Abstract
There are myriad of factors used in assessing health information technology (HIT)/e-Health of healthcare institutions in developing countries and beyond. In this paper, we intended to identify and gain a deeper understanding of factors used in assessing HIT/e-Health readiness in developing countries through the identification of contextual attributes using Ghana as an exemplary developing country. Through in-depth interviews using aide memoire as interview guide, we explored Core readiness, Engagement readiness, Technological readiness, HIT funding readiness, Regulatory and policy readiness, Workforce readiness and Change Management readiness. We adapted the systematic thematic analysis of qualitative data guide suggested by Braun and Clarke (2013) and O’Connor and Gibson (Pimatisiwin 1: 63–90, 2003) in order to generate codes and build over-arching themes. While Organizational cultural readiness was found to be a more applicable theme/factor in place of Engagement readiness and Change management readiness, Resource readiness wasalso deemed a more appropriate theme for HIT funding readiness and Workforce readiness respectively. A total of 23 factors likely to promote HIT adoption in Ghana and 29 factors capable of impeding HIT adoption in Ghana and potentially in other developing countries were identified. For effective assessment of HIT readiness factors, there is a critical need for a deeper understanding of their applicability in differing settings. The outcome of this study offers a valuable insight into improving circumstances under which HIT/e-Health is adopted. When effectually carried out, assessment of this nature could be help side-step losses on large money, effort, time, delay and importantly, dissatisfaction among stakeholders while enabling change processes healthcare institutions and communities involved. This study also contributes to the limited literature on HIT/e-Health implementation scenarios while offering basis for theory-building.
Similar content being viewed by others
Notes
e-Health and health information technology have been used interchangeably. For the purpose of this study they are considered to mean the same.
Individuals who are or have been involved in e-Health related projects
References
Majeed M, Khan F (2019) Do information and communication technologies (ICTs) contribute to health outcomes? An empirical analysis. Qual Quant 53(1):183–206
Moreira M et al (2019) Biomedical data analytics in mobile-health environments for high-risk pregnancy outcome prediction. J Ambient Intell Humaniz Comput:1–14
Saronga N et al (2019) mHealth interventions of improving nutrients intake of pregnant women in low and lower-middle income countries: systematic review. Matern Child Nutr:e12777
Laar A, Bekyieriya E, Isang S, Baguune B (2019) Assessment of mobile health technology for maternal and child health services in rural upper west region of Ghana. Public Health 168:1–8
World Health Organization (2016) eHealth. cited 2014 14 June. Available from: http:// www.emro.who.int/ehealth/
Wu F et al (2017) The role of health information technology in advancing care management and coordination in accountable care organizations. Health Care Manag Rev
Khan S et al (2012) Hopes and fears in implementation of electronic health records in Bangladesh. EJHISDC 54(8):1–8
Kemper AR, Uren RL, Clark SJ (2006) Adoption of electronic health records in primary care pediatric practices. Pediatrics 118(1):20–24
Middleton B et al (2005) Accelerating U.S. recommendations based on the 2004 ACMI Retreat. J Am Med Inform Assoc 12(1):13–19
Watson PJ (2006) Electronic Health Records –Manual For Developing Countries. 14 November 2013. Available from: http://64.233.179.104/scholar?hl=zh-
Yusif S, Soar J, Su Y (2013) Telehealth enhancement of hospital outreach for the aged and chronic disease management: a UTAUT-based model for review of patients acceptance. in The 4th International Workshop on Human-centered eHealth. October 25–27 2013, Wuhan, Nanjing, China
Nguyen L, Bellucci E, Nguyen L (2014) Electronic health records implementation: an evaluation of information system impact and contingency factors. Int J Med Inform 83(11):779–796
Lucas H (2008) Information and communications technology for future health systems in developing countries. Soc Sci Med 66:2122–2132
Kisiedu CO (1999) Barriers in using new information technology in document delivery in the third world: prospects for the IFLA project in Ghana. Interlend Doc Suppl 27(3):108–115
Salia E (1994) Telecommunications’ role in national development in Ghana. Commun Mag IEEE 32(11):46–47
Latifi R et al (2009) “Initiate–build–operate–transfer”—a strategy for establishing sustainable telemedicine programs in developing countries: initial lessons from the Balkans. Telemed e-Health 15(10):956–969
Kiberu V, Scott R, Mars M (2019) Assessment of health provider readiness for telemedicine services in Uganda. Health Inf Manag J 48(1):33–41
Afarikumah E (2014) Electronic health in Ghana: current status an future prospects. Online J Public Health Inf 5(3):230
D’Urso P, De Giovanni L, Spagnoletti P (2013) A fuzzy taxonomy for e-Health projects. Int J Mach Learn Cybern 4(5):487–504
Khoja S, Scott RE, Casebeer AL, Mohsin M, Ishaq AF, Gilani S (2007) e-Health readiness assessment tools for healthcare institutions in developing countries. Telemed e-Health 13(4):425–432
WHO (2016) Hospital. [cited 2016 12/10]; Available from: http://www.who.int/topics/hospitals/en/
Australian Red Cross and ACCORD (2009) Health care in Ghana
ACDEP and CORDAID (2007) Survey on the practice of traditional medicine in the operational area of eight ACDEP member primary health care programmes in the Upper East and Northern regions of Ghana. ACDEP
Quaicoe-Duho R (2015) Ghana reports general improvement in doctor ratio. 04 July 2016. Available from: http://www.graphic.com.gh/news/health/ghana-reports-general-improvement-in-doctor-ratio.html
Ghana Hospitals (2012) Hospitals in Ghana. 07 January 2016]; Available from: http://ghanahospitals.org/home/
Mitchell RMF (2013) Backgound. [cited 2012 29 December 2012]; Available from: http://www.robertmitchellfoundation.org/
Ministry of Health, G (2007) Health sector 5 year programme of work, 2002-2006: Independent Review of POW-2006, Health, Editor
Van den Boom G, Nsowah-Nuamah N, Overbosch G (2004) Healthcare provision and self-medication in Ghana
Biruk S et al (2014) Health professionals’ readiness to implement electronic medical record system at three hospitals in Ethiopia: a cross sectional study. BMC Med Inf Decis Mak 14(1):115
Chipps J, Mars M (2012) Readiness of health-care institutions in KwaZulu-Natal to implement telepsychiatry. J Telemed Telecare 18(3):133–137
Coleman A, Coleman M (2013) Activity theory framework: a basis for E-health readiness assessment in health institutions. J Commun 4:95–100
Coleman, A., M. Herselman, and D. Potass, E-health readiness assessment for e-health framework for Africa: a case study of hospitals in South Africa, in Electronic Healthcare. 2012, Springer. p. 162–169
Durrani H et al (2012) Health needs and eHealth readiness assessment of health care organizations in Kabul and Bamyan, Afghanistan
Jennett P, Jackson A, Healy T, Ho K, Kazanjian A, Woollard R, Haydt S, Bates J (2003) A study of a rural community’s readiness for telehealth. J Telemed Telecare 9(5):259–263
Jennett P, Jackson A, Ho K, Healy T, Kazanjian A, Woollard R, Haydt S, Bates J (2005) The essence of telehealth readiness in rural communities: an organizational perspective. Telemed J E Health 11:137–145
Justice E (2012) E-Healthcare/telemedicine readiness assessment of some selected states in Western Nigeria. Int J Eng Technol 2(2)
Khatun F, Heywood AE, Ray PK, Hanifi SM, Bhuiya A, Liaw ST (2015) Determinants of readiness to adopt mHealth in a rural community of Bangladesh. Int J Med Inform 84(10):847–856
KHOJA S, SCOTT R, GILANI S (2008) E-health readiness assessment: promoting ‘hope’ in the health-care institutions of Pakistan. World Hosp Health Serv 44(1):41
Khoja et al (2007) Testing reliability of eHealth readiness assessment tools for developing countries. ehealth Int J 3(1)
Leon N, Schneider H (2012) MHealth4CBS in South Africa: a review of the role of mobile phone technology for monitoring and evaluation of community based health services. Medical research council of South Africa (MRC). Health systems research unit
Li J et al (2012) An E-Health readiness assessment framework for public health services--pandemic perspective. in System Science (HICSS), 2012 45th Hawaii International Conference on. IEEE
Mucheneh O (2014) Assessing the level of readiness for computerized health management information system among nurses in Kenyatta National Hospital, Nairobi, Kenya. KENYATTA UNIVERSITY
Nahm E et al (2008) Exploration of patients’ readiness for an eHealth management program for chronic heart failure: a preliminary study. J Cardiovasc Nurs 23(6):463–471
Oio S et al (2007) Formal model for e-healthcare readiness assessment in developing country context. in Innovations in Information Technology, 2007. IIT’07. 4th International Conference on. IEEE
Qureshi Q (2014) E-readiness: a crucial factor for successful implementation of E-Health projects in developing countries like Pakistan. Public Policy Adm Res 4(8):97–103
Scharwz F, Ward J, Willcock S (2014) E-Health readiness in outback communities: an exploratory study. Rural Remote Health 14(2871)
Simon S et al (2008) Readiness for electronic health records: comparison of characteristics of practices in a collaborative with the remainder of Massachusetts. Inf Prim Care 16(2):129–137
Snyder-Halpern R (2001) Indicators of organizational readiness for clinical information technology/systems innovation: a Delphi study. Int J Med Inform 63(3):179–204
Tamburis O et al (2012) The LITIS conceptual framework: measuring eHealth readiness and adoption dynamics across the healthcare organizations. Heal Technol 2(2):97–112
Touré M, Poissant L, Swaine B (2012) Assessment of organizational readiness for e-health in a rehabilitation Centre. Disabil Rehabil 34(2):167–173
Heeks R (2005) Health information systems: failure, success and improvisation. Int J Med Inform 75(2):125–137
Lackner A (2015) Implementation guide for patient generated health information in healthcare organizations
Ford E, Menachemi N, Phillips M (2006) Predicting the adoption of electronic health records by physicians: when will health care be paperless? J Am Med Inform Assoc 13(1):106–112
Huang W, Seitz J, Wickramsinghe N (2010) Manifesto for E-Health Success
Adjorlolo S, Ellingsen G (2013) Readiness assessment for implementation of electronic patient record in Ghana: a case of University of Ghana Hospital. J Health Inf Dev Ctries 7(2):128–140
Acquah-Swanzy M (2015) Evaluating electronic health record systems in Ghana: the case of Effia Nkwanta regional hospital
Noble H, Smith J (2014) Qualitative data analysis: a practical example. Evid Based Nurs 17(1):2–3
Cooper J, Lewis R, Urquhart C (2004) Using participant or non-participant observation to explain information behaviour. Inf Res 9(4):9–4
Deegan C, Blomquist C (2006) Stakeholder influence on corporate reporting: an exploration of the interaction between WWF-Australia and the Australian minerals industry. Acc Organ Soc 31(4):343–372
Pontin D (2000) Interviews in Cormack, DThe research process in nursing
Bell L et al (2018) Applications of Blockchain within healthcare. Blockchain in Healthcare Today
Braun V, Clarke V (2013) Successful qualitative research: a practical guide for beginners. Sage
O’Connor H, Gibson N (2003) A step-by-step guide to qualitative data analysis. Pimatisiwin 1(1):63–90
Watkins R, Meiers M, Visser Y (2012) A guide to assessing needs. World Bank, Washington DC
Gunasekaran S, Garets D (2004) Managing the IT strategic planning process. In: Healthcare Information Management Systems. Springer, pp 22–34
Cresswell K, Bates D, Sheikh A (2013) Ten key considerations for the successful implementation and adoption of large-scale health information technology. J Am Med Inform Assoc 20(e1):e9–e13
Ricciardi L et al (2013) A national action plan to support consumer engagement via e-health. Health Aff 32(2):376–384
Mudd-Martin G, Biddle MJ, Chung ML, Lennie TA, Bailey AL, Casey BR, Novak MJ, Moser DK (2014) Rural Appalachian perspectives on heart health: social ecological contexts. Am J Health Behav 38(1):134–143
Turman A (2013) CHIME Time: Patient empowerment as a strategy for engagement in rural facilities. [cited 2016 March 4]; Available from: http://www.modernhealthcare.com/article/20130820/NEWS/308209951
Peterson R (2004) Crafting information technology governance. Inf Syst Manag 21(4):7–22
McNurlin B, Sprague R (2006) Information systems management in practice, 7th edn. Prentice-Hall International
Terlizzi M, Meirelles F, Cortez da Cunha MV (2017) Behavior of brazilian banks employees on Facebook and the Cybersecurity governance. J Appl Secur Res 12(2):224–252
Al Qassimi N, Rusu L (2015) IT governance in a public organization in a developing country: a case study of a Governmental organization. Procedia Comput Sci 64:450–456
Hartzler A et al (2013) Stakeholder engagement: a key component of integrating genomic information into electronic health records. Genet Med 15(10):792–801
Townsend R (2012) Doctors and patients uneasy about new e-health records system. The conversation 5
Stegers-Jager K et al (2015) Predicting performance: relative importance of students’ background and past performance. Med Educ 49(9):933–945
Yusif S, Soar J (2014) Preparedness for e-health in developing countries: the case of Ghana. JHIDC 8(2):18–37
Simba D (2004) PRACTICE POINTS application of ICT in strengthening health information systems in developing countries in the wake of globalisation. Afr Health Sci 4(3):194–198
Ross J et al (2016) Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update). Implement Sci 11(146)
Gregory M, Tembo S (2017) Implementation of E-health in developing countries challenges and opportunities: a case of Zambia. Sci Technol 7(2):41–53
Luna D, Almerares A, Mayan JC 3rd, González Bernaldo de Quirós F, Otero C (2014) Health informatics in developing countries: going beyond pilot practices to sustainable implementations: a review of the current challenges. Healthc Inf Res 20(1):3–10
Carayon P et al (2011) Sociotechnical systems analysis in health care: a research agenda. IIE Trans Healthc Syst Eng 1(3):145–160
Hyder A, Selig H, Ali J, Rutebemberwa E, Islam K, Pariyo G (2019) Integrating capacity development during digital health research: a case study from global health. Glob Health Action 12(1):1559268
Sittig D, Singh H (2011) Legal, ethical, and financial dilemmas in electronic health record adoption and use. Pediatrics 127(4):e1042–e1047
Norman I, Aikins M, Binka F (2011) Ethics and electronic health information technology: challenges for evidence-based medicine and the physician-patient relationship. Ghana Med J 45(3):115–124
Zayyad M, Toycan M (2018) Factors affecting sustainable adoption of e-health technology in developing countries: an exploratory survey of Nigerian hospitals from the perspective of healthcare professionals. PeerJ 6:e4436
Isabalija S et al (2011) Factors affecting adoption, implementation and sustainability of telemedicine information systems in Uganda. J Health Inf Dev Ctries:5(2)
Hoque M, Bao Y, Sorwar G (2017) Investigating factors influencing the adoption of e-Health in developing countries: a patient’s perspective. Inf Health Soc Care 42(1):1–17
Mugo D, Nzuki D (2014) Determinants of electronic health in developing countries
Shuvo T et al (2015) eHealth innovations in LMICs of Africa and Asia: a literature review exploring factors affecting implementation, scale-up, and sustainability. Health Care 8:9
Acknowledgements
The authors wish to acknowledge the support of the Australian Government Research Training Program (AGRTP) and the management and staff of participating healthcare organizations.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
For this research, ethical approvals were obtained from USQ Human and Ethics application committee granted approval for the project (H13REA149) as well as the Committee on Human Research, Publication and Ethics Komfo Anokye Teaching Hospital (CHRPE/AP/119/17), Ghana.
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendices
Appendices
Rights and permissions
About this article
Cite this article
Yusif, S., Hafeez-Baig, A. & Soar, J. An Exploratory Study of the Readiness of Public Healthcare Facilities in Developing Countries to Adopt Health Information Technology (HIT)/e-Health: the Case of Ghana. J Healthc Inform Res 4, 189–214 (2020). https://doi.org/10.1007/s41666-020-00070-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41666-020-00070-8