A homogenous IT system and the expectations of the primary healthcare patients

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1 JOURNAL JOURNAL OF PUBLIC OF PUBLIC HEALTH, HEALTH, NURSING NURSING AND AND MEDICAL MEDICAL RESCUE RESCUE No.2/2013 No.2/2013 (23-29) JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (2) 23 A homogenous IT system and the expectations of the primary healthcare patients (Jednolity system informatyczny a oczekiwania pacjentów podstawowej opieki zdrowotnej) A Strzelecka 1, B, C, D 1, A, E, F, G Nowak-Starz Abstract - The introduction of a homogenous computer system into healthcare is bound to result in the proper manment of patient data. If the standards are not met in a given facility, it will not be possible to send medical data outside it. That would cause unnecessary redundancy of patient data on subsequent levels of healthcare service. The purpose of the study was to determine the possibilities of supporting patient satisfaction by means of introducing a homogenous IT system in primary healthcare institutions in the Świętokrzyskie province. The research was conducted between June and December 2011, involving patients of public and non-public healthcare centres in the Świętokrzyskie province as an extended sample. 61,16% of the patients studied saw a need for a homogenous IT system. As people are not informed on the advants of such an innovation, every fourth person does not know whether or not a system like that should be implemented (25,83%). As perceived by the patients interviewed, a homogenous IT system is a chance to facilitate the work in primary healthcare institutions. Key words - IT system, healthcare quality, patient satisfaction. Streszczenie Wprowadzenie jednolitego systemu informatycznego w ochronie zdrowia spowoduje odpowiednie zarządzanie danymi medycznymi pacjenta. Brak wypracowanych standardów powoduje niemożność przysyłania danych medycznych poza obszar danej placówki. Powoduje to niepotrzebną redundancję danych pacjenta przy kolejnych szczeblach usług medycznych. Celem badań była próba ustalenia możliwości wspierania satysfakcji pacjentów poprzez wprowadzenie jednolitego systemu informatycznego w placówkach podstawowej opieki zdrowotnej na terenie województwa świętokrzyskiego. Badania przeprowadzono w okresie od czerwca do grudnia 2011 roku obejmując w reprezentatywnej próbie pacjentów publicznych i niepublicznych zakładów podstawowej opieki zdrowotnej województwa świętokrzyskiego. Potrzebę wprowadzenia jednolitego systemu informatycznego wskazało 61,16% badanych pacjentów. Brak informacji na temat takiego rozwiązania skutkuje tym, że co 4 osoba nie wie czy istnieje potrzeba wdrożenia takiego rozwiązania (25,83%). Jednolity system informatyczny w opinii badanych pacjentów stwarza szanse na usprawnienie pracy w placówkach podstawowej opieki zdrowotnej. Słowa kluczowe - system informatyczny, jakość opieki zdrowotnej, satysfakcja pacjentów. Author Affiliations: 1. University of Jan Kochanowski, Faculty of Health Sciences Kielce Authors contributions to the article: A. The idea and the planning of the study B. Gathering and listing data C. The data analysis and interpretation D. Writing the article E. Critical review of the article F. Final approval of the article Correspondence to: Agnieszka Strzelecka, University of Jan Kochanowski, Faculty of Health Sciences Kielce, Stefana Żeromskiego 5 Str., Pl Kielce, Poland, A.Strzelecka@ujk.edu.pl P I. INTRODUCTION atients believe that healthcare features should be aimed at encouraging them to come back to the same healthcare provider in the future [10]. Defining quality in healthcare is a complex matter and it is related to the idiosyncratic characteristics of this kind of service. In the European Union, a lot of emphasis is put on the quality of healthcare. However, providing medical service in such a way so as to meet the patients expectations and satisfy their needs is becoming increasingly difficult. Healthcare are compelled to increase the quality and efficiency of the service they provide [5]. The quality of care provided in healthcare is greatly influenced by a number of processes, including not only medical technology and human resource manment. Other influential factors are related to information technology [4].

2 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (2) 24 Modern computer technologies are of increasing importance. The accessibility of health-related information is dependent on them. Only few healthcare in Poland employ modern methods of provider-patient communication. Websites of primary healthcare institutions, provided they exist at all, offer only general information on the structure of a given unit, the personnel employed and the range of services provided. The absence of interactivity forces patients to be passive, in a way [7]. An information manment system is composed of specific IT architecture, equipment, software and the participants of that process: here these are patients and medical staff [9]. An information society is the type of society whose social structure is accommodated to services related to the creation, processing, interpretation and publication of information using digital technology, e.g. the Internet [3]. Such circumstances are relevant to healthcare. Computerization consists in rational use of already possessed data within IT systems. A condition of the successful implementation of such solutions is the use of verified methodologies and approaching computerization as a complex endeavour [2]. The implementation of an IT system is a continuous process requiring many years; its development is supposed to be systematic. How fast this process can be implemented depends to a large extent on the organization of work in a given unit and the involvement of the users of the system as well as the rate at which they can acquire the knowledge necessary to use the system in their everyday medical practice [12]. An IT system should serve as a complex structure registering all the processes occurring in healthcare as well as provide a multidirectional and multi-level manment of patients data. A universal structure would provide an option of registering all medical activities, the result of which would be, in turn, the possibility of processing data in accordance to the specific needs of the institutions participating in the healthcare system, including the prevention of abuse [6]. The Information System in Healthcare Act of 29 th April 2011 has a crucial significance in the Polish healthcare [11]. Importantly enough, the existing and new data must be compatible and accessible to many users. Databases created for a single healthcare facility are either too narrow or their identification numbers are different, which renders other institutions unable to use them [6]. In response to a European appeal, the Healthcare Information Systems Centre, a unit subordinated to the Ministry of Health in terms of computerization, prepared the Healthcare Computerization Programme. Currently, projects aimed at introducing complex ICT systems into Polish healthcare are being implemented. The currently implemented projects are: [13]. The P1 Project: the Electronic Platform of Gathering, Analysing and Sharing Medical Event Digital Resources, The P2 Project: the Platform of Making Available Online the Services and Resources of Digital Medical Registers to Entrepreneurs. II. MATERIALS AND METHODS The purpose of the study was to assess the possibility of enhancing patient satisfaction by means of implementing a homogenous IT system in primary healthcare in the Świętokrzyskie province. The study was conducted between June and December 2011, involving patients of public and non-public healthcare centres in the Świętokrzyskie province as an extended sample. The directors of those consented for the research to be conducted at a time approved by them. The data were collected using a structured interview. An original questionnaire was used. This study was supported by the Knowledge and Economy developing science and business competence to enhance the competitiveness of regional economy project, which is cofinanced from the European Social Fund of European Union within the Human Resources Development Operational Programme. In order to analyse the differences between the populations, the χ2 test or Fisher s Exact Test was used. The latter provides more reliable estimations in cases when there are only few answers in a given category. A null hypothesis that there are no statistically significant differences between the distributions of answers to a given question (in the public vs. non-public healthcare patient groups) was tested. The significance level was assumed to be α = 0,01 or 0,05. The decision on the rejection of the null hypothesis or the claim that there are no grounds for the rejection were made on the basis of the comparison between α value and the p-value obtained in the test to signify the likelihood of a type I error. The results of the test indicate the value of test statistic, degrees of freedom (df) and the p-value and present the verdict on the null hypothesis.

3 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (2) 25 Table 1. The sex of the primary healthcare patients interviewed The sex of the primary healthcare patients interviewed Public Male 83 38, , ,63 Female , , , , , ,00 A total of 422 people were interviewed. There were 163 men and 259 women, which yields the percent distribution of 38,63% to 61,37%. Table 2. The of the primary healthcare patients interviewed years of or more The of the primary healthcare patients interviewed Public 15 6,94 8 3, , , , , , , , , , , , , , , , ,00 Table 3. The place of residence of the primary healthcare patients interviewed The place of residence of the primary healthcare patients interviewed Public Vills , , ,90 Towns, up to 20 thousand inhabitants 29 13, , ,90 Towns, population , , ,19 thousand Cities, population , , ,01 thousand , , ,00 The results of the chi-squared test: the value of the test statistic = 8.314, df = 3, p-value = With the significance level of α = 0,04, the null hypothesis is rejected. There is a statistically significant difference between the responses of both the populations studied. Out of the 422 interviewees, 51,90% resided in vills, 19,19% in towns with thousand inhabitants, 18,01% in cities with thousand inhabitants and 10,90% in towns up to 20 thousand inhabitants. Among the 422 interviewees, the range of was the most dominant (32,23%). It was followed by the ranges of: (24,64%), (24,17%), 65 or more (13,51%) and (5,45%).

4 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (2) 26 Table 4. Health self-assessment of the primary healthcare patients interviewed Health self-assessment of the primary healthcare patients interviewed III. RESULTS Table 4. The primary healthcare patients opinion on the need to implement a homogenous IT system in Poland Public The primary healthcare patients opinion on the need to implement a homogenous IT system in Poland Poor 34 15, , ,74 Public Satisfactory 54 25, , ,64 Good 93 43, , ,00 Very good 32 14, , ,25 Yes , , ,61 Excellent 3 1,39 7 3, , , , ,00 No 23 10, , ,56 The results of the chi-squared test: the value of the test statistic = , df = 4, p-value = There are no grounds for the rejection of the null hypothesis. On the basis of the sample analysis it can be stated that the populations were not different in a statistically significant manner as far as the response to the question was concerned. The analysis of the next parameter the assessment of patients own health shows that 43,06% of the public healthcare patients believe their health is good, 25,00% of them claim it is satisfactory, 15,74% consider their health poor, 14,81% believe to be of very good health and 1,39% stated their health was excellent. Don t know 60 27, , , , , ,00 Over 60% of all interviewees claim a homogenous IT system is needed. Every fourth interviewee does not know whether or not such a system should be implemented. The situation stems from the interviewees lack of knowledge on the functions of a nationwide homogenous computer system.

5 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (2) 27 Table 5. The primary healthcare patients opinion on a homogenous IT system that could facilitate the work in primary healthcare institutions The primary healthcare patients opinion on a homogenous IT system that could facilitate the work in primary healthcare institutions Totally agree Partially agree No opinion Partially disagree Totally disagree Public 88 40, , , , , , , , ,70 8 3,70 9 4, ,03 9 4, , , , , ,00 One of the proposed elements of an IT system is the possibility of online appointment scheduling. Over 50% of the interviewees stated that such a solution would help schedule appointments for a time that fits the patients. 34,72% of the public and 40,78% of the non-public healthcare patients pointed to the lack of waiting in a line to see a general practitioner. Table 6. The interviewees general assessment of the services provided by primary healthcare. The interviewees general assessment of the services provided by primary healthcare. Public Positive 72 33, , ,23 Moderately positive , , ,47 Negative 19 8, , ,29 The patients interviewed believe that a homogenous IT system would facilitate the work in primary healthcare institutions (totally agree - 41,47%, Partially agree - 25,12%). The percent of negative responses did not exceed 10%. public non-public , , ,00 The results of the chi-squared test: the value of the test statistic = , df = 2, p-value = With the significance level of α = 0,01, the null hypothesis is rejected. There is a statistically significant difference between the responses of both the populations studied. Patients of non-public healthcare institutions have a positive opinion on the medical service provided (49,51%). Only every third patient of a public healthcare institution had a positive opinion on primary healthcare. at another non-wait alternative time convenient to you Figure 1. Advants of online appointment scheduling as perceived by the primary healthcare patients

6 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (2) 28 public non-public negative moderate positive Figure. 2. The interviewees general assessment of the services provided by primary healthcare. public non- public Figure. 4. The expectations towards a homogenous IT system vs. the type of institution Patients of non-public healthcare have higher expectations towards a homogenous IT system than those from public healthcare. IV. DISCUSSION negative moderate positive Figure. 3. The interviewees opinion on the expectations towards a homogenous IT system vs. their general assessment of the services provided by primary healthcare. The opinion on the expectations towards a homogenous IT system is higher in case of those interviewees who had a positive opinion on the services provided by primary healthcare. The patients waiting in a line in a primary healthcare facility under research were informed that the interview was anonymous and voluntary. In both samples women were dominant (61,37% of all) over men (38,63% of all) [table 1]. In another study on the assessment of medical service quality, women were the majority as well (72,1%), with the percent of men being 27,9% [8]. The greatest percent of the total number of interviewees was in the range (32,23%) [table 2]. In the other study on the patient satisfaction level as an element of the primary healthcare quality [8], 191 patients of 14 random primary healthcare centres in Warsaw were interviewed and the same group was dominant (35,8%). Analysing the next parameter the place of residence, one can observe that most of public healthcare patients reside in vills (55,56%). They are followed by those from towns with populations between 20 and 100 thousand (15,74%), cities with thousand (15,28%) and towns up to 20 thousand (13,43%). [Table 3]. The results are similar in the group of non-public healthcare patients, with 48,06% constituted by vill inhabitants, 22,82% from towns with populations between 20 and 100 thousand, 20,87% from cities with thousand and 8,25% from towns up to 20 thousand.

7 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (2) 29 61,16% of the patients studied saw a need for a homogenous IT system [Table 4]. As no information on that solution is accessible, every fourth person does not know if such a solution should be implemented (25,83%). 41,45% of the interviewees stated that a homogenous IT system would definitely facilitate the work of primary care institutions [Table 5]. The benefits of that solution perceived by the sample group include shorter waiting time in a line to a doctor [Figure. 1]. The implementation of new technologies has been confirmed to bring about the following advants: reduction of appointments with general practitioner (9,7%) and the increase in the number of patients who set themselves a goal related to their disease (52%) [1,5]. As far as the service provided within primary healthcare, the patients in this study rated non-public healthcare higher (49,51%) than the public one (33,33%) [Table 6, Figure. 2, 3]. Responses valuing health service as negative amounted to 8,29% of the total number. Most of the patients in the other study opted for positive assessment (70,2%). They were followed by the groups offering moderately positive assessment (25,6%) and negative assessment (4,2%) [8].. V. CONCLUSIONS 1. The need for a homogenous IT system was indicated by 61,61% of the studied primary healthcare patients. No disproportions between the opinions of public and non-public healthcare patients were noted. In the of information society, new technologies provide foundations for an effective healthcare system. 2. In the interviewees opinion, a homogenous IT system would facilitate the work in primary healthcare institutions The possibility of online appointment scheduling may result in shorter waiting time in a line to a general practitioner. 3. The directions of the information society development set by the European Union indicate that the implementation of computer technology to healthcare is essential. Such a solution would improve and facilitate healthcare and contribute to the improvement of the medical service quality in primary healthcare in the Świętokrzyskie province. VI. REFERENCES [1] Benchmarking ICT use among General Practitoners In Europe Final Report, European Commission, Bon April, 2008: [2] Cieciura M. Zasady informatycznego wspomagania funkcjonowania placówki ochrony zdrowia. W: Modelowanie i zastosowanie komputerowych systemów medycznych. Cieciura M, Olchowika W. (red.), Warszawa; PZWL, 2009: [3] Dąbrowska A, Janoś-Kresł M, Wódkowski A. E-usługi a społeczeństwo informacyjne. Warszawa; Wyd. Delfin, 2009: [4] Detyna B, Detyna J. Jakość usług medycznych. Ocena statystyczna. Podstawy metodyczne. Warszawa; Wyd. Delfin, 2009: [5] Frączkowski K. Systemy informacyjne oraz usługi w ochronie zdrowia oparte na technologiach SOA (Service Oriented Architecture), Acta Bio-Opt. Inf. Med. Biomed.Eng.2010; 1: [6] Kierunki informatyzacji e-zdrowie Polska na lata , Opracowanie w ramach Aktualizacja dokumentu Strategia e-zdrowie , będącego przedmiotem Umowy realizowanej w ramach projektu nr 2006/ współfinansowanego przez Unię Europejską ze środków Transition Facility Warszawa; CSIOZ, 2009: [7] Krot K. Jakość usług medycznych, ABC. Warszawa; Wyd. Delfin, 2008, [8] Miller M. Ocena poziomu satysfakcji pacjentów leczonych na terenie województwa mazowieckiego. Warszawa; Centrum Medyczne Kształcenia Podyplomowego, Państwowy zakład Higieny, 2007:6-81. [9] Nosko J. (red.) Ekonomika i zarządzanie w opiece zdrowotnej, Łódź; Instytut Medycyny Pracy im. Prof. J. Nofera, 2009: [10] Opolski K, Dykowska G, Możdżonek M. Zarządzanie przez jakość w usługach zdrowotnych. Warszawa; Wyd.CeDeWu, 2009: [11] Shaw R. Nowej spojrzenie na marketing. Warszawa; Wydawnictwo Studia Emka, 2001: [12] Ustawa z dnia 28 kwietnia 2011 r. o systemie informacji w ochronie zdrowia (Dz. U. Nr 113, poz. 657). [13] &mi=795&mx=0&ma=16749