The Complexities Of Healthcare System Health And Social Care Essay


This chapter presents aims at presenting a brief overview about the topic of the research and also highlights the basic purpose and aim of the current research. The chapter starts with the background of the topic of study that familiarizes the reader about the basis upon which the research is based. The chapter moves further by describing the rationale and significance of the study in which the principal investigator illustrates that why the research developed interest to the principal investigator and why there was a need for such study. Finally, the chapter concludes by providing the structure of the remaining thesis, with a brief outline of the thesis flow and the headings included in those chapters. The purpose of this chapter is to provide the reader a brief overview about the research topic and provides the main purpose and aim behind this research study. It comprises of the background of the problem, which provides a brief overview of the topic of the research and the problem.


As technology and medicine combine and techno-medical functions turn out to be technically and economically viable, recognizing the factors that control end user acceptance will become more critical to strategic planning and technological design in healthcare organizations (Krein et al. 2007). Due to current developments in pervasive and ubiquitous technology, the exposure and quality of healthcare have increased noticeably (Varshney, 2009). Union of cellular and broadband communication with pervasive technology devices has resulted in the development of pervasive healthcare. Pervasive healthcare provides healthcare services to anyone at anytime, entertaining the restrictions of place, time and quality. Though, pervasive healthcare does not develop from technology progression alone (Katz & Rice, 2009). The growing attention in pervasive healthcare is also resulted from technology dispersion and increasingly accepted technology imposition.

With sustaining networks and wireless communication becoming conventional more pervasive healthcare function is apparent in hospitals, emergency departments, battlefields, as well as home care for persistent circumstances (Munnelly & Clarke, 2007). Pervasive healthcare is a reaction to the requirement for personalized and nonhospital trouble. Pervasive healthcare removes the physical limits of hospitals and provides each individual a chance to contribute personally in their own healthcare (Pai & Huang, 2011). Pervasive healthcare has the ability for unhindered data link as well as real-time synchronous interaction in a practical space. Data link is critical in high-risk conditions where a misplaced episodic symbol can result in a severe outcome. Using pervasive technology, healthcare, often faulted for its remote and mechanical feel, can offer the in-person touch recommended by customary medicine (Olguin, Gloor & Pentland, 2009).

Pervasive healthcare technology is in quick development and it is becoming more technically refined and more persistent to privacy due to current pervasive advancement. With the advance in technology, attention on pervasive healthcare technology has considerably increased in the technology examining society (Pai & Huang, 2011). Having the prospective of healthcare without limits of time and space, pervasive healthcare technology not only answers the requirement for patient self supervision in disease recovery and other long-term care arrangements, but also the vital requirement for intensive observations in sensitive, high-risk conditions.

Motivation and Goals

Aged population and the massive increase in chronic diseases spurred the need for pervasive healthcare systems. Age-related illness dominates future health care trends. The objective of this paper is to discuss research challenges in pervasive healthcare to pave the way for a pervasive, user-Centred model in the context of home-based aged population as a preventive healthcare approach.

Research Questions

The research questions for the study are as follows:

RQ1: Are there any benefits of implementing pervasive healthcare?

RQ2: What are the main problems with the current system of pervasive healthcare?

RQ3: What are the main concerns with existing solutions of pervasive healthcare?

Aims and Objectives

The aims and objectives of a research summarize what is to be achieved by the study. These should be closely related to the statement of the problem and cover the different aspects of the problem and its contributing factors in coherent way and in logical sequence. Following are the aims and objectives for this study:

To study pervasive healthcare

To determine the main problems of pervasive healthcare

To evaluate the main concerns of the existing solutions which are provided through pervasive healthcare

To find methods for improving existing solutions which are provided through pervasive healthcare

Time Scale

Time is an important factor when considering project work. A considerable amount of time will be required to complete this project, as it will require the gathering of a good amount of secondary data. Moreover, the research will make progress according to the university rules so as to collect extensive data for the research study to make it an effective one. The time adjustment of daily hours will be accumulated according to the submission date given by the instructor. Furthermore, the final submission date of the thesis may get negotiable with the instructor keeping in view the current scenario of the research work at that moment of time.

Gantt chart for Time Distribution

The following time management chart illustrates the amount of time required on the tasks set aside for the completion of the project.

Thesis Organization

The remaining chapters of thesis are structured as follows:

The second chapter provides the appropriate and significant literature review for the selected research topic that signifies the past study in this field. The literature will help to develop an understanding concepts and perceptions about various terminologies that are important keeping in view the topic of the research. The content for the chapter was gathered through online libraries, scholarly journals and peer reviewed articles to maintain authenticity of the provided information.

The third chapter provides a general idea about the research methodology that has been selected for this research. The methodology mainly includes; the research design, questionnaire design and framework, sampling technique, data collection method, ethical considerations for the research. In addition, reliability and validity of the survey is also defined in this chapter.

The fourth chapter provides the analysis of findings in a detailed manner so that a conclusive outcome can be obtained. The chapter provides complete analysis of secondary data that is collected in the second chapter.

The fifth chapter summarizes the complete study with flair of personal views on the topic of the research. The chapter moves forward and provides implications of the current research and then ends up by providing future recommendations of the study. These recommendations can help researchers and concerned individuals to pile on the current level of provided information.


This chapter examines all the past literature that it is relevant to the research topic and that has been published up till now. The main purpose of this chapter is to identify and obtain various scholarly and non-scholarly sources that can prove beneficial in obtaining positive results during the course of the study. The literature review is to identify, obtain and check various sources and other materials that may be useful for research purpose and to extract and compile relevant information necessary to the research problem. Majority of this data is collected through secondary sources on online and public libraries. The literature review section builds upon the concept of pervasive healthcare in smart environment with post-processing of data.

Complexities of Healthcare System

Healthcare system is a complex one where outcomes are difficult to predict and the market as a whole does not behave in linear ways (Garson, 2008; Munnelly & Clarke, 2007). This complexity comes from several sources both human and environmental with differing goals and behaviors. These differences can be seen in the many layers that make up the entirety of the healthcare system. The healthcare system or environment is comprised at a high level of at least three interacting markets, healthcare delivery (patient-provider), health insurance (patient-providerpayo), and healthcare research (education-provider-funder) (Pai & Huang, 2011). Each market maintains its own goals and is comprised of different sets of agents that interact in their own unique ways.

These agent interactions are non-linear and often uncertain. If we examine the basic patient-provider relationship, we can see many of these complexities and uncertainties. Illness itself is uncertain. Who becomes ill, the illnesses effect on any single individual and the individual treatment prescribed appears random and uncertain. Not everyone becomes sick and not everyone reacts in the same way to treatment (Appari & Johnson, 2010; Ziefle & Rocker, 2010). Providers vary in their recommendations and the cost of care is often not considered when seeking treatment. Patients desire the "best" care, not the cheapest or most efficient care. Decisions on where to seek care are frequently based on word of mouth or appearance of the provider’s office. High cost is regularly associated with high quality where this is frequently not the case Anderson & Wittwer, 2011).

Treatments themselves are becoming complex. New technologies are generating better diagnostic tools, improving treatment options, and increasing the expectation of cure. Decisions about whether to pay for these treatments and what to pay for these treatments are complicating the insurance and pay or portion of the market (Varshney, 2009). The complexities of treatment and high price of care often result in attempts to manage treatment decisions. The goal of insurers to control costs and the goal of the providers to increase revenue and maintain control over treatment decisions regularly conflict, creating a complex relationship between providers and insurers. The normal economic patterns of supply and demand do not seem to apply within the healthcare system (Doukas & Maglogiannis, 2008; Lankton & Wilson, 2007). These uncertainties and conflicting goals contribute to the complexity of the healthcare system and healthcare policy decisions.

The current goals of healthcare policy to increase access, control costs and improve quality do not easily complement each other. Attempts to control cost directly impact treatment decisions and employment levels (jobs). Attempts to increase access to care increase healthcare costs (Nachman et al. 2010; Pai & Huang, 2011). Attempts to improve quality often increase costs and/or limit treatment options. Because of these complexities and the non-traditional economic behaviors of the healthcare market, policies must be designed to promote value from both a provider and patient perspective (De Moraes et al. 2010; Anderson & Wittwer, 2011). Many of the current policies do not address value, but rather focus on the lowest acceptable costs for a particular service. Medicare and Medicaid are prime examples of this cost control focus (Olguin, Gloor & Pentland, 2009). Examining the value added of policies to each agent in healthcare and other markets will be important to future healthcare policy discussions.

Overview of Healthcare Technology

Healthcare Technology existed long before it was recognized for its critical role in healthcare. The origin of modern Healthcare Technology can be traced back to 1905 when Willem Einthoven transmitted an electrocardiogram (ECG) from the hospital to his laboratory through standard telephone lines (Thuemmler et al. 2009). Tele-consultation came into practice in 1920 when a Norwegian Hospital was connected with ships at sea via Bergen Radio. In April 1924, the Radio News in the United States presented the emergence of the same tele-consultation concept in a news article (Krein et al. 2007). Thereafter, significant events occurred with the creation of the International Radio Medical Centre in Italy in 1935 and with the Centre of Maritime Health Care in France in 1945, in order to provide medical support to the ship crews and remote islands. In the late 1940s, A.G. Cooley and J.G. Cohen experimented in X-ray transmission over telephone wires and the term telognosis was coined in 1950 (Thuemmler et al. 2009).

In the late 1950s, Jutras transmitted video-recordings and radiogram through coaxial cable, and resulted in the term of tele-fluoroscopy. Tele-education started in the late 1950s and early 1960s as medical instructional programs on the television (Sneha & Varshney, 2007; Varshney, 2009). The first televised medical conferencing occurred in 1965 on an open heart surgery between the hospitals in Houston, TX and Geneva that were linked through an international communication satellite. In 1959, Wittson used a two-way closed circuit television as a teaching and diagnostic tool focused on neuro-anatomy at Nebraska Psychiatric Institute. The service was intended for group therapy through television supervision and monitoring (Munnelly & Clarke, 2007). The result was improved patient consultation and rehabilitation and reduced hospitalization.

Medical instruments have played an integral role in surgery, dissection, diagnosis, treatment, and other forms of medical investigation and intervention. Sets of surgical instruments have been found that date back to 50 AD that closely resemble surgeons’ tools used today (Sneha & Varshney, 2007; Varshney, 2009). These instruments would be an example of a form of medical technology, in the form of tools, assisting the medical practitioner. Another form of technology used in medicine for many millennia is information technology (Munnelly & Clarke, 2007).

Medical information technology is often thought of in the modern context of computers, but the careful collection and analysis of information related to observation of patient condition, effectiveness of different treatments, and design of new treatments dates back to the time of Hippocrates (ca. 460 BC - ca. 370 Be) (Washburn & Hornberger, 2008). Hippocrates took meticulous notes that enabled him to make numerous breakthroughs both in the understanding of the workings of the human body and in the ethics and approach to thinking that are essential to modern medical practice and investigation (Olguin, Gloor & Pentland, 2009). Comparatively little innovation took place in furthering, the practice of medicine from the time of Hippocrates until the early 20th century, with developments such as the smallpox vaccine in 1901.

During the 20th century, the growth of medical technology has increased continuously, with innovations such as penicillin, X-ray, PET/MRI scanning, computers, robotic surgery, radiation therapy, chemo-therapy, and many other forms of technology and treatments (Garson, 2008; Munnelly & Clarke, 2007). While the use of medical hardware and information technology has been essential to healthcare for thousands of years, these same tools can create difficult problems (Appari & Johnson, 2010; Ziefle & Rocker, 2010). For example, the over-use of antibiotics has caused a new form of pathogen commonly called super-bugs, such as methicillin-resistant staphylococcus aureus (MRSA) and other antibiotic resistance strains that are extremely difficult and expensive to treat.

Healthcare facilities (buildings) can also be considered to be a form of technology. As with other forms of technology, physical facilities involve a mutual interaction between users of the technology and the technology Anderson & Wittwer, 2011). In healthcare contexts, the physical facilities are often intimately interrelated with the staff and other technology that the building contains (Munnelly & Clarke, 2007). Often, technology is integrated into the building itself. As with other forms of technology in healthcare, organizations spend significant sums of money on their facilities. If these funds are not spent wisely, they contribute to the rising cost of healthcare and can affect the financial or operational viability of the organization (Aziz et al. 2006; Washburn & Hornberger, 2008).

Among the pioneers of Healthcare Technology, the National Aeronautics and Space Administration (NASA) has been one of the most supportive. Concerned with the wellness of the astronauts during space missions, NASA scientists developed technological devices for the measurement and transmission of physiological and medical data between space and earth stations in the 1960s (Lankton & Wilson, 2007). This effort was later applied in the 1970s to support medical services to the rural Papago Native American Reservation in Arizona using a manned mobile medical unit linked to local hospitals. The first full service Healthcare Technology operation appeared in 1968 between Logan Airport Health station and the Massachusetts General Hospital (MGH) of Harvard Medical School (Garson, 2008; Munnelly & Clarke, 2007). The service included 10 remote sites linked through the New Hampshire-Vermont Medical Interactive Television Network with a central hub stationed at Dartmouth. The service supported medical education and specialty medical services including psychiatry, cancer, and dermatology (Pai & Huang, 2011).

Another significant Healthcare Technology event occurred in the 1990s when NASA launched the first large scale international Healthcare Technology project, Spacebridge. Spacebridge currently supplies a variety of medical specialist consultations and medical educational opportunities to the Eastern European region (Sneha & Varshney, 2007; Varshney, 2009). Modern Healthcare Technology in the last century evolved from basic telephone consultations as experimental projects. Propelled by emerging technologies and the information superhighway, Healthcare Technology has resurfaced with new content and meaning. Healthcare Technology experiments that are currently used in pilot form will prove to be routine in the future.

Impact of Technology on Healthcare

The purpose of this section is to review the literature on the impacts of technology in healthcare. Evidence on the impact of technology in healthcare is mixed. Literature on technology impacts in healthcare have looked at both final outcome measures, such as productivity or output or mortality , as well as intermediate performance measures such as error rates, cycle times, utilization, and complications (Pai & Huang, 2011). A recurring theme among studies on technology and healthcare is the role of time lags; the empirical evidence generally supports the notion that technology investments require a substantial time period for users to learn how to use the technology (Ziefle & Rocker, 2010).

Studies drawing from technology literature base, consistent with the literature on technology investment, appeared more likely to include complementary investment factors such as business process reengineering (BPR) and training (Varshney, 2009). These studies find positive impacts to technology and often included (Varshney, 2009). Studies based in the medical literature painted a more mixed view of outcomes technology investment (Bardram, 2008; Coronato & Pietro, 2010). These studies generally did not include complementary investments and generally took a "tool view" of technology investments. The studies based in the medical literature used a more nuanced choice of outcomes; consistent with the idea that healthcare is a unique context, including outcome measures such as error rate, differential mortality, utilization rates, and complication rates (Sneha & Varshney, 2007; Varshney, 2009).

What is missing from this literature is a study that takes into account the unique nature of technology investment, as well as the unique context of healthcare. Theory and evidence about the impacts of technology investment suggest that technology: a) is a general-purpose technology which often requires complementary investments to yield positive returns, b) lowers search costs, which lower the variance of outcomes, c) facilities the accumulation of "memory capital" over time, d) lowers monitoring costs, e) speeds information diffusion, and f) exhibits network effects (Ziefle & Rocker, 2010). While many of the potential impact of technology would seem to result in positive returns in healthcare, findings on the impact of technology in healthcare to date are mixed. Most studies on the impacts of technology in healthcare have either: a) used a rich understanding of technology investments focused upon the impact of technology on traditional outcome measures such as profitability or response time, or b) used a simplified view of technology investment with a rich understand of the particular phenomena which arise out of the unique context of healthcare (Coronato & Pietro, 2010). What is needed in this literature is a study which takes into account the particular impacts of technology investments on phenomena which are unique to healthcare, such as treatment inconsistency.

Research Conceptual Framework and Theoretical Background

Present research examines the factors that influence patient Healthcare Technology adoption drawing support from the following theory.

Theory of Reasoned Action

The Theory of Reasoned Action asserts that beliefs influence attitudes. Attitudes, in turn, influence the intentions that guide behaviour, and acceptance of technology is then demonstrated through behaviour. TRA is well-tested and has been proven valid in predicting and explaining behaviours in general human behaviours. The concept of Theory of Reasoned Action was founded on Fishbein and Ajzen’s social psychology research. TRA suggested that significant relations exist between beliefs, attitudes, intentions, and behaviours (Aziz et al. 2006; Washburn & Hornberger, 2008). According to TRA, most social behaviours are not automatic actions; instead, they are under volitional controls. TRA asserts that people consider the implications of their action based on the information available to them before they decide to perform behaviour (Aziz et al. 2006; Washburn & Hornberger, 2008).

Since behaviour is a result of cognitive reasoning, behaviour is predictable. Theory of Reasoned Action is built on three constructs: attitude (AT), subjective norm (SN), and behavioural intention (BI). TRA has been examined and tested through numerous research studies. In TRA, attitude reflects personal behavioural beliefs and subjective norm refers to social influences. TRA suggests that behaviour intention is a function of two determinants, a person’s attitude and the subjective norm. A person’s behavioural intention, in turn, is the immediate determinant of the actual action (Aziz et al. 2006; Washburn & Hornberger, 2008). Based on the pictorial presentation of TRA by Ajzen and Fishbein, TRA may be expressed as:

BI = AT + SN and actual behaviour = BI.

A person holds different beliefs from past experience about objects, actions, and events. Beliefs serve as the immediate determining factors of a person’s attitude (Aziz et al. 2006; Washburn & Hornberger, 2008). Positive belief means stronger conviction and acceptance toward the behaviour in question. With positive beliefs, a person tends to gather positive attitudinal intention to behaviour, which in turn leads to more potential realization of the behaviour. Attitude is a person’s evaluation of the entity in question (Lankton & Wilson, 2007). Attitude arises as a function of beliefs. Beliefs may change due to time and circumstances or be replaced by new beliefs; these changes in turn affect a person’s attitude. Social scientists have long established that attitude is a critical behavioural disposition (Lankton & Wilson, 2007).

However, a person’s favourable or unfavourable perception to behaviour in consideration alone does not always produce the behavioural outcome. To accurately predict attitude, an additional variable must be taken into account of the attitude-behaviour relationship. This additional variable in TRA is the subjective norm (Aziz et al. 2006; Washburn & Hornberger, 2008). Subjective norm refers to a person’s perceived expectations from relevant individuals or groups on whether or not to perform the behaviour in question (Varshney, 2009). Subjective norm is a function of normative beliefs, the resulting influence of the social environment. Social pressure can force an individual to perform or avoid behaviour in consideration regardless of the person’s existing intention. Since it has the potential of overriding a person’s own intention, subjective norm is an independent construct to attitude in the TRA model.

Concept of Pervasive Healthcare Technology

Many Pervasive Healthcare Technology devices have undergone experimental trials in hospitals as well as in patients’ homes. Infrared technology, motion sensors (infra-red detection or acoustical detection), video cameras, and so on, that use wireless, Internet, ISDN, and telephone lines have been installed in healthcare facilities (Snyder, 2007). Traditional non-invasive Pervasive Healthcare Technology often requires patient engagement with devices at a set time and location. For at risk cases, such as post-stroke and postoperative wound-related complications where a close un-obstructive monitor is crucial in the recovery process, periodic monitoring may not catch episodic signs at the critical time (Washburn & Hornberger, 2008). Recent development of pervasive monitoring systems focuses on automated and un-obstructive Pervasive Healthcare Technology without the restrictions of time and place.

Pervasive healthcare requires wireless technologies and the matching infrastructure capabilities. Pervasive services are supported through wireless LANs, cellular GSM/3G networks, satellite-based systems, and so forth (Varshney, 2007). Pervasive healthcare applications include "pervasive health monitoring, intelligent emergency management system, pervasive healthcare data access, and ubiquitous mobile Healthcare Technology" (Varshney, 2007). Research on pervasive Healthcare Technology started in the early 2000s using the then budding pervasive computing technologies. The goal was to utilize ubiquitous communication technologies to improve patient autonomy and healthcare mobility through continuous monitoring. In cases such as myocardial ischemia and post abdominal operations, continuous physiological data for timely detection of deterioration can change the entire care outcome.

Extended from Varshney’s definition for pervasive healthcare (2007), present research defines pervasive Healthcare Technology as a Pervasive Healthcare Technology for anyone, anytime, and anywhere without location, time, and other restraints. Earlier pervasive Healthcare Technology experimented with video-telephony installations (Thuemmler et al. 2009). These devices provide live video interactive communication through plain old POTS for its wide availability and relatively low costs (Lankton & Wilson, 2007). Using video-telephony, the healthcare professional can review the therapies and provide support in real-time. More importantly, these devices alleviate the gap of distance, allowing care providers to monitor the patient’s emotional and mental states and not simply physiological information (Olguin, Gloor & Pentland, 2009).

Other types of pervasive Healthcare Technology are enabled by portable topical sensors that integrate wireless technology with clinical devices. Tele-devices such as tele-ECG and ring-sensors are worn by the patients for Pervasive Healthcare Technology. Data, such as ECG, pulse rate, respiration rate, and oxygen saturation levels, is collected and forwarded to the healthcare providers automatically (Tu, Zhou, & Piramuthu, 2009; Varshney, 2007). This continuously monitored data can provide important clinical insight for timely and accurate diagnosis. Advanced pervasive devices for automatically collecting multiple clinical parameters have shown success in a body sensor network system (Nachman et al. 2010).

This Pervasive Healthcare Technology system equipped with multiple sensors is able to collect, process, and wirelessly transmit the received data via a secured link to a laptop for further diagnosis. Pervasive Healthcare Technology devices that do not require patients to wear the tele-devices also have been developed in the past years. For example, mattresses, toilets, kitchen appliances, and clothing embedded with monitors can sense sleep pattern, body weight, body temperature, pulse rate, and so forth (Bardram, 2008; Coronato & Pietro, 2010).

Further experiments on advanced tele-sensing systems utilize the Doppler radar technique to gather scattered vital signs from throughout the body (Ziefle & Rocker, 2010).

These systems can gather multiple clinical parameters and are able to operate autonomously without disturbing the lives of the patients. Pervasive Healthcare Technology is built on widely deployed wireless networks and advanced computing technologies. Pervasive Healthcare Technology solutions have focused mainly on at risk disease management Anderson & Wittwer, 2011). However, a growing market in a wide range of the healthcare field is ready to propel the development and consumption of pervasive Healthcare Technology. This practice has had