Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals.

BACKGROUND: Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. OBJECTIVE: The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people's health and well-being. METHODS: Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. RESULTS: The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was "access to technology and systems," which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was "collecting and sharing of information," which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients' social environment. The third theme was that all respondents identified similar "barriers to uptake": cost and funding issues, usability of systems by older people, and information security and privacy concerns. CONCLUSIONS: The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people's unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

Technology to Assist Aging in Place: The Perspective of Health Organizations.

This paper presents findings from a series of focus groups which is exploring the implications of, and stakeholder requirements for, integrating social media technologies and 'smart home' technologies to connect older adults with their formal support networks (i.e. to healthcare and social service providers) thus enabling them to live independently at home.

User Requirements for Technology to Assist Aging in Place: Qualitative Study of Older People and Their Informal Support Networks.

BACKGROUND: Informal support is essential for enabling many older people to age in place. However, there is limited research examining the information needs of older adults' informal support networks and how these could be met through home monitoring and information and communication technologies. OBJECTIVE: The purpose of this study was to investigate how technologies that connect older adults to their informal and formal support networks could assist aging in place and enhance older adults' health and well-being. METHODS: Semistructured interviews were conducted with 10 older adults and a total of 31 members of their self-identified informal support networks. They were asked questions about their information needs and how technology could support the older adults to age in place. The interviews were transcribed and thematically analyzed. RESULTS: The analysis identified three overarching themes: (1) the social enablers theme, which outlined how timing, informal support networks, and safety concerns assist the older adults' uptake of technology, (2) the technology concerns theme, which outlined concerns about cost, usability, information security and privacy, and technology superseding face-to-face contact, and (3) the information desired theme, which outlined what information should be collected and transferred and who should make decisions about this. CONCLUSIONS: Older adults and their informal support networks may be receptive to technology that monitors older adults within the home if it enables aging in place for longer. However, cost, privacy, security, and usability barriers would need to be considered and the system should be individualizable to older adults' changing needs. The user requirements identified from this study and described in this paper have informed the development of a technology that is currently being prototyped.

Intelligent Digital Environment for Wellbeing and Health.

This three-phase project seeks to identify the user-requirements and develop a novel and unobtrusive technology platform interpreting and integrating diverse sources of information from a variety of digital devices monitoring the health and wellbeing of an older person with social media networking. This technology platform will communicate that information within an individualised support network thus supporting the older person to 'age in place'. This poster presents the process and preliminary results of phase one.

Knowledge management systems success in healthcare: Leadership matters.

PURPOSE: To deliver high-quality healthcare doctors need to access, interpret, and share appropriate and localised medical knowledge. Information technology is widely used to facilitate the management of this knowledge in healthcare organisations. The purpose of this study is to develop a knowledge management systems success model for healthcare organisations. METHOD: A model was formulated by extending an existing generic knowledge management systems success model by including organisational and system factors relevant to healthcare. It was tested by using data obtained from 263 doctors working within two district health boards in New Zealand. RESULTS: Of the system factors, knowledge content quality was found to be particularly important for knowledge management systems success. Of the organisational factors, leadership was the most important, and more important than incentives. CONCLUSION: Leadership promoted knowledge management systems success primarily by positively affecting knowledge content quality. Leadership also promoted knowledge management use for retrieval, which should lead to the use of that better quality knowledge by the doctors, ultimately resulting in better outcomes for patients.

Consent and widespread access to personal health information for the delivery of care: a large scale telephone survey of consumers' attitudes using vignettes in New Zealand.

OBJECTIVES: In light of recent health policy, to examine factors which influence the public's willingness to consent to share their health information in a national electronic health record (EHR). DESIGN: Data were collected in a national telephone survey in 2008. Respondents were presented with vignettes that described situations in which their health information was shared and asked if they would consent to such sharing. The subset, consisting of the 18 vignettes that covered proving care, was reanalysed in depth using new statistical methods in 2016. SETTING: Adult population of New Zealand accessible by telephone landline. PARTICIPANTS: 4209 adults aged 18+ years in the full data set, 2438 of which are included in the selected subset. MAIN OUTCOME MEASURES: For each of 18 vignettes, we measured the percentage of respondents who would consent for their information to be shared for 2 groups; for those who did not consider that their records contained sensitive information, and for those who did or refused to say. RESULTS: Rates of consent ranged from 89% (95% CI 87% to 92%) for sharing of information with hospital doctors and nurses to 51% (47% to 55%) for government agencies. Mixed-effects logistic regression was used to identify factors which had significant impact on consent. The role of the recipient and the level of detail influenced respondents' willingness to consent (p<0.0001 for both factors). Of the individual characteristics, the biggest impact was that respondents whose records contain sensitive information (or who refused to answer) were less willing to consent (p<0.0001). CONCLUSIONS: A proportion of the population are reluctant to share their health information beyond doctors, nurses and paramedics, particularly when records contain sensitive information. These findings may have adverse implications for healthcare strategies based on widespread sharing of information. Further research is needed to understand and overcome peoples' ambivalence towards sharing their information.

User experience of interRAI assessment tools in New Zealand.

The international residential assessment instrument (interRAI) has been adopted for phased national implementation in New Zealand. It targets people over 65 years who require needs assessment for access to long term publicly funded services. There is limited research on the barriers to adoption for interRAI electronic assessment tools, and none relating to the New Zealand health sector. This research qualitatively explored clinicians' perceptions and experience of using interRAI electronic assessment tools using semi-structured interviews guided by constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT) model [9]. Analysis was conducted using thematic analysis. Three major barriers to adoption of interRAI tools emerged from the research: 1) lack of ready access to individual laptops/computers with consistent network connectivity, 2) need for ongoing training for interRAI assessors, and, 3) lack of understanding of what information is being collected and for what reasons. The growth in aging populations will see greater use of interRAI electronic assessment tools, and therefore more clinicians required to learn and use the technology. Addressing these barriers to adoption is therefore vital.

The use of information technologies for knowledge sharing by secondary healthcare organisations in New Zealand.

PURPOSE: To explore the extent of use of information technologies (ITs) for knowledge sharing by secondary healthcare organisations in New Zealand. METHODS: We used a self-administered questionnaire to survey Chief Information Officers at all 21 of New Zealand's District Health Boards regarding the extent to which their organisations use knowledge sharing activities involving ITs. The list of activities to include in the questionnaire was compiled by reviewing the literature. We analysed the extent of use of the knowledge sharing activities using descriptive statistics, repeated measures ANOVA, and correlation analysis. RESULTS: The response rate was 76%. Although all the responding organisations reported using ITs to share knowledge, they used ITs to share documents significantly more than to support discussions or to connect employees to experts. Discussions via teleconferencing, videoconferencing, and email lists were significantly more common than discussions via social media technologies: electronic discussion forums, blogs, and on-line chatrooms. There were significant positive correlations between publishing and accessing documents, between using teleconferencing and using videoconferencing, and between publishing and finding contact details of experts. CONCLUSION: New Zealand's District Health Boards are using a range of ITs to share knowledge. Knowledge sharing activities emphasising the sharing of explicit knowledge (via exchanging documents in electronic form) are significantly more common than knowledge sharing activities emphasising the sharing of tacit knowledge (via technology-mediated discussions and via using technology to connect employees to experts). In view of the evidence in the literature that information technology may be highly effective in supporting tacit knowledge exchanges, our results suggest that health organisations should consider greater adoption of ITs for sharing tacit knowledge. The finding that several organisations are currently making extensive use of teleconferencing and videoconferencing facilities and expertise databases suggests that these technologies are useful and could be of benefit to other healthcare providers and that barriers to their adoption can be overcome. In order to facilitate the wider adoption of technologies, early adopters of both relatively established technologies and of the emerging technologies such as social media should be encouraged to publish accounts of their experiences of success and lessons learnt from any failures so that the knowledge gained is disseminated to the wider medical informatics community.