An information technology framework for strengthening telehealthcare service delivery

Health-tech startups in healthcare service delivery: A scoping review

BACKGROUND

An efficient and affordable healthcare service delivery to everyone is a prerogative of the national governments. Such delivery is quite exacting, and gaps remain. In this regard, startups are trying to disrupt the market with innovative solutions and reach the underserved market. Though anecdotal evidence remains, a rigorous literature review is missing. This paper attempts to understand the status of health-tech startups in healthcare service delivery.

METHODS

We scanned a total of 110 journals - Financial Times top 50, top ten information systems journals listed by the Australian Business Dean Council, and the top 50 Scopus indexed journals in health informatics and health information management. We followed a systematic process for this scoping review - reading of titles, abstracts, and then full papers for final analysis based on inclusion and exclusion criteria.

RESULTS

A total of 76 articles met the inclusion criteria. Only five studies portrayed the status of health-tech startups in healthcare service delivery. To capture the overall startup ecosystem, we continued with a scoping review of all the 76 articles.

DISCUSSIONS

The identified five themes are Technology adoption, Electronic health services, Business planning and framework, Psychographics, and Regulations. There is evidence of technology adoption in service delivery and its nature in the businesses undertaken by startups. Very few studies represented the patterns of the existing business model. The acceptance of the services is dependent on service effectiveness and affordability. The challenges are licensing, policies, data privacy and security, and inadequate technology access among healthcare seekers.

CONCLUSIONS

Albeit the feasibility potential, research concerning the impact of health tech startups in healthcare service delivery is emerging but incipient. The review indicates that research on startups is inadequate, especially related to entrepreneurship, business frameworks, and regulations. Future research should explore the same.

The Influence of Remote Monitoring on Clinical Decision Making

The aim of this study was to examine the meaningful use of remote monitoring. In partnership with a home health care agency, we examined the degree to which the information obtained from remote monitoring influenced change in decisions that affect readmission rates among patients diagnosed with heart failure. Hospital utilization was highly associated with nurses’ clinical decisions to go to the hospital; the additional data provided by technology did not modify decisions. The role of nurses in heart failure management is critical to quality outcomes. Investments into remote monitoring technology should accompany strategies to enhance decision making and align clinical decision making with quality goals.

The application of a biometric identification technique for linking community and hospital data in rural Ghana

BACKGROUND

The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana.

OBJECTIVE

Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting.

DESIGN

A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age.

RESULTS

A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes.

CONCLUSIONS

Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

Evaluating self-management behaviors of diabetic patients in a telehealthcare program: longitudinal study over 18 months

BACKGROUND

Self-management is an important skill for patients with diabetes, and it involves frequent monitoring of glucose levels and behavior modification. Techniques to enhance the behavior changes of diabetic patients have been developed, such as diabetes self-management education and telehealthcare. Although the patients are engaged in self-management activities, barriers to behavior changes remain and additional work is necessary to address the impact of electronic media and telehealthcare on patient self-care behaviors.

OBJECTIVE

The aims of this study were to (1) explore the behaviors of diabetic patients interacting with online applications, (2) determine the impact of a telehealthcare program among 7 self-care behaviors of the patients, and (3) determine the changes in glycosylated hemoglobin (HbA1c) levels.

METHODS

A telehealthcare program was conducted to assist the patients with 7 self-care activities. The telehealthcare program lasted for 18 months and included the use of a third-generation mobile telecommunications glucometer, an online diabetes self-management system, and a teleconsultant service. We analyzed the data of 59 patients who participated in the telehealthcare program and 103 who did not. The behavioral assessments and the HbA1c data were collected and statistically analyzed to determine whether the telehealthcare services had an impact on the patients. We divided the 18-month period into 3 6-month intervals and analyzed the parameters of patients assisted by the telehealthcare service at different time points. We also compared the results of those who were assisted by the telehealthcare service with those who were not.

RESULTS

There was a significant difference in monitoring blood glucose between the beginning and the end of the patient participation (P=.046) and between the overall period and the end of patient participation (P<.001). Five behaviors were significantly different between the intervention and control patients: being active (P<.001), healthy eating (P<.001), taking medication (P<.001), healthy coping (P=.02), and problem solving (P<.001). Monitoring of blood glucose was significantly different (P=.02) during the 6-12 month stage of patient participation between the intervention and control patients. A significant difference between the beginning and the 6-12 month stage of patient participation was observed for the mean value of HbA1c level (P=.02), and the differences between the overall HbA1c variability and the variability of each 6-month interval was also significant.

CONCLUSIONS

Telehealthcare had a positive effect on diabetic patients. This study had enhanced blood glucose monitoring, and the patients in the program showed improvements in glycemic control. The self-care behaviors affect patient outcomes, and the changes of behavior require time to show the effects.