Publications by authors named "Inga Hunter"

17 Publications

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Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Sri Sathya Sai Central Trust, Puttaparthi, India.

Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response.

Methods: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems.

Results: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response.

Conclusion: COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.
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http://dx.doi.org/10.1055/s-0041-1726484DOI Listing
April 2021

Survey protocol for exploring video and phone use in Aotearoa New Zealand general practice: considerations for future telehealth.

BMJ Health Care Inform 2021 Mar;28(1)

School of Population Health, The University of Auckland, Auckland, New Zealand.

Introduction: Telehealth became the most practical option for general practice consultations in Aotearoa New Zealand (NZ) as a result of the national lockdowns in response to the COVID-19 pandemic. What is the consumer experience of access to telehealth and how do consumers and providers perceive this mode of care delivery going forward?

Methods And Analysis: A national survey of general practice consumers and providers who used telehealth services since the national lockdowns in 2020 will be distributed. It is based on the Unified Theory of Acceptance and Use of Technology framework of technology acceptance and the access to care framework. The data will be statistically analysed to create a foundation for in-depth research on the use of telehealth services in NZ general practice services, with a specific focus on consumer experiences and health outcomes.

Ethics And Dissemination: Ethics approval was granted by the Auckland Health Research Ethics Committee on 13/11/2020, reference AH2539. The survey will be disseminated online.
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http://dx.doi.org/10.1136/bmjhci-2020-100309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986763PMC
March 2021

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

JMIR Mhealth Uhealth 2020 12 2;8(12):e24157. Epub 2020 Dec 2.

School of Management, Massey University, Palmerston North, New Zealand.

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.
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http://dx.doi.org/10.2196/24157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744268PMC
December 2020

Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems.

Yearb Med Inform 2020 Aug 17;29(1):44-50. Epub 2020 Apr 17.

School of Health Sciences, University of Canterbury, New Zealand.

Objectives: To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives.

Methods: We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth.

Results: Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts.

Conclusions: Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth.
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http://dx.doi.org/10.1055/s-0040-1701976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442533PMC
August 2020

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

Stud Health Technol Inform 2019 Aug;264:1688-1689

School of Engineering and Advanced Technology, Manawatu campus, Massey University, Palmerston North, New Zealand.

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.
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http://dx.doi.org/10.3233/SHTI190598DOI Listing
August 2019

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

JMIR Mhealth Uhealth 2018 Jun 6;6(6):e10741. Epub 2018 Jun 6.

School of Engineering and Advanced Technology, College of Science, Massey University, Palmerston North, New Zealand.

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.
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http://dx.doi.org/10.2196/10741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010833PMC
June 2018

Intelligent Digital Environment for Wellbeing and Health.

Stud Health Technol Inform 2017 ;245:1229

School of Engineering and Advanced Technology, Manawatu Campus, Massey University, Palmerston North, New Zealand.

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.
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June 2018

Knowledge management systems success in healthcare: Leadership matters.

Int J Med Inform 2017 01 17;97:331-340. Epub 2016 Nov 17.

School of Management, Massey University, Private Bag 11 222, Palmerston North, New Zealand. Electronic address:

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.
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http://dx.doi.org/10.1016/j.ijmedinf.2016.11.004DOI Listing
January 2017

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.

BMJ Open 2016 08 23;6(8):e011640. Epub 2016 Aug 23.

Faculty of Medicine, Muru Marri Indigenous Health Unit, School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.

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.
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http://dx.doi.org/10.1136/bmjopen-2016-011640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013334PMC
August 2016

Why should I?--Acceptance of Health Information Technology Among health professionals.

Stud Health Technol Inform 2015 ;216:962

School of Business, Massey university, Palmerston North, New Zealand.

Applying the Technology Acceptance Model, the end user intentions to use technology applications is studied. The study finds the end users negative perception of the usefulness of the application as a major factor in its suboptimal utilisation.
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April 2016

Increased electronic information sharing by sexual health services: confidentiality and consent.

Health Informatics J 2014 Mar 30;20(1):3-12. Epub 2013 Aug 30.

Massey University; MidCentral District Health Board, New Zealand.

New Zealand is moving towards an integrated health-care model with information accessible electronically regardless of location, linking existing health provider systems, regional clinical results repositories and a shared care record. However, such information sharing has been a major concern for patients attending sexual health services. In this study, we investigated patient attitudes towards a change in practice to support an integrated care model. Outcomes showed that confidentiality remains a significant concern, and routine sharing of patient information may create barriers to attendance for some, leading to a potential increase in untreated infections. We conclude that sexual health services may be able to change their information management practices to an opt-out consent system and routinely share health information with other health providers, but further public discussion to ensure informed consent is needed before this can happen. Regardless of national policy, it is still necessary to keep clinic visit details confidential for some patients attending sexual health services.
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http://dx.doi.org/10.1177/1460458212475140DOI Listing
March 2014

Health informatics community priming in a small nation: the New Zealand experience.

Stud Health Technol Inform 2013 ;192:950

School of Computing and Mathematical Sciences, Auckland University of Technology.

New Zealand (NZ) has a rapidly expanding health information technology (IT) development industry and wide-ranging use of informatics, especially in the primary health sector. The New Zealand government through the National Health IT Board (NHITB) has promised to provide shared care health records of core information for all New Zealanders by 2014. One of the major barriers to improvement in IT use in healthcare is the dearth of trained and interested clinicians, management and technical workforce. Health Informatics New Zealand (HINZ) and the academic community in New Zealand are attempting to remedy this by raising awareness of health informatics at the grass roots level via free "primer" workshops and by developing a sustainable cross-institutional model of educational opportunities. Support from the NHITB has been forthcoming, and the workshops start in early 2013. This poster presents the process, development and preliminary findings of this work.
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April 2015

User experience of interRAI assessment tools in New Zealand.

Stud Health Technol Inform 2013 ;192:744-8

Older Persons Services, MidCentral District Health Board, Palmerston North, NewZealand.

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.
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April 2015

Building an educated health informatics workforce--the New Zealand experience.

Stud Health Technol Inform 2013 ;188:86-90

School of Computing and Mathematical Sciences, Auckland University of Technology.

New Zealand has a rapidly expanding health information technology (IT) development industry and wide-ranging use of informatics, especially in the primary health sector. The New Zealand government through the National Health IT Board (NHITB) has promised to provide shared care health records of core information for all New Zealanders by 2014. One of the major barriers to improvement in IT use in healthcare is the dearth of trained and interested clinicians, management and technical workforce. Health Informatics New Zealand (HINZ) and the academic community in New Zealand are attempting to remedy this by raising awareness of health informatics at the "grass roots" level of the existing workforce via free "primer" workshops and by developing a sustainable cross-institutional model of educational opportunities. Support from the NHITB has been forthcoming, and the workshops started in early 2013, reaching out to clinical and other staff in post around New Zealand.
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April 2014

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

Int J Med Inform 2012 Jul 27;81(7):500-6. Epub 2012 Mar 27.

Department of Management, Massey University, Private Bag 11 222, Palmerston North, 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.
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http://dx.doi.org/10.1016/j.ijmedinf.2012.02.011DOI Listing
July 2012

New Zealanders' attitudes towards access to their electronic health records: preliminary results from a national study using vignettes.

Health Informatics J 2009 Sep;15(3):212-28

Department of Management, Massey University, Palmerston North, New Zealand.

This project investigates public attitudes towards sharing confidential personal health information held in electronic health records (EHRs). The project uses computer assisted telephone interviewing (CATI) to conduct a quantitative national survey of the attitudes of New Zealanders towards access to their personal health information using vignettes. Respondents are presented with vignettes which describe ways in which their health information might be used, and asked about their attitude to and consent for each type of access. The project outcome will be a specification of requirements for an e-consent model meeting the needs of most New Zealanders, thus enabling the potential benefits of electronically sharing confidential health information from EHRs. This article presents preliminary results from the first 1828 respondents. Respondents were most willing to share their information for the purpose of providing care. However, removing their name and address greatly increased the acceptability of sharing information for other purposes.
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http://dx.doi.org/10.1177/1460458209337435DOI Listing
September 2009

Patients' attitudes towards sharing their health information.

Int J Med Inform 2006 Jul 28;75(7):530-41. Epub 2005 Sep 28.

Department of Information Systems, Massey University, Palmerston North, New Zealand.

Objectives: The current policies of the governments of Australia and New Zealand encourage the use of electronic information systems to exchange patient information between various stakeholders. This research investigated (1) the attitudes of patients toward sharing their medical information and (2) whether patients considered themselves to be well-informed about the uses that are made of their information.

Methods: A questionnaire survey of adult primary-care patients was conducted in five clinics within a medium sized New Zealand city. Outcome measures were the proportions of respondents willing to share different categories of their information with different classes of recipients. Patients' evaluations of their knowledge about the uses made of their information were also collected.

Results: Over 200 responses were collected from five clinics. Respondents' attitudes toward sharing their information were found to be influenced by three factors. (1) Identity of recipient: whilst respondents were generally willing to have their information shared between health professionals, they were increasingly unwilling for it to be distributed to other stakeholders, such as administrators, researchers or other government departments. (2) Level of anonymity: respondents were more prepared to share anonymous information. (3) Type of information: respondents were increasingly unwilling to share their information as it takes on a more personal nature. Respondents were also found to be very poorly informed about the use of their information, 90% of respondents indicated that they had either incomplete or no knowledge of how their information was shared and 79% had no knowledge of the uses of their National Health Index (NHI) number. The findings also indicate that respondents would prefer to be consulted about the distribution of their information.

Conclusions: These findings indicate that many respondents were unwilling to have their personal information distributed other than for purposes of clinical care and a sizeable proportion of the respondents would like to be consulted before their information is released. The high level of interest and concern that this research revealed among respondents, suggests that more attention should be directed towards ensuring that patients are fully informed about current information sharing practices. The findings also imply that the design and development of future systems should also incorporate sophisticated and flexible access control policies that can be adapted to meet the preferences of individual patients.
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http://dx.doi.org/10.1016/j.ijmedinf.2005.08.009DOI Listing
July 2006