PERSPECTIVES OF PRIMARY HEALTH CARE AND PSYCHIATRIC PROFESSIONALS ON THE EXPERIENCE OF VIDEO CONFERENCING
FOR CHILD PSYCHIATRIC COUNSELING
Fanny-Maria Aleksandra Kilpinen Master's thesis Public Health University of Eastern Finland Faculty of Health Sciences School of Medicine November 2020
Public Health
KILPINEN, FANNY-MARIA: Perspectives of primary health care and psychiatric professionals on the experience of video conferencing for child psychiatric counselling Master's thesis, 72 pages, 2 attachments (14 pages).
Supervisors: Sohaib Khan MBBS, MPH, PhD and Hannele Turunen, PhD, RN November 2020
Key words: eHealth, telehealth, video conferencing, information and communication technologies, mental health, adolescent, Finland
PERSPECTIVES OF PRIMARY HEALTH CARE AND PSYCHIATRIC PROFESSIONALS ON THE EXPERIENCE OF VIDEO CONFERENCING FOR CHILD PSYCHIATRIC COUNSELING
Digitalization and technology are the key parts of modern life, and their rapid development is changing the services in social and healthcare. Increasing use of smartphones in everyday life enables faster access to health services. Transformation of digital era has brought new eHealth technological tools for health sector which have been found to increase work efficiency among all healthcare professionals. One of those new features is video consultation (VC) and it has begun to be utilized in the treatment of psychiatric patients. VC has been noticed to be effective and convenient for all actors. VC optimises both parties time and reduce healthcare costs without impacting the patient-centred approach. Additionally, it brings new technology aspects to the treatment. However, implementation new technologies to processes can be challenging.
Healthcare professionals´ perceptions, usability, attitudes, willingness and characteristics have considerable influence on user experience.
The aim of this study is to describe and illustrate the experiences, usability, effectiveness, user- friendliness and necessity of the video conferencing meetings in eHealth Services for Child and Adolescent Psychiatry-project in North Savo, Finland. The qualitative and quantitative data was collected by the “eHealth Services for Child and Adolescent Psychiatry (eCAP) project in 2018.
The project obtained a total of 94 participants from primary health care and Kuopio University Hospital. The data was accumulated by online structured questionnaire. The questioners were used to identify the experiences of utilizing VC.
The results of the study indicated that perceived experiences were positive among all actors.
eHealth services in mental health sector are beneficial for all parties. According to healthcare professionals; work efficiency, usability, experienced benefits and delivering services for mental health patient increased due to VC. Collaboration among all participants were experienced successful. Regarding to results, important topics were addressed in every VC. However, Kuopio University Hospital (KUH) professionals experienced that the consultation problems were broader than expected. In some VC, the booked time was not adequate to assist in all problems.
For future development, KUH professionals proposed more extensive overview of the patient´s problems. While user experiences seemed promising, some technical problems were identified while using VC. As a future suggestion, new technological equipment must be invested.
CAP — Kuopio University Hospital Child and Adolescent Psychiatry outpatient clinic eCAP—eHealth Services for Child and Adolescent Psychiatry
eHealth—Electronic Health Services EHR—Electronic Health Record EU—European Union
ITC— Information and Communication technologies
KANTA— Finnish information management service for patient data and prescription KELA— Finnish government and Finnish Social Insurance Institute
KUH— Kuopio University Hospital mHealth—Mobile Health
OECD—Organization for Economic Co-operation and Development SMS—Short Messaging service
STM—Ministry of Social Affairs and Health UEF—University of Eastern Finland
UN— United Nations VC— Video Conferencing
WHO—World Health Organization
1 INTRODUCTION ... 4
2 LITERATURE REVIEW ... 7
2.1 DIGITAL TECHNOLOGY IN HEALTH CARE: DEFINITIONS & CONCEPTS ... 7
2.1.1 E-HEALTH ... 7
2.1.2 TELEHEALTH ... 8
2.1.3 TELEMEDICINE ... 9
2.1.4 ELECTRONIC HEALTH RECORD ... 9
2.1.5 VIDEO CONFERENCING ... 10
2.1.6 M-HEALTH ... 10
2.1.7 COMBINING TECHNOLOGIES ... 11
2.2 DIGITAL HEALTH CARE GLOBALLY ... 12
2.3 DIGITAL HEALTH CARE IN FINLAND ... 13
2.3.1 BRIEF HISTORY OF DEVELOPMENT ... 15
2.3.2 CURRENT STATUS ... 17
2.2.3 E-HEALTH POLICIES ... 18
2.4 HEALTH CARE PROFESSIONALS EXPERIENCES ON DIGITAL HEALTH CARE21 2.4.1 PERCEPTIONS, ATTITUDES & CHARASTERISTICS ... 21
2.4.2 BARRIERS, FACILITATORS & INFLUENCES ... 23
2.5 FUTURE OF DIGITAL TECHNOLOGY IN HEALTH CARE ... 26
2.6 SUMMARY OF LITERATURE REVIEW ... 29
3 STUDY AIMS ... 32
4 METHODOLOGY ... 33
4.1 eCAP-PROJECT ... 33
4.2 STUDY DESIGN AND SETTING ... 33
4.3 SUBJECTS ... 34
4.4 DATA COLLECTION ... 34
4.4.1 TOOL ... 34
4.4.2 PROCESS ... 35
4.5 DATA ANALYSIS ... 36
4.6 ETHICAL CONSIDERATION ... 37
5 RESULTS ... 39
5.1 STUDY PARTICIPANTS ... 39
5.3 WHAT HAVE THE VC MEETINGS BEEN LIKE? ... 44
5.4 HOW HAVE THE RESPONDENTS PERCEIVED THE VC MEETINGS? ... 47
5.5 WHAT SHOULD THE CHILD PSYCHIATRIC VC MEETINGS BE LIKE IN THE FUTURE? ... 53
5.6 SUMMARY OF RESULTS ... 56
6 DISCUSSION ... 59
6.1 DISCUSSION OF THE FINDINGS AND METHODOLOGY ... 59
6.2 STRENGHTS OF THIS STUDY ... 61
6.3 LIMITATIONS OF THIS STUDY ... 62
6.4 IMPLICATIONS FOR FUTURE ... 62
7 CONCLUSIONS ... 63
8 REFERENCES ... 64
9 APPENDICES ... 73
9.1 eLPSY Feedback from Primary Healthcare professionals ... 73
9.2 eLPSY Feedback from Kuopio University Hospital ... 76
LIST OF FIGURES
Figure 1. Timeline of Finnish Healthcare ICT standardization for interoperability Figure 2. National architecture of eHealth and e-Social solutions in Finland in 2018 Figure 3 Main elements of the literature review and its connection
1 INTRODUCTION
Digitalization transformation has been ongoing process in health care sector worldwide. The virtual dimension has become part of our everyday life and interaction. Virtual reality is innovating health care for better. Its development has continued in health care in different aspects of information and communication technology (ITC). Providing different elements of ICT in health care has been noticed to increase prevention, treatment and cure of diseases (World Health Organization, 2010a). Health care utilizes health technology in medical devices, procedures; consultations, electronic patient data repository, diagnostics, medical imaging, in- patient monitoring and medical databases as well as in research area. In addition, video conferencing (VC), electronic guidance and support patient self-management elements are exploit. (McLean et.al 2013) ITC aims to improve health care sector efficiency, patient health and wellbeing, quality and safety of care and cost-effectiveness (World Health Organization, 2012 & Report of the Health ICT Industry Group, 2009) Healthcare responds and adapts to the changing society and population health needs.
Digital technology can be defined as electronic technology which generates, stores and processes data (Chu, 2007). The benefit which digital technology supports for health care is information storage, monitoring, speed for communication and versatile working among all health professionals. Digital technology enables access to use digital audio, video and ITC.
(Salmons & Wilson, 2008) In health care, digital technology is used for transmitting information in digital format, monitoring patients´ vital signs or imagining human body. It offers a level of creativity and distributions of information (Salmons & Wilson, 2008). It has been manifest that the quantity and quality of general patient data and reposited data from Finland will be source of resources in the future. It can create incentives to involve innovate ideas for mental health patients and professionals in healthcare organizations. (Holopainen, 2014) Modern technology and ITC solutions will be enchanting eHealth ability to run successful practice. In mental health field, VC has been introduced and it has noticed to be cost- effective with high-risk patients (McLean et.al 2013). However, health care professionals’
experiences and adoption to ICT has been contradictory. Health information technology and information management development must clearly base on strategic health care development plans.
World Health Organization (WHO) has published the Mental Health Action Plan 2013-2020 and its target is to decrease mental health sigma and expand more efficient services. The action plan includes six principles which proposes multisector approach to promote mental health and well-being. WHO defines that the action plan´s goal is: “To promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders” (World Health Organization, 2013) Globally several projects aims to improve and engage mental health activities for eHealth services. Example in Finland, National Institute for Health and Welfare (THL) is conducting currently ten mental health projects (THL, 2020). Also, at the municipality level, health centers and specialized medical care facilities offer mental health services.
However, those services are not deficient to cover the need of all mental health services. As a consequence, several non-governmental organizations have had significant priority providing mental health services in Finland.
Studies show that mental health services are globally rising. According to WHO, one leading cause of disability among young children is mental health disorders (World Health Organization, 2005). According to studies, mental disorders have negative effect on children’s´
development and therefore it is important to promote mental health and prevent mental health disorder in the early age. WHO confirms that children and adolescent’s mental well-being is fundamental to their development. Exploiting new eHealth services among young mental health patient can be effective because today´s young people are using technology increasingly. There is high demand for new services which can be utilized in mental health sector.
Utilizing technology in health have evoked different opinions. Overall, technology provides the specific guidelines for care in all access. New technical infrastructure is required if VC will become one of the elemental services in health care. Health technology offers and creates health services locally, regionally and worldwide (Minichiello et all. 2013). It improves quality of customers´ life, reduces costs, improves efficiency, enhances capacity of innovation and develops better outcomes of health care. However, user experiences have shown that new technology solutions in health care have developed too quickly. Several findings show, that due to rapid development, professionals do not keep up with reforms. Technical issues arise and professionals work becomes more difficult. Health care professionals must orientate their selves to new innovations.
This final thesis will focus on “eHealth Services for Child and Adolescent Psychiatry” (eCAP) project which was conducted in 2015-2018 in Kuopio area. Its aim was to develop new technology solutions for field of mental health care among children and adolescent in isolated areas in Northern Savo. The specific goal was to improve the quality and accessibility of mental health services, develop the consultation opportunities; professional guidance and improve the multi-professional collaboration. The project was launched in Kuopio University hospital and primary health care professionals who were working with mental health children and adolescent. Project included online booking system and VC solution which would support the professional’s decision making in the child patients treatment path. The VC solution alleviated the interactions between all participants of the multi-professional collaboration. The project has been implemented in Sweden, Norway and Scotland and its was funded by the Northern Periphery and Arctic program (NPA). The aim of this study is to describe and assess eCAP- projects online booking systems and VC solutions usability in health care professionals’
perspectives.
2 LITERATURE REVIEW
A literature search on the digital technology in healthcare and health care professionals´
experiences was conducted in November 2019 to May 2020. The search was conducted using the Cinahl, Pubmed and Medic databases. Additionally, articles of eCAP- project were exploit.
Furthermore, national and global health organizations and governmental publications were considered. The search criteria were that all articles were published in 2000-2020 and the publishing language was English or Finnish. All articles and publications had to be available completely free of charge and available on electronically. Selected articles and publications addressed the overall digital technology in healthcare, health care professionals´ experiences utilizing technology, development and future of digital technology in health care.
2.1 DIGITAL TECHNOLOGY IN HEALTH CARE: DEFINITIONS & CONCEPTS Health care services has improved by adopting new technologies along the couple of decades.
Interactive communication in the delivery of care has become a critical tool in mental health care. E-health, telehealth, telemedicine can be known as different approaches to offer communication and transmissions of information to remote areas. Establishing full understanding of the differences in these terms is essential.
2.1.1 E-HEALTH
Term of E-health (also written as eHealth= electronic health services) has been on transformation phase, where it has been linked to several concepts such as electronic records and business industry. The term has been associated as “umbrella” term, which covers extensive health care services through information and communication technologies. (Barbabella et al.
2017) Clear definition of E-health has been stated by the WHO; “the use of information and communication technologies (ICT) for health. Examples include treating patients, conducting research, educating the health workforce, tracking diseases and monitoring public health”
(World Health Organization, 2017a). E-health focuses to offer and provide better health care services in different places. Furthermore, E-health is not only providing health care to remote areas but increasing the integrity of efficiency in health care.
E-health term encases electronic tools and services, health records, health information systems, remote monitoring and consultation services and health data analytics (Barbabella et al.2017).
E-health involves interaction between patients and health care professionals, institution-to- institution and communication between patients and/or health care professionals. (European Commission, 2012). Health care utilizes ITC to improve disease prevention, diagnosis, treatment, monitoring, and healthcare management. The concept encompasses variety of objectives such as efficiency, enhancing quality and evidence-based health (Eysenbach, 2001).
Types of eHealth
• A phone or message conversation between patient and health care professional
• Remote monitoring vital signs
• Providing guidance for patients via technology device
• Providing health promotion and management advices via technological device
• Remote consultation between patient and health care professional or health care professional to another
• Video conferencing
• Electronic health records and services
• Health information systems
• Health data analytics
(Barbabella et al. 2017 & Peate 2013, 18) 2.1.2 TELEHEALTH
Telehealth has been said to be the 21st century health care. (Maeder et al. 2014) Telehealth enables people to manage their own health care from remote areas by their technology devices.
Oxford´s Concise Medical Dictionary defines telehealth as utilizing information and communication technology to connect health care professional and patients which are geographically separated (Molineux, 2017). Telehealth offers beyond new strategy to clinical settings. According to WHO, delivering health care includes virtual home care, guidance in procedures, monitoring different body functions and educating and engaging patients (World Health Organization, 2018b) In addition, it offers easier access to health care professionals if the patient is living in remote place (Hockstein, 2019).
Telehealth services has been applied in several specified field in health care. In Finland, effective alternative solution for clinical setting is video conferencing services. Those services
are utilized with geriatric- and psychiatric patients. Furthermore, occupational health services have integrated telehealth to their services (Koivisto et al. 2019). Several findings show that telehealth services have provided effective interventions and solutions for chronically ill patients (Langarizadeh et al. 2017).
2.1.3 TELEMEDICINE
Telemedicine is referred to “healing at distance” with utilizing different aspects of ITC. The term has begun to take place in the medical field since 1970s. (World Health Organization, 2010b) Telemedicine offers and enables people to provide health care services for patients who were located in remote places. Before telemedicine was associated with medical doctors providing the service but nowadays it used by different health care providers. It has become a convenient tool for health care professionals. Medical procedures can be remoted and accessibility to health care services is provided. (Fong et. al 2011) The valid exchange what it imports, is information for diagnoses, medical care and prevention, research, evaluation and education (World Health Organization, 2016c).
Telemedicine services offers clinical support for intended geographical barriers, such as people living in remote areas. Current innovation in health care is utilizing field of telemedicine among child and adolescent mental health in remote, sparsely populated areas in Northern Savo.
Several articles have shown that telemedicine promotes effective collaborative care in chronical disease management. With mental health patients, it has found to be the most successful if its combed with right technologies. Collaborative care with utilizing videoconferencing has found to be the most effective and it offers the most optimized care for mental health patients (Turvey
& Fortney, 2017).
2.1.4 ELECTRONIC HEALTH RECORD
Digital version of patients’ medical and health history is called an Electronic Health Record (EHR). It stores and contains available information about patients´ medical and treatment history. An EHR has played considerable role of in primary health care and it has noticed to increased clinical information with reference of improving quality of care (Raymond et al.
2017). Based on WHO, the EHR includes comprehensive information about individual ´s health profile, test and imaging, medications, immunizations, behaviour and environmental aspects.
The information is enrolled and accessed by the health care professionals. Moreover, it stores the information over the individuals´ lifetime (World Health Organization, 2006g) Every individual must encounter access to their EHR. European Union (EU) has secured EU-citizens to access their medical data. (Strudwick & Eyasu, 2015)
The EHR´s are continuously implemented in alternating environments, such as mental health field. Nurses in mental health settings have had positive experiences by using EHR. They found care planning and standardized approach to achieve better outcomes for mental health patient (Strudwick & Eyasu, 2015). Overall, use of an EHR have been noticed to increase quality of care, productivity, legibility in a streamline and reduce medical errors (Hoover, 2016).
2.1.5 VIDEO CONFERENCING
One of oldest and promising online support form of care for mental health patients is called Video Conferencing. It is specified as a transmitting audio-and visual signal conference service between two or more participants in different places in real time. It utilizes the technology- enabled real-time transmission of video and audio. VC has been successfully used globally in several ways in mental health services (Benavides-Vaello et.al 2013). It has addressed to increase a quality and accessibility of mental health patients´ care (Pesämaa et al. 2004). In addition, it has been shown to be as effective as face-to-face counselling. (Buckley & Weisser 2012; De Weger et al. 2013; Hilty et al. 2013). The VC innovations are utilized by conferencing with several participants, medical consultations, telemonitoring, evaluating and education (Hasselberg, 2020). Furthermore, it is the most commonly used form of eHealth.
2.1.6 M-HEALTH
M-health, also known as mobile health, refers to wireless technologies for medicine and public health. It provides medical practices and health services in broad reach and wide acceptance through telecommunication and multimedia technologies. It allows health care support, delivery and interventions through different mobile devises (Marston et al.2017). Health care field offers M-health services via mobile services such as applications, smartphones and tablets.
The application utilizes imagine sends, voice overs, short messaging services (SMS), sensors, attachments which could sending data from blood samples or heart rate (Steinhubl et al. 2015)
However, M-health´s rapid expand, According to WHO, the M-Health does not own standardized definition (World Health Organization, 2011).
2.1.7 COMBINING TECHNOLOGIES
New innovations of technologies have revolutionized the health care provision. If efficiency and changes in the service structure are conducted, it is essential to think which new solutions will help in the future when the population changes radically. Concept of health care technology stand of digital applications, processes and different platforms which are used in improve collection, management, distribution of information and data (Arak & Wójcik, 2017). New solutions, such as mobile medical devices, remote monitoring technologies and electronic patient records has noticed to alleviate patients prompt diagnoses and treatments. Simply by combining features like audio, graphic, storage, data transfer, sensor-based technology and software; integrates and analyses new solutions for health care. These solutions have been started exploit globally in field of health care.
Based on eHealth Economics report, in 2017, a variety of health-related applications were estimated to be available in the world at 325,000 (eHealth Economics report, 2017). With smartphone applications, wearable sensors, web-services and other technical aids, people collect data related to eating, moods, physical and mental performance, time management, social interaction, movement and sleeping. The key idea is to use one's personal information to improve the quality of life.
Health technology is nowadays seen as an important part of our society in providing health services. The field of healthcare is increasingly shifting from disease management to health promotion. Which stands for that health technology have key role in health care field. New possible technological trends and drivers in healthcare will take place. Technology promotes and supports self-management in health and well-being. It will contribute to better well-being and cost-effectiveness of society (Thimbleby, 2013). With eHealth technology, people have opportunity to receive high quality and proficient health care services (PwC, 2007). E-health features has perceived to reduce mortality rates, reduce diagnosing complications and shorten hospital stays. All benefits linked together guarantees economic benefit (good eHealth report, 2009). As health technology evolves and expands its use, reduce costs, benefiting society, the consumer and the environment (Toimialaraportti, 2007, 7).
2.2 DIGITAL HEALTH CARE GLOBALLY
Globally, digital health technologies have demanding role in prevention, diagnosis and treatment of illness. Over the years, it has improved from operational efficiency to high standards in patient care. Health technology and medical devices has taken large part of health care. Globally, digital technology can support and accelerate achievement of sustainable development goals (United Nations). World Health Organization has published 12 functions which digital technology is providing in health care. These components include from offering better information relating to health and illness, providing verifiable and searchable health records and; offers information about finances and human resource management. (Labrique et al. 2013) Moreover, WHO published a draft strategy (2020-2024) which puts digital health initiatives on greater use of ITC and aims to achieve affordable and universal access to care and shapes the future of health care. (World Health Organization, 2019d)
According to a survey by WHO, globally 60% of countries have some source of digital technology in healthcare. Including components of eHealth and mHealth, e.g. electronic health records, wearable sensors and telemedicine. (World Health Organization, 2018e) Because of health technology, data can be found more less time-consuming and medical errors are reduced.
Based on a survey, 70% of care-plan are based on health care technology (Nordic Healthcare Group, 2019). Nowadays, artificial intelligence, robotics and utilization of genomic data create and assist healthcare professionals conduct right diagnoses. Globally, strong emergency of digitalization in healthcare is a concrete demonstration of how traditional boundaries between industries are breaking down and developing new services. New digital health innovations are cross-industry consortium. High-income countries have extensive use of technology, people in low-income countries lack the most fundamental equipment and medicine. (Howitt et.al 2012) Governments which have started adopting communication and technology advancements has been found to ensure better health care. However, global effort must be needed to develop a use of health technologies. Particularly in developing countries, the challenge remains in accessing the service (World Health Organization, 2010). Approximately 74% of WHO member countries has especially mentioned the eHealth and have some sort of universal health care coverage. Of the 191 WHO member countries 152 have legislations protecting a privacy data and electronic health record (World Health Organization, 2010).
Globally, health technology is one of the fastest growing areas in technology export and it is expected to continue to grow. In 2019, the health technology export globally distributes with United States; Canada and Mexico (41%), Europe (34,1%), East-Asia (11%), Latin America (4%), Russia (2,6%), Australia (2,3%), Middle East (1,6%) and Africa (0,9%).
(Terveysteknologian vuosikerta, 2019) In high-tech sectors, including health technology, are increasingly employing people globally.
Globally, there is an evidence that telehealth is practical and cost-effective when it is combined in mental health field. World Health Organization has reported 25% countries offering telepsychiatry services. However, in rather deeper perspective, only 15% of countries had established the telepsychiatry.
2.3 DIGITAL HEALTH CARE IN FINLAND
New innovations and solutions of digital technology have been implemented in high-income countries. Prime example is Finland, which has remained a world leader in digitalization and the domain of the EU countries. In digitalization, accessing medical records and billing-system are becoming more effective.
Population Information and Communication Technologies survey shows that use of social media has increased over all age groups in recent years. (Statistics Finland, 2018) Moreover, several studies show that social media and mobile-intensive period has influenced people to seek best medical practices and varying healthcare settings. Social media have extensive platform for intervening health information and programs in people’s lives (Abroms, 2019).
80% use social media has been noticed to utilized in distributing health messages. (World Health Organization, 2015) Digital technology and communication variations ensures people receiving health information in real-time. Based on WHO, information and communication technology are one of the most effective ways how eHealth can be utilized and implemented.
In the future we can expect changed balance between provider and patient. The shift is changing to enabling to client-centred health care. Globally, the number of telemedicine for remote treatment will increase (Mitchell, 2019). Already the service has been introduced in geriatric
and mental health care. Furthermore, the digital health will have big impact in low-and middle- income countries
Digital technologies in field of healthcare are constantly evolving and finding new applications and solutions. In Finland, the industry is in adoption phase, also called as a digital transformation. The era of digital technology has been strong and optimistic. The growth in the industry looks promising. Because of the new innovations and supportive applications and solutions, the Finnish healthcare system has been recognized to be the most efficient and cost- effective. (European Health Consumer Index 2018). Finnish healthcare system combines and enhances technologies and practices to improving the health of citizens and people globally.
According to Ministry for foreign affairs (2019), there are about 300 companies operating in the health technology sector in Finland. They have published a revenue of 2.6 billion EUR in 2019. Health technology industry have accounted to be more than half of Finland´s high-tech export. If it is indicated to the trade surplus, the sector has grown to over 1 billion EUR in a year (Laakso, 2019). Digital technology has been said to revolutionizing health and the economy.
In Finland, healthcare technology utilizes specialized fields of genomics, digital health, senior care and advanced diagnostics. Health genomics offers detailed information about population structures, genomics and genome variation (Dhavendra, 2012). Genomics emphasises on medical and health issues. Finnish healthcare exploits genomics in big data analytics, health registries and bioinformatics. Healthcare professionals collect data from ICT-technologies, diagnostics, sensors and medical imaging. Telemedicine and Healthcare of the European Commission has reported, that the use of Big Data: “increases earlier diagnosis and the effectiveness and quality of treatments; widening possibilities for prevention of diseases;
improvement of pharmacovigilance and patient safety; prediction of outcomes.” (Report of European Commission, 2016) In consequence of Big Data, individual prevention, diagnosis and diseases treatment becomes the most appropriate (Pastorino et. al. 2019).
Digital technology provides better way to promote peoples´ well-being in general healthcare services. There is only limited amount of research conducted in eHealth in mental health care.
More research must be conducted on the use of eHealth for mental health care.
2.3.1 BRIEF HISTORY OF DEVELOPMENT
Finland is one of the leading countries in digital technology. It´s health care actions have been followed since 1990s´. First implemented clinical radiological imagining devices were in 1994 in all five universal hospitals (Khari & Prasad, 2011). First electronic patient record system (EPR) was demonstrated in 1995, however in that time, several records were still kept in paper format. Nowadays, all information is recorded in many EPR and it is utilized in private-and public sector. In 2002, Finnish government accustomed EPR in policies and legislations. The aim was to enable exchange of information between regions. Because of the quick transformation in the healthcare, had led to new law reforms healthcare. The purpose of those laws was to ensure patient safety. Based on Finnish Nurses Association, the purpose of all reforms was to improve the quality of healthcare services (Finnish Nurses Association, 2014).
Already in 2005, several hospital districts were using EPR also as an imagining database and providing e-referrals (Khari & Prasad, 2011). It gave flexibility and made treatment path more proficient. For the first time, information was enabled to exchange between regions with any paper format. Because of EPR, patient safety and quality of care has been noticed to increase and medical errors to decrease (Tubaishat, 2017).
Digitalization has been announced to make health care more accurate (El- Miedany, 2017). In 2006, Finnish government and Finnish Social Insurance Institute (KELA) launched national project for e-prescription database which allowed patient to have descriptive medicines without paper format. Also, the eServices such as eAccess and eArchive were introduced in 2006 (KANTA, 2017). Those digital services offered Social welfare and healthcare sector professionals (e.g. pharmacies, hospitals) and citizens information in real-time. That form of statutory service has been said to be unique in Europe. During the same year, EPR had its own legislation where patient data will be collected in the same database. (Khari & Prasad, 2011).
Concept of e-prescription is introduced in EU-countries. It is estimated, that a cross-border e- prescription will be utilized more broader in few years.
Considerable transformation to Finnish health care was in 2010, when Kanta published finished product of Kanta-services for Finnish citizens (Kanta, 2017c). It was developed in stages.
Today, Kanta offers digital services such as prescription services, patient data repository, sharing medical certificates, archiving old patient clinical data and online services to citizens and health care professionals (Kanta, 2019). Customers have several benefits of using online
health services. According to Kivekäs doctoral research (2019), eHealth services aim to improve access to information and reduce health center visits and it has considered to be alternative traditional option for social and health services (Kivekäs, 2019). Kanta customers have constant access with internet access to their health records regardless of their location.
Because of the increased health information, customers are more empowered to take responsibility of their health. Also, benefit for health care professionals is that creating better comprehensive picture of the customer´s clinical status is easier. (Kanta, 2019). Based on Kivekäs, patients visiting in specialized care services will find e-Health services easily available and they are considered to be more motivated to monitor their health (Kivekäs, 2019).
FIGURE 1. Timeline of Finnish Healthcare ICT standardization for interoperability (KANTA 2017).
The first videoconference experiment in Finland was held between Utsjoki Health Center and Helsinki in 1993. (Snellman, 1996) Since then it has been utilized in psychiatry and extended to other health centers. (Kvist 1996) Experiments of the video conferencing had been carried out in several localities and specialties. However, its activity had been higher in remote areas than in urban area. In the history, psychiatry was the second highest specialty where videoconferencing was utilized. Already in 1997, several articles recommended more research of applicability of videoconferencing (Baer et al. 1997). Considerable number of experiments
with video conferencing have been carried out in several localities and specialties. However, the use and adoption of videoconference in healthcare has been on a slow process
2.3.2 CURRENT STATUS
Currently eHealth services in Finland are in national level. All citizens´ have opportunity to view their own patient information from My Kanta pages. The key principles for eHealth services is that it is offered equally and universally to everybody. Additionally, it is residence based which signify that everyone who is living in Finland is entitled to view their health records. According to Hyppönen & Ilmarinen, popularity to view patients own health data, laboratory tests and renewing prescriptions has grown compared to 2014 and 2017 (Hyppönen
& Ilmarinen, 2018). Finnish society has been accepted eHealth applications from a technical capacity aspect. At the moment all patient information is stored in national repository which will be beneficial for the future. Finnish government has adjusted semantic and technical standards for interoperability (Kallio, 2020). It includes sufficient data connections and protection of data. Finnish government offers new implementation models, cooperation with other stakeholders and solid foundation to develop eHealth services. (Kallio, 2020)
Electronic records have been exploiting in broadly in Finland. Its utilized at the regional and national level. EPR distribution covers 100% of both specialized care and primary care and also, in the private sector. The aim is that the paper format no longer exists in healthcare field.
Everything will be in high-performance digital format in the future. Several systems are networked and implemented using various technologies. Typically, the imaging systems, and existing legacy systems are integrated. It has noticed to increase the efficiency in patient care.
In the future, national unified ITC-system (Apotti) will take place in Southern Finland. It is expected to shape the health care professionals work by harmonizing the operation methods.
However, its development has been slow and problematic.
The Finnish government’s eHealth strategy 2020 demonstrate that all health care professionals have access to all information systems, and they will be well operative and supports their work.
The Finnish healthcare sector work to ensure that information is well organized and accessible.
Digitalization has changed the relationship between citizens and the healthcare professionals in a more equal and people-centered direction (Metsäniemi, 2018). Currently, the information is
shared via different digital systems. If the eHealth service is accessibility and easy to use it automatically increases productivity and activity. According to Kivekäs, especially medical doctors have experienced positive effect on patient safety and high quality of care when utilizing ePrescribtion (Kivekäs, 2019). The latest digital technology applications are exploit over the national boarder. First cooperation (2020) started between Finland and Estonia. (Kanta, 2020a) Now, all ePrescriptions can be purchased in Estonia and Croatia. However, the service is being introduced step-by- step and its expectable the implementation will be slow. In the future, the services will be introduced in all EU-countries (Kanta, 2020a).
2.2.3 E-HEALTH POLICIES
Health technology is a rapidly growing area of the future, which is becoming increasingly important as population age and the birth rates decline. New technology solutions provide better patient care, help for health care professional, productivity and well-being for Finland. Health technology is an important part of the health sector, together with the pharmaceutical industry and private and public service of social and health care. Different strategies have intensified collaboration between all actors. Finland has been first an example country where the electronic health information has been used diversely and where new policies has taken in action.
Finland has been committed to the WHO International Mental Health promotion program and has been a pioneer in its commitment to the WHO eHealth Strategy since 1995. (World Health Organization 2016) First policy and strategies towards eHealth and ITC were introduced by Ministry of Social Affairs and Health in 1996 in Finland. At that time, the goal was to promote efficient, accessible, equity, affordable and high-quality health care. Since then, new operation systems, deployment projects and eHealth policies has been continuously under development.
Based on Organization for Economic Co-operation and Development (OECD) survey (2012), the new key principles for social and health services are residence-based, universal and equal right (OECD Health System Characteristics Survey 2012).
World Health Organization published Mental Health Action Plan 2013-2020 where there are four major objectives. It guides governments more active and effective leaderships; more integrates mental health services in community-based settings and implementation of different strategies to promotion and prevention. (World Health Organization, 2013) Globally, multi-
stakeholder collaboration in a local, national, regional and global level must be promoted. In addition, more policies which guides use of health technology and promotion of mental health must be conducted. Finnish eHealth and eSocial Strategy 2020 have included those parts in its strategy. Finland has taken an action to increase equality between mental health rehabilitators and other citizens. Several projects are conducted to increase distribution of mental health services. (Alanko, 2017)
Finnish government introduced eHealth and eSocial Strategy 2020, which promotes active citizens, capable health care professionals, effective service system, knowledge-based management, steering and co-operation and info-structure (Kallio, 2015). The aim of the strategy is to support the reform of Social and Health Care and the active participation of citizens in maintaining their well-being by improving information management and increasing e-services (Räty et.al 2014). The strategy outlines that professionals will have access to information systems that support work and operational processes, involve professionals in system procurement and operational modeling, strengthen knowledge management skills and provide good on-the-job training for new applications.
Over the last few years, Finnish government has conducted national eAchive and ePrescribing systems where citizens can review their own health records independently (Hämäläinen et al.
2009). First laws regarding to eHealth were conducted in July 2007 when the parliament approved the legislation (Act 159/2007) of electronic processing of social and health care customer data. (Finlex, 2019) It covers all archive services, patient access data and Kanta- services. Kanta services offers digital services for the social well-fare and healthcare sector.
The overall service benefit citizens and health care professionals to access people’s health information wherever you live in Finland (Kanta, 2020b). Since all the development, the health care services have expand significantly. The national eHealth and eSocial solutions in 2018 can be seen in Figure 2. (Kouri, 2018 & Jormanainen, 2018) The Finnish Government has stated, that the development of information system is to be continued.
Figure 2: National architecture of eHealth and eSocial solutions in Finland in 2018
(Source: Kouri, 2018 & Jormanainen, 2018)
The newest law regarding to the healthcare devices and supplies (Act 629/2010) is based on EU Directives on equivalent devices. The health technology device must meet all requirements and different conditions when it introduced to the medical markets. Due to the fragmented nature of the healthcare system and the inexperienced decision-making in their procurement, investments in health technology equipment and systems are hampered. In the past, Valvira was responsible monitoring health technology devices in Finland, but from December 2019 the control has shifted to Finnish Medicines Agency Fimea (Fimea, 2019). Delegated tasks included health care devices and supplies supervision and control (Fimea, 2018).
Government play an active role in the further development in eHealth. The overall principles are to develop services that are customer-oriented, eliminate unnecessary transactions, build easy-to-use and secure services, provide customer benefits, be able to serve even in the event of a disruption, request new information, leverage existing public and private electronic services companies and citizens and designate an owner of the service and its implementation
(Vehko et.al, 2018) The social and health care system is on transition as the legislation changes, but also with technological and scientific advances.
2.4 HEALTH CARE PROFESSIONALS EXPERIENCES ON DIGITAL HEALTH CARE
This chapter will discuss about digital technology fields adoption and experiences among providers and individuals’ perspectives. Utilization technology and eHealth services have become more common in healthcare, and it has brought unity to the social and health care field.
Adoption of information and communication technology has been complicated in healthcare.
For healthcare organization, the adjustment can be described as an event that takes employees out of their “comfort zone” to an unknown area (Wiest, 2006) or an event where employees have to adapt and have no opportunity to contribute (Bruhn, 2004). Individual’s motivation, working conditions and management are the elements which will affect the type of service provided. Transition of digitalization in healthcare is complex and difficult process. In the beginning, there is little information on how it affects the daily life of an organization. Almost always, changes temporarily impair the performance (Kallankari, 2019).
ITC has known to bring well-known advantages, such as improve quality of care, increase effectivity and opportunities to educate healthcare professionals. (Rouleau et.al, 2015) In general, the use of eHealth services is depended on the attitudes and willingness among individuals. The evidence has showed diverse experiences from nurses and medical providers.
There is only limited research conducted of the professionals´ experiences of health technology.
This chapter will introduce the variety of experiences among healthcare professionals globally and in Finland.
2.4.1 PERCEPTIONS, ATTITUDES & CHARASTERISTICS
Adapting to the digital era is often the diligent part to the health care professionals. It requires a shift towards flexible and risk-taking mindset. Often the digitalization can bring out challenges and it can be experienced as threat. Most of Finnish health care professionals regards the digitalization of health services as a benefit. Attitudes towards using technology and remote services are mostly positive. However, the use of eHealth services depends on the overall attitudes and willingness. The attitudes are mostly based on individuals’ preferences. The
attitude of the individual is influenced by enthusiasm, interest and confidence towards own work. Sufficient technical skills require the ability to take risks and withstand uncertainty (Ministry of Finance, 2017, 16).
Most of the conducted researches focuses on the attitudes towards VC. Technology utilization and remote services are prevalent in social and health care field in Finland. They are integrated into the use of healthcare organizations and different work processes. Since technology services has been activated in Finnish healthcare, commitment and deployment process of all healthcare professionals has been important because new models are anchored in their daily work. The functionality of the ITC-systems is important for performance of healthcare professionals.
(Koivisto et.al, 2019) Overall impact of health technology has been positive.
Positive experiences have been reported in particular with regard to improving workflow.
Technology allows more efficient communication and improved availability of services.
(Koivisto et.al 2019) When health information is more accessible, the productivity at work increases. Health care professionals do not have to consume time on searching information from EHR, when they can achieve patient´s health status more quickly. Health care professionals are willing to use the eHealth services because they are aware of its utility, usability and cost- effectiveness. Medical providers found the use of ePrescribtion easy and useful for work and thought it will improve patient safety. Because of ePrescribition, number of medical errors has decreased (Kivekäs, 2019). According to reports, collaboration between nursing staff improved because of ICT. (Saurman et.al, 2011) Improvements in communication and improved access to services has accepted by the Finnish health care professionals. Medical providers overall experience was satisfied.
Telehealth has been introduced in mental health care, home care, remote monitoring and remote- consultation services. Benefit of utilization of video technology in consultation, treatment or monitoring has been shown to be as effective as face-to-face counselling. (Bucley
& Weisser, 2012) The benefits have considered to increase safety, assist of nursing care and improvement of quality of care. In rural areas in Australia, the health care professionals have experienced benefits by providing healthcare services remote. Telehealth offers opportunity for better health outcomes for people living in remote areas. (Bradford, 2015) Providing remote services, neither of participants needs to travel. It has been stated that introducing new technology solutions for telehealth, improves monitoring, access and efficiency of care.
Providing similar services such social and psychosocial support as face-to-face appointment is possible because of telehealth. Literature shows negative attitudes towards utilizing VC in mental health field. Most of the opinions were result that face-to-face contact was not a substitute for video contact. The views reported that relationship with patient was challenging to accomplish via VC. In health care, human interactions still play a major role and digitalization will not replace it. Patient examination, data collection and storage, data analysis and decision about treatment plan are the responsibility of health care professional. The health technology will only support these functions (Kauhanen et.al 2012).
Overall experiences of the health care professionals are positive. Cooperation between organizations are fluent. The report (2019) concluded that because of the health care technology services are available on a regional level, medications in other organizations are available, patient data is up-to-date and information systems try to help improve quality, continuity and support treatment recommendations (Vehko et. al 2019b). However, evidence shows that more effort must be focused on health care professionals’ attitudes, education and technical support.
2.4.2 BARRIERS, FACILITATORS & INFLUENCES
There are many different factors which influence eHealth and its professional healthcare users.
Globally, health care professionals’ experiences have been contradictory to eHealth services.
In 2009, health care professionals experienced and stated that the use of ITC was low. However, according to EU report (2019), countries with highest level of adoption were Denmark, Estonia, Finland, Spain, Sweden and United Kingdom. The way of transformation and the type of health system is associated with the overall eHealth adoption. Barriers became from the needs of strengthening the implementation and training. The indicators showed that more planning must be conducted by the policymakers in a government level (Flynn et.al 2009). Adoption has been relative slow compared to many other industries. However, nowadays the experiences towards eHealth have changed. Especially, the EU-survey showed that those countries had positive influence on digital transition. (EU report, 2019) Positive factors include EHR, VC, ePrescription and self-monitoring devices.
Organizations have been noticed to have a considerable influence towards the choices people make. Digital technology allows health care professionals improve efficiency and communicate more effectively. If the organization and management are motivated towards integrating
eHealth services, promotes it to positive implementation in the workplace. (Brwster et.al 2014) In addition, ITC bring autonomy for nurses in their role and support for co-workers and administration. (Rouleau et.al 2015) As stated in Philips Future Health Index 2019, health care professionals are in adoption mode and it’s the beginning to recognise benefits of digital health.
69% of the respondents agreed with improvements by digital technology, also their satisfaction had increased after they gradually became more comfortable with artificial intelligence-based technology (Future health index, 2019 Positive attitude has seen to promote adaption towards technology in all fields. Also, employees must be motivated to learn more and able to explore beyond their comfort. Adoption to technology can be challenging. Häyrinen states that professional’s knowledge, skills and competences are necessary for the development process (Häyrinen, 2019).
Understanding and committing new guidelines is not an easy task for health care professions.
Multilevel change will present number of challenges and barriers. Several barriers will surface and therefore managers play a big role. The most challenges have been noticed in implementation of the digital health services. It involves changes in different levels such as healthcare providers, organization and governmental. Implementation must be focused on case- by-case basis and needs of each participant. Every participant has active role of implementation.
(De Weger et. al. 2013) Literature shows the considerable barrier has been noticed in implementation the services to healthcare. Addressing new implementation strategies to health care is important. It enhances health care professionals values, needs and attitudes and alleviate the implementation process. (Parra-Calderón, 2017). The overall challenges of implementations were lack of resources, lack of organizational support and technical problems (Odeh, 2014).
Being aware of health care professionals’ attitudes can facilitate the implementation of new technology. (Montero-Marin et.al 2014).
The most challenges have been in implementation the digital services. Based on a survey, every health care professional has different technology skills. Health care professionals experience that technical support must active in all time (Cegarra-Navarro & Carrion, 2011). Need of an education increases when the starting point varies. Therefore, it is necessary to look at what kind of skills needs the staff have and how they can develop their skills and practices. Kujala points out that employees must give enough time to learn and adapt new things. (Kujala et. al, 2018). Based on a survey in Netherlands, the registered nurses were more willingness to use technology when it was supported by the colleagues. It increased their workflow, usability and
cost-effectiveness. The most surprising of the results were that older staff nurses used technology rather than young nurses. (Van HouweIngens et.al 2015) In North- Scotland, health care professionals believed utility and cost-effectiveness of technology but did not felt comfortable using new health technology such as VC. (Levy & Strachan, 2013) Increasing training increases has been seen a willingness to use technology. Positive experiences were recorded of the working equipment, collaboration of the technical service provider and user- friendliness (Brwster et.al 2014). Several articles emphasize technology to enhance health care professional’s confidence in care, responsibility and decision-making (Trondsen et.al 2014). In addition, support from management is important.
According to several reports, the reduction of the face-to-face encounters and technical problems of the use of technology are perceived as negative. Changes in the working profile through the use of technology and telehealth services are perceived as contradictory. (Koivisto et.al, 2019) Even though several articles have shown telemental health services effective, health care professionals’ attitudes and perspectives towards it are negative. Telemental health services has been introduced in several areas in health services, but more research must be conducted on its effectivity and experiences among patients. Other disadvantages have been stated in privacy and security, complexity of the communicated information and access and competences related issues (Ahmadinia & Eriksson-Backa).
Finnish health care professionals’ experiences are mostly positive but concerns towards technical problems are rising. Challenges has been issued from deficiencies and inconveniences in the technical equipment, connections, and applications that limit work. More closely, in developing countries establishing eHealth is difficult because lack of communication infrastructure (Iluyemi, 2009). Experiences have been tough, but from 2009 development has been significant. According to EU report (2016) states that by focusing on accessibility, usability, training and implementation will adopt health care workers to digital health care (EU report, 2016). Using satellite broadband technology is often only solution to provide accessible services. Fortunately, there is no need to concern about slow internet access in Finland. Based on eHealth report (2019), medical providers manifest about the requirement for supportive system and technical support. Technical problems such as downtime and slowness, multiple system logins, and simultaneous operation of many systems caused stress for healthcare professionals. (Vehko et.al 2018a) The report (2019) revealed that private sector´s medical
providers were more satisfied with their EHR concerning the technical reliability. (Kouri et.al 2019)
In the future, employees will be required to understand and see the potential of ITC in different situation. A shared vision of a desirable future will help motivate and coordinate measures that will bring about change. Different applications will be available to facilitate work, and also to help patients receive virtual treatment and guidance. Despite all the technological issues, the overall experiences have been mainly positive. If extensive trainings are offered, the participants have been even more satisfied (Adler et.al 2013). eHealth does not only influence health care professional but other people. All in all, benefits of eHealth will build better capacity, decrease professional isolation and alleviate communication. Globally range of health care professionals have experienced ITC feasible and acceptive. In a broader view, technology plays important role achieving and developing new approaches to medicine and care, and also more personalized care (Sebri & Savioni, 2019).
2.5 FUTURE OF DIGITAL TECHNOLOGY IN HEALTH CARE
It has stated that digital technology is the future of health care. It has advanced more rapidly than any innovation in the history. Digital technology provides high quality, safe, cost effective and innovative solutions and services for patients, social and health care and another stakeholder. According to several articles, in the future, health technology can further improve the quality and efficiency of health care. It allows people to live their live independently, fullest possible extent, regardless of their condition, illness or disability. (Naumanen, 2019) Likewise, technology alleviates health care professional resource shortages and provides solutions.
Transformation of the digital health care will benefit people, health care systems and economy (European Commission, 2019).
The use of health technology has been seen to be particular benefit in the treatment of all patients. By monitoring health of the patients, targeted treatment can be provided those in need and prevent complications. The most beneficial target group are vulnerable groups such as surgical patients, cardiac patients, patients with chronical illness and disabled patients. Remote monitoring makes medicine more predictive and personalized. The collected data will be fed to machine-learning algorisms to monitor patient’s health status. (Xu et.al 2019) Because of
sensors, patient can be monitored at home and observed if their condition deteriorates. It has been argued, that telemonitoring increases among elderly care and mental health care field. In addition, use of VC is demonstrated to be satisfactory to patients and improve outcomes (Richardson et.al 2009). However, more research must be conducted in order to receive more information about use of VC with mental health patients. An occurrence, it evolves that support structures, technical support and maintenance must be at the same level as development. Health technology devices will increase the patient´s sense of security when they are receiving care.
Furthermore, because of health technology, the number of office visits and the cost for all parties will be decrease.
In economical aspect, health technology investments and exports will boost Finland´s economic growth in the future. The value of exports of health technology products has doubled in the last 20 years in Finland. In the future, the competitiveness between companies will increase and the importance of production process will be in transformation. Health technology companies must have necessary resources maintain competitiveness ability. Finnish health technology companies employ already over 13 000 people (Healthtech Finland, 2019). Those companies have an internationally extensive research and development presence and they manufacture most of their products in Finland. Also, new research is conducted regarding health care technology, and it will create new business opportunities. Because of the economic growth, more jobs are created for skilled workers.
For health care professionals, the future looks bright. New innovations will support the importance of health technology in relation to care. Utilization of these requirements demand more and more new knowledge and training, as well as cooperation. On the other hand, healthcare professionals must be willing to adapt as they adopt new technologies, learning and adjusting as they go. Attitudes and prejudices have biggest impact how work is approached.
Finnish education system is preparing for the future and adds more focus on digitalization.
eHealth competences have been already required in nursing education in Finland. European qualification framework acknowledged during the curriculum development (Ministry of Education, 2009). In the future, nursing graduates are more aware of outcomes of eHealth and ITC (European Federation of Nurses Associations, 2015). Because of new tools, wearable medical devices, telehealth, 5G mobile technology and virtual reality tools patients can receive
better treatment. Utilizing those tools, improves patient outcomes, reduces human errors and lowers the health care costs.
In the future, wellbeing technology will be connected to the IoT network, where different devices communicate together. It will improve the usability of devices and thereby promote wellbeing. Therefore, health data is more accessible, and number of errors decrease. Already healthcare field is collecting information from people’s health. And in the future, healthcare benefits from big data storages and therefore comprehensive research studies can be conducted.
The results can obtain new critical information about peoples´ health and new treatments.
Advanced data analytics will help accelerate health research, personalised medicine, early diagnosis and more effective treatments. Utilizing genomic and cognizable health information can move towards individualized treatment and more effective prevention.
Digital technology has had positive impact already, but the future looks bright. Digitalization, robotics and utilization will be extensive help to healthcare professionals and patients themselves. Services are becoming more depended on technology and more general education must be offered. Artificial intelligent technology has enabled new forms of treatment and diagnosis. Robotics, artificial intelligence will be a great help for healthcare professionals in the future.
Bringing all aspects together, digital health is future of health care. It offers effective wellbeing solutions, enables people to live independently, creates investments and expertise. It will facilitate different platforms, improved operational efficiency, integrated approached to care, high capacity for innovation, improve patient outcomes and apply new strategies for implementing and integrating new solutions to health care. In addition, the shift is showing to processing towards computer-based processing and storage and from institution centre to global health information systems (Haux, 2006). Globally, the goal is that everybody will have affordable and effective health care without suffering economic hardship. All things considered, the future shift is processing health technology towards more client-centred care (Mitchell &
Kan, 2019).
2.6 SUMMARY OF LITERATURE REVIEW
Digital technology has taken several critical steps to develop e-services for health in all nations.
It has taken considerable advancement to develop different strategies towards target groups.
World Health Organization has set a goal to increase the efficiency of mental health care by expanding globally all services. The use of eHealth services has found to be well suited for different client groups and the applications has noticed to provide better treatment results that in treatment without eHealth services (Hilty et.al 2013) eHealth solutions has seen as a bridge between different sectors and solutions. Because of eHealth, several sectors can improve their collaboration and communication. Increased use of digital technology has been found to increase staff collaboration, patient- orientation and facilitate clinical decision-making (Buckley & Weisser, 2012).
Several studies have shown that technology-based care is effective, efficient and can reduce medical errors and travel time (Buckley & Weisser, 2012). New innovative ways to communicate, e.g. video conferencing is becoming globally more utilized. Using VC, people have more access to support they need regardless of the location they are. Specially in mental health care, doctor-patient interactions become more comfortable and ideal. Therapy sessions become safe and private. However, health care professionals have had contradictory experiences towards VC in mental health care. VC have said to improve health, care management, access and cost when its utilized in care of chronical illnesses. With VC, healthcare professionals have better capacity to support those who are in need. Innovative methods and interventions have become the most essential to enhance the care in mental health.
Nonetheless, healthcare professionals´ negative experiences emerge on their own perceptions and attitudes, not entirely based on the user experiences. However, more research is needed to assess the effectiveness in mental health care and experiences of health care professionals (Mallow et.al 2016).
The introduction of the technology is particularly influenced by the perceived benefits and ease of use. E-health services and applications implementation must be focused because all actors have different technology skills to start with. In its entirety, technology application and solutions towards work in healthcare has been welcomed by several professions. Technical problems, attitudes and perceptions have an influence towards user experiences. Challenges might occur in management and in technical level. Despite the challenges, eHealth does not
only influence health care professionals but other people. It enables virtual care, remote monitoring, health data storage and analytics. Technology plays important role developing new approaches to more personalized care. In the future, more extensive utilization of different technological tools will improve and offer better patient outcomes, improve work efficiency and innovate new approached to healthcare.
Currently, people use technology in their everyday life and studies have shown that if health care professionals used technology in their free time and have a positive attitude towards technology, their attitude towards utilizing technology at work may also be positive. (Van Houwelingenes et al. 2015). E-health solutions have gained more demand because of recent global health threat has occurred, e.g. Corona (2020). Technological application and services will have advanced collaborative response to becoming situations.
Figure 3: Main elements of the literature review and its connections
DIGITAL TECHNOLOGY IN HEALTHCARE
E-HEALTH
DATA STORAGE
VIDEO CONFERENCING
TELEHEALTH
TELEMEDICINE
M-HEALTH
ITC-PROVIDER
TECHNICAL SUPPORT
SERVICE MANAGEMENT ITC-SYSTEMS &
SOLUTIONS
EFFECTIVENESS
USABILITY
USERFRIENDLIN ESS
NECESSITY
HEALTHCARE PROFESSIONALS
USER EXPERIENCES
ATTITUDES
PERCEPTIONS
BARRIERS
INFLUENCES
CHARASTERISTI CS
TRAINING
&TECHNICAL SKILLS
ADOPTION TO DIGITAL TECHNOLOGY
