Exploring the Impact of a Telehealth Care System on Organizational Capabilities and Organizational Performance from a Resource-Based Perspective

Information-Driven Integrated Healthcare: An Analysis of the Cooperation Strategy of County Medical Community Based on Multi-Subject Simulation

The fragmentation and uneven quality of primary medical resources in China call for a deepening of integrated healthcare reform. China is promoting its county medical community (CMC) reform on a large scale in county-level administrative regions to promote the integration of local primary healthcare systems through information technology, which is consistent with the current trend of the digital governance era. Considering that the construction of a county medical community involves collaborative relationships between multi-level subjects, the evolutionary game theory was adopted in this study to construct a game model between the lead hospital of a CMC and primary healthcare institutions, and then the incentives of government department support were introduced to analyze the behavioral evolution of these three subjects. Taking into account the uncertainty of the real-life environment and information transformation, white Gaussian noise was introduced as a random disturbance term, and a numerical simulation was performed. In the two-subject model we focus on four parameters: information and management authority ceded by the primary healthcare institutions, integration coefficient of CMC information construction, intensity factor of information integration in the CMC, and medical resources delivered by the lead hospital. In the three-subject model we focus on three parameters: information and portion of authority ceded by the primary healthcare institutions and government departments, policy effect coefficient of CMC construction, and intensity of government departments' support for CMC construction. The simulation results show that there is a positive incentive for the concession of management power and information from the primary healthcare institutions to the lead hospital, but further determination of empowerment boundaries is needed. The lead hospital can improve the balance of medical resources in the county through the downward transfer of medical resources, but long-term resource delivery may inhibit the enthusiasm of the lead hospital. An improvement in the information integration intensity of the CMC can promote the efficient flow of information and knowledge and enhance the organizational closeness of the county medical community. At the same time, the integration of CMC information construction reduces the cost of collaboration among medical community members and streamlines and consolidates business modules, which can promote more efficient use of medical resources. The government departments' policies and funds provide obvious incentives to the lead hospital and primary healthcare institutions, but there is a need to explore appropriate financial payment ratios to balance the government's financial pressure.

Building resilient hospital information technology services through organizational learning: Lessons in CIO leadership during an international systemic crisis in the United States and Abu Dhabi, United Arab Emirates

BACKGROUND

The COVID-19 pandemic was an international systemic crisis which required an unprecedented response to quickly drive the digital transformation of hospitals and health care systems to support high quality health care while adhering to contagion management protocols.

OBJECTIVE

To identify and assess the best practices during the COVID-19 pandemic by Chief Information Officers (CIOs) about how to build resilient healthcare IT (HIT) to improve pandemic preparedness and response across global settings and to develop recommendations for future pandemics.

METHODS

We conducted a qualitative, interview-based study to sample CIOs in hospitals. We interviewed 16 CIOs from hospitals and health systems in the United States and Abu Dhabi, United Arab Emirates. We used in-depth interviews to capture their perspectives of the preparedness of hospitals' information technology departments for the pandemic and how they lead their IT department out of the pandemic.

RESULTS

Results showed that healthcare CIOs were ambidextrous IT leaders who built resilient HIT by rapidly improving existing digital business practices and creating innovative IT solutions. Ambidextrous IT leadership involved exploiting existing IT resources as well as exploring and innovating for continuous growth. IT resiliency focused on four inter-related capabilities: ambidextrous leadership, governance, innovation and learning, and HIT infrastructure.

CONCLUSIONS

We propose conceptual frameworks to guide the development of healthcare IT resilience and highlight the importance of organizational learning as an integral component of HIT resiliency.

Telehealth care system for chronic disease management of middle-aged and older adults in remote areas

Background

With the global spread of the coronavirus disease pandemic, governments have become more interested in applying telehealth technology in 2020.

Objective

This study integrates the technology acceptance model and information system success model to explore the influence of satisfaction, attitudes, and continued use of telehealth systems among middle-aged and older people in remote areas.

Methods

The study participants were patients over 40 years (inclusive) who lived in remote townships in eastern Taiwan, were diagnosed with diabetes or hypertension, and used the telehealth care system. In total, 545 questionnaires were returned, resulting in a recovery rate of 99%.

Results

Accepting the hypothesized structural equation model, this study found that information, system, and service quality were influenced by the mediating effect of perceived ease of use and the perceived usefulness of the technology acceptance model. The use of telehealth care systems among chronic patients increased significantly.

Perceptions of Telemental Health Care Delivery During COVID-19: A Cross-Sectional Study With Providers, February-March 2021

The COVID-19 pandemic accelerated adoption of telemental health (TMH). Providers with limited TMH experience faced challenges during the rapid switch to remote patient care. We investigated TMH providers' perceptions about remote care one year into the pandemic according to when providers adopted telemedicine (i.e., before vs. after March 2020) and how much of their caseloads were served remotely (i.e., < 50% vs. ≥ 50%). Between February-March 2021, 472 TMH providers completed a cross-sectional, web-based survey that measured perceived benefits and satisfaction with telemedicine, therapeutic alliance, patient-centered communication, eHealth literacy, multicultural counseling self-efficacy, and facilitating factors of using telemedicine. Providers who began using telemedicine before the pandemic reported having better training, task-related therapeutic alliance with patients, and ability to conduct multicultural interventions, assessments, and session management. Providers who served ≥ 50% of their caseload remotely reported greater satisfaction with their practice, stronger beliefs about the benefits of telemedicine, and greater perceived effects of telemedicine on alleviating the impact of COVID-19. There were no differences in reports of patient-centered communication nor eHealth literacy. In conclusion, providers who adopted TMH more recently may require additional training and support to successfully establish a working alliance with their patients, especially with multicultural aspects of care.

Telehealth and hospital performance: Does it matter?

Introduction

Previous studies indicated that telehealth services may improve hospital performance. However, the extent to which these telehealth provisions would improve hospital total performance score under the hospital value-based purchasing (HVBP) programme is not clear. The aim of this study is to examine the association between telehealth provision and hospital performance.

Methods

We performed a retrospective analysis of the association between the provision of telehealth services and 2699 hospital’s total performance score (TPS) on the 2018 HVBP programme and its four domains. Multivariate regression models were used to analyse TPS and hospital performance on each domain. Telehealth services offered by a hospital was categorically operationalized as hospitals with no telehealth services, with one to two telehealth services, and with three or more telehealth services.

Results

Hospitals with one to two telehealth services have TPS (ß coefficient = 1.50; 95% confident intervals (CI): 0.28, 2.73; p < 0.05) and hospitals with three or more telehealth services have higher efficiency and cost reduction (ß = 1.10; 95% CI: 0.32, 1.87; p < 0.01) domain scores. However, the impact of telehealth on clinical care, person and community engagement, and safety domain scores was not significant.

Discussion

The expansion of hospital telehealth service provision can improve not only the efficiency of care, but also the total performance of the hospital. Since total performance is directly associated with hospital payments from the government, these findings have significant practice and policy implications. In addition, the effect of telehealth on other quality measures such as clinical care and safety needs further investigation.