Analysis of Factors Inhibiting the Dissemination of Telemedicine in Japan: Using the Interpretive Structural Modeling

This paper discusses the nature of Interpretive Structural Modelling (ISM) as methodology for dealing with complex issues. Aspects of managing complexity relating particularly to the use of ISM with a group of participants are explored. These include the interrelations between the issue, group and methodology, and between content, context, process and product. Languages for modelling structure are briefly examined, and ISM is presented as a computer-assisted modelling approach incorporating words, graphics and mathematics. The steps of using ISM in practice are considered in the context of group work. Each step is elaborated upon and important features discussed. The use of Nominal Group Technique as an idea-generation method which may be used in conjunction with ISM is outlined. An example of an application is given concerning the structuring of a set of objectives to produce an Intent Structure.

Objective: To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning. Materials and Methods: A prior Organization for Economic Cooperation and Development–led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and telehealth. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking. Results: While electronic records are widely used to store and manage patient information at the point of care—all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%—patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist. Discussion: Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., structural and health systems issues that can affect measurement) important for future comparisons. Conclusion: While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and accelerate the progress of individual countries.