The identified gap in quality related to the delivery of healthcare is technology barriers in care coordination for chronically ill patients. Care coordination is a complicated process since it involves a variety of specialists from different locations and at different times. One should highlight that the delivery of quality care should be based on healthcare professionals’ willingness to cooperate, share information with one another, and educate patients on health issues. It may be complicated to arrange high-quality coordination of care depending on several major aspects. These include the seriousness of the patient’s condition, the availability of specialists, accessibility to healthcare facilities, and the willingness of each of the stakeholder to collaborate with the aim of gaining the optimal result. Recent breakthroughs in technology allow planning and carrying out coordinated care with high efficiency due to ample opportunities offered by smartphone applications (Carayon et al., 2019; Liss et al., 2018). However, because of insufficient accessibility to such apps, as well as due to some patients’ low acceptability of this option, a gap in health care delivery quality has emerged.
Among the most unfavorable associations with technology use for care coordination, scholars identify insufficient notifications and poor access to information. More specifically, Carayon et al. (2019) have reported such problems as restricted usability and usefulness of technologies, inadequate information, using multiple health information technologies, and technical issues. Meanwhile, Liss et al. (2018) expand this list by such complications as smartphone battery drainage, false alerts, and excessive burden on the user. Therefore, the mentioned problems make up the gap in quality of health care delivery, which demands effective solutions.
Whereas the use of digital technology in health care has shown positive results, scholars note that the uptake of this approach is too low. For instance, Palacholla et al. (2019) have found that although technologies can enhance patient care, their adoption in clinical settings is introduced at a low pace. Upon assessing a historical point of view, one can ambivalently describe the issue. On the one hand, it is possible to state that technology barriers are a modern-day issue. Liss et al. (2018) admit that smartphones and health apps are relatively young technologies, meaning that people in the past did not face them and associated difficulties. That is why one can stipulate that the identified gap is a current issue. On the other hand, one should also remember that technology is only a tool that emerged to facilitate healthcare operations. This statement denotes that medical professionals were forced to coordinate care for people with chronic conditions when modern technologies were absent. One can suppose that such patients suffered from even more mediocre care coordination before technology advancements entered the scene.
The socioeconomic background is a significant aspect when it comes to assessing healthcare access. Moscelli et al. (2018) focus on this issue and identify an obvious connection between a person’s status and opportunities, meaning that wealthier people have better options. Individuals with chronic illnesses are representatives of diverse socioeconomic backgrounds, meaning that the gap affects members of this population group differently. Some people cannot afford to buy new smartphones to install the most contemporary applications. Others do not have sufficient money to cover co-pays at the office, which also forces them to save funds to buy the required medications. This information demonstrates that not all individuals have equal access to technology and its benefits.
Inevitably, the health care delivered to the population is negatively affected by the gap in access. Firstly, the lack of communication and cooperation between providers can result in the fact that patients take the same medication twice because it is prescribed under different names. This scenario occurs when providers do not have the ability to see the patient’s previous prescriptions, making people suffer from taking higher doses. Secondly, complete reliance on technology and insufficient smartphone use literacy can also imply adverse consequences. Healthcare applications can produce false alerts that, for example, can make patients take medications when it is not necessary or skip taking the required pill. Technical issues can result in this state of affairs, and some users, especially elders, can fail to notice this problem.
If the gap is not addressed timely and properly, negative implications can be experienced both by the population in question and healthcare facilities. First of all, without appropriate coordination of care, chronically ill patients are under the threat of having their symptoms complicated and health condition deteriorated. If an individual does not receive the necessary information, feedback, receipt, or any other crucial element of care, there is a risk of wasteful health spending and excessive readmission rates (Liss et al., 2018). Since the financial burden on hospitals and clinics is already too high, it is crucial to avoid the gaps in care delivery that can complicate the situation. Also, readmissions affect patients negatively, including both psychical health condition and psychological state. On the part of healthcare employees, the failure to address the gap poses a threat of burnout due to work overload. In the current environment of the world being overwhelmed with COVID-19 aftermath and healthcare workers’ shortenings, it is of utmost importance to do everything possible to eliminate the possibility of the identified gap’s further development.
The Existing Initiative Put in Place to Address the Gap
As it has been mentioned above, the existing gap exists due to technology barriers in care coordination for chronically ill patients. Among the major problems, patients emphasize insufficient preparation to use technologies for care coordination (Chang et al., 2018). Meanwhile, healthcare employees admit that they find it difficult to use multiple health information technology (IT) systems (Carayon et al., 2019). In order to meet both of the mentioned issues, several initiatives can be applied, such as addressing policy regulations, ensuring technology integration, and the readiness of technologies to meet the ‘gold standard’ (Wallis et al., 2017). However, the most effective solution that has been implemented so far is the implementation of education strategies for all stakeholders, including patients and healthcare workers (Wallis et al., 2017). With the help of appropriate educational strategies, it will be easier for all of the participants of the care coordination process to address the gap. It is worth admitting that the program should be free of charge for patients with chronic illnesses because some of these individuals are of disadvantaged socioeconomic status, meaning that they do not have much money.
Educational interventions to improve patients’ and healthcare workers’ use of IT in care coordination pursue the following goals:
- to eliminate the problems of understanding and use of technology by patients from various backgrounds;
- to increase patients’ interest in utilizing technology and cooperating with their healthcare coordinators;
- to decrease the burden on healthcare professionals due to using multiple health IT systems;
- to reduce the number of applications for healthcare employees and increase the efficiency of the existing ones;
- to improve chronic patients’ health conditions due to timely professional coordination of their health issues;
- to reduce the financial burden of healthcare facilities by lowering the number of hospital visits.
Now, it is reasonable to stipulate that the goals draw attention to the needs of the elderly. It is possible to suppose that this population experiences the most evident effects of the gap because older individuals typically have lower technology literacy. Consequently, the given goals demonstrate that the elderly will be provided with assistance to understand how and when they should use technology. Furthermore, the older population should be addressed to increase their interest in using technological advancements in the healthcare sphere because this approach can provide these individuals with significant benefits.
Development of the Existing Initiative
The given section is going to comment on how the suggested initiative can be developed. According to Fan and Zhao (2022), educational interventions have emerged recently and gained noticeable popularity in the healthcare industry. One should highlight that the proposal is to organize educational programs for patients and healthcare professionals, meaning that new technologies or applications should not be developed. The task is to select efficient and affordable technologies and ensure that all the stakeholders have a clear understanding of how to use them.
Specific research activities have allowed for identifying that the Office of the National Coordinator for Health Information Technology is a suitable organization to develop an initiative. Established by the US Department of Health & Human Service, this body is responsible for addressing the issues that relate to the use of information technology in healthcare settings. The same establishment should also monitor and analyze how the intervention is implemented. For this purpose, the Office should allow the stakeholders to provide their feedback to present their experience of participating in the program. The Office should also consider objective indicators, including the number of technology users. For example, a high number of people with chronic diseases using technology will be a success of the initiative.
Resources to Fund the Initiative
The resources needed to fund the initiative are mostly concerned with time and financial support. Since the initiative should be implemented by the government organization, funds for its implementation can be taken from the federal budget. The resources are needed to develop the educational program and implement it. In particular, educated and skillful mentors should be hired to present the required information to patients and healthcare professionals. One should also indicate that the budget should include the required learning materials, which refers to the creation of guidelines and presentations to help the stakeholders absorb the information. Ideally, the initiative could imply the provision of the involved stakeholders with the necessary facilities. In particular, the government should allocate sufficient resources to ensure that all the participants have smartphones with enough memory and are capable of downloading the necessary applications.
The Need for Improvement
At the moment, many potential users of new IT lack the financial opportunity to purchase the most up-to-date smartphones. Therefore, the major improvement point should be the focus on reducing the cost of new apps and creating software that can be downloaded even on older models of smartphones. Although this approach might be challenging, the benefits will definitely outnumber the limitations. If more people are able to use health apps without resorting to considerable financial losses, it will become easier to persuade all stakeholders to participate in care coordination by means of technology.
Currently, the Health Information Technology for Economic and Clinical Health (HITECH) Act regulates the area under analysis. The given legislation piece provides the US Department of Health & Human Services with the opportunity to improve care quality, manage the promotion of information technology, secure information exchange, and others (The Office of the National Coordinator for Health Information Technology, 2019). This Act appeared in 2009 when technology started actively entering the healthcare industry, which resulted in many issues that required regulation. For example, many patients and medical professionals were not aware of existing tools and instruments, meaning that they should have been educated on possible opportunities to improve the quality of care. The Act also addressed the fact that the use of technology raised privacy issues. Consequently, it is possible to mention that the suggested initiative should also rely on the HITECH Act to address the technology barriers in care coordination.
According to the information above, it is evident that the current initiative is addressed at the federal level. The rationale behind this statement is that the federal government agency is involved in its development and monitoring, while resources from the federal budget should be allocated to implement it. This approach also demonstrates that the identified gap received adequate attention from the government, which increases the probability of solving the problem. However, one should also stipulate that appropriate actions should be introduced at the state and local levels. This statement denotes that it will be challenging for the federal government to ensure that the initiative is correctly implemented on the ground. That is why a suitable decision is to make state and local authorities involved in the initiative and make them supervise educational programs in the accountable areas.
The final report has commented on the fact that technology barriers significantly harm the quality of care for chronically ill patients. In particular, the problem results in worsened care coordination among different healthcare professionals. The problem is relatively young because it emerged with more active use of technology advancements in the healthcare industry and affects people with diverse socioeconomic backgrounds. One should admit that the issues imply many adverse outcomes for people with chronic conditions, which can subject these individuals to compromised health outcomes. That is why the given report offers to implement a specific educational initiative to make patients and healthcare professionals rely more actively on the use of smartphones in health care delivery. The initiative is going to meet specific goals aimed at promoting technology use, increasing patients’ interest in information technology, and others.
The educational program seems appropriate because such interventions are requested and effective in the healthcare industry. One should also state that the Office of the National Coordinator for Health Information Technology is a suitable organization that can deal with the development and management of the initiative. Since this body was established by the US Department of Health & Human Service, it is not surprising that the federal budget is considered a leading resource to fund the suggested intervention. The report has also commented on the regulatory aspect of the initiative. It has determined that the Health Information Technology for Economic and Clinical Health Act emerged to regulate the sphere. However, appropriate changes are needed at the federal, state, and local levels to implement the current initiative. Consequently, it is reasonable to organize educational programs to promote technology use and improve the coordination of care.
Carayon, P., Hundt, A. S., & Hoonakker, P. (2019). Technology barriers and strategies in coordinating care for chronically ill patients. Applied Ergonomics, 78, 240-247.
Chang, L., Wanner, K. J., Kovalsky, D., Smith, K. L., & Rhodes, K. V. (2018). “It’s really overwhelming”: Patient perspectives on care coordination. Journal of the American Board of Family Medicine, 31(5), 682-690.
Fan, K., & Zhao, Y. (2022). Mobile health technology: A novel tool in chronic disease management. Intelligent Medicine, 2, 41-47.
Liss, D. T., Serrano, E., Wakeman, J., Nowicki, C., Buchanan, D. R., Cesan, A., & Brown, T. (2018). “The doctor needs to know”: Acceptability of smartphone location tracking for care coordination. JMIR mHealth and uHealth, 6(5), e112.
Moscelli, G., Siciliani, L., Gutacker, N., & Cookson, R. (2018). Socioeconomic inequality of access to healthcare: Does choice explain the gradient? Journal of Health Economics, 57, 290-314.
Palacholla, R. S., Fischer, N., Coleman, A., Agboola, S., Kirley, K., Felsted, J., Katz, C., Lloyd, S., & Jethwani, K. (2019). Provider- and patient-related barriers to and facilitators of digital health technology adoption for hypertension management: Scoping review. JMIR Cardio, 3(1), e11951.
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