The Impact of Information Communication and Technology

Introduction

Globally, Information, Communication, and Technology (ICT) has revolutionised healthcare industry. Patients can now access remote consultations with physicians through such technology-based systems as telemedicine (telehealth) (Yellowlees, 2005; Adler-Milstein, and Bates, 2010). The technological age characterised by information availability, internet, and intranet systems, to the patients and health care providers and regulatory bodies. ICT in healthcare encompasses digitalisation of healthcare systems specific and, to some extent, the consequence of broader digitised society. Broadly, Africa still struggle with provision of basic healthcare registering 24% of the global burden of disease (GBD) despite having 14% of the world population (Gouda et al., 2019; Feigin et al., 2016). Moreover, in term of financing healthcare systems, report found only the continent expenditure on healthcare systems and service is equivalent to 1% of the world health expenditure. Largely, ICT in healthcare refer to integration of technology-driven approaches ranging from using computers and electronics health dossiers in the context of handling, organising, producing, and delivery of service as well as using computer aided visualisation and decision-making support systems. In term of adoption of technology by healthcare system, it can be viewed in different faceted that include; impact on learning, treatment, consultations, communications, research, data on different diseases, and effectiveness in treatment (diagnosis and surgery). In hindsight, according to Bhavnani et al. (2016) and Winter et al. (2018), implementation of the systems and platform that enables access to pool of healthcare systems that include information, data, and skills is perceived as a solution to bridging the gap. Therefore, countries with large gross domestic income (GNIs) and number of organisations in support of various governments have increasingly implemented technology-based health projects. Many of these projects are rooted on health education, telemedicine, and health-oriented research.

Literature review

Broadly, research has found significant correlation between health information technology that incorporates advanced technology-driven medical infrastructure aiding in decision-making and trickling down chart representation and record keeping, and such factors as improved patient safety, effectiveness of healthcare professionals in services delivery, reducing human errors, and tracking patients’ health conditions and treatment over time. On a global scale, implementation of ICT-based systems such as patient data management systems (PDMS), electronic medical record (EMR), electronics physician’s orders (CPOE), clinical decision support (CDS), remote patient monitoring (tele-monitoring) and automated medication dispensing cabinets (ADC) vary with success and failure determined by various factors (Fretschner et al., 2001; Queenan et al., 2011; Kim et al., 2015). The rapid changes in healthcare industry ranging from demographics to multi-morbidities linked to increasing demand of the service and its effectiveness has shifted attention to the technology as a solution. However, addressing the problems faced by the system through digitalisation calls not just integration and implementation of technology-based approaches but combination of right and properly aligning it with professional skills sets and working process (Lapão, 2019; Zakaria et al., 2010).

Studies on ways implementation of technology in the healthcare system suggest proper digitalisation of the systems would improve the services delivery and revolutionising the engagement and participation of patients (Haluza, and Jungwirth, 2015; Andreassen et al., 2015; Kapadia et al., 2015). Literature on tele-monitoring and telehealth solutions for chronic health conditions indicate the approach results in reduction hospital admission, improve blood pressure control in hypertension patients, low mortality rate for patients with chronic heart problems, and may aid in glycaemic control in diabetic patients (Ambrosino et al., 2016; Adler-Milstein et al., 2014). In addition to altering the content healthcare system through enhancement of treatment and rehabilitation possibilities, preventive measures, and increasing knowledge and diagnostics, digital transformation of healthcare industry has led its complexity, rapid changing responsibilities and roles of both providers and patients as well as regulators. Ricciardi (2019) acknowledged that healthcare digitalisation is a complex and multifaceted issues branching into various

Figure 1: Illustration of complexity of digital transformation in healthcare system (Source: Expert Panel on Investing in Health, European Commission (EPIE), 2018)

Fundamentally, digitalisation of the healthcare systems goes beyond adoption of computer-aided hardware to incorporate the core changes in the infrastructural aspects of the health care services, cultural, and mode, at both specific healthcare level and social perspective. According to World Health Organisation (WHO, 2010), there are four categories of digital services as follows. First, intervention for clients that include promotion of health activities to the public and caregivers. Secondly, intervention for health workforce who deliver health services. Thirdly, intervention for data services that incorporate data collection, handling, management, interpretation, storage, and transfer. Lastly, intervention for resource management encompassing administration, supply chain management, human resource management (HRM), and oversight of the systems. Ideally, as illustrated by Lupiáñez-Villanueva et al. (2011) and Zakaria et al. (2010), complete integration of the ICT into healthcare system would have a profound impact on the larger healthcare systems and service delivery. In countries such as South Korea, United Kingdom, and Germany, Mobile health services (mHealth) has seen a steady growth in adoption and application influencing health care delivery with evidence from studies pointing to positive impact of smoking cessation, asthma treatment, awareness on infectious diseases, and diabetic and heart conditions.

Moreover, in most studies into the implementation of HIT neglect to highlight the influence of constant change in the healthcare systems, hospitals organisational culture, and social perception of the technology. Study conducted by Yusif et al. (2019) identified five such factors limiting successful implementation of HIT in public hospitals in Ghana that include first, lack of stakeholders participations (healthcare providers, patients, and hospital management), second, lack of commitment to change, and lack thereof of change agents. Third, lack of clearly articulated implementation structures and process. Fourth, lacking in experiences of implementation and handling of technology-driven systems, and lastly, low training of personnel on use and functionality of the equipment. Building from technology acceptance model (TAM), successful digitalisation of the healthcare systems that include implementation of the eHealth, mHealth, and HIT is subject to perceived usefulness and ease of use (Marangunić, and Granić, 2015). Fundamentally, digitalisation of the healthcare demand overhauling the system that in case of thee HIT and e-health covering a country’s health system requires a beyond large-scale hospital transformation and organizational change.

Studies have found challenges constituting social and organizational ranging from privacy-related, data inaccuracies, confidentiality, and interoperability in successful implementation of the HIT systems (Ruxwana et al., 2010; Hanseth, and Bygstad, 2015). In addition to lack of the HIT and supporting infrastructure, lack of interest form the stakeholders that include health care service providers, and the role change play a huge part in success implementation of ICT in healthcare system. Nevertheless, despite huge positive implication and profound influence of ICT through digitalisation of healthcare system, implementation of ICT in Ghana and subsequent success remain relatively low. Other studies tied corruption and misappropriation of the funds allocated for health system by corrupt leaders (poor leaderships) at both social and specific health centres levels (Yusif et al., 2019; Kesse-Tachi et al., 2019; Meskó et al., 2017). Evaluating adoption of ICT particularly the electronic health record systems in Ghana’s healthcare, Adjorlolo and Ellingsen (2013) pointed to lack of supporting infrastructure as major issues, perceived high cost of implementation, political influence, and inadequate skills sets. Some studies have indicated, at hospital levels, readiness of the providers and the users to adopting health information technology (HIT) remain low in most hospitals (Bedeley, and Palvia, 2014; Borketey, 2017; Yaw et al., 2015).

Research Gap

There exist a wide range of studies focusing on factors affecting and challenges on adoption and implementation of technology in the healthcare system in both developed nations and developing nations that include Ghana. From the literature, researchers have focused on the broader factors of technological implementation particularly in hospital facilities. However, they have failure to incorporate the broader healthcare systems that include role of society, health care providers, managements, and regulatory bodies (government and non-governmental organizations). Similarly, several studies focusing on developed countries and particularly Ghana have outlined such elements as readiness, infrastructural failures, skills, financial cost, and commitment to change as core challenges to adoption within healthcare facilities but these factors fail to capture the wider systems that include the social-economic, cultural, and structures supporting ICT and digitalisation of the system. Additionally, studies highlight the challenges of implementation of ICT, HIT, and digitalisation of healthcare. These raise the question of whether challenges prevent successful implementation of technology in the system or there are other underlying factors rooted on cultural, infrastructure, beliefs, educational, or policy, which hold back successful shift to ICT-driven system in healthcare in Ghana.

Research questions

What are the driving factors in implementation of ICT in healthcare system?

What are factors limiting digitalisation of healthcare system in Africa?

What are factors that have led to failed digitalisation in developing nations?

What role does a society have in successful implementation of healthcare-oriented technology?

What are the factors preventing success implementation of ICT in healthcare?

To what extent do social, political, and economic factors prevent successful adoption and implementation of ICT in Ghana’s healthcare system?

What are the factors preventing Ghana from digitising its healthcare system?

Research aim

This research intends to investigate the factors preventing the success implementation of ICT in healthcare facilities taking a case study of Ghana healthcare

Research objectives

To critically analyse theories on technology adoption and implementation

To critically evaluate literature on technology adoption and implementation in healthcare system

To critically analyse previous studies on factors influence technology implementation in healthcare system

To conduct a review on factors preventing success implementation of ICT healthcare systems in developing and African countries

To collect primary data on factors preventing success implementation of ICT in healthcare systems in Ghana

To appraise collected data drawing conclusion and recommendation on factors preventing successful digitisation of Ghana’s healthcare systems

Methodology

Mixed research philosophical paradigm

In this research, development of knowledge with be based on the assumption that world can be perceived both subjectively and objectively. Technology acceptance that include successful implementation does not only involve technological knowhow, availability of technology, and supporting infrastructure but also largely rooted on the perception of stakeholders and sociological factors. The pragmatism paradigm integrates the truth and reality (Morgan, 2014; Goldkuhl, 2012). It argues that multiple realities exist depending one constructs of beliefs, perception, values, and experience. Pragmatist argue that reality of know cannot be determined by just measurable scientific facts but also normative concept informed by social constructions (Yvonne Feilzer, 2010). Unlike interpretivism assumption arguing that knowledge is constructed socially and positivism contending that all knowledge is measureable and verifiable through scientific methods, pragmatist view knowledge as combination of the two paradigms.

Research design

Research design outlines the procedures and methods employed in acquiring data to answer research problems and address research objectives. In exploratory research, researcher investigates a problem to get into deeper insight of the issues (Goeman, and Solari, 2011). Numerous research into factors limiting implementation of a technology as well as challenges of adoption in various industries, countries, and cultural setting and hence this research into factors preventing successful implementation of ICT in healthcare in Ghana will base the knowledge development of existing research in the industry while seeking to have a deeper understanding of the factors. It will follow a longitudinal study framework.

Research methods

In order to adequately answer research questions and address aim of the research requires a systematic and elaborate system built around ways of data collection and data analysis. In this research, the researcher aims to delve and understand underlying factors preventing Ghana from successfully implementing ICT in its healthcare system. However, the research will first quantify some factors in a wide perspective through investigative measureable and observable parameters (Hesse-Biber, 2010; Creswell, and Clark, 2017). As such, it will apply both quantitative and qualitative research approaches under a mixed research method.

Data collection

The data will be from primary sources collected using survey and interview. The survey will encompasses open- and close- ended questions aimed at developing themes and patterns of hindrance of successful technology adoption in healthcare system in Ghana. The survey will be administered to 200 participants. The sampling process of the survey data collection methods will be include a wider range of individuals residing in Ghana. It will be limited to education level, occupation, gender, religion, cultural values, or socio-economic factors. On the other hand, the interview process will incorporate 10-15 participants drawn from various background that include healthcare providers, larger society, healthcare facility management, and regulatory bodies. The responses from survey will be analysed regression analysis that will subsequent informing the second part of the data collection, interview. The interview data will be recorded, transcribed, then used Nvivo data analysis tool to draw patterns and themes.

Ethical consideration

Before collecting primary data, all potential participants of the research will be required to sign consent letter containing scope of the research, use of collected data and subsequent information, and handling of collected data. Moreover, the consent letter coupled with participant information letter will assure the potential participant of privacy and confidentiality during data collection, interpretation, and presentation. The participants will be 18+ years old and not a person with disabilities. Additionally, this research will uphold academic integrity that include citing accordingly the source of data and information used in knowledge development and within the report,

Timeframe

Gantt Chart

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References

Acquah-Swanzy, M., 2015. Evaluating electronic health record systems in Ghana: The case of Effia Nkwanta Regional Hospital (Master's thesis, UiT Norges arktiske universitet).

Adjorlolo, S. and Ellingsen, G., 2013. Readiness assessment for implementation of electronic patient record in Ghana: a case of university of Ghana hospital. Journal of Health Informatics in Developing Countries, 7(2).

Adler-Milstein, J. and Bates, D.W., 2010. Paperless healthcare: Progress and challenges of an IT-enabled healthcare system. Business Horizons, 53(2), pp.119-130.

Adler-Milstein, J., Sarma, N., Woskie, L.R. and Jha, A.K., 2014. A comparison of how four countries use health IT to support care for people with chronic conditions. Health Affairs, 33(9), pp.1559-1566.

Ambrosino, N., Vagheggini, G., Mazzoleni, S. and Vitacca, M., 2016. Telemedicine in chronic obstructive pulmonary disease. Breathe, 12(4), pp.350-356.

Andreassen, H.K., Kjekshus, L.E. and Tjora, A., 2015. Survival of the project: a case study of ICT innovation in health care. Social Science & Medicine, 132, pp.62-69.

Bedeley, R. and Palvia, P., 2014. A study of the issues of E-health care in developing countries: The case of Ghana.

Bhavnani, S.P., Narula, J. and Sengupta, P.P., 2016. Mobile technology and the digitization of healthcare. European heart journal, 37(18), pp.1428-1438.

Borketey, P., 2017. A literature review on the challenges of eHealth implementation in developing countries among rural folks: A case of Ghana.

Creswell, J.W. and Clark, V.L.P., 2017. Designing and conducting mixed methods research. Sage publications.

Feigin, V.L., Roth, G.A., Naghavi, M., Parmar, P., Krishnamurthi, R., Chugh, S., Mensah, G.A., Norrving, B., Shiue, I., Ng, M. and Estep, K., 2016. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet Neurology, 15(9), pp.913-924.

Fretschner, R., Bleicher, W., Heininger, A. and Unertl, K., 2001. Patient data management systems in critical care. Journal of the American Society of Nephrology, 12(suppl 1), pp.S83-S86.

Goeman, J.J. and Solari, A., 2011. Multiple testing for exploratory research. Statistical Science, 26(4), pp.584-597.

Goldkuhl, G., 2012. Pragmatism vs interpretivism in qualitative information systems research. European journal of information systems, 21(2), pp.135-146.

Gouda, H.N., Charlson, F., Sorsdahl, K., Ahmadzada, S., Ferrari, A.J., Erskine, H., Leung, J., Santamauro, D., Lund, C., Aminde, L.N. and Mayosi, B.M., 2019. Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: results from the Global Burden of Disease Study 2017. The Lancet Global Health, 7(10), pp.e1375-e1387.

Haluza, D. and Jungwirth, D., 2015. ICT and the future of health care: aspects of health promotion. International journal of medical informatics, 84(1), pp.48-57.

Hanseth, O. and Bygstad, B., 2015. Flexible generification: ICT standardization strategies and service innovation in health care. European Journal of Information Systems, 24(6), pp.645-663.

Hesse-Biber, S.N., 2010. Mixed methods research: Merging theory with practice. Guilford Press.

Kapadia, V., Ariani, A., Li, J. and Ray, P.K., 2015. Emerging ICT implementation issues in aged care. International journal of medical informatics, 84(11), pp.892-900.

Kesse-Tachi, A., Asmah, A.E. and Agbozo, E., 2019. Factors influencing adoption of eHealth technologies in Ghana. Digital health, 5, p.2055207619871425.

Kim, S., Lee, K.H., Hwang, H. and Yoo, S., 2015. Analysis of the factors influencing healthcare professionals’ adoption of mobile electronic medical record (EMR) using the unified theory of acceptance and use of technology (UTAUT) in a tertiary hospital. BMC medical informatics and decision making, 16(1), p.12.

Lapão, L.V., 2019. The future of healthcare: the impact of digitalization on healthcare services performance. In The Internet and Health in Brazil (pp. 435-449). Springer, Cham.

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J. and Ficapal, P., 2011. The integration of Information and Communication Technology into nursing. International journal of medical informatics, 80(2), pp.133-140.

Marangunić, N. and Granić, A., 2015. Technology acceptance model: a literature review from 1986 to 2013. Universal Access in the Information Society, 14(1), pp.81-95.

Meskó, B., Drobni, Z., Bényei, É., Gergely, B. and Győrffy, Z., 2017. Digital health is a cultural transformation of traditional healthcare. Mhealth, 3.

Morgan, D.L., 2014. Pragmatism as a paradigm for social research. Qualitative inquiry, 20(8), pp.1045-1053.

Queenan, C.C., Angst, C.M. and Devaraj, S., 2011. Doctors’ orders––If they’re electronic, do they improve patient satisfaction? A complements/substitutes perspective. Journal of Operations Management, 29(7-8), pp.639-649.

Ricciardi, W., 2019. Assessing the impact of digital transformation of health services: Opinion by the Expert Panel on Effective Ways of Investing in Health (EXPH) Walter Ricciardi. European Journal of Public Health, 29(Supplement_4), pp.ckz185-769.

Ruxwana, N.L., Herselman, M.E. and Conradie, D.P., 2010. ICT applications as e-health solutions in rural healthcare in the Eastern Cape Province of South Africa. Health information management journal, 39(1), pp.17-29.

Winter, A., Stäubert, S., Ammon, D., Aiche, S., Beyan, O., Bischoff, V., Daumke, P., Decker, S., Funkat, G., Gewehr, J.E. and de Greiff, A., 2018. Smart medical information technology for healthcare (SMITH). Methods of information in medicine, 57(S 01), pp.e92-e105.

World Health Organization, 2010. Telemedicine: opportunities and developments in member states. Report on the second global survey on eHealth. World Health Organization.

Yaw, A.A.S., Twum, F., Hayfron-Acquah, J.B. and Panford, J.K., 2015. Cloud computing framework for e-health in Ghana: adoption issues and strategies: case study of Ghana health service. International Journal of Computer Applications, 118(17).

Yellowlees, P.M., 2005. Successfully developing a telemedicine system. Journal of telemedicine and telecare, 11(7), p.331.

Yusif, S., Hafeez-Baig, A. and Soar, J., 2019. Change management and adoption of health information technology (HIT)/eHealth in public hospitals in Ghana: A qualitative study. Applied Computing and Informatics.

Yusif, S., Hafeez-Baig, A. and Soar, J., 2019. Change management and adoption of health information technology (HIT)/eHealth in public hospitals in Ghana: A qualitative study. Applied Computing and Informatics.

Yvonne Feilzer, M., 2010. Doing mixed methods research pragmatically: Implications for the rediscovery of pragmatism as a research paradigm. Journal of mixed methods research, 4(1), pp.6-16.

Zakaria, N., Affendi, S. and Zakaria, N., 2010. Managing ICT in healthcare organization: culture, challenges, and issues of technology adoption and implementation. In Health Information Systems: Concepts, Methodologies, Tools, and Applications (pp. 1357-1372). IGI Global.

Zakaria, N., Affendi, S. and Zakaria, N., 2010. Managing ICT in healthcare organization: culture, challenges, and issues of technology adoption and implementation. In Health Information Systems: Concepts, Methodologies, Tools, and Applications (pp. 1357-1372). IGI Global.