. Nevertheless, basic digital and health literacy skills are necessary for using and understanding these services and information. eHealth literacy, defined as the “ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem,” is crucial for the successful uptake of online-based health tools. Research shows that individuals with high eHealth literacy display greater health information-seeking practices and better quality of life. Low adoption and use of online health interventions, however, has resulted in efforts to develop a more comprehensive assessment of eHealth literacy. The eHealth Literacy Questionnaire (eHLQ) is a measure of eHealth literacy not yet tested in US cancer patients, who have complex, time-sensitive healthcare needs. Furthermore, no studies have yet examined the relationships between eHealth literacy, cancer literacy, information processing styles, and its impact on mental health outcomes, such as patient anxiety. Using these factors, the current study surveyed a sample of cancer patients (n= 153) actively receiving treatment or follow-up in the oncology department at Temple University Hospital in Philadelphia, PA. The survey was used to assess patient characteristics, eHealth literacy (eHLQ), cancer health literacy (CHLT-6), information processing style (MBSS-Monitoring) and patient anxiety (HADS-A). This data was then used to examine the fitness of a unidimensional latent factor model for the eHLQ. Results were also used to assess correlations between eHealth literacy, cancer literacy, information processing, and patient anxiety. Finally, moderation tests were performed to determine the effects of eHealth and/or cancer health literacy on the relationship between information processing style and anxiety level. The results indicate the eHLQ adequately fits a one-factor model, which incorporates its seven underlying domains under one construct. Also, engagement with digital services and cancer health literacy appears to be significantly associated with information processing. Through these findings, our study provides initial steps towards the application of a comprehensive eHealth literacy measure in the web 2.0 world, and how this variable correlates to cognitive-behavioral processes and affective outcomes in an underserved group of US cancer patients. / Public Health / Accompanied by 2 files (.jpg and .png): 1) Rincon_temple_0225E_171/Maria Rincon_dissertation_figure 1.jpg 2) Rincon_temple_0225E_171/Maria Rincon_chapter 2 dissertation figure 1.png

The combination of declining birth rates and an aging Swedish population presents challenges for the government in terms of accommodating and providing for the needs of a larger and older population. This demographic shift will exert significant pressure on the public sector, particularly the healthcare system. The potential of digitized healthcare to address the challenges posed by the aging population is significant, and mHealth technologies may be part of the solution to addressing these challenges. This study seeks to examine and quantify the key factors that influence the attitudes of young elderly (ages 45-60) individuals in Sweden towards the adoption of mHealth technologies. Specifically, the research aims to assess the factors that impact willingness to adopt technologies for managing primary healthcare needs. By identifying and measuring these influencing factors, the study strives to contribute to a better understanding of the drivers behind the adoption of mHealth solutions among this demographic. The study employs a single-method research design with a deductive empirical approach, using an online survey to collect quantitative data through a snowballing sampling technique. The study introduced three new variables (General Technology Experience, Healthcare Technology Experience, and Security and Privacy) and three new moderators (Being a Parent, Highest Level of Education, and Frequency of Primary Care Visits) to the widely recognized UTAUT framework. The results were analyzed using Excel and SPSS to identify patterns, relationships, and trends that emerged from the empirical data. Via analysis of the collected survey data, it was found that Performance Expectancy strongly influences the adoption of mHealth technologies among young elderly Swedes. Social Influence and Security and Privacy have minimal impact on adoption decisions. Security and Privacy show a negative correlation to willingness to adopt, indicating mistrust. Higher education levels are associated with digital literacy and belief in technology's job performance benefits. Lower education levels correlate with higher social influence. Individuals visiting primary care 2-3 times a year exhibit higher technology experience and social influence.

Sweden's aging population makes the need for a viable health care urgent and telemedicine can be a solution to enable older people to receive or give themselves care in their homes. Furthermore, implementation of telemedicine has the potential to realise profits in society by increasing the accessibility of health care and minimizing travel costs. Sweden’s low population density and geographical configuration makes the advantages of telemedicine even more appealing.   To illustrate the differences between the county councils’ use of telemedicine and thus increasing the possibility for coordinated care between them, the authors have on behalf of the Innovation Centre at the Karolinska University hospital mapped the amount of telemedicine technologies that are available in the Swedish county councils’ today. To collect information an electronic survey and video or telephone interviews were used. This report answers the question of how the use of telemedicine differ between Sweden's county councils in terms of techniques used, how well implemented the technologies are and to what extent the guidelines for development, implementation and use of telemedicine is available. The report also investigated whether the county councils geographic characteristics, in terms of population density and the number of hospitals and health centers, influenced the development of telemedicine.   Of the 21 regional councils information has been collected from 10 counties in seven weeks and the results that were collocated indicated that there are major differences between the county councils' use of telemedicine. It is clear that the northern region and especially Västerbotten and Norrbotten County Council have come a long way in implementing telemedicine technology.   When the results of the electronic survey and interviews were compared with the county councils’ geographical features no correlation could be detected between population density and the use of telemedicine. This can be a result of the low number of participating counties and that we have not examined all departments in health care. The county councils which have university hospitals use multidisciplinary rounds more so than others. In summary, the Swedish county councils are at different stages in the implementation of telemedicine due to several external and internal factors that makes it possible for counties to benefit a lot from collaboration and sharing each other's knowledge. / Sveriges åldrande befolkning gör behovet av en fungerande vård stor och telemedicin kan vara en lösning för att ge äldre möjlighet att få eller ge sig själva vård i hemmet. Genom implementering av telemedicin har Sverige på grund av sin låga befolkningstäthet och geografisk utformning potential att öka tillgängligheten av vård och minska resekostnader.   För att belysa skillnader mellan landstingens användning av telemedicin och på så sätt öka möjligheten för samordnad vård mellan landstingen har författarna på uppdrag av Innovationsplatsen på Karolinska Universitetssjukhuset med hjälp av elektronisk enkät och video- eller telefonintervjuer kartlagt hur mycket telemedicinsk teknik som finns tillgänglig på Sveriges landsting idag. I rapporten besvaras frågeställningen hur användningen av telemedicin skiljer sig mellan Sveriges landsting i avseende på vilka tekniker som används, hur väl implementerade i verksamheten teknikerna är samt i vilken omfattning riktlinjer för utveckling, implementering och användning av telemedicin är tillgängliga. Rapporten har även undersökt om landstingens geografiska egenskaper i form av befolkningstäthet samt antal sjukhus och vårdcentraler påverkat utvecklingen av telemedicin inom landstingen.   Av Sveriges 21 landsting har information samlats in från 10 landsting under sju veckor och resultatet som sammanställdes tydde på att det finns stora skillnader mellan landstingens användning av telemedicin. Det är tydligt att norra regionen och speciellt Västerbottens- och Norrbottens läns landsting har kommit långt i implementering av telemedicinsk teknik.   Då resultaten från den elektroniska enkäten och intervjuerna jämfördes med landstingens geografiska egenskaper drogs slutsatsen att inget tydligt samband kunde upptäckas mellan befolkningstäthet och användandet av telemedicin. Slutsatsen kan bero på för få deltagande landsting och att undersökningen inte utfördes på varje avdelning. En annan slutsats som var tydlig var att landsting som har universitetssjukhus i större utsträckning använder multidisciplinära ronder via videokonferensteknik. Sammanfattningsvis har Sveriges landsting kommit olika långt i utvecklingen av telemedicin på grund av flera yttre och inre faktorer vilket gör det möjligt för landstingen att dra stor nytta av varandras kunskap vid samarbete.

Sharing of information between health care workers improves evidence dissemination and quality of care. One way to share information is through a community of practice (CoP), whereby members interact regularly towards a common goal. Advances in technology allow CoPs to exist virtually, removing the traditional barriers to information sharing. Virtual CoPs have been shown to be effective, but little is known about why health care workers choose to use them — warranting further investigation. This exploratory research consisted of 86 participants and took place in partnership with Health Quality Ontario. At the time of data collection, the organization was developing a virtual CoP for those in health care to learn from one another about quality improvement. The research utilized the elaboration likelihood model (ELM) — a theoretical model of persuasion that posits that one’s motivation and ability determines how information is processed — to guide the study of attitude formation. ELM distinguishes between Central Route information processing, whereby one is highly motivated and able and pays attention to argument quality, and Peripheral Route processing, whereby lower motivation and ability cause one to be persuaded by peripheral messaging cues. The sustainability of resulting attitudes is influenced by the route through which information is processed. Higher motivation to use a virtual CoP was found to be more strongly correlated to the central route than peripheral route, as expected. Post-hoc analysis found that argument quality had the greatest overall influence on attitudes towards virtual CoPs, regardless of the user’s experience level with them. Users with more experience were also influenced by peripheral cues. The chosen theoretical framework provided insight into the determinants of attitude formation, allowing for a better understanding of how to design and position a virtual CoP for those working in health care — a population yet to be studied through ELM. / Thesis / Master of Science (MSc) / A community of practice (CoP) is a group of people with a shared interest who regularly interact to share knowledge and increase their expertise. Virtual CoPs use information and communications technology to support these knowledge-sharing activities, and have been shown to effectively improve knowledge utilization, but researchers have not examined them from a health care practitioner point of view. The present research aimed to explore the factors affecting how attitudes towards virtual CoPs are formed. The elaboration likelihood model was used to guide this study and suggests that a person’s motivation and ability determine the route through which they process information and form attitudes, leading to their intention to use the system. By understanding what influences attitudes, we can better understand how to design and position a virtual CoP for health care practitioners.

Because of the prevalence and associated health-care costs of obesity, it is widely recognized today as a serious public health issue. The Affordable Care Act (ACA) passed in 2010 includes provisions for all adults to be screened and behavioral intervention offered to those with a body mass index (BMI) of > 30 kg/m2. While the measure is intended to improve access to weight-loss resources for millions of Americans affected, it may not achieve its intended effect in part because of the inability of disadvantaged populations for whom the burden of obesity is the greatest to access ACA-supported services. The objectives of this study were to identify the characteristics that, paired with an evidence-based weight-loss intervention, will have the highest potential reach while achieving a clinically meaningful weight loss, and whether likely participation differs by gender, race, ethnicity or socioeconomic status. Using characteristics from the most effective adult weight-loss studies that use technology to expand reach, three alternative interventions were examined. Findings show that, while the majority of participants favor the traditional ACA face-to-face model, a program delivered completely online may appeal to racial and ethnic minority groups, which were more likely to choose alternative program structures. Alternative program structures should continue to be explored as an important next step toward developing viable referral options for primary care physicians and could have far-reaching impact toward reducing the disparity of obesity and obesity-related disease among disadvantaged populations. / Master of Science