Clinical information technology & health services integration for chronic disease management

Abstract

The broad topic that this thesis aims to investigate is the implementation issues in the digital transformation of healthcare, including how to understand the transformation process and the changes it brings about within healthcare services. The study centres around three case studies of how medical officers use clinical applications in Canberra Health Services. These case studies include WhatsApp (a secure messaging service owned by Meta Platforms Inc.), MedChart (an electronic medication management system [EMMS] developed initially in Canberra and now owned by DXC technology), and My Health Record (MyHR) (the Australian Government's patient-controlled electronic health record). Data collection methods include semi-structured interviews, narrative literature reviews, and document analyses.

The three case studies were chosen based on the different levels of achievement they have reached in implementation and the heterogeneous nature of the implementation formats. This thesis used a multiple case study method to enable a comparison between the three health information technology (HIT) applications and identify common themes and elucidate important insights and implications for the implementation of digital technologies for integrating chronic care.

The identified themes are 'The impact of COVID-19 has accelerated digital transformation', 'Embracing digitalisation: how healthcare providers are recognising the long-term benefits' and 'Integrating chronic care through digitalisation: a path to improved healthcare delivery'. These themes set the current and predict the future contexts for HIT implementation for integrating chronic care. Meanwhile, 'the persistence of dated methods', 'interoperability challenges in HIT implementation', 'challenges in ensuring data quality for HIT implementation' and 'concerns for data security' were identified as the main challenges found in this research. To deepen the understanding of the above findings and provide practical recommendations, this thesis used the ANT-affordance framework to examine the root causes of the challenges and present practical suggestions to improve future HIT implementation. It highlights the following key recommendations/key factors for improving HIT implementation:

1. Recognise problems with the technology rather than blaming user attitudes and willingness. 2. Accelerate problematisation through user-driven design and personalisation. 3. Drive interessement and enrolment by structuring HIT implementation based on the assessment and adjustment of the degree of technological affordances. 4. Emphasise the importance of well-defined clinical representatives and user-centric problem-solving channels for effective mobilisation. Show more