Assessing the readiness of public healthcare facilities to adopt health information technology (hit)/e-health: a case study of komfo anokye teaching hospital, Ghana

Most health information technology (HIT)/e-Health initiatives in developing countries are still in project phases and few have become part of routine healthcare delivery due to the lack of clear implementation roadmap. Ghana has been piloting a number of e-Health initiatives, which have not guaranteed a sustainable implementation of such systems. The objective of this research study was to explore the information technology (IT) readiness of public healthcare institutions (primary, secondary and tertiary) in Ghana to adopt e-Health in order to develop a standard HIT/e-Health readiness assessment model. For a population of 28,678,251 people there are only 2,615 medical doctors on the Ministry of Health’s (MoH) payroll as at 2013 and 1818 public hospitals. Consequently, the doctor to population ratio is extremely low as compared to other developing countries, which falls far below the WHO revised standard of 1:600. Under these circumstances there is evidence in developed countries that adoption of health informatics technologies can contribute to improving the situation. An extensive review of literature on e-health in developing countries has identified a general lack of adoption due to a lack of readiness to incorporate the technology into the healthcare environment. Literature provides myriad but fragmented models/frameworks of health information technology (HIT)/e-Health adoption readiness assessment limited measuring tools to assess factors of HIT readiness. This risks the outcomes of HIT/e-Health readiness assessment, which eventually limits knowledge about the strategic gaps warranting the need for the implementation of HIT/e-Health systems in public healthcare institutions in Ghana. Whiles previous studies acknowledge the existence of HIT readiness assessment factors, there exist very limited measuring items for these factors. Simply put, there is not just limited studies on HIT readiness assessment, but there is also no standard guiding readiness assessment model. This study has identified the lack of standard assessment model/framework as well as their accompanying measuring tools for effective outcomes as major gaps. Thus, there was the need for gaining a deeper understanding of existing readiness factors and their applicability in the context of the readiness of public healthcare facilities in Ghana and how they promote or impede HIT/e-Health adoption in order to develop standard HIT readiness assessment model, which comprises readiness factors and most importantly their measuring tools. This study used a mixed method approach, specifically the exploratory sequential design (the exploratory design) where the outcome of qualitative data collected from 13 senior health CIOs and leaders of e-Health initiatives in Ghana analysed built to quantitative data collection instrument. The survey instrument was used to collect quantitative data from 298 clinical and non-clinical staff (Administration/Management leadership) Komfo Anokye Teaching Hospital (KATH) in a form of case study to confirm the findings of the initial exploratory study. This was because the mixed method is rooted in the pragmatism of philosophical assumptions, which guide the direction of the collection and analysis of data and the mixture of qualitative and quantitative approaches in many phases of the research process. Furthermore, mixed research methods design strategy provides a powerful mechanism for IS researchers in dealing with the rapidly changing environment of ICT. An initial standard regression analysis using IBM SPSS version 23 established that five factors (Technology readiness (TR); Operational resource readiness (ORR); Organizational cultural readiness (OCR); Regulatory policy readiness (RPR); and Core readiness (CR)) and 63 indicators (measuring tools) promote and/or impede HIT/e-Health adoption readiness in public healthcare facilities in Ghana. Consequently, these factors were used in developing a standard HIT readiness assessment model. Whiles these five factors all proved to have strong association with the dependent variable Health Information Technology readiness (HITR) in the standard regression, (R2 = 0.971) the findings of a latter PLS-SEM, an advanced regression analysis deployed suggest that Regulatory policy readiness (RPR) and remarkably Core readiness (CR) did not impact on the readiness of KATH to adopt e-Health/HIT. As many public healthcare organizations in Ghana have already begun the process of implementing various HIT/e-Health systems without any reliable HIT/e-Health regulatory policy in place, there is a critical need for reliable HIT/e-Health regulatory policies (RPR) and some improvement in HIT/e-Health strategic planning (core readiness). The final model (R2 = 0.558 and Q2= 0.378) suggest that TR, ORR, and OCR explained 55.8% of the total amount of variance in health information technology/e-Health readiness in the case of KATH, partially supporting the hypotheses of this study. Although no formal hypotheses were proposed for the relationships/effects, which exist between exogenous/independent constructs in the model structure, the SmartPLS3 model path analysis did show that there exist such relationships. For instance, the significant paths from regulatory policy readiness (RPR) to organizational resource readiness (ORR) (t = 23.891; Beta = 0.774) and from technological readiness (TR) to operational resource readiness (ORR) (t = 11.667; Beta = 0.624) obtained from SmartPLS3 bootstrap procedure indicate the presence of mediation. Fit values (SRMR = 0.054; NFI = 0.739). Generally, the GoF for this SEM are encouraging and can substantially be improved when public healthcare facilities in Ghana intending to implement HIT/e-Health pay equal attention to relevant regulatory policies and strategic planning. The readiness assessment model developed this study essentially offers a useful basis for healthcare organizations to enhance the conditions under which HIT/eHealth is launched in order to achieve successful and sustainable adoption with particularly attention being paid to HIT/e-Health regulatory policies and strategic planning. When evaluations such as this are carried out effectively, there could be a circumvention of large losses in money effort and time, delays and disappointments among planners, staff and users of services whiles facilitating the process of change in the institutions and communities involved. This study was conducted with selected subjects and selected public healthcare facilities in the southern cities/parts of Ghana. Therefore, a replication or transfer of this study to other parts of Ghana especially the rural areas and the private healthcare environment should consider the potential differences resulting from varying cultural, socioeconomic and political backgrounds since healthcare is a much-institutionalised industry. The same caution must be exercise when replicating this study in other developing countries and across the globe.