E-Health Readiness of Medical Professionals in India

With the 11^thFive-year Plan, large amount of resources are allocated to push health reforms in India. A steady increase in the healthcare sector spending, especially in the deployment of information technology (IT) in the healthcare delivery system, was observed recently. Constant changing patient demographics, chronic disease growth and increased healthcare expenditure has increased the demand for implementation of health-related IT in India. Enterprises are now moving towards a more integrated IT-enabled or e-healthcare delivery models for a sustainable healthcare delivery. Large-scale implementation of e-Health projects across the country would dramatically increase the accessibility of healthcare for patients residing in the remote rural parts of India also.

The preparedness for e-Health related change can be measured only through the readiness assessment. Readiness assessment holds the key element to facilitate this process of change for individuals and organizations to actively adopt such programs. The literature shows that e-Health readiness assessment helps in successful planning and process implementation in healthcare institutions. To understand the perspective and preparedness of Indian healthcare professionals, the study was conducted on 2,306 medical professionals such as practicing doctors, medical students, and professors teaching in various medical institutions across the 30 states of India. In first phase, 306 interviews were conducted over internet and in second phase, 2000 interviews were done face-to-face. The survey used the ‘WHO 60-cluster-sampling method’ for the second phase of data collection.

The researchers analyzed the e-Health readiness of India’s health practitioners by assessing various parameters. The study has segregated the subject pool on the basis of gender, age, attitude towards technology, behavior towards technology, awareness of health IT, usage of health IT, working profile, employer profile and multiple other parameters. This study measures the multiple facets of healthcare IT and their use by the healthcare professionals. The following factors were studied extensively:

• Usage of computing devices
• Usage of IT in their professional domain
• Attitudes towards using IT in their professional domain
• Disposition towards taking training to enhance their IT skills

The study has successfully identified the key barriers towards technology adoption in healthcare in India. The survey findings suggest that medical professionals display segmented attitudes with respect to e-Health. This assessment provides a directional overview of the current e-Health readiness of healthcare practitioners. It aims in identifying opportunities for policy makers and e-Health solution vendors for an active engagement of e-Health practitioners in better patient care.

Objectives and Methodology

This report sets out the findings of significant new research on health practitioners across the country. Health practitioners or doctors are critical information and delivery hubs in a health ecosystem. They have varied roles in intervention and care, ongoing patient education, management of chronic conditions, diagnosis and treatment, etc. e-Health readiness assessment measures their engagement in the use of health – IT for patient care and trainings as it is essential in promoting e-Health use and health outcomes across the system.

The study conducted a Pan-India survey of 2,306 medical professionals such as practicing doctors, medical students, and professors teaching in various medical institutions across the 30 states of India. The subjects were attached to either government hospitals, private hospitals, hospitals run by non-governmental organizations or educational institutes. The survey was conducted in two groups. The first group included 306 doctors who were surveyed using a net-based questionnaire. They responded via the internet. All the professionals who consented for the survey and who had access to internet connectivity were included in the survey. The second group included 2000 doctors. The survey was based on face-to-face interviews. This ‘second phase’ coincided with that of the home-to-home-based National Healthcare Survey (NHS) 2013–14 conducted by IIHMR. The face-to-face survey for Technology Adaptation Survey was clubbed along with NHS 2013–14 to enhance the coverage of doctors in the interiors of the country. Conducting face-to-face interviews ensured the participation of doctors who did not use the internet but used other forms of health IT applications such as EMR/EHR/mobile apps, etc. The survey used the ‘WHO 60-cluster-sampling method’ for the second set of data collection.

The step-by-step detail of the ‘WHO 60-cluster-sampling method’ methodology used was:

• Determination of the number of population to be screened for conducting and capturing the responses of the individuals and doctors surveyed using an EPI calculator = 12,000 households’ coverage worth area.
• The 12 states chosen for face-to-face survey across the country
• Two highly populated districts per state were chosen. A sample screening target of 1000 households was covered from each district. These 1000 households (per district) had equal representation of 500 rural and 500 urban households. This was done so as to ensure equal representation of all socio-economic strata (for doctors practicing amongst the varied population surveyed).

Conclusion

Regular usage of healthcare platforms is quite low across medical professionals of all segments. However, disposition to use IT and specifically mobile apps is quite positive. Disposition is more positive amongst younger professionals. Most patient records are stored still in paper formats by most professionals. However, in private hospitals and research institutes records are started storing in digital format along with traditional paper record method. It is felt by the fraternity that EMRs will definitely enhance patient care quality and efficiency; however, they are concerned about the costs and investments that the system would entail.

Key barriers to acceptance of IT on healthcare are:

• High cost of implementation for things like EMR
• Lack of user-friendly options
• Vendors lacking healthcare domain knowledge
• Fear of data loss
• IT attitudinal segments of medical professionals

The survey findings suggest that medical professionals display segmented attitudes with respect to e-Health. However, they all lie on a continuum with respect to adoption of IT in healthcare and this overlaps with their age continuum.