R Gururajan et al. Implementing wireless hand-held technology
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" Challenges for implementing wireless hand-held technology in health care: views from selected Queensland nurses Raj Gururajan, Clint Moloneyw and Jeffrey Soarz Department of Information Systems, University of Southern Queensland; wToowoomba Health Service District, Queensland; z
Programme for Health and Aged Care Informatics, University of Southern Queensland, Toowoomba, Australia
Summary Many health-care providers in Australia are exploring the use of wireless technology to improve service delivery. It appears that the solutions so far have been dictated by the hardware vendors and that the business case is yet to drive the implementations. A focus group discussion was facilitated with eight senior management staff involved in health care in Western Australia. This resulted in a set of challenges, which were used to invite opinions from nursing staff in Queensland. A total of 31 interviews were conducted. The analysis returned a set of 63 themes, which were grouped. These groupings reflected the challenges as lack of user-friendly applications, unreliable technology, substandard testing, shortage of staff, concerns for security, reliance on technology, existing problems, work schedule, training, outdated health policy, coverage of wireless links, confidentiality and lack of awareness. The interviews clearly indicated the need for training and awareness procedures. The present study provides some of the information necessary to realize an enterprise-wide implementation of wireless technology.
Introduction
....................................................................... Wireless technology has begun to be used in health-care applications, mainly to solve local problems, where ad hoc solutions are provided at department or unit level. Common to most of these wireless developments is the enthusiasm exhibited by hospital information technology (IT) people, a push for innovative solutions to solve existing problems, the complications of establishing wired networks due to cost, and a drive by the executive officer to trial innovative solutions (usually read in a magazine while travelling) and to test ‘proof of concept’. However, in many cases, it also appears that there is a lack of an integrated approach to implementation since users such as nurses are often not consulted. To our knowledge, there has been no proper study to verify the claims made in the literature about the challenges of implementing wireless solutions in health care. Previous studies in the area of telemedicine clearly demonstrate that technology alone will not solve the problems encountered in health care.1,2 The management’s attitude in assuming that hospital users are computer literate has been cited as a major reason for failure. It should be noted that in many studies of information systems, training was identified as one of Correspondence: Raj Gururajan, Department of Information Systems, University of Southern Queensland, QLD 4350, Australia (Fax: þ61 7 4631 5594; Email:
[email protected])
Journal of Telemedicine and Telecare 2005; 11 (Suppl. 2): S2:37–38
the main factors in success. Despite this, it appears that current implementations in wireless technology have ignored training. Previous studies in health have also identified security as the most significant factor in the successful implementation of wireless technology. In a study conducted in Western Australia (WA) with health executives involved in policy making, it was found that there were 15 factors that inhibited the successful adoption of wireless technology in their health-care environment.3 The present study was designed to obtain opinions from nursing staff in a specific health district about challenges to implementing wireless technology in their workplace.
Methods
....................................................................... As a pilot study, a focus group discussion was facilitated with eight senior management staff involved in health care in WA in February 2005. These participants came from both public and private hospitals, as well as academia. They were chosen based on their experience, role, leadership and knowledge of wireless technology as applicable to their health-care setting. The aim of the exercise was to rank the challenges and to establish the variability of the responses. This resulted in a set of challenges – security concerns, availability of suitable hand-held devices, existing software limitations, cost, user demand (some do not want it; some have not
R Gururajan et al.
Implementing wireless hand-held technology
accepted it), unrealistic user perceptions and expectations, management of hand-held devices, legal issues, potential for problems with electronic records, clinical issues, environment of change, standards, consumer issues, technology is arriving at an advancing rate and data storage issues. This initial set of challenges was used to invite opinions from nursing staff in Queensland through a set of interviews. The main study used interviews to collect data in order to understand users’ feelings. Ethics approval was obtained from the appropriate committees. User opinions were obtained prior to any implementation studies. Participants for the interview were selected from the nursing staff. Only nurses working with technology were eligible for participation: any nursing staff involved with administration only were ineligible for interview. The nurses were chosen from a wide range of backgrounds, including pharmacy, oncology and emergency medicine. A total of 31 interviews were conducted. The interviews were scheduled in such a way that nurses’ work schedules were disrupted as little as possible. Each interview lasted about 45 min. The interviews were recorded and the interview schedule, participant names, location, start time and end time were documented. The interviews were then transcribed for data analysis using software for qualitative data analysis (NVivo, QSR International Pty Ltd).
Results
....................................................................... The analysis returned a set of 63 themes (nodes in NVivo). These were grouped, based on similarity of interview dialogue. These groupings reflected the challenges as lack of user-friendly applications, unreliable technology, substandard testing, shortage of staff, concerns for security, reliance on technology, existing problems, work schedule, training, outdated health policy, coverage of wireless links, confidentiality and lack of awareness.
Discussion
....................................................................... The results of the interviews gave useful insights into the challenges as seen by the users in implementing wireless
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technology in health care. The terms ‘user-friendly’ and ‘user-friendliness’ are particularly significant, because the first term is expressed in relation to users using a new system and the second term is expressed in relation to management issues associated with implementing the system. The subtle difference also indicates the adoption of a new technology as seen by its users and by the managers. There were similarities between the outcomes of the interview data and the results from the WA executives. For example, security was a challenge in the view of both groups. While WA participants expressed concerns about security, Queensland nurses expressed concerns about security as well as confidentiality of data. WA executives were concerned about software limitations, but nurses were concerned about testing, reliability and awareness. The clinical issues were mentioned by both groups. While executives were concerned with legal issues, environmental changes and unrealistic user perceptions, nurses identified staff shortages (to handle new technology), the unreliability of the technology as well as of the system, existing health policies and their orientation towards wireless technology as issues. The focus group and the interviews, conducted with two different sample groups in two different health domains, using two different qualitative techniques, identified similar challenges in implementing wireless technology in health care. While the focus group yielded 15 barriers, the interviews resulted in similar numbers with freely expressed opinions. The interviews clearly indicated the need for training and awareness procedures. The present study provides some of the information necessary to realize an enterprise-wide implementation of wireless technology.
References 1 Anogeianaki A, Ilonidis G, Anogianakis G, et al. A training network for introducing telemedicine, telecare and hospital informatics in the Adriatic-Danube-Black Sea region. J Telemed Telecare 2004;10 (Suppl. 1):1–3 2 Bensink M, Armfield N, Russell TG, Irving H, Wootton R. Paediatric palliative home care with Internet-based video-phones: lessons learnt. J Telemed Telecare 2004;10 (Suppl. 1):10–13 3 Gururajan R, Quaddus M, Fink D, Vuori T, Soar J. Drivers and barriers to adoption of wireless handheld system in WA healthcare: selected views. HIC 2005. Melbourne: HISA, 2005
Journal of Telemedicine and Telecare Volume 11 Supplement 2
2005
