Nature and extent of FPs’ assimilation of digital health
Table 1 presents the descriptive statistics and indices of reliability and multicollinearity of the research variables. The main descriptive message emanating from the data is that a large majority of FPs in Quebec have yet to assimilate digital health technology into their medical practice. This is true both in terms of the physicians incorporating digital health technology into their routine work patterns (routinization), and in terms of their using this technology to its full potential (infusion).
In terms of routinization, the sampled physicians either rarely or occasionally seek medical information by searching the web or using a mobile app. For those who do so more frequently, medical information is mostly obtained from online pharmaceutical advisers/prescribers, medical calculators, and medical guidelines. Also, physicians very rarely use online sources of medical information. Those who use such sources more frequently rely essentially on mobile apps such as Epocrates and BMJ Best Practice. A great majority of physicians engage in no or limited online consultation activities with patients and other physicians, whether through secure or unsecured communication software (e.g. Reacts, Skype). They rarely or occasionally exchange medical information or images via secured or unsecured email (e.g. Outlook), text messaging or social media (e.g. Messenger) with patients and other physicians.
In terms of their infusion of digital health, the sampled physicians very rarely or rarely consult the data collected by their patients through mobile apps or smart devices. In this regard, the devices most used by patients include smart bracelets (for physical activity tracking and sports training), smart pedometers, and smart glucometers (for diabetes tracking). Note that the two main reasons given by respondents for not consulting such data is that most of their patients do not collect this type of data (44% of respondents) and that they lack knowledge about such mobile apps and smart devices (17%). The FPs also perceive the overall benefits of using digital health technology to be of no or slight importance. In this regard, the two most important benefits are that digital health technology allows FPs to discuss the goals to be achieved (e.g. blood glucose level, blood pressure) with their patients, and that it supports better clinical decision-making. Finally, a slight majority of the sampled physicians (55%) indicate that they are open to using artificial intelligence (AI) for medical diagnosis purposes.
Individual, motivational, and work-related factors of digital health assimilation
As shown in Figure 2, the causal paths inferred from the conceptual framework were tested by assessing the path coefficients (β) estimated by the SEM procedure as executed by the SmartPLS software. The performance of the theoretical model of interrelationships between the five research constructs was assessed by the strength and significance of the path coefficients (β) and the proportion of explained variance (R2), as befits PLS’s focus on prediction and concern with generalization . Further details on the SEM procedure can be found in Appendix II.
Given the results of the causal analysis provided by the SEM procedure, an initial finding is the positive and significant path coefficients linking the FPs’ motivations to their routinization (β = 0.29, p < 0.001) and infusion (β = 0.27, p < 0.05) of digital health in their daily medical practice. Here, the primary factors that motivate FPs to assimilate digital health are their patients’ requests and behaviors with regard to digital health technology. The two most frequent patient requests in this regard are making an appointment online for a consultation and communicating with their physician by email or text messaging. The two most frequent patient behaviors are seeming more anxious and needing to be reassured due to information that they found on the web, and exploring treatment modalities, medication or natural medicine options found on the web (other than those prescribed by their physician). Another significant motivational factor linked to a greater assimilation of digital health by FPs is the size of their chronic care caseload (as a percentage of total caseload).
Second, individual differences in terms of the FPs’ digital health training needs, age, teaching position, and health self-tracking behavior directly influence their routinization of digital health (β = 0.42, p < 0.001). Thus, greater incorporation of digital health technology into an FP’s clinical work pattern requires the acquisition of more knowledge on the various technologies if they are to be used to their full potential. In this regard, their two most important needs are related to acquiring knowledge on the effective integration of mobile apps and smart medical devices into their daily practice (85% of respondents) and on the range of apps and devices that are most useful (84%). The physicians who have acquired this knowledge tend to be younger, occupy a teaching position in a medical faculty, and use digital health technology for personal self-tracking purposes.
A third result concerns the influence of the contextual characteristics of the physicians’ medical practice on their infusion of digital health technology (β = 0.17, p < 0.05). Here, the one characteristic that truly matters is the digital health capability of the EMR system used by FPs . In this regard, the digital health functionalities most available within the physicians’ EMR systems are pharmaceutical advisers or prescribers (59% of respondents), medical calculators (34%), and medical guidelines (10%), such as Diabetes Canada’s clinical practice guidelines. Thus, the more these EMR functionalities are available to physicians, the greater their ability to make extended use of digital health technology.
This study’s final finding lies in the positive and significant path coefficient (β = 0.21, p < 0.05) linking FPs’ routinization of digital health to their infusion of digital health. This result is in line with the notion that routinization, as a pre-condition for infusion within the technology assimilation process, provides a facilitating context for FPs to make a more extensive, integrative and innovative use of digital health technology .