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E-Health Preparedness Assessment in the Context of an Influenza Pandemic

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E-Health Preparedness Assessment in the Context of an Influenza Pandemic Open Access Research BMJ Open: first published as 10.1136/bmjopen-2012-002293 on 13 March 2013. Downloaded from e-Health preparedness assessment in the context of an influenza pandemic: a qualitative study in China Junhua Li,1,2 Holly Seale,2 Pradeep Ray,1 Quanyi Wang,3 Peng Yang,3 Shuang Li,3 Yi Zhang,3 C Raina MacIntyre2,4 To cite: Li J, Seale H, Ray P, ABSTRACT et al ARTICLE SUMMARY . e-Health preparedness Objective: To assess the preparedness status of a assessment in the context of hospital in Beijing, China for implementation of an an influenza pandemic: Article focus e-Health system in the context of a pandemic a qualitative study in China. ▪ How to assess organisational preparedness for BMJ Open 2013;3:e002293. response. the implementation of an e-Health system in the doi:10.1136/bmjopen-2012- Design: This research project used qualitative context of a pandemic response? 002293 methods and involved two phases: (1) group ▪ What is the preparedness status at a hospital in interviews were conducted with key stakeholders to Beijing for the implementation of an e-health ▸ Prepublication history for examine how the surveillance system worked with records system? this paper are available information and communication technology (ICT) ▪ How did the surveillance system work with infor- online. To view these files support in Beijing, the results of which provided mation and communication technology support please visit the journal online background information for a case study at the second in the 2009 influenza A (H1N1) pandemic (http://dx.doi.org/10.1136/ phase and (2) individual interviews were conducted in response in Beijing? bmjopen-2012-002293). order to gather a rich data set in relation to e-Health preparedness at the selected hospital. Key messages Received 1 November 2012 ▪ Setting: In phase 1, group interviews were conducted The occurrence of a pandemic can place an Revised 28 January 2013 immense burden upon healthcare services, and Accepted 14 February 2013 at Centres for Disease Prevention and Control (CDC) in Beijing. In phase 2, individual interviews were e-Health systems may facilitate the functioning of healthcare facilities. The implementation of any This final article is available performed at a secondary hospital selected for the for use under the terms of case study. information system in an organisational context http://bmjopen.bmj.com/ requires proper planning and management for the Creative Commons Participants: In phase 1, three group interviews were change. Prior to the implementation of e-Health Attribution Non-Commercial undertaken with 12 key stakeholders (public health/ systems, the assessment of organisational pre- 2.0 Licence; see medical practitioners from the Beijing city CDC, two http://bmjopen.bmj.com paredness is an essential requirement. district CDCs and a tertiary hospital) who were ▪ There has been no work reported on the assess- involved in the 2009 influenza A (H1N1) pandemic ment of e-Health preparedness at healthcare response in Beijing. In phase 2, individual interviews facilities. were conducted with 23 participants (including physicians across medical departments, an IT manager on September 29, 2021 by guest. Protected copyright. and a general administrative officer). and uncertainty over return on investment, and their Primary and secondary measures: For the case dissatisfaction with the software in use. study, five areas were examined to assess the hospital’s Conclusions: Prior to the implementation of e-Health, preparedness for implementation of an e-Health system planning must be undertaken to ensure the smooth in the context of a pandemic response: (1) motivational introduction of the system. The assessment of forces for change; (2) healthcare providers’ exposure to organisational preparedness is an important step in this e-Health; (3) technological preparedness; (4) planning process. On the basis of a case study, deficient organisational non-technical ability to support a clinical areas of organisational preparedness were identified for ICT innovation and (5) sociocultural issues at the the prospective implementation of electronic health organisation in association with e-Health records. Accordingly, we suggested possible solutions for implementation and a pandemic response. the areas in need of improvement to facilitate e-Health Results: This article reports a small subset of the case implementation’s success. study results from which major issues were identified For numbered affiliations see under three main themes in relation to the hospital’s end of article. preparedness. These issues include a poor sharing of patient health records, prescription errors, unavailability of Correspondence to software tools to assist physicians in answering patient BACKGROUND Junhua Li; questions, physicians’ concerns about the reliability of ICT Influenza pandemics can occur with the [email protected] and the high monetary cost of e-health implementation appearance of a new strain of an influenza A Li J, Seale H, Ray P, et al. BMJ Open 2013;3:e002293. doi:10.1136/bmjopen-2012-002293 1 Organisational preparedness for e-Health BMJ Open: first published as 10.1136/bmjopen-2012-002293 on 13 March 2013. Downloaded from Action taken subsequently that addresses deficient areas ARTICLE SUMMARY of preparedness would hopefully facilitate changes ’ Strengths and limitations of this study resulting from e-Health systems implementation. ▪ A part of our findings shows how IT applications were used in Although there have been some preliminary attempts to the functioning public health surveillance system in Beijing. develop a framework for e-Health preparedness assess- This may provide decision makers at other settings with valu- ment, there has been no work reported on a systematic able insights to prepare themselves for a next pandemic from study on the evaluation of e-Health preparedness for the surveillance perspective. public health services. Recently, an integrated e-Health pre- ▪ Our case study at a hospital in Beijing demonstrates how paredness framework10 was developed from the perspec- organisational preparedness can be assessed for the imple- tives of the healthcare organisation and providers. Then mentation of e-Health systems. Similar studies can be con- the authors validated it by contextual interviews with 20 ducted in the future at various healthcare settings in countries domain experts: 10 with e-Health implementation practi- to manage and plan the implementation of varied and specific tioners and the rest with medical/public health practi- e-Health systems. fi ▪ Reported results from the case study may assist decision tioners, and no modi cationshavebeenmadeonthe makers in the hospital to take action to address deficient areas constructs. However, this framework has not yet been in their preparedness and, as a result, facilitate the e-Health applied in real healthcare settings. As a research strategy, implementation’s success. the case study is used in many situations to contribute to ▪ The study results may be limited due to the participants’ over- our knowledge of individual, group, organisational, social, reporting or their recall bias. political and related phenomena—it allows investigators to ▪ Another limitation is on the study design. This single-case retain the holistic and meaningful characteristics of real-life study demonstrates the applicability of an integrated prepared- events.11 In light of the integrated framework, we con- ness assessment framework that was developed and published ducted a case study at a healthcare organisation in Beijing, recently. We understand that the evidence from multiple cases which aimed to test its applicability and assess the pre- is often considered more compelling, and the overall study is paredness status for the implementation of an e-Health therefore regarded as being more robust. However, the conduct of a multiple-case study requires extensive resources system in the context of a pandemic response. and time. For this project, we received no specific grant from any funding agency in the public, commercial or not-for-profit METHODS sectors; therefore, we selected a representative and typical case to achieve the study objectives. This study used a qualitative research approach and involved two phases: (1) group interviews were conducted with key stakeholders involved in the 2009 influenza A (H1N1) pandemic response in Beijing to examine how http://bmjopen.bmj.com/ virus against which none of the population has any the surveillance system worked with ICT support, which immunity.1 A severe pandemic has the potential to provided background information for the case study and increase morbidity and mortality levels, and conse- (2) individual interviews at a selected hospital to gather a quently to cause economic losses worldwide.2 e-Health is rich data set in relation to e-Health preparedness assess- an application of information and communication tech- ment. The Medical and Community Health Research nology (ICT) across the whole range of functions that Ethics Advisory Panel, the University of New South Wales affect health. It may mitigate the impact of a pandemic and the Beijing Center for Disease Prevention and by enhancing surveillance and control (eg, rapid case Control (CDC) approved the study protocol. on September 29, 2021 by guest. Protected copyright. reporting), and improving the performance of clinical practice (eg, efficient documentation).34 Interview guide The implementation of e-Health systems represents a Phase 1 disruptive
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