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Bass Connections: Challenges of Technology Implementation

Updated: Sep 5, 2019

Shengjie Xu

Technology innovation in the last century has tremendously improve the quality of life. Increasing number of new technology is continuously shaping the healthcare system. However the implementation of technology has to be tailored to a specific context. Complex devices such as surgical robots developed for high-income countries may be less likely to be adopted in low and middle income countries (LMIC) with limited resource and infrastructures. Whereas less tangible technologies such as mobile telephone supporting health (m-helath) has great potential to be implemented in LMIC. Due to the various challenges in real-life application setting, it is important to understand how to best leverage technological tools so that they can be used to the full extent.

Case Study of Health Information Technology (HIT)

Due to the wide ranges of technology that are now embedded within the healthcare system, the ways in which technology can fit and work into the global platform are almost infinite. However, by focusing on a particular technology, we can study at a more concrete level how it fits in. A case study of Health Information Technology (HIT) reveals more detail about how technology and healthcare can work together. An editorial titled, “Successful Health Information Technology Implementation Requires Practice and Health Care System Transformation” from the Annals of Family Medicine discussed the impacts of electronic health records (EHR) and the disconnect between their design, implementation and client base.[1] When describing the current EHR system the author describes how EHR is designed for day to day patient interactions and to improve the efficiency of clerical work such as billing. This technology, while tremendously useful for staff in physician offices, isn’t designed to help doctors or patients have a holistic, long-term data collection process or management system that is necessary for long-term health care for chronic conditions such as diabetes. This is yet another example of how a technology designed to combat a problem in the healthcare system falls short of having a maximum impact.


Figure 1: The percentage of individuals who communicate with health care providers through certain health information technology from 2012-2014 [2]

Electronic health records today open the door not only for easy retrieval of a patient's medical records but also for the development of a smarter health industry as a whole. Other exciting components of the ever-evolving EHR scene include anonymized big data analytics, remote medicine and various forms of highly personal and wholistic diagnosis and treatment. While technology makes many things possible, perhaps its single most impressive and useful aspect is its ability to transform increasingly large, complex set of data into comprehendable and manageable patterns and traits [3]. This includes everything from allowing a physician to identify warning signs and potential risk factors for a neuromuscular disease to helping a health system cut down on wasted supplies. Additionally, the case of EHR reveals how indirect but related issues such as patient privacy, legal structure, coexistence with previous systems (in this case paper filing) are all serious challenges to implementation. Today, Healthcare Information Technology is a robust and thriving industry, all working to find ways to take powerful technological systems and embed them into our current medical systems in meaningful and effective ways.

Barriers of Technology Implementation in Global Health

Technology can improve global health through treatment plans with pharmaceuticals and devises, preventative screening and vaccination. However the present technology for health focuses mainly on the needs of the wealthy. Technologies developed for the wealthy are often negligent of the settings in low-resource countries with limited infrastructures and become useless when they are transferred to be used in LMICs. According to hospital inventories, around 40% of donated health-care equipment in developing countries is out of service because of lack of maintenance or energy supply (4). Even when the desired technology is accessible, public acceptance and inertia can also be an issue to prevent technology benefiting global health. Three major barriers should be considered for developing and implementing new technology in LMIC: compatibility, accessibility and adoption of the new technology, adapted from the the Lancet Commissions technologies for global health report (Fig. 2).


Figure 2. Barriers to greater use of technology for global health (7).


Compatibility

Depend on the target population, new technology should be developed to meet the needs of the majority. In Peru, the incidence rate of cervical cancer is the highest compare to other cancers in women of all ages (5), which calls for the increasing needs of effective and efficient cervical cancer prevention, diagnosis and treatment. POCKeT Colposcope developed by teams in Duke University can fit the needs for the diagnosis of cervical cancer in Peru. The likelihood for key stakeholder in Peru to approve the use of POCKeT Colposcope is high due to the national demands for cheap and effective diagnosis of cervical cancer. Whereas countries with low cervical cancer rates, such as the Middle East, may be reluctant to adopt POCKeT Colposcope as there are less needs.

Accessibility

In the USA the average total spending on pharmaceuticals was $956 per person in 2009, while the expenditure of 49 low-income countries on all health care was $25 per person (6). Hence, the design and production of health technologies need to address the affordability of such technologies. Low-cost point-of-care POCKeT Colposcope, which delivers similar clinical performance compared to the existing standard of care, cost almost ten times less than the traditional colposcope ($250 compared to $20,000) can successful address the issue of cost in low and middle-income countries such as Peru.

The distribution of medical devices or pharmaceuticals are also a potential barrier for technology to reach the desired healthcare system. Vaccines that require refrigerated can be a big challenge to be allocated to small rural areas without the power supply for big cooling system. Renovating vaccine formula to stabilize them in room temperature could be a good solution for this challenge. On the other side, POCKeT Colposcope has no requirement for storage temperature. The size of POCKeT Colposcope is about a tampon and portable to carry without the assistance of large vehicle.

Inadequate human resources is another challenge for technology to be accessible to healthcare practice. Practitioners need to have certain level of professional background and training to operate with a new technology powered system. Under the condition when there are not enough doctors with expertise in cervical cancer, the images captured from colposcope are usually sent to these professionals and await their diagnosis. This process can take days to be done. This increase the chances of losing patients without a point-of-care testing. New generation of POCKeT Colposcope aims to integrate an algorithm where diagnosis can be done directly from the pictures captured from the patients. Healthcare provider can give result back to patients and decide follow-up procedure within the same visit.

In summary, the successful implementation the new technology in healthcare system relies much on the design of new technology and the context of system it intend to be of use. Health technologies introduction into low-resource settings should be carefully decided upon evidence-based science and taking into considerations of the obstacles that could hinder the implementation of the technology.

References

1. Jaén, Carlos Roberto. “Successful Health Information Technology Implementation Requires Practice and Health Care System Transformation.” Annals of Family Medicine 9.5 (2011): 388–389. PMC. Web. 10 Oct. 2016.

2. 2012-2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange.

3. Frost & Sullivan: Drowning in Big Data? Reducing Information Technology Complexities and Costs for Healthcare Organizations.

4. Perry L, Malkin R. Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world? Med Biol Eng Comput 2011;49: 719–22.

5. Bruni L, Barrionuevo-Rosas L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in Peru. Summary Report 7 October 2016. [Date Accessed]

6. Taskforce on Innovative International Financing for Health Systems. More money for health, and more health for money. http://www. hanshep.org/resources/further-reading/taskforce-for-innovative- international-financing-for-health-systems-2009-report/ (accessed Jan 12, 2012). 2009.

7. The Lancet. Technologies for global health The Lancet, Volume 380, Issue 9840, 4–10 August 2012, Page 447


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