Pekka Turunen, Aapo Immonen and Jarmo Tähkäpää
In cases where businesses have been using customer based data systems for quite some time, health care customer type information and communication, ICT, services have only been emerging e.g. (Ragupathi 1997). In health care as a specific area, there are special social and ethical aspects that have to be taken under consideration and which do not apply in the customer data cases of business (Stanberry 2001; Kazanjian and Green 2002).
Healthcare has traditionally been organisation-orientated and hierarchical. Health care professionals have possessed the information and have been the decision maker c.f. (Kim and Michelman 1990) The Internet or mobile based systems used by the customers have partially been dissolved by this circumstance. Based on this; the willingness or ability of customers to use information pertaining to their personal matters health care professionals have rejected the utilisation of these kind of information technology.
Based on these facts, a study directed at the users of health care services has been conducted by the city of Kuopio, which produced results that are quite surprising: The majority of the participants in the study claim they want health care available in the Internet.
The objective of the study
Kuopio is a city of approximately 90000 inhabitants located in the North east region of Finland. The social- and health care centre of Kuopio is finalising a comprehensive refurbishment process of the social- and health care informatics systems which started in 1999. The Shiftec -research unit from the University of Kuopio evaluated the effects of the ongoing process. One part of the study was a customer questioner targeted at the citizens of Kuopio comprising 1) how day-to-day health care related routines had preformed in health care centres using the technology. 2) And what kind of services the citizens would like to see available in the Internet or trough mobile terminals.
This article restricts itself to the latter part of the research study and its results. E.g. experiences in National Health Service in UK, research of internet services has been centered very much around quality of information itself rather than attitudes and needs of people accessing the information. On the other hand in health care this is quite natural given the importance of authoritative and accurate information, but since progress is towards patient centered approach the patient viewpoint can not be bypassed anymore. [Nicholas, 2002 #9628]
The customer questioner was exulted in the internet with a web application form. The questionnaire was publicised in the local newspaper and at health care centre check up points. The total amount of the questionnaire was 623, the median age was high, and 41 years the gender split was 77% female. The educational level was 55% secondary school, primary school 33%, and 10% lower than primary school level. In terms of professional education higher or college level 67%, professional institute level 23% professional education was lacking in 10% of the cases, the majority of which could be identified as students.
Up to 67% o the applicants had had visited a health care unit more than once or more during the past year. Twenty three percent of the answers submitted indicated a health related problem resulting in regular medical check up procedures. In sixty four percent of cases, the reason for a medical check up visit was personal and 28% answered hat they had escorted a child. In addition to this, 3% escorted an elderly patient. The reason of visiting health care centres in 83% of the case was a physicians check up, 6% visiting a nurse and 3% had an appointment to the laboratory. Out of the answered, 60% had reserved an appointment booked a time pre-emptively by phone.
Approximately 20% had not phoned beforehand and 17% has arrived on sight to reserve an appointment.
Out of the responses eighty seven percent considered themselves to be skillfull users of ICT. The internet is visited mainly from home (65%) and from work (28%). Daily use of the internet is established at 89% and on weekly access 9% of the respondents. Electronic mail was used daily by 81%; whereas weekly access was 13% and 5% of the respondents not access the Internet at all. Out of the respondents 95% had a cellular phone.
The results differ to what the health care staff and researchers generally would expect.
Opposite to belief, the Internet and mobile terminals utilising new forms of health services were widely appreciated. The reservation of a check up appointment, changing or cancelling the appointment via the internet was considered highly relevant by 73% and quite relevant 20% almost as popular was a proposal of printing hardcopies of necessary forms and personal medical instructions receivable over the internet or via email. Also feedback related to personal medical check up calls vie Internet was supported by a surprisingly high figure (highly appreciated 67%, relatively appreciated 18%). All proposals of different health care service forms were well accepted by the majority. Most dispersion of opinions was caused by matters concerning health in open or closed conversation forums, 28% indicated high importance, relatively importance 36%, not very important 18% and not recommendable at all close to 6% of the respondents.
The use of the Internet in open health care procedures was laid under suspicion because of privacy and confidentiality issues (64%) and the cost 8% approximately 31% did not indicate any reason submitted in the survey. An open auxiliary comment or alternative reason was submitted in 20% of the cases. The open comment was primarily concerning reasoning for a qualitative answer. The qualitative question was by nature steering. Mobile services were not as popular as services available through the internet, or rather; the mobile services caused a higher level of suspicion. Delivering check up times as SMS-messages were received the most positive out of three proposals in the field of mobile services. It was considered as meaningful by 70% result of laboratory and other research results as SMS-messages was considered interesting by 54% and not relevant by 40% . Dosage of personal drug and other forms of therapy planning and correction 54% considered as useful and not useful around 39%
The use of mobile informatics in open heath care procedures was diffused mainly by prices and confidentiality 49%, also costs (18%) and accessibility (13%) were issues brought up by this survey.
In the case of mobile informatics 32% did not answer to any of the alternative questions because of instability of use. A reason or comment was submitted in 20% of the answers.
The customer survey was executed exclusivity in the Internet. This, obviously, could be considered as casting a bias in the questioner gathering, as all citizens do not have access to the Internet. However, our judgement is that the research method used in this case supplies us with comprehensive feedback, as there are new types of health care services available over the Internet (Nicholas, Huntington et al. 2002)
The data security issue pertaining to customer data is considered to be crucial but the risks involved are evaluated moderately and are not considered as thresholds for the implementation of new technologies. The respondents consider themselves to be apt computer users and this persisting they understood the data security issues related to computer use.
The client has also perceived the risk of paper archiving or hard copy systems. This was punctuated when asking attitudes towards systems used by staff. Only one fourth (24%) considered the clients data security to decrease when switching to computer based documentation.
In the discussion parts of the article, the next important topics shall be covered: health care services rendered over the Internet – is this a means to shorten queue and improve the availability of health care services or, rather, a privilege dedicated to a small computer educated groups? On the other hand, speculation will be imminent about potential emancipating influence of different systems reaching diverse groups of special groups. How will health care staff react to the possible outcome of patients having more access to their own medical or other personal files? How realistic are the data security assumptions of the end users and how should the health care staff being educated in the data security issues?
Kazanjian, A. and C. J. Green (2002). “Beyond effectiveness: the evaluation of information systems using a comprehensive health technology assessment framework.” Computers in Biology and Medicine 32: 165-177.
Kim, K. K. and J. E. Michelman (1990). “An Examination of Factors for the Strategic use of Information Systems in the Healthcare Industry.” Strategic Use of Hospital Information Systems(June 1990): 201-215.
Nicholas, D., P. Huntington, et al. (2002). “NHS Direct Online: its users and their concerns.” Journal of Information Science 28(4): 305-319.
Ragupathi, W. (1997). “Health Care Information Systems.” Communications of the ACM 40(8): 81-82.
Stanberry, B. (2001). “Legal ethical and risk issues in telemedicine.” Computer Methods and Programs in Biomedicine 64: 225-233.