EXPANDING ACCESS TO HEALTH SERVICES THROUGH

TELE HEALTH (E-HEALTH) IN A CURRENT

PANDEMIC SITUATION IN NEPAL.

RASEEL ADHIKARI

A thesis submitted in fulfilment of the requirements for the award of the degree of
M.SC. IN INFORMATION TECHNOLOGY MANAGEMENT

ASIA PACIFIC UNIVERSITY OF TECHNOLOGY & INNOVATION (APU)

SCHOOL OF COMPUTING AND TECHNOLOGY

SEPTEMBER 2023

i
EXPANDING ACCESS TO HEALTH SERVICES THROUGH
TELE HEALTH (E-HEALTH) IN A CURRENT
PANDEMIC SITUATION IN NEPAL.

RASEEL ADHIKARI

ASIA PACIFIC UNIVERSITY OF TECHNOLOGY AND INNOVATION

(APU)

ii
 DECLARATION OF THESIS CONFIDENTIALITY

Author’s full name: RASEEL ADHIKARI

IC No./Passport No.: NP000483

Thesis/Project title: EXPANDING ACCESS TO HEALTH SERVICES THROUGH

TELE HEALTH (E-HEALTH) IN A CURRENT PANDEMIC
SITUATION IN NEPAL.

I declare that this thesis is classified as:

 CONFIDENTIAL

 RESTRICTED

 OPEN ACCESS

I acknowledged that Asia Pacific University of Technology & Innovation (APU) reserves the
right as follows:

1. The thesis is the property of Asia Pacific University of Technology & Innovation (APU).
2. The Library of Asia Pacific University of Technology & Innovation (APU) has the right
to make copies for the purpose of research only.
3. The Library has the right to make copies of the thesis for academic exchange.

Author’s Signature: ……………………………

Date:13th September 2023

Supervisor’s Name: Ephin Muthayyan

Date:13th September 2023 Signature: ……………………………

iii
 DECLARATION OF SUPERVISOR(S)

“We hereby declare that We have read this thesis and in our opinion this
thesis is sufficient in terms of scope and quality for the award of the
degree of
Master of Science in Information Technology”

Name of Supervisor: EPHIN MUTHAYYAN

Signature: ……………………………

Date: September 2023

Name of Supervisor (II) Click here to enter text.

Signature: ……………………………

Date: Click here to enter a date.

Name of Supervisor (III) Click here to enter text.

Signature: ……………………………
Click here to enter a date.
Date:

iv
DECLARATION OF ORIGINALITY AND EXCLUSIVENESS

I declare that this thesis entitled

EXPANDING ACCESS TO HEALTH SERVICES THROUGH TELE HEALTH (E-
HEALTH) IN A CURRENT PANDEMIC SITUATION IN NEPAL.

is the result of my own research work except as cited in the references.

This thesis has not been accepted for any degree and it is not concurrently
submitted in candidature of any other degree.

Signature: Click here to enter text.

Name: Click here to enter a date.

Date: ……………………………

v
 DEDICATION

To My Beloved Family
Special thanks also go out to my parents, family, and friends. Thank you
for your unyielding support, for believing in me, and always being there
When I needed you most. Thank you for being the best emotional support
system I could not have done this without you

vi
vii
 ACKNOWLEDGEMENT

In preparing this thesis, I was in contact with many people, researchers, academicians, and
practitioners. They have contributed towards my understanding and thoughts. In particular, I wish
to express my sincere appreciation to my main thesis supervisor, Ephin Muthayyan, for
encouragement, guidance, critics and friendship. I am also very thankful to my co-supervisors

Prof Suman Bhattacharya for their guidance, advices and motivation. Without their continued
support and interest, this thesis would not have been the same as presented here.
I am also indebted to Asia Pacific University (APU) for funding my Ph.D. study. Librarians at
APU, Staffordshire University also deserve special thanks for their assistance in supplying the
relevant literatures.

My fellow postgraduate students should also be recognized for their support. My sincere
appreciation also extends to all my colleagues and others who have provided assistance at various
occasions. Their views and tips are useful indeed. Unfortunately, it is not possible to list all of
them in this limited space. I am grateful to all my family members.

viii
 ABSTRACT

The purpose of this study is to investigate the adoption of information technology into the
healthcare system reflects this to better organize patient data, improve care coordination, and
increase communication. It was to find strategies that would improve EMR use in primary care
settings. When compared to controls, treatments that focused on the usage of EMR functionalities
were five times more likely to exhibit gains in EMR use. When compared to controls, data
quality interventions were five and a half times more likely to exhibit gains in EMR use.
Individuals in primary health care settings who want to enhance their EMR use might benefit
from initiatives such as EMR feature add-ons, teaching materials, or financial incentives aimed at
boosting EMR function utilization and data quality. EMRs are electronic medical records that
store a portion of a patient's health information and are maintained by the health care provider.
EMRs, as the name implies, store all information pertaining to a patient's medical appointments,
including diagnostic, treatment, and pharmaceutical prescription information.

ix
 Table of Contents

EXPANDING ACCESS TO HEALTH SERVICES THROUGH TELE HEALTH (E-HEALTH) IN A CURRENT..............................I

PANDEMIC SITUATION IN NEPAL........................................................................................................................... I

EXPANDING ACCESS TO HEALTH SERVICES THROUGH TELE HEALTH (E-HEALTH) IN A CURRENT PANDEMIC
SITUATION IN NEPAL............................................................................................................................................ II

DECLARATION OF THESIS CONFIDENTIALITY........................................................................................................ III

DECLARATION OF SUPERVISOR(S)....................................................................................................................... IV

DECLARATION OF ORIGINALITY AND EXCLUSIVENESS...........................................................................................V

DEDICATION....................................................................................................................................................... VI

ACKNOWLEDGEMENT........................................................................................................................................ VII

ABSTRACT......................................................................................................................................................... VIII

LIST OF TABLES................................................................................................................................................. XIII

LIST OF FIGURES............................................................................................................................................... XIV

LIST OF ABBREVIATIONS.................................................................................................................................... XV

EXPANDING ACCESS TO HEALTH SERVICES THROUGH TELEHEALTH (E-HEALTH) IN A CURRENT PANDEMIC

SITUATION IN NEPAL............................................................................................................................................ 1

CHAPTER 1........................................................................................................................................................... 1

INTRODUCTION.................................................................................................................................................... 1

1.1 INTRODUCTION...............................................................................................................................................1
1.2 BACKGROUND OF THE STUDY.........................................................................................................................2
1.3 PROBLEM STATEMENT....................................................................................................................................3
1.4 RESEARCH QUESTIONS....................................................................................................................................4
1.5 PURPOSE OF THE STUDY.................................................................................................................................4
1.6 OBJECTIVES OF THE STUDY.............................................................................................................................5
1.7 SCOPE AND LIMITATION OF THE STUDY.........................................................................................................5
1.8 SIGNIFICANCE OF THE STUDY.....................................................................................................................6

x
 1.9 OVERVIEW OF THE THESIS..........................................................................................................................6

CHAPTER 2........................................................................................................................................................... 7

LITERATURE REVIEW............................................................................................................................................ 7

2.1 LITERATURE REVIEW...........................................................................................................................................7

2.1.1 TELEHELATH AND PUBLIC HEALTH PROTECTION REDUCING HEALTHCARE FAILURE..................................8
2.1.2 PUBLIC HEALTH PROTECTION................................................................................................................8
2.1.3 MORE TREATMENT OR LOW CARE SHOULD BE AVIOD..........................................................................8
2.1.4 FAILURES IN CARE COORDINATION AND PRICING.................................................................................8
BY ASSIGNING A COST TO IT, IT ALSO AIDS IN THE REDUCTION OF ORGANIZATIONAL COMPLEXITY: PAYERS SHOULD BE ASSESSED A
HIGHER RATE FOR TREATMENT REIMBURSEMENT ASSOCIATED WITH HIGH BUT DECREASED ADMINISTRATIVE TASKS...........................8

2.2 LITERATURE MATRIX...........................................................................................................................................8

2.3 RELATED WORK................................................................................................................................................38
2.4 TECHNOLOGY ACCEPTANCE MODEL(TAM).......................................................................................................52
2.5 PRIMARY HEALTH CARE(PHC)...........................................................................................................................52
2.5.1 EMR IMPACT.............................................................................................................................................52

CHAPTER 3......................................................................................................................................................... 55

RESEARCH DESIGN AND METHODOLOGIES......................................................................................................... 55

3.1 INTRODUCTION................................................................................................................................................55
3.1.1 PROCEDURE AND PARTICIPANTS............................................................................................................................55
3.1.2 MEASURES..............................................................................................................................................................55
3.2 RESEARCH FRAMEWORK..................................................................................................................................56
The important ideas covered by the study variables used in the implementation research framework for Tele-
health systems are listed in the following table:................................................................................................56
3.2.1 INDEPENDENT VARIABLES........................................................................................................................56
3.2.2 DEPENDENT VARIABLES............................................................................................................................56
3.3 RESEARCH METHODOLOGY..............................................................................................................................57
Find out about the tele-health capabilities of the patients, and look into the trends and relationships between tele-
health capabilities and other factors including demographics, search strategies, and HI sources, as well as their
influence on Tele-health in the COVID-19 pandemic.......................................................................................................57
● Location of study...................................................................................................................................................57
● Participants........................................................................................................................................................... 57
● Questionnaire development.................................................................................................................................57
● Statistical analysis SPSS.........................................................................................................................................57

3.4 RESEARCH DESIGN, APPROACH AND STRATEGY...............................................................................................57

xi
 3.4.1 RESEARCH DESIGN....................................................................................................................................57
3.4.2 RESEARCH APPROACH..............................................................................................................................57
3.5 DATA COLLECTION............................................................................................................................................58
3.5.1 SAMPLING METHODS AND SAMPLE DESIGN.............................................................................................58
3.5.2 DATA COLLECTION METHODS...................................................................................................................59
3.5.3 DATA CAPTURING AND DATA EDITING.....................................................................................................59
3.5.3.1 DEMOGRAPHICS..................................................................................................................................................60
3.5.3.2 INTERNET USE......................................................................................................................................................60
3.5.4 DESIGN OF THE INTERVIEW AND QUESTIONNAIRE QUESTION...............................................................................61
3.6 DATA COLLECTION LIMITATIONS......................................................................................................................62
3.7 DATA COLLECTION ASSUMPTIONS...................................................................................................................62
3.8 VALIDITY...........................................................................................................................................................63
3.8.1 FEEDBACK FROM INTERVIEW PARTICIPATIONS........................................................................................63
3.9 LIMITATIONS.................................................................................................................................................... 63
3.10 SUMMARY......................................................................................................................................................64

CHAPTER 4......................................................................................................................................................... 65

DATA ANALYSIS AND FINDINGS OF RESEARCH.................................................................................................... 65

4.1 MODE OF ANALYSIS..................................................................................................................................65

4.2 OVERVIEW ANALYSIS OF QUESTIONNAIRE RESULTS............................................................................65
4.2.1 QUESTIONNAIRE DURATION............................................................................................................................65
4.2.2 PROFILE OF PARTICIPANTS...............................................................................................................................66
4.2.3 NUMBER OF PARTICIPANTS....................................................................................................................................66
4.2.4 ANALYSIS AND INTERPRETENTION..........................................................................................................................66
4.3 OVERVIEW ANALYSIS OF INTERVIEW RESULTS....................................................................................79
4.3.1 INTERVIEW DURATION.....................................................................................................................................79
4.3.2 ADVANTAGES..........................................................................................................................................................79
4.3.3 DISADVANTAGES..............................................................................................................................................80

4.4 DATA FINDINGS BASED ON TOE...........................................................................................................80

4.4.1 TECHNOLOGY...................................................................................................................................................80
4.4.2 ORGANIZATION................................................................................................................................................81
4.4.3 ENVIRONMENT................................................................................................................................................81

CHAPTER 5......................................................................................................................................................... 82

PROPOSING THE FRAMEWORK........................................................................................................................... 82

5.1 PROPOSED FRAMEWORK.............................................................................................................................82

xii
 5.2 FINDINGS.............................................................................................................................................82
5.2.1 CHANGE MANAGEMENT..................................................................................................................................83

5.3 CONCEPTUAL MODEL..........................................................................................................................85

5.4 IMPLEMENTATION AND ANALYSIS OF THE PROPOSED FRAMEWORK................................................85
5.4.1 PATIENT / USERS..............................................................................................................................................85
5.4.2 HOSPITAL......................................................................................................................................................... 85
5.4.3 EMR( Electronic Medical Record).....................................................................................................................85
5.4.3.1 LABORATORY.......................................................................................................................................................86
5.4.3.2 RADIOLOGY..........................................................................................................................................................86
5.4.3.3 PHARMACY..........................................................................................................................................................86
5.4.3.4 DIAGNOSIS........................................................................................................................................................... 86
5.4.4 EHR (Electronic health record)................................................................................................................................86
5.5 SUMMARY...........................................................................................................................................87

CHAPTER 6......................................................................................................................................................... 88

CONCLUSIONS AND RECOMMENDATIONS.......................................................................................................... 88

6.1 EXPECTATION......................................................................................................................................88
6.2 SUMMARY OF THE FINDINGS..............................................................................................................88
6.3 FUTURE RECOMMENDATIONS.............................................................................................................89
6.4 OUTCOME OF THE RESEARCH IN RELATION TO THE LITERATURE........................................................90
6.5 LIMITATIONS........................................................................................................................................91

REFERENCES....................................................................................................................................................... 92

APPENDICES....................................................................................................................................................... 97

1.10 1.10 APPENDIX A......................................................................................................................................97

1.11 1.11 APPENDIX B....................................................................................................................................103
1.12 1.12 APPENDIX C....................................................................................................................................106

xiii
 LIST OF TABLES

Table 2.1 Literature Matrix ............................................................................................................. 8

Table 2.2: Table of related work in LR ....................................................................................... 39

Table 2.3: Table of related work in LR ....................................................................................... 44

Table 2.4: Table of related work LR .......................................................................................... 48

Table 2.5: Table of related work in LR ....................................................................................... 49

Table 2.6: Table of related work in LR .................................................................................. 51
Table 3.1: Frequency table for education ................................................................................... 61
Table 3.2: Frequency table for gender .......................................................................................... 61

Table 3.3: Frequency table of internet use .................................................................................... 62

Table 4.1: Table for reliability variable ........................................................................................ 67

Table 4.3:Descriptive statistics ..................................................................................................... 69

Table 4.4: Correlations with dependence and independence variables ........................................ 69

Table 4.5: Frequency table internet use, medical information and E-Health adaptations ............ 74

Table 4.7: Regression model summary ................................................................................. 77

Table 4.9: Coefficients .................................................................................................................. 78

Table 6.1 Top Health application in Nepal.................................................................................... 89

Table 6.2: EMR system in Nepal................................................................................................... 89

xiv
 LIST OF FIGURES

Figure 1: Health System (A. Kotevski, 2021) ............................................................................. 3

Figure 2.1: TAM (C. Maspero, 2020) ........................................................................................... 53

Figure 2.2: E-Health Implementation (A. Kotevski, 2021) .......................................................... 54

Figure 3.1: Research Framework................................................................................................... 57

Figure 3.3: Survey estimates ......................................................................................................... 60

Figure 4.1 Relability statistics ............................................................................................... 68

Figure 4.2: Bar chart of internet helping making decision for health ........................................... 70

Figure 4.3: Histogram for confident to protect medical records ............................................ 71

Figure 4.4: Histogram for sharing personal health information online through website .............. 72

Figure 4.5: E-Health impact on current process of communication with patients ..................... 73

Figure 4.6: Internet access of people ............................................................................................ 75

Figure 4.7: Adaptation of E-Health application and process......................................................... 76

Figure 4.8: EHR medical information .......................................................................................... 77

Figure 4.10: E-health implementation Process ............................................................................. 86

xv
 LIST OF ABBREVIATIONS

EHRs .................. Electronic Health Records

ICTs ................... Information and communication technologies

CSFs................... Critical success factors

WHO .................. World Health Organisation

HMIS ................. Hospital Management and Information System

IoT ..................... Internet of Things

LR ...................... Literature Review

TAM .................. Technology Acceptance Model

PU ...................... Perceived Utility

PEU ................... Perceived Ease of Use.

IS ........................ Information System

PHC ................... Primary Health Care
eHEALS.............eHealth Literacy Scale
eHL ................ …eHealth Literacy
VSIS................... Vaccine Schedule Information System (VSIS)

CRM .................. Customer relationship management

RCM .................. Revenue cycle management

CAD ................... Computer-aided Design

DIT..................... Digital Imaging Technology

IS ........................ Information Systems

DHIS2 ................ District Health Information Software 2

xvi
Expanding Access to health services through Telehealth (e-health) in
a current pandemic situation in Nepal.

CHAPTER 1

INTRODUCTION

1.1 INTRODUCTION

This chapter discusses the literature that is pertinent to the subject of the inquiry. The importance
of HIS with their role in assisting the healthcare industry cannot be overstated. In comparison to
other nations, Nepal has taken its time implementing e-health, which is defined as the use and
usage of e-commerce technologies within the healthcare sector. While the Technology has been
more important in healthcare over the previous few decades. Despite the fact that adoption
barriers have a long history, many health authorities believe it will be challenging to remove
them. A diversified set of stakeholders with various objectives, a risk-averse environment
because patient care is so important, and emotions of overwhelm because of the size of the
information and communication technology transformation project are some of these traits. (al. L.
H., 2021) Focusing on important system objectives or crucial success criteria appears to be a
realistic choice given the difficulties of tackling fundamental concerns in the healthcare industry.
The fundamental idea behind a vital success factors approach is that, in a project setting, if a
significant portion of the development's features is finished or effectively handled, the system as
a whole has a far higher likelihood of being implemented correctly and having overall success.
In this work, we advocate for the importance of EMS and the avoidance of overly straightforward
data value techniques. I really believe that a greater understanding of the significance of data
value issues improves decision-making, which in turn improves patient outcomes. In order to
arrange medical treatment in a way that is both economical and effective, including the secure
exchange of patient data among various healthcare providers, EHRs are a crucial tool, if not a

1
competitive weapon. A smart use of current health ICTs, like an EHR system, can aid to raise
patient safety and care quality. The removal of important aspects that might have an impact on
the successful adoption of EHR systems in a particular work environment is a fundamental
challenge that motivates the current study. (SedaSGÜT E. C, 2022) We'd like to know which
CSFs are crucial for maximizing the benefits of EHR implementation in Nepal hospitals and
making a positive effect, according to the relevant gatekeepers. (i.e., doctors who are in practice).
Electronic medical records, e-health, and health systems are all covered in the literature review.
There were several reasons given for not using digital services or technology, including lack of
access to them, hostility toward them, or rejection of them. (al. L. H., 2021)

1.2 BACKGROUND OF THE STUDY

In order to improve health, information and communications technology infrastructure must be

safe. WHO defines e-Health as "the premium and health-related professions such as health care,
observation, publications, and health education, information, and study." The development of
information and communication technology has a significant impact on the standard of
healthcare. New healthcare initiatives and strategies aimed at assisting people with inherited or
chronic illnesses have been developed as a result of the advancements. These initiatives increase
the accessibility and quality of the healthcare system while fostering knowledge sharing among
medical professionals. Data management in these systems is growing more challenging.
Additionally, we compare several aspects of data quality and thoroughly examine the effects that
EMS's unique features have on data quality. Improving creates new opportunities for healthcare
and medical practice, but it also poses a number of unanswered questions for decision-makers
regarding quality, security, and other crucial issues. Many research and methodologies,
particularly
in the healthcare sector, have shown the importance of end-user data quality. Usage of electronic
methods for local and remote therapeutic, educational, and administrative purposes to transport,
store, and assess digital data. (A. Kotevski,2021)

The growing trend of requiring digital connectivity for government services, including health care
services, as seen in Nepal, raises the issue of how those who are unable to use technology can

2
participate in the creation of new digital possibilities and benefit fully from digitalization.

Figure 1: Health System (A. Kotevski, 2021)

1.3 PROBLEM STATEMENT

The outbreak has caused further issues for healthcare professionals around the world.
Nevertheless, there is a dearth of information on these problems in many undeveloped countries,
including Kathmandu. Due to its population of 28.087 million people, Nepal experienced a
shortage of medical doctors, nurses, and paramedics prior to COVID-19. Compared to more
developed nations, Kathamndu faces more difficulties when it comes to access to healthcare
services. The quality of HC services offered in Kathmandu is impacted by poverty, illiteracy, a
lack of resources, a shortage

of health-care workers, attitude toward doctors, doctor security concerns, health-care insurance
policies, geographic distribution, culture, governmental policies, and physical limitations.
Address challenges head-on and implement improvements in all areas, including operations, the
supply chain, and customer interactions. If they don't change, they'll lose clients and money.
Health equity is a significant priority for healthcare executives and organizations. According to
the global healthcare forecast, digital transformation will completely disrupt the healthcare
industry.

3
  Implementation should be done in accordance with current care procedures and after
consulting with the necessary parties. (A. Kotevski,2023)
 Technological solutions for round-the-clock home health care should be straightforward,
dependable, considerate of patients, and concerned with routines. (Karim, 2020)

 When activities change, patients and professionals may need support and training to
adjust. (Karim, 2020)

 Patients and professionals alike seek explanations and clarity, as well as agreement on
each other's respective new responsibilities. (Kim H. &., 2017)

 It is essential to do patient assessments, expert evaluations, and home health monitoring

program monitoring. (S. A. H. Wangberg, 2010)

1.4 RESEARCH QUESTIONS

 Is there a causal link between using the internet and adopting an e-health system?
 Does the use of an electronic gadget or application and the adoption of an e-health
system have any meaningful relationships?
 Is there a causal link between the growth in e-health systems and health care reminder
systems?
 Is there a connection between the adoption of an e-health system and the electronic
storage of medical information?

1.5 PURPOSE OF THE STUDY

 The study's objective is to evaluate the health-care system in Kathmandu.

 What adjustments are done to our health system during lockdown.
 How individuals are adjusting to technological innovations for health monitoring and
doctor communication.
 How hospitals are going digital to reduce crowding while in lockdown.
 What are the latest developments for apps and web applications to assist in implementing
digital our health ecosystem? COVID-19.

4
1.6 OBJECTIVES OF THE STUDY

 To determine the connection among internet use as well as e-health system adaptability.
 To determine how the use of an electronic application or device and the adoption of an e-
health system are related.
 To determine the connection between the adoption of an e-health system and the use of
health care reminder systems.
 To determine the connection between the adoption of an e-health system and the
electronic storage of medical information.

1.7 SCOPE AND LIMITATION OF THE STUDY

Patients and experts should assess and monitor home health monitoring programs. To offer
recommendations for the future based on important success factors from huge home healthcare
monitoring system installations in the past. This paper outlines CSF that might aid with the
efficient execution of homecare surveillance in an effort to aid implementation planning. When it
concerns information quality, e-Health monitoring tools have certain distinctive characteristics. A
good healthcare service and management process includes gathering data, establishing diagnoses,
and
Monitoring administration statistics. (al. D. R., 2020) The effectiveness of the patient aid
increases with data accuracy. HMIS, short for Healthcare Information and Management System,
is the abbreviation for this system. Data gathering, compiling, analysis, and evaluation for
information that can be used to improve health and medical service planning, surveillance, and
control, and also to raise the caliber and effectiveness of the provision of healthcare. Something
can be done to enhance the healthcare system.

The situation, which includes patient mobility and telecommunication technologies performance,
has a significant impact on information management and application success. These results have
prompted us to investigate data quality problems with e-Health tracking apps (al. A. D., 2020).

All aspects of quality, including its constituents, features, metrics, and measures, are represented
by quality models. Data linkages and a wide range of quality criteria have been offered. Yet, it is
important to consider the limits of our findings. (M. Zubair Elahi,2021) The data was initially

5
gathered from the general population. Therefore, it is strongly encouraged to collect information
from Covid-19 patients and doctors to evaluate the effect of the e-health system on patient
outcomes and doctor-patient relationships. (al J. A., 2020) This approach is intended to assist in
improving the generalizability of findings and acquiring a better knowledge of typical behaviors
as well as potential variations because of various contexts and geographic locations..

1.8 SIGNIFICANCE OF THE STUDY

The following are some ways that study could be beneficial to various parties:
 The purpose of this study is to determine what factors make health care in rural areas
more accessible from established urban centers that provide specialized care.
 This study will examine the advantages of e-health, which brings medical treatment to
areas that might not otherwise have access to it.
 The conceptual framework provided by this study may be useful for e-health
consultations, which allow the treating physician to assess and monitor the patient's status.

1.9 OVERVIEW OF THE THESIS

It is a thorough evaluation with the aim of identifying treatments to improve the usage of
electronic medical records in primary care. A review of the literature occurs in the second
chapter. In Chapter 3, the inclusion criterion, meta-analysis methodology, and the use of the
hazard of partiality appraisal device are all covered, along with the process of searching the
literature for pertinent research. The results of the DB search are displayed in Chapter 4 together
with the pertinent findings of the individual studies that were included. The results of the risks of
partiality appraisal are then shown using a bar chart, and the meta-analysis findings are displayed
using forest plots. In Chapter 5, the argument chapter, and the key conclusions of the review, the
findings are briefly explained. Chapter 5 further discusses the strengths and drawbacks of the
study.

6
 CHAPTER 2

LITERATURE REVIEW

2.1 LITERATURE REVIEW

A fragmented body of research supports the challenging topic of home health monitoring. Yet,
the study demonstrates that many important success variables, such reviewing operation in the
context of contemporary concerns, are comparable. The best tools should be created in
cooperation with important partners and should be simple to use, reliable, and integrated with
patient and care activities. When they transition to new roles, duties, and activities, patients and
experts can seek assistance, training, information, and support. At the end, patients and experts
should review home health monitoring. (Yuce, 2021) According to a review of the literature,
there are a number of critical success elements that should be taken into account while putting in
place home care monitors. The majority of the included studies seemed to be of very high quality,
indicating that the conclusions are reliable enough to be used in preliminary planning for
widespread adoption.

E-health monitoring has become more popular over the past thirty years due to advancements in
ICT, decreased communication costs, better technological accessibility, and real-time data
transfer. (Kamila Adellund Holt A. K, 2019) Every year, technological advancements increase
the effectiveness of current telemedicine services, and it is anticipated that telecommunications
services will become more affordable in the future, making telemedicine a more viable alternative
to traditional medical care. The main benefit of e-health monitoring is that it increases access to
specialized medical care in established urban centers for people living in rural locations. Because
of technology developments, access to health-care services has improved. (2018) (Zheng M. J.)

The distance traveled and how challenging the trip was People's health in rural areas has
consistently differed from that of city dwellers due to access to more specialized hospitals. 2020
(C. Maspero)
7
2.1.1 TELEHELATH AND PUBLIC HEALTH PROTECTION REDUCING
HEALTHCARE FAILURE
Considering the challenges, the COVID-19 scenario could present a huge opportunity for space
and distance-spanning technologies. Several online self-tests provide triage solutions to lessen the
pressure on doctors.

2.1.2 PUBLIC HEALTH PROTECTION

The significance of thoroughly developed behavioral public health and readily accessible data is
emphasized. Finally, we must address current issues with the creation of innovative therapies. For
instance, antibiotics constitute a global health concern. Drug companies should receive a lot more

2.1.3 MORE TREATMENT OR LOW CARE SHOULD BE AVIOD

Increasing capacity for and treating critically ill patients are the current areas of concern for
healthcare professionals. Diagnostic procedures and elective care are delayed as a result.

2.1.4 FAILURES IN CARE COORDINATION AND PRICING

By assigning a cost to it, it also aids in the reduction of organizational complexity: Payers should
be assessed a higher rate for treatment reimbursement associated with high but decreased
administrative tasks.

2.2 LITERATURE MATRIX

Table 2.1 Literature Matrix

No Journal Article title Author Quotatio IV DV Discussion and

Name n Research Gap
1 (M. Ndiaye, IoT in the Musa These This article Cost The different IoT
2020) Wake of Ndiaye includes: discusses simplicit deployment
IEEE COVID-19: / 2020 Related the y tactics have been
Access · A Survey on Stephen Work advanceme robustnes influenced by the
Contributio S. Healthcar nt of s regulations
ns, Oyewo e IoT for sensor- reliabilit defining the
Challenges bi / virus based y (M. necessity for
and 2020 pandemic health in Ndiaye, lack of

8
 Evolution Adnan managem the familiarity in IoT
(M. Ndiaye, M. ent manageme data collecting.
2020) Abu- IoT nt. (M. Because of
mahfou solutions Ndiaye, COVID-19's
z / 2020 for social 2020) contagious
Gerhar distancing character, IoT
d P. Data It also administrators
Hancke collection provides have looked out
/ 2020 and an answer a variety of
Anish monitorin to successful and
M. g influenced ethical channel
Kurien (M. opportunit assignment
/ 2020 Ndiaye, y of IoT approaches.(M.
Karim 2020) networks. Ndiaye, 2020)
Djouani (M.
/ 2020 Challenge Ndiaye,
s of 2020)
implemen
ting H-
IoT
Research
gaps and
future
trends
2 (M. G. do Covid-19: A Stefan These Organizati Physical Failures in
Nascimento Window of Auener includes: ons and consultat health-care
et al., 2020) Opportunity / 2020 Eliminati rules have ion delivery
for Positive Daniell ng health- evolved E- Care
Internationa Healthcare e care into highly consultat coordination
l Journal of Reforms Kroon / failures: flexible ion failures
Health (M. G. do 2020 communic systems. Consultat Overtreatment or
Policy and Nascimento Erik ations and Choices ion by poor-quality care

9
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t s / 2020 health take (M. G. complication
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van Preservati make are Nascime Nascimento et
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2020) impromptu
policy
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failures reduce
(M. G. do threats, but
Nascimen they may
to et al., also
2020) provide
opportuniti
es
Performers
can use
their
political
authority
and

10
 personal
interests to
further
their goals.
(M. G. do
Nasciment
o et al.,
2020)

3 (al. L. H., Covid-19 Linda These are social Explanati This article
2021) and the Hantrai some of connection on of brings together
Contempora digital s / 2021 them: s (al. L. H., how information on
ry Social revolution Paul Official 2021) artificial the impacts of
Science (al. L. H., Allin / data intelligen Covid-19 in
2021) 2021 during ce digitized society
Mihalis period morals and policy
Kritiko Artificial became a responses from
s / 2021 intelligenc top diverse areas of
Melita e and priority social scientific
Sogom research for expertise.
onjan / ethics in national The authors
2021 the and show how the
Prathiv context of internatio pandemic drove
adi B. period nal changes in
Anand / The governm official statistics
2021 influence ent data gathering
Sonia of the regulatio and distribution
Livings covid-19 n, and practices, as well
tone / epidemic how the as how
2021 on character seemingly
Mark Estonian istics that insurmountable
Willia e-mental allow challenges to

11
 ms / health smart adopting e-health
2021 policy cities to treatments were
Martin Families operate substantially
Innes / living as surmounted.. (al.
2021 Smart productiv L. H., 2021)
cities ity
Viral drivers
disinform did not
ation face always
online provide
hazards them an
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es. social during
media the
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domestica .. (al. L.
tion and H., 2021)
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deception
(al. L. H.,
2021)

4 (M. Zubair Fear of Muham These Fear of Expanding the

Elahi, 2021) Covid- mad includes: covid 19, TAM to contain
19and Zubair Theory supposed the fright of
Internationa Intentions Elahi / and effortlessn Covid-19
l Journal of towards 2021 hypothesi ess of component,
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12
 Economics health Liang / developm E-Health able to find a
and services: 2021 ent (M. (M. Zubair connection
Managemen Exploring Muham Zubair Elahi, between fear of
t the mad Elahi, 2021) Individuals'
technology Jawad 2021) attitudes about
acceptance Malik / accepting e-
model in the 2021 health
scenario of Sana services(M.
pandemic Dilawar Zubair Elahi,
(M. Zubair / 2021 2021)
Elahi, 2021) Bena
Ilyas /
2021
5 (al J. A., Remote Joachi These This paper restriction of
2020) health m A. includes: provide mobility in
Physiol diagnosis Behar / Review of Throughou certain areas
Meas and 2020 remote t the It's difficult to
monitoring Chengy health pandemic, break out from
in the time u Liu / initiatives an this paradigm
of COVID- 2020 in various overview without
19 (al J. A., Kevin countries of remote introducing new
2020) Kotzen (al J. A., health obligations or
/ 2020 2020) monitoring falling into
Kenta efforts privacy
Tsutsui undertaken difficulties,
/ 2020 in 20 states which might
Valenti This jeopardize the
na D.A. research initial good
Corino focuses on intentions.
/ 2020 specific Furthermore,
Janmaj characterist while the quality,
ay ics that are accuracy, and

13
Singh / shared by value of video
2020 all of the camera-
Marco evaluated measured heart
A.F. nations, rate, respiration
Piment such as the rate, and oxygen
el / pandemic's saturation levels
2020 potential have yet to be
Philip influence established,
Warric on remote many
k / health telemedicine
2020 monitoring operators are
Sebasti and data seriously
an privacy investigating this
Zaunse concerns.. equipment as an
der / (al J. A., adjunct to replay
2020 2020) evaluation.(al J.
Fernan A., 2020)
do
Andreo
tti /
2020
David
Sebag /
2020
Georgy
Kopanit
sa /
2020
Patrick
E.
McShar
ry /

14
 2020
Walter
Karlen
/ 2020
Chanda
n
Karmak
ar /
2020
Gari D.
Clifford
/ 2020
6 (P. W. Critical Putu These The To reach a
Handayani, success Wuri includes: purpose bigger market,
2018) factors for Handay Mobile of The all mobile health
Heliyon mobile ani / health and goal of apps should be
health 2018 applicatio this as consumer
implementat Dira n research pleasant as
ion in Ayu implemen is to find possible for
Indonesia Meigas tation CSFs in patients.(P. W.
(P. W. ari / Methods the Handayani,
Handayani, 2018 and adoption 2018)
2018) Ave results of
Adriana Qualitativ mobile
Pinem / e analysis health
2018 (P. W. apps..
Achma Handayan This
d Nizar i, 2018) study
Hidaya focuses
nto / on four
2018 dimensio
Dumila ns:

15
 h system
Ayunin quality,
gtyas / informati
2018 on
quality,
service
quality,
and
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quality.
(P. W.
Handaya
ni, 2018)

7 (Mishra, E-Health Leena Mobile Technolo

2020) Technology Kar / Devices gies,
JOURNAL Challenges 2020 (Mishra, Applicati
OF in India: An Bibhuti 2020) ons
CRITICAL Analysis Bhusan (Mishra,
REVIEWS with Mishra 2020)
COVID-19 / 2020
Check Ups
(Mishra,
2020)

8 (al M. G., Covid-19: A Mateus These This In addition, a

2020) Digital Gonçal includes: paper (RS) algorithm
IEEE Transformat o do Big data presents was developed to
Symposium ion Nascim Recomme an better
on Approach to ento / ndation ongoing comprehend user
Computers a Public 2020, systems research behavior based

16
and Primary Gabriel Digital effort on critical
Communica Healthcare Iorio / transform aimed at signals.. (al M.
tions Environmen 2020 ation (al bridging G., 2020)
t (al M. G., Thiago M. G., a digital
2020) G. 2020) transfor
Thomé mation
/ 2020 gap in a
Alvaro public
A.M. primary
Medeir healthcar
os / e system
2020 (al M.
Fabrici G., 2020)
o M.
Mendo
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2020
Fernan
da A.
Campo
s / 2020
José M.
David /
2020
Victor
Ströele
/ 2020
Mario
A.R.Da
ntas /
2020
Depart

17
 ment of
Comput
er
Sience
(DCC)
/ 2020
Depart
ment of
Electric
al
Engine
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Federal
Univers
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Juiz de
Fora
(UFJF)
Juiz de
For a /
2020
Minas
Gerais
Brazil /
2020
9 (Natalia Innovations Natalia These The paper The widespread
Serbulova, during Serbulo includes: describes consumption of
2020) COVID-19 va / The the online content
pandemic: 2020 Economic mechanism creates
trends, Tatyana and s for opportunities for
technologies Morgun Industrial adapting technologies that
, prospects ova / Impact of corporate can capture and

18
 (Natalia 2020 COVID- COVID-19 engage the user.
Serbulova, Galina 19 developme (Natalia
2020) Persiya Technolo nt Serbulova, 2020)
nova / gical methods,
2020 breakthro as well as
ughs and technology
new and
business solutions
models that may
(Natalia be applied
Serbulova to address
, 2020) contempor
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difficulties.
(Natalia
Serbulova,
2020)
10 (Liliana The Liliana These Conductio As a result of the
Hawrysz, Research on Hawrys includes: n of Level analyses, Certain
2021) Patient z / 2021 the of flaws in the data
Int J Satisfaction Gra ̇ research satisfaction analysis
Environ Res with zyna on patient with methodological
Public Remote Giersze satisfactio remote quality were
Health. Healthcare wska / n with health discovered.
Prior to and 2021 remote services It was also
during the Agnies healthcare before and discovered that
COVID-19 zka was during the researchers are
Pandemic Bitkow conducted epidemic unsure of how to
(Liliana ska / . has been define and
Hawrysz, 2021 Study of studied. measure
2021) Patient (Liliana fulfillment
Satisfactio Hawrysz, preceding to and

19
 n with during the
Remote COVID-19
Healthcar pandemic.
e (Liliana (Liliana
Hawrysz, Hawrysz, 2021)
2021)

11 (Nasser Technology Nasser These Evaluates Providing people

Alshammari -driven 5G Alsham includes: the with right to use
, 2021) enabled e- mari / COVID- potentiality to COVID-19-
IET healthcare 2021 19 is of new and related info
Communica system Md controlled emerging COVID-19 is
tion during Nazirul by a 5G technologi controlled by an
COVID-19 Islam communic es advanced
pandemic Sarker / ation available communication
(Nasser 2021 system. system (5G and
Alshammari M.M. Deep 6G).
, 2021) Kamruz learning is Ensure COVID-
zaman / being 19-related life
2021 used to quality (Nasser
Madall combat Alshammari,
ah the 2021)
Alruwa COVID-
ili / 19
2021 pandemic.
Saad Powered
Awadh by digital
Alanazi technolog
/ 2021 y
Md Containm
Lamiur ent of the
Raihan COVID-

20
 / 2021 19
Salman pandemic
Ali Digital
AlQaht technolog
ani / y is being
2021 used to
manage
regional
covid-19.
Data-
driven
digital
technolog
y has the
potential
to be used
in a
variety of
ways.
(Nasser
Alshamm
ari, 2021)

12 (Parisa E-Health Parisa These The The findings of

Eslami, solutions to Eslami includes: potential This evaluation
2021) fight against / 2021 E-Health for E- might be used to
Med J Islam COVID-19: Sharare solutions Health to learn more about
Repub Iran A scoping h R. Various aid in the the existing E-
review of Niakan subdomai The Health solutions
applications Kalhori ns of E- COVID-19 available or
(Parisa / 2021 Health epidemic proposed in
Eslami, Moloud solutions requires response to the

21
 Taheriy for major COVID-19
an1 / pandemic prevention, pandemic..
2021 control diagnosis, (Parisa Eslami,
(Parisa treatment, 2021)
Eslami, screening,
2021) manageme
nt, and
control..
(Parisa
Eslami,
2021)

1 (al. D. R., Wearable Dhruv These This paper to The COVID-19

3 2020) Sensors for R. includes: describes mobilise pandemic has
Front. Digit. COVID-19: Seshadr Wearable clinically front-line highlighted the
Health A Call to i / 2020 sensor relevant workers critical For
Action to Evan measurem physiologi and remote
Harness Our V. ent of cal metrics engineers monitoring, we
Digital Davies physiolog that can be in the must harness and
Infrastructur / 2020 ical measured develop use our internet
e for Ethan metrics with ment of infrastructure.
Remote R. for commercia Platform (al. D. R., 2020)
Patient Harlow COVID- l Today's s for
Monitoring / 2020 19 technologi controlli
and Virtual Jeffrey monitorin es and their ng and
Assessment J. Hsu / g importance measurin
s (al. D. R., 2020 Future in tracking g the
2020) Shanina expectatio the health, epidemic
C. ns and stability, using
Knight recommen and digital
on / dations recovery of health.
2020 Implemen COVID- (al. D.

22
 Timoth tation of 19+
y A. wearable persons
Walker sensor and front-
/ 2020 technolog line
James y (al. D. professiona
E. Voos R., 2020) ls are
/ 2020 highlighted
Colin . (al. D. R.,
K. 2020)
Drumm
ond /
2020
14 (Khan & Developme Moham These Smart E- The video
Karim, nt of Smart mad includes: Health calling service
2020) e-Health Moniru Materials system for will be
IEEE System for jjaman and the extremely
Covid-19 Khan / methods pandemic beneficial to
Pandemic 2020 Develope (Khan & patients who are
(Khan & Rezaul d system Karim, concerned about
Karim, Karim / & result 2020) their health.
2020) 2020 (Khan & This service will
Karim, be extremely
2020) beneficial to
people living in
rural areas.
They can also
order medicine
through the
platform, which
extends the app's
and web's
functionality.

23
 (Khan & Karim,
2020)

15 (Kamila Differences Kamila These The

Adellund in the Level Adellun includes: digitalization of
Holt A. K., of d Holt / The health care
Differences Electronic 2019 purpose services
in the Level Health Astrid of this guarantees that
of Literacy Karnoe study was more services
Electronic Between / 2019 to see are available and
Health Users and Dorthe how that
Literacy Nonusers of Overga digital communication
Between Digital ard / service with healthcare
Users and Health 2019 users and workers is
Nonusers of Services: Sidse non-users enhanced.
Digital An Edith differed in
Health Exploratory Nielsen terms of
Services: Survey of a / 2019 of eHL in
An Group of Lars a group of
Exploratory Medical Kayser patients
Survey of a Outpatients / 2019 who
Group of Michae visited a
Medical l Einar hospital
Outpatients. Røder / outpatient
, 2019) 2019 clinic on a
INTERACT Gustav regular
IVE From / basis.
JOURNAL 2019
OF
MEDICAL
RESEARC
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24
16 (Lars Enhancing Lars literacy, developed and
Kayser 1, the Kayser this paper defined a
2019) Effectivenes / 2015 proposes framework for
s of Andre when modelling users'
JMIR Hum Consumer- Kushnir creating demands for
Factors Focused uk / new constructing
Health 2015 informati EHS that
Information Richard on and combines
Technology H communic previous assist in
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Through E- e / 2015 technolog user job
Health Ole y perspective
Literacy: A Norgaa solutions matrix with the
Framework rd / in health burgeoning field
for 2015 care, how of E-Health
Understandi Paul users' literacy. (Lars
ng Users' Turner requireme Kayser 1, 2019)
Needs / 2015 nts and
(Lars competen
Kayser 1, ces may
2019) be taken
into
account.
(Lars
Kayser 1,
2019)

17 (Kim H. &., Health Henna discovere easily way in to and

2017) literacy in Kim / d studies available utilisation of
Patient the E-Health 2017 on the use to people online HI might
Education era: A Bo of online with low be hampered by
and systematic Xie / health reading poor readability

25
 Counseling review of 2017 services levels, of material and
the literature by and to poor usability of
(Kim H. &., persons improve E-Health
2017) with low individua services. (Kim
health l health H. &., 2017)
Because literacy
the through
findings educatio
may shed nal
light program
about how mes
health (Kim H.
informati &.,
on has 2017)
been
treated
and
should be
addressed
in the E-
Health
age,.
(Kim H.
&., 2017)

18 (Knapp C. Internet use Caprice Internet

M., 2011) and E- Knapp / for this
J Med Health 2011 purpose
Internet literacy of Vaness requires
Res. low-income a access to
parents Madde the
whose n / Internet as

26
 children 2011 well as
have special Hua the ability
health care Wang / to
needs 2011 understan
(Knapp C. Phyllis d and
M., 2011) Sloyer / analyse
2011 online
Elizabe health
th informati
Shenk on.
man / (Knapp C.
2011 M., 2011)

19 (Monkman The Helen

H, 2015) Consumer Monkm
Stud Health Health an /
Technol Information 2015
Inform System Andre
Adoption W
Model Kushnir
(Monkman uk /
H, 2015) 2015

20 (Samantha E-Health Samant hampered

R Paige, literacy in ha R by a lack
2017) chronic Paige / of They
Patient Educ disease 2017 lack
Couns patients: An Janice computer
item L and health
response Krieger literacy,
theory / 2017 limiting
analysis of Michae their

27
 the E-Health l ability to
literacy Stellefs take use
scale on / of online
(eHEALS) 2017 health
(Samantha Julia M informati
R Paige, Alber / on.
2017) 2017 (Samanth
a R Paige,
2017)

21 (Park, 2008) Group Daniel Within Access to

disparities Lorenc such an Internet portals,
Health and health e / 2018 environm as well as
Informatics information: Heeyou ent, the computers in
Journal a study of ng Park formation general,
online / 2018 of a continues to be a
access for chronic problem.
the 'digitally Many
underserved underserv technological
(Park, 2008) ed projects have
populatio sought to reduce
n' will barriers to many
effectivel care clients'
y limit the access to web-
prospects based patient
of information.
implemen (Park, 2008)
ting a As
part of the
national
strategy, a
consumer-

28
 focused,
collaborat
ive
decision-
making
approach
will be
implemen
ted.(Park,
2008)

22 (Manganell The Jennifer Understan In order to find

o J. G., Relationship Manga ding the specific for
2017) of Health nello / relationshi health
J Public Literacy 2017 p between information,
Health With Use of Gena health people with
Manag Pract Digital Gerstne literacy lower self-
Technology r / 2017 and reported health
for Health Kristen patterns literacy had
Information: Pergoli of access more difficulties
Implications no / and use of with their most
for Public 2017 digital recent search..
Health Yvonne technologi (Manganello J.
Practice Graham es, as well G., 2017)
(Manganell / 2017 as It is
o J. G., Angela necessary
2017) Falisi / for public
2017 health
David organisati
Strogat ons to
z / 2017 target
channels

29
 for health
informati
on
distributio
n
appropriat
ely based
on their
preference
s for
sources of
health
informati
on..
(Mangane
llo J. G.,
2017)

23 (Wangberg Use of the Silje This study The

S A. H., internet for Wangb emphasise internet
2010) health erg / s both the is a
Scand J purposes: 2010 potential valuable
Caring Sci trends in Hege for source of
Norway Andrea internet health
2000-2010 ssen / use to informati
(Wangberg 2010 promote on that is
S A. H., Per health and only
2010) Kumme the going to
rvold / potential grow in
2010 for it to relevance
Rolf exacerbat in the
Wynn / e social coming

30
 2010 inequities years.
Tove in health. (Wangbe
Sørense (Wangber rg S A.
n / g S A. H., H., 2010)
2010 2010)

24 (Zheng M. The Mengy Based on Access to care is

J., 2018)Hea relationship un a typically
lth Qual between Zheng / systematic connected to
Life health 2018 review negative health
Outcomes literacy and Hui and meta- outcomes such
quality of Jin / analysis, as low self-
life: a 2018 the study's efficacy,
systematic Naiyan goal is to increased
review and g Shi / objectivel mortality, poor
meta- 2018 y examine health status, and
analysis Chunxi the lower quality of
(Zheng M. ao associatio life. of life
J., 2018) Duan / n between (QOL). (Zheng
2018 health M. J., 2018)
Donglei literacy
Wang / (HL) and
2018 QOL.
Xiaoge (Zheng
Yu / M. J.,
2018 2018)
Xiaonin
g Li /
2018
25 (Sharma S. Electronic S provides a to assess There is a need
O., 2019) health– Sharma starting nursing to pay attention
literacy / 2019 point for students' to nursing

31
 Adv Med skills among N Oli / nursing knowled students' E-
Educ Pract. nursing 2019 students' ge of E- Health literacy
students B E-Health Health demands
(Sharma S. Thapa / literacy (Sharma (Sharma S. O.,
O., 2019) 2019 (Sharma S. O., 2019)
S. O., 2019)
2019)

26 (Seda The Seda Self-efficacy has

SÖGÜT E. Relationship Sögüt / been shown to
C., 2022) Between E- 2022 impact students'
J Nurs Res Health Eda academic
Literacy and Cangöl achievement and
Self- / 2022 objectives. (Seda
Efficacy İlknur SÖGÜT E. C.,
Levels in Dolu / 2022)
Midwifery 2022
Students
Receiving
Distance
Education
During the
COVID-19
Pandemic
(Seda
SÖGÜT E.
C., 2022)

27 (Rathnayake Self- Sarath evaluate A good Half of nursing

S. &., 2019) reported E- Rathna nursing attitude students have
Nurse Educ Health yake / students' towards insufficient E-
Today literacy 2019 E-Health the internet Health literacy

32
 skills among Asela literacy has a abilities,
nursing Senevir abilities significant particularly in
students in athna / and impact on recognising
Sri Lanka: 2019 associated the trusted health
A cross- aspects developme resources and
sectional (Rathnaya nt of E- utilising this
study ke S. &., Health knowledge in
(Rathnayake 2019) literacy health decision
S. &., 2019) skills. making,
(Rathnayak emphasising the
e S. &., need for nursing
2019) students to
improve their E-
Health literacy
skills.
(Rathnayake S.
&., 2019)

28 Nurs Forum A concept Terri A As Patients' reading

(Parnell T. analysis of Ann conceptua empirical and
A., 2019) health Parnell l research comprehension
literacy / 2019 definition and levels are
(Parnell T. Jaynell of health theoretical sometimes
A., 2019) e F literacy literature conflated with
Stichler that develop, their level of
/ 2019 incorporat additional health literacy.
Amy J es system examinatio (Parnell T. A.,
Barton demands, n and 2019)
/ 2019 burdens, evolution
Lori A and of the
Loan / complexit notion is
2019 ies that necessary

33
 Diane are an for health
K important literacy
Boyle / componen (Parnell T.
2019 t of A., 2019)
Patricia patients'
E Allen level of
/ 2019 health
literacy.
(Parnell
T. A.,
2019)
29 UiT The Impact and Sadiksh M-Health services. Due to political
Arctic Challenges a has been a Design issues, lack of
University of M-health Lamich bridge thinking is resources
of Norway Application. hane between based on and budget from
(Lamichhan A 2020- the the agile government,
e, 2020) 05-15 health methodolo infrastructures
Study in care gy having like
Rural profession an iterative reliable
Nepal. al and in electricity
(Lamichhan patients nature supply, internet
e, 2020) living in which facility, quality
rual improves schools hence
areas who the lack of
are outcome awareness, road
lacking overtime and
from as transportation
insufficie more are still present
nt iterations in rural areas
healthcare passed. In which
specialists this in turn have a
. device approach, direct impact on

34
that understand conducting any
is helping ing of E-Health
to provide users’ projects and
healthcare empathy services. People
facilities using of remote
to a wide ‘action areas still reach
range of oriented out to witch
people of prototypin doctors instead
rural g’ of of
communit solutions is visiting
ies. highly healthcare
Through prioritized. services which is
M-Health (Lamichha also making it
technolog ne, 2020) difficult to
y convince them to
Healthcar use E-Health
e services
profession for their own
al and benefit. Even
patients (Lamichhane,
are being 2020)
able to
connect
without
needed to
visit each
other
physically
thus help
them to
connect
through

35
different
locations.
Due to the
use of
telemedici
ne
people of
rural
communit
ies are
also being
educated
about the
modern
internet
technologi
es
and use of
mobile
(Lamichh
ane, 2020)
phone.
Through
M-Health
technolog
y, local
healthcare
workers
can take
advice of
medical
specialists

36
 of various
hospitals
and can
perform
the
required
30 UiT The Co-creating Vitalii E-Health Design e-health has not
Arctic since 1990s: Ikoev benefits thinking is always been
University an 2020- includes based on matched when it
of Norway qualitative 05-14 informati the agile comes to
(Ikoev, analyses of on sharing methodolo utilization in
2020) the among gy having practice.
exploratory various an iterative Analysis on
case study departmen in impact of E-
on a small ts of nature Health services
private which shows the
health IT healthcare improves deviation
company in services, the between real
North clinical outcome outcomes and
Norway decision overtime the
though the support as expected
prism of systems, more benefits.
ANT(Actor- updated iterations Furthermore,
Network health passed. In improvement in
Theory). related this Considering the
(Ikoev, informati approach, hopeful
2020) on, understand outcomes of
effortless ing of theoretical
maintenan users’ research, actual
ce of empathy practice may not
hospital using be possible.
services ‘action Today's health-

37
 and oriented care
improved prototypin organizations
administra g’ of (Ikoev, 2020)
tive solutions is
system. highly
(Ikoev, prioritized.
2020) Every
iteration
has several
rounds of
ideation,
prototypin
g and
testing are
involve for
innovation
to emerge.
(Ikoev,
2020)

2.3 RELATED WORK

Table 2.2: Table of related work in LR

TITLE Impact and Challenges of M-health

Application. A Study in Rural Nepal.
(Lamichhane, 2020)
AUTHOR NAME/YEAR Sadiksha Lamichhane 2020-05-15
FEATURES
BENEFITS Telemedicine (M-Health), one of many E-

38
 Health services, is being used in Nepal's rural
areas.M-Health has served as a link between
medical professionals and people in remote
areas who lack access to medical specialists. a
device that assists in offering healthcare
services to a variety of people in rural
locations. Through the technology of M-health.
The ability of healthcare professionals and
patients to communicate without physically
meeting one another enables them to do so
from various locations. People in remote
communities are learning about modern
internet and mobile technologies as a result of
the use of telemedicine. (Lamichhane,202)
Local healthcare professionals are able to
consult with medical experts from different
hospitals thanks to M-Health technology and
treat patients as necessary. Also, a health
expert can remotely instruct distant health
workers via telemedicine services,
strengthening the connection between
technology and the medical community. The
most well-known application of M-Health is
the Medic Mobile program, which is located in
the Nepalese village of Baglung. The
healthcare infrastructure in Nepal's rural
districts has been gradually improving, yet
there are still significant infrastructure gaps
between rural and urban areas. In Nepal, all of
the top hospitals and medical professionals are
located in the country's major cities, and M-
Health has been instrumental in bridging the

39
 gap between rural patients and these
specialists. (Lamichhane, 2020)
LIMITATIONS Even though the Medic Mobile Program in
rural Baglung municipalities has significantly
improved the health of the locals—especially
the health of infants and expectant mothers—
many challenges remain, including a lack of
adequate infrastructure, management flaws, a
lack of human resources and funding, and
patriarchal social and cultural values.
Implementing telemedicine programs in
Nepal's remote areas is difficult due to a lack
of smart phone availability, internet access, and
electrical infrastructure. (Lamichhane, 2020)
The geographic area of Nepal is made up of
mountains, hills, and several rivers. Most rural
areas lack sufficient infrastructure due to their
challenging environment, making it difficult to
easily access healthcare facilities there.
Infrastructures like dependable electricity
supply, internet facility, quality schools, lack
of awareness, road and transportation are still
present in rural areas due to political issues,
lack of resources and budget from the
government, which in turn has a direct impact
on conducting any E-Health projects and
services. It is challenging to persuade people in
distant places to use e-health services for their
own advantage since they still consult witch
doctors instead of going to the doctor.
Although though technology is developing
quickly in Nepal, it is still difficult for

40
 telemedicine programs to grow and spread
since technology is improved quickly, and with
rapid improvement comes the need for update
and maintenance. But due to resource and
economic constraints, Nepal is still unable to
fund new technological advancements.
(Lamichhane, 2020)
ADVANTAGES
M-Health applications have significantly
improved maternal and infant mortality rates as
well as peoples' general health levels around
the world. The Medic Mobile project in Nepal
has trained community health workers in the
use of smartphones and data collecting, with
accuracy rates of about 94%. Such
enhancement contributes to community health
maintenance, which lowers mortality rates.
When M-Health system utilization is properly
understood with the aid of a clinical decision
support system, the healthcare system is
improved, which lowers healthcare expenses.
Decision support systems in M-Health assist to
save travel expenses for people and improve
the quality of healthcare facilities by providing
patient support more promptly and effectively.
(Lamichhane, 2020)
The community health professionals have
received training to manage the emergency
situation involving the pregnant Baglung
residents via medic mobile. Follow-up
reminders (feature of medic mobile system) on
pregnant women keep community health

41
 professionals to make regular check and keep
track of health of pregnant women of the
community. Women's emergency patients from
the Baglung areas are sent to specialized urban
hospitals with the aid of the medical mobile.
(Lamichhane, 2020) Hence, the maternal and
child mortality rates in the Baglung districts
have dramatically decreased as a result of the
use of Medic mobile. The introduction of
Medic Mobile has had a significant positive
effect on the Baglun area of Nepal, particularly
on pregnant women who have seen changes in
their beliefs and way of life as a result of using
Medic Mobile. With the aid of the medic
mobile, they feel more secure and confident to
talk about their pregnancy.. (Lamichhane,
2020)
METHODS OF RESEARCH Case Study
MODEL USED Quantitative

Table 2.3: Table of related work in LR

TITLE Through the lens of ANT, a qualitative analysis

of an exploratory case investigation on a small
private medical IT firm in North Norway
shows that co-creation has been taking place
since the 1990s (Actor-Network Theory).
(Ikoev, 2020)
AUTHOR NAME/YEAR Vitalii Ikoev 2020-05-14
FEATURES
BENEFITS Health portals, wearable technology,
42
 telemedicine, and simply "E-Health" are all
examples of telehealth. The advantages of e-
health include enhanced administrative
systems, systems for clinical decision-support,
updated health-related information, easy
maintenance of hospital services, and
information sharing between different
departments of healthcare services. (Ikoev,
2020) E-health solutions can also be relied
upon to address issues with little resources,
new issues that arise, and to enhance the course
of therapy. benefits include enhanced safety,
efficiency, and quality, as well as patient and
healthcare professional empowerment. Private
health IT companies are concentrating on
developing hospital and clinical healthcare
initiatives for the Norwegian healthcare sector
as the country's e-healthcare system appears to
possess the potential to have an important role
in healthcare delivery. provide services to
patients, radiography being one of them.
(Ikoev, 2020) Computed tomography,
mammogram, magnetic resonance imaging,
computed tomography angiography, as well as
digitally produced, stored, and transferred x-
rays are all included in diagnostic radiology.
Hence, creating and implementing
telemedicine or E-Health was the ideal solution
to the issue that radiologists were experiencing.
(Ikoev, 2020)
LIMITATIONS E-Health has a lot of potential for improving
healthcare delivery, but regulators, lawmakers,

43
 and developers are interested in technical
advancement When it comes to e-health, there
hasn't always been a fit when it comes to use in
practice. (Ikoev, 2020) Study of the effects of
e-health services reveals the discrepancy
between actual results and anticipated
advantages. Moreover, improvements in
Although theoretical research has produced
encouraging findings, practical implementation
may be impossible. Changes in one area of the
organization can have an impact on other areas
of the business and the healthcare delivery
system as a whole since modern health
organizations are extremely complex, with
numerous interconnected and interdependent
technical and social elements. (Ikoev, 2020).
Chances of having an impact on work practices
are always strong whenever there is a shift in
technology. E-Health requires the creation and
analysis of an infrastructure that is necessary
for knowledge sharing, contact, and the
administration of healthcare delivery. Just
designing software is not sufficient. (Ikoev,
2020) One of the key problems with healthcare
technology is the ongoing need for training and
support during the adoption of E-Health
software. The entire department needs to
undergo extensive education and training for
health providers before becoming digital.
(Ikoev, 2020)
Traditional software development
methodologies frequently include the

44
 development team making design decisions
with very little input from the end users. The
involvement of users in ensuring that a
software product is created ensures that their
suggestions and comments are taken into
consideration. which is lacking in conventional
software development methodologies, to be
useable and valuable for customers. (Ikoev,
2020)

ADVANTAGES In contrast to conventional techniques, the

Design Thinking methodology incorporates
both individuals and organizations in the
software development process. Design thinking
is being employed to develop infrastructures
that will increase the efficiency and
accessibility of the delivery of healthcare
services while also taking into account the
possibilities of E-Health technology. Design
thinking is based on an agile iterative
methodology that allows for continuous
product improvement as more iteration are
completed. This method places a strong
priority on understanding users' empathy
through "action oriented prototyping" of
potential solutions. Each revision has It takes
several iterations of thinking, prototyping, and
testing for innovation to emerge. The Design
thinking paradigm, one of many HCD (human-
centered design) processes, contains five main
steps: Explore, Define, Prototype, Implement,
and Iterate. The creative thinking method has a

45
 benefit over the conventional approach in that
the final product created using this method is
dependable, understandable, and usable by end
customers (customers). Each cycle, the service
is improved by examining what consumers
want and refining it in light of actual user
feedback. (Ikoev, 2020)

METHODS OF RESEARCH Case Study

MODEL USED Quantitative

46
 Table 2.4: Table of related work LR

Title IoT in the Wake of COVID-19: A Survey

on challenges,Contributions, and Evolution
(Ndiaye et al., 2020) (M. Ndiaye, 2020)

Author Name / Year Musa Ndiaye / 2020

Stephen S. Oyewobi / 2020
Adnan M. Abu-mahfouz / 2020
Gerhard P. Hancke / 2020
Anish M. Kurien / 2020
Karim Djouani / 2020

Features These includes:

 Abstract
 Introduction
 Motivation of Paper
 Research problem and contribution
 Outline of Paper
 Related Work
 • To combat a viral pandemic, the
Internet of Things (IoT) in hospitals
is being deployed. IoT-based
approaches to social distancing IoT-
based healthcare (pandemic)
development monitoring and data
collection. The difficulties in
adopting H-IoT were explored at
Covid-19. Pandemic . Future trends
and research gaps (M. Ndiaye, 2020)
Benefits  • The rise of sensor-based E-health
in the control of pandemics around

47
 the world is covered in this article. It
also discusses how a widespread
virus outbreak has affected the
direction of IoT networks. (M.
Ndiaye, 2020)
Limitations  • The laws specifying the
requirement for social distance in
IoT data collection have influenced
the various IoT deployment
strategies. Because to the spreading
nature of COVID-19, IoT
administrators have searched for a
number of effective and moral
sensor deployment strategies. (M.
Ndiaye, 2020)
Advantages Finding that
Methods of Research Review
Models Used

Table 2.5: Table of related work in LR

Title Covid-19: Opportunities for Beneficial

Healthcare Reforms (Auener et al., 2020)
(S. Auener, 2020)

Author Name / Year Stefan Auener / 2020

Danielle Kroon / 2020
Erik Wackers / 2020
Simone van Dulmen / 2020
Patrick Jeurissen / 2020
Features These includes:

48
  Background
 Cutting down on healthcare failures:
protection of public health and
telehealth the preservation of the
general health. reduce excessive
treatment
 Inadequate pricing and care
coordination
Benefits  Organizations and laws have become
incredibly adaptable throughout
time. Decisions that once would
have required months of deliberation
are now made quickly. Some ad hoc
policy adjustments are implemented
simultaneously to reduce risks
without a solid foundation, yet they
might also present opportunities for
people to use political authority and
achieve personal goals. (S. Auener,
2020)
Limitations  Failures in delivering health care
 Mistakes in the coordination of care.
Overtreatment or poor quality of
care Administration-related
difficulties (S. Auener, 2020)
Advantages This essay makes the case that current
circumstances may prompt certain urgent
reforms to increase the long-term
sustainability of our systems. (S. Auener,
2020)
Method of Research Review

49
Models Used

Table 2.6: Table of related work in LR

Title digital revolution and covid-19 (Hantrais et

al., 2021) (al. L. H., 2021)

Author Name / Year Linda Hantrais / 2021

Paul Allin / 2021
Mihalis Kritikos / 2021
Melita Sogomonjan / 2021
Prathivadi B. Anand / 2021
Sonia Livingstone / 2021
Mark Williams / 2021
Martin Innes / 2021
Features These includes:
Official data were available during Covid-
19. Artificial intelligence and study ethics
are covered within the context of COVID-
19. covid-19 epidemic's impact on Estonia's
e-mental healthcare policy. ....... in the... in
the..... Smart cities and COVID-19 Viral
misinformation was promoted by Covid-19
and social media. Digital deception's
domestication and normalization with
Covid-19(S. Auener, 2020)
Benefits  This page combines data about
Covid-19's effects on society's
digitalization and policy reactions
from many social science areas. The

50
 authors demonstrate how the
pandemic changed official statistics'
methods for collecting and
disseminating data as well as how
previously insurmountable obstacles
to the use of e-health solutions were
largely overcome. (S. Auener, 2020)
Limitations
Advantages The characteristics that allow smart cities to
function as efficiency enhancers didn't
always give them an edge during the
epidemic, demonstrating how artificial
intelligence morality became a significant
priority for national and global government
regulation. (S. Auener, 2020)
Method of Research Review
Models Used

51
2.4 TECHNOLOGY ACCEPTANCE MODEL(TAM)

Consumers accept and use technology according to the TAM. The actual system/application use
is the last place where people/users use technology. People's behavioral intentions are one factor
that drives their usage of technology. The extent to which a person believes that applying a
particular technique would enhance their productivity at work. It deals with the question of
whether or not a piece of technology is thought to be useful for the current task. PEOU measures
how strongly someone thinks utilizing a certain system will be painless. If the technology is easy
to use, then the obstacles will be removed. Nobody likes something that is challenging to use or
has a confusing interface.(Parnell T. A., 2019)

Figure 2.1: TAM (C. Maspero, 2020)

2.5 PRIMARY HEALTH CARE(PHC)

In basic healthcare, the patient and healthcare providers interact face-to-face.

2.5.1 EMR IMPACT

The Internet has had a profoundly positive impact on health care. People are using the Internet in
record numbers to research diagnosis, treatments, and prognoses. There were three factors that
were associated with searching out health information: being highly educated, living in a city, and
being in bad health. (A. Kotevski, 2021) although being associated with a younger age group,
computer use was connected to greater affluence and educational success. Statistics on Internet

52
use and eHL, which is the capacity to look for, examine, incorporate, and use information
obtained through electronic platforms, are scarce.

Figure 2.2: E-Health Implementation (A. Kotevski, 2021)

53
Figure 2.3: E-Health and Covid-19 effect (Manganello J. G., 2017)

54
 CHAPTER 3

RESEARCH DESIGN AND METHODOLOGIES

3.1 INTRODUCTION

This chapter covers the research design, variables, study setting, demographic and sample
selection, sampling strategy and sample size, data collection methods, data collection works
processes, and data analysis. The eHEALS, a questionnaire based on literature, was used in the
study to gather data. The majority of the research's conclusions were based on the E-Health,
which evaluates online information seeking activity in relation to health, despite the fact that this
study tied E-Health to digital behavior.

3.1.1 PROCEDURE AND PARTICIPANTS

Methods are methods for collecting and analyzing data. You can use statistical methods on either
qualitative or quantitative data to analyze relationships between factors.
You can use strategies like theme analysis to examine trends and implications in qualitative data.

3.1.2 MEASURES
The scale assumes that attitudes can be evaluated and that their intensity is linear, i.e., on a scale
from strongly agree to strongly disagree.

55
3.2 RESEARCH FRAMEWORK

Internet use

Application and Electronic Adoption of Tele-

Device health system

Hospitals
Health Reminder

Patient
Tele Health Record Doctors

Figure 3.1: Research Framework

The important ideas covered by the study variables used in the implementation research
framework for Tele-health systems are listed in the following table:

3.2.1 INDEPENDENT VARIABLES

 Internet use
 Electronic device
 EHR use
 Health Reminders

3.2.2 DEPENDENT VARIABLES

 Tele-health service transformation

56
3.3 RESEARCH METHODOLOGY

Find out about the tele-health capabilities of the patients, and look into the trends and
relationships between tele-health capabilities and other factors including demographics, search
strategies, and HI sources, as well as their influence on Tele-health in the COVID-19 pandemic.

● Location of study
● Participants
● Questionnaire development
● Statistical analysis SPSS

3.4 RESEARCH DESIGN, APPROACH AND STRATEGY

3.4.1 RESEARCH DESIGN

To engage in decision-making and gain power, patients and their families should have access to
information technology education and training.
The goal of this study was to identify the elements that are linked to higher Tele-Health, describe
Internet access for specific health-care needs, explain the factors that influence Tele-Health
usage, explain Tele-HL, and describe the factors that are linked to higher Tele-Health.

3.4.2 RESEARCH APPROACH

Describe Internet access and use surrounded by people in Kathmandu with health care needs,
determine which kid and household characteristics have been associated to Internet usage, and
how they are related helpful and how Tele-Health has made it easier for people to take medical
supervision. T-HL among Internet users, and figure out factors were linked to greater t-HL.

57
 Figure 3.2: Gantt chart

3.5 DATA COLLECTION

The study used a quantitative approach and included a questionnaire. The two hospitals that were
utilized the most frequently received the most responses (a total of 308). Using the analysis
approach, it was determined which independent factors had the strongest correlation with eHL.
The importance of health information and the effects of digital literacy are also examined in the
study.

3.5.1 SAMPLING METHODS AND SAMPLE DESIGN

Due to the size of the District of Kathmandu, study areas were selected utilizing a multi-stage
sampling strategy. The administrative ladder of division, location, and sub location was used to
choose research regions because institutional features influence community responses so greatly.
Meteorological information and the level of public interest were used to determine the scope and
frequency of the health system.

58
 patients
Doctors 40%
10%

Managers
Nurse 8%
12%

Others 30%

Figure 3.2: Survey estimates

3.5.2 DATA COLLECTION METHODS

Individuals and patients were invited to participate in a study that asked about demographics
including age, sex, education, and self-rated health as well as how they used digital services like
online communication with their general practitioner and the toolkit, a national health website.
308 persons in total participated in the survey. For individuals who used digital services and those
who did not, there were differences. Correlation tests were used to ascertain the relationships
between scale and age, education, and self-reported health. The null hypothesis was rejected in
the instance of E-Health and the utilization of digital services using a substantial criterion.

3.5.3 DATA CAPTURING AND DATA EDITING

The scale evaluates an individual's ability to look for, examine, incorporate, and apply data
gained through technological platforms. It consists of tests that evaluate how well-versed people
think they are in information technology. The response categories determine the amount of
agreement (agrees, uncertain, disagrees) with the assertions regarding online health information.
High internal consistency was discovered during the testing.

59
3.5.3.1 DEMOGRAPHICS
A whopping 78% of people responded to the survey. (A total of 400 individuals were approached
with reliable information; 308 responded to the survey.) 48 persons out of 308 (48%) were
female, 250 out of 308 (77%) spoke English as their first language, and 54% had at least a high
school diploma (Table 1). The patients' conditions were described as fair or terrible by 34% of the
participating clinicians. Sixty-six percent of respondents said their health ranged from excellent to
good.
Table 3.1: Frequency table for education

Table 3.2: Frequency table for gender

3.5.3.2 INTERNET USE

94.8 percent of people use the internet everyday overall. One was specified as the independent
variable for Internet usage and zero for non-use. Patients with less than a bachelor's degree,
limited English proficiency, and advanced age all had lower Internet usage rates. 49.4% of the

60
time they use their phones to access the internet, with the remaining time spent on laptops or
desktops. It is used at home by 51% of users.

Table 3.3: Frequency table of internet use

3.5.4 DESIGN OF THE INTERVIEW AND QUESTIONNAIRE QUESTION

There are 5 sections in the questionnaire. Demographic data on respondents, such as gender,
grade, job, health insurance, English proficiency, and income status, were gathered in the first
phase. In the second section, participants were questioned about their internet usage, time spent
online, Internet-enabled device use, internet connection issues, contentment, the impact of online
61
health discussions, connecting with doctors online, and using the phone to communicate medical
information about changes to their health over the internet. Participants were questioned about
medical reminders for lab results, appointments, health advice, reminders for doctor's visits,
important information, symptoms, and digital photographs in the third section. Participants were
questioned regarding medical information electronically in the fourth section, including their
comfort level with sharing their medical records online and whether they prefer online diagnosis.
In the final segment, participants from the hospital and health technology were questioned about
how the EHR facilitates communication and aids in patient diagnosis.

3.6 DATA COLLECTION LIMITATIONS

 All generation data analysis was not completed

 Only a small number of hospitals were visited and Health posts were overlooked.
 Data analysis was completed in Kathmandu, where internet access was good.
 The information obtained during the fieldwork is utilized to generate conclusions.
 The results gained may not be extended to other domains when analyzing data and
developing interpretations that is relevant across wider scales.

3.7 DATA COLLECTION ASSUMPTIONS

The information in this chapter was gathered and presented using statistical analysis. The findings
indicate that the patient's overall care is deficient, which needs to be fixed in order to treat the
patient in accordance with WHO recommendations. The following issues were included to the
study because they required to be addressed in addition to the research goals. The following study
sections on online appointments for e-health and m-health were studied and provided in the
study's final analysis: Personal health records, or PHRs, are records of a patient's lifelong health
that have been kept by the individual or a family member..
 People utilize mobile and confirm their email for verification of report.
• Due to their busy schedules, people may be interested in using telecommunication for
their routine checks.
• They may also be interested in sharing their experiences using e-health appointment
systems like e-appointments.
• Individuals have been observed using mobile devices to pay for checkups.

62
3.8 VALIDITY

The study's ultimate objective was to determine whether parent, child, and household variables
are related to rising Internet and e-health usage. Age, religion or ethnicity, ethnicity, language
spoken at home, parental education levels, household type, and health problems were some of the
topics examined in the survey to investigate these concerns. To determine their health state,
participants were asked to rate their health as outstanding, very good, good, fair, or awful.

3.8.1 FEEDBACK FROM INTERVIEW PARTICIPATIONS

The results show that people Students who were 15 years old or younger, were from low-income
homes, spent less than an hour online each day, were unsatisfied with distance education, and
wanted to continue their education were shown to have low eHL and self-efficacy. Also, students'
self-efficacy with regard to online technology was low if they thought Internet services were
expensive, had issues connecting to the Internet, or favored asynchronous learning. Also, there
was a connection between eHL and online learning self-efficacy levels.
Benefit of online booking:
• Consultation, treatment, and radiological appointments with eSewa Booking.
• Cancellation and rescheduling of appointments.
• Doctor's duty schedule.
• Patients are reminded.
• For app users, customer support is straightforward, hassle-free, and accessible seven days
a week, twenty-four hours a day.

3.9 LIMITATIONS

IT and family departments frequently use internet platforms to gather data for their work. As a
result, not all age groups may benefit from the findings. Also, different apps used by
organizations may affect how patients feel, and it is believed that using health technology for
patients in all hospitals and by doctors at the same time lessens the possibility of a pandemic.
Additionally, no age category comparison could be made because the study only included
participants who were mid-life. The age range of the study's participants ranged from 15 to 45
years old on average. Despite the fact that younger generations are much more organized to
utilize digital technologies effectively, it is crucial to evaluate self-efficacy in hospitals that are
now in operation as well as the impact of healthcare-related decisions on those same decisions.

63
3.10 RESEARCH TIMEFRAME
The data collection and research on Kathmandu's e-health system took three to four months. How
Covid-19 has altered the healthcare system in and around individuals. In the middle of the
research, a survey was taken that lasted for about a month.

3.10 SUMMARY

The outcomes of the data analysis, which were presented in a statistical and visual manner, were
covered in this chapter. The literature contained results that were comparable. The results of 308
questionnaires show that Kathmandu's healthcare system is getting better. People prefer to use an
online health system for appointments, lab results, and diagnoses. The research is concluded in
Chapter 5, which also examines the results and their limitations and makes recommendations for
future practice and study.

64
 CHAPTER 4

DATA ANALYSIS AND FINDINGS OF RESEARCH

4.1 MODE OF ANALYSIS

A statistician used a computer to analyze the data from 308 samples, convert the results into
percentages, and construct tables, graphs, and figs to clearly present the facts. Utilizing the
study's initial research questions, the data was examined. We computed frequencies, percentages,
averages, and standard deviations as descriptive statistics. The demographic and distance
education statistics were reported using frequency, percentage, mean, and standard deviation.

4.2 OVERVIEW ANALYSIS OF QUESTIONNAIRE RESULTS

The gender and occupation breakdown of the research population is examined in this section.
Individuals with little resources that require specific HC services can use the Internet to research
their health. On the other hand, some people struggle to distinguish between good and poor
content and avoid accessing the Internet. This knowledge is essential because difficulties with
access and equity must be addressed as the desire to use the Internet to empower consumers,
exchange information, and empower consumers grows.

4.2.1 QUESTIONNAIRE DURATION

In Kathmandu, it took a month to gather more than 200 samples. People Individuals who were
too young, had poor cognitive functioning, or were incapable of understanding were not included
in the study. The nurses at the outpatient clinic delivered the questionnaire, which included the
names of the two hospitals—Chirayu and Ishan—and checked to see if the respondent had the
necessary mental capacity to participate. The nurses made the decision to exempt some patients
from study participation in some instances for reasons not specified in the protocol. Either the
questionnaire was finished while the respondent waited on the survey were from Kathmandu.
They include manager, health associates, patients and normal users. To prepare question for the
survey it took 2 week for research and finalizing the questionnaire then continue with collecting
data.

65
4.2.2 PROFILE OF PARTICIPANTS
According to the statistics gathered, there were 35% patients, 20% workers, 10% doctors, and
45% regular users.

4.2.3 NUMBER OF PARTICIPANTS

Male and female participants totaling 308 completed the survey.

4.2.4 ANALYSIS AND INTERPRETENTION

Reliability
Scale: ALL VARIABLES

Table 4.1: Table for reliability variable

The advantages of the internet for making health-related decisions are shown in Figure 4.1. Of of
the total participants, 165 feel neutral about using the internet to make health decisions. More
people respond to not useful than to useful, unfortunately. Only a small percentage of people
think the internet is completely useless.

66
 Figure 4.1 Relability statistics

We went through a process that began with ensuring the legitimacy and dependability of the
constructs. According to this reliability analysis, all of the variables' cronbach's alphas in Table
4.2 are 0.780.

67
Correlations
Table 4.2: Descriptive statistics

Table 4.3: Correlations with independence and dependence variables

Table 4.4 is displayed in the output (Table 4.4). To evaluate the strength of a linear relationship
between two variables, correlation coefficients are used. A correlation coefficient more than
zero, as demonstrated by the three numbers in the reminder, which is the E-health adaptation,

68
indicates a good relationship; however, a correlation coefficient less than zero, as shown by the
sharing of medical information, indicates a negative relationship.
There is no correlation between the two variables under comparison, as shown by a value of 0. A
crucial idea in building well-diversified portfolios that can survive portfolio volatility is negative
correlation, often known as inverse correlation.

Figure 4.2: Internet Barchart helping decision making for health

Figure 4.1 contains a graph illustrating how many people use the internet to make health-related
decisions. Fewer than 15 individuals have stated it is not useful, more than 150 have said it is
neutral, and between 50 and 70 have said it is useful.

69
 Figure 4.3: Histogram for assuredly defending medical records

Figure 4.2 shows the mean and standard deviation of how confident people are in being allowed
to view their health records. Using a 308 survey, 618.

70
 Figure 4.4: Timeline for online sharing of private health information

Figure 4.3's mean and standard deviation show that more people are using websites to access
health information. 429 individuals make up the total after 308 samples.

71
 Figure 4.5: E-effect Health's on patient communication currently in use

Figure 4.4 illustrates how the 200+ have a greater impact on doctor-patient communication.

72
Frequencies

Table 4.4: Internet use, medical information, and E-Health adaptations frequency table

Figure 4.5 shows that among the 308 participants who used an internet-enabled device, together
with medical information and a reminder, the mean score ranged from 3.0870 to 1.6360. The
median is higher than 3.11 and the percentage is higher than 2.89. It has a favorable effect on how
tele-health is adapted.

73
 Figure 4.6: People with internet access

Figure 4.5 shows that more than 70% of people use the internet every day.

74
 Figure 4.7: E-Health process and application adaptation

Figure 4.6 shows that more than 60% of adults utilize health reminders to conduct daily health
examinations.

75
Figure 4.8: EHR medical information

76
Regression

Table 4.5: Regression model summary

Table 4.6 :Coefficients

77
According to Table 4.7, Table 4.8, and Table 4.9, cronbach's alpha is used to compare various
reliability measures in order to determine the tele-Health risk tolerance scale. An evaluation of a
set of scale or test items' internal consistency or reliability is done using the Cronbach's alpha
statistic. In other words, the dependability of a measurement depends on how consistently it
assesses a notion, and one method for measuring consistency is Cronbach's alpha.
The descriptive statistics for this study show that there were 308 observations, as indicated by the
notation N = 308. For this statistics report, a number of variables, including gender, education
level, and health status, are defined. For the objective of collecting descriptive data, a survey
questionnaire was created with a variety of questions. The survey received 106 responses from
men and 98 responses from women. Out of all observations, 4.4 percent of people have finished
high school, 51 percent have finished their undergraduate degrees, 42.2 percent have finished
their master's degrees, and 2.5 percent have finished college.
The advantages of the internet for making health-related decisions are shown in Figure 4.1. Of of
the total participants, 165 feel neutral about using the internet to make health decisions. More
people respond to not useful than to useful, unfortunately. Only a small percentage of people
think the internet is completely useless.

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4.3 OVERVIEW ANALYSIS OF INTERVIEW RESULTS
● Internet access
● Technology use for health
● Attitudes about utilizing technology to monitor health

4.3.1 INTERVIEW DURATION

Miss Aaryana Joshi and I had one meeting. She was questioned about how the digitization of
healthcare has impacted the way she gets checked out. "For me, patient-facing apps have made
visiting the hospital and the clinic lot simpler," she said. The e-Appointments program in eSewa
makes it simple for me to schedule appointments, which has cut down on the amount of time I
have to wait in the hospital.
Currently, I even see some doctors using medical recording software at a few hospitals. I found
out that our medical information are maintained digitally and may one day be utilized for study
when I asked them what this was all about. My guess is that even the government is working on
the idea of a data repository, and if it materializes, our data may be shared with different hospitals
and doctors. If things like these can be worked on, I suppose that will bring about a drastic
transformation in the broader health system.
Also, ordering test reports online is certainly another factor that has made my life simpler. I don't
have to go back to the hospital to pick up my reports, which has saved me time.

4.3.2 ADVANTAGES
Clinical Record Management outlines the storage recommendations that will ensure that records
are appropriately maintained, managed, and regulated in accordance with the operational,
informational, and legal requirements of pre-hospital emergency care services and practitioners.
This module manages the following tasks:
 When a patient is admitted, their files are delivered to them.
 Patient files that had been discharged were obtained.
 Files are distributed to employees, students, and doctors.
 Records acquired from doctors, students, and workers.
 Monitors your whereabouts.
 Monitoring file movement.

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4.3.3 DISADVANTAGES
 Privacy,
 Security and issues of data leakage,
 Data mismatches caused by incorrect user input.

4.4 DATA FINDINGS BASED ON TOE

In order to better understand the consequences of data privacy, security and reliability as
important technological components, this analysis will delve further.

Figure 4.1: TOE (Karim, 2020)

4.4.1 TECHNOLOGY
Use of cloud computing necessitates thoughtful consideration of data privacy, security, and
dependability, particularly in the healthcare industry. The usage of specific information
technologies by the organization. Data security has been regarded as the main danger involved
with the use of cloud computing, especially in the health sector. Due to the complexity of the
healthcare IT infrastructure, businesses are taking additional security measures to protect patient
data transfers. (Brown CA, 2010). Users and organizations may captivate the interest of
individuals who depend on cloud-based programs for prompt responses and reliable information
due to their high level of dependability. (Kim H. &., 2017)

80
4.4.2 ORGANIZATION
Top management support is essential for businesses looking to create a welcoming environment
and offer the resources required for cloud computing adoption. The success of resource
integration requires top management support, according to study. (M. Zubair Elahi, 2021)
Reengineering processes and preserving potential organizational change through a clear strategy
and dedication, as well as sending encouraging signals of belief to all business employees, are
crucial as technological complexity increases. (M. Ndiaye, 2020) Cloud computing services can
only integrate into a company's value chain activities if it has the required infrastructure,
economic ability, and staff experience.

4.4.3 ENVIRONMENT
This will surely have an influence when healthcare businesses adopt new information systems as
a reflection of the operating environment of the healthcare industry. (Kim S. &., 2020) Due to
pressure from the competition, businesses are outsourcing their IT infrastructure in an effort to
improve service quality while also looking for more affordable prices to increase their market
share. Recent Tele-Health care studies suggest that competition has significantly impacted
hospitals' choices to adopt new technology. (Kim S. &., 2020)

81
 CHAPTER 5

PROPOSING THE FRAMEWORK

5.1 PROPOSED FRAMEWORK

One type of IT that could affect patient health outcomes is EMRs. The benefits that EMRs may
offer to the healthcare system, such as improved patient HIMS, improved care coordination, and
simpler electronic utilization of medical knowledge and expert opinion, have attracted a lot of
attention. A EMR has They have garnered a lot of interest because of the advantages they can
provide to the HIMS, such as better patient HIMS, better care coordination, and simpler
electronic access to healthcare information and expert opinion. A CAD tool is called COVID.
International organizations and governments have started initiatives to promote the use of EMRs
in the healthcare system.
An better Tele-Health system in COVID utilization is defined as the use of EMRs in line with the
standard for the aims of boosting E-Health in this evaluation. On the other hand, strategies for
increasing telecommunications usage have not yet been discovered. This extensive investigation's
goal was to find treatments that would make EMR usage better. a database of patient information
that can be viewed by many people with permission. Depending on usage in Kathmandu, the
phrases EMR, EHR, and PHR are all equivalent. PHC providers must act as care team members
and, when necessary, help patients access supplemental medical treatment.

5.2 FINDINGS
According to the statistical study, e-Health is the provision of health care through modern EMR
and modern communications when patients and medical professionals are not in direct contact
and their engagement is mediated through electronic means. The rapid adoption of the Internet
has altered many facets of society and different industries by facilitating extensive information
sharing, the development of new business relations, and the ability to interact directly with
customers as opposed to using more conventional communication channels. Nonetheless, the
Internet is employed as a high functioning yet affordable communication medium because it
crosses continents and instantly links billions of people worldwide. The previous paradigm

82
between physicians and their patients, in addition to the way healthcare is provided to patients,
are about to change as a result of the consistent use of technology.

Based on Fig. 4.9 and Fig. 4.6, it is evident that mobile phones are playing an increasingly
important role in monitoring and providing healthcare services. They are commonly referred to as
"pocket computers" due to their superior computing capabilities, expanded desires, and
diversified capabilities. The ease of use, practicality, and efficacy of these devices have received
accolades from both patients and healthcare professionals. In order to progress the healthcare
system, e-health technology incorporates cutting-edge concepts and methodologies from a
number of fields, including electronics engineering, computer engineering, biomedical
engineering, and medicine. It was found that patients and healthcare professionals have been
embracing mobile-based applications at an increasing pace in recent years, and they have grown
in popularity. Notwithstanding the advantages of cell phones in patient monitoring, instruction,
and management, there are a number of important challenges and impediments that must be
overcome, including data security and privacy, acceptance, dependability, and cost.

According to the data analysis, the results showed that although computer reminders could be
more effective, physical reminders are currently more widely used and easier to implement. Due
of the adaptability of the e-health system, this study examines the effects of digital and manual
national healthcare reminder systems on compliance.
The outcomes of the investigation EHR can do a lot more than just gather and store patient data.
As more and more of these recordings are processed and shared, new insights that could affect
treatment choices are emerging. For instance, information shared via an EHR can help physicians
decide which medication to give an intolerant patient or give background information about a
patient who is not responding when they reach at an emergency ward.

5.2.1 CHANGE MANAGEMENT

There are numerous services offered by hospitals, including
 call center
 Patient Consultation with Patient
 Outpatient Medical Data System for Nurses
 Emergency Patient Enrollment Follow-Up System

83
 Information/Customer Service Desk
 Outpatient Enrollment for Health Membership
 Patient Admission & Bed Control System Health information system for inpatients
patient billing system
 Patient medical file & statistics system
 Operation theater at the nursing station
 Nutritional support for patients
 The Vaccination Strategy Information System (VSIS) is a system that monitors
vaccination schedules.
 The Patient Discharge and Billing System.
 These helps to track every patient and help in categories the patients.

84
5.3 CONCEPTUAL MODEL

Hos EMR
Laboratory
pital CRM
People/Patients
Radiology Softwar
e /
Pharmacy
EHR

IPD Admission

Figure 4.9: E-health implementation Process

5.4 IMPLEMENTATION AND ANALYSIS OF THE PROPOSED FRAMEWORK

5.4.1 PATIENT / USERS

 Request a doctor's appointment using a fintech or mobile health app (such as esewa, E-
Appointment, or a hospital website)
 Access medical records and test results via a patient portal or mobile health app.
 The patient arrives at the hospital

5.4.2 HOSPITAL
 Patient registration using hospital EMR software
 Online health insurance verification using an API
 Issues on billing

5.4.3 EMR( Electronic Medical Record)

Healthcare professionals had to reevaluate their approach and switch to digital treatment as
quickly as was practical. The healthcare industry's future depends on digital transformation, the
study finds, as the sector strives to put the client at the core of its offers.
ICD AND COSS: dosage recommendations, likely diagnoses, lab value interpretations, etc.
Exam, history, EMR, CPOE, lab/radiology order, pharmacy order, and diagnosis certain formats.
85
5.4.3.1 LABORATORY
 Sampling
 Reporting
 Verification
 Observation in SI metric units
 Machine interfacing

5.4.3.2 RADIOLOGY
 PCS integration
 Integration of many Dicom viewers

5.4.3.3 PHARMACY
 Pharmacy Dispensing Labels
 Coding for Medical and Surgical Supplies
 Purchase and Sale Return Forms
 Reporting forms for purchases, purchases of drugs, and stores

5.4.3.4 DIAGNOSIS
 Electronic Triage
 IPD modules
 Nurse's App Tab feasibility
 Nutritive calculator

5.4.4 EHR (Electronic health record)

 Medical Research
 CRM/Analytics
 Embedded software for statitics
 HIS Reports
 DHIS-2 Integration
 OpenIMS Integration Head

86
5.5 SUMMARY
As the sector searches for ways to mix inpatient and community-based care, cloud investment and
utilization are rising. When healthcare providers use reliable health-tech solutions, patients health
and financial outcomes improve. During the COVID-19 epidemic, online health diagnostic or
eHL levels were at their highest. The research revealed that participants maintained a regular
touch with medical professionals and help lines. Individuals who had a low degree of satisfaction
with the doctor's E-Health hotline but still wanted to have physical diagnoses since some of them
were having resource issues. To drive the development of an interoperable online health
ecosystem that enhances patient health outcomes and to become Nepal's top-choice health-tech
company for both customers and healthcare professionals. Low eHL was in education. According
to the survey, individuals in the current wave were adjusting to the new HS modifications and
thought Internet services were inexpensive. They also reported having problems connecting to the
Internet when using online technologies. The participants also shared a connection with eHL for
online learning. By developing contemporary, cutting-edge health technology solutions, such as
EHR, RCM, patient engagement solutions, personal health records capable of seamlessly
integrating with various health information systems, as well as other cross-cutting systems, Nepal
can create a thriving digital health ecosystem.

87
 CHAPTER 6

CONCLUSIONS AND RECOMMENDATIONS

6.1 EXPECTATION
Table 6.1 Top Health application in Nepal

NepMed
ePharmacy
HamroDoctor
MeroHealthCare
Jeevee
eAppointment
DoctorOnDemand

Table 6.2: EMR system in Nepal

Cogent Health Are located in over 38 hospitals.

Midas Are located in over 47 hospitals.
Mediflow Are located in over 20 hospitals.
Dolphin Are located in 15 hospitals.
Okhati Are located in 5 hospitals.

6.2 SUMMARY OF THE FINDINGS

 Utilizing [EMRs], increasing efficiency, quality, and safety while reducing health
inequities.
 In addition to longterm health records, computerized patient records, also known as EMR,
electronic HR, or simply e- records, are also available.
88
  Telemedicine appointments became popular in order to ensure everyone's security.
 The utilization of these EMR elements for the exchange of PHC is one advantage of
health templates.
 EMRs offer choices for setting alerts and reminders to assist with the supervision of
medications and the evaluation of screening, research lab, and diagnostic tests, and they
also provide options for controlling the flow of laboratory, medical testing, and
prescription patient information.

 EMRs may be equipped with additional functions to enhance performance.

 With the aid of focused feedback, these qualities may lead to comprehensive and secure
recording of patient data, which may facilitate improved, prompt, and unrestricted access,
greater coordination of care, fewer errors, more engaged patients, and more efficient
administrative processes.

 Information on patients' electronic health may be more useful to doctors in understanding

patients' reasons for not using digital health services than sociodemographic information
or self-reported health.

6.3 FUTURE RECOMMENDATIONS

6.3.1 For Doctors
 Creating systems for education in medical and professionals in health competent
 Creating virtual system and Appointments for In-person to work together
 Creating a Doctor's work roster system
 Creating systems for patient for multiple consultations and follow up
 Creating manageable system of patient like QR code, QR id card etc
 Creating systems Extended Health Services (EHS) support

6.3.2 For Patients

 Establishing mechanisms for medical education and hiring qualified medical personnel.
 Coordination of in-person and online appointments
 Making use of eSewa Appointment
89
  Using Booking for Radiology, Procedures, and Consultations
 Utilizing Radiology, Processes, and Consultations Booking
 Using system of reminder for patients
 Offering 24 hour, hassle-free customer service to app users.
 Paying using cash, credit cards, debit cards, and digital wallets
 Making use of the deposit option depending on category
 IP and OP metering used for analysis and research

6.3.3 For Stakeholders

 Decentralizing medical facilities in rural areas
 Building new, state-of-the-art, specialized medical facilities that are well-equipped.
 Enhancing the state of government hospitals currently
 Offering superior healthcare services; charging nothing or very little for healthcare
services.
The best healthcare services can only be obtained and provided when relations between patients,
physicians, healthcare professionals, health providers, and government are conducted with mutual
collaboration and understanding. (2021, Prajwal Neupane)

6.4 OUTCOME OF THE RESEARCH IN RELATION TO THE LITERATURE

The findings of this study provide important details for the following.
 Providing health and medical professionals with education to aid in diagnosis and
connect them with eHL and skills training.
 Individuals will have the ability to make decisions that will enhance the standard of care
they provide and the safety of their patients in distant regions by including the idea of
eHL and the use of internet technologies into the take care curriculum.
 The study's goals were to track people's access to and use of the Internet as well as their
level of e-health.
 If they've ever were using the Internet before, we questioned them about how frequently
they did so.
 Individuals were asked about their online behavior (work, home, or mobile device). The
scale was created to evaluate the eHL of internet users.

90
  New community partnerships, new funding sources, fresh market entrants with a range of
skill sets, and significant steps to digitally transform the healthcare sector all appear to be
on the horizon.
 Many factors, such as housing and education, have an impact on healthcare outcomes,
and solving these problems will require cooperation.

6.5 LIMITATIONS
 The study's primary flaw is that it was conducted as an ongoing study at an inpatient
hospital with participants who worked in a Kathmandu neighborhood with a somewhat
medium income and educational profile.
 For this analysis, the population of Kathmandu was constrained to those nations having a
lower level of digitization.
 Research that is designed to rigorously test our conclusions must be done prior to
additional inferences may be drawn.

91
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APPENDICES
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1.10 1.10 APPENDIX A

Project Log Sheet – Supervisory Session

Notes on use of the project log sheet:
1. This log sheet is designed for meetings of more than 15 minutes duration, of which there must be at minimum SIX(6) during
the course of the project ( SIX mandatory supervisory sessions).
2. The student should prepare for the supervisory sessions by deciding which question(s) he or she needs to ask the supervisor and
what progress has been made (if any) since the last session, and noting these in the relevant sections of the form, effectively
forming an agenda for the session.
3. A log sheet is to be brought by the STUDENT to each supervisor session.
4. The actions by the student (and, perhaps the supervisor), which should be carried out before the next session should be noted
briefly in the relevant section of the form.
5. The student should leave a copy (after the session) of the Project Log Sheet with the supervisor and to the administrator at the
academic counter. A copy is retained by the student to be filed in the project file.
6. It is recommended that students bring along log sheets of previous meetings together with the project file during each
supervisory session.
7. The log sheet is an important deliverable for the project and an important record of a student’s organization and learning
experience. The student must hand in the log sheets as an appendix of the final year documentation, with sheets dated and
numbered consecutively.
Student Name: Raseel Adhikari Date: 02 Aug, 2023 Meeting
No:01

Project Title: EXPANDING ACCESS TO HEALTH SERVICES THROUGH TELE HEALTH (E-HEALTH)
IN A CURRENT PANDEMIC SITUATION IN NEPAL

Supervisor Name: Ephin Muthayyan Signature:………..

Items for discussion

1. Discussion and queries on the chapters 1,2 and 3

Record
1. The structure of thesis portion was suggested.
Action List
1. The first three chapters set mandatory to be completed next.

STUDENT COPY

97
 Project Log Sheet – Supervisory Session
Notes on use of the project log sheet:
1. This log sheet is designed for meetings of more than 15 minutes duration, of which there must be at minimum SIX(6) during
the course of the project ( SIX mandatory supervisory sessions).
2. The student should prepare for the supervisory sessions by deciding which question(s) he or she needs to ask the supervisor and
what progress has been made (if any) since the last session, and noting these in the relevant sections of the form, effectively
forming an agenda for the session.
3. A log sheet is to be brought by the STUDENT to each supervisor session.
4. The actions by the student (and, perhaps the supervisor), which should be carried out before the next session should be noted
briefly in the relevant section of the form.
5. The student should leave a copy (after the session) of the Project Log Sheet with the supervisor and to the administrator at the
academic counter. A copy is retained by the student to be filed in the project file.
6. It is recommended that students bring along log sheets of previous meetings together with the project file during each
supervisory session.
7. The log sheet is an important deliverable for the project and an important record of a student’s organization and learning
experience. The student must hand in the log sheets as an appendix of the final year documentation, with sheets dated and
numbered consecutively.
Student Name: Raseel Adhikari Date: 15 Aug, 2023
Meeting No:02
Project Title: EXPANDING ACCESS TO HEALTH SERVICES THROUGH TELE HEALTH (E-
HEALTH) IN A CURRENT PANDEMIC SITUATION IN NEPAL
Supervisor Name: Ephin Muthayyan Signature:…………..
Items for discussion
1. Detail discussion for the first three chapters.
2. Discussion of objective and research questions
3. Literature review matrix concept

Record of discussion
1. Some changes are suggested on research questions
2. The literature matrix table was suggested to put in literature review section.
3. The structure of thesis portion was suggested

Action List
1. The first three chapters set mandatory to be completed next.
2. The changes and modifications suggested has to be incorporated.

STUDENT COPY

Project Log Sheet – Supervisory Session

Student Name: Raseel Adhikari Date: 25 August 2023
98
 Meeting No:03
Project Title: EXPANDING ACCESS TO HEALTH SERVICES THROUGH TELE HEALTH (E-
HEALTH) IN A CURRENT PANDEMIC SITUATION IN NEPAL
Supervisor Name: Ephin Muthayyan Signature:………..
Notes on use of the project log sheet:
1. This log sheet is designed for meetings of more than 15 minutes duration, of which there must be at minimum SIX(6) during
the course of the project ( SIX mandatory supervisory sessions).
2. The student should prepare for the supervisory sessions by deciding which question(s) he or she needs to ask the supervisor and
what progress has been made (if any) since the last session, and noting these in the relevant sections of the form, effectively
forming an agenda for the session.
3. A log sheet is to be brought by the STUDENT to each supervisor session.
4. The actions by the student (and, perhaps the supervisor), which should be carried out before the next session should be noted
briefly in the relevant section of the form.
5. The student should leave a copy (after the session) of the Project Log Sheet with the supervisor and to the administrator at the
academic counter. A copy is retained by the student to be filed in the project file.
6. It is recommended that students bring along log sheets of previous meetings together with the project file during each
supervisory session.
7. The log sheet is an important deliverable for the project and an important record of a student’s organization and learning
experience. The student must hand in the log sheets as an appendix of the final year documentation, with sheets dated and
numbered consecutively.

Items for discussion

1. List of questionnaires for survey and format.
2. Appropriate way for survey and data collection
Record of discussion
1. The first three chapters found to be satisfactory and approved.
2. The questionnaire list and items were finalized and approved.
3. Google form should be used for the online data collection
Action List
1. 8 should be prepared.
2. The questionnaire should be mapped with the research objective

STUDENT COPY

Project Log Sheet – Supervisory Session

Notes on use of the project log sheet:
99
1. This log sheet is designed for meetings of more than 15 minutes duration, of which there must be at minimum SIX(6) during
the course of the project ( SIX mandatory supervisory sessions).
2. The student should prepare for the supervisory sessions by deciding which question(s) he or she needs to ask the supervisor and
what progress has been made (if any) since the last session, and noting these in the relevant sections of the form, effectively
forming an agenda for the session.
3. A log sheet is to be brought by the STUDENT to each supervisor session.
4. The actions by the student (and, perhaps the supervisor), which should be carried out before the next session should be noted
briefly in the relevant section of the form.
5. The student should leave a copy (after the session) of the Project Log Sheet with the supervisor and to the administrator at the
academic counter. A copy is retained by the student to be filed in the project file.
6. It is recommended that students bring along log sheets of previous meetings together with the project file during each
supervisory session.
7. The log sheet is an important deliverable for the project and an important record of a student’s organization and learning
experience. The student must hand in the log sheets as an appendix of the final year documentation, with sheets dated and
numbered consecutively.
Student Name: Raseel Adhikari Date: 28 Aug 2023
Meeting No:04

Project Title: EXPANDING ACCESS TO HEALTH SERVICES THROUGH TELE HEALTH (E-HEALTH)
IN A CURRENT PANDEMIC SITUATION IN NEPAL

Supervisor Name: Ephin Muthayyan Signature:……..

Items for discussion
3. Finalization of the questionnaire.
4. Data collection
1. Data analysis and SPSS tools discussion

Project Log Sheet – Supervisory Session

Notes on use of the project log sheet:
1. This log sheet is designed for meetings of more than 15 minutes duration, of which there must be at minimum SIX(6) during
the course of the project ( SIX mandatory supervisory sessions).
2. The student should prepare for the supervisory sessions by deciding which question(s) he or she needs to ask the supervisor and
what progress has been made (if any) since the last session, and noting these in the relevant sections of the form, effectively
forming an agenda for the session.
3. A log sheet is to be brought by the STUDENT to each supervisor session.
4. The actions by the student (and, perhaps the supervisor), which should be carried out before the next session should be noted
briefly in the relevant section of the form.
5. The student should leave a copy (after the session) of the Project Log Sheet with the supervisor and to the administrator at the
academic counter. A copy is retained by the student to be filed in the project file.
6. It is recommended that students bring along log sheets of previous meetings together with the project file during each
supervisory session.

100
Record of discussion
1. Questionnaire was discussed
2. More than 200 responses should be collected.
3. More session need to be conducted on data analysis.
7.
Action List T
1. The survey link was forwarded to the supervisor.
2. The data collection stared through the online mode.
3. SPSS class for the data analysis attended.

he log sheet is an important deliverable for the project and an important record of a student’s organization and learning
experience. The student must hand in the log sheets as an appendix of the final year documentation, with sheets dated and
numbered consecutively.
Student Name: Raseel Adhikari Date: 02 Sep 2023 Meeting No:05
Project Title: EXPANDING ACCESS TO HEALTH SERVICES THROUGH TELE HEALTH (E-
HEALTH) IN A CURRENT PANDEMIC SITUATION IN NEPAL
Supervisor Name: Ephin Muthayyan Signature:……..
Items for discussion (noted by student before mandatory supervisory meeting)
1. Discussion on chapter 4, 5 and 6.
2. Discussion of appropriate statistical test and tool.

Record of discussion (noted by student during mandatory supervisory meeting):

1. Proceed to work for the remaining chapters and was approved.
2. Reliability test including the all question is mandatory.
3. Factor analysis can be relevant.
4. Graphical and tabular data representation should be included in chapter 4.
Action List (to be attempted or completed by student by the next mandatory supervisory meeting):
1. To start and proceed to work for the next chapters.
2. Use and test the statistical data using the SPSS tool.
3. Descriptive analysis for the most relevant questions.
4. Analytical discussion should be included in chapter 5.

STUDENT COPY

Project Log Sheet – Supervisory Session

Notes on use of the project log sheet:
1. This log sheet is designed for meetings of more than 15 minutes duration, of which there must be at minimum SIX(6) during
the course of the project ( SIX mandatory supervisory sessions).
2. The student should prepare for the supervisory sessions by deciding which question(s) he or she needs to ask the supervisor and
what progress has been made (if any) since the last session, and noting these in the relevant sections of the form, effectively
forming an agenda for the session.
3. A log sheet is to be brought by the STUDENT to each supervisor session.
4. The actions by the student (and, perhaps the supervisor), which should be carried out before the next session should be noted
briefly in the relevant section of the form.
5. The student should leave a copy (after the session) of the Project Log Sheet with the supervisor and to the administrator at the
academic counter. A copy is retained by the student to be filed in the project file.

101
6. It is recommended that students bring along log sheets of previous meetings together with the project file during each
supervisory session.
7. The log sheet is an important deliverable for the project and an important record of a student’s organization and learning
experience. The student must hand in the log sheets as an appendix of the final year documentation, with sheets dated and
numbered consecutively.
Student Name: Raseel Adhikari Date: 5 Sep 2023
MeetingNo:06
Project Title: EXPANDING ACCESS TO HEALTH SERVICES THROUGH TELE HEALTH (E-HEALTH)
IN A CURRENT PANDEMIC SITUATION IN NEPAL

Supervisor Name: Ephin Muthayyan Signature:…..

Items for discussion
1. Chapter 4 concluded and discussion for chapter 5 and 6.
2. About conceptual model and model validation.
3. Discussion on conclusion and recommendation section.
4. Some relevant issue and noticeable points for further change in the literature review
section.
Record of discussion
1. Chapter 4 approved and further discussion and recommendation.
2. Conceptual model developed.
3. Further elaboration on chapter 5 and 6 is necessary.
4. Future work, limitation should be included in conclusion part.

Action List :
1. The validation should be done with the health system professional and having IT
Knowledge.
2. Chapter 5 and 6 should be validated in coming days.
3. Summary for each chapter should be included
4. The suggested points are modified and changed in the final copy.
STUDENT COPY

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1.11 1.11 APPENDIX B

Survey Questionnaire

103
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105
1.12 1.12 APPENDIX C

Digital Receipt.

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