Information and communication technology (ICT) can enhance communication among health care providers which may lead to various health system improvements, such as gains in efficiency. However, there is inadequate evidence regarding the extent to which ICT improves communication among specific groups of health care professionals. This dissertation incorporates a mix of methodological approaches across three interrelated research studies to address this gap. Study 1 consists of a systematic review which suggested that ICT can play an important role in enhancing health care related communication among physicians, but the extent of that benefit is influenced by: 1) the impact of ICT on existing work practices; 2) the availability of adequate resources for ICT implementation and use; and 3) the nature of institutional elements, such as privacy legislation. Study 2 consists of a document analysis that examined guidelines for health information protection when using ICT from the provincial regulatory colleges for physicians. These documents were notable for the considerable variation in the scope and detail of guidance provided, which may result in unequal and inequitable protection of health information across the provinces. Study 3 is a case study that examined the use of a relatively novel form of ICT, smartphones, for communication among postgraduate medical trainees (medical residents). Efficiency and convenience were identified as the main reasons that medical residents use smartphones to communicate health care related information with colleagues. In addition, by applying a neo-institutional perspective, it became clear that medical residents base their smartphone use primarily on normative elements (professional norms; what peers/staff are doing) and cultural-cognitive elements (beliefs/perceptions regarding facilitation of task completion). Regulative elements (guidelines/policies) around smartphone use play a smaller role in shaping behaviour, particularly when they: 1) lack clarity; 2) are not seen as credible/legitimate; or 3) are viewed as cumbersome and do not align with workflow needs. Taken together, these studies provide timely insights regarding the use of ICT by physicians, which can be drawn upon by a variety of decision-makers as efforts to improve health system performance continue. / Thesis / Doctor of Philosophy (PhD) / The goal of this doctoral dissertation was to develop a better understanding of how and why physicians are using information and communication technology (ICT) to exchange health care related information, along with the role of such communication in enhancing health system performance. Findings indicate that physicians use ICT in various circumstances as they perceive it to be more convenient and efficient. However, guidelines for the exchange of health information in digital/electronic format vary by jurisdiction and organization, which may result in different uses of ICT by physicians. Moreover, as these guidelines often lack clarity or are not seen as credible/legitimate, some physicians base their use of ICT primarily on what peers/colleagues are doing or by acting in a manner that they believe facilitates task completion and, hence, patient care. The insights gained from this work can be adopted by decision-makers to improve communication among physicians using ICT and, consequently, health system performance.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/22594 |
| Date | January 2018 |
| Creators | Barr, Neil G. |
| Contributors | Randall, Glen E., Health Policy |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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