e-Readiness Assessment - A Health Perspective - Global e-Health Research and Training Program  Health Telematics Unit www.ucalgary.ca/telehealth e-Readiness Assessment - A Health Perspective - Dr. Shariq Khoja; MD, MS, PhD Student Global e-Health Research and Training Program Health Telematics Unit, University of Calgary, Calgary, Alberta, Canada

e-Readiness - Definition - The degree to which a community is prepared to participate in the networked world. Measured by assessing the community’s relative advancement in the areas that are most critical for Information and Communications Technology (ICT) adoption and most important applications of ICT. Source: Center of International Development’s ‘Readiness for the networked world’

e-Readiness - e-Readiness Assessment - A method to assess if a community or institution is prepared to respond to a pre-identified problem, through ICT. It is NOT classical ‘needs-assessment’ which identifies the issues or problems. A strategy to identify gaps in the ability of a community or institution to implement an ‘e-health solution’ to its problems. Most of the readiness assessment has been done for e-learning and e-business purposes.

e-Readiness - Importance - Has high value For both the planners of an activity and the participating communities. Avoids delays and disappointments Identifies any lack of preparedness of a community to implement a virtual response at an early stage. Avoids huge losses in time, money and effort. Can prepare remote communities in developing countries, in order to reduce the digital divide. Telehealth/ e-health programs require lots of planning and investment. It is therefore necessary to conduct a readiness-assessment to avoid major losses at a later stage.

e-Readiness - Importance - Readiness is: “An integral and preliminary step in successful adoption of an innovation”. (CANARIE report, 2002). Required to successfully initiate a change process: Stages of Change (Scholl RW, 2002) Precontemplation is the stage at which there is no intention to change behavior in the foreseeable future. Contemplation is the stage in which individuals are deciding whether or not there is a need to take action to correct the problem.  Do the pro & cons of change outweigh the pro & cons of maintaining the status quo?  Preparation is a stage entered into once the individual decides there is a need to take some action.  Specific plans of action are developed in this stage as the individual chooses among alternative potential solutions. Action is the stage in which individuals put their plans into action and change their behavioral patterns.  Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action. Pre- contemplation Contemplation Preparation Action Maintenance Readiness Transtheoretical model of Behavioral Change (Richard W Scholl, 2002)

e-Readiness - Tools for e-Readiness Assessment - 22 e-readiness tools available on www.bridges.org. Some important ones are: Computer Systems Policy Project (CSPP’s) - Readiness Guide for Living in a Networked World. Crenshaw and Robinson’s – ‘Cyber-space and Post Industrial Transformations: Cross-network Analysis of Internet’. Center of International Development (CID’s) Readiness for the Networked World: A Guide for Developing Countries. Most of these tools are designed for e-learning and e-business purposes. CID’s readiness guide has been tested in 8 countries and is most suitable for the developing countries.

e-Readiness - CID’s Guide for Developing Countries - Creator: Center of International Development (CID) at Harvard University - 2000 (www.readinessguide.org) Goal: To systemically organize the assessment of factors determining the network readiness of a community in the developing world. Standards: ‘e-Ready’ society has: Necessary physical infrastructure. Integrated current ICT’s throughout communities and government Strong telecommunications competition Independent regulations with commitment to universal access No limits on trade or foreign investments in ICT

e-Readiness - CID’s Developing Country Guide - Measures: 19 different categories covering: availability, speed, and quality of network access; use of ICT in schools, the workplace, economy, government and everyday life; ICT policies; ICT training programs; and the diversity of organizations. Results: CID’s grid: 5 groupings: Access, Learning, Society, Economy and Policies). 4 stages of advancement in each of 19 categories

e-Health Readiness - Definition - Related to, but different from, e-readiness Defined as: “The degree to which users, health care organizations, and the health system itself, are prepared to participate and succeed with e-health implementation”. (CANARIE- report, 2002) Current activity: Efforts underway to develop assessment tools for e-health / telehealth readiness.

e-Health Readiness - Current Tools - Lead organization: Health Telematics Unit, University of Calgary Activity: Development of ‘Telehealth Readiness’ assessment tools for organizations and practitioners in the developed world. (Jennett P, 2003). Key Components: a) Organization’s Core-readiness b) Organization’s engagement / planning readiness c) Workplace environment readiness

e-Health Readiness - Tool for Developing Countries - Issue: At this time there are no e-health readiness tools for developing countries Study Goal: Develop tools appropriate for developing countries Study Team: Collaboration of HTU, Supercourse and Institutions in Pakistan. Setting: To be tested in Pakistan using Supercourse

e-Health Readiness - Assessment in Pakistan - We need to develop tools to measure e-readiness in Pakistan, in order to take the best use of available technology and new innovations, and provide benefits to the deserving communities.

e-Health Readiness - Assessment in Pakistan - Process: Building partnerships with the medical colleges and universities in Pakistan. Collectively develop an ‘e-health readiness assessment tool’ for Supercourse. Test the tool in various medical colleges in Pakistan. Finalize a culturally sensitive tool for e-health readiness that can be used by participating institutions and Supercourse for other programs.

e-Health Readiness - Proposed Tool for Developing Countries - 5 Components will be assessed: Core readiness Cultural readiness (Access) Learning (Training in Media) Society (Internet use and interaction) Policy (at institutional and government levels)

Core Readiness - Component I - Intended to measure basic characteristics of the target population: Identification of need Dissatisfaction with the status quo Awareness Comfort with language, and Comfort with technology

Cultural Readiness - Component II - Intended to measure the minimum necessary access to adequate network infrastructure: Speed (bandwidth) and quality of Internet Service and support Hardware and software Internet availability and affordability Regular usage of computer and internet

Learning Readiness - Component III - Intended to measure the minimum required knowledge and training in the community to use ICT: An institution’s access to ICT Use of ICT to enhance education The ICT workforce in the community

Society Readiness - Component IV - Intended to measure the Community’s use of ICT in regular activities: Online communication Availability of locally relevant content Use of ICT in everyday life

Policy Readiness - Component V - Intended to measure creation of an enabling environment and culture at institutional and government levels: ICT (telecommunications) regulations Ethics Mandatory courses and increasing availability Influence of HFA over use of technology

References Bridges.org: Spanning the International Digital Divide. www.bridges.org. CID’s Readiness for the Networked World: A Guide for Developing Countries www.readinessguide.org. CANARIE report: Framework for Rural and Remote Readiness in Telehealth. June 2002.

Acknowledgements Dr. Richard Scott. Associate Professor and Harkness Associate. Global e-Health Research and Training Program, University of Calgary, Calgary, Alberta, Canada. Ronald E. LaPorte. Director, Disease Monitoring and Telecommunications. WHO Collaborating Center. University of Pittsburgh, Pittsburgh, PA., USA Dr Sunita Dodani. Department of Epidemiology, Graduate School of Public Health. Pittsburgh, PA., USA